Common Malocclusion Research Articles

Prevalence of Dental Anomalies in Various Categories of Malocclusion among Orthodontic Patients in the Kosovo Region: A Retrospective Study

Abstract Objectives The objective of this retrospective research was to investigate the prevalence and the association between dental anomalies and malocclusion in a subset of Kosovo's population. Materials and Methods This retrospective descriptive study was conducted by recruiting 557 patients; 215 (38.6%) were males and 342 (61.4%) were females. The age range was from 7 to 44 years. The exclusion criteria were employed for the sample size, and 307 of 864 patients were excluded from the study. Malocclusion groups were divided through Angle's classification, and dental anomalies were defined according to the literature. Pretreatment panoramic radiographs, medical and dental history, study casts, and photographs were included to categorize malocclusion and identify dental anomalies (i.e., hypodontia, ectopic eruption, impaction, and diastema). The data were analyzed with IBM SPSS software version 16.0. The chi-squared test was utilized to calculate the frequency and percentages of malocclusion and dental anomalies. A p-value of 0.05 was considered statistically significant. Results Five hundred and fifty-seven patient records from 2015 to 2020 were included. An increased prevalence of ectopic eruption (24.8%) was found in this study, whereas the least common was hypodontia (7.0%). The most common malocclusion was class I (46.9%). Vertical plane malocclusion demonstrated that 31.4% had a deep bite and 9.5% had an open bite. Most dental anomalies were significantly associated with class I malocclusion and least associated with class III malocclusion. Transverse malocclusion exhibited that 14% had anterior crossbite and 10.8% had posterior crossbite. Posterior crossbite was significantly less in the class III malocclusion group (p = 0.019). Conclusion The prevalence of the selected dental anomalies was overall high in our study; 557 of 864 patients faced dental anomalies. An association was seen between malocclusion and dental anomalies in the Kosovan population, especially with class I malocclusion. Deep bite was prominent in the vertical plane malocclusion, whereas anterior crossbite was the most common finding in the transverse plane. Anterior crowding was prevalent in the maxilla and posterior crowding in the mandible.

Parafunctional Oral Habits: Frequency and Association with Malocclusion Traits in Adolescents

OBJECTIVE: To determine the frequency of parafunctional oral habits and their association with types of malocclusions in all three planes among the adolescents. METHODOLOGY: This cross-sectional study involved 610 students studying in 8 different schools of Raiwind, Lahore. Ethical approval for the study was obtained from Sharif Medical and Dental College, Lahore. Data was collected by the primary researcher and recorded in predesigned proforma. Each student was inspected while seated in an upright position in natural day light, using disposable wooden blades to retract the cheek to record posterior dental relationships and to retract lips to record anterior dental relationships. Data was scrutinized using SPSS and chi-square test was used to find the statistical significance of the association between various parafunctional oral habits and types of malocclusions. RESULTS: The frequency of parafunctional oral habits was 57.3% among 610 adolescent students, being more prevalent in females (72.9%) than males (52.3%). The most common oral parafunctional habit was bruxism (18.0%) and least frequent was thumb sucking (8.4%). Association between oral parafunctional habits and malocclusion in all three planes was found to be significant (p=0.0). CONCLUSION: The parafunctional oral habits such as bruxism, tongue thrusting, nail biting, mouth breathing and thumb sucking are very commonly found among adolescents in the same descending order. Most common malocclusions found to be associated with parafunctional oral habits are exaggerated over-jet, open bite and deep bite. Parafunctional oral habits have a strong influence on developing malocclusion traits in all three dimensions. KEYWORDS: Parafunctional oral habits, malocclusion, thumb sucking, tongue thrusting, mouth breathing, bruxism, nail biting.

The Effects of Intrusion of Anterior Teeth by Skeletal Anchorage in Deep Bite Patients; A Systematic Review and Meta-Analysis.

