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.

Qualitative Assessment of Reliability of Cone-beam Computed Tomography in evaluating Bone Density at Posterior Mandibular Implant Site.

Introduction: The success of dental implants depends primarily on the primary implant stability and the bone density so that predictable osseointegration can be achieved. To achieve the desired results, systematic preoperative planning for implant placement is required. The sole aim of the study was to assess the reliability of preoperative bone density of mandibular posterior region for implant placement using computerized tomography-derived bone densities in Hounsfield units (HU). Materials and methods: A total of 200 patients with 352 implant sites between 2014 and 2017 were assessed for the posterior mandibular area using cone-beam computed tomography (CBCT). Evaluation was done by two experienced observers independently. Results: The mean bone density of males was 690.5 ± 104.12 HU and in females, it was 580.20 ± 120.2 HU. Overall, 21% of sites were of low bone density, 39.5% were of intermediate density, and 39.4% were of high density. Receiver operating characteristic (ROC) analysis presented that the CBCT intensity values had a high predictive power for predicting both high-density sites and intermediate-density sites. Conclusion: We can say from our results that, for predicting the bone densities in posterior mandible for determining implant sites, so as to achieve best osseointegration, CBCT values can be reliably used. Clinical significance: It has been proved that bone density and implant stability are dependent on each other and osseointegration is important for the success of treatment. With advancements in dentistry and introduction of CBCT, treatment planning and prediction of appropriate implant sites could be made easy and more predictable. Thus, we can say that CBCT can be considered an alternative diagnostic tool for the bone density evaluation during treatment planning for implant placement. Keywords: Bone density, Cone-beam computed tomography, Implants, Osseointegration.

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.

Modified SARME (Surgically Assisted Rapid Maxillary Expansion) in Conjunction with Orthodontic Treatment-A Case Report.

Transverse maxillary hypoplasia or maxillary constriction in conjunction with unilateral or bilateral posterior cross bites is a common finding in cleft palate patients. These situations are also commonly encountered in adults who have not had recourse to orthodontic treatment in childhood. In adults, after ossification of the mid palatal suture is complete, the accepted means of correcting transverse skeletal discrepancies is by Surgically Assisted Rapid Maxillary Expansion (SARME). The disadvantage of this technique in the Indian scenario is reduced patient acceptance and increased treatment costs. Le Fort-I down fracture and mid palatal suture sectioning requires hospitalization and increases morbidity. A case of a 21-year-old non-cleft male who presented with Class I malocclusion with transverse skeletal discrepancy and bilateral posterior cross bites is presented. A modified SAARME technique was performed without pterygomaxillary disjunction, as an outpatient procedure. The results obtained were satisfactory and the desired amount of transverse skeletal correction was achieved. The patient was discharged the same day. The technique can be used to successfully treat a large number of patients in India with maxillary skeletal transverse problems with increased predictability, reduced costs and morbidity and higher rates of acceptance.