Comparison of treatment effects during en-masse retraction of upper anterior teeth placed using mini-implants placed at infrazygomatic crest and interradicular sites: A randomized controlled trial.

INTRODUCTION: The objective of this prospective study was to examine the efficacy of posterior interradicular and infrazygomatic crest mini-implants for en-masse anterior retraction. METHODS: The 22 patients were divided into two groups. In group 1 (IZC n = 11), mini-implants were placed in the infrazygomatic crests and in group 2 (IR, n = 11), mini-implants were placed in the molar-premolar interradicular sites. Soft tissue, skeletal, and dental treatment effects between two groups were compared using lateral cephalometric measurements. RESULTS: The average angle between the cranial base and A point was 1.01 degrees (P = .004), and the linear distance between the upper incisor and A point was 2.67 to 5.2 millimetres (P = .00). In IZC group the maxillary incisor to the palatal plane moved upward by a mean of -5.20 mm (P = .059), whereas in IR group the incisor movement changed by -2.67 mm (P = .068). There was no significant difference between groups IZC and IR while comparing overall treatment changes on upper incisor position change, angle, and overjet. CONCLUSIONS: Mini-implants placed in between the molar and premolar as well as the infrazygomatic crest can withstand the deepening of the bite during retraction. Mini-implants in IZC are capable of causing intrusion of the anterior teeth and preventing intrusion of the molars, thereby providing absolute anchoring in all planes. Placement of the mini-implants in the infrazygomatic crest resulted in more linear retraction.

Assessment of Toxicity of Green Synthesized Silver Nanoparticle-coated Titanium Mini-implants with Uncoated Mini-implants: Comparison in an Animal Model Study.

AIM: To assess the potential for systemic toxicity when silver nanoparticle-coated mini-implants were implanted in Wistar albino rats conducted as a comparative study in the animal model by assessing the blood biochemistry, liver and kidney function, and histology of the implanted site. MATERIALS AND METHODS: The surface of the mini-implant was coated with a green-mediated silver nanoparticle. Uncoated mini-implants were placed in two groups of eight Wistar albino rats, and silver nanoparticle-coated mini-implants were placed in another eight rats. The bone's general conditions, blood biochemistry assessing for ALT, AST, GPT, GOT, and histological sections using H and E stain and Masson's Trichrome stain were examined at 7, 14, and 28-day intervals. RESULTS: The creatinine, urea, ALP, and ALT showed no signs of systemic toxicity during the 28-day follow-up period in the Wistar rats both in the test and control groups. The histological evaluation, which was conducted using HE and MTS stain, revealed osteogenesis and adequate healing of the insertion site in the group where coated mini-implant was placed. The bone sample revealed no abnormalities in the control group with uncoated mini-implants. CONCLUSION: Green synthesized silver nanoparticle-coated mini-implant does not cause systemic toxicity as indicated by no abnormalities in the levels of creatinine, urea, ALT, ALP, GPT, and GOT. The bone histology indicates that the coated mini-implants placed in animal bone healed with adequate osteogenesis. CLINICAL SIGNIFICANCE: Silver nanoparticles have potential for antimicrobial activity. Mini-implants placed as temporary anchorage devices in orthodontics often fail due to inflammation and plaque. Silver nanoparticle-coated mini-implants would reduce the risk of mini-implant failure as it would have antimicrobial potential and eliminate this cause for failure of mini-implants. How to cite this article: Sreenivasagan S, Subramanian AK, Mohanraj KG, et al. Assessment of Toxicity of Green Synthesized Silver Nanoparticle-coated Titanium Mini-implants with Uncoated Mini-implants: Comparison in an Animal Model Study. J Contemp Dent Pract 2023;24(12):944-950.

Assessment of Insertion Torque of Mini-implant and Its Correlation with Primary Stability and Pain Levels in Orthodontic Patients.

