Comparison of efficacy between MBT preadjusted edgewise appliance and clear aligner therapy among class I crowding cases: A randomized controlled trial.

Background: To compare the efficacy of McLaughlin Bennett Trevisi (MBT) appliance and Clear Aligner Therapy (CAT) among nonextraction Class I crowding cases. Methods: The study sample (60 patients) was allotted into two equal groups (30 patients each) using block randomization wherein Group 1: treated with 0.018" MBT appliance and Group 2: treated with CAT for correction of malocclusion. At the end of treatment (T1), treatment duration, chairside time, laboratory time, number, and type of appointments were noted from treatment record cards. For comparing the acceptability among patients treated with both modalities at T1, the patients were interviewed regarding the comfort and ease of using an appliance with a questionnaire-based survey. Results: The median number of nonscheduled/emergency and finishing stage appointments was significantly higher in Group 1 compared to Group 2 (P-value <0.001). The median duration of treatment at the scheduled, finishing, and overall appointments, was significantly higher in Group 1 compared to Group 2 (P-value <0.001). The median chairside time of all appointments was significantly higher in Group 1 compared to Group 2 (P-value <0.001). The experience with treatment and overall acceptability was significantly higher in Group 2 compared to Group 1 (P-value <0.001). However, mean laboratory time per aligner fabrication in Group 2 was 30.26 ± 3.45 min against no laboratory time consumed in Group 1. Conclusions: CAT significantly reduces treatment duration, chairside time, number of nonscheduled/emergency, and finishing stage appointments in nonextraction Class I crowding cases. Prospective studies with 3D aligner systems are recommended to add further evidence in this regard. Clinical Trials Registry-India Registration No: CTRI/2018/04/013301.

Correlating Nasal Patency with Obstructive Sleep Apnea in Obese Versus Non-Obese Patients: An Acoustic Rhinometry Study.

The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value < 0.05 for all). BMI showed a statistically significant positive (direct) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). The nasal cross-sectional areas and volume showed a statistically significant negative (inverse) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). OSA diagnosed cases with high BMI may not present with an obvious nasal obstruction; the nasal patency may still be compromised due to reduced nasal lumen secondary to obesity. AR, being cost-effective and non-invasive modality; is advocated to evaluate pre-treatment nasal patency, as well as follow up evaluation to ascertain improvement after the intervention.

Effectiveness of Titratable Oral Appliance in Management of Moderate to Severe Obstructive Sleep Apnea-A Prospective Clinical Study with Acoustic Pharyngometry.

To assess effectiveness of titratable Oral Appliance (OA) in management of moderate to severe cases of Obstructive Sleep Apnea (OSA). Thirty Polysomnography (PSG) diagnosed cases of moderate to severe OSA were subjected to a thorough cranio-facial-dental evaluation, a detailed sleep history and three dimensional assessment of upper airway geometry utilising Acoustic Pharyngometry (AP) (Eccovision, sleep group solutions). A titratable OA was delivered to all patients for mandibular advancement. Apnea Hypopnea Index (AHI), Oxygen Saturation (SPO2), Epworth's Sleepiness Scale (ESS), Mean area and volume of upper airway were recorded at Baseline (T0) and after 08 weeks of appliance delivery (T1). The mean AHI & ESS scores were significantly lower and SPO2 was significantly higher at T1 compared to T0 (P-value < 0.05 for all). The mean area and volume of upper airway at T1 were significantly higher compared to values at T0 (P-value < 0.05 for both). The mean area showed 19.51% increase at T1 whereas mean volume increased by 18.55%. OA therapy is highly efficacious in cases with moderate to severe OSA, especially, in those with retrognathic mandible. This modality should be considered as an effective alternate to Continuous Positive Airway Pressure (CPAP) therapy in non-compliant patients rather than no treatment. AP is an effective modality to predict airway changes after advancement with OA, to ascertain follow up changes and is highly recommended in routine clinical practice. Large scale, multicenter studies are recommended to elaborate the findings of the present study and to add better quality evidence in this regard.

Long-Term Study of Relapse After Mandibular Orthognathic Surgery: Advancement Versus Setback.

