Orthodontic-surgical management of severe skeletal class iii malocclusion: A case report.

Skeletal Class III malocclusion possess a difficult challenge to treat for clinicians. They are multifactorial and include genetic and environmental factors. Early intervention of Class III needs orthopedic correction, whereas, in adults, orthodontic camouflage can be done to treat mild cases while severe skeletal discrepancies demand orthognathic surgery along with orthodontic therapy. In this case report, a case of mandibular prognathism with Bilateral Sagittal Split Osteotomy (BSSO) setback was presented.

Assessment of gingival biotype in different facial patterns: A cross-sectional study.

Objective: The aim of the present study is to evaluate the relationship of gingival biotype in different malocclusions. Methods: A total of 157 periodontally healthy subjects (88 males and 69 females) were enrolled in this cross-sectional study. The study participants were divided into three groups of skeletal class I, class II, and class III. The probe transparency method was used to determine the quality and gingival tissue into thick and thin biotype. Results: There was significant difference in gingival biotype among different skeletal malocclusion with high prevalence of thin gingival biotype in class I subjects and more prevalence of thick biotype in class II and class III individuals (P-value: 0.022). Pairwise comparison of gingival biotype in class I versus class II showed significant difference (P-value: 0.032); however in class I versus class III and class II versus class III, the test result was nonsignificant. The overall frequency of thin gingival biotype was significantly less in female subjects with respect to males (P-value: 0.025). Conclusion: A significant relationship is present between skeletal malocclusion and quality of gingival biotype. The prevalence of thick gingival biotype is found more in females as compared to male individuals. The thin gingival biotype is more commonly seen in skeletal class I than class II and class III.

Evaluation of surface-modified orthodontic wires by different concentration and dipping duration of titanium oxide (TiO2) nanoparticles.

OBJECTIVE: To evaluate in-vitro surface characteristics and frictional properties of orthodontic stainless steel and beta-titanium archwires after surface modification with different concentrations and coating time of titanium oxide (TiO2) nanoparticles by Sol-gel dip coating method. MATERIALS AND METHODS: The experiment was carried out with 4 different concentrations (1:2, 1:4, 1:6, and 1:8) and three different dipping durations (24 hours, 48 hours, and 72 hours) over ten main test groups of SS and TMA archwires with uncoated wires acting as control in both dry and wet conditions. Phase analysis and surface characterization of TiO2 was analyzed by X-ray Diffractometry, surface evaluation with the help of scanning electron microscopy (SEM), and frictional characteristics were evaluated. RESULTS: Among all the concentrations 1:6 ratio with 48 hours of dipping duration showed better surface characteristics. A statistically significant difference in frictional coefficient was observed in both SS and TMA wires than their respective controls (p = 0.001). Intragroup comparison among SS and TMA groups showed that groups with 1:6 ratio and 48 hours dipping duration had least frictional coefficient in both dry and wet conditions (p = 0.001). Intergroup comparison between SS and TMA showed that SS group had significantly reduced friction than TMA (p = 0.001) except in few groups. CONCLUSION: TiO2 nanoparticle with a concentration ratio of 1:6 and 48 hours dipping duration is recommended for surface modification of orthodontic archwires.

Effect of orthodontic retraction force on thick and thin gingival biotypes in different grades of gingival recession and alveolar bone quality: A finite element analysis.

INTRODUCTION: To evaluate the effect of orthodontic retraction force on thick and thin gingival biotypes of anterior teeth having grade I and II gingival recession with D1 and D2 alveolar bone densities by assessing the displacement of teeth and deformation in gingival tissue, along with evaluating the amount of equivalent stress on teeth and gingiva in finite element model. MATERIALS AND METHOD: Based on cone-beam computed tomography datasets, eight models (LC01-LC08) of maxilla with appliance assembly were created. A retraction load of 150 gm was applied on each model during the finite element analysis (FEA), and then values of teeth displacement, gingival deformation, and von Mises stress were evaluated. RESULT: All the models with D1 bone density (LC01-04) were showing gingival deformation, whereas models with D2 bone quality (LC05-08) give no significant outcome. The amount of von Mises stress for teeth and gingival tissue in each model was the same for both central and lateral incisors. CONCLUSION: All the models having D1 bone quality showed greater gingival deformation after applying retraction force, whereas in models with D2 bone density, deformation was not significant. Changes in gingival tissue are brought about by orthodontic treatment, which also helps to correct the periodontal defects; however, bone density plays a significant role in improving gingival recession.

