Evaluation of Soft and Hard Tissue Changes Following the Use of Rapid Molar Intruder for the Management of Skeletal Anterior Open Bite in Mixed Dentition: A Randomized Controlled Trial.

Objective The aim of the study was to evaluate skeletal, dentoalveolar, and soft tissue changes following early anterior open bite (AOB) treatment using a rapid molar intruder (RMI). Materials and methods A two-arm, parallel-group, randomized controlled trial was conducted on 40 patients aged 8-12 years with anterior open bites. They were randomly allocated to the RMI group and the untreated control group (UCG) with a 1:1 allocation ratio. At the beginning of the treatment (T1) and after nine months of treatment (T2), lateral cephalometric images were taken of each patient. The primary outcome measures were skeletal, dentoalveolar, and soft tissue changes. A two-sample t-test was used in the intergroup comparisons of the cephalometric measurement. Results The findings showed that the overbite increased significantly in the RMI group compared to the control group (x = 4.44 mm, x = 0.19 mm, respectively; p<0.001). A statistically significant intrusion of the upper and lower first molars was observed in the RMI group (x = 2.9 mm, x = 1.54 mm, respectively) compared to a slight extrusion in the control group. The differences between the two groups were significant (p<0.001). The SN: GoMe angle and the sum of Bjork decreased significantly in the RMI group compared to an increase observed in the control group. The differences between the two groups were significant (p<0.001). Conclusion The rapid molar intruder is an effective appliance for correcting anterior open bites in mixed dentition, inducing favorable skeletal, dentoalveolar, and soft tissue changes.

Soft- and hard-tissue changes following treatment of Class II division 1 malocclusion with Activator versus Trainer: a randomized controlled trial.

Background: Increased awareness on the role of oral functions in the aetiology of Class II deformities has led to the wide spread of myofunctional training appliances as easy and possibly effective treatment for children with Class II malocclusion but their efficacy is yet to be proven. Objectives: To evaluate soft- and hard-tissue changes following 12 months of Class II division 1 treatment in growing patients with a conventional functional appliance (a modified Activator) versus a myofunctional Trainer system (T4K®). Setting and sample population: Department of Orthodontics, Dental School. Participants, study design, and methods: Sixty Class II division 1 children (8-12 years old) were recruited from primary schools and were distributed randomly into two equal groups. Randomization was based on a computer-generated sequence of random numbers. Data analysis included: the Activator group (28 patients, mean age = 10.6 ± 1.3 years); the T4K® group (26 patients, mean age = 10.3 ± 1.4 years). Skeletal, dentoalveolar, and soft tissues changes were assessed using standardized lateral cephalograms collected before and after 12 months of treatment. No blinding was applied in this trial. Results: Improvement in the Class II skeletal and dentofacial characteristics were significantly greater in the Activator group when compared with the T4K® group. The improvement was evident in a significant decrease in the skeletal angle ANB with Activator (x¯ = -1.89 ± 1.12) compared to T4K® (x¯ = -0.9 ± 1.01) (P = 0.01), a significant greater increase in the facial convexity angle with Activator (x¯ = 2.61 ± 3.71) more than T4K® (x¯ = 0.2 ± 2.51) (P = 0.04), and a significant reduction in the overjet (x¯ = -3.0 ± 2.3 mm) compared to (x¯ = -1.5 ± 1.9 mm; P = 0.01) with Activator versus T4k®, respectively (P = 0.001). Limitations: This study was a short-term study (12-month follow-up). Conclusions: The results of the current study indicated that the Activator was more effective than the T4K® in treating Class II division 1 growing patients. Registration: The trial was not registered in any major database of clinical trials. Protocol: The protocol was not published before the commencement of the trial but can be given upon request.

Efficiency of Er:YAG utilization in accelerating deep bite orthodontic treatment.

BACKGROUND AND AIMS: The long duration of orthodontic treatment is a major patients' concern. A noninvasive method of accelerating tooth movement in a physiological manner is needed. The aim of the study was to evaluate the effects of Er:YAG laser application during orthodontic treatment of deep bite and to evaluate its analgesic effect during that movement. MATERIALS AND METHODS: A prospective randomized controlled clinical trial (RCT) was performed on 30 patients with deep bite. Sample was divided into two groups: (A), 15 patients (orthodontic treatment-control group) and (B), 15 patients (orthodontic treatment and Er:YAG Laser - laser group). The tooth movement was evaluated as the primary outcome variable by measuring angular and linear changes on three progress lateral cephalometeric radiographs (T1, T2 and T3); Lateral cephalograms were taken before treatment (T1), immediately after finishing the stage of leveling and alignment (T2) and after completion of the intrusion stage (T3).Laser parameters were 400 mJ/10 Hz/4 W and 400 mJ/15 Hz/6 W, depending on the handpiece used. The levels of pain and discomfort were evaluated and ranked according to a visual analog scale. Paired t-tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences. RESULTS: The main findings of the treatment were (1) significant positive difference in the rates of tooth intrusion movement on the experimental group compared with the control group at the baseline to T2 and T3 interval and the tooth movement rate was approximately 3 times faster in the experimental group. (2) The pain score in the experimental group was significantly lower compared with the control group on day 3 as on day 7. CONCLUSION: The application of Er:YAG laser is an effective mean to speed orthodontic tooth movement with a significant reduction in pain and discomfort after application.

