Extraction Of Maxillary Premolars Research Articles

A pedicled buccal periosteal flap for the closure of oro-antral fistula

BackgroundAn oroantral fistula is a communication between the maxillary antrum and oral cavity. This pathological communication is formed mainly due to dental extraction of maxillary premolars and molars. Adequate management should include closing the oroantral fistula and eliminating sinus infections to prevent recurrence and sinusitis.PurposeThis study aimed to evaluate the effectiveness of using the pedicled buccal periosteal flap for closing an oroantral fistula without changing the native intraoral structure.Patients & MethodsPatients with oroantral fistulas were included in this study. The patients were examined clinically by Valsalva test and cheek-blowing test, the hole was probed, and the extent of the underlying bone defect was determined radiographically using computed tomography preoperatively. All patients underwent surgical closure of oroantral fistula using a pedicled buccal periosteal flap.ResultsAll 10 patients obtained satisfactory results with marked improvement in the function of the maxillary sinus and complete healing of oroantral fistula with no recurrence except in Case No. 5, who had a recurrence of the oroantral fistula, also there was no statistically significant difference between the vestibular depth preoperatively and postoperatively.ConclusionA pedicled buccal periosteal flap is a novel technique for oroantral fistula closure as it preserves vestibular depth with a tension-free closure flap and harbors the advantages of the regenerative potential of the periosteum.Registration date14/8/2023Registration numberNCT05987943

The effect of micro-osteoperforations on the rate of maxillary incisors' retraction in orthodontic space closure: a randomized controlled clinical trial

BackgroundThis single-centered randomized controlled clinical trial aimed to evaluate the effectiveness of micro-osteoperforations (MOPs) in accelerating the orthodontic retraction of maxillary incisors.MethodsForty-two patients aged 16–40 were recruited and randomly assigned into two groups, one which underwent MOPs (MOPG) in the buccal and palatal region of all maxillary incisors immediately before the start of retraction and one which did not (CG). Eligibility criteria included the orthodontic need for maxillary first premolars extraction and space closure in two phases. The primary outcome of the study consisted of measuring the rate of space closure and, consequently, the rate of incisors’ retraction using digital model superimposition 14 days later and monthly thereafter for the next 4 months. The secondary outcomes included measuring anchorage loss, central incisors’ inclination, and root length shortening, analyzed using cone beam computed tomography scans acquired before retraction and 4 months after retraction. Randomization was performed using QuickCalcs software. While clinical blinding was not possible, the image’s examinator was blinded.ResultsTwenty-one patients were randomly assigned to each group. However, due to various reasons, a total of 37 patients (17 male and 20 female) were analyzed (mean age: 24.3 ± 8.1 years in the MOPG; 22.2 ± 4.2 years in the CG) during the trial. No statistically significant difference was found between the MOPG and the CG regarding the incisors’ retraction measured at different time points at the incisal border (14 days, 0.4 mm vs. 0.5 mm; 1 month, 0.79 mm vs. 0.77 mm; 2 months, 1.47 mm vs. 1.41 mm; 3 months, 2.09 mm vs. 1.88 mm; 4 months, 2.62 mm vs. 2.29 mm) and at the cervical level (14 days, 0.28 mm vs. 0.30 mm; 1 month, 0.41 mm vs. 0.32 mm; 2 months, 0.89 mm vs. 0.61 mm; 3 months, 1.36 mm vs. 1.10 mm; 4 months, 1.73 mm vs. 1.39 mm). Similarly, no statistically significant differences were detected in the space closure, anchorage loss, central incisors’ inclination, and radicular length between groups. No adverse effect was observed during the trial.ConclusionsMOPs did not accelerate the retraction of the maxillary incisors, nor were they associated with greater incisor inclination or root resorption.Trial registration ClinicalTrials.gov NCT03089996. Registered 24 March 2017—https://clinicaltrials.gov/ct2/show/NCT03089996.

