A Correlation Analysis between Arch Width and Molar Inclination Using Cone-Beam Computed Tomography Transverse Measurements: A Cross-Sectional Study.

A new era in 3-dimensional analysis has begun with the use of cone-beam computed tomography (CBCT) in orthodontics, which promises to provide a more thorough understanding of the craniofacial skeletal architecture. This study aimed to investigate the correlation between the transverse basal arches discrepancy and dental compensation by utilizing CBCT width analysis. An observational study was conducted to retrospectively review 88 CBCT scans of patients presented to dental clinics from 2014 to 2020 obtained from the Planmeca Romexis x-ray system at three centers. Dental compensation data across normal and narrow maxillae were analyzed and a Pearson correlation was used to find the relationship between molar inclination and width difference. Significant maxillary molar compensation differences were observed between the normal maxilla and narrow maxilla group, where the amount of dental compensation (164.73 ± 10.15) was higher in the narrow maxilla group. A significant negative correlation (r = -0.37) was observed between width difference and maxillary molar inclination. Maxillary molars were tipped buccally to compensate for the reduced maxillary arch width. These findings are important to determine the amount of needed maxillary expansion taking into account the buccal inclination while treating cases.

Successful treatment modalities for missing lateral incisors- A systematic review.

BACKGROUND: Effective management of Missing lateral incisor has remained a challenge for the clinicians. A multi-disciplinary approach involving orthodontist, restorative dental specialist, pediatric dental specialist, periodontist, oral surgeon and general dentist has proved ideal. Our aim is to review the ultimate esthetic success, and long term survival results between the orthodontic and restorative management of missing lateral incisor. MATERIALS AND METHODS: Following the PRISMA guidelines, a systematic review of the published articles pertaining to the topic of interest was done. Searches were carried out in four different databases since February 2021 to April 2021. RESULTS: A total of 580 references were found from searches conducted in PubMed, Scopus, Cochrane and Web of Science, and 19 articles were selected and analyzed fully, after screening the title and abstract, 6 articles were included for the study. CONCLUSION: An essential orthodontic space closure in combination with modern aesthetic prosthetic tooth replacement techniques has been reported to achieve greater success.

Assessment on the Precision of the Orthodontic Bracket Slot Dimensions Using Micro-computed Tomography (Micro-CT).

AIM: To evaluate the precision of the orthodontic bracket slot dimensions of 0.022 inch and to compare them with those of the manufacturers' specifications. MATERIALS AND METHODS: The slots of upper-right central incisor brackets (n = 5) from 11 commercial bracket systems of three different manufacturers (3M Unitek: Victory Mini Metal, Clarity, SmartClip, Clarity SL; ORMCO/SYBRON: Mini Diamond Twin, Damon Q, Damon Clear; Dentsply/GAC: Ovation, Mystique, In-Ovation R, In-Ovation C) were measured. The orthodontic brackets were scanned using micro-computed tomography (micro-CT), and the bracket slots were measured using micro-CT images. The slot was measured at four different surfaces (occlusal, gingival, base, and face) for both mesial and distal sites. Data were subjected to ANOVA and unpaired t-tests. A p-value of ≤0.05 was considered statistically significant. RESULTS: All brackets had slot dimensions that were significantly larger (p < 0.05) than the stated 0.022 inch. 3M-victory were 11.99% larger (0.02509 inch) and the closest to the stated dimension and the ORM-Damon C were 24.07% larger (0.02948 inch) than the quoted slot size of 0.022 inch. Comparison between mesial and distal sides showed that 91% of the bracket slots were asymmetrical at their bases and 100% asymmetrical at their faces. All of the bracket system showed divergent walls from base to face with values ranging from 1.96 (3M-SmartClip) to 26.58% (ORM-Damon C). CONCLUSION: The actual measurements of 11 bracket systems from three different manufacturers were more substantial than the manufacturers' specifications, and the walls of the slots diverged from the bracket bases in all of the tested bracket system. CLINICAL SIGNIFICANCE: Orthodontic bracket slots vary significantly from that of the manufacturers' specification. The orthodontist should anticipate such shortcomings and be able to modify treatment mechanics through additional wire bending in three spatial planes.

