Idiopathic Osteosclerosis in Orthodontic Patients: A Report of Two Cases.

Idiopathic osteosclerosis (IO) is described as a localized radiopacity of unknown etiology. Also known as dense bone islands, enostoses, bone scar, or focal periapical osteopetrosis, it is generally clinically asymptomatic and appears round, elliptical, or irregular in shape on a radiograph. The internal structure is usually homogenous. It should be distinguished from condensing osteitis and other alveolar bone-related radiopacities. This condition may cause changes in tooth position or interfere with orthodontic treatment. Two cases of IO involving the maxilla and mandible are highlighted. Both patients were females and presented with complaints of malocclusion and desired orthodontic correction. One case was detected incidentally on routine radiographic examination of the patient. In contrast, the other case presented as an expansile lesion lingual to the left mandibular first molar and second premolar. Radiographically, both lesions appeared as well-defined radiopaque masses with no surrounding radiolucent rim; the maxillary lesion was irregular in shape, while the mandibular lesion was elliptical. Both patients underwent orthodontic treatment without any adverse sequelae. The clinical and radiographic findings are discussed to facilitate the diagnosis of radiopacities of jaws. Usually asymptomatic and of no clinical significance, IO may occasionally induce root resorption, traumatic occlusion, traumatic/pathologic migration of teeth, and inhibit eruption of teeth. Though orthodontic tooth movement through areas of IO can be undertaken, the rate of tooth movement may be slower due to higher trabecular bone density. Lower force levels are warranted to avoid adverse effects like root resorption and bone hyalinization.

Incisor torque expression characteristics in two passive self-ligating brackets placed at different heights. A finite element investigation.

Objective: This study investigated torque expression in maxillary incisors using two passive self-ligating bracket types (Damon Q and Pitts 21) placed at different heights using the Finite element method. Materials and methods: Two passive self-ligating brackets, Damon Q (Ormco, USA) and Pitts 21 (OC Orthodontics, USA) were 3D modeled using micro-computed tomography. Damon Q (0.022Ë® x 0.028″ slot size) and Pitts 21 (0.021Ë® x 0.021″ slot size) brackets were placed on a maxillary central incisor at predetermined vertical heights. Arch wires of size 0.019Ë® x 0.025″ stainless steel (Damon Q) and 0.020Ë® x 0.020" Titanium Molybdenum (Pitts 21) were placed in the bracket slots. Results: Pitts 21 brackets showed higher torquing moments at all bonding heights as compared to Damon Q brackets. The minimum torquing moment was 9.03Nmm at 5 mm for Damon Q and the maximum torquing moment was 14.92Nmm for Pitts 21 at a bracket bonding height of 8 mm. Total deformation for Pitts 21 at a height of 5 mm from the incisal edge was 0.61 × 10-6mm as compared to that of Damon Q which was 0.41 × 10-6mm. Lowest Von Mises stress values were at 27.07 MPa in Damon Q brackets at a bracket height of 5 mm from the incisal edge. Highest Von Mises stress values were 36.80 MPa for Pitts 21 brackets at a bracket height of 8 mm from the incisal edge. Conclusion: Pitts 21 brackets exhibited superior torquing characteristics compared to Damon Q. Total deformation in Pitts 21 was higher than Damon Q at all tested bracket bonding heights.

Evaluation of stress distribution patterns produced with the Advansync2 class II corrector - A finite element analysis.

Background: This study used finite element modeling to investigate stress distribution patterns during treatment with Advan Sync 2 Class II correctors. Methods: - A 3-D finite element model of the skull was constructed from images obtained from cone-beam computerized tomography images. Surface data of the AdvanSync2, brackets and archwires were derived and used to construct 3-D models. Stress distribution patterns and variations were assessed and quantified during appliance simulation and after advancement by 4 mm using spacers, on the finite element model. Results: Stress levels were recorded in Megapascals (MPa) and were visualized with a color scale. Maximum stress was evident in the mandible near the neck of condyle, anterior part of ramus and medial part of the coronoid process. Maxillary and mandibular teeth experienced negligible stress. Stress levels increased on advancing the appliance with spacers, though the regions and patterns of stress concentration in the maxilla and mandible remained constant to a great extent. Conclusion: The AdvanSync2 is an appropriate fixed functional appliance to correct Class II malocclusions with a retrognathic mandible, as it does not apply unnecessary and deleterious stresses on the maxillary and mandibular teeth.

