Prevalence and factors influencing bullying among Egyptian schoolchildren.

OBJECTIVE: To evaluate the prevalence of bullying among schoolchildren and to study the correlation between bullying and a specific type of malocclusion, self-esteem, oral health-related quality of life (OHRQoL), the need for orthodontic treatment and socioeconomic status. DESIGN: A cross-sectional study. SETTING: Low, middle and high socioeconomic group schools in the same educational district in Cairo, Egypt. PARTICIPANTS: A total of 324 Egyptian schoolchildren aged 11-14 years. METHODS: Validated questionnaires were used to assess self-reported bullying frequency and intensity, self-esteem and OHRQoL. The Index of Orthodontic Treatment Need (IOTN) was used to assess the orthodontic treatment need and the participants' occlusion was classified according to the British Standard Incisors (BSI) classification. RESULTS: Bullying was found to be prevalent in 61.7% of the sample. Regression analysis revealed that participants with a Class II division 1 incisor relationship had the highest odds ratio (OR) for predicting bullying (OR = 1.86, 95% confidence interval [CI] = 1.38-2.15). Being bullied was significantly associated with lower self-esteem (OR = 0.47, 95% CI = 0.13-0.78), worse OHRQoL (OR = 2.73, 95% CI = 1.95-3.15) and a high need for orthodontic treatment, as determined by the IOTN Dental Health Component score (OR = 1.33, 95% CI = 1.05-1.95) and IOTN Aesthetic Component score (OR = 1.52, 95% CI = 1.12-1.88). Moreover, participants in high and middle socioeconomic groups had a lower OR for predicting bullying than those in the low socioeconomic group (OR = 0.27, 95% CI = 0.13-0.54). CONCLUSION: The bullying prevalence among Egyptian schoolchildren aged 11-14 years was very high. The prevalence of bullying was higher in schoolchildren with higher orthodontic treatment need and Class II division 1 incisor relationship. Bullying was correlated to poor self-esteem as well as poor OHRQoL. In addition, low socioeconomic status was found to be a potential predictor for bullying.

Position and root resorption of the incisors following anterior segment retraction using friction versus frictionless mechanics: A randomised controlled trial.

AIM: To evaluate the three-dimensional position and root resorption of incisors after anterior segment retraction (ASR) using friction versus frictionless mechanics. PARTICIPANTS AND METHODS: Thirty female patients (13-18 years) with bimaxillary protrusion were randomly allocated into two groups. In the intervention group, ASR was undertaken using an elastomeric chain rendering 160 g/side extending between mini-screw implant and a hook crimped on 0.017 × 0.025-inch stainless-steel wire distal to the lateral incisor. In the comparison group, ASR was undertaken using closing T-loops fabricated from 0.017 × 0.025-inch titanium molybdenum alloy (TMA) wire rendering comparable retraction force. In both groups, the canine brackets were ligated after retraction to the mini-screw implants that were inserted in both the upper and lower arches bilaterally. The primary outcome was the three-dimensional changes in the position of the incisors. The secondary outcome was root resorption. These were measured from cone-beam computed tomography scans. RESULTS: Statistically significant decreases in the upper (UI) and lower incisors (LI) crown torque were seen in both groups; however, the difference between groups was not statistically or clinically significant (UI MD -2.04°; 95% confidence interval [CI] = -8.02-3.95; LI MD -0.49°; 95% CI = -7.06-6.08). Significant tipping of upper (MD -1.17°; 95% CI = -2.06--0.27) and lower (MD -1.13°; 95% CI = -1.66--0.60) incisors was found in the friction, but not the frictionless group after retraction; however, the changes were not clinically significant. Significant lower incisor intrusion was found in both groups after retraction; however, the difference between groups was not statistically or clinically significant (MD -0.61°; 95% CI = -1.99-0.77). Statistically significant decreases in the UI and LI root length were seen in both groups. The difference between groups for UI changes was statistically significant (MD 0.54 mm; 95% CI = -0.02-1.07) but probably not clinically significant. CONCLUSION: Considering the limitations in the current study, there was no advantage of either mechanics over the other regarding the final position of incisors. The likelihood of root resorption should be considered when frictionless mechanics are used for retraction of incisors. REGISTRY: Clinicaltrials.gov (NCT04878939).