Background: Relapse is a continuing process and should be evaluated on a long rather than short term. Materials and Methods: Treatment records of 46 patients who underwent mandibular orthognathic surgery were divided into two groups, i.e. Group 1: Mandibular Advancement (MA) surgery (n = 26) and Group 2: Mandibular Setback (MS) surgery (n = 20). Lateral cephalograms were traced at T0 (01 week before surgery), T1 (01 week after surgery), T2 (01 year after surgery) and T3 (minimum 05 years after surgery) to study short- and long-term skeletal and dental relapse in horizontal, vertical and angular parameters selected for the study. Relapse was correlated with gender, age, amount of surgical movement and intra-operative change in mandibular plane angle to study effect of these factors on relapse. Results: All horizontal, vertical and angular parameters studied showed significant relapse at short term (from T1 to T2) which continued significantly till long-term evaluation (T2 to T3) in both groups (P value < 0.001). Horizontal relapse in all parameters, vertical relapse in all parameters (except Pog and overbite at T1-T2) and angular relapse in all parameters (except Ramus inclination at T1-T2) was significantly higher in Group 2 compared to Group 1 (P value < 0.001 for all). Relapse showed significant and positive correlation with amount of surgical movement and intra-operative change in mandibular plane angle in both groups (P value < 0.05 for all). Conclusion: Both MA and MS surgeries show significant relapse on both short- and long-term evaluation which it is higher in MS as compared to MA surgeries.

Comparison of long-term skeletal stability following maxillary advancement using rigid external distraction in growing and non-growing patients with cleft lip and palate: a systematic review and meta-analysis.

OBJECTIVES: To compare the long-term skeletal stability following maxillary advancement using Rigid External Distraction (RED) in growing and non-growing patients with Cleft Lip and Palate (CLP). METHODS: Data sources: A systematic literature search was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines from database inception till August 2020 in MEDLINE-PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Science Direct, Google Scholar and a manual search in the institutional library. Study eligibility criteria, participants and intervention: All available literature published in English, with a minimum of six human subjects with well-defined age range either 7-14.9 years or 15-30 years, follow up period of a minimum of 12 months assessing the skeletal stability as horizontal change at Point A (Subspinale) following maxillary advancement using a RED device, without the use of rigid internal fixation or bone grafts were included in the study. Study appraisal and synthesis method: The quality assessment of selected articles was done using the Newcastle-Ottawa scale. The meta-analysis was carried out with Q statistic method, I-squared statistics, fixed-effect model to estimate pooled mean and Begg-Mazumdar bias indicator. RESULTS: Selected nine articles that were qualitatively assessed for relapse rate following maxillary advancement using a RED device, showed consistent and stable results. The meta-analysis found no significant difference in long-term skeletal stability of maxillary advancement by RED device in growing and non-growing patients with CLP [(growing group: Pooled proportion = 0.2927; 95% CI = 0.1534 to 0.4319) (non-growing group: Pooled proportion = 0.23077; 95% CI = 0.09854 to 0.36300)]. LIMITATIONS: No study, as revealed by the search, was available that compared the two groups as defined by the inclusion criteria. Data for the two groups were retrieved from different studies and meta-analysed. CONCLUSION: RED is an effective modality for correction of maxillary hypoplasia secondary to CLP, requiring large maxillary advancement. The technique can be used in young and adult patients with similar long-term results. PROSPERO REGISTRATION NUMBER: CRD42020205513.

Effect of Mandibular Setback Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The changes in length and height of tongue following mandibular setback (MS) surgery may affect pharyngeal airway dimensions. There is limited literature correlating tongue dimensional changes with linear and volumetric airway changes following MS with bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients. MATERIALS AND METHODS: Treatment records of 18 patients who underwent MS with BSSRO were evaluated for changes in tongue and linear airway dimensions, mean airway volume and area at T1 (1-week pre-surgery), T2 (6-month post-surgery) and T3 (2-year post-surgery). Amount of MS was recorded from case sheets of patients. Mean tongue length reduced, whereas mean tongue height increased at T2 compared to T1 (P value = 0.001 for both). Linear, area and volumetric airway parameters at T2 were significantly reduced (P value = 0.001). All parameters showed statistically nonsignificant increase from T2 to T3 (P value > 0.05). Correlation analysis showed that change in tongue length at T3 did not show statistically significant correlation with amount of MS, changes in linear, area and volumetric airway parameters (P value > 0.05). However, the change in tongue height at T3 showed a significant (P value < 0.05) negative correlation (r value = - 0.742) with change in posterior airway space (PAS). CONCLUSIONS: The appraisal of tongue length and height after MS surgery should be an integral part of diagnosis and treatment planning. The retro-positioning of tongue and increase in its height after MS surgery may compromise pharyngeal airway especially PAS. Additional options such as bi-jaw surgery, debulking of tongue volume and genioplasty should be explored to minimize adverse effects post-surgically.

Comparison of in vivo and in vitro force decay of elastomeric chains/modules: a systematic review and meta analysis.