Airway changes in patients with sleep apnea using AdvanSync2 Class II correctors - a case series.

Background: Obstructive sleep apnea (OSA) is a condition that affects a patient's ability to sleep normally, predisposing them to many risks and reduced quality of life. Myofunctional therapy has been proven to increase the airway space according to literature. Aim: To report the effects of AdvanSync2 Class II corrector in the management of 3 orthodontic patients who reported sleeping difficulties due to breathing problems and retrognathic mandible. Case presentation: Three patients reported to Department of Orthodontics and Dentofacial Orthopaedics with Class II malocclusion associated with sleep apnea requiring treatment. Clinical examination revealed a retrognathic mandible with airway constriction in all subjects. A non-extraction approach using an AdvanSync2 Class II corrector (Ormco Corp, Glendora, Calif) with fixed appliances was considered. Lateral cephalometric records were obtained at three stages: pre-treatment, post functional and prefinishing/post treatment. The airway was divided into 3 parts in the lateral cephalogram: velopharynx, hypopharynx and glossopharynx. The most constricted part of the airway was noted. Pre and post treatment lateral cephalograms were compared to assess the changes in airway dimensions after using AdvanSync2. Significant enhancement in airway dimensions was noted in all three parts (velopharynx, glossopharynx and hypopharynx) in all patients. Conclusion: Airway assessment is an important aspect in orthodontic diagnosis. Use of the AdvanSync2 Class II corrector in combination with fixed orthodontic appliances enhanced quality of life in Class II patients by improving airway dimensions. This approach can be recommended in the management of mild to moderate Class II malocclusions associated with mandibular retrognathism and airway constriction.

In vivo investigation of gingival health and oxidative stress changes in patients undergoing orthodontic treatment with and without fluoride use.

Background and Aims: We aimed to investigate gingival index changes and oxidative stress in orthodontic patients with and without the use of fluoridated agents over a 6-month period. Materials and Methods: Ninety subjects divided into three groups (30 untreated controls, 30 with fixed appliances using nonfluoridated toothpaste, and 30 with fixed appliances using fluoridated toothpastes and mouthwashes ) comprised the sample. The Loe gingival index was used to rank gingival health at four specific time periods in the groups to determine differences (before, at 7 days, 30 days, and 6 months). Gingival crevicular fluid was evaluated for cytokines (interleukin [IL]-1ß and tumor necrosis factor [TNF]-α) to determine differences in oxidative status between the groups. Results: Controls showed no changes in gingival index throughout the 6-month observation period. There was a deterioration in gingival health in both the fluoridated and nonfluoridated groups till 6 months. IL-1ß levels in the fluoridated group increased from the 7th day, reached a peak at 30 days, and remained slightly elevated at 6 months. The nonfluoridated group also showed elevated levels at all tested time periods, but levels were lower as compared to fluoridated samples. The differences in IL-1ß values between the fluoridated and nonfluoridated treated groups were significant. TNF-α levels in the three groups also showed a similar pattern with elevated levels seen in both the treated groups at the 7th, 30-day, and 6-month periods. The fluoridated group showed the highest levels at three time periods which was statistically significant. Conclusions: Gingival health of subjects treated with fixed orthodontic appliances deteriorated from appliance placement till a 6-month time period. Cytokines such as IL-1ß and TNF-α associated with oxidative stress during orthodontic treatment increased in both the treated groups, with higher levels in fluoridated subjects. Long-term consequences of oxidative stress changes need further investigation.

Evaluating upper lip changes during smiling and at rest in Indian population.

