Buccal Segment Research Articles

Are zygomatic implants an alternative to orthognathic surgery in the treatment of a vertical discrepancy ? A case series to describe an open bite treatment protocol

IntroductionThis report aims to present case series to describe a treatment protocol for correction of severe open bite in non-growing patients MethodologyPatients diagnosed with skeletal open bite malocclusion (overbite range: -3 to -6 mm) were treated using a bonded appliance and skeletal anchorage. Intrusive force was applied between buccal bars of appliance and zygomatic multipurpose implants (MPI). Intrusion was continued until positive overbite occurred. Treatment progressed with conventional fixed orthodontic treatment for alignment and settling. MPIs were retained until the end of treatment for retention of intrusion ResultsClinically effective open bite correction was achieved by intrusion of maxillary buccal segment and mandibular counterclockwise autorotation ConclusionThis protocol includes zygomatic anchorage and an appliance that aims triple intrusion effect through combination of orthodontic and physiological forces. Achieving significant maxillary intrusion, controlling mandibular eruption and maximizing mandibular counterclockwise autorotation are the main outcomes of this protocol.

Class III correction and enhanced periodontal health with aligner treatment in a 53-year-old patient.

In this case report, we describe the successful camouflage treatment of a 53-year-old female with dental and skeletal Class III malocclusion combined with anterior crossbite, gingival recession, and mobility of the lower incisors, using clear aligners. The treatment involved periodontal debridement followed by orthodontic treatment. The mandibular posterior teeth were distalized to correct the anterior crossbite and to establish Class I molar relationships. During treatment, the mandibular incisors were intruded, and the mandibular occlusal plane underwent a clockwise rotation due to slight extrusion of the maxillary buccal segments and distalization of the mandibular posterior teeth. Following treatment, all objectives were achieved, including resolution of the anterior crossbite, significant reduction of gingival recession and tooth mobility, and improved functional occlusion. The dental and skeletal Class III malocclusion was corrected, and the marginal alveolar bone dehiscence was significantly reduced. The results remained stable over a 3-year retention period, with enhanced molar intercuspation and gingival growth progression. This case adds to the evidence supporting the adaptability and effectiveness of clear aligners in treating orthodontic patients with compromised periodontium. The treatment outcomes support that orthodontic treatment using clear aligners, combined with periodontal monitoring, can assist in managing alveolar bone defects, gingival recession, and tooth mobility.

Orthodontic treatment protocol versus Peer Assessment Rating: Assessing the quality of orthodontic treatment.

To apply the Peer Assessment Rating (PAR) to cases that have been assessed by the NHS Business Service Authority (NHSBSA) using the orthodontic treatment protocol (OTO), then compare the NHSBSA outcome assessment with weighted (W) and unweighted (U) PAR scores. Cross-sectional study. UK. Anonymised orthodontic cases submitted to the NHSBSA. A sample of 30 reports from 2021/2022 were randomly selected to include different standard of treatment grades. The records were de-identified and the pre- and post-treatment study models were PAR scored by a calibrated assessor. The mean percentage change in PAR was higher in cases from green reports (W: 78%; U: 79%) than amber (W: 68%; U: 67%) and red reports (W: 65%; U: 65%). Alignment and poor buccal segment interdigitation were the most reported concerns for cases included in the red and amber graded reports. A residual increased overjet was the most common occlusal feature leading to PAR scores not being more than 70% improved. Only slight agreement was shown between OTP and PAR using the kappa statistic, and the chi-square statistical test found that outcome measures are statistically significantly different. There are fundamental differences between OTP and PAR, and general agreement between them has not been demonstrated. The NHSBSA Report provides a more critical outcome assessment than PAR, identifying elements that are not assessed or measured by the PAR index.

CBCT Evaluation of Alveolar Bone Change and Root Resorption after Orthodontic Treatment: A Retrospective Study.

