Effects of various remineralizing agents on the outcome of post-orthodontic white spot lesions (WSLs): a clinical trial.

BACKGROUND: One of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs. METHODS: Forty-five subjects in the age range of 16-25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use. RESULTS: Twice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations (P = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs (P < 0.01). Twice daily use of CPP-ACP plus crème along with fluoride toothpaste had significant effect on remineralization of WSLs at the end of 6 months of observation (P < 0.05). Between the group comparison showed that the mean visual and DIAGNOdent scores at various time intervals of observations were decreased more when fluoride varnish and CPP-ACP crème were used in addition to daily use of fluoride toothpaste, but the differences were not statistically significant (P > 0.05). CONCLUSIONS: The use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.

Long-Term Effect of Maxillary Distraction Osteogenesis (DO) on Nasal Index in Adult Patients with Cleft Lip and Palate Deformities.

PURPOSE: To test the hypothesis that there is no immediate and long-term effects of maxillary distraction osteogenesis (DO) on nasal index among adult subjects with cleft lip and palate deformities. MATERIALS AND METHODS: Twelve adult subjects in the age range of 17-20 years with complete unilateral cleft lip and palate underwent advancement of maxilla by DO. The immediate and long-term effects of maxillary DO on nasal index were evaluated from extra-oral full face frontal photographs recorded prior to DO (T0), at the end of active DO (T1) and at least 2-years after the DO (T2). The ANOVA, Post Hoc test (Bonferroni) and Pearson correlation coefficients were used. The probability value (P value) 0.05 was considered as statistically significant. RESULTS: SNM angle and Ptm-M distance increased significantly by DO (P < 0.001). The nasal index increased significantly (P < 0.01) by 13.85 % from T0 value of 85.15 ± 4.49 to 99.02 ± 11.16 % at the end of active distraction (T1) and by 12.69 to 97.84 ± 9.14 % at the end of long-term follow-up (T2). The correlation between sagittal maxillary advancement and nasal index was statistically significant (P < 0.001). For each millimeter of maxillary advancement, the nasal index increased by 1.38 % and 1.8 % at the end of active distraction and long-term follow-up respectively. CONCLUSION: The advancement of maxilla by distraction osteogenesis among subjects with cleft lip and palate deformities increased nasal index significantly.

Implementation of post treatment critical evaluation improved the quality of orthodontic care in postgraduate orthodontic clinic: A 10 years comparative study.

OBJECTIVE: The aim of the study was to evaluate the effect of post- treatment critical evaluation on the quality of orthodontic care in a postgraduate orthodontic clinic. MATERIALS AND METHODS: Orthodontic treatment outcome of 109 consecutively treated cases was evaluated in Phase-I evaluation. Following Phase-I evaluation, PTCE of each case was made mandatory. After 6-years of implementation of compulsory PTCE for each case, orthodontic treatment outcome of all consecutively treated cases (n = 126) was evaluated (Phase-II). The treatment outcome was evaluated by American Board of Orthodontics Model Grading System (ABO MGS) and Subjective evaluation (Visual Analogue Scale, VAS). RESULTS: Based on the ABO scores, the cases were divided into three grades, that is, Grade-I, Grade-II, and Grade-III. The mean total ABO score was improved significantly in Phase-II evaluation (P < 0.01). The total number of cases in ABO Grade-II were increased significantly (P < 0.01) whereas cases in ABO Grade-I remained comparable. The VAS score was improved from 5.66 ± 0.77 at Phase-I to 6.02 ± 0.99 at Phase-II evaluation (P < 0.01). CONCLUSION: The implementation of PTCE significantly improved the quality of orthodontic care in a postgraduate orthodontic clinic. CLINICAL SIGNIFICANCE: Grading one's own treatment improves the quality of future treatment.

Comparison of risk indicators of dental caries in children with and without cleft lip and palate deformities.