Deep bite is known as one of the most common malocclusions, and its treatment and retention are often challenging. The use of mini-screws has been suggested as an ideal method for the intrusion of incisors in deep-bite patients. Still, there are conflicting reports regarding the superiority of this method compared to other common treatments. The aim of this systematic review and meta-analysis was to evaluate the effects of the intrusion of anterior teeth by skeletal anchorage in deep bite patients. From the beginning to 15 September 2022, articles on the topic of interest were searched in electronic databases including PubMed, Web of Science, Scopus, EMBASE, and Cochrane's CENTRAL. Additionally, a hand search for pertinent studies and a search of the grey literature were carried out. After the selection of eligible studies, data extraction was performed using piloted forms. Inverse-variance random-effects meta-analyses were used to combine the outcome measures of dental indices, skeletal cephalometric indices, and dental cephalometric indices. A total of 15 studies (6 RCT; 9 CCT) were included in the systematic review and 14 were used in the meta-analyses. The differences in overbite changes (MD = -0.45, p = 0.04), true incisor intrusion [u1-pp] (MD = -0.62, p = 0.003) and molar extrusion [u6-pp] (MD = -0.40, p = 0.01) were statistically significant and TADs showed better treatment results than other intrusion methods (segmented intrusion arch, utility arch, J hook headgear). No significant differences regarding overjet, molar and incisor tipping, and skeletal indices between mini-screw and other intrusion methods could be found. The use of mini-screws leads to lower overbite and higher true intrusion (about 0.45 and 0.62 mm, respectively) compared to the use of other methods for intruding upper incisors. Furthermore, the effect of TAD on extrusion of molar teeth is less (by 0.4 mm) than other methods.

Identification of Malocclusion by Dental Undergraduate Students: A Cross-sectional Study

Introduction: Health is multifaceted and influenced by a variety of variables. Along with dental caries, periodontal and gingival disorders, malocclusion is one of the most prevalent dental issues. It can impair oral health by increasing the prevalence of dental caries, periodontal diseases, and temporomandibular disorders, as well as predispose to oral habits in the majority of cases. Hence, knowledge about the need for treatment and the correct time of commencement is essential for treating malocclusion. Aim: To assess the level of understanding of dental undergraduate students in the identification of malocclusion. Materials and Methods: A cross-sectional study was conducted on 150 final-year dental undergraduate students from private dental colleges who were randomly chosen. A pre-tested questionnaire with closed-ended questions was given to every participant, and their knowledge levels were evaluated on the same day after the collection of completed questionnaires. The questionnaire contained intraoral and extraoral photographs of patients with malocclusions. Students were asked questions about the identification of various malocclusions, and the data was analysed as frequency (n) and percentages (%). Results: Questionnaire responses by a total of 150 dental undergraduate students, (48 males and 102 females) with a mean age of 21±2 years were analysed. The majority of students were able to identify Angle’s Class-I (n=139, 92.7%), Class-II (n=103, 68.7%), and Class-III (n=122, 81.3%) malocclusions, as well as canine relationships (n=136, 90.7%). The majority of students had no difficulty in recognising transverse malocclusions, such as posterior crossbite (n=103, 68.7%) and scissors bite (n=99, 66%), as well as common malocclusions like crowding, spacing, midline shift, and deep bite. Conclusion: Most of the students were familiar with the diagnosis of malocclusion. However, knowledge regarding the type of appliance to be used and the age of starting treatment was lacking.

Timing of early correction of mandibular hypoplasia in skeletal class II malocclusion: a review.

Skeletal Class II malocclusion is a common malocclusion seen in clinics. It is characterized by maxillary protrusion and mandibular retrognathia and has a high incidence in adolescent mixed dentition and early permanent dentition. The early functional correction has achieved some clinical results in treating skeletal Class II malocclusion with mandibular hypoplasia. During treatment, the timing of correction is the key factor in determining the therapeutic effect, although it is difficult to understand. This review focuses on the timing of early correction of mandibular hypoplasia in combination with relevant assessment indicators and historical literature from four perspectives-the law of mandibular growth and development, the necessity of early treatment, the timing of early treatment, and the determination of the peak period of mandibular growth and development-to provide a theoretical reference for the timing of the treatment of clinical skeletal Class II malocclusion. This review shows that skeletal Class II mandibular growth has different characteristics in males and females. Bone growth assessment before treatment helps diagnose mandibular developmental morphology and the timing of early correction in adolescents with skeletal Class II malocclusion and hypoplasia of the mandible.