For years, there has been a long debate about the impact of orthodontic treatment on the periodontium of patients. Therefore, it is important to understand the effects of orthodontic forces on the periodontium. The objective of this study was to evaluate the height of the alveolar bone at the four surfaces of specific teeth and the root length of the central incisors before and after orthodontic treatment. CBCTs from a group of fifty patients were evaluated before (T0) and after orthodontic treatment (T1). Evaluations of the alveolar bone were performed by measuring the distance from the most apical point of the marginal portion to the CEJ at the buccal (B-ABL), lingual (L-ABL), mesial (M-ABL), and distal (D-ABL) surfaces of the central incisor (CI), first premolar (1st PM), and first molar (1st M). Meanwhile, root resorptions were evaluated by measuring the distance from the center of the tooth at the CEJ to the most apical point of the central incisor. The reduction in the alveolar bone level was highest at the buccal segment (75%) and lowest at the distal (42%) segment, although the decrease was not statistically significant. Root resorption, in terms of reduction in the total length, was detected in the upper central incisor. Fixed orthodontic treatment can produce a significant reduction in root length, but not at the level of the alveolar bone.

Evaluating malocclusion patterns in children with autism spectrum disorder using the index of complexity, outcome and need: a cross-sectional study

BackgroundThe purpose of this study was to evaluate the complexity of malocclusion and existing patterns in children with autism spectrum disorders (ASD) using the index of complexity, outcome and need (ICON).MethodsThis cross-sectional study included children diagnosed with ASD, aged 9–15 years. A group of healthy children with the same demographic characteristics was randomly selected as the control group. Malocclusion was assessed according to ICON scoring protocol. The following parameters were recorded: dental aesthetics, upper arch crowding/spacing, presence of crossbite, anterior-vertical relationship (open and deep bite) and buccal segment anterior-posterior relationship. Finally, an overall ICON score was derived and reported for each patient. Descriptive analysis was performed for all investigated variables. Significance level was set at p < 0.05.ResultsA total of 324 children, divided into ASD (162) and control (162) groups, comprised the study population. Our results demonstrated that the average overall ICON score was significantly higher in the ASD group compared to the control group (38.77 vs. 27.43, p < 0.001). ASD children also obtained significantly higher scores regarding the dental aesthetics component (3.84 vs 2.78, p < 0.001). Study groups were significantly different in terms of the prevalence of incisor overbite and open bite (p = 0.002 and p < 0.001, respectively). Patients in the ASD group showed a higher prevalence of Class II and Class III malocclusions (p < 0.001).ConclusionASD children obtained significantly higher overall ICON scores, indicating more complex and severe malocclusions. These children also exhibited a greater tendency towards Class II and III malocclusions.

Development of an Instrument for the Online Evaluation of Orthodontic-Treated Cases: A Pilot Study

Background: It is necessary to create a sound method for the optimal evaluation of treated cases of orthodontic board exam candidates. This cross-sectional study aimed to design and validate a new method for the national orthodontic board exam using a web-based program. Methods: Complete documents of 10 patients randomly selected from a pool of the previously presented cases at the national board examination were entered into a web-based program called "the Orthoboard". The documents were arranged according to the European Board of Orthodontist Standards, and 15 related questions were asked based on the index of complexity, outcome, and need index and the American Board of Orthodontics evaluation standards. A customized grading system was used for the finalized questionnaire. They were asked to be evaluated by 10 orthodontists (5 with less and 5 with more than 10 years of experience). The content validity of the questionnaire was analyzed by the content validity index and content validity ratio. The reliability of this questionnaire was measured using the Kappa statistical test. Results: Most evaluators do not consider it necessary to ask questions about the diagnostic resume, problem list, treatment plan, and treatment resume. Crowding after treatment and cross-biting before and after treatment had the best interexaminer reliability. The least agreement among examiners was between the pre-treatment aesthetic index and the pre-treatment buccal segment relationship. Conclusion: Inter-examiner reliability was lower than expected, indicating that the orthodontic board test scoring is too subjective. The addition of a 3-dimensional cast is recommended for better objective evaluation.