Occupational Stress among Orthodontists in Saudi Arabia.

AIM: The aim of this study was to identify potential occupational stressors among orthodontists practicing in Saudi Arabia, and to evaluate their relationship to personal and professional characteristics. MATERIALS AND METHODS: Using a validated occupational stress assessment (OSA) questionnaire, demographic information and data pertaining to potential occupational stressors and professional characteristics of the participants were collected. The OSA questionnaire was adopted and modified based on Cooper et al. classification of potential stressors. To assure anonymity of the protocol, the respondents were given the OSA questionnaire at their clinical settings or scientific meetings and requested to return the filled copy of the questionnaire without any personal disclosures. The severity of stressors was assessed using a five-point Likert scale, and individual scores were summed to obtain the overall severity score. The collected data were coded, tabulated, and analyzed using statistical software. RESULTS: Samples of 253 orthodontists were evaluated with a response rate of 82.6% (209) and a higher proportion of male participants (75.1%). The mean severity score for stress was higher among orthodontists of age less than 30 years when compared with those more than 50 years of age (F = 3.486; P = 0.017). Similarly, the mean severity score was higher among orthodontists who had completed their residency program in Saudi Arabia, Arab countries, and Asian countries (F = 5.425; P < 0.0001). Further categorization of the stressors based on patient-, time-, staff-, work-, referral-, and income-related factors were carried out. Although patient-related factors (mean = 3.38) were considered the most stressful, referral- and income-related factors (mean = 2.39) were considered the least stressful. CONCLUSION: Pronounced variation was evident in assessing the potential stressors among orthodontists. Nevertheless, time management and proper patient education can address the most concerning stressors among orthodontists in Saudi Arabia.

Evaluation of the airway space changes after extraction of four second premolars and orthodontic space closure in adult female patients with bimaxillary protrusion - A retrospective study.

BACKGROUND & OBJECTIVES: Previous studies have found that first premolar extractions during orthodontic treatment may alter the upper airway dimensions. The objective of this study is to investigate the effects of second premolar extraction during orthodontic treatment on the dimensions of the upper airway in a sample of female adults. METHODS: Twenty-nine female adult patients with ages between 18 and 30 years old and incisor bimaxillary protrusion were included in this study. They were treated with comprehensive orthodontic treatment which included the extraction of four second premolars. Pre and post cephalometric radiographs were analyzed using Dolphin imaging software for changes in tongue length and height, soft palate thickness and length, the superior, middle, and inferior airway space, and vertical airway length. Descriptive statistics were used to characterize measurements. Student's paired t-test was preformed to compare the pre- and post-test mean values of the dimensions. RESULTS: A significant increase in the vertical airway length was observed after the extraction of the second premolars (p = 0.02). The soft palate length showed a tendency towards an increase that did not reach statistical significance (p = 0.053). No other significant changes in the airway soft tissue measurements were observed. The proclination and protrusion of the upper and lower incisors were significantly decreased compared to pre-treatment measurements.Interpretation & conclusions.Orthodontic treatment involving the extraction of all four second premolars in females with bimaxillary protrusion increases the vertical airway length, which is the amount of distance between base of the tongue and posterior nasal spine. No other significant alterations in the upper airway measurements were observed.

Efficacy of Yttrium (III) Fluoride Nanoparticles in Orthodontic Bonding.