AIM: The aim of this study was to assess the insertion torque of the mini-implant used in orthodontic patients and to assess the correlation between the insertion torque, primary stability, and perception of pain in patients undergoing orthodontic therapy with mini-implant-augmented anchorage. MATERIAL AND METHODS: Among the patients undergoing orthodontic therapy, 31 samples who required mini-implant for anchorage purpose were selected. A total of 59 mini-implants were placed in these patients. This included interradicular mini-implants and extra-alveolar mini-screws. Immediately after placement, the insertion torque in all these was measured using a digital torque meter and primary stability was assessed by identifying any mobility of the implant placed. Primary stability was noted at two time intervals immediate post-placement and 1 week after that. All the mini-implants that were considered in this study were immediately loaded. Patients were asked to record any pain experienced on the visual analog scale (VAS) score sheet at 24 hours and 1 week post-placement. RESULTS: Among the mini-implants placed, those with 2 mm diameter needed higher placement torque, i.e., infrazygomatic crest mini-implants and buccal shelf mini-implants were placed with average placement torque of 10.08 and 10.25 N cm, respectively. Extra-alveolar screws caused more pain, especially higher in the mandible than the maxilla. Decrease in pain scores was noted from T0 to T1 in almost all the cases. CONCLUSION: Thicker mini-implant needed more insertion torque and highest insertion torque was recorded with extra-alveolar screws. No direct correlation could be obtained with the pain levels experienced by the patients and with the primary stability of the mini-implants. CLINICAL SIGNIFICANCE: Mini-implants placed with an insertion torque above the recommended range tend to fail and break more often. Patients placed with extra-alveolar bone screws reported more pain than that of the smaller-dimension mini-implant.

Photographic Frankfort plane subnasale pogonion (FSA) angle for assessment of anteroposterior discrepancies in malocclusion subjects: A prospective study.

INTRODUCTION: Anterior-posterior discrepancy assessment is a crucial component of orthodontic diagnosis and is often carried out using hard tissue cephalometric analysis. The purpose of this study was to compare the photographic Frankfort plane subnasale pogonion (FSA) angle with established cephalometric parameters to determine the accuracy of the angle in determining maxillomandibular anteroposterior discrepancies. MATERIALS AND METHODS: In this prospective study, a total of 60 subjects, 20 in each skeletal sagittal malocclusion, were included in the final sample based on the selection criteria. Both photographic and cephalometric records were taken, and the parameters assessed were the beta angle, Steiner's analysis, the ANB (A point- Nasion- B point) angle in the cephalograms, and the FSA angle in the profile photographs. Statistical analysis was done with SPSS software. The correlation between the measured parameters was assessed using Pearson's correlation test. RESULTS: A high positive and significant correlation between the FSA angle and beta angle (r = 0.793) was noted, and a high negative and significant correlation between the FSA angle and ANB angle (r = -0.848) was noted. CONCLUSION: The photographic FSA angle can be used as a reliable parameter to diagnose anteroposterior discrepancies.

Computed Tomographic Evaluation of Buccal Shelf Dimensions in South Indian Patients With Sagittal Skeletal Class III Malocclusion: A Retrospective Study.

Background Computed tomographic evaluation of mandibular buccal shelf region in skeletal class III malocclusion cone beam computed tomography (CBCT) studies have been reported to have great alteration in the thickness of mandibular buccal shelf region owing to the different growth patterns and ethnic variations. The aim of this study was to determine the total and cortical bone thickness in the mandibular buccal shelf (MBS) region for extra-alveolar mini-screw placement in South Indian patients with sagittal skeletal class III malocclusion. Material and methods This retrospective computed tomographic study consisted of archived files of the Dravidian population with class III skeletal base that met the eligibility criteria. The total bone and cortical bone thickness of the buccal shelf regions were evaluated in relation to three anatomical sites at various depths and angulations. One-way ANOVA and Tukey honestly significant difference (HSD) post hoc tests were used for statistical analysis. Pearson correlation coefficient was performed to compare if any relation existed between bone thickness and the growth pattern. Results The maximum bone thickness in the buccal shelf region in our study was found at the distal portion of the second molar root, 8-12 mm from its cementoenamel junction (CEJ) and at 30-45 ° angulation (p-value<0.005). There was a positive correlation between the hypo-divergent growth pattern and the thickness of the bone. Conclusion Based on the sites recorded, the preferred site for mini screw placement in Class III patients is the distobuccal cusp region with respect to the second molar at a depth of 8-12 mm and at angulation of 30-45 °. There was a moderate correlation with hypo-divergent growth patterns, suggestive of a wider and thicker mandibular buccal shelf region in these subjects.

Virtual Schooling in Dental Undergraduate and Postgraduate Education: A Knowledge, Attitude, and Practice (KAP) Survey.