Cephalometric and digital model analysis of dentoskeletal effects of infrazygomatic miniscrew vs. Essix- anchored Carriere Motion appliance for distalization of maxillary buccal segment: a randomized clinical trial

Trial designParallel.ObjectiveTo compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA.MethodsThirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed.ResultsDistalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups.ConclusionIZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation.Trial registrationThe ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022.

Evaluation of Two Bone Anchored Appliances During En Masse Distalization of Maxillary Buccal Segment with Class II Patients; A Comparative Clinical Study

Objective: to assess quality of orthodontic tooth movement during distalization by two different skeletally anchored distalizing appliances. Patients and methods: the current study was applied on 22 orthodontic patients with class ΙΙ molar relationship. Patients were divided into two active groups; group Ι: include 11 patients treated by modified sagittal screw distalizer and group ΙΙ: include 11 patients treated by modified distal jet distalizer. Quality of distalization was assessed by the following measurements; first and second premolars root horizontal distance (mm), first and second molars root horizontal distance(mm), SNA, SNB, U1 to FH. Results: The highest change (%) in first molar root horizontal distance (mm) was recorded in group II with a decrease by -11.5 % in the left side and -11.4 % in the right side. Conclusion: Bone anchored Distal Jet and modified Sagittal screw distalizer provide an effective tool for treating mild to moderate class II malocclusion. But the modified distal jet produces high quality of distalization than the modified Sagittal screw distalizer.

Heritability of dental arches and occlusal characteristics: a systematic review and meta-analysis.

The genetic basis of dentoalveolar characteristics has been investigated by several studies, however, the findings are equivocal. The objective of this systematic review and meta-analysis was to evaluate the heritability of dental arches and occlusal parameters in different stages of human dentition. Electronic databases PubMed, Embase, Scopus, Web of Science, and Dentistry and Oral Science Source were searched up to August 2023 without the restriction of language or publication date. Empirical studies investigating the heritability of dentoalveolar parameters among twins and siblings were included in the review. Study selection, data extraction, and risk of bias assessment were performed independently and in duplicate by two authors and a third author resolved conflicts if needed. Joanna Briggs Institute's critical appraisal tool was used to evaluate the risk of bias among studies and the certainty of evidence was assessed using the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) criteria. Twenty-eight studies were included in the systematic review, of which 15 studies reporting heritability coefficients in the permanent dentition stages were deemed suitable for the meta-analysis. Random-effects meta-analyses showed high heritability estimates for maxillary intermolar width (0.52), maxillary intercanine width (0.54), mandibular intermolar width (0.55), mandibular intercanine width (0.55), maxillary arch length (0.76), mandibular arch length (0.57), and palatal depth (0.56). The heritability estimates for the occlusal parameters varied considerably, with relatively moderate values for crossbite (0.46) and overbite (0.44) and low values for buccal segment relationship (0.32), overjet (0.22), and rotation and displacement of teeth (0.16). However, the certainty of evidence for most of the outcomes was low according to the GRADE criteria. Based on the available evidence, it can be concluded that the dental arch dimensions have a high heritability while the occlusal parameters demonstrate a moderate to low heritability. PROSPERO (CRD42022358442).

Reestablishment of the Smile after Hypoglossal-Facial Nerve Transfer: What Can We Learn?

Objective The aim of this study was to assess the ability to smile following a hypoglossal-facial nerve transfer (N12-N7). Design This is a retrospective chart review. Setting National tertiary referral center for skull base pathology. Participants Seventeen patients. Main Outcome Measures The ability to smile following an N12-N7 transfer was assessed by five medical doctors on photographs of the whole face and frontal, orbital, and oral segments. The (segmented) photographs were scored for the symmetry, asymmetry, and correct or incorrect assessment of the affected side. Results Seventeen patients were analyzed by 5 assessors providing 85 assessments. The whole face at rest was judged symmetrical in 26% of the cases and mildly asymmetrical in 56%. Frontal, orbital, and oral segments were symmetrical in 63, 20, and 35%, respectively. The affected side was correctly identified in 76%. When smiling, the whole face was symmetrical in 6% and mildly asymmetric in 59%. The affected side was correctly identified in 94%. The frontal, orbital, and oral segments during smiling were symmetrical in 67, 15, and 6%, respectively. The affected side of the frontal, orbital, and buccal facial segments during smiling was correctly identified in 89, 89, and 96%, respectively. Interobserver variability with Fleiss' kappa analysis showed that the strength of the agreement during smile of the total face was good (0.771) Conclusion Following an N12-N7 transfer, a good facial symmetry at rest can be achieved. During smiling, almost all patients showed asymmetry of the face, which was predominantly determined by the orbital and oral segments. To improve the ability to smile after an N12-N7 transfer, additional procedures are needed.