CONTEXT: Smile aesthetics is one of the major goals to be achieved after orthodontic mechanotherapy as it visibly displays the results of orthodontic treatment. Although orthodontic retainers aid in maintaining post-treatment occlusion, soft tissue function and aesthetics, appropriate knowledge of smile changes with age can help orthodontists to obtain stable and aesthetically appealing treatment results. AIM: To assess and quantify soft tissue changes in the upper lip in vertical dimension at both repose and maximum smiling and to evaluate changes occurring with the smile index and upper lip with age and sex in subjects of Indian origin. SETTINGS: Department of Orthodontics and Dentofacial Orthopaedics, Army College of Dental Sciences, Secunderabad, Telangana, India. DESIGN: Observational study. METHODS AND MATERIALS: A total of 160 volunteers (80 males and 80 females) selected and were divided into 4 groups according to age and were further divided into 2 sub-groups according to gender. Thirteen measurements of relaxed and smiling upper lip were taken with a calibrated metal ruler and divider directly on the subjects. STATISTICAL ANALYSIS USED: Analysis of variance (ANOVA) was done followed by post hoc test to determine which groups were significant from others. Levene's test was done to assess equality of variance and t-test for equality of means was done. RESULTS: Statistically significant results were obtained in between groups and sub-groups for parameters like smile index, upper lip elevation while smiling and smile pattern in males and females changing with increase in age. CONCLUSIONS: High smile patterns with more vertical smile are more common among females and low smile patterns are more common among males. With age, the smile tends to be more horizontal in both genders.

Stereomicroscopic analysis of microleakage, evaluation of shear bond strengths and adhesive remnants beneath orthodontic brackets under cyclic exposure to commonly consumed commercial "soft" drinks.

OBJECTIVE: This study aimed to evaluate the effects of Coca-Cola®, Sprite®, and Maaza® on Microleakage, shear bond strength (SBS) and adhesive remnants underneath orthodontic brackets. MATERIALS AND METHODS: A total of 192 human premolar teeth were used in this study. The sample was divided into four groups: Artificial saliva (control) [Group 1], Coca-Cola [Group 2], Sprite [Group 3] and Maaza [Group 4]. All the samples were stored in artificial saliva and immersed in their respective testing media (except the control group) for 15 minutes 3 times a day, separated by intervals of 8 hours. The immersion cycle was repeated for 15 days. After the immersion cycle, 24 teeth from each group were tested for SBS and adhesive remnant index subsequently. The remaining 24 teeth from each group underwent dyeing with methylene blue and were analyzed stereomicroscopically to evaluate microleakage underneath the brackets. Kolmogorov-Smirnov and Shapiro normality tests were performed and homogeneity of variance was tested with the Levene test. One-way ANOVA and Kruskal-Wallis tests were carried out separately for SBS, ARI and microleakage. Statistical analyses were performed using SPSS 20 for Windows (SPSS Inc., Chicago) software. RESULTS: Coca-Cola showed a significant reduction in SBS and microleakage (p < 0.05) compared to the other groups. ARI did not show any significant differences between any groups (p > 0.05). The mean microleakage scores were higher for the gingival side of the brackets compared to the incisal side. Both Sprite and Maaza showed significant differences compared to artificial saliva, despite the SBS not being statistically significant (p > 0.05). CONCLUSIONS: A significant reduction of SBS was observed in Coca-Cola while increased microleakage was seen in all three drinks compared to artificial saliva.

Alleviation of Lower Anterior Crowding with Super- Elastic and Heat-Activated NiTi Wires: A Prospective Clinical Trial.

OBJECTIVE: To compare the amount of alleviation of lower anterior crowding and changes in intercanine width (ICW), intermolar width (IMW), and arch depth (AD) dimensions using 2 different types of nickel-titanium (NiTi) archwires. METHODS: Thirty participants were randomly allocated to 2 treatment groups, using heat-activated NiTi (HANT) or super-elastic (SE-NiTi) round (0.014") archwires. The inclusion criteria were a Little's Irregularity Index (LII) greater than 4, malocclusion requiring non-extraction therapy, all teeth erupted to the second molars in the lower arch, and Angle's Class I malocclusion. The primary aim was to measure alleviation in mandibular crowding over 12 weeks; the secondary aim was to measure changes in ICW, IMW, and AD during those 12 weeks. Simple randomization was performed. The measurements were made on dental stone casts using a coordinate measuring machine at 4-week intervals. RESULTS: LII at 0, 4, 8, and 12 weeks was 8.59 ± 1.44, 6.17 ± 1.65, 4.65 ± 1.63, and 3.28 ± 1.57 mm in the HANT; 8.87 ± 1.29, 6.92 ± 1.49, 5.25 ± 1.32, and 3.63 ± 1.32 mm in the SE-NiTi group, respectively. ICW increased from 25.43 ± 1.39 to 27.41 ± 1.29 mm in the HANT and from 25.81 ± 1.78 to 27.27 ± 1.83 mm in the SE-NiTi groups over a period of 12 weeks, at P < .05. There was a statistically significant increase in IMW, CAD (canine arch depth), and MAD (molar arch depth), favoring the HANT group (P < .05). No significant differences in LII between the 2 groups were noted (P > .05). CONCLUSIONS: The amount of alleviation of lower anterior crowding was similar with both archwires. ICW, IMW, and AD increased with HANT archwires.

