Comparative evaluation of displacement and stress distribution pattern during mandibular arch distalization with extra and inter-radicular mini-implants: a three-dimensional finite element study.

OBJECTIVE: To compare the initial stress distribution and displacement on mandibular dentition using extra and inter-radicular mini-implants for arch distalization, by means of finite element analysis. METHODS: For this study, two finite element models of the mandible were designed. The models consisted of periodontal ligament (PDL) and alveolar bone of all teeth until second molars. In the Case 1, bilateral extra-radicular buccal-shelf stainless steel mini-implants (10.0-mm length; 2.0-mm diameter) were placed between first and second permanent molars. In the Case 2, bilateral inter-radicular stainless steel mini-implants (10.0-mm length; 1.5-mm diameter) were placed between second premolar and first permanent molar. Power hook was attached between canine and first premolar at a fixed height of 8mm. In the two cases, 200g of distalization force was applied. ANSYS v. 12.1 software was used to analyze and compare von Mises stress and displacement in the mandibular dentition, PDL and bone. RESULTS: Higher stresses were observed in mandibular dentition with the inter-radicular implant system. The amount of von Mises stress was higher for cortical bone (85.66MPa) and cancellous bone (3.64MPa) in Case 2, in comparison to cortical bone (41.93MPa) and cancellous bone (3.43MPa) in Case 1. The amount of arch distalization was higher for mandible in Case 1 (0.028mm), in comparison to Case 2 (0.026mm). CONCLUSION: Both systems were clinically safe, but extra-radicular implants showed more effective and controlled distalization pattern, in comparison to inter-radicular implants, in Class III malocclusion treatment.

Paraplegia treated with blood transfusion.

Extramedullary hematopoiesis is a compensatory response in patients with thalassemia and other chronic anemia and can result in compressive myelopathy, if untreated. Two young adults with history of thalassemia presented with symptoms of spinal cord compression. Presence of extramedullary hematopoiesis was confirmed by magnetic resonance imaging. Both the patients were treated with blood hypertransfusion and showed improvement clinically and radiologically. Although there are various options in the management of such condition, including decompression surgery and radiation treatment, hypertransfusion can be very effective even in severe compression of the spinal cord. Hypertransfusion should be tried as the first line of management in patients with thalassemia presenting with compressive myelopathy to decrease the bulk of extramedullary hematopoietic tissue.

Therapeutic extraction of lower incisor for orthodontic treatment.

UNLABELLED: Lower incisor extraction in orthodontic treatment was very rare modality of orthodontic treatment because there are few patients who meet the standards for such treatment. Proper diagnosis and treatment planning should be done to achieve good occlusion and facial esthetics. Criteria for lower incisor extraction included degree of crowding, tooth size discrepancy, pathologic condition, vertical overbite, sagittal incisal relationship, skeletal growth pattern and age of the patient. This article comprises of a case of class I malocclusion treated with lower incisor extraction, with comprehensive analysis, diagnosis and treatment planning, treatment results were satisfactory. CLINICAL SIGNIFICANCE: Mandibular incisor extraction can be an effective treatment option in borderline cases with mild crowding in lower arch. Minimal alteration of mandibular arch form is key factor for success and stable results.

Biomechanical and clinical considerations in correcting skeletal class II malocclusion with Forsus™.

AIM: The present case report describes the importance of understanding of biomechanical and clinical considerations in application of Forsus appliance in correction of class II skeletal malocclusion. BACKGROUND: Angle's class II malocclusion is one of the most prevailing that may be either skeletal or dental presenting with different clinical manifestations. There are number of appliances to treat such a malocclusion in a growing child. Fixed functional appliances are indicated for class II corrections in patients who report late with minimal residual growth left. CASE DESCRIPTION: A case of class II skeletal and dental malocclusion treated with preadjusted edgewise appliance supplemented with Forsus Fatigue Resistant Device (FRD) (3M Unitek Corp, California, USA) is reported. CONCLUSION: Forsus device is an effective alternative in treating moderate skeletal class II malocclusion. The Forsus FRD (3M Unitek Corp, California, USA) can be used instead of class II elastics in mild cases and in place of Herbst appliance in severe cases. Alteration of force vector by modifying the archwire as shown in this case report while applying Forsus and incorporation of 10 degree labial root torque in lower archwire will minimize the effects on dentition. Engaging modules or tubing on to the pushrod and leaving 1 to 2 mm clearance between distal end of the upper tube and L-pin as shown in this case report will significantly improve the patient compliance. CLINICAL SIGNIFICANCE: Much emphasis should be given to biomechanical considerations which were discussed in this article while treating patients with Forsus to prevent the unwanted effects. Clinical considerations and certain modifications advised in this case report should be utilized while treating class II skeletal malocclusions with Forsus appliance to eliminate the patient cooperation factor and make treatment time estimates much more accurate.

A retrospective cephalometric evaluation of dental changes with activator and activator headgear combination in the treatment of skeletal class II malocclusion.