Evaluating the Effect of Sumac Extract on Dentine Micro-Hardness during pH Cycling.

Although sumac extract (SE) is reported as a collagen cross linker, the available data regarding its effect on the dentine micro-hardness is quite sparse. Therefore, the aim of this study includes evaluating the effect of different concentrations of SE on dentine micro-hardness comparing to grape seed extract (GSE). In this experimental study, the GSE was purchased from available market and convert to 5% solution. Meanwhile the 5, 10, and 20% of SE solutions were prepared experimentally. The base line micro-hardness of 60 samples (30 premolars divided to buccal and lingual segments) was recorded triplicate for each specimen and they were randomly divided into 5 groups (four abovementioned experimental solutions and de-ionized water as negative control). For 35 consecutive days, each sample was twice pH cycled and treated by solutions. Ultimately, the final micro-hardness was recorded triplicate again for each sample and the numerical data was compared with each other using one-way ANOVA and Tukey HSD Post Hoc tests (α=0.05). The meanSD values of micro-hardness for the groups was recorded as 54.45 13.4, 65.6518.5, 39.572.26, 41.131.66 and 43.794.96 at base line and 10.40.99, 11.85 0.75, 10.161.84, 8.481.16 and 6.311.01 at final stage for control, GSE 5%, SE 5%, SE 10% and SE 20% respectively. There was no significant difference among the micro-hardness of the groups before treatment (p= 0.369). However, after experimental treatment, there was significant difference between the groups (p= 0.024) while in pairwise comparison just two groups (GSE 5% and SE 20%) had significant difference with each other (p= 0.017). The efficacy of SE was reversely related to its concentration. Moreover, neither GSE nor SE had significant effect on dentine micro-hardness after 35 day pH cycling.

Refining the Anatomy of Percutaneous Trigeminal Rhizotomy: A Cadaveric, Radiological, and Surgical Study.

Percutaneous trigeminal rhizotomy (PTR) is a widely used procedure for trigeminal neuralgia. However, comprehensive analyses that combine anatomic, radiological, and surgical considerations are rare. To present high-quality anatomic dissections and radiological studies that highlight the technical nuances of this procedure. Six silicon-injected postmortem heads underwent PTR. The surgical corridors were dissected, and the neurovascular relationships were studied. In addition, 20 dried human skulls and 50 computed tomography angiography and MRI scans were collected to study the anatomic relationships for a customized puncture corridor. The PTR corridor was divided into 3 segments: the buccal segment (length, 34.76 ± 7.20 mm), the inferior temporal fossa segment (length, 42.06 ± 6.92 mm), and the Meckel cave segment (length, 24.75 ± 3.34 mm). The puncture sagittal (α) and axial (β) angles measured in this study were 38.32° ± 4.62° and 19.13° ± 2.82°, respectively. The precondylar reference line coincided with the foramen ovale in 75% of the computed tomography angiography scans, and the postcondylar line coincided with the carotid canal in 70% of the computed tomography angiography scans; these lines serve as the intraoperative landmarks for PTR. The ovale-carotid-pterygoid triangle, delineated by drawing a line from the foramen ovale to the carotid canal and the lateral pterygoid plate, is a distinguished landmark to use for avoiding neurovascular injury during fluoroscopy. Knowledge of the anatomic and radiological features of PTR is essential for a successful surgery, and a customized technical flow is a safe and effective way to access the foramen ovale.

