Evaluation of pharyngeal airway volume three-dimensionally in various sagittal skeletal patterns - Systematic review.

To investigate the pharyngeal airway volume in different anteroposterior skeletal malocclusions. This study was prepared according to the Cochrane criteria for creating a systematic review and meta-analysis and confirms the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This search was conducted to answer the patient/population, intervention, comparison and outcomes (PICO) question: To evaluate (outcome) and compare (comparison) whether there is a difference in airway volume in patients (participants) with different skeletal malocclusions diagnosed using 3D data (intervention).The first two authors extracted the data from the included studies and assessed the risk of bias in the individual studies using the Newcastle-Ottawa scale. Meta-analysis was done using STATA version 16, which compared various three-dimensional pharyngeal airway parameters in skeletal Class II and skeletal Class III malocclusions with that of skeletal class I malocclusion. Out of 370 articles from the initial search, 17 articles were included in the systematic review. Out of 17 studies, 12 eligible studies were included in the quantitative synthesis. The nasopharynx, oropharynx, hypopharynx, and total airway volume were increased in skeletal Class I malocclusion compared to that of skeletal Class II malocclusion and decreased in comparison to skeletal Class III malocclusion. The moderate quality of evidence indicates the total airway volume, oropharynx, and hypopharynx are largest in skeletal Class III compared to Class I and Class II skeletal malocclusion.

Color stability of aligner materials on exposure to indigenous food products: An in-vitro study.

Background: In the recent day, there has been an exponential growth in the usage of clear aligners for orthodontic treatment. As with any removable appliance, the compliance of patients to remove it during ingestion of food is, at times, poor. Thus, the stability of the clear aligner to be "clear" becomes questionable. This in-vitro study examined how the clear aligners changed colour on exposure to various indigenous food products used in everyday life. Methods: Aligners from 5 different companies (K Line, Clearbite Aligners, The Aligner Company, iAligners and MaxDent CA Digital) were exposed for 12 hours and 24 hours to various indigenous substances (tea, green tea, coffee, turmeric, saffron and Kashmiri red chili powder) and a control solution (distilled water) in-vitro. The color change was assessed with the help of VITA Easyshade compact colorimeter based on Commission Internationale de I'Eclairage L*a*b* color system. Values were then modified to NBS units for clinical relevance. Results: The hue of the transparent aligners was noticed to change in a statistically meaningful way when exposed to turmeric, saffron, Kashmiri red chili powder and coffee in decreasing order and mild color change in tea and green tea at both 12 hours and 24 hours intervals. Conclusion: Aligners are prone to color change when exposed to indigenous foods that contain staining properties.

Multi-disciplinary orthodontic camouflage treatment of a severe skeletal class III malocclusion with 1 year follow-up - A case report.

Rationale: Orthodontic camouflage serves its purpose in treating mild to moderate skeletal dysplasia and in conditions where the patient is reluctant to opt for orthognathic surgery or when it is contraindicated. Patient Concerns: A 22-year-old male was concerned about his irregular teeth. Diagnosis: Angle's dentoalveolar class III malocclusion on class III skeletal on an average mandibular plane angle with anterior crossbite, deep bite, crowding in maxillary and mandibular anteriors, proclined maxillary anteriors and retroclined mandibular anteriors with reverse overjet and congenitally missing 12, 22, palatally impacted 13 and retained deciduous 63 and palatally placed 23. Treatment: Orthodontic camouflage with a multi-disciplinary approach. Outcome: Optimal functional and dentofacial aesthetics were achieved by 22 months. Take-Away Lesson: The limitations of camouflage must be kept in mind and explained to the patient. The biomechanics need to be customized and integrating different specialties helps maximize the treatment benefits.

Guidelines of Revised Orthodontic Practices for Establishing "New Normality" Post COVID-19 Pandemic.