OBJECTIVE: To test the hypothesis that there are no differences in various risk factors of dental caries among children with cleft lip and palate when compared to non-cleft high caries risk and non-cleft caries free children. DESIGN: Seventy-three children in the age range of 4-9 years comprised three groups; Group-I (n = 23, children with cleft lip and palate), Group-II (n = 25, non-cleft high caries risk children) and Group-III (n = 25, non-cleft caries free children). Various risk factors for dental caries like type of oral hygiene practice, sugar exposures/day, developmental defects of enamel, caries activity, salivary streptococci mutans levels and lactobacilli levels were evaluated and compared among the three groups of children. RESULTS: The mean deft score among Group-II children was significantly more (P < 0.01) as compared to the Group-I children. The mean deft + DMFT score among Group-I and Group-II children was comparable (P = 0.149). Developmental enamel defects were more among Group-I children as compared to Group-II and Group-III children (P < 0.01). Hypoplasia of the maxillary anterior teeth was more common among Group-I children as compared to Group-II (P < 0.05) and Group-III children (P < 0.001). The association between hypoplastic teeth and dental caries was significant (P < 0.05). The salivary acidogenic potential as evaluated by Snyder test was comparable among Group-I and Group-II children. The salivary streptococcus mutans levels in Group-I and Group-II children were higher when compared to lactobacillus counts. CONCLUSION: The risk factors of dental caries among children with cleft lip and palate were more as compared to non-cleft high caries risk and non-cleft caries free children.

Effects of twin-block appliance on the anatomy of pharyngeal airway passage (PAP) in class II malocclusion subjects.

BACKGROUND: The use of functional appliances for the correction of retrognathic mandible is very common in orthodontics. Similar appliances known as oral appliances are also frequently used in adults for the treatment of mild to moderate obstructive sleep apnea (OSA). Many studies have reported improvement of pharyngeal airway passage (PAP) dimensions following functional appliance therapy in children and oral appliance therapy in adults. There is only one study in the literature that discussed the effect of oral appliance therapy on posterior pharyngeal wall thickness (PPWT) among subjects with OSA. The effect of functional appliance therapy on PPWT has never been investigated. Thus the present study was conducted to evaluate the effects of twin-block appliance on pharyngeal airway passage (PAP) dimensions and posterior pharyngeal wall thickness (PPWT) in class II malocclusion subjects with retrognathic mandibles. METHODS: Thirty-eight class II malocclusion subjects in the age range of 8 to 14 years with mandibular retrusion were divided into a treatment (n = 20) and control (n = 18) group. Mandibular retrusion in the treatment group subjects was corrected by twin-block appliance. The effect of twin-block appliance on PAP and PPWT dimensions were evaluated from lateral cephalograms recorded prior-to and after 6 months of appliance therapy in the treatment group subjects and the changes were compared with the changes in the control group subjects. Student's t-test was used for statistical analysis; P-value of 0.05 was considered a statistically significant level. RESULTS: The depth of the oropharynx was increased significantly in the treatment group subjects (P < 0.001) as compared to the control group subjects (P < 0.05). The depth of the hypopharynx increased significantly in treatment group subjects (P < 0.01). The PPWT at the level of the nasopharynx, oropharynx, and hypopharynx were maintained in the treatment group subjects; whereas in control group subjects, the PPWT was further reduced although the changes were not statistically significant. CONCLUSIONS: Correction of mandibular retrusion by twin-block appliance in class II malocclusion subjects increased the PAP dimensions and maintained the pre-treatment thickness of posterior pharyngeal wall.

Midsymphyseal distraction osteogenesis with lingual tooth-supported distractor: a case report.

This report presents the treatment of a patient with severe mandibular anterior crowding caused by anterior transverse deficiency of the mandible. The treatment plan called for midsymphyseal distraction osteogenesis. A tooth-supported distractor placed on the lingual aspect of the mandible was used for mandibular widening.

Maxillary distraction osteogenesis at Le Fort-I level induces bone apposition at infraorbital rim.

OBJECTIVE: The aim of this study is to evaluate whether there is any remodeling of bone at infraorbital rim following maxillary distraction osteogenesis (DO) at Le Fort-I level. MATERIALS AND METHODS: Twelve adult subjects in the age range of 17-21 years with complete unilateral cleft lip and palate underwent advancement of the maxilla by DO. The effect of maxillary DO on the infraorbital rim remodeling was evaluated from lateral cephalograms recorded prior to the DO (T0), at the end of DO (T1), and at least 2-years after the DO (T2) by Walker's analysis. The ANOVA and two-tailed t test were used and probability value (P value) 0.05 was considered as statistically significant level. RESULTS: There was anterior movement of maxilla by 9.22 ± 3.27 mm and 7.67 ± 3.99 mm at the end of immediate (T1) and long-term (T2) follow-up of maxillary DO, respectively. The Walker's analysis showed 1.49 ± 1.22 mm and 2.31 ± 1.81 mm anterior movement of the infraorbital margin (Orbitale point) at the end of T1 and T2, respectively (P < 0.01). This apposition of bone at the infraorbital rim region further improved the facial profile of these patients. CONCLUSION: The advancement of maxilla by distraction osteogenesis at Le Fort-I level induced significant bone apposition at infraorbital rim. CLINICAL RELEVANCE: Patients with mild midface hypoplasia who would otherwise may be candidates for osteotomy at Le Fort-II or Le Fort-III level may benefit from maxillary distraction at Le Fort-I level.