Bracket positioning in orthodontics: Past and present

Bracket positioning is a fundamental aspect of orthodontics, resulting in force delivery in three planes of space using the straight wire appliance. Ideal bracket placement aims to achieve esthetic and functional tooth position, with a consonant smile arc, as well as level marginal ridges and interdigitated buccal segments. Variation in bracket positioning alters the expression of the prescription of the straight wire appliance, and consequently tooth position in three planes of space. A variety of approaches have been proposed for ideal bracket positioning, however, shortcomings are evident and detailed in this paper, which reviews the different positioning methods and identifies their shortcomings. Described is a new method of bracket positioning, Smile Arc and Marginal Ridge Approach (SAMRA), designed to achieve the goals of bracket positioning consistently and reliably.

The acquired anterior open bite: possible aetiologies and management strategies

An anterior open bite (AOB) is present when there is no vertical overlap between the upper and lower incisors when the buccal segment teeth are in occlusion, and most commonly develops during childhood. This article presents a series of cases in which an AOB has developed in adulthood, together with a discussion of potential aetiological factors and management strategies. CPD/Clinical Relevance: A review of the potential causes, presentation and management of the anterior open bite, applicable to clinicians in primary and secondary care

Gambaran Tingkat Keberhasilan Perawatan Ortodonti di Klinik Ortodonti RSGM-P FK Usakti Berdasarkan Indeks PAR (Laporan Penelitian)

Background: The success of orthodontic treatment is very much dependent on the degree of malocclusion of the patient's teeth also affects the success of orthodontic treatment. The success of orthodontic treatment can also be assessed using an index, such as the Peer Assessment Rating Index (PAR).Objective:To describe the success rate of orthodontic treatment in the orthodontic clinic of RSGM-P FKG USAKTI based on the PAR index. Method: Descriptive observational study on a study model of orthodontic clinic patients aged 8-12 years. PAR index was measured in 40 pre emptive study models and orthodontic treatment evaluation study models. The components of the PAR index measured included 5 components, namely the assessment of the maxillary and mandibular anterior segments, the assessment of the right and left buccal segment occlusion scores, the overjet score assessment, the overbite score assessment, and the median line score assessment. Result: There were 47.5% included in the "unchanged" category, 50% included in the "changed" category and 2.5% included in the "very much change" category. Conclusion: The description of the success rate of orthodontic treatment in the orthodontic clinic of the RSGM-P FKG Usakti based on the PAR index is changing.

Is socket shielding an option in esthetic region?

The implant cannot preserve the surrounding bone from resorption when placed in the extraction socket. After teeth extraction, a change in the bony architecture of the anterior region makes oral rehabilitation difficult by an implant. This leads us to explore such a critical issue and the relevant data were collected from Pubmed, Google Scholar, and Cochrane database and reviewed. Socket shielding technique is intentional retention of the buccal segment of root fragment during the implant placement in the extraction socket. Socket shielding is an effective procedure in minimizing the buccal bone resorption along with minimizing the buccal contour changes it is minimally invasive as the bone graft is optional thus reducing the cost of the treatment procedure. The limited studies were available to support the routine clinical use of the socket shielding technique. Socket shielding seems to become the non-invasive technique for the preservation of hard and soft tissue by dental implant especially in the esthetic zone in the future. Therefore studies should be carried out on a large population to obtained more précised results related to the socket shielding technique.