Planas direct tracks to treat functional crossbites in children: scientific evidence

Introduction: Posterior functional crossbite is a common malocclusion in children, with a prevalence between 7.5-24 %. It has an important impact on facial functions, and may cause asymmetries in craniofacial development. Different interventions have been used to correct this malocclusion but there is a lack of studies with methodological rigor that support these interventions. Planas Direct Tracks (PDT) constitute one of such interventions. They seek to reestablish the functional occlusal balance of children through selective grinding, complementing this adjustment with composites. Objective: To present the level of scientific evidence available on PDT to correct posterior crossbites. Method: A sensitive search was carried out in the main databases: Pubmed, BVS Odontology, Cochrane, SciElo and Google academic. The articles were selected, duplications removed and critical evaluation of the literature performed classifying the studies according to the evidence pyramid. The aim is to point out ways to improve the quality of the studies. Results: 32 studies were included. 30 studies were narrative reviews, case reports or case series and two were controlled trials. All studies had important biases. No randomized controlled trial was found. Conclusion: So far, there are no studies, sufficiently rigorous methodology, on Planas direct tracks to correct functional crossbites.

Temporomandibular Joint Disorder and Airway in Class II Malocclusion: A Review.

In class II malocclusion, there is an anteroposterior disparity between the upper dentition and the lower dentition, which may or may not be accompanied by a skeletal discrepancy. For orthodontists, this is one of the common malocclusions encountered during clinical practice. This might be due to excess maxillary growth or retarded growth of the mandible or a combination of both. In such types of malocclusion, both the upper and lower airways are affected, the lower one most commonly. Characteristic features seen are a narrow maxillary arch, a proclined upper anterior, and mouth breathing as a developing habit. Also, the position of the condyle in the skeletal type of class II malocclusion plays a vital role in the development of temporomandibular joint disorders. Treating such disparity in a growing individual leads to better results in the long term as well as prevention of malocclusion taking a severe form. Myofunctional appliances are useful for repositioning the mandible as well as the condyle. In adults, extraction of the upper premolars is most commonly done for the correction of class II malocclusion. This provides the patient with a better esthetic appearance.In addition to this, various treatment modalities, such as splint therapy, exercise, and prolotherapy, are beneficial for pain relief and temporomandibular disorder (TMD) correction. This article deals with the characteristics, development, etiology, and comprehensive treatment options of class II malocclusion and its co-relation with the upper and lower airway along with the severity of temporomandibular joint disorders. Repositioning of the condyle in the glenoid fossae is the key to the correction of this disorder.

INCIDENCE OF DEEP BITE IN DENTAL CLASS 1 PATIENTS WITH VERTICAL MAXILLARY EXCESS SEEKING ORTHODONTIC TREATMENT

Deep bite / Deep overbite is excessive vertical overlapping of mandibular incisors by the maxillary incisors in a centric occlusion. The incisal edges of the lower teeth should contact slightly at or above the cingulum of the upper teeth, which would be approximating 1-3mm overbite. Deep bite is the most common malocclusion in children and adults. The excessive overbite is a complex orthodontic problem that may involve a particular group of teeth or whole dentition or maxilla and mandible. This retrospective cross-sectional study was carried at the UG students clinic and Department of orthodontics. Case records of all the cases were tabulated and after applying the inclusion criteria 19 case records with Class 1 dental occlusion patients with vertical maxillary excess were collected. This data was tabulated and analysed in SPSS and descriptive statistics were performed. The results gave information that 68% of them were females showing high female predilection. Age limit was not mentioned because people of all ages were included in the study. Results showed less male predilection with 32% than females. The study concluded that most of the Female patients were incident to Deep bite in Dental Class 1 with vertical maxillary excess seeking orthodontic treatment. It is widely accepted that correction of deep bite is easier to accomplish and more stable when done on growing patients than those with no appreciable growth remaining. Adults often need only correction of excessive overbite either due to its isolated nature or a demand for limited treatment. In adults, this treatment is often part of periodontal, restorative or temporomandibular joint therapy.