Cephalometric norms for orthognathic surgery for North Indian population.

OBJECTIVE: The objective of this study is to establish the cephalometric hard tissue norm for orthognathic surgery for North Indian subjects. MATERIALS AND METHODS: A total of 100 young adults which consists of 46 males and 54 females with the age range of 14-24 years with balanced facial profile and minimum arch length discrepancies were chosen for the study. Lateral cephalograms with teeth in occlusion were recorded and analyzed manually to establish the norm. The mean values of various cephalometric hard tissue variables for North Indian males and females were compared with those Caucasians. P < 0.05 was considered to be statistically significant. RESULTS: All the cephalometric parameters for orthognathic surgery except mandibular length and lower incisor inclination were comparable among North Indian males and females. The mandibular length was significantly more among North Indian males than females (P < 0.05) and the inclination of lower incisors was significantly more among North Indian females than males (P < 0.05). However, many of the cephalometric parameters for orthognathic surgery were significantly different among North Indian and Caucasian males and females. CONCLUSION: The cephalometric norms for orthognathic surgery were established for North Indians and many measurements were different from those for Caucasians.

Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible.

OBJECTIVE: To test the hypothesis that twin-block and Mandibular Protraction Appliance-IV (MPA-IV) are not effective in improving the pharyngeal airway passage (PAP) dimensions among Class II malocclusion subjects with a retrognathic mandible. MATERIALS AND METHODS: Eighty-three subjects ranging in age from 8 to 14 years were divided into four groups. Group I included 30 Class I malocclusion subjects (healthy controls); group II consisted of 16 Class II malocclusion subjects (Class II controls); group III had 16 subjects in whom Class II malocclusion was treated by MPA-IV; and the remaining 21 subjects formed group IV, whose Class II malocclusions were corrected by twin-block appliance. Lateral cephalograms recorded at the beginning of orthodontic treatment in group I subjects and at the beginning and end of follow-up/treatment with functional appliance in group II, III, and IV subjects were analyzed to determine the PAP dimensions. Paired t-test, one-way analysis of variance, and Tukey tests were applied for statistical analysis, and a P-value .05 was considered statistically significant. RESULTS: Soft palate length was decreased significantly in group III (P < .05) and group IV (P < .001) subjects. Soft palate thickness in group IV subjects was increased significantly as compared to group II (P < .05) and group III (P < .01) subjects. The improvement in soft palate inclination in group III and group IV subjects was significant (P < .01). The oropharynx depth was increased significantly in group III (P < .05) and group IV (P < .001) subjects. The depth of the hypopharynx was increased significantly (P < .01) in group IV subjects. CONCLUSIONS: The twin-block appliance was more efficient than the MPA-IV in the improvement of PAP dimensions among Class II malocclusion subjects with retrognathic mandible.

Treatment outcome and long-term stability of skeletal changes following maxillary distraction in adult subjects of cleft lip and palate.

AIM: To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. MATERIALS AND METHODS: Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months) after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. RESULTS: Maxillary distraction resulted in significant advancement of maxilla (P<0.001). Counterclockwise rotation of the palatal plane took place after maxillary distraction. The position of the mandible and facial heights were stable during distraction. During the first 6 months of the post-distraction period, the maxilla showed relapse of approximately 30%. However, after 6 months post distraction, the relapse was very negligible. CONCLUSIONS: Successful advancement of maxilla was achieved by distraction osteogenesis in adult subjects with cleft lip and palate. Most of the relapse occurred during the first 6 months of post-distraction period, and after that the outcomes were stable.

Effect of three different motivational techniques on oral hygiene and gingival health of patients undergoing multibracketed orthodontics.

