Perception of laypersons, orthodontists, and oral and maxillofacial surgeons about the transverse occlusal plane.

INTRODUCTION: Transverse occlusal plane (TOP) should be parallel to the true horizontal lines of the face (ie, the interpupillary line [IP] and commissural line [CL]). This study aimed to investigate the opinions of laypersons, orthodontists, and oral and maxillofacial surgeons about the impact of imbalanced IP and CL on facial attractiveness. METHODS: We used a symmetrical face image as the reference. Then, using Photoshop software, we constructed the following 6 photographs: TOP roll relative to CL and IP (3° and 6°) with parallelism of CL and IP, CL roll relative to TOP and IP (3° and 6°) with parallelism of TOP and IP, TOP and CL roll relative to IP (3° and 6°). Consequently, the participants rated the photographs on the basis of their attractiveness. Kruskal-Wallis and Mann-Whitney U tests were used to compare the ratings. RESULTS: One hundred thirty-one laypersons, 22 orthodontists, and 20 surgeons participated in this study. It was found that 51.1% of laypersons, 86.4% of orthodontists, and 70% of surgeons selected the reference photograph as the most beautiful, followed by the photograph with a 3° roll of CL relative to TOP, with parallelism of TOP and IP (29% of laypersons, 31.8% of orthodontists, and 35% of surgeons). CONCLUSIONS: Most participants selected the reference photograph as the most beautiful and realized a roll in the horizontal planes up to 3°. The parallelism of the esthetic line of dentition relative to interpupillary is preferred over its parallelism relative to CL.

Is there any relationship between fixed orthodontic treatment and developmental indicators in children and adolescents? A prospective cohort study.

Background: Fixed orthodontic treatment may cause discomfort four to six weeks after the initiation of the treatment as it may change the type and amount of food consumed by children. This temporary change may have a long-term effect on the growth status of such children. This study aimed to detect the longitudinal relationship between fixed orthodontic treatment and developmental indicators in children and adolescents. Methods: The study population encompassed adolescents undergoing fixed orthodontic treatment as the exposure group (n = 30) and adolescents with no orthodontic treatment as the control group (n = 90). The patients' dental age, weight, height, body mass index (BMI), and wrist circumference were assessed at the baseline, as well as 1, 3, and 6 months after the orthodontic treatment. The significance level was set to be p = 0.05. Results: One-hundred twenty participants were included in this study. In the two groups, all growth parameters revealed an increasing trend. In the exposure group, weight-related indices (i.e., weight, BMI, and wrist circumference) decreased in the first month and then increased during the next five months. All indices in the control group and height in the exposure group exhibited a continuous increase. Conclusion: Fixed orthodontic treatment affects childhood growth indices. However, these effects are probably short-term, and the catchup growth mechanism can offset these effects and modify the changes in growth indices. A longer follow-up period is recommended to be considered by future researchers.

Prediction accuracy of Dolphin software for soft-tissue profile in Class I patients undergoing fixed orthodontic treatment.

BACKGROUND: Simulation and prediction can facilitate the decision between an extraction versus nonextraction treatment plan. This study aimed to assess the accuracy of Dolphin Imaging software in predicting profile changes in class I borderline cases. METHODS: In this retrospective study, class I borderline patients (i.e., both extraction and nonextraction treatment plans were possible for them) aged 15-35 years were enrolled. All of the cephalometric analyses were done by Dolphin Imaging software, version 11.8 Premium. The initial cephalograms were superimposed on initial photographs. The final values for the 7 angular and linear landmarks of the upper and lower incisors were extracted from post-treatment cephalograms and inserted in the "Goals" tab of the Dolphin Imaging software. Post-treatment images of patients were simulated. Final post-treatment photographs were superimposed on the simulated pictures. The differences between the real and simulated pictures were calculated in relation to the reference lines. The P value was set at 0.05. RESULTS: A total of 70 patients (36 with tooth extraction, and 34 without tooth extraction) were included. In the extraction group, the horizontal position of both lips was predicted to be significantly more protruded than it actually was, whereas in the nonextraction group, the only difference between the simulated and actual results was that the vertical position of the lower lip, which was simulated as being more inferior than it actually was. CONCLUSIONS: Despite the statistically significant differences between the real and simulated pictures, the differences were small and clinically insignificant. Prediction via Dolphin Imaging software can be an appropriate guide in extraction-nonextraction borderline cases.