Comparison of cephalometric measurements of the Twin Block and A6 appliances in the treatment of Class II malocclusion: a retrospective comparative cohort study.

BackgroundSkeletal Class II malocclusion is a common malocclusion that seriously affects patients’ profile and occlusal function. The key to treatment is to use functional appliances guide the mandible forward. This study aimed to evaluate the clinical efficacy of traditional functional appliance Twin Block (TB) and invisible functional appliance (A6).MethodsIn the retrospective cohort study, 46 patients with Class II Division 1 mandibular retrognathia (23 females, 23 males; mean age 13.66±4.25 years) from the Third Affiliated Hospital of Sun Yat-sen University were selected. They were divided into A6 group and TB group according to the type of appliance guided mandibular forward used in orthodontic treatment (n=23 each; average treatment time 9.82±3.52 months). Lateral cephalometric radiographs were taken before and at the end of each treatment, and paired t-test or paired rank-sum tests were performed when appropriate to detect any statistical significance at the level of α=0.05.ResultsThe baseline characteristics of the two groups of patients were similar. Treatment with both appliances helped correct Class II malocclusion, improve the discrepancy between the maxilla and mandible, reduce the labial inclination of the maxillary anterior teeth, and relieve the deep overbite. A comparison of the treatment effects of the TB and A6 groups showed that the A6 had a better effect when moving Point A backward, and performed better in the abduction of the anterior teeth. TB group has more advantages than A6 group in moving forward point B and improving the nasolabial angle.ConclusionsBoth the A6 and TB can significantly improve Class II malocclusion. A6 showed an obvious advantage in moving Point A backward and adducting the anterior teeth, which better corrects a skeletal Class II malocclusion.

Clinical efficacy and influencing factors of molar distalization with clear aligner

Dental crowding is the most common malocclusion, and molar distalization possesses significant advantages in obtaining space, molar neutral relationship and avoiding invasive manipulation. The esthetic problem remains a major challenge for traditional molar distalization appliances. However, the advent of clear aligner technology has brought a new strategy for molar distalization. Accordingly, this review seeks to evaluate the clinical efficacy of molar distalization with clear aligners from the perspectives of three-dimensional control, displacement accuracy, anchorage protection and post treatment stability. Moreover, it aims to investigate the factors which affect the clinical efficacy with regard to material property of clear aligner, treatment planning and dentoskeletal characteristics and patient compliance, in order to provide guidance for the clinical application of the technique.

Management of malocclusion with pre-fabricated myofunctional appliance in the primary dentition

The most common malocclusion presented during primary dentition are anterior crossbite and deep overbite.If the primary dentition does not show severe skeletal discrepancy, it is possible to treat malocclusion using pre-fabricated myofunctional appliance that is easily applied to children. By improving the malocclusion in the primary dentition, normalization of the oral muscle function can be induced. In addition, the normal occlusion of the primary incisor region and ideal position of the lips can make a desirable occlusal relationship at the transition of incisors. If factors such as growth pattern, patient cooperation, and post-treatment maintenance are carefully judged and implemented, the interceptive treatment of primary dentition can contribute to normal growth and development.

Evaluation of successful treatment of patients with unilateral functional crossbite