Efficacy of 4% articaine with 1:100000 epinephrine versus 2% lignocaine with 1:100000 epinephrine in infiltration for extraction of maxillary premolars for orthodontic correction – A prospective, randomized, double-blind, crossover study

Background: Unlike other amide local anesthetics (LAs), articaine has better lipid solubility and potency. Very few studies have been done on comparing articaine with other LAs as buccal infiltration among the participants requiring paired extraction of maxillary premolars but limitations of those studies include smaller sample size, lack of washout periods, and diversity in study designs. Aims and Objectives: This study compares the anesthetic efficacy of 4% articaine (1:100,000 epinephrine) with 2% lidocaine (1:100,000 epinephrine) as buccal infiltration. Materials and Methods: This is a randomized double-blinded crossover study conducted at the Department of Oral and Maxillofacial Surgery in collaboration with the Department of Pharmacology, SRIHER, Chennai. This study was done on 59 participants on an outpatient basis. The selected participants received 4% articaine or lignocaine with epinephrine (1:100000) in the mucobuccal fold at the maxillary area during their first visit and the same individual received the other local anesthetic drug on the other side in the same area during the second visit, i.e., 1 week from the date of the first visit. All the statistics were calculated using the software Statistical Package for the Social Sciences 16 version. For all primary and secondary outcomes in the study, the Mann–Whitney U-test was employed to compute the mean and standard deviation. Results: The total mean age of the participants included was 21.69. The volume of drug required was 1.578 ± 0.2760 mL for articaine and 2.2068 ± 0.0984 ml for lignocaine. The onset time was 30–45 s with articaine and 75–90 s with lignocaine. A decrease in pain scores was seen in the articaine group compared to the lignocaine group. Conclusion: This study showed better efficacy of articaine in comparison to lignocaine. Articaine may replace lignocaine in orthodontic corrections with its higher efficacy, faster action, and longer duration.

Comparative Evaluation of the Local Anesthetic Action of Tramadol Hydrochloride With Adrenaline Versus Lidocaine Hydrochloride With Adrenaline for Maxillary Exodontia: A Randomized Control Trial

Tramadol hydrochloride (T-HCl) has demonstrated to have a local anesthetic effect similar to lidocaine hydrochloride (L-HCl) when administered locally for minor oral surgical procedures. Our study aimed to compare the anesthetic effect of T-HCl versus L-HCl in maxillary premolar extraction. The study is a split-mouth, double-blind randomized clinical trial at the Faculty of Dental Sciences, Ramaiah University of Applied Sciences, Bengaluru, India. The study sample was composed of patients referred for maxillary bicuspid extraction. Patients were excluded from the sample if, allergic to the study drugs, pregnant or lactating females, and smokers. The variable is an anesthetic drug administered for local anesthesia and it is grouped into 2 categories, T-HCl and L-HCl. A supraperiosteal infiltration of T-HCl with adrenaline on one side and L-HCl with adrenaline on the contralateral side was injected. The primary outcome variable was profound anesthesia of T-HCl, where the patient sensed the loss of sensation of touch, temperature, and pain. Secondary outcomes were onset and duration of anesthesia, intraoperative pain, postoperative analgesia, and adverse reactions, were recorded. Inferential statistics, the χ2 Test, the Mann-Whitney Test, and the Wilcoxon signed-rank test were used to compare the parameters. The level of significance was set at ≤ 0.05. A total of 40 patients were included, and 80 teeth were extracted. Profound anesthesia was achieved in all the cases. The mean subjective duration of anesthesia in the T-HCl and L-HCl groups was 130.80±20.01minutes and 111.40±14.87minutes, respectively, with a P value of .001. The mean Visual Analogue Scale (VAS) score for pain during the procedure in the T-HCl and L-HCl groups was 0.60±0.67 and 1.10±0.71, respectively, with a P value of .002. The mean Visual Analogue Scale score for pain postoperatively in the T-HCl and L-HCl groups was 0.70±0.72 and 1.40±0.67, respectively, with a P value of .001. Six patients in T-HCl required postoperative analgesia when compared to 18 patients in L-HCl (Pvalue < .003). T-HCl provides similar anesthetic outcomes in the extraction of maxillary bicuspids as L-HCl.