OBJECTIVE: To compare the effectiveness of three different motivational techniques for maintaining good oral hygiene during fixed appliance orthodontic treatment. MATERIALS AND METHODS: A total of 62 adolescents in the age range of 12-18 years, requiring fixed orthodontic treatment were evaluated for the efficacy of three different motivational techniques, ie, conventional plaque control measures (group I), chair side motivational tests with conventional plaque control measures (group II), and phase contrast microscopy with conventional plaque control measures (group III), in improving oral hygiene and gingival health over a period of 6 months. RESULTS: A gradual decline in mean plaque scores in group III was found, ie, from 1.13 ± 0.42 at baseline to 0.64 ± 0.39 at 6 months (P < .05). An intragroup analysis of mean gingivitis scores in group III showed statistically significant decline in the mean gingival scores from 1.49 ± 0.45 to 1.08 ± 0.61 over a period of 6 months(P < .05). CONCLUSIONS: Phase contrast microscopy along with the conventional method of plaque disclosure and demonstration of the horizontal scrubbing method of brushing have a long-lasting effect on the patient. This reduces the need of frequent reinforcement sessions of plaque control programs when compared to chair side motivational tests and conventional plaque control measures.

Effects of sagittal maxillary growth hypoplasia severity on mandibular asymmetry in unilateral cleft lip and palate subjects.

OBJECTIVE: To test the hypothesis that sagittal maxillary growth hypoplasia has no effect on mandibular asymmetry among subjects with complete unilateral cleft lip and palate (UCLP). DESIGN: A total of 86 subjects (normal noncleft, 42; UCLP, 44) in the age range of 15 to 25 years were chosen. Normal noncleft subjects were included in Group I. Based on the severity of sagittal maxillary growth hypoplasia, subjects with UCLP were divided into two groups. Subjects with UCLP in whom the SNM angle was ≥71 degrees and the M-point to Nasion perpendicular distance was ≤-10 mm were included in Group II. Group III consisted of subjects with UCLP in whom the SNM angle was <71 degrees and the M-point to Nasion perpendicular distance was >-10 mm. The mandibular asymmetry index (condylar, ramal, and condylar+ramal), gonial angle, and depth of the antigonial notch of three groups of subjects were examined on orthopantomograms (OPGs). RESULTS: Among Group II subjects in whom sagittal maxillary growth was near normal, ramal and condylar+ramal heights were significantly less on the cleft side than on the normal side (P < .01). Condylar, ramal, and condylar+ramal asymmetry indices were significantly greater among Group II subjects. Mandibular asymmetry indices among Group III subjects were comparable with those in Group I subjects. CONCLUSION: The hypothesis was rejected. The mandible was significantly asymmetrical among subjects with UCLP in whom sagittal maxillary growth was near normal, whereas the mandible was nearly symmetrical among subjects with UCLP in whom sagittal maxillary growth hypoplasia was very severe.

Sagittal mandibular development effects on the dimensions of the awake pharyngeal airway passage.

OBJECTIVE: To test the hypothesis that sagittal mandibular development has no effects on the dimensions of the awake pharyngeal airway passage. MATERIALS AND METHODS: Ninety-one subjects (age 15-25 years) with a normal vertical growth pattern of the mandible, normally positioned maxilla, and various sagittal mandibular developments were divided into three groups based on the sagittal mandibular development. Group I included 37 subjects who had a normally positioned mandible (76 degrees < or = angle between 'S,' 'N,' and 'B'; it represents the antero-posterior position of the maxilla in relation to the anterior cranial base [SNB] < or = 82 degrees ), Group II included 31 subjects in whom the mandible was retrognathic (SNB < 76 degrees ), and Group III included 23 subjects in whom the mandible was prognathic (SNB > 82 degrees ) in relation to the anterior cranial base. Lateral cephalograms were traced manually to evaluate the pharyngeal airway passage. RESULTS: The length of the soft palate was significantly smaller in mandibular prognathism subjects than in subjects with mandibular retrognathism (P < .01). The thickness of the soft palate was significantly greater among subjects with mandibular prognathism than in subjects with normal (P < .01) and retrognathic (P < .001) mandibular development. The sagittal mandibular development had no effect on the dimensions of the nasopharyngeal and hypopharyngeal airway passage. The depth of the oropharynx was comparable among the subjects with normal and retrognathic mandibles but was greater (P < .001) among subjects with mandibular prognathism. CONCLUSIONS: The hypothesis is rejected. Sagittal mandibular development had significant effects on the dimensions of the awake pharyngeal airway passage.