Our study evaluated the adhesion strength and antibacterial effect of a conventional orthodontic composite resin blended with yttrium fluoride (YF3) nanoparticles. Yttrium fluoride nanoparticles (NP) were added to the conventional orthodontic composite resin (Transbond XT) at concentrations of 1%, 2%, and 3% (w/w), and the blended composite resins were labeled as NP1, NP2, and NP3, respectively. A total of 60 extracted human premolars was randomly allocated to four groups of 15 samples (n = 15). Orthodontic brackets were bonded using the conventional (control) and experimental composite resins (NP1, NP2, and NP3). The adhesion strengths of the composite resins were determined using a universal testing machine. The debonding sites were assessed and scored using the adhesive remnant index (ARI). The antibacterial effect of YF3 nanoparticles against Streptococcus mutans was assessed by the viable cell counting method. For the same, 40 composite disc specimens were prepared using the control and experimental composite resins (n = 10). The data was analyzed by one-way ANOVA and Tukey's post hoc analysis. In all the tests, the significance level was determined to be 0.05. The highest adhesion strength values were found in the control group (11.61±0.23) and the lowest values were found in the NP3 group (10.49±0.17). A significant difference was observed between the control and experimental groups, NP2 and NP3 (P < 0.05). NP1 group showed insignificant (P = 0.388) adhesion strength values compared with the control group. There was no significant difference between the ARI scores of the conventional and experimental groups (P > 0.05). The highest colony forming units (CFU) were found in the control group (75.85±1.15) and the lowest CFU were found in the NP1 group (2.24±1.14). A significant difference between the mean CFU of the conventional and experimental composite groups was observed (P < 0.05). Despite higher antibacterial activity in the NP1 group compared with NP2 (P = 0.146) and NP3 (P = 0.117), the difference was not significant. Similarly, no significant difference was observed between NP2 and NP3 groups (P = 0.97). Our results suggested that yttrium fluoride nanoparticles, blended with a conventional resin at 1% concentration, demonstrated significant antibacterial effect and did not compromise adhesion strength.

The characteristics of dental occlusion in patients with moderate to severe obstructive sleep apnea in Saudi Arabia.

OBJECTIVES: To evaluate characteristics of dental occlusion among non-obese Saudi adult patients suffering from moderate to severe obstructive sleep apnea(OSA). METHODS: Following ethical approval, a cross-sectional study was conducted at Sleep Disorders Center, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January and March 2017. Non-obese adult Saudi patients with moderate/severe OSA (apnea-hypopnea index more than 15) and without history of malocclusion or edentulism were included with an estimated sample size of 50. Demographic details and severity of OSA as diagnosed by polysomnography were recorded. Characteristics of dental occlusion, namely molar, canine and incisor relationship, overjet, overbite, crossbite and arch form were obtained through calibrated examiners (kappa 0.81). Descriptive statistical analysis and Chi-square test, with 95% significance level (p less than 0.05), were used to identify relationships between the severity of OSA and characteristics of dental occlusion. RESULTS: A total of 51 patients (31 males, 20 females; mean age 49.45±10.35 years), were enrolled in the study. Severity of OSA was moderate in 17 patients and severe in 34 patients. Severe form of OSA was more among males (64.7%) and in patients with Class-II division-1 incisor relationship (94.1%). Neither the demographic characteristics, nor characteristics of dental occlusion showed statistically significant relationship with the severity of OSA. CONCLUSION: The results of the present cross-sectional study indicate that the characteristics of dental occlusion are not related to the severity of OSA among non-obese adult Saudi patients.

Elementary school staff knowledge about management of traumatic dental injuries.

AIM: This study investigated the knowledge of elementary school staff regarding the management of traumatic dental injuries (TDIs) in children. METHODS: The present cross-sectional study analyzed data collected between September 2016 and April 2017. The sample consisted of 2,027 elementary school staff members in Riyadh, Saudi Arabia. A stratified cluster random sampling technique was used to select the required sample. Those who agreed to participate in the study completed a 4-part self-administered questionnaire comprising questions regarding demographic data, knowledge on management of tooth fracture, and avulsion using photographs of TDI cases. RESULTS: The majority of the school staff showed inadequate basic knowledge regarding the importance of saving the broken piece of the tooth and identifying the tooth involved in the trauma (67% and 66.3%, respectively), P<0.05. However, they had a significantly high number of correct responses regarding the immediate management of TDIs for the 2 case scenarios presented in the questionnaire (P<0.05), and the majority (41%) reported normal saline as a suitable storage medium (P<0.01). CONCLUSION: This study revealed a lack of knowledge in certain aspects of TDIs among elementary school staff.

An assessment of job satisfaction: A cross-sectional study among orthodontists of Saudi Arabia.