Aim The purpose of this survey was to appraise the knowledge, attitude, and practice (KAP) of dental undergraduate and postgraduate students in India towards virtual learning and provide an improved understanding of practicing this learning strategy as a complementary tool for the evolution of dental education. Materials and methods A cross-sectional, closed-ended, multiple-choice online questionnaire was distributed on a national scale to undergraduate and postgraduate dental students throughout India. The questions focused on the choice of virtual platforms, learning methods, duration of classes, mental health, pros and cons, and approach to virtual education as a complementary tool in the future. The survey was distributed in the form of a web-based link and quick-response (QR) code via various social platforms. Descriptive statistics was performed to compile the data. Results  A total of 2130 students (1318 undergraduate and 812 postgraduate students) participated in the study. The study found that 81.1% of the undergraduate and 92.5% of the postgraduate students were exposed to virtual learning. Zoom and Google Meet were the most widely used platforms for online education. The most common mode of virtual learning was webinars conducted by subject faculties. Ease, comfort of access, and flexibility of time were the most common advantages, while internet connectivity issues along with negative psychological impact are a few common drawbacks. The concept of blended learning was most preferred by the students.  Conclusion Undergraduate and postgraduate students showed good knowledge and a positive attitude to virtual schooling and preferred a hybrid model of instruction.

Knowledge, attitude, and awareness toward orthodontic treatment among patients: A questionnaire survey.

The current study's objective is to learn more about how patients, depending on their gender, perceive, feel, and know about orthodontic therapy.There was a cross-sectional survey among 100 patients to evaluate their knowledge and attitude toward orthodontic treatment. The questionnaire was prepared and circulated among patients using online google forms. The online responses were collected and tabulation of the data was done in excel sheets. Data was analysed using statistical software. Chi square test to compare the association of gender and patients knowledge regarding orthodontic treatment. In the current study 53% of the study population had visited an orthodontist. 79.6% of the patients are conscious that their teeth can be aligned properly by an orthodontist. 73.5% think that teeth should be properly positioned for a better facial appearance. According to the findings in the present study, it is evident that there is awareness and understanding regarding the orthodontic treatment among patients.

Herbal-mediated preparation of nano-sized particles of selenium, its characterization, and evaluation of its antimicrobial activity.

This study aimed to synthesize selenium nanoparticles (SeNPs) using stevia plant leaves and to evaluate the antimicrobial effect of nano-sized particles of selenium. A new organic synthesis of nano-sized selenium particles was done in this study. In this study, stevia leaves for the synthesis of nano-sized particles along with sodium selenite were done. This mixture was mixed homogeneously using an orbital shaker overnight. The color change indicated the formation of SeNPs. The SeNPs were evaluated for their size and shape and their antimicrobial property was assessed. SeNPs showed excellent antimicrobial activity against Candida albicans at 100 µL concentration. At 25 µL and 50 µL, C. albicans showed intermediate susceptibility to SeNPs which also indicated a good antimicrobial potential. Following C. albicans, SeNPs showed good antimicrobial potential against Streptococcus mutans at all concentrations. SeNPs possessed good antimicrobial activity against most common oral pathogens.

Knowledge, attitude, and awareness on the protocols and trends in orthodontic retention among dental students.

This survey aimed at evaluating the knowledge and awareness regarding the various retention protocols used in orthodontic practice. A survey has been conducted among the dental students by circulating 15 close-ended questions online to analyze the data collected on the protocols and trends in orthodontic retention. The male and female distribution among the study population was evaluated, and the retention protocols used were computed; statistical analysis was performed using SPSS software. Ninety-four percent accepted that Hawley retainers are predominantly used compared to fixed retainers. Eighty-seven percent agreed that they aim at a more stable dentition by the completion of orthodontic treatment. The Chi-square test on the knowledge of respondents on the permanent retention to be followed after orthodontic treatment to close generalized spacing is statistically not significant, P = 0.056. Within the considered limitations, it is clear that there is awareness among the dentists regarding the use of a retention appliance to ensure stability at the finish of orthodontic treatment. But the protocol for the same remains variable. Further studies can be performed to identify the effectiveness of each of the different retention protocols and their indications in various cases.

Awareness on three-dimensional printing of orthodontic appliances among dental students.