The aim of this article is to shed light upon formulation of new guidelines of revised orthodontic practices in the post-pandemic era caused due to the novel coronavirus disease 2019 (COVID-19) and also to adapt to the new regulations to prevent further spread of infection. All relevant information pertaining to the area of concern was collected using electronic databases which include Google Scholar, PubMed, Cochrane, orthodontic journals, and health bodies such World Health Organization, the British Orthodontic Society, and the National Institute of Health. Post-pandemic visionary was also contemplated. Data collected through the electronic databases were studied and compiled to provide an overview of the possible modifications which could be employed to prevent crosscontamination during and after the orthodontic therapy in the -post-pandemic era. Refashioning of the dental set-up along with the formulation of new regulations have been elucidated. This review highlights that the post-pandemic orthodontic practice is a divergent layout requiring tedious clinical and environmental modifications. New categorization of patients requiring orthodontic treatments and procedural classification based on generation of aerosol must be taken into consideration. Formulation of new regulations and redesigning the clinical set-up is crucial yet essential.

Surgery-First Approach: A Boon for Periodontally Compromised Patients - A Case Report.

The Rationale: The surgery-first approach (SFA) has revolutionized orthognathic surgery in recent years and in trend because it addresses the dentofacial abnormalities first, making the patient compliant and outcome more predictable. Patient Concerns: A 22-year-old female was concerned about her forwardly placed teeth. Diagnosis: She had a compromised periodontium with a skeletal Class II malocclusion and dental malocclusion. Treatment: A SFA plan was executed with the extraction of all first premolars followed by postsurgical orthodontic treatment. Outcomes: Optimal functional and dentofacial esthetics were achieved by 11 months. Take-away Lessons: Research has attributed several advantages of SFA over the conventional triphasic approach, which has proven to be beneficial in periodontally compromised individuals as it intends to relieve any traumatic occlusion primarily by stabilizing tissue integrity. It is most favorable in patients seeking a quick transformation with the least possible duration.

Evaluation of volume change in oral cavity proper before and after mandibular advancement.

OBJECTIVES: To evaluate the tongue and oral cavity proper volume in pre- and post-bilateral sagittal split osteotomy (BSSO) patients, and to establish whether there was a correlation between them. MATERIALS AND METHODS: A retrospective study that evaluated 12 patients' pre- and post-surgical computed tomography records satisfying the inclusion criteria. Borders were defined for measurement of tongue and oral cavity proper volume. The volume assessment was carried out using 3D slice software. RESULTS: The mean difference of tongue volume was 5.7 ± 1.7 cm3, which showed high statistical significance. The mean difference of oral cavity proper volume (OCVP) was 6.9 ± 3.4 cm3 and indicated high statistical significance. A very strong positive correlation existed between pre- and post-surgical tongue volume. Positive correlation was also evident between pre and post - surgical OCVP. Medium positive correlation was noted when the difference between pre- and post-surgical tongue and OCVP were assessed. CONCLUSIONS: There was a significant change in volume of tongue and oral cavity proper after BSSO advancement surgery. The space around the tongue, position of tongue, and maxillary and mandibular relationship influence the volume of tongue and oral cavity proper.

Management of supraerupted maxillary molars in an adult patient using orthodontic miniscrew implants: A pre-prosthodontic therapy.

The sequelae of chronic edentulous space is the supraeruption of the opposing teeth which hinders prosthodontic replacement. Molar intrusion of overerupted teeth can be done using miniscrew implants which serves as a promising technique, especially in adult patients. This case report highlights pre-prosthodontic therapy by pure molar intrusion using Temporary Anchorage Device (TAD) in an adult patient seeking prosthesis to enhance chewing efficiency.

An Interdisciplinary Management of Severe Facial Asymmetry Due to Hemifacial Microsomia.