AIM OF THE STUDY: The main objective of the present study was to investigate the level of job satisfaction among professional orthodontists in relation to some significant intrinsic and extrinsic factors that generally affect their performance. MATERIALS AND METHODS: A cross-sectional study was conducted among orthodontists working in the Kingdom of Saudi Arabia using an online survey questionnaire through Survey Monkey. A total of 161 responses were received; among those, 57.8% of the respondents were Saudi and 42.2% were non-Saudi. RESULTS: On an overall satisfaction basis, a majority of orthodontists (80.7%) were satisfied with orthodontics as their profession irrespective of their gender. Only 4.4% showed dissatisfaction, whereas the remaining 14.9% were moderately satisfied with orthodontics as a profession. In-depth analysis revealed that a majority of the respondents (56.2%) showed reservations over having ample time for their family life. 52.8% of the respondents strongly agreed that they are assigned significant paperwork. Likewise, 66.5% of the orthodontists showed moderate to dissatisfaction over time adherence by the patients. CONCLUSION: The findings of the present investigations depicted a higher level of passion and commitment among the male and female respondents for the profession in spite of the fact that they do not have adequate time for their personal life. The working efficiency of orthodontists may be significantly enhanced by sparing them from too much paperwork and ensuring that their patients appear on time.

Retention practices and factors affecting retainer choice among orthodontists in Saudi Arabia.

OBJECTIVES: To identify the retention protocols practiced by orthodontists in Saudi Arabia, and the factors affecting retainer choice.  METHODS: This cross-sectional study took place between February and March of 2015 at the College of Dentistry, University of Dammam, Dammam, Saudi Arabia. A previously tested electronic survey of 34 items was sent to all 1,200 orthodontic members of the Saudi Orthodontic Society. The questionnaire elicited data on the subjects' demographics, orthodontic treatment practices, retention, and post-retention protocols.   RESULTS: One hundred and sixty-seven (13.9%) responses were received during the study period. The results showed predominant use of Hawley in the maxillary arch (61.3%), and fixed lingual in the mandibular arch (58.5%). Approximately 90.3% recommended full-time maxillary removable retainer wear. Overall, orthodontists who performed fewer extractions tended to use fixed retainers, and those who performed more extractions used removable retainers (p=0.018). Interproximal enamel reduction was used by 28% of the respondents as an adjunct procedure to enhance retention. Approximately 64% practiced a post-retention phase of retainer wear. Participants who used removable retainers most commonly prescribed lifetime retention.  CONCLUSION: Hawley in the maxilla, and fixed lingual in the mandible were the most common retention protocols prescribed. Lifetime retention was the most common choice for participants who used removable retainers, especially when extractions were carried out.

Prevalence and risks of habitual snoring and obstructive sleep apnea symptoms in adult dental patients.

OBJECTIVES: To determine the prevalence of habitual snoring and risk of obstructive sleep apnea (OSA) among dental patients and investigate factors associated with high-risk OSA. METHODS: This cross-sectional study was performed at the Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Kingdom of Saudi Arabia, between October and December 2014. A total of 200 consecutive female and male dental patients were included in this study. Subjective and objective assessments were carried out. Habitual snoring and risk of OSA were assessed using the Arabic version of the Berlin questionnaire. Two trained investigators carried out the objective measurements of anthropometric data, blood pressure, oxygen saturation, pulse rate, and clinical examination of upper-airway, and dental occlusion.  RESULTS: Habitual snoring was present in 18.2% of the females and 81.8% of the males (p less than 0.05). Breathing pauses during sleep of more than once a week occurred in 9% (n=17) of the sample. Of the males, 78.3% were at high risk of OSA compared with 21.7% of the females. Multivariate analysis for risk of OSA revealed that obese patients were almost 10 times more likely to report OSA symptoms than their non-obese counterparts (odds ratio: 9.9, 95% confidence intervals: 4.4-22.1). Tongue indentations, tonsil size, and a high Epworth Sleepiness Scale score were also independent risks of OSA. CONCLUSION: Tongue indentations and tonsil grades III and IV were significantly associated with risk of OSA. This validates the important role of dentists in the recognition of the signs and symptoms of OSA.

Evaluation of the fit of preformed nickel titanium arch wires on normal occlusion dental arches.