The effect of intra-oral LED device and low-level laser therapy on orthodontic tooth movement in young adults: A randomized controlled trial.

INTRODUCTION: This randomized controlled clinical trial aimed to assess the effect of LED5 and LLLT6 in a three-arm parallel setting. METHODS: Sixty patients who needed the maxillary first premolar extraction were allocated to three groups using the stratified block randomization method. In the LED group, a custom-made device with a wavelength of 640nm and a power density of 40 mW/cm2 was used 5min/day. In the laser group, Ga Al As7 laser with a wavelength of 810nm and a power of 100 mW was used on days 0, 3, 30, and 60 each time for 18seconds. Patients in the control group received placebo treatment as the laser group protocol, using a coated light cure device. Models were made at baseline and monthly until the end of the retraction. The rate of canine retraction was the primary outcome, while canine rotation and pain were secondary outcomes. The final data were anonymous for the outcome assessor and statistical consultant. Data were analyzed per protocol using a linear mixed model. RESULTS: The rate of canine retraction significantly increased by 60.8% in the laser group, while it increased not significantly by 26% in the LED group compared with the control group. There was no significant difference among the groups in terms of tooth rotation and pain. CONCLUSIONS: LLLT can accelerate orthodontic tooth movement (OTM). LED with the present setting couldn't increase the rate of OTM. LLLT and LED did not affect canine rotation or pain. TRIAL REGISTRATION: IRCT20120220009086N4. On 1 June 2019 was retrospectively registered.

Does a diluted chlorhexidine-based orthodontic mouthwash cause less discoloration compared to chlorhexidine mouthwash in fixed orthodontic patients? A randomized controlled trial.

OBJECTIVE: Chlorhexidine gluconate is currently the most effective oral antimicrobial agent against microorganisms, but discoloration of the teeth prevents its long-term use and can reduce patient cooperation. In this study, the effect of chlorhexidine and a diluted chlorhexidine-based, fluoride, cetylpyridinium and vitamin added mouth rinse (Orthokin) on stain index in fixed orthodontic patients was compared. MATERIALS AND METHODS: This study was performed as a double blind randomized controlled trial on 50 patients undergoing fixed orthodontic treatment in the age group of 14-30 years. The patients were categorized as two groups of chlorhexidine and Orthokin mouth rinses and were asked to use mouthwash for eight weeks. Groups were matched according to colouring food consumption. Extrinsic staining index was assessed by modified Loben technique. Data was analysed by SPSS software. P value was set to be 0.05. RESULTS: In the chlorhexidine group, the stain extent index and overall stain index were increased significantly at 8 weeks (P<0.001 and P=0.002, respectively). However, the increase in stain intensity index was insignificant (P=0.07). In Orthokin group, the changes in stain extent, stain intensity and overall stain were insignificant (P=0.66, P=1.000, P=0.47, respectively). CONCLUSION: According to the results of the present study, chlorhexidine mouthwash causes more staining of teeth compared to Orthokin mouthwash. It seems that lower concentrations of chlorhexidine can be prescribed to orthodontic patients. Although these compounds are effective in sense of oral hygiene, they do not cause significant discoloration.

Plaque Removal Efficacy of Three Cleaning Methods for Removable Orthodontic Appliances: A Crossover Randomized Clinical Trial.