Comparison of the Efficacy Between Articaine and Lignocaine in Simultaneous Bilateral Orthodontic Maxillary Premolar Extractions: A Split-Mouth Comparative Study.

Introduction Local anesthesia plays a crucial role in ensuring patient comfort during orthodontic extractions. Among the various local anesthetic agents commonly used in the field of oral surgery are articaine and lidocaine, which differ in their duration of action and pain effectiveness (pain control) during surgical procedures. This article aimed to analyze the characteristics of 2% lignocaine with 1:80000 adrenaline and 4% articaine with 1:100000 adrenaline regarding duration of action and pain control in patients undergoing bilateral orthodontic maxillary premolar extractions. Materials and methods A split-mouth comparative study was conducted at Saveetha Dental College and Hospitals,Chennai, for which 50 patients of age less than 30 years and who required bilateral orthodontic premolar extractions were selected. Approximately4% articaine hydrochloride solution was administered on one side, and 2% lignocaine hydrochloride was administered on the contralateral side. Palatal infiltration was not given in the articaine group.The degree of extraction difficulty was similar in both groups, with no discernible variation. In each patient, the duration of anesthesia and pain control were assessed. The IBM Statistical Package for Social Sciences(SPSS version 24.0, IBM SPSS Statistics for Windows, Armonk, NY) was used to perform the student's paired t-test for detecting the difference in outcome parameters between the two groups. Results Upon comparing both groups, it was concluded that the articaine group had a longer mean anesthetic duration of action of 217 minutes, whereas for the lignocaine group, it was 169 minutes, and greater pain reduction was present with the articaine group. The articaine group exhibited less pain (superior pain control) with a mean visual analogue scale (VAS) score of 1.07compared to that of the lignocaine group with a mean VAS score of 1.53 during orthodontic premolar extractions. Both the results were statistically significant (P=0.001). Conclusion This split-mouth comparative study concludes that articaine is a more effective local anesthetic in terms of duration of action andpain reduction than that of lignocaine, and it can be used as a local anesthetic of choice for orthodontic maxillary premolar extractions.

Characterizing orthodontic tooth movement in real time using dental monitoring scans: A pilot study.

This pilot study aimed to quantify the magnitude and type of tooth movement occurring in short time intervals within the regular monthly orthodontic visits for patients with fixed appliances and undergoing maxillary canine retraction. Additionally, this pilot study aimed to provide a descriptive evaluation for the accuracy and reliability of the Dental Monitoring (DM)-captured scans to those of an iTero digital scans in an extraction space closure model. 3D intraoral photographic scans (DM) for 12 patients with maxillary first premolar extractions in a single-centre academic institution. Twelve patients treated with fixed appliances and undergoing space closure for maxillary premolar extraction(s) were included. Nickel-titanium (200 g) closing coil springs were used for canine retraction. At initiation of space closure (T1), iTero scans were acquired, and patients were instructed to take DM scans every 4-5 days until their next visit in 4-5 weeks (T2). At T2, a final iTero scan in addition to a DM scan was taken. The number of patients who did the scans regularly as instructed declined as time elapsed. Stereolithography (STL) files generated from the DM scans were superimposed with the STL files from the iTero scans using GOM Inspect software to determine the accuracy of the DM 3D models. To assess rate, type and direction of tooth movement, each of the 3D image STL files generated from the DM scans, taken every 4-5 days by each patient, was superimposed on the previously captured scan. The rate of tooth movement for the maxillary molars and canines was calculated in the 3 planes of space (X, Y, Z) at each time point, until the end of the experiment. Preliminary results indicated that the maxillary canines appeared to be displaced the greatest amount in the first 4-5 days with initial distolateral movement. As time elapsed, the rate of tooth movement decreased, and the tooth started moving distolingually. Dental monitoring software provides a high-tech platform to monitor tooth movement in a 'real-time' approach. Accuracy of the photographic scans in relationship to the intraoral scans appears promising. There seems to be some evidence that the greatest amount of movement occurs initially in the first few days after activation, dropping thereafter to become a slower constant rate of tooth movement.