The aim of the study was to evaluate the knowledge and awareness regarding the use of three-dimensional (3D)-printed appliances used in orthodontics among students pursuing dentistry. The distribution of the questionnaire was done using an online Google Forms link to about 100 dental students. The questionnaire compromised questions that were designed for assessing the various findings and knowledge of update, and finally, questions related to facts on various 3D-printing appliances. Among the total population, 58% of the population are aware of 3D printing used for various dental applications, whereas 42% of the population are not aware of the same. Among the total population, 58% of the population are aware of 3D printing used in dentistry, whereas 42% of the population are not aware of 3D printing used in dentistry. Inside the limits of the review, it very well may be inferred that 3D-printed machines have a rising use in the majority of the dental fields and understudies chasing after dentistry know about it. The knowledge about the basic and fundamental working and the usage of such appliances is developing among undergraduate students. Further continuing education programs can be provided to improve the same.

CBCT comparison of buccal shelf bone thickness in adult Dravidian population at various sites, depths and angulation - A retrospective study.

INTRODUCTION: It is important to understand the variations in the bone thickness of the buccal shelf region among different ethnic groups, as these variations will influence the placement and success of the buccal shelf mini-screw. OBJECTIVES: The primary objective was to analyse the total buccal bone and cortical bone thickness of the mandibular buccal shelf region (MBS) at various depths, mesiodistal positions and angulations in Dravidian population and to find the best site for insertion of buccal shelf mini-implant. MATERIAL AND METHODS: This was a retrospective study done on 30 cone-beam computed tomography samples collected from 30 subjects, aged 16 to 25 years and of Dravidian origin, who reported for orthodontic treatment. The total bone and cortical bone thicknesses of the buccal shelf regions were evaluated in relation to the Disto-Buccal cusp of 1st Molar (DB1M), Mesio-Buccal cusp of 1st Molar (MB1M), and Disto-Buccal cusp of 2nd Molar (DB2M) at the depths of 4mm, 8mm and 12mm from cemento-enamel junction (CEJ). The total bone thickness and the clearance from the root and cortical bone thickness were assessed at angulations of 30, 45 and 60 degrees from 5mm below the root apex. ANOVA and Post Hoc tests were done to compare the bone thickness measurements. Kappa statistics was done to assess the intraobserver reliability. Pearson's correlation test was done to find the correlation between growth pattern and thickness of the bone. RESULTS: The mean age group of the included sample was 20.5 years. Maximum total bone thickness was observed at a depth of 8mm in relation to the MB2M (6.41±0.29mm) and 12mm in relation to the DB2M 6.56±0.28mm and the P value was 0.000. Maximum bone thickness was present in the DB2M at 30° followed by DB2M 45° of 11.42±0.35mm and 10.89±0.3mm and the P value was 0.000. The maximum clearance from the root was observed at 30° and 45° in the DB2M with 5.35±0.2mm and 5.18±0.27mm, the P value was 0.014 when comparing angulation 30 and 45°. The DB2M had a cortical bone thickness of 2.97±0.15mm and 2.8±0.2mm at 45° and 60° and was statistically significant. CONCLUSIONS: The insertion site with optimal bone quantity was observed in relation to the buccal aspect of distobuccal cusp of 2nd molar at depth of 8mm or greater with a preferred angulation of 30-45° to have adequate clearance from the molar tooth roots and to penetrate a region of cortical bone of minimum 2mm.

FSA Angle: A Soft Tissue Approach for Assessing Sagittal Skeletal Discrepancy.

INTRODUCTION: Lateral cephalograms are taken as a diagnostic aid for the evaluation of the anteroposterior relationships. The assessment of anteroposterior soft tissue relationships is by using skeletal points and cranial reference planes. The anteroposterior relationships are, however, clinically affected by soft tissue structures. In this pilot study, we aim to assess the anteroposterior relationships based on soft tissue landmarks. MATERIALS AND METHODS: Lateral cephalograms were collected from 100 patients and evaluated on Facad software. The subject consisted of a mean age of 20 ± 7 years. Fifty-four cephalograms selected were used to perform the analysis. A new angle FSA was measured based on soft tissue landmarks. A new plane used for this analysis is the SA plane. Using this angle, we classified the cephalograms as class I, II, and III. RESULTS: There is a statistically significant value to differentiate the profile of patients using the FSA angle. Thus, this new angle is created to determine the anteroposterior soft tissue relationship using soft tissue landmarks on a cephalometric analysis and from our data, the value was 81 ± 7.57° for class 1 patients that is consistent with the previous studies which evaluate sagittal skeletal relationships. CONCLUSION: There are various difficulties and errors in the previous analysis that is used to determine the anteroposterior jaw relations. Skeletal landmarks have been used previously and most of these points are not stable points. Thus, this new analysis that will be using soft tissue landmarks can be used to differentiate in the various profiles of patients with different malocclusions. HOW TO CITE THIS ARTICLE: Sreenivasagan S, Sivakumar A. FSA Angle: A Soft Tissue Approach for Assessing Sagittal Skeletal Discrepancy. Int J Clin Pediatr Dent 2021;14(S-1):S54-S56.