OBJECTIVE: The mechanical plaque removal methods of removable orthodontic appliances (ROAs) may damage the appliance surface and may not effectively eliminate the entire microbial plaque. METHODS: This study aimed to compare the efficacy of brushing + denture cleanser tablets, brushing + propolis mouthwash and brushing only for plaque removal from each orthodontic appliance surface. This crossover randomized clinical trial evaluated 32 patients between 7-15 years with ROAs. The patients were randomly assigned to three groups of brushing (control), brushing + denture cleanser tablets (intervention group 1), and brushing + propolis mouthwash (intervention group 2). The plaque removal methods were switched among the groups during three 1-month periods. One month after practicing a certain protocol, the plaque disclosing agent was applied on the surface of the appliance. The photographs of appliances were analyzed by Image J software to calculate the surface area occupied by the residual microbial plaque. RESULTS: The ratio difference of residual plaque surface area to the surface area of the entire appliance was significant between the intervention group1 and control group (p<0.001), while it was not significant in intervention group 2 and control group (p=0.105). Also, this difference between the intervention group1 and 2 was statistically significant (p<0.001). CONCLUSION: Simultaneous use of toothbrush with denture cleanser tablets decreased the microbial biofilm on the surface of ROAs, compared with brushing alone. Thus, it seems that the use of denture cleaning tablets may be suitable for effective cleaning of ROAs.

Photobiomodulation therapy as a high potential treatment modality for COVID-19.

COVID-19 is now a worldwide concern, causing an unprecedented pandemic. The infected cases show different symptoms based on the severity of the disease. In asymptomatic and non-severe symptomatic cases, the host immune system can successfully eliminate the virus and its effects. In severe cases, however, immune system impairment causes cytokine release syndrome which eventually leads to acute respiratory distress syndrome (ARDS). In recent years, photobiomodulation (PBM) has shown promising results in reducing acute pulmonary inflammation. Considering the high potential impact of PBM on immune responses, we hypothesized that using PBM could be an effective treatment modality for ARDS management in COVID-19 patients.

Orthodontic patients' oral hygiene compliance by utilizing a smartphone application (Brush DJ): a randomized clinical trial.

Considering the widespread use of smartphones and their applications (apps), as well as the undeniable role of reminders and apps in behavioral interventions, this study aimed to assess the efficacy of a smartphone app (Brush DJ) for oral hygiene compliance of patients with fixed orthodontic appliances. In this randomized clinical trial, 120 patients between 15 to 25 years who had just started fixed orthodontic treatment were randomly divided into two groups (n = 60). Control patients received conventional oral hygiene instruction, while patients in the intervention group were asked to use the Brush DJ smartphone app, after receiving conventional oral hygiene instruction. The plaque index (PI) and gingival index (GI) were measured at baseline (T0), and at 4 weeks (T1), 8 weeks (T2) and 12 weeks (T3) after the onset of study. A questionnaire was given to all patients to assess the frequency and duration of tooth brushing per day, and the frequency of app usage and reminder noticing in the intervention group. Improvements in PI and GI were noted in the intervention group; while these parameters increased in the control group. Significant differences were noted in PI and GI changes between the two groups (p < 0.001). Brushing frequency and duration were positively correlated with app usage during the follow-up period. Ultimately, we believe that smartphone apps, as motivators and reminders, can greatly help in improving the orthodontic patients' oral hygiene compliance, especially in adolescents.

Extraction versus non-extraction orthodontic treatment: Soft tissue profile changes in borderline class I patients.

BACKGROUND: The decision regarding the selection of extraction or non-extraction orthodontic treatment is a common challenge in orthodontic treatment planning. OBJECTIVES: The objective of this study was to compare the effects of extraction and non-extraction orthodontic treatment on the soft tissue profile of borderline class I patients. MATERIAL AND METHODS: In this retrospective study, 70 patients were selected from among those referred to the Department of Orthodontics of the Faculty of Dentistry at Hamadan University of Medical Sciences in Iran. The inclusion criteria were skeletal class I, 4-10 mm of space deficiency, and the possibility of applying both extraction and non-extraction orthodontic treatment. All patients underwent fixed orthodontic treatment with the use of 0.022-inch-slot edgewise brackets. The patients were divided into 2 groups (n = 35) according to the 4-premolar extraction or non-extraction treatment plan. The 2 groups were compared by means of the cephalometric analysis. RESULTS: There were 11 males and 24 females at a mean age of 17.46 years in the non-extraction group, and 9 males and 26 females at a mean age of 18.46 years in the extraction group. The upper and lower incisors as well as the lower lip moved forward in the non-extraction group (lower lip to E­plane = 0.87 ±1.39 mm, U1-SN = 2.83 ±8.03°, IMPA = 4.64 ±5.47°). The incisors and the lips moved backward in the extraction group (upper lip to E­plane = -1.42 ±2.08 mm, lower lip to E­plane = -1.56 ±1.97 mm, U1-SN = -7.63 ±9.02°, IMPA = -7.05 ±6.79°). The differences were statistically significant (p < 0.05). Mentolabial sulcus became more pronounced in the non-extraction group (1.92 ±2.73 mm; p < 0.001) and shallower in the extraction group (-1.90 ±4.2 mm; p = 0.000). CONCLUSIONS: Orthodontic treatment can change the soft tissue appearance of the lower third of the face. The lips and the incisors moved forward in the non-extraction group and backward in the extraction group.