This case report outlines the importance of an interdisciplinary approach and a patient centric outcome for the treatment of facial asymmetry resulting from hemifacial microsomia. Different treatment modalities are available to treat asymmetries. However, the best treatment outcome can be achieved only when the treatment plan is individualized for every patient. This report portrays an adult patient with hemifacial microsomia, who had facial asymmetry from the level of supraorbital region with a Class II skeletal base. Orthodontic treatment, along with surgical management, was required to transform the patient into a symmetrical profile, which is esthetically pleasing. A sound knowledge of the various technologies and resources that are available to us and making the best use of it to bring out a drastic change in the patient's life. Combined effort of the orthodontists and oral surgeons are required to manage patient's with hemifacial microsomia that has caused the severe facial asymmetry. Moreover, special attention has to be given to a patient-centric outcome.

A Comparative Evaluation of Changes in Soft Tissues After Single-Jaw Surgery and Bimaxillary Surgery in Skeletal Class III Patients.

AIMS AND OBJECTIVES: The aim of this study was to compare cephalograms for the hard and soft tissue changes observed in skeletal Class III patients of Indian origin who had undergone either single-jaw mandibular setback (BSSO) or bimaxillary surgery (Le Fort I advancement + BSSO setback) and also to derive a correlation between the changes brought about in the soft tissues by the surgical alteration in hard tissue. MATERIALS AND METHODS: The study included records comprising 18 treated skeletal Class III patients, who were divided into two groups based on the surgical procedures advocated: Group I: single-jaw procedure comprised of only mandibular set back, Group II: bimaxillary surgery. Presurgical and post-treatment cephalograms were calibrated and traced using Ilexis FACAD AB-2014 Version 3.8.0.0 software and analyzed with COGS hard tissue analysis and soft tissue analysis. All values for the hard tissue and soft tissue measurements were compared with the norms prescribed for the Indian population. RESULTS: Upper lip changes were evident in both groups but greater significance was observed in bi-jaw group. Single-jaw patients showed positive correlation for hard to soft tissue mandibular position. Bi-jaw surgical cases exhibited positive correlations between changes Wits variable to soft tissue convexity as well as mandibular position. CONCLUSION: The soft tissues changes between Class III patients treated by single-jaw surgery and those treated by bimaxillary surgery when compared revealed that significant differences were observed only in relation to certain measurements such as facial convexity, maxillary prognathism, and upper lip protrusion.

Surgical Management of Hyperdivergent Class II Malocclusion with Vertical Maxillary Excess: A 2-year Follow-up.

Skeletal Class II malocclusions with vertical maxillary excess (VME) present with an amalgamation of several problems pertaining to psychological, esthetics, and function. The optimal treatment plan in such cases includes a synchronized orthodontic-surgical approach through superior repositioning and setback of maxilla by means of Le Fort I osteotomy and augmentation genioplasty. This case report describes a multidisciplinary approach in the successful management of a patient with VME to achieve superior esthetics and function.

Orthognathic Surgical Approach for Management of Skeletal Class II Vertical Malocclusion.

The current era of orthodontics has evolved from regular dental corrections to achieve the most needed harmony between functional stability and esthetics enhancement of craniofacial structures. The "desire" for attaining this harmony led to the birth of orthognathic surgeries. The orthognathic approach has undergone a paradigm shift through the years, from correcting the skeletal component to addressing the soft tissues, thus optimizing esthetic outcome. This present case report is of a patient with skeletal Class II malocclusions with vertical maxillary excess (VME), managed by multidisciplinary treatment approach. The treatment progressed through presurgical orthodontics with premolar extraction followed by bi-jaw surgery. The outcome resulted in a phenomenal change in the profile by establishing a Class I skeletal base with a stable occlusion.

Stress and displacement pattern evaluation using two different palatal expanders in unilateral cleft lip and palate: a three-dimensional finite element analysis.