The Efficacy of Articaine Single Buccal Injection for Maxillary Premolars Extraction: A Randomized Clinical Study

Background: The palatal injection is the most frequently used painful injection, but there is evidence that articaine 4% administered through buccal injection alone can extract maxillary teeth painlessly. Objective: A comparative study is conducted to evaluate the anesthetic efficacy of articaine 4% buccal without palatal injection for extraction of maxillary premolars compared to lidocaine 2% buccal and palatal injection. Methods: A randomized, single-blinded clinical trial was carried out involving 200 patients, of whom 104 were females and 96 were males, who were indicated for extraction of maxillary premolar teeth. The patients were randomly divided into two groups: Group A, control group: The maxillary premolar tooth extraction was performed under buccal and palatal infiltration anesthesia with 1.8 mL of 2% lidocaine hydrochloride with 1:80,000 epinephrine. Group B, a study group, extracted the maxillary premolar’s teeth under buccal anesthesia without palatal infiltration anesthesia with articaine hydrochloride 1.8 mL, 4% with 1:100,000 epinephrine. The outcome variable was the pain experienced during the extraction using the Visual Analogue Scale (VAS). Results: Statistical analysis showed that the difference in pain perception during extraction by VAS scores was statistically non-significant between the control and the study groups. Conclusions: The painful palatal injection in the extraction of maxillary premolars can be overcome by using only a buccal injection of articaine 4%.

Comparison of Different Decompensation Approaches on Facial Profile in Orthodontic-Orthognathic Treatment for Skeletal Class III Patients.

The objective of the present study was to assess the hard and soft tissue differences of skeletal Class III malocclusion patients treated with orthodontic-orthognathic surgery treatment between two decompensation approaches including extraction of maxillary premolars in preoperative orthodontics and clockwise rotation of the maxilla in orthognathic surgery. 22 skeletal Class III patients with the crowding of maxillary dental arch less than 3mm were included in this study. These patients were divided into two groups: extraction group and non-extraction group. Lateral cephalograms taken before preoperative orthodontic treatment and after postoperative orthodontic treatment were used to analyze the differences of hard and soft tissues between two groups. Independent t test was used to evaluate the differences of variables between extraction group and non-extraction group. After treatment, there was significant difference of Wits between extraction group and non-extraction group (- 4.34 mm vs - 2.82 mm, respectively, P <0.05). Co-Gn was significantly greater in non-extraction group than in extraction group (77.18 mm vs 71.58 mm, P <0.05). U1-SN and L1-MP in extraction group were significantly closer to the normal values than non-extraction group (P <0.05). Regarding the change of variables before and after orthodontic-orthognathic treatment, NLA (7.25° vs 1.46°, P <0.01) and G-Sn-Pog' (8.06° vs 4.62°, P <0.05) were significantly greater in extraction group than in non-extraction group. For patients with skeletal Class III malocclusion, extraction of maxillary premolars in preoperative orthodontic treatment can more effectively eliminate the dental compensation and achieve a more harmonious facial profile compared to clockwise rotation of the maxilla in orthognathic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

A Split-Mouth Clinical Comparative Evaluation of the Anesthetic Efficacy of Articaine and Lignocaine for Maxillary Bicuspids Extraction.