Maxillary molar distalization using conventional versus skeletal anchorage devices: A systematic review and meta-analysis.

INTRODUCTION: The purpose of this study was to systematically review the evidence regarding conventional versus skeletal anchorage devices for molar distalization. METHOD: An electronic search was conducted. Hand searching was done in the reference lists of included studies and some journals. Studies comparing conventional and skeletal anchorage for molar distalization in Angle class I or II malocclusions were assessed. Presence of periodontal disease, second or third molar extraction and application of tooth accelerating methods led to exclusion of studies. Generic-inverse variance approach was used for meta-analysis by use of the mean difference and random-effect model. Risk of bias was evaluated in included studies. RESULTS: A total of 1996 articles were found; of which, 1991 were excluded. The mean amounts of molar distalization/tipping in skeletal anchorage and conventional anchorage groups were 5.35mm/8.44° and 4.25mm/8.31°, respectively, which were not significantly different. The mean amounts of premolar movement in skeletal anchorage and conventional anchorage groups were -0.96mm and +2.21mm, respectively, which was statistically significant (P=0.004). Duration of treatment in skeletal anchorage and conventional anchorage groups was 8.23 months and 7.95 months, respectively, which were significantly different (P=0.0001). Risk of bias was assessed to be high. CONCLUSION: The conventional and skeletal anchorage devices were not significantly different in terms of the amount of molar distalization/tipping. However, the anchorage loss was lower in the skeletal anchorage group. The treatment time was shorter in the conventional anchorage group. More studies with proper design are required.

Tooth-borne versus bone-borne rapid maxillary expansion for transverse maxillary deficiency: A systematic review.

PURPOSE: The aim of this study was to compare dentoskeletal effects of bone-borne expanders with those of conventional expanders in adolescent and adults having transverse maxillary deficiency. METHODS: All randomized clinical trials (RCTs) comparing the effects of bone-borne with those of tooth-borne expansion for treatment of maxillary transverse deficiency in adults and adolescents with maxillary transverse deficiency or posterior crossbite were included. The systematic search was irrespective of language and publication type. The electronic search was conducted from 1980 to January 2018. RESULTS: The electronic searches retrieved 713 references after screening for eligibility criteria. Eight studies met the inclusion criteria for this systematic review involving 289 participants. Four studies compared rapid maxillary expansion (RME) between bone-borne and tooth-borne devices and indicated effectiveness of both devices on maxillary expansion. In the first molar region, there was no significant difference between two devices in either skeletal or dental expansion. Two studies compared the effects of bone-borne and tooth-borne device following SARME and suggested no significant difference regarding amount and pattern of expansion at various levels and in molar and premolar region between two groups. Two studies compared bone-borne and tooth-bone-borne devices. CONCLUSION: Within the limit of the present evidence regarding maxillary expansion, it seems that both tooth-borne and bone-borne devices result in the same outcome in terms of the amount of maxillary expansion, dental tipping, stability and perceived pain both in RME and SARME procedure. PROSPERO registration: CRD42017061078.

Effects of facemasks versus intraoral appliances in treating maxillary deficiency in growing patients: A systematic review and meta-analysis.