BACKGROUND: The study evaluated and compared the force decay of orthodontic elastomeric chains/modules in both in vivo and in vitro settings. METHODS: A protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was formulated and registered with the International Prospective Register of Systematic Reviews. A total of 53 articles (44 in vitro and 9 in vivo studies) found via search of the electronic databases of Cochrane and the National Library of Medicine (MEDLINE; PubMed), and manual search of the gray literature from institutional library resources, were selected. Data extraction, quality analysis, risk of bias assessment, and meta-analysis of the level of force decay of elastomeric chains/modules were conducted per standard protocol, and suitable statistical analyses were applied. RESULTS: The mean force decay in the in vivo setting was 41.9% at 24 hours, 42.6% after 1 week, 46.8% after 2 weeks, and 55.0% after 3 weeks. Similarly, the force decay in the in vitro studies was 38.9% at 24 hours, 42.1% after 1 week, 44.6% after 2 weeks, and 51.1% after 3 weeks. However, at the 95% confidence interval, the force decay rates of in vivo and in vitro studies overlap, with a statistically insignificant difference in force decay observed in the in vivo and in vitro settings. CONCLUSIONS: This systematic review and meta-analysis observed more force decay in the in vivo studies versus the in vitro studies (although this difference was statistically insignificant), with the maximum force decay occurring during the initial days, with a reduction to approximately 50% within 3 weeks. Hence, change of the elastomeric chains/module, at intervals of 3 weeks, is advised. (PROSPERO registration no. CRD42020209535).

Quantifying Upper Airway Changes Following Mandibular Orthognathic Surgery.

ABSTRACT: The aim of this study was to quantify upper airway changes following mandibular orthognathic surgery. Treatment records of 50 patients who underwent mandibular orthognathic surgery were divided into 2 groups, that is, Group 1: Cases treated with Mandibular Advancement Surgery and Group 2: Cases treated with Mandibular Setback Surgery with 25 patients in each group. The Lateral Cephalogram and Acoustic Pharyngometry records of both groups were studied at T0 (01 week before surgery) and T1 (01 year postsurgery) for changes in linear airway measurements (Nasopharyngeal Airway Space - NAS, Superior Airway Space - SAS, Posterior Airway Space - PAS and Hypopharyngeal Airway Space (HAS)), hyoid bone position (Mandibular Plane Hyoid distance), mean area and mean volume. The percentage change and change in these parameters per millimeter advancement or setback of mandible at T1 was calculated. A significant increase in linear airway parameters (SAS and PAS); decrease in hyoid distance; and increase in volume and area of upper airway was observed at T1 in Group 1 and reverse was observed in Group 2. The change in airway parameters (SAS, PAS, mean volume and area) was more significant in Group 1 as compared to Group 2. In the current airway centric approach, meticulous assessment and prediction of long-term airway changes post surgery should be an integral part of ortho-surgical diagnosis and treatment planning and suitable modifications in the treatment plan must be made to cater for any potential adverse effects on airway.

Does Presurgical Nasoalveolar Molding Have a Long-Term Effect on Nasal and Upper Airway Dimensions?

OBJECTIVES: To compare nasal and upper airway dimensions in patients with cleft lip and palate (CLP) who underwent nasoalveolar molding (NAM) with those without NAM during infancy using acoustic pharyngometry and rhinometry. MATERIALS AND METHODS: Eccovision acoustic pharyngometry and rhinometry (Sleep Group Solutions) was used for assessment of mean area and volume of nasal and upper airway in patients with complete unilateral CLP (age range 16-21 years) treated with NAM (group 1, n = 19) versus without NAM (group 2, n = 22). RESULTS: The mean nasal cross-sectional areas and volume were higher in group 1 compared to group 2 on both cleft (P value <.001) and noncleft side (P value >.05). The mean area and volume of upper airway were also significantly higher in group 1 compared to group 2 (P value <.05). CONCLUSIONS: Nasoalveolar molding being one of the first interventions in chronology of treatment of patients with CLP, its long-term outcome on nasal and upper airway patency needs to be ascertained. The results of the present study show that the patients with CLP who have undergone NAM during infancy have better improvement in nasal and upper airway patency compared with those who had not undergone NAM procedure. The basic advantages of being noninvasive, nonionizing and providing dynamic assessment of nasal and upper airway patency make acoustic pharyngometry and rhinometry a diagnostic tool of choice to be used in patients with CLP.

