Comparison Of Different Methods Of Controlling Pain During Debonding Of Orthodontic Brackets.

Objective: To compare the efficacy of finger pressure and plastic wafers in terms of pain control during debonding. METHODS: This cross sectional study was conducted at the Department of Orthodontics, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January to June 2020, and comprised patients of either gender aged 13-21 years who had completed fixed orthodontic treatment with 0.022 brackets of Roth prescription and required debonding. The patients was divided into two equal groups. In group A, teeth were stabilised with finger pressure with cotton between the finger and teeth, and then debonding was done using open mouth technique. In group B, teeth were stabilised using a plastic wafer between maxillary and mandibular teeth, and then debonding was done using closed mouth technique. Pain was assessed using a visual analogue scale VAS. Data was analysed using SPSS 23. RESULTS: Of the 110 patients, each of the 2 groups had 55(50%) subjects. Overall, there were 35(32%) males and 75(68%) females. The mean age of the sample was 16±2.4 years. Mean pain scores among the males was 32.0±7.68 compared to 34.067±12.59 among the females (p>0.05). Subjects in group B had significantly less pain than those in group A (p<0.05). Conclusion: Plastic wafer was found to be more effective in terms of controlling pain during debonding compared to finger pressure.

Condylar Size and Position, Comparison among Different Sagittal Skeletal Relationships: A CBCT Study.

OBJECTIVE: To compare the size and spatial position of mandibular condyles among different sagittal skeletal patterns using CBCT imaging. STUDY DESIGN: A cross-sectional study. Place and Duration of the Study: Department of Orthodontics, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from 20th March 2021 to 4th January 2022. METHODOLOGY: CBCT scans of 66 subjects (33 males, 33 females) were divided into three equal groups on basis of sagittal skeletal relationships (Class I, Class II, and Class III). Condylar size and position were determined using the method described by Hilgers et al. and Ricketts et al. respectively. Independent samples t-test was applied to compare condylar size and position variables between the right and left condyles and between male and female subjects. All study groups were compared using ANOVA and Post Hoc Tukey's test. RESULTS: In males, the condylar size was larger and condyles were slightly more anteriorly positioned. Condylar width and height were smallest in skeletal Class II relation and largest in skeletal Class III relation. Regarding the condylar position, the anterior distance was investigated to be the smallest in Class II. The posterior distance was lesser in skeletal Class I subjects whereas the superior distance was lesser in Class III subjects. Angle of articular eminence was greater in class I, intermediate in class II, and lower in class III. Height of articular eminence was the lowest in Class III subjects. CONCLUSION: Statistically significant differences existed for the size and position of mandibular condyles among different sagittal skeletal relationships. KEY WORDS: Temporomandibular joint, Condylar position, Condylar size, Sagittal skeletal relationships, CBCT.

Comparison of ramal heights in individuals with clinically symmetrical and asymmetrical faces.

Objective: To compare the mandibular ramal height differences between clinically symmetrical and asymmetrical face individuals. METHODS: The comparative cross-sectional study was conducted from May 2020 to July 2021 at the Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, and comprised subjects regardless of age and gender who were divided into two equal groups. Those with a clinically symmetrical face were in Group-I, and those with a clinically asymmetrical face were in Group-II. Mandibular ramal height of both sides of all subjects was measured, and asymmetry index. Differences of both right and left ramal heights of each group were measured and compared. Data was analysed using SPSS 26. RESULTS: Of the 78 subjects, 40(51%) were males and 38(49%) were females. The overall mean age was 18±5.78 years, with 44(56%) aged 16-25 years, 28(36%) <15 years and 6(8%) >26 years. There was high but non-significant correlation between the right and left sides of both the groups (p>0.05). Inter-group differences were significant with respect to ramal height (p=0.000), whereas difference in terms of asymmetry index was not significant (p>0.05). CONCLUSIONS: There were significant differences in the mean ramal height between clinically symmetrical and asymmetrical face individuals.

Vertical Skeletal Changes after Extraction and Nonextraction Orthodontic Treatment.

OBJECTIVES: Due to the constant battle regarding the controversial topic of orthodontic extraction, this study aims to assess the changes in vertical dimensions of patients treated with premolar extractions compared with nonextraction orthodontic patients. MATERIALS AND METHODS: A sample of 60 borderline patients were recruited and divided into extraction and nonextraction groups. Eleven pretreatment cephalometric measurements were recorded using WebCeph and patients were followed-up until the completion of treatment. STATISTICAL ANALYSIS: Intragroup and intergroup comparisons were made using paired t-test and two-sample independent t-test, respectively. The joint significance of differences was measured using F-tests. RESULTS: The intragroup comparison revealed that in the extraction group, the vertical dimension was significantly increased posttreatment for four cephalometric measurements, that is, mandibular plane angle (p < 0.05), palatal plane angle (p < 0.05), Frankfort mandibular plane angle (p < 0.05), and y-axis (p < 0.05). In the comparison of the posttreatment values of both groups, the mean differences of the posttreatment values for sella nasion (SN)-gonion (Go)-gnathion (Gn) angle (p = 0.008), the total anterior (p = 0.050), and lower anterior facial heights (AFH; p = 0.011) were significantly higher. At the same time, the Jarabak ratio was significantly (p = 0.006) lower in the extraction group than in the nonextraction group. CONCLUSION: The increase in vertical dimension is significantly higher in the extraction group than in the nonextraction group which indicates a significant impact of orthodontic extraction on the vertical dimensions.