Erratum: Retraction notice to "Performance comparison of vibration devices on orthodontic tooth movement - A systematic review and meta-analysis"[J Oral Biol Craniofac Res. 10 (2020) 814-823].

[This corrects the article DOI: 10.1016/j.jobcr.2020.10.013.].

Stress distribution patterns in mini-implant and bone in the infra-zygomatic crest region at different angulations: A finite element study.

PURPOSE: To evaluate, using the finite element method (FEM), von Mises stress patterns produced both in a mini-implant (MI) and the infra-zygomatic crest region (IZC) at different placement angles and force magnitudes. MATERIAL AND METHODS: FEM modeling of an infra-zygomatic crest MI, of dimensions 2 mm × 12 mm, was designed and placed in the IZC bone. The MI was inserted at 50°, 60°, 70°, 80°, and 90° angulations to the IZC surface. Simulated orthodontic forces of magnitudes 8, 9, 10, 11, and 12 oz were applied to the MI head. Von Mises stress and magnitude both in the MI and surrounding bone were measured. RESULTS: Von Mises stress in the MI and bone was maximum at 90°. Least stresses were observed at 50° and 60° angulations. As force magnitude increased, von Mises stress increased linearly. Maximum stresses in the MI and bone were observed when loads were 12 oz and minimum stresses were observed at 8 oz. CONCLUSION: To achieve optimum primary stability, angles of insertion between 50° and 60° are recommended in the IZC region. Highest von Mises stress values were detected in the MI, followed by cortical and cancellous bone. Also, loading force between 8 and 12 oz exerted stresses below the tolerable threshold of bone and MI. Hence, proper placement of MI in IZC using these findings might provide better biomechanical stability during retraction and may help in preserving the bone-implant interface.

Performance comparison of vibration devices on orthodontic tooth movement - A systematic review and meta-analysis.

BACKGROUND: To evaluate the efficiency of vibratory devices in altering rate of orthodontic tooth movement. METHODS: A literature search up to January 31, 2020 was conducted in three electronic databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Science Direct, to identify studies on vibratory devices reporting any alteration in tooth movement as a primary outcome. Only articles published in English language were included. A meta-analysis was done to compare the amount of tooth movement (in mm) in patients treated with vibratory devices compared to control groups, to quantify weighted treatment effects. RESULTS: A total of two split mouth studies, six parallel arm randomized control trials (RCT) one split mouth RCT, and three regular RCTs were assessed qualitatively. Quantitative assessment was done for 8 randomized trials using a forest plot (310 patients). Pooled data showed increase in the amount of tooth movement by 0.34 â€‹mm (95% CI:0.25,0.42). There was a statistically significant difference noted for this result at p â€‹< â€‹0.00001. CONCLUSION: Current evidence suggests a moderate to high level of certainty in regard to included studies in this systematic review and meta-analysis. Vibratory devices when used in conjunction with fixed orthodontic appliances show significant increase in the rate of tooth movement. These devices can be used by clinicians to reduce treatment duration and patient discomfort. PROSPERO REGISTRATION: CRD42020169675.

Effect of fluoride agents on surface characteristics of NiTi wires. An ex vivo investigation.