Evaluation of the efficiency of computerized algorithms to formulate a decision support system for deepbite treatment planning.

INTRODUCTION: This study aimed to evaluate the efficiency of a newly constructed computer-based decision support system (DSS) on the basis of artificial intelligence technology and designed to plan treatment for patients with a deep overbite. METHODS: With the help of information technology, a DSS was developed specifically for treatment planning of deepbite malocclusion. The program inputs were the components and the contributing factors used commonly by the orthodontic clinicians in deepbite diagnosis. The program outputs were the treatment planning options for deepbite treatment. A total of 357 decisions made by the algorithm were evaluated for accuracy by comparing them to the actual treatment changes of 51 patients with a well-treated deepbite. RESULTS: The decisions made by the algorithm were precise, with 94.4% having a very good agreement with actual treatment changes determined using Cohen's kappa coefficient. CONCLUSIONS: The constructed DSS was shown to be an efficient tool for planning treatment of deep overbite malocclusion in the permanent dentition; thus, the artificial intelligence could be used to formulate a customized plan for orthodontic clinicians.

LEAN SIX SIGMA TECHNIQUES TO IMPROVE OPHTHALMOLOGY CLINIC EFFICIENCY.

PURPOSE: Ophthalmologists serve an increasing volume of a growing elderly population undergoing increasingly complex outpatient medical care, including extensive diagnostic testing and treatment. The resulting prolonged patient visit times ("patient flow times") limit quality, patient and employee satisfaction, and represent waste. Lean Six Sigma process improvement was used in a vitreoretinal practice to decrease patient flow time, demonstrating that this approach can yield significant improvement in health care. METHODS: Process flow maps were created to determine the most common care pathways within clinic. Three months' visits from the electronic medical record system, which tracks patient task times at each process step in the office were collected. Care tasks and care pathways consuming the greatest time and variation were identified and modified. Follow-up analysis from 6 weeks' visits was conducted to assess improvement. RESULTS: Nearly all patients took one of five paths through the office. Patient flow was redesigned to reduce waiting room time by having staff members immediately start patients into one of those five paths; staffing was adjusted to address high demand tasks, and scheduling was optimized around derived predictors of patient flow times. Follow-up analysis revealed a statistically significant decline in mean patient flow time by 18% and inpatient flow time SD by 4.6%. Patient and employee satisfaction scores improved. CONCLUSION: Manufacturing industry techniques, such as Lean and Six Sigma, can be used to improve patient care, minimize waste, and enhance patient and staff satisfaction in outpatient clinics.

Three-dimensional imaging for indirect-direct bonding.

The aim of this article is to introduce a new concept of bracket positioning with special consideration to root axes. Cone-beam computed tomography imaging and computer-aided manufacturing were used to produce stereolithographic trays for indirect-direct bonding.

Corticotomy-facilitated orthodontics using piezosurgery versus rotary instruments: an experimental study.

OBJECTIVE: The aim of this study was to evaluate corticotomy-facilitated orthodontics (CFO) using piezosurgery versus conventional rotary instruments. MATERIALS AND METHODS: Ten healthy adult male mongrel dogs of comparable age with a complete set of permanent dentition with average weights between 13-17 kilograms were used. CFO using conventional rotary instruments versus piezosurgery was performed on each dog in a split mouth design. For every dog, mandibular 2nd premolar retraction on each side was attempted after extracting 3rd premolars followed by corticotomy-facilitated orthodontics using conventional rotary surgical burs on the left side and an ultrasonic piezosurgery system on the right side of the same animal. Intraoral measurements of the rate of tooth movement were taken with a sliding caliper. Measurements were performed by the same operator at the time of surgery (appliance delivery) and every month for six months. The dogs were sacrificed after six months from initiation of tooth movement to evaluate the amount of tooth movement for both conventional rotary and piezosurgery corticotomy techniques. RESULTS: A statistically significantly higher mean amount of tooth movement for conventional rotary instrument versus the piezosurgery corticotomy technique was observed at all time intervals. CONCLUSIONS: Tooth movement was 1.6 times faster when CFO was done using conventional rotary instruments as compared to a piezosurgery device.