BACKGROUND: Class III malocclusion is one the most challenging types of orthodontic problems. OBJECTIVES: The aim of this study was to compare the dentoskeletal effects of facemasks and intraoral appliances in treating class III maxillary deficiency in growing patients through a systematic review of the available literature. MATERIAL AND METHODS: Electronic and manual searches were performed in the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR), MEDLINE (PubMed), Embase (OVID), and Scopus to find all the relevant studies published by January 2018. All randomized controlled trials (RCTs) recruiting 5-12-year-old patients who received maxillary protraction treatment with any type of facemask and comparing the facemasks with any type of intraoral appliance were included. The primary outcome measure was changes in the A point-nasion-B point angle (ANB), and the secondary outcomes included changes in the overjet, upper-1 (U1) inclination, the mandibular plane angle, and treatment time. The meta-analysis was carried out using the inverse variance-weighted random effects model. RESULTS: Out of 1,629 articles found in the initial search, 5 studies met the inclusion criteria. The meta-analysis showed no differences in the duration of treatment or in any of the cephalometric variables, with the exception of the overjet. CONCLUSIONS: It seems that intraoral appliances and facemasks are similar in terms of dentoskeletal effects in the treatment of class III malocclusion as well as treatment duration. However, due to a lack of a sufficient number of high-quality studies, these results should be viewed with caution. Further high-quality, long-term studies are recommended.

Evaluation of the Changes in the Quality of Life in Patients Undergoing Orthognathic Surgery: A Multicenter Study.

Orthognathic surgery can affect patients' quality of life. The aim of the present study was to assess changes in quality of life during combined orthodontics-surgery treatment and effect of orthodontist-surgeon teamwork on final patient's satisfaction. Twenty-six orthognathic patients who were referred to oral and maxillofacial department of 3 hospitals in Tehran were included in the study. Orthognathic quality of life questionnaire (OQLQ) was given to patients 1 week before, 4 weeks and 4 months after surgery. Two self-designed forms were used for evaluating mood and comfort of patients 1 week before surgery and 4 days after surgery. Self-designed forms were given to the orthodontists and the maxillofacial surgeons to assess quality of teamwork and difficulty of the procedure. Twenty-four patients (15 females and 9 males) with the mean age of 22.62 ±â€Š3.57 completed the study. Quality of life increased from 1 week before surgery to 4 months after surgery (P < 0.013) and the difference was statistically significant between OQLQ score at 1 week before surgery and that of 4 months postoperative. Esthetic and social domain showed significant changes during the studied period. Orthognathic quality of life questionnaire at 4 months postoperative was correlated with surgery difficulty and duration. It can be concluded that orthognathic surgery can improve quality of life, especially in esthetic and social aspects.

A Comparison of Radiographic Film Densitometry Using a New Computerized Tool with a Digital Densitometer.

OBJECTIVES: The purpose of this study was to develop and test a new tool for radiographic densitometry by combining periapical films and aluminum step wedge. MATERIALS AND METHODS: We reviewed 50 Kodak E-speed intraoral films. An aluminum step wedge consisting of 16 steps was constructed. Each step was 1mm×3m×10mm. The step wedge was exposed to varying exposure times, ranging from 0.05 second to 0.5 second, increasing in 0.05 second increments. Films were digitalized after processing and the MATLAB software algorithm was ran subsequently. Density of the films was measured again using a digital densitometer. In order to compare the two imaging techniques, three steps were selected. Output data from the MATLAB algorithm were compared with data obtained from the digital densitometer. RESULTS: The new method could detect significant differences between subsequent exposure times in step 7, while the densitometer did that in steps 7 and 12. The new method's sensitivity in determining density changes was 5.26%, 84.1% and 93.02% in steps 2, 7, and 12 respectively. CONCLUSIONS: Our new method has an acceptable sensitivity for determining density changes of at least 7 mmEq/Al.

Mini-Screw Supported Intrusion Mechanics Used For Open Bite Closure and Facial Improvement: A Case Report.