Excessive overjet, steep mandibular plane, and posterior buccal crossbite treated with aligners, infrazygomatic crest bone screws, and Class II elastics

A 23-year-old male with dysfunctional incisors due to a large overjet preferred clear aligner therapy. Facial profile was convex with a skeletal Class II relationship (ANB, 8.4°). Overjet of 8.0 mm was associated with a hyperdivergent facial pattern and recessive chin. The UL7 was in buccal scissors bite, which contributed to a 2.0 mm functional shift to the right. Buccal relationships were Class I molar and Class II canines bilaterally. Other dental and facial structures were within normal limits. Aligners alone corrected the buccal scissors bite in 6 months and provided intrusive force in maxillary and mandibular buccal segments. Infrazygomatic crest bone screws served as anchorage for intra-arch elastics to retract the maxillary anterior segment. Class II intermaxillary elastics were added for the last stages of aligner treatment to help retract the upper incisors. After 12 months of treatment, the 8.0 mm overjet was resolved. Alignment with the initial set of aligners was completed in 15 months. A 5-month refinement phase with a second set of aligners was initiated to finish the occlusion. Total treatment time was 20 months. Overall, a malocclusion with a Discrepancy Index of 41 was treated to a Cast-Radiograph Evaluation score of 16 and a Pink and White esthetic score of 4.

Green coffee as a modified agent for improving the erosive potentiality of the energy drinks on hard tooth structure

Background/aim The interest in herbal products has increased in the last years because of their limited adverse effects. The aim of this study was to evaluate the remineralization effect of green coffee on demineralized enamel in comparison with green tea. Materials and methods A total of 42 crowns of primary molars were divided equally into buccal and lingual segments (84 totals). Each specimen was embedded into an acrylic block and then immersed in Red Bull for 4 h. The specimens were divided into two groups according to the type of remineralizing solution used: group 1 using green tea and group 2 using green coffee. In each group, the buccal halves were subjected to microhardness test, whereas the lingual halves were subjected to scanning electron microscopy and energy-dispersive radiograph analysis examinations. Results The results of scanning electron microscopy revealed a demineralization effect after immersion into Red Bull, which decreased after immersion into both remineralizing solutions of green tea and coffee. The energy-dispersive radiograph analysis showed a decrease in calcium and phosphorous weight% after demineralization, which is increased after remineralization with both solutions. The microhardness test revealed a decrease in surface hardness after demineralization, which increased after the remineralization process. Moreover, in comparing the two remineralizing solutions, the remineralization effect of green coffee was statistically higher than that of green tea. Conclusion Green coffee has an efficient remineralizing effect than green tea, which was superior in treatment of initial caries.

Expanding the concept of orthodontic camouflage for a skeletal Class II camouflage case through the use of skeletal anchorage system

This study aimed to report the treatment steps in a 26-year male patient, presented with a class II div 1 incisor relationship on a class II skeletal base with increased vertical proportions. The case was complicated by missing lower second premolars and retained lower second deciduous molars. Severe crowding was evident in the lower arch with mild crowding in the upper arch. The overbite and the overjet were increased. Scissor bite was evident in the left buccal segment. Treatment involved extraction of upper first premolars and lower second deciduous molars, utilizing moderate anchorage using a preadjusted edgewise fixed appliance (0.022’’ X 0.028”) with Roth prescription. Treatment duration was 20 months in total. The envelope of discrepancy specifies strict rules when camouflaging class II cases. The ability to retract incisors and the use of class II mechanics are within limited range to avoid damage to the periodontium. The current case report showed that the ability of the clinician to retract incisors using TADs could be carried out with high rate of success and safety.

Root resorption associated with maxillary buccal segment intrusion using variable force magnitudes.

To compare the root resorption resulting from miniscrew-supported maxillary posterior dentoalveolar intrusion using two different force magnitudes. Adult patients with skeletal open bite, indicated for maxillary posterior dentoalveolar intrusion, were recruited and randomly assigned to the comparison or intervention groups. The comparison group involved applying 200 g of intrusive force per segment, which measured 20 g per root, while this force was 400 g per segment in the intervention group, measuring 40 g per root. Twenty participants were included in the final analysis after 2 patients dropped out, 1 in each group, to end up with 10 subjects (200 roots) per group. There was statistically significant root resorption of 0.84 ± 0.96 mm and 0.93 ± 1.00 mm in the comparison and the intervention groups, respectively. However, there was no statistically significant difference between the groups. Root resorption inevitably took place in association with orthodontic intrusion. However, increasing the magnitude of the intrusive force did not increase the amount of root resorption, either statistically or clinically.