BACKGROUND: In this finite element (FE) study, the stress distribution and displacement pattern was evaluated in the mid-palatal area and around circum-maxillary sutures exerted by bone-borne palatal expander (BBPE) in comparison with conventional HYRAX rapid palatal expander in unilateral cleft lip and palate. METHODS: Computed tomography scan images of a patient with unilateral cleft palate was used to create a FE model of the maxillary bone along with circum-maxillary sutures. A three-dimensional model of the conventional HYRAX (Hygienic Rapid Expander) expander and custom-made BBPE was created by laser scanning and programmed into the FE model. RESULTS: With the BBPE, the maximum stress was observed at the implant insertion site, whereas with the conventional HYRAX expander, it was at the dentition level. Among the circum-maxillary sutures, the zygomaticomaxillary suture experienced maximum stress followed by the zygomaticotemporal and nasomaxillary sutures. Displacement in the X-axis (transverse) was highest on the cleft side, and in the Y-axis (antero-posterior), it was highest in the posterior region in the BBPE. CONCLUSIONS: The total displacement was observed maximum in the mid-palatal cleft area in the BBPE, and it produced true skeletal expansion at the alveolar level without any dental tipping when compared with the conventional HYRAX expander.

Assessment of Skeletal Maturation in Concordance to Statural Height and Body Weight in 12-Year-Old Children - A Cross-Sectional Study.

INTRODUCTION: To analyse the importance of bodily characteristics of growing children and its correlation towards skeletal maturity. This further aids orthodontists in proper treatment planning. AIM: The purpose of this study was to assess the correlation between cervical vertebrae maturation, statural height and body weight as measured in 12 -year-old children. MATERIALS AND METHODS: Lateral cephalograms were taken as a part of treatment records in 94 children along with their statural height and body weight. The Cervical Vertebrae Maturation Index (CVMI) was used to trace the C2, C3 and C4 vertebrae respectively and the data were then correlated to the chart provided by the Indian Council for Medical Research (ICMR). RESULTS: The overall sample showed a statistically significant correlation between CVMI and height (p=0.047). Girls showed significant correlation in their mean heights to the CVMI staging (p=0.012) while the boys exhibited a maximal mean height value in Cervical Stage (CS) 5 followed by CS3. There was no significant correlation between weight and CVMI. The mean CVMI stage seen in boys and girls were CS2 and CS3 respectively. CONCLUSION: There exists a definitive correlation between height and CVMI stages in growing children. Girls showed an advanced level of skeletal maturity in comparison to boys. CVMI staging should be used along with statural height and body weight when considering growth modification procedures.

Relationship of Anterior Alveolar Dimensions with Mandibular Divergence in Class I Malocclusion - A Cephalometric Study.

INTRODUCTION: One of the major limiting factors in retraction of proclined teeth is the width of the alveolus both in maxilla and mandible. AIM: The objective of this study was to assess the maxillary and mandibular anterior alveolar dimensions and to correlate with mandibular divergence in Class I bi-dento-alveolar protrusion patients. MATERIALS AND METHODS: Pretreatment lateral cephalograms (n=88) were analysed using a composite analysis with cephalometric software. Both maxillary and mandibular anterior alveolar widths and heights were measured and correlated with mandibular divergence. One-way analysis (ANOVA) and Pearson correlation test were used to compare and establish the significance between groups. RESULTS: Segregation of the data based on variation in the bi-cortical widths and heights showed that lesser alveolar widths and greater alveolar heights were associated with the high angled subjects and greater alveolar widths and lesser heights were associated with low angled subjects. CONCLUSION: Patients with hyperdivergent mandible exhibited thin anterior alveolar width and greater alveolar height whereas low angled subjects had wider alveolar width and lesser alveolar height. Orthodontic treatment plan for retraction of anterior teeth must be based on these differences caused by variations in mandibular divergence.

Comparative evaluation of efficacy of self-ligating interactive bracket with conventional preadjusted bracket: A clinical study.