Aim The study compared the anesthetic effectiveness of articaine and lignocaine when premolars are extracted bilaterally for orthodontic purposes. Material and methods This prospective split-mouth study was performed on 30 cases selected from orthodontic referral patients reporting to the Oral and Maxillofacial Surgery Department at Maharaja Ganga Singh Dental College and Research Center, Rajasthan, India, for bilateral extraction of premolars under local anesthesia. We used 4% articaine hydrochloride and adrenaline 1:100000 (AH) as group A and 2% lignocaine hydrochloride with adrenaline 1:100000 (LH) on the control side as group B. For premolar anesthetization, 0.6-1.6 ml of AH and 1-2 ml of LH were injected submucosally in the buccal vestibular area. The extraction procedure was then carried out after achieving adequate anesthesia. The pain was assessed with Visual Analog Scale. The average onset time and duration of anesthesia were recorded. Data collected were summarized with descriptive statistics.The SPSSversion 23.0 (IBM Corp., Armonk, New York) was used for data entry, validation, and analysis. Means of continuous variables were compared using the student t-test. All tests were 2-tailed and significant at equal or less than 0.05. (p≤0.05). Results When comparing the overall anesthetic efficiency, Group A had a lower overall pain score of 0.43 while Group B had a higher overall pain score of 2.9. The average onset time of anesthesia in Group A was 1.2 minutes and 2.55 minutes in Group B. In Group A, the average duration of anesthesia was 70 minutes, and 46.5 minutes in Group B. These parameters were statistically significant with a p-value of <0.05. Conclusion The study concluded that as an alternative to lignocaine, articaine could be used effectively for maxillary premolar extractions for orthodontic reasons obviating palatal injection which is very painful to the patient.

Pulp Vitality of Orthodontic Retracted Canine Using Two Approaches of Periodontal Distraction: A Comparative Clinical Study

Objectives: All studies performed periodontal distraction with interseptal bone cuts but no one performed it without interseptal bone cuts. Therefore the aim of the present study was to evaluate and compare the effect of periodontal distractor with and without interseptal bone cuts on the pulp vitality of the retracted canines. Methods: The sample of the study consisted of 32 canines in 16 female patients (16- 21 years old) requiring extraction of bilateral maxillary first premolars and canine retraction. They were divided into two groups: canine retraction by periodontal distractor with distal interseptal bone cuts (Group I), canine retraction by periodontal distractor without distal interseptal bone cuts (Group II). After bilateral maxillary premolar extraction in both groups inter septal bone cuts was done in group I only. Then the periodontal distractor was cemented and activated twice per day in both groups. An electrical vitality test was evaluated before and after the distraction procedure. Results: None of the teeth reacted negatively to the electrical vitality test that was performed one month after the completion of the distraction procedure. There was no clinical sign of discoloration or pulpal pain in any tooth. Conclusions: Canine retraction was accelerated effectively by periodontal distraction technique either with or without distal interseptal bone cuts. The electrical pulp tester was positive in both groups.

Efficacy of Transdermal Ketoprofen Patch in Comparison to Transdermal Diclofenac Patch in Postoperative Analgesia for Orthodontic Extractions: A Randomized Split-Mouth Study.

Introduction Non-steroidal anti-inflammatory drugs (NSAIDs) are the most prescribed analgesics for controlling post-exodontia pain, administered by various routes. The transdermal route possesses the advantages of providing sustained release of the drug, being non-invasive, bypassing first-pass metabolism, and eliminating gastrointestinal adverse effects. This study compared the analgesic efficacy of diclofenac 200 mg and ketoprofen 30 mg transdermal patches for post-orthodontic exodontia pain. Materials and methods Thirty patients who underwent orthodontic bilateral maxillary and/or mandibular premolar extractions under local anaesthesia were included in the study. Each patient received single transdermal diclofenac 200 mg patch and single transdermal ketoprofen 30 mg patch on the outer, ipsilateral upper arm immediately post-extraction in the two appointments in random order. The pain score was recorded every second hourly for the first 24 hours postoperatively using a visual analog scale (VAS). The requirement of rescue analgesics at various time points and the total number of rescue analgesics taken in the first 24 hours postoperatively were noted. Any allergic reaction to the transdermal patches was also recorded. Results The analgesic efficacy of the two transdermal patches at any given time point in 24 hours by Mann-Whitney U test showed no statistically significant (p<0.05) difference. An overall intragroup statistically significant difference (p<0.05), by Wilcoxon matched pairs test, was found by comparison of VAS pain scores at different time points to that at 0-2 hours after application of transdermal ketoprofen and diclofenac patches, respectively. The mean maximum pain intensity was slightly lower for ketoprofen (2.33) than diclofenac (2.60) transdermal patch. Patients consumed the rescue analgesic within the first 12 hours postoperatively, with the mean value of the total number of rescue analgesics taken with ketoprofen transdermal patch (0.23) slightly lower than diclofenac transdermal patch (0.27) application. Conclusion Ketoprofen and diclofenac transdermal patches provide similar analgesia post orthodontic extraction. The patients required rescue analgesics only during the initial hours of the postoperative follow-up period.