Assessment of chin morphology in different skeletal dysplasia - A cross-sectional study.

Objective: The objective of the study is to evaluate the morphology of the symphyseal region of adult skeletal Class II and Class III malocclusion as compared with Skeletal Class I subjects. Materials and Methods: The symphyseal width and height were evaluated using data from 80 lateral cephalograms of the age range of 18 years to 25 years. Average growing Skeletal Class II (n = 30) and Class III (n = 20) subjects were used as a comparison group. Average growing normal occlusion samples (n = 30) were used as controls. Results: Alveolar height was similar in all groups. The width of the symphyseal region including basal width, the width of the cervical region of the lower central incisor at the cementoenamel junction, and symphysis width were found to be similar in all groups. There is no significant difference in gonial angle in both Class II and III groups as compared to control. Articular angle showed no significant difference. Mandibular incisor dentoalveolar height (L1-AH) was found to be significantly higher in the Class II group (P < 0.05). Conclusions: There are no definite morphological differences in the symphyseal region between average grower Class I, Class II, and Class III skeletal malocclusions except mandibular incisor dentoalveolar height (L1-AH) and incisor mandibular plane angle which is higher whereas ramus length and body length which is lesser in Class II group as compared with controls. Width of the cervical region of the lower central incisor at the cementoenamel junction (Id-Id') and incisor mandibular plane angle was lower than control in Class III subjects.

Perception of facial esthetics in young North Indian population.

INTRODUCTION: A person's ability to recognize a beautiful face is innate, but translating this into defined treatment goals is a challenge for clinicians. AIM: To determine if faces considered esthetic and pleasing in the young North Indian population (both males and females) exhibit similar cephalometric measurements as used for ideal treatment and successful results. MATERIALS AND METHOD: A panel of five judges evaluated a set of one frontal, one frontal during smiling, and one profile extra-oral photograph of 160 students (80 females and 80 males) on a five-point attractiveness scale. For each photographic set, the mean and final scores were calculated. Once the sample was assessed, 60 subjects (30 females and 30 males) with the highest final facial aesthetic score were selected and cephalometric analysis was performed. The obtained data were subjected to statistical analysis using SPSS 20 software. RESULTS: Both males and females with class I skeletal jaw bases were found to be attractive. The females with short faces; mild facial convexity and lower lip closer to the esthetic line were found to be attractive. The males with a prominent chin, straight profile, prominent nose, increased upper lip thickness, upper lip length, and lower lip length were found to be attractive. CONCLUSION: The faces considered attractive in this study fulfilled most of the cephalometric norms commonly used for the diagnosis and treatment planning except for a few inconsistencies which may be attributed to the gender and demographic origin.