Virtual techniques for designing and fabricating a retainer.

The purpose of this article was to report a procedure for using 3-dimensional cone-beam computed tomography imaging, computer-aided design, computer-aided manufacturing, and rapid prototyping to design and produce a retainer.

Digitization and validation of the open bite checklist manifesto: a step toward artificial intelligence.

OBJECTIVES: To introduce and validate newly designed computer software to aid in the diagnosis of anterior open bite (AOB). MATERIALS AND METHODS: The software was constructed based on the algorithm of a standardized open bite checklist, which considered skeletal, dental, and soft tissue components, as well as smile characteristics. Feeding the software with this input yielded a digital form output (DFO) in the guise of a diagnostic report characterizing the AOB phenotype, contributing components, severity, associated problems, and functional factors. For validation, DFO was compared to a conventional form output (CFO), created in a standardized manner according to expert opinions. Agreement between the DFO and CFO in terms of AOB phenotype was the primary outcome, while the secondary outcome was the number of missing diagnostic components in either method. RESULTS: Percentage of agreement between CFO and DFO was 82.2%, with a kappa coefficient of 0.78, which is considered a good level of agreement. There was a statistically significant relationship between the number of missing diagnostic components in CFO and level of disagreement, which rendered the DFO more reliable. CONCLUSIONS: Newly constructed software represents an efficient and valid diagnostic tool for AOB and its contributing components. There was good agreement between CFO and DFO, with the latter being more comprehensive and reliable. The algorithm built in the software can be used as the basis for a future artificial intelligence model to aid in the diagnosis of AOB.

Evaluation of anchorage loss after en masse retraction in orthodontic patients with maxillary protrusion using friction vs frictionless mechanics: randomized clinical trial.

OBJECTIVES: To evaluate anchorage loss after en masse retraction in bimaxillary dentoalveolar protrusion patients using friction vs frictionless mechanics. MATERIALS AND METHODS: Thirty patients with bimaxillary dentoalveolar protrusion needing extraction of upper first premolars and en masse retraction with maximum anchorage were included in this two-arm, parallel, single-center, single-blinded randomized clinical trial with a 1:1 allocation ratio using fully sealed opaque envelopes. Friction group retraction utilized elastomeric power chain between miniscrews and hooks crimped mesial to upper canines on 17 × 25 stainless steel archwire. Frictionless group used customized T-loop springs loading upper first molars indirectly anchored to miniscrews. Activation was every 4 weeks until full retraction. The primary outcome assessed was anchorage loss evaluated at cusp tip and root apex of the first molar. First molar rotation, incisor tip and torque, and root resorption of anterior teeth were evaluated on digital models and cone beam computed tomography taken before and after space closure. RESULTS: Anchorage loss at crown of first molar was significantly more in frictionless group by 2.1 mm (95% CI = -0.4 to 3.5), (P = .014), while there was no significant difference in anchorage loss at root apex between groups. Significant mesial in molar rotation of 6.672° (95% CI = 12.2-21.2), (P = 0.02) was greater in the frictionless group. Both groups showed comparable tip, torque, and root resorption values. No severe harms were reported. There was mild gingival overgrowth and inflammation in the frictionless group due to T-loop irritation. CONCLUSIONS: Extra anchorage considerations are needed during en masse retraction when frictionless mechanics is implemented as higher anchorage loss and molar rotation were detected. No difference in tip, torque, and root resorption was observed.

Organoclay-assisted disperse dyeing of polypropylene nanocomposite fabrics in supercritical carbon dioxide.