Correlation of lip profile preferences in Pakistani population; and its comparison with orthodontic norms.

OBJECTIVE: To determine the most desired lip profile and compare the subjective sense of aesthetics among orthodontists, general dentists and the general population. METHODS: The cross-sectional study was conducted at the Orthodontic Department of the Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from January 1 to February 25, 2020, and comprised different silhouettes for each gender with increasing lip procumbence from -6mm to +6mm with respect to Rickett's E-line which were created using Photoshop CS 8.0 after cephalometric analysis of 20 cephalograms. The sample comprised an equal number of orthodontists in group A, general dentists in group B and orthodontic treatment-seekers in group C with equal representation of the two genders. Data was analysed using SPSS 24. RESULTS: Of the 180 subjects, there were 60(33.3%) in each of the three groups, with 30(50%) males and as many females in all the groups. All the three groups preferred the average lip profile for males (p=0.018) and 2mm procumbent lips for females (p=0.008). There was significant difference of opinion between groups A and C (p=0.034) and between groups B and C (p=0.022). CONCLUSIONS: There was found to be a marked difference of opinion among the orthodontists, the general dentists and the orthodontic treatment-seekers regarding the desired lip profile.

Comparative Analysis of Dentoskeletal Changes of the Twin Block Appliance and the AdvanSync2 Appliance in Treatment of Skeletal Class-II Malocclusion in Pakistani Population: A Randomized Clinical Trial.

OBJECTIVE: This study aimed to compare dentoskeletal changes in skeletal class-II malocclusion with removable twin block appliance and fixed AdvanSync2 appliance. MATERIALS AND METHODS: A prospective randomized clinical trial was conducted over a span of 1 year at AFID at Rawalpindi. Thirty patients with skeletal class-II malocclusion, 16 males (53.3%) and 14 females (46.6%), were randomly selected and divided in two equal groups (15 each) to be treated with either fixed functional appliances (FFAs) or with removable functional appliances (RFAs). Out of 30 patients, 15 between cervical vertebral maturation (CVM) stages of 2 and 3 were treated with RFA (twin block appliances) and remaining 15 between CVM stages of 4 and 5 were treated with FFA (AdvanSync2 appliances). Pretreatment (T1) and posttreatment (T2), angular variable, and linear variable were measured to compare the dentoskeletal effects between the two groups. STATITICAL ANALYSIS: Paired sample t-test was used to assess significant difference between variables at T1 (Pre-treatment) and T2 (Post-treatment) stage for both RFA and FFA group. Comparison among the RFA and FFA group was made using non-parametric Mann-Whitney U Test. IBM SPSS version 25.0 was used for evaluation. RESULTS: No significant difference was found in angular variables between the RFA and FFA groups (p > 0.05) with the exception of linear variables. Sella-posterior nasal spine (S-PNS) length significantly increased and Jarabak's ratio significantly decreased for FFA group (p = 0.010 and 0.045, respectively), when compared with RFA group. CONCLUSION: Both the appliances, twin block (RFA) and AdvanSync2 (FFA), are effective for correction of skeletal class-II malocclusion. Both the appliances produced similar effects in the sagittal plane but for better vertical control twin block should be the appliance of choice. AdvanSync2 appliance could be preferred over twin block appliance when dentoalveolar and slight retrusive effect on the maxilla is desired especially for individuals in postpubertal growth spurt.

Comparison of commercially available preformed archwires with average natural arch forms.

OBJECTIVE: To compare the dimensions of commercially available preformed archwires with natural arch forms of Pakistani subjects. METHODS: The cross-sectional study was conducted at the Department of Orthodontics, Armed Forces Institute of Dentistry, Rawalpindi, Pakistan, from September 2019 to February 2020, and comprised maxillary and mandibular dental casts of orthodontically untreated subjects that were evaluated to obtain arch dimensions at the canines and first molar levels with the help of digital Vernier calipers. Bracket-archwire assembly was constructed to accurately measure widths from bracket-slot points at both the canine and molar levels in an attempt to mimic clinical archwire-bracket interface. Canine and molar depths were also recorded for accurate estimation of the digitised archwire widths at the aforementioned levels. Data was analysed using SPSS 25. RESULTS: Of the 52 subjects, 26(50%) each were males and females with age ranging from 12years to 35 years. The archwires evaluated for maxilla were significantly wider at canines and first molars compared to the canine and molar dimensions of the dental casts obtained from the subjects (p<0.05). For mandible, significant differences were found at the canine level where archwires exhibited greater dimensions than mean intercanine widths of the subjects (p<0.05). CONCLUSIONS: Commercially obtainable preformed archwires were inconsistent with diverse arch forms manifested in subjects with almost ideal occlusion. Therefore, utilisation of these archwires may create unwarranted wider dimensions of the arch form, especially in the intercanine region which can influence post-treatment retention, stability and facial aesthetics.