AIM: The aims of this study were to evaluate the dental changes brought about by activator and activator headgear combination (ACHG) and to determine whether we can achieve control over the lower incisor proclination which is a side effect of using functional appliances; or not, while treating cases of skeletal class II malocclusions. METHODS: Lateral cephalograms of 45 skeletal class II division 1 patients were selected for the study. Fifteen of them were successfully treated with an Andresen activator and the other 15 with an activator headgear combination. Fifteen class II subjects who had declined treatment served as the control group. Cephalometric landmarks were marked by one author to avoid interobserver variability. RESULTS: The results revealed that both the activator and the activator headgear combination significantly (p < 0.001) affected dental variables measured. The mandibular incisor proclination was effectively controlled in the activator headgear combination group. CONCLUSION: An activator headgear combination would offer itself as a better option compared with activator alone in the treatment of skeletal class II malocclusions especially in cases with proclined mandibular incisors. CLINICAL SIGNIFICANCE: When one of the treatment goals is to achieve a greater control over mandibular incisor proclination in the treatment of Skeletal Class II malocclusions, employing a combination of activator and headgear may substantially improve clinical outcomes.

Comparative evaluation of displacement and stress distribution pattern during mandibular arch distalization with extra and inter-radicular mini-implants: a three-dimensional finite element study

ABSTRACT Objective: To compare the initial stress distribution and displacement on mandibular dentition using extra and inter-radicular mini-implants for arch distalization, by means of finite element analysis. Methods: For this study, two finite element models of the mandible were designed. The models consisted of periodontal ligament (PDL) and alveolar bone of all teeth until second molars. In the Case 1, bilateral extra-radicular buccal-shelf stainless steel mini-implants (10.0-mm length; 2.0-mm diameter) were placed between first and second permanent molars. In the Case 2, bilateral inter-radicular stainless steel mini-implants (10.0-mm length; 1.5-mm diameter) were placed between second premolar and first permanent molar. Power hook was attached between canine and first premolar at a fixed height of 8mm. In the two cases, 200g of distalization force was applied. ANSYS v. 12.1 software was used to analyze and compare von Mises stress and displacement in the mandibular dentition, PDL and bone. Results: Higher stresses were observed in mandibular dentition with the inter-radicular implant system. The amount of von Mises stress was higher for cortical bone (85.66MPa) and cancellous bone (3.64MPa) in Case 2, in comparison to cortical bone (41.93MPa) and cancellous bone (3.43MPa) in Case 1. The amount of arch distalization was higher for mandible in Case 1 (0.028mm), in comparison to Case 2 (0.026mm). Conclusion: Both systems were clinically safe, but extra-radicular implants showed more effective and controlled distalization pattern, in comparison to inter-radicular implants, in Class III malocclusion treatment.

RESUMO Objetivo: Comparar a distribuição da tensão inicial e o deslocamento na dentição inferior usando mini-implantes extra e inter-radiculares para distalização da arcada, por meio da análise de elementos finitos. Métodos: Dois modelos de elementos finitos da mandíbula foram criados, os quais consistiram de ligamento periodontal (PDL) e osso alveolar de todos os dentes até os segundos molares. No Caso 1, mini-implantes extra-radiculares de aço inoxidável (10,0 mm de comprimento; 2,0 mm de diâmetro) foram colocados bilateralmente na buccal-shelf entre o primeiro e o segundo molares permanentes. No Caso 2, mini-implantes de aço inoxidável inter-radiculares (comprimento de 10,0 mm; diâmetro de 1,5 mm) foram colocados bilateralmente entre o segundo pré-molar e o primeiro molar permanentes. Um Power hook foi preso entre o canino e o primeiro pré-molar a uma altura fixa de 8mm. Nos dois casos, foi aplicada força de distalização de 200g. O software ANSYS v. 12.1 foi usado para analisar e comparar a tensão de von Mises e o deslocamento na dentição inferior, ligamento periodontal e osso. Resultados: Maiores tensões foram observadas na dentição inferior com o sistema de implantes inter-radiculares. A quantidade de tensões de von Mises foi maior para osso cortical (85,66MPa) e osso esponjoso (3,64MPa) no Caso 2, em comparação com osso cortical (41,93MPa) e osso esponjoso (3,43MPa) no Caso 1. A quantidade de distalização da arcada inferior foi maior no Caso 1 (0,028 mm), em comparação com o Caso 2 (0,026 mm). Conclusão: Ambos os sistemas foram clinicamente seguros, mas os implantes extra-radiculares mostraram um padrão de distalização mais eficaz e controlado, em comparação com os implantes inter-radiculares, para tratamento da má oclusão de Classe III.

Effect of Various Finishing Procedures on the Reflectivity (Shine) of Tooth Enamel - An In-vitro Study.