Effect of Mandibular Advancement Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The spatial position and dimensions of oral and pharyngeal soft tissues change post-mandibular advancement (MA) surgery which involves changes in position of soft palate, tongue and associated musculature. There is no study which simultaneously evaluates changes in tongue length and height post-MA surgery and correlates these changes with changes in upper airway dimensions and the amount of MA. MATERIALS AND METHODS: Treatment records of 18 patients that underwent MA with bilateral sagittal split ramus osteotomy were evaluated at T1 (01 week before surgery) and T2 (06 months post-surgery). Linear airway and tongue measurements were done on lateral cephalogram. Mean volume and mean pharyngeal area values were recorded from the acoustic pharyngometry (AP) records of patients. RESULTS: A statistically significant increase in tongue length (P value < 0.001) and nonsignificant change in tongue height were observed at T2 (P value > 0.05). A statistically significant increase in airway parameters recorded on both lateral cephalogram and AP was observed at T2 (P value < 0.001). Correlation analysis did not show a statistically significant correlation of change in tongue length and tongue height at T2 with the amount of MA, change in airway parameters on lateral cephalogram and AP (P value > 0.05). CONCLUSIONS: Mandibular advancement surgery is a viable option for improvement in pharyngeal airway in skeletal Class II patients with retrognathic mandible. Changes in tongue length observed in our study may correspond to the stretch of protruders of tongue, especially genioglossus, and may point toward possible relapse on a long-term follow-up.

Validation of Association between Breastfeeding Duration, Facial Profile, Occlusion, and Spacing: A Cross-sectional Study.

INTRODUCTION: This cross-sectional retrospective study was designed to assess the relationships among breastfeeding duration, nonnutritive sucking habits, convex facial profile, nonspaced dentition, and distoclusion in the deciduous dentition. MATERIALS AND METHODS: A sample of 415 children (228 males, 187 females) aged 4 to 6 years from a mixed Indian population was clinically examined by two orthodontists. Information about breastfeeding duration and nonnutritive sucking habits was obtained by written questionnaire which was answered by the parents. RESULTS: Chi-square test did not indicate any significant association among breastfeeding duration, convex facial profile, and distoclusion. Statistically significant association was observed between breastfeeding duration and nonspaced dentition and also between breastfeeding duration and nonnutritive sucking habits. Nonnutritive sucking habits had a statistically significant association with distoclusion and convex facial profile (odds ratio 7.04 and 4.03 respectively). Nonnutritive sucking habits did not have a statistically significant association with nonspaced dentition. CONCLUSION: The children breastfed < 6 months had almost twofold increased probability for developing sucking habits and nonspaced dentition, respectively, than the children who had breastfeeding > 6 months duration. It can also be hypothesized that nonnutritive sucking habits may act as a dominant variable in the relationship between breastfeeding duration and occurrence of convex facial profile and distoclusion in deciduous dentition. How to cite this article: Agarwal SS, Sharma M, Nehra K, Jayan B, Poonia A, Bhattal H. Validation of Association between Breastfeeding Duration, Facial Profile, Occlusion, and Spacing: A Cross-sectional Study. Int J Clin Pediatr Dent 2016;9(2):162-166.

Association between breastfeeding duration, non-nutritive sucking habits and dental arch dimensions in deciduous dentition: a cross-sectional study.

BACKGROUND: This cross-sectional retrospective study was conducted to determine association between breastfeeding duration, non-nutritive sucking habits, dental arch transverse diameters, posterior crossbite and anterior open bite in deciduous dentition. METHODS: 415 children (228 males and 187 females), 4 to 6 years old, from a mixed Indian population were clinically examined. Based on written questionnaire answered by parents, children were divided into two groups: group 1 (breastfed for <6 months (n = 158)) and group 2 (breastfed for ≥6 months (n = 257)). The associations were analysed using chi-square test (P < 0.05 taken as statistically significant). Odds ratio (OR) was calculated to determine the strength of associations tested. Multivariate logistic regression analysis was done for obtaining independent predictors of posterior crossbite and maxillary and mandibular IMD (Inter-molar distance) and ICD (Inter-canine distance). RESULTS: Non-nutritive sucking (NNS) was present in 15.18% children (20.3% in group 1 as compared to 12.1% in group 2 (P = 0.024)). The average ICD and IMD in maxilla and average IMD in mandible were significantly higher among group 2 as compared to group 1 (P < 0.01). In mandible, average ICD did not differ significantly between the two groups (P = 0.342). The distribution of anterior open bite did not differ significantly between the two groups (P = 0.865). The distribution of posterior crossbite was significantly different between the two groups (P = 0.001). OR assessment (OR = 1.852) revealed that group 1 had almost twofold higher prevalence of NNS habits than group 2. Multivariate logistic regression analysis revealed that the first group had independently fourfold increased risk of developing crossbite compared to the second group (OR = 4.3). Multivariate linear regression analysis also revealed that age and breastfeeding duration were the most significant determinants of ICD and IMD. CONCLUSIONS: An increased prevalence of NNS in the first group suggests that NNS is a dominant variable in the association between breastfeeding duration and reduced intra-arch transverse diameters which leads to increased prevalence of posterior crossbites as seen in our study. Mandibular inter-canine width is however unaffected due to a lowered tongue posture seen in these children.