Purpose: Unilateral functional crossbite (UFCB) is one of the most common malocclusions in the deciduous and early mixed dentition stage. It is accompanied by lateral mandibular shift and mandibular midline deviation due to the narrow maxillary dental arch. The aim of this study was to assess the effects of early correction of UFCB with the Fränkel (FR–3) functional regulator.
 Methods: Ninety Caucasian subjects (32 boys and 58 girls) with UFCB in the early mixed dentition stage (mean age, 6 years and 8 months (SD±1.8)) were treated with the FR–3 functional regulator and monitored. The diagnosis was based on anamnestic data, clinical examinations, radiographs, and analyses of study cast models. Dental casts taken before and after treatment were used in the analysis of effects.
 Results: Treatment of UFCB involved expansion of the maxillary arch, removal of occlusal interferences, and elimination of the functional shift. The width of the maxilla increased by 2.90 mm (SD±1.63) in the canine region and by 2.78 mm (SD±1.60) in the molar region. Another advantage of early treatment was improvement of maxillary arch length deficiency secondary to maxillary constriction because the permanent incisors were afforded more space before or during eruption than if the crossbite was treated at a later age. At least one abnormal orofacial function was identified in 69 (76,67%) patients with UFCB. Aftertreatment, all crossbites were corrected, functional deviations were eliminated, and no relapses were observed during follow–up at 2 years and 8 months.
 Conclusion: The Fränkel functional regulator is a functional orthodontic–orthopedic device that is an effective alternative for the treatment of UFCB. Dental occlusion was significantly improved, and the prognosis for normal craniofacial growth and normal function of the stomatognathic system was enhanced.

Stress evaluation during simultaneous intrusion and retraction of maxillary anteriors with mini-implants: A finite element analysis

Space closure is one of the most challenging process in orthodontics and require a comprehension of biomechanics in order to avoid undesirable side effects. The versatility of Mini implants has increased its demand in respect of anchorage, minimizing reciprocal effects and reducing overall treatment duration. Bi-alveolar dental protrusion is one of the common malocclusion encountered by orthodontist and the most common treatment modality includes extraction of 4 first premolars followed by intrusion and retraction of maxillary anteriors to obtain ideal dental and soft tissue profile.Force application for longer duration can lead to orthodontic induced root resorption.Thus it is utmost important to study the amount of stress produced and pattern of stress distribution in PDL after force application. Thus with the help of FEM model stress evaluation was done during simultaneous intrusion and retraction of maxillary anteriors with the help of implants.

Effect of Low-Level Laser Therapy on Bone Formation in Rapid Palatal Expansion: A Systematic Review.

Introduction: Crossbite is a common malocclusion with a 7-23% prevalence rate. Treatment is based on the expansion of the mid-palatal suture (MPS) with Rapid Palatal Expansion(RPE) followed by a retention period to reach new bone maturation, enough to maintain the results stable. This systematic review was conducted to evaluate the effectiveness of low-level laser therapy (LLLT) in increasing bone formation in MPS. Methods: This article was written by the PRISMA checklist. Electronically, 3 databases, namely PubMed, Scopus, and Embase, were searched with the keywords selected based on PICO. Time (2010-2021) and language restrictions were performed. Results: 528 articles, out of which 374 studies were screened, were found, and 9 full-text articles were subsequently included considering these inclusion criteria: randomized clinical trial (RCT) that examines the efficacy of LLLT in rapid palatal expansion (RPE), age under 15 years, non-surgical RPE with a tooth-supported appliance, and low-intensity laser application. Finally, 4 articles were appraised by Cochrane version 5.2.0 with 7 domains. 3 of 4 articles showed LLLT has a significant impact on bone formation. One of them showed no significant difference in pain perception and bone density between the laser and non-laser groups. Conclusion: While many studies have assessed the effect of LLLT on bone formation in animal models, high-quality clinical trials are missing in this regard. The available clinical trials suggest a positive effect of LLLT on sutural bone formation after RPE.

COMPARATIVE EVALUATION OF THE EFFECTIVENESS OF FIXED VERSUS REMOVABLE ORTHODONTIC APPLIANCES IN CORRECTING ANTERIOR CROSSBITE IN MIXED DENTITION.