Variables to predict spontaneous eruption of palatally displaced permanent canine after interceptive extraction of primary canine: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the effectiveness of different diagnostic variables measured on panoramic radiographs (PAN) to predict spontaneous eruption of palatally displaced canine (PDC) after interceptive extraction in late mixed dentition. MATERIALS AND METHODS: Digital databases (MEDLINE, CENTRAL (Cochrane), Scopus, clinicaltrials.gov, ISRCTN registry) and hand searches were performed up to March 2020. Both randomized and non-randomized controlled trials were considered for the review. Study selection, data extraction, risk of bias assessment (RoB2.0 and ROBINS-I), and the certainty of evidence evaluation (GRADE) were performed according to Cochrane Handbook for Systematic Reviews of Interventions. The random-effects method for quantitative synthesis of dichotomous as well as continuous data was used. RESULTS: Out of 767 retrieved records, 4 controlled trials fulfilled the eligibility criteria and were included in the review. Studies were assessed at low risk of bias except one. Overall certainty was strong to moderate. PDCs in distal sectors (RR: 1.621; 95%CI: 1.259 to 2.086; P<0.001) and alpha-angle <30° (SMD: -1.350; 95%CI: 1.924 to -0.776; P<0.001) were significantly benefited from interceptive extraction. However, Vertical distance of PDC cusp tip from occlusal plane had statistically insignificant (p: 0.855) roll on eruption prediction. CONCLUSION: Interceptive extraction at a younger age, initial horizontal localization (sector position), and alpha-angle (initial mesial inclination) are the most important variables predicting the spontaneous eruption of palatally displaced canines. Findings of this review can be utilized to make evidence-based decisions for managing PDCs with diverse sectors and mesial inclinations. However, well-designed clinical trials are recommended to strengthen the evidence.

Management of Unusual Rotation of Maxillary Central Incisor with Impacted Mesiodens: Case Report.

Supernumerary teeth are frequently found in the maxillary anterior region, largely in permanent dentition (rare in deciduous dentition). Shape of the supernumerary teeth may vary from conical, tueberculate, supplemental to odontome. Mesiodens is a conical type of supernumerary teeth located in the maxillary central incisor region and is generally unerupted. Presence of mesiodens may result in rotation, uneruption, or malalignment of adjacent maxillary incisors. In this article, we present a case report of unusual rotation of maxillary central incisor with impacted mesiodens.

Correction of Scissor's Bite with Modified Transpalatal Arch.

Compromised occlusion because ofscissor' bite can eventually lead to temporomandibular disorders and severe consequences. Wany devices and orthodontic techniques have been proposed for the correction of this defect. Treatment of scissor's bite with the help of cross. elastics between maxillary and mandibular molars may lead to extrusion of molars resulting in increased vertical dimension. Here, we are going to present management of two cases of scissor's bite with the help of modified transpalatal arch.

An overview of surgery-first approach: Recent advances in orthognathic surgery.

The disadvantages of having orthodontic interventions both before and after orthognathic surgery include a long treatment time of 7-47 months and temporary worsening of facial appearance. Nowadays, the concept of surgery-first, followed by orthodontic treatment is applied to orthognathic surgery cases in different orthodontic centers in the world. This concept and technique is called "surgery-first-orthognathic-approach" or "surgery-first approach" (SFA) rigid fixation (skeletal anchorage system) of the bony segments and regional acceleratory phenomenon were keys to broad implementation of the SFA. This article is intended to provide an overview of SFA including indications, general and specific guidelines, different protocol variations, success rate and potential problems.

Effect of Oral Appliance for Snoring and Obstructive Sleep Apnea.

To analyze therapeutic and clinical efficacy of mandibular advancement device (MAD) on snoring and obstructive sleep apnea (OSA). Thirty patients with OSA were recruited on the basis ofpolysomnography with an Apnea and Hypopnea Index (AHI) greater than 5 but less than 30. Repeat polysomnography was performed in follow up with the appliance in place. MAD used in the study is Medical Dental Sleep Appliance (MDSA). It is a titratable appliance. With the appliance in position, the mandible was advanced to an extent that did not exceed 70% of maximum protrusion capacity; Vertical opening did not exceed on an average 3-4 mm beyond freeway space. Comparison of pre AHI scores (diagnostic PSG) with post AHI scores (PSG with OA in-situ) showed a decrease from Mean +/- SD 26.2367 +/- 6.53 to 13.7111 +/- 627. A highly significant (p < 0.001) improvement in AHI was observed. Pre and post ESS score showed a mean decrease from 14.2333 +/- 5.00 to 6.1481 +/- 2.46 MDSA is effective in reducing apnea hypopnea index scores and improving oxygen saturation level.