AIM: To determine the fits of preformed nickel titanium (NiTi) archwires on dental arches with normal occlusion. METHODS: Forty sets of upper and lower plaster models were obtained from men and women with Class I occlusions. Preformed 0.016″ × 0.022″ NiTi archwires from Rocky Mountain Orthodontics (RMO), 3 M Unitek, Ormco, and Dentaurum were evaluated in terms of their fits on dental arches from male, female, and combined cases. Data were analyzed by using fourth- and sixth-order polynomial equations, analysis of variance (ANOVA), and the Duncan post hoc test. RESULTS: In the upper arches, the best fit and least error were obtained with RMO Ovoid and Ormco Orthos Large archwires for male cases, but with 3 M Orthoform LA archwires for female and combined cases. In the lower arches, the best fit and least error were obtained with Ormco Orthos Large for male cases, with 3 M Orthoform LA and RMO Normal for female cases, and with 3 M Orthoform LA, RMO Normal, Ormco Orthos Large, and Ormco Orthos Small for combined cases. When both dental arches were matched, Ormco Orthos Large was the best wire for male cases. 3 M Orthoform LA was the best wire for female and combined cases. CONCLUSIONS: Using an archwire form with the best fit to the dental arch should produce minimal changes in the dental arch form when NiTi wires are used and require less customization when stainless-steel wires are used.

Live demonstration versus procedural video: a comparison of two methods for teaching an orthodontic laboratory procedure.

BACKGROUND: To measure the effectiveness of procedural video compared to live demonstration in transferring skills for fabricating orthodontic Adam's Clasp. MATERIALS AND METHODS: Forty-nine fourth-year undergraduate male dental students were randomly assigned to two groups. The students in group A (n = 26) attended a live demonstration performed by one faculty, while students in group B (n = 23) watched a procedural video. Both the procedural video and live demonstration described identical steps involved in fabricating the Adam's Clasp. Students in both groups were asked to fabricate an Adam's Clasp in addition to completing a questionnaire, to measure their perceptions and satisfaction with the two teaching methods and lab exercise. Blind assessment was performed by one faculty for both groups. RESULTS: The mean students' scores in the fabrication of the Adam's clasp were 6.69 and 6.78 for the live demonstration (group A) and the procedural video (group B), respectively. No significant difference was detected between the two groups (P = 0.864). Statistically significant difference was found in the mean response between the two groups for statement 6 on the questionnaire, "The steps in the teaching method were presented in a clear fashion and were easy to understand". A higher mean response for group B was found compared to group A (P = 0.049). No significant differences were found between the two groups for the other statements (P > 0.05). CONCLUSION: Procedural video is equally as effective as a live demonstration. Both methods should be considered in teaching undergraduate orthodontic courses in order to improve the learning experience and to match different learning preferences of students.

Validity of moyers mixed dentition analysis for Saudi population.

OBJECTIVES: To evaluate the applicability of Moyers probability tables and to formulate more accurate mixed dentition prediction tables in the Saudi population. METHODS: A cross-sectional study was conducted at the College of Dentistry, Kind Saud University, Saudi Arabia. The data were collected from 410 (203 males and 207 females) orthodontic study models, which had erupted mandibular permanent incisors, maxillary, mandibular canines and premolars. The mesiodistal widths were measured using a digital caliper with an accuracy of 0.01 mm. Student's paired t-test was used to compare the mean width values derived from this study with the values derived using the Moyers table. Simple linear regression was used to evaluate the linear relationship between the combined mesiodistal widths of the mandibular permanent incisors and the canine-premolar segments in each dental arch. RESULTS: The regression equations for the maxillary canine-premolar segment (males: Y=10.27+0.48X; females: Y=11.71 + 0.39X) and the mandibular canine-premolar segment (males: Y=9.71 + 0.40X; females: 11.28 + 0.39X) were used to formulate new probability tables on the Moyers pattern. Statistically significant differences were observed between predicted widths in our subjects and the widths obtained using Moyers tables. CONCLUSIONS: The new prediction tables derived in this study provided a more precise mixed dentition space analysis than Moyers prediction tables in estimating tooth dimensions in the Saudi population.