Critical Appraisal of Clinical Research.

Evidence-based practice is the integration of individual clinical expertise with the best available external clinical evidence from systematic research and patient's values and expectations into the decision making process for patient care. It is a fundamental skill to be able to identify and appraise the best available evidence in order to integrate it with your own clinical experience and patients values. The aim of this article is to provide a robust and simple process for assessing the credibility of articles and their value to your clinical practice.

Evaluation of Periodontal Changes Adjacent to Extraction Sites during Upper Canine Retraction.

INTRODUCTION: There is an intimate relationship between orthodontic therapy and the periodontal changes that occur during tooth movement. MATERIALS AND METHODS: This prospective clinical trial aims at investigating the movement of both the free and attached gingiva, as well as the movement of the alveolar bone in the extraction site of the upper 1st premolars during the retraction of the upper canines. In this study, 17 patients (10 female, 7 male) requiring 1st premolar extraction before orthodontic tooth movement were selected and treated at the Department of Orthodontics in the Faculty of Dentistry in University of Hama, Hama, Syria. The upper 1st premolars were extracted, and the implant AutoTacs were applied on the alveolar bone afterward. Then, measurements between the center of the implant AutoTacs and the L-shape wire were taken, utilizing digital Vernier caliper. After 3 weeks of extraction, tattooing marked points were placed on the free and the attached gingival, and the measurements were taken using the same digital Vernier caliper. Closed coil springs made of nickel-titanium were used to retract the upper canines, and a force of 150 gm was applied. RESULTS: The results of this study showed significant differences between the movement of both the free and attached gingiva and the movement of the corresponding upper canines (p < 0.001). The movement of the free gingiva had formed about 77% of the amount of the movement of the upper canine retraction. No significant differences were detected between the place of implant AutoTac X1 and the L-shaped wire (W) during the retraction of the upper canine. On the contrary, significant differences were noticed between the place of implant AutoTac X2 and the L-shaped wire (W) during the retraction of the upper canine (p < 0.001). CONCLUSION: There is significant movement of hard and soft tissues during and after premolar extraction and orthodontic therapy. CLINICAL SIGNIFICANCE: The movement of supporting tissues of the teeth along with the alveolar bone during canine retraction is an important biological characteristic of the orthodontic tooth movement. Clinicians need to understand the role and importance of the supporting tissues during orthodontic treatment, which needs to be incorporated into their routine clinical evaluations.

Protocol Writing in Clinical Research.

Writing a research proposal is probably one of the most challenging and difficult task as research is a new area for the majority of postgraduates and new researchers. The purpose of this article is to summarize the most important steps and necessary guidelines for producing a standard research protocol. Academic and administrative success of any project is usually determined by acquiring a grant for the related field of research. Hence, the quality of a protocol is primarily required to achieve success in this scientific competition.

Does alveolar corticotomy accelerate orthodontic tooth movement when retracting upper canines? A split-mouth design randomized controlled trial.

PURPOSE: To evaluate the efficacy of alveolar corticotomy on orthodontic tooth movement when retracting upper canines compared with the conventional technique and to evaluate patients' pain and discomfort levels after corticotomy. MATERIALS AND METHODS: A split-mouth design randomized controlled trial at the Department of Orthodontics (University Al-Baath Dental School) was performed. A total of 30 patients whose orthodontic treatment required canine retraction were included. The predictor variable was the use of corticotomy to facilitate tooth movement. The velocity of space closure was evaluated as the primary outcome variable by measuring the distance between the canine and first molar on each side of the mouth immediately after corticotomy and at 1, 2, 4, 8, and 12 weeks after corticotomy. The levels of pain and discomfort were evaluated as the secondary outcome variables using a questionnaire administered 4 times during the first week after corticotomy. Paired t tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences. RESULTS: A total of 30 patients (15 males and 15 females) were recruited with a mean age of 20.04 ± 3.63 years (range 15 to 24). The space closure velocity after corticotomy was significantly faster on the experimental side than on the control side (mean = 0.74 mm/week vs 0.20 mm/week between 1 week after and immediately after corticotomy, respectively; P < .001). The pain encountered during eating was high, with 50% and 30% of patients reporting severe pain at 1 and 3 days postoperatively, respectively. No significant differences were detected between the male and female patients regarding the tooth movement velocity on the experimental side. CONCLUSIONS: Alveolar corticotomy increased orthodontic tooth movement and was accompanied by moderate degrees of pain and discomfort.