Skeletal, Dental and Smile Esthetic Changes in Skeletal Class II patients Treated with Maxillary Premolar Extraction and Non-extraction Mechanotherapy – A Cross-sectional Study

ABSTRACT Introduction This study aimed to compare smile aesthetics in skeletal class II subjects who underwent fixed appliance therapy with maxillary premolar extraction (PME) and non-extraction fixed mechanotherpy (NEF), and to evaluate the perception of esthetic smiles among three panels of raters. Materials and Methods A cross-sectional study was conducted on a sample of 36 skeletal class II subjects ideally planned for PME. The study subjects were divided into two groups: 18 cases treated with PME and 18 cases treated with NEF at the patient’s request. Seven smile variables were measured on pre- and post-treatment frontal close-up smile photographs of two groups. Ten laypersons, general dentists and orthodontists evaluated those photographs on visual analogue scale. An Independent t-test was applied to compare the post-treatment smile variables and scores between the groups. Results In a comparison of post-treatment photographs between the groups, a statistically significant difference was found in the values of arch form index (AFI) (p = 0.01) and overjet (p = 0.006). A statistically significant difference was observed in the perception of smile aesthetics among the raters (p < 0.001). Conclusions Patients ideally planned for maxillary premolar extraction when treated with non-extraction fixed mechanotherapy using class II elastics did result in dental and soft tissue improvement but were not able to achieve ideal values at the end of treatment. Laypersons and dentists preferred smile aesthetics in maxillary first premolar extraction treatment, whereas all three panels of raters gave higher scores to non-extraction fixed mechanotherapy in terms of improvement in the smile.

Evaluation of the Effect of Two Different Activation Protocols of Periodontal Distractor on the Periodontal Health after Rabid Canine Retraction

Aim: To evaluate the effect of two different activation protocols of periodontal distractor on periodontal health after rabid canine retraction. Objectives: 1) to evaluate the periodontal health of two activations/day of periodontal distractor. 2) To evaluate the periodontal health of four activations/day of periodontal distractor. 3) To compare between two different activation protocols of periodontal distractor on periodontal health. Methods: The study was carried out on 32 canine of 16 female patients (16-22 years of age) requiring extraction of bilateral maxillary first premolars and maximum anchorage. They were divided into two groups. (Group I): Canine retraction was done by periodontal distractor with twice activations per day. (Group II): Canine retraction was done by periodontal distractor with four activations per day. Periodontal distractor was cemented after bilateral maxillary premolar extraction and inter septal bone corticotomy was done. The periodontal health of maxillary canines was evaluated using these parameters before and after retraction: (gingival index, periodontal index and probing depth). All data were explored for normality by using Shapiro Wilk and Kolmogorov Normality test which revealed that all data originated from non-parametric data. Results: for periodontal index and probing depth there was insignificant difference between them in before and after in both groups. For gingival index there was insignificant difference between them in before, while in after group II was significantly higher than group I. Conclusion: In this study, there was increase in all periodontal health parameters including (gingival index, periodontal index and probing depth) after using of periodontal distractor with both protocols of activations denoting gingivitis. The 2 activations/day was better than 4 activations/day for periodontal health during canine retraction by periodontal distractor.