AIM: To analyze the degree of corrosion of nickel titanium arch wires in patients with and without exposure to fluorides. MATERIAL AND METHODS: This was an ex vivo study comprising of 60 subjects undergoing fixed orthodontic treatment. Group 1(controls) comprised of 30 sets of new unused NiTi wires and unused 11, 15 brackets, Group 2(patients) comprised of 30 sets of non fluoridated NiTi wires and 11, 15 brackets and Group 3(patients) had 30 sets of fluoridated NiTi wires and 11, 15 brackets. NiTi wires were used over 6 months of treatment(0.014″,0.016″, 16 × 22", each wire was used for 2 months and replaced with the next size). All wires were retrieved, stored and analyzed. At 6 months, brackets from 11 to 15 were debonded in both treatment groups. Archwires and brackets in 3 groups were subjected to SEM analysis at 500 and 1000X to observe differences. Additionally, EDX Spectroscopy was undertaken to evaluate surface elemental compositional differences in groups. RESULTS: Significant differences among groups were evident in brackets and archwires tested. Maximum degradation, cracks and dark spots were seen in wires and brackets exposed to fluoride agents. EDX spectroscopy revealed least Ni% in fluoridated wires and brackets. CONCLUSIONS: Increased leaching of metal ions was evident when wires and brackets are exposed to fluoride agents during treatment. Use of non fluoridated mouthwash and toothpastes may be considered in orthodontic patients without risk of caries to mitigate such effects.

Comparison of pain levels in patients treated with 3 different orthodontic appliances - a randomized trial.

BACKGROUND AND AIMS: To compare pain levels experienced during initial alignment with three different orthodontic appliance types and to correlate pain with male and female differences, if any. METHODS: A prospective, randomized 3-arm parallel trial allocated 36 adult orthodontic patients into three appliance groups: MBT 0.022" slot (Mini Twin, Ormco, Glendora, USA), self ligating 0.022" slot Damon 3MX (Ormco, Glendora, USA) and clear aligners (Smile align, Mumbai, India). The level of discomfort was assessed through a questionnaire based on the visual analogue scale at four hours, twenty four hours, third and seventh day after appliance placement. RESULTS: Patients treated with clear aligners reported less pain than patients treated with conventional and self ligating fixed appliances. Patients treated with MBT conventional appliances showed greater pain levels than Damon appliances. A significantly higher visual analogue scale score was observed at 24 hours and the least visual analogue scale scores on the seventh day post appliance placement. CONCLUSION: During the first week of orthodontic treatment, patients treated with clear aligners reported lower pain than those treated with conventional and self-ligating appliances.

Bolton's analysis using a photogrammetric method on occlusal photographs.

PURPOSE: The aim of the study is to present a photogrammetric technique using standardized occlusal photographs to perform Bolton's analysis and assess reliability of this new method with plaster study casts. MATERIALS AND METHODS: The study was conducted on 16 subjects (8 males, 8 females), aged 18-25 years. Standardized occlusal photographs and plaster study casts were obtained. The occlusal photographs were calibrated in Nemoceph® software. Mesio-distal dimensions of all teeth up to first molars were calculated and Bolton's analysis was performed. Similarly, a digital calliper with 0.1 mm sensitivity was used to measure mesio-distal dimensions of all teeth on plaster study casts to perform Bolton's analysis. 28 parameters were measured on study models and corresponding occlusal photographs. Paired t test and intraclass correlation tests were carried out to test validity and reliability of the photogrammetric method. An intraclass correlation test was calculated for 4 derived parameters to test reliability of Bolton's analysis measurements obtained from occlusal photographs as compared to study models. RESULTS: All 28 parameters showed a statistically significant and excellent correlation (r>.80) in the Intra Class Correlation test. 4 variables used to calculate Bolton's analysis showed statistically significant correlation (r>.96) in the intraclass correlation test. CONCLUSION: Photogrammetry is a reliable tool to measure mesio-distal tooth size. Bolton's analysis from standardized occlusal photographs using the described photogrammetric technique can be used as an effective clinical tool.

Photogrammetric reliability of frontal facial photographs with radiographs and anthropometric measurements.