Dyeing using supercritical carbon dioxide (SC-CO2) is carried out on the polypropylene (PP) nanocomposite fabrics with model disperse dye compared with their regular fabric at various dyeing temperatures and pressures. The results are compared with those obtained in aqueous dyeing method. The PP nanocompsite fabrics dyed in SC-CO2 medium exhibited higher colour strength (K/S) values compared with their PP regular fabric. The PP nanocompsite fabrics and their regular fabric dyed in SC-CO2 medium have higher K/S values than those dyed in aqueous medium. The color coordinates of all PP fabrics dyed in SC-CO2 and aqueous medium were positive with respect to a* and b* coordinates depending on the disperse red dye uptake. The PP nanocomposite fabrics dyed in SC-CO2 and aqueous medium exhibited higher antibacterial properties than their regular fabrics. All PP fabrics dyed in SC-CO2 and aqueous medium present very good washing, perspiration and light fastness.

Volumetric changes of the nose and nasal airway 2 years after tooth-borne and bone-borne surgically assisted rapid maxillary expansion.

This study aimed to assess the effects of bone-borne and tooth-borne surgically assisted rapid maxillary expansion on the volumes of the nose and nasal airway 2 yr after maxillary expansion. This prospective cohort study included 32 patients with transverse maxillary hypoplasia. Expansion was performed with a tooth-borne distractor (Hyrax) in 19 patients and with a bone-borne distractor [transpalatal distractor (TPD)] in the remaining 13. Cone beam computed tomography scans and three-dimensional (3D) photographs of the face were acquired before treatment and 22 ± 7 months later, and were used to evaluate the volumes of the nose and nasal airway. Nasal volume increased by 1.01 ± 1.6% in the Hyrax group and by 2.39 ± 2.4% in the TPD group. Nasal airway volume increased by 9.7 ± 5.6% in the Hyrax group and by 12.9 ± 12.7% in the TPD group. Changes in the nasal volume and in the nasal airway volume between the pre- and post-treatment measurements were statistically significant, whereas differences between the treatment groups were not; 22 months after surgically assisted rapid maxillary expansion, the increases in the nasal volume and in the nasal airway volume were comparable between tooth-borne and bone-borne devices.

Three-dimensional evaluation of soft tissue changes in the orofacial region after tooth-borne and bone-borne surgically assisted rapid maxillary expansion.

OBJECTIVES: This study seeks to three-dimensionally assess soft tissue changes in the orofacial region following tooth-borne and bone-borne surgically assisted rapid maxillary expansion (SARME). MATERIALS AND METHODS: This prospective cohort study included 40 skeletally mature patients with transverse maxillary hypoplasia. A tooth-borne distractor (Hyrax) was used for expansion in 25 patients. In the remaining 15, a bone-borne distractor (transpalatal distractor, TPD) was used. Cone beam computed tomography (CBCT) scans were acquired before treatment (T0) and 22 months later (T1). 3D models were constructed from CBCT data and superimposed using voxel-based matching. Distance maps between the superimposed 3D models were computed to evaluate the degree of skeletal and soft tissue changes in the maxillary region. RESULTS: Distance maps showed negative distances (mean -1.25 (±1.5) mm) in the middle of the upper lip, indicating posterior repositioning of this area. The cheek region showed positive changes (mean 1.66 (±1.1) mm), reflecting the underlying increase in maxillary width. There was no significant difference between the two groups in all measured distances (p > 0.05). Retro-positioning of the upper lip accompanied skeletal remodeling in the anterior alveolar region at a mean ratio of 88 %, while the cheek region followed 32 % of the alveolar expansion. CONCLUSION: Soft tissue changes following SARME include posterior repositioning of the upper lip and increased projection of the cheek area. These changes were comparable between bone-borne and tooth-borne appliances. CLINICAL RELEVANCE: This study provides clinicians with more information over the expected orofacial soft tissue changes following SARME.

Dual mapping of MTHFR C677T (A1298C) and BDNF G196A (Val66Met) polymorphisms in patients with diabetic peripheral neuropathy.