Root resorption in Class II malocclusion treatment with and without maxillary premolar extractions

Class II malocclusion treatment efficiency with maxillary premolar extractions has been reported. However, no study evaluated the root resorption associated with this protocol. Therefore, this study aimed to compare the degree of root resorption of the maxillary incisors in Class II malocclusion treatment with and without maxillary premolar extractions. The sample consisted of 56 patients with complete Class II malocclusion, divided into 2 groups. Group 1 comprised 28 patients (10 female, 18 male) treated with maxillary first premolar extractions, and group 2 was composed of 28 patients (16 female, 12 male) treated without extractions. The groups were matched regarding initial age, treatment time, crowding, initial malocclusion severity, finishing quality, initial overjet, and overbite. Periapical radiographs of the maxillary incisors were used to assess the degree of root resorption using a scoring system. In addition, treatment changes involving maxillary incisors were evaluated in lateral headfilms. Intergroup comparisons were performed with t, Mann-Whitney U, and chi-square tests (P<0.05). Overjet, overbite, inclination, vertical positional changes, and vertical and horizontal apical displacements of maxillary incisors were similar between groups. There was no statistically significant difference between groups regarding root resorption of maxillary incisors. Root resorption degree ranged from mild to moderate in both groups. Treating complete Class II malocclusion with 2 maxillary premolar extractions resulted in a similar root resorption as treating without maxillary premolar extractions. An individualized evaluation of root resorption predisposing factors should be performed for each patient.

Extraction of maxillary premolars in Class III surgical patients

Surgical procedures are essential for achievement of favorable outcomes in adult patients diagnosed with Class III malocclusions and exhibiting aesthetic, skeletal, and dental disharmony. Premolar extractions may be necessary in some cases in order to allow proper positioning of the teeth in relation to their bony bases. The current case report presents two patients who underwent ortho-surgical treatment with maxillary premolar extraction to upright the maxillary incisors and correct their excessive labial inclination. The treatment results showed adequate Class III reduction, justifying the use of this treatment plan.

Modified orthodontic treatment of substitution of canines by first premolars: A case report

BACKGROUNDCanines are the most important teeth in the dentition. Usually, doctors choose to remove premolars rather than canines. Canine extraction is extremely rare in orthodontic treatment. However, dentists sometimes encounter situations in which canines require extraction due to defects caused by improper medical treatment.CASE SUMMARYThe present study reports a case of a class II adult patient treated with the extraction of maxillary canines and right mandibular second premolar. After postactive treatment for 28 mo, then the canines were substituted by the upper first premolar, a satisfactory occlusal was established, the lips were competent, and the profile was improved. Intraoral pictures and X-ray data retrieved 3 years after the end of orthodontic treatment demonstrated the possibility of canine extraction and premolar substitution of canines in function and beauty.CONCLUSIONThe extraction of canines and substitution by first premolars could be a feasible orthodontic treatment.

Efficacy and safety of piezocision in accelerating maxillary anterior teeth en-masse retraction: study protocol for a randomized controlled trial