Open-bite is one of the most challenging malocclusions to be corrected orthodontically. Temporary anchorage devices had enabled orthodontists to treat open-bite cases successfully. In this case report a 15 years old girl with open-bite was treated with maxillary molar intrusion with the aid of alveolar mini-screws.

High Insertion Torque and Peri-Implant Bone Loss: Is There a Relationship?

Because primary stability has a critical role in implant osseointegration, greater insertion torque is more desirable. However, excessive pressure on the peri-implant bone may lead to bone resorption. This study evaluates the effect of insertion torque on crestal bone level. Periapical radiographs of 136 bone-level implants were assessed in this retrospective cohort study. Sixty-four implants were inserted with high insertion torques (45-70 N/cm) and 72 implants were placed with a torque in the range of 20 to 30 N/cm. The distance between implant shoulder and proximal bone crest was measured on radiographs taken immediately after the insertion and compared to those calculated after uncovering surgeries (inserting the healing abutment). The mean bone resorption around implants placed with high and lower insertion torques was 0.33 and 0.4, respectively; thus, the difference between the two groups was insignificant (p = 0.88). High insertion torques (up to 70 N/cm) did not significantly increase bone resorption around implants.

The effectiveness of barrier membranes on bone regeneration in localized bony defects: a systematic review.

PURPOSES: The aim of this study was to assess the effectiveness of barrier membranes in bone augmentation through a systematic review of the literature. MATERIALS AND METHODS: Electronic data banks and hand searching were used to find relevant articles on the reconstruction of localized bone defects published up to May 2011. Controlled animal and human studies with more than 4 weeks of follow-up were included; studies of periodontal lesions, extraction sockets, and maxillary sinus grafts were excluded. Applications of recombinant growth factor or assessments of membranes' effects on implant osseointegration were also considered exclusion criteria. Defects filled with bone graft/bone substitute material and covered with a membrane were considered the test group, while uncovered defects were considered the control group. Thereafter, human and animal studies were evaluated separately by meta-analysis. RESULTS: Of the 3,986 articles found in the initial search, 34 studies met the inclusion criteria. Four animal studies concluded that the use of barrier membranes would increase the amount of vertical augmented bone (mean difference 0.32 mm; P = .006). Qualitative results regarding horizontal bone augmentation were controversial. Membranes do not increase the risk of improper healing, according to both human studies (odds ratio 5.67; P = .32) and animal studies (odds ratio 3.35; P = .12). CONCLUSION: There is limited evidence to support the effectiveness of barrier membranes in the treatment of bone deficiencies. Membranes do not increase postoperative infection, wound dehiscence, or membrane/bone graft exposure in either human or animal models. Because a majority of the results are based on animal studies, more randomized clinical trials are needed to objectively measure the efficacy of membranes in human bone augmentation.

Conventional versus digital radiographs in detecting artificial voids in root canal filling material.

INTRODUCTION: Inappropriate condensation of gutta-percha or improper use of sealer can lead to voids in root canal filling material and consequent failure of the treatment. Timely detection of voids within root canal filling may prevent complications. In this study, we compared the accuracy of digital and conventional radiograph for detecting voids within root canal fillings. MATERIALS AND METHODS: The root canals of 50 extracted maxillary permanent incisors were prepared and filled with gutta-percha and sealer. The teeth were then randomly divided into two groups of 25 incisors. The teeth were imaged using the paralleling technique with E-speed film and digital/digital zoomed system. The accuracy of radiographic techniques was evaluated for detecting voids by three independent observers. Presence/absence of voids was recorded and compared with the baseline data. The sensitivity, specificity, accuracy and positive and negative predictive values was recorded. RESULTS: The sensitivity, specificity and accuracy of conventional radiography and digital radiography were 48%, 52%, 50%, and 82.7%, 80% and 81.3%, respectively. The positive and negative predictive value of conventional radiography was 50%. Digital images showed the positive predictive value of 80.3% and negative predictive value of 83.5%. The values of positive and negative predictive were reported as 81.6% and 81.1% in digital zoomed images. CONCLUSION: Digital and digital zoomed images performed better than conventional radiographs in detecting voids, but there were no differences between the performances of both digital images.