AIM: To evaluate relationships between frontal cephalograms and photographic measurements of Indian population with anthropometric measurements and if frontal photographic analysis could be utilized with precision for orthodontic diagnosis. MATERIAL AND METHODS: A cross-sectional ex vivo study was conducted on 300 subjects with age range of 18-25yrs. Standardized frontal cephalograms and photographs were obtained for all subjects and were analysed with Nemoceph 10.4.2 (Nemotec Dental Systems, Madrid, Spain) software program. Linear anthropometric measurements were recorded with the help of a digital Vernier caliper. 21 linear measurements were made, of which 10 were horizontal and 11 were vertical. Repeated measures of ANOVA followed by Bonferroni's Post hoc Analysis was used to compare mean values of horizontal and vertical parameters between 3 different methods. The level of significance was set at p < 0.05. RESULTS: Statistically significant differences were found with most parameters. Between the analogous photographic, cephalometric and anthropometric measurements, only N'-Me' showed reliability with all three methods (p = 0.53,0.53,0.53). CONCLUSION: The photographic method has proven to be a repeatable and reproducible tool for only few parameters. Therefore, it cannot be considered a reliable diagnostic tool.

Photogrammetric Correlation of Face with Frontal Radiographs and Direct Measurements.

INTRODUCTION: Photogrammetry is a science of making measurements from photographs. As cephalometric analysis till date has focused mainly on skeletal relationships, photogrammetry may provide a means to reliably assess and compare soft tissue and hard tissue measurements. AIM: To compare and correlate linear measurements taken directly from subject's faces and from standardized frontal cephalometric radiographs and to correlate them with standardized frontal facial photographs of Indian population and to obtain mean values. MATERIALS AND METHODS: A cross-sectional study was conducted on 30 subjects of Indian origin. Frontal cephalograms and standardized frontal photographs were obtained from subjects in the age group of 18- 25 years. Vernier calipers were used to obtain facial measurements directly. Photographs and radiographs were uploaded and measured using Nemoceph software. Analogous cephalometric, photographic and direct measurements were compared by one-way ANOVA to assess Pearson correlation coefficients for 12 linear measurements (6 vertical, 6 horizontal). Bonferroni post-hoc test was done for pair wise comparison. RESULTS: Among all measurements used, OR-OL (orbitale right-orbitale left) showed a high correlation r = 0.76, 0.70, 0.71. There was moderate correlation with EnR-EnL (endocanthion rt - endocanthion lt) r2 = 0.62, 0.68, 0.68. Highly significant correlation was evident with N-Sn, EnR-EnL and AgR-AgL with p<0.001. CONCLUSION: A statistically significant correlation was found between photographic, radiographic and direct measurements. Therefore, photogrammetry has proven to be an alternative diagnostic tool that can be used in epidemiologic studies when there is a need for a simple, basic, non-invasive and cost-effective method.

Benign reactive lymphadenopathy associated with submandibular gland enlargement during orthodontic treatment.

Lymphadenopathy may be caused due to various reasons, most common being infections, neoplasms and immunologic disorders. Considering the frequent use of biomaterials in dentistry, it is not uncommon to find allergic reactions in the oral mucosa. Delayed-type hypersensitivity is one mechanism of allergy, which may manifest as either contact stomatitis or rarely present as only lymphadenopathy. An unusual case of unilateral submandibular gland swelling with associated lymphadenopathy during orthodontic treatment is reported. The processes followed in the differential diagnosis of the condition have been elucidated. Delayed hypersensitivity as a possible causative factor has been discussed. The article highlights the possibility of such conditions manifesting at any time during orthodontic therapy.

Rapid Maxillary Expansion to Correct Palatal Fracture Malunion: A Case Report.

Mid palatal fractures are usually present in conjunction with Le Fort I maxillary fractures. Literature on isolated mid palatal fractures as seen in this case is relatively rare. A novel approach for the management of this case was undertaken. A rapid maxillary expander was used to separate palatal segments which healed well. The patient's crossbite and open bite was corrected with elastic use. The protocol of management of malunion of isolated mid palatal fractures is simple with reduced costs, morbidity and higher rates of acceptance. We report a case of a 26-year-old male patient involved in a road traffic accident leading to an isolated mid palatal fracture which is a rare entity. Due to lack of specialized care, the fracture fragments united inadequately resulting in deranged occlusion, open bite and reduced masticatory efficiency.