Prevalence and Cause of Mini-Implant Failure Encountered by Orthodontic Residents.

This study was designed to increase understanding of mini-implants as well as causes of mini-implant complications and failure in orthodontic patients. Orthodontic case sheets were evaluated to identify retraction in mini-implant cases. Samples were taken and tabulated to determine causes and sites of mini-implant failure. The overall success rate of mini-implants over a period of 3 months postplacement follow-up was 83.5%, indicating that screw implants can be used for orthodontic anchorage. To minimize failure, clinicians should attempt to reduce inflammation around screw implants.

Variation in condylar morphology in different malocclusion among Indians.

Temporo-mandibular joint (TMJ) joint and the condyle of mandible are observed in the radiographs of the skull and the jaw. Therefore, it is of interest to assess the predictability of four different shapes of condyle in skeletal class I, II and III malocclusion. The four commonly visualized shapes are oval, bird beak, diamond and crooked were assessed using an ortho pantomogram (OPG). Each of the malocclusion was visualized for different shapes of the condyle. 987 OPGs were radiographically evaluated and the morphology of 1974 condylar heads was visualized. The shapes of the condyles were grouped under four different types. Data shows that oval shaped condyle was most common followed by bird beak. There was variability in the diamond and crooked shape and was lesser than the other types. Thus, the shapes of the condyle are useful predictable guide in deciding the nature of the occlusion.

Pain Perception Associated with Mini-Implants and Interventions for Pain Management: A Cross-Sectional Questionnaire-Based Survey.

BACKGROUND: Orthodontists use mini-implants temporarily as an effective mode of skeletal anchorage devices. The placement of mini-implants can cause pain and discomfort to the patients. Patients often develop swelling, and the pain could interfere with their daily activities. Practitioners tend to prescribe antibiotics and pain medication for management. OBJECTIVES: The main objectives of this study are to evaluate the pain perception and discomfort due to mini-implant placement experienced by the patient and evaluate the interventions for pain management commonly practiced among orthodontists. MATERIALS AND METHODS: The study was designed as a questionnaire-based cross-sectional study. A total of 271 patients were assessed, for whom 625 mini-implants (ranging from 1.2 to 2 mm diameter and length 8-14 mm) were placed. Pain scores were assessed using the VAS and the "Faces" pain rating scale to collect data about discomfort in daily activity and function. Data was collected from 244 patients. A total of 155 orthodontists were questioned regarding the prescription of medications and the interventions for managing pain and adverse effects. RESULTS: Average pain score among female subjects was 16.71 and among men was 13.5. The highest pain scores were recorded for palatal mini-implants with an average score of 36.29 and the least for interradicular mini-implants with an average score of 9.02. Among the subjects, 47.9% of them took analgesics, and the most commonly prescribed analgesics were paracetamol (39%). Swelling at the site is where the mini-implants were placed, and ulceration due to implants were commonly dealt with the excision of the surrounding soft tissue, composite placement, and palliative care with oral analgesic gels. CONCLUSION: Female subjects had more mini-implants placed, and female subjects had also given more pain scores than their male counterparts. Palatal mini-implants caused the highest pain, followed by mini-implants placed at the infrazygomatic crest and the buccal shelf region. Palatal mini-implants caused maximum discomfort during speech and eating, followed by the mini-implant in the buccal shelf and the infrazygomatic crest region that also caused difficulty in yawning and laughing. Infiltration anesthesia was commonly given for the placement of interradicular implants and extra-alveolar mini-implants. Paracetamol was the most prescribed by the orthodontists, and more than half the doctors did not regularly prescribe antibiotics.