INTRODUCTION: Reflectivity of an object is a good parameter for surface finish. As the patient evaluates finishing as a function of gloss/reflectivity/shine an attempt is made here to evaluate changes in surface finish with custom made reflectometer. AIM: The aim of the present study was to study the effect of various procedures during orthodontic treatment on the shine of enamel, using a custom made reflectometer. MATERIALS AND METHODS: Sixty one extracted premolars were collected and each tooth was mounted on acrylic block. Reflectivity of the teeth was measured as compared to standard before any procedure. One tooth was kept as standard throughout the study. Sixty teeth were acid etched. Reflectivity was measured on custom made reflectometer and readings recorded. Same procedure was repeated after debonding. Then 60 samples were divided into three groups: Group 1 - Tungsten Carbide, Group 2 - Astropol, Group 3- Sof-Lex disc depending upon the finishing method after debonding and reflectivity was measured. RESULTS: The mean percentage of reflectivity after acid etching was 31.4%, debonding 45.5%, Tungsten carbide bur finishing (Group 1) was 58.3%, Astropol (Group 2) 72.8%, and Sof-Lex disc (Group 3) 84.4% as that to the standard. There was statistically very highly significant (p<0.001) difference in reflectivity restored by the three finishing materials in the study. Thus, the light reflection was better in Group 3> Group 2> Group 1. CONCLUSION: The primary goal was to restore the enamel to its original state after orthodontic treatment. The methods tested in this study could not restore the original enamel reflectivity.

Friction between Archwire of Different Sizes, Cross Section, Alloy and Brackets Ligated with Different Brands of Low Friction Elastic Ligatures- An Invitro Study.

INTRODUCTION: Friction in orthodontic treatment does exist and is thought to reduce the efficiency of orthodontic appliances during sliding mechanics. During sliding mechanics, a friction force is produced at the bracket archwire-ligature unit which tends to counteract the applied force and in turn resists the desired movement. AIM: The aim of this invitro study was to determine the friction between archwire of different sizes, cross section, alloy and brackets ligated with different brands of low friction elastic ligatures. MATERIALS AND METHODS: An 0.022-in slot, 10 stainless steel brackets and various orthodontic archwires which were ligated with low-friction ligatures and subjected to evaluate frictional resistance i.e. static friction and dynamic friction. The archwires of 0.014″ and 0.016″ nickel titanium (NiTi), 0.016 × 0.022″ stainless steel (SS), 0.017 × 0.025″ NiTi, 0.017 × 0.025″ SS, 0.017 × 0.025″ titanium molybdenum alloy (TMA), 0.019 × 0.025″ SS were used. Each bracket/archwire combination was evaluated 10 times at room temperature of 27 ± 2°C. The study groups included Group I of conventional round shape module with reduced friction coating i.e. super slick and synergy and Group II contained figure of "8" shape module i.e. Octavia ties and Slide ligature. RESULT: The mean static friction force and dynamic friction force for all 7 types of wires was lower in Group II (C, D) combined compared to Group I (A, B) and the difference was statistically very highly significant (p<0.001). CONCLUSION: Super slick and synergy can be used in the initial and final phase of treatment when full engagement of archwire in the bracket slot is necessary for proper tip and torque expression. Slide and Octavia ties modules can be used in the premolar brackets during en mass retraction when using friction mechanics.

Comparative Evaluation of Shear Bond Strength of Recycled Brackets using Different Methods: An In vitro Study.

BACKGROUND: Debonding of brackets commonly occurs during orthodontic treatment. Due to increase in costs replacement of a damaged bracket is not liked by the dentist. This study is done to assess the shear bond strength of recycled brackets using different methods. MATERIALS AND METHODS: This study was conducted using five groups of orthodontic brackets (0.022" × 0.028", MBT prescription) bonded on the premolars mounted in cubes. Other materials required were cubical trays, bonding material, light cure unit, universal testing machine, digital camera and sandblasting unit. RESULTS: From the result of ANOVA test we observed the test is significant (F = 20.79, P < 0.01) and the test is rejected. When the Tukey's t-test result was applied it was seen that the mean shear bond strength of all groups of brackets is as follows: Group I (5.31 Megapascals [Mpa]) < Group II (7.37 Mpa) < Group III (8.96 Mpa) < Group IV (5.56 Mpa) < Control group (9.24 Mpa). Alternatively we can say that shear bond strength of following bracket groups can be arranged as Group I < Group IV < Group II < Group III. CONCLUSION: From this study we conclude that Group III, which was recycled with an ultrasonic cleaner with electropolisher and silane coupling agent in place of primer, showed the highest shear bond strength.

Spectrum of renal disease in malaria.

Between January 2000 and December 2001, renal involvement in 81 cases of malaria was studied. Their age ranged between 05 and 66 (mean 35.5) years. Distribution of malarial parasite was P falciparum (75), mixed infection (4) and P vivax (2). The evidence of clinical renal disease in the form of acute renal failure, electrolyte abnormality, abnormal urinary sediment and increased urinary protein excretion (>500 mg/24 hours) was found in 100%, 91.3%, 46.9% and 18.5% respectively. Probable aetiopathogenesis of acute renal failure (ARF) was multifactorial. Volume depletion (72.8%) was the dominant cause of ARF in these patients. In addition, hyperbilirubinaemia, intravascular haemolysis and sepsis were responsible for ARF in 64.2%, 70.3% and 25.9% cases respectively. All the patients were managed with anti-malarial drugs and dialysis support was needed in 35 patients (43.2%). Prognosis of malarial acute renal failure is favourable with mortality rate of 18.5%. Multi-organ failure was the commonest cause (33.3%) of death.