AIMS AND OBJECTIVES: This clinical study was conducted to compare the interactive self-ligating twin brackets and the standard double width brackets for their efficiency in Rate of Retraction. MATERIALS AND METHODS: A total of 20 patients with Angle's class I or class II or class III dento-alveolar malocclusions between the age group of 18-25 years were selected. 10 patients in each group both males and females were randomly selected for the study. Ten patients were bonded using conventional brackets (Group I) the other ten patients were bonded using Interactive self-ligating brackets (Group II). The Rate of retraction was quantified using the scanned models. Pretreatment and post treatment models were taken and scanned to measure the amount of Incisor movement and Anchor loss. RESULTS: (1) Interactive Self-ligating brackets showed significant Rate of retraction when compared with conventional brackets on right and left quadrant. (Group I 0.545 ± .205: Group II 0.827 ± .208 P = .013*) (Group I 0.598 ± .160: Group II 0.804 ± .268 P = .071) (2) Interactive self-ligating brackets when compared with conventional brackets had significant amount of incisor movement on right and left quadrant. (Group I 3.51 ± .548: Group II 4.38 ± .1.06 P = .047*) and (Group I 3.66 ± .899: Group II 4.67 ± 1.02 P = .047*) (3) Conventional brackets showed significant Amount of Anchor loss when compared with that of Interactive self-ligating brackets on right and left quadrant. (Group I .948 ± .392: Group II 0.501 ± .229 P = .013*). In the left side (Group I 0.861 ± .464: Group II 0.498 ± .227 P = .060). CONCLUSION: The interactive self-ligating brackets show more efficiency in Rate of Retraction, Amount of Incisor movement and Amount of Anchor loss when compared with the conventional brackets.

Comparative Evaluation of Frictional Properties, Load Deflection Rate and Surface Characteristics of Different Coloured TMA Archwires - An Invitro Study.

INTRODUCTION: During tooth movement the success of sliding mechanics is dependent upon various factors which include frictional resistance at bracket-archwire interface, surface roughness of archwire materials and elastic properties of archwires. Ion implantation techniques reduce the frictional force and allow better tooth movement clinically. AIM: The main objective of this study was to evaluate and compare the frictional properties, load deflection rate and surface characteristics of Honey dew and Purple coloured (Ion implanted) TMA wires with uncoated TMA wires. MATERIALS AND METHODS: Fifteen archwire samples were divided into three groups comprising of five samples in each group namely, Group I - Uncoated TMA wires (Control), Group II - Purple coloured TMA wires and Group III- Honey dew TMA wires. Friction and load deflection rate testing were performed with the Instron Universal testing machine and the surface characteristics of the wires were evaluated before and after sliding using Scanning Electron Microscope. RESULTS: The mean frictional characteristics and surface roughness for Honey dew TMA wires was lesser than Purple coloured TMA wires which was statistically significant. Both the coloured TMA wires showed low frictional characteristics and less surface roughness than uncoated TMA wires (the control). The mean load deflection rate was low for both coloured ion implanted TMA wires when compared to uncoated TMA wires which was statistically significant. CONCLUSION: Coloured ion implanted TMA wires, especially Honey dew TMA wires have low friction, low load deflection rate and improved surface finish. Hence they can be used in frictionless as well as sliding mechanics, where uncoated TMA wires are inefficient.

Anti cariogenic effect of terminalia chebula.

BACKGROUND: Terminalia chebula is one of the traditional medicines used in the treatment of many diseases and possesses a wide variety of therapeutic activities. The aim of this study was to determine the antimicrobial properties of Terminalia chebula against oral pathogens related to caries. MATERIALS AND METHODS: In this study, Antimicrobial activity was tested using Kirby bouer method by streaking. Total phenol and total flavonoid content were analysed. Twenty high caries risk patients were subjected to rinse aqueous extract of Terminalia chebula. Salivary samples were collected for pH and microbial screening. Oral pathogens were identified by qualitative biochemical analysis. RESULTS: The total phenol content of extract was found to be 21.33 ±1.633 (mean ± SD) and total flavonoids was found to be 23.17 ± 2.317 (mean ± SD). There was a gradual increase in pH till 45mts post-rinse when compared to pre-rinse was observed. Antimicrobial effect of Terminalia Chebula aganist microbes showed that there was a significant reduction between the pre-rinse and post-rinse samples. CONCLUSION: These promising findings suggested the presence of antimicrobial activity of Terminalia Chebula against oral pathogens and proven to be an effective alternate antimicrobial agent.