Background: Anterior crossbite is a common malocclusion whose prevalence vary from country to country. It is around 6-8% in India. Aim & Objective: To evaluate the effectiveness of fixed versus removable orthodontic appliances in correction of anterior crossbite in the mixed dentition. Material & Methods: A sample size of 75 subjects were selected on differential selective criteria with history of no previous orthodontic treatment, mixed dentition, anterior crossbite with moderate space discrepancy (< 3mm), non- extraction orthodontic mechanotherapy with ANB > 0°. A written consent was signed. Treatment with two parallel mode was designed, either with a removable appliance with springs or a fixed appliance with orthodontic brackets. To standardize the design for evaluation "Randomized Controlled Trials" (RCTs) were applied and parameters like rate of success, treatment duration, pre & post treatment differences in the overjet, overbite and arch length were accessed. Results: The treatment was successfully completed in all the patients by both the treatment modalities. Method Error Analysis (MEA) & Statistical Package for the Social Sciences (SPSS) were used for statistical analysis. SPSS significantly showed the average treatment time by the fixed appliance was comparatively less (1.4 months, P < 0.05). Increase in arch length and overjet in both treatment modalities were recorded, but it was significantly higher in fixed mechanotherapy (P < 0.05 and P < 0.01). Conclusion: Both, fixed and removal orthodontic appliances can successfully treat anterior crossbite in mixed dentition with short- term orthodontic treatment.

Index assessment of malocclusion in schoolchildren in the endemic fluorosis area (pilot study). Part 2

Relevance . The formation of malocclusion is due to some general and local risk factors, well described in the specialized literature. At the same time, information on the possible effect of an increased concentration of fluorides in drinking water on the prevalence and structure of malocclusion in children and adolescents is scarce and contradictory. The study aimed to investigate the prevalence of malocclusion in schoolchildren aged 12 and 15 years old, living in the area of endemic fluorosis, using DAI. Materials and methods . A cross-sectional dental examination was performed in 361 (12- and 15-year-old) schoolchildren permanently residing in a settlement with high fluoride levels in drinking water (up to 4.5 ppm). The examined children were divided into several groups based on the presence and severity of dental fluorosis (DF). The study assessed DF according to the WHO classification and malocclusion according to the DAI. The obtained results were statistically processed using the SPSS ® Statistics 23.0 program. Results . The study revealed a high prevalence of FD (65.4%) and malocclusion (66.2%) among the examined students. 49% of schoolchildren had mild fluorosis. Incisal segment crowding was the most common malocclusion (DAI, component 2). Pronounced (more than 1 mm) irregularity (DAI, component 5) of the upper incisors was more common than the lower ones. Deviation in anterior-posterior molar relation was the second most common malocclusion (DAI - component 10). Half-a-cusp deviations were twice as frequent as full-cusp deviations. The prevalence of most DAI components was comparable in groups of schoolchildren without fluorosis and with dental fluorosis of different severity. The study noticed an increase in the frequency of deviations in the anterior-posterior first molar relation in patient groups with severe dental fluorosis. Conclusions . The prevalence of most DAI components in schoolchildren without and with dental fluorosis of different severity was comparable. Further research is necessary to verify the obtained results.

Effect of Twin Block Therapy Versus Fixed Functional Appliances on Pharyngeal Airway Space in Skeletal Class II Patients: A Prospective Cephalometric Study.

Class II malocclusion is one of the most common malocclusion with varied prevalence. Functional therapy with appliances like Twin Block or Fixed functional appliances forms the mainstay of treatment in growing Class II patients. These patients might demonstrate narrow airway due to the retrognathic position of the mandible. This study investigated the effects of twin block and fixed functional appliance therapy (Forsus™ FRD) on the pharyngeal airway space in skeletal Class II patients. Forty patients with Class II malocclusion were selected and divided into two equal groups of 20 patients each for both Twin block and Forsus group. Lateral cephalograms were obtained before and after the functional appliance therapy. Evaluation was done for changes in hyoid bone position, pharyngeal airway dimensions and tongue position. The variables of the study showed better hyoid position in both the groups. In Twin Block group, an increase in hy-apw2 and hy-PoFH suggested anterior positioning of hyoid and a decrease in H-MP and hy-ML indicated superior positioning. In Forsus group an increase in H-H', hy-FH, hy-ML, hy-NL, hy-NSL and hy-OL suggested inferior positioning of hyoid, while an increase in hy-apw2, hy-CVT, hy-PoFH, hy-RL and hy'-tgo indicated anterior positioning of hyoid bone after functional therapy. Both the twin block and Forsus™ FRD improved the position of the hyoid bone after the functional appliance therapy however the changes were not statistically significant. Twin block and Forsus™ had similar effect on the hyoid bone position, pharyngeal dimensions and the tongue position.