OBJECTIVE: Diabetic peripheral neuropathy (DPN) is a loss of distal sensory function in the lower limbs that is accompanied by pain and severe morbidity. The goal of this study was to perform a screening of the MTHFR C677T (A1298C) and BDNF G196A (Val66Met) polymorphisms and determine their possible relationships using biochemical blood tests and clinical presentations of symptoms in Jordanian patients with DPN. PATIENTS AND METHODS: A cross-sectional study was conducted, and medical records were used to identify and recruit patients with DPN and collect their demographic and clinical characteristics. The total neuropathy score (TNSr) was used to assess the severity of sensory symptoms. In addition, direct sequencing was performed after Polymerase Chain Reaction (PCR) amplification to screen the two single nucleotide polymorphisms (SNPs) of interest. RESULTS: Ninety patients with DPN participated in the study. The MTHFR-SNP variant (CT) and (TT) genotypes were identified in 39 (43.3%) and 19 (21.1%) patients, respectively. On the other hand, the BDNF-SNP variant (GA) and (AA) genotypes were identified in 22 (24.4%) and 11 (12.2%) patients, respectively. The distributions of the genotype frequencies of the MTHFR-SNP and BDNF-SNP variants statistically differed between patients with DPN and the control group (p < 0.0001, p < 0.002). Moreover, patients carrying variant genotypes of the two analyzed SNPs were more likely to have unsatisfactory HbA1c levels (> 7 mg/dl, p = 0.029) and moderate to severe symptoms (TNSr score 8-24). CONCLUSIONS: The results of this study show that the MTHFR C>T-677 SNP and the BDNF G>A-196 SNP can be used as genetic risk markers for DPN. Assessing patients' genetic-metabolic risk profiles is recommended for providing personalized treatment.

Skeletal maturation in different anteroposterior and vertical skeletal growth patterns in female subjects.

PURPOSE: The aim of the present work was to study the sequence of skeletal maturation in the various anteroposterior and vertical skeletal growth patterns and to detect whether differences existed between them. METHODS: Cephalograms of 861 growing and adolescent female patients were traced to categorize the subjects into 9 skeletal patterns. Each subject was assigned a skeletal maturational stage. Analysis of variance (ANOVA) followed by Bonferroni test were used to detect differences in the onset of the three growth stages (prepubertal, pubertal and postpubertal) between the 9 groups. The same statistical methods were used to detect differences between the mean ages at the three growth stages within each group. RESULTS: No statistically significant differences were found between the mean ages of pubertal and postpubertal growth stages between the 9 skeletal patterns. However, class III growers had a significantly earlier onset of prepubertal growth (10.25 ± 1.56 years) when compared to that of class II high angle cases (11.11 ± 1.67 years; P < 0.01). Also, significant differences were found between the mean ages at the three growth stages within the groups. CONCLUSION: A map was created defining the sequence of skeletal maturation for each skeletal growth pattern. This map defines clinically relevant differences in the starting time points and the optimum intervals of growth modification for each skeletal growth pattern.

Implant-supported canine retraction using different reactivation intervals of elastomeric chains: A CBCT-based split-mouth randomized controlled trial.

INTRODUCTION: Orthodontists attempt to maximize treatment efficiency regarding time, tooth position and adverse effects. A new approach, not yet explored, is the activation frequency. OBJECTIVE: The aim of this split-mouth randomized controlled trial was to evaluate the effect of reactivation intervals on the efficiency of tooth movement. METHODS: Thirty eight patients having a Class I malocclusion with bimaxillary dentoalveolar protrusion or severe crowding, Class II with mandibular deficiency or Class III, requiring first premolar extraction and canine retraction were recruited. Elastomeric chains producing 150g were replaced every two, four, six or eight weeks. There were 36, 37, 36, and 36 quadrants randomly allocated to these groups, respectively. The canine retraction rate was the primary outcome. Canine tipping, rotation, and root resorption and pain were the secondary outcomes. Only the outcome assessors were blinded to group assignment. RESULTS: The average total movement for the 6 months was 5.14, 5.31, 2.79 and 3.85 mm for the two-week, four-week, six-week and eight-week reactivation intervals, respectively. Root resorption was significantly higher in the two-week and four-week groups. No adverse events were observed. CONCLUSION: The canine retraction rate, tipping, rotation and pain were similar in 2, 4, 6 and 8-week activation intervals groups. Longer reactivation intervals show less root resorption. The trial protocol was not pre-registered. The study was self-funded.