Comparison of Tooth Widths, Arch Widths and Arch Lengths in Class-I Normal Dentition to Class-I and II Crowded Dentitions.

BACKGROUND AND OBJECTIVE: Dental study casts play a vital role in the diagnosis and treatment planning of various orthodontic cases. This study was carried out to compare the tooth widths, arch widths, and arch lengths in Class-I normal dentition to those in Class-I and Class-II crowded dentition in an effort to improve treatment planning and to eventually reduce treatment duration. METHODS: Total 170 patients, 12 to 40 years of age with a complete set of permanent teeth till 1st molars; who presented to the Orthodontics Department at Armed Forces Institute of Dentistry (A.F.I.D), Rawalpindi from Sep 2019 to Feb 2020, were included in the study. Non-probability purposive method of sampling was used. The dental casts obtained were used to measure tooth widths, arch widths, and arch lengths. Subjects were classified into Class-I normal and Class-I and Class-II crowded occlusion and comparison of the sum of tooth widths, arch widths, and arch length discrepancies were determined among the three occlusion groups. Data was analyzed in SPSS version 21 and independent samples t-test was used to differentiate the variables of interest. RESULTS: Out of 170 subjects, 73 (42.9%) subjects had Class-I normal occlusion while 97 (57%) had Class-I and Class-II crowded occlusions. No statistical difference was found between the occlusal groups with regard to the sum of tooth widths, inter-canine widths, inter-first premolar widths, inter-second premolar widths and inter-molar widths. However, a remarkable difference was observed between the occlusal groups with respect to arch perimeters and arch length discrepancies (p = 0.000 and 0.000 respectively). CONCLUSIONS: Results of the current study indicate that crowding of teeth occurs as a consequence of decreased arch perimeters which may lead to increased arch length discrepancies. However, no prominent difference was noticed in the sum of tooth widths and arch widths among different occlusal groups.

Comparison of Collum Angle of Maxillary Central Incisors in Different Incisor Relationships.

OBJECTIVE: To compare the collum angle of maxillary central incisors in patients with different incisor relationships. STUDY DESIGN: Comparative, cross-sectional study. PLACE AND DURATION OF STUDY: Department of Orthodontics, Armed Forces Institute of Dentistry, Combined Military Hospital, Rawalpindi, from March to October 2019. METHODOLOGY: Patient data was obtained from the Department of Orthodontics, Armed Forces Institute of Dentistry, Rawalpindi. One Hundred patients were included in the study, which were divided into four groups, 25 patients in each group, based on incisor relationship, i.e. class I, class II div 1, class II div 2, and class III. The collum angle of maxillary central incisors was then measured twice by a single investigator on lateral cephalograms. Sagittal skeletal relationship, age and gender were noted. Molar relationship of the above groups was also recorded from their respective casts. RESULTS: Out of the 100 patients, 31 were males, while 69 were females. Mean collum angles of maxillary central incisors for class I, class II div 1, class II div 2, and class III were 5.12 ±3.78, 6.09 ±4.57, 15.02 ±7.99, and 6.94 ±3.80, respectively. Collum angle of class II div 2 incisor relationship was significantly greater than other classes (p <0.05). Collum angle of incisors of casts with class II molar relationship also exhibited the same trend, i.e. a greater angle than other groups (p=0.002). There was no significant difference in collum angle among different sagittal skeletal relationships (p=0.476), between males and females (p-value .731) and among different age groups (p=0.194). ICC showed good agreement between the readings of collum angle (Crohnbachs Alpha .997). CONCLUSION: Class II div 2 incisor relationship had a significantly greater collum angle than other groups. Key Words: Collum angle, Incisor inclination, Crown to root angle, Class II div 2 malocclusion.

Silver-Russell Syndrome: Orthodontic Perspective.

Silver-Russell syndrome (SRS) is a rare disorder characterised by prenatal and postnatal growth deficiency, a relatively large head size with triangular face, a prominent forehead, body asymmetry, feeding difficulties, clinodactyly and other features.  Abnormalities of chromosome number 7 and 11 have been found in 60% of patients, but the diagnosis of the disease is mainly by ascertaining clinical features. We, herein, report a case of an 11-year boy who presented to Orthodontics Department of Armed Forces Institute of Dentistry (AFID), for treatment of craniofacial and oral problems, which included small-sized jaws and severely crowded teeth. The patient is undergoing serial extraction treatment at the moment, which will be followed by further orthodontic treatment. Key Words: Silver-Russell syndrome, Growth deficiency, Triangular face, Body asymmetry.

Adenoid cystic carcinoma of larynx.

This case report presents the clinical picture, diagnostic methodology, and surgical treatment of a 30 years old female patient, who presented with hoarseness of voice and difficulty in breathing. Direct laryngoscopy showed mass in right side of subglottic region, and biopsy-proven adenoid cystic carcinoma. Total laryngectomy was performed and patient was discharged three weeks postoperatively and doing well.