PREVALENCE OF SUBJECTIVE AND OBJECTIVE FACTORS IN PATIENTS WITH TEMPOROMANDIBULAR JOINT DISORDERS

Aim and objectives: the aim of this work is to investigate prevalence of subjective and objective factors in patients with TMJ disorders. Material and methods: this investigation is a part of a prospective study which was started in autumn of 2018. The investigation was performed in Hospital of Lithu­anian University of Health Sciences Kaunas Clinics in the Department of Maxillofacial surgery and in the De­partment of Orthodontics. Investigation comprised of three parts – extraoral and intraoral investigation and two questionnaires about the patient’s symptoms and health. There were 14 questions in patient’s symptoms ques­tionnaire about self-reported pain. In the questionnaire about health there were 9 questions about stress which was felt by the patient. Statistical analysis was performed using “Microsoft Office Excel” and “IBM SPSS Statis­tics 25” software programs. To determine the statistical relationship between independent variables t-test and χ2 test were used. Results: from October 4th, 2019 to February 4th, 2020 72 subjects were reffered to the Department of Maxillofacial surgery, Hospital of Lithuanian University of Health Sci­ences Kaunas Clinics. 50 eligble subjects were included into this research. Other data of additional 50 subjects was taken from the available earlier database. 80% of the subjects were female and 20% were male. 49% of the subjects were younger than 30 years old. 86,60% of included subjects suffered from pain in the temporo­mandibular joint area, in 2/3 of them pain was chronic. 97% of the subjects were diagnosed with TMJ disorders, for 49,98% of them had disc dislocation with reduction was diagnosed and for 50,52% – disc dislocation without reduction. All patients experienced stress. For 82,47% of them stress did not have an effect or had only a small effect on their daily life, for 17,53% stress affected their daily life a lot. The most common malocclusion for all types of TMJ disorders was Angle class II malocclusion. Conclusions: there was a wide range of subjective and objective factors in patients with TMJ disorders. Angle class II malocclusion was the most common in all TMJ disorders.

Different realms of twin block- A review article

Malocclusions need to intercepted at an early developing stage to prevent severe disturbing outcomes. In all reported cases, Class II is one of the most common malocclusions that is seen which requires treatment using functional appliances as it presents with considerable difficulty in later stages. Twin block has the advantage of versatility of appliance designs and they meet a wide range of requirements for correction of various types of malocclusions for patients. The aim of this study is to include all modifications that could be incorporated in the appliance design to be customized to individual patients according to their need.

Distribution and type of malocclusion treated by post graduate students in State Of Punjab

Malocclusion is one of the most prevalent oral pathologies, next only to dental caries and periodontal disease and usually ranked third among worldwide public health dental disease priorities. The prevalence of malocclusion has been reported to vary from place to place, henceforth, rational planning of orthodontic measures on a population basis is essential in assessing the resources required, to provide a good dental service. Therefore, this study aimed to evaluate most prevalent type of malocclusion cases reporting to dental colleges. Methods- A cross sectional study was done using the google form-based questionnaire. Post graduates of dept. of orthodontics, who attended the PG Master course programme, from all the 8 dental colleges of Punjab, was asked to fill the form. Results and Discussion- Class II Div 1 malocclusion was the most common malocclusion both dentally and skeletally, seeking orthodontic treatment. The most common treatment strategy used nowadays fixed orthodontic therapy using MBT prescription. Among the use of Growth modification modalities, fixed functional appliances are more commonly used than myofunctional appliances, reason being more older age group seeking treatment. Conclusion- Among the three occlusal traits, Class II Div 1 was the most common occlusal trait present. Therefore, Post-graduates must be thoroughly trained to treat this type of malocclusion using different modalities of growth modification and orthopaedic appliances and general dentists must have enough knowledge about this malocclusion to diagnose it at a very early stage so that preventive or interceptive therapy can be started well in time.