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.

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.

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.

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.