BackgroundOrthodontic treatment is commonly more time-consuming in adults than in teenagers, especially when it comes to the maxillary en-masse retraction, which may take 9 months or even longer. As to solve this concern, orthodontists have been striving to seek new methods for shortening orthodontic treatment time. Piezocision, as a popular alternative treatment, has been widely used in different types of tooth movement. However, its effect on en-masse retraction of maxillary anterior teeth remains unclear. This randomized controlled trial intends to figure out the role piezocision plays in accelerating en-masse retraction.MethodsThis protocol is designed for a prospective, single-center, assessor-blinded and parallel-group randomized controlled trial. Twenty adult patients aged from 18 to 40 whose orthodontic treatment required bilateral maxillary first premolars extraction will be randomly assigned to the piezocision group and the control group at a ratio of 1:1. The piezocision group will undergo en-masse retraction immediately after the piezo surgery, while the control group will start en-masse retraction directly. Both groups will be followed up every 2 weeks to maintain the retraction force until the end of space closure. The space closing time is set as the primary endpoint. Meanwhile, the secondary endpoints include the change of root length, labial and palatal alveolar bone thickness, vertical bone height, probing depth of maxillary anterior teeth, cephalometric measurements, visual analogue scale, and postoperative satisfaction questionnaire.DiscussionThis study will attempt to provide more convincing evidence to verify whether piezocision will shorten the time of en-masse retraction or not. Distinguished with previous studies, our study has made some innovations in orthodontic procedure and primary outcome measurement, aiming to clarify the efficacy and safety of piezocision-assisted en-masse retraction in Chinese population.Trial registrationChinese Clinical Trial Registry ChiCTR 1900024297. Registered on 5 July 2019

The Effectiveness of Trans-Electrical Nerve Stimulation (TENS) in Reducing Pain Caused by Orthodontic Movement; A Randomized Controlled Trial

Objective: To check the effectiveness of TENS therapy in reducing pain caused by orthodontic movement. Methods: This was a single-blinded parallel-arm randomized controlled trial among patients presented for treatment of increased overjet using the split-mouth technique. Ethical consent was obtained from 45 patients. An initial levelling and alignment of dentition were achieved, followed by extraction of maxillary pre-molars, and canines were distalized, maintaining 100grams of force. The TENS pads were placed on the cheeks. One side was supplied with active impulses, considered an interventional side, while the other was not supplied with impulses and was marked as the control side. Pain intensity was measured on the tested tool (NRS scale) during resting and clenching (T1). The patient was instructed to use the device the same way for a total of five more times, at T2 (2hrs), T3 (6hrs), T4 (24hrs), T5 (48hrs), and T6 (72hrs). The data were analyzed using SPSS version 24, Chi-square test was applied to compare the pain intensity. Results: Among 45 patients (77.8% female and 21.2% male), the mean age of 19.0 ± 4.13 years. The average pain intensity on rest at 0 and 2 hours was 1.33 ± 1.108, which was at peak T3 (6 hours) 1.87 ± 1.546 and T4 (24 hours) 1.71 ± 1.359. However, it significantly decreased at T5 (48 hours) and T6 (72 hours) of intervention, which were 1.38 ± 0.8 and 1.31 ± 1.04, respectively. This difference was statistically significant (p&lt;0.05). The same pattern of pain reduction was seen in patients with clenching (p&lt;0.05). This showed that the pain intensity was decreased, but the pattern was not linear, as indicated that the pain at T3 and T4 was increased, but later, it was significantly decreased at T5 and T6. A negative correlation was observed between pain intensity and interval of TENS applied onward from the 4th interval in both groups (TENS applied on rest and TENS applied on clenching). Pain score at 72 hours was significantly low compared to post TENS applied (p&lt;0.001). Conclusion: TENS efficacy is insignificant at T1 and T2, with a significant increase in pain during T3 and T4; however, at T5 and T6, there was a significant reduction in pain which indicates a greater efficacy of the device reducing pain compared to the placebo. Key Words: Orthodontic, Pain, Periodontal and Trans-electrical nerve stimulation

The Effects of Increased Maxillary Canine Bracket Angulation on Tooth Movement and Alignment Efficiency: A Prospective Clinical Study.

This study aimed to evaluate the effects of a 10° angulation of a maxillary canine (Mx3) bracket on Mx3 and maxillary central incisor (Mx1) tooth movements and alignment efficiency in treatments involving maxillary premolar extraction. This split-mouth study included 29 individuals in a +10° angulation study group and a 0° angulation control group. The initial (T0) and 12th week (T1) orthodontic models were prepared and digitized with a three-dimensional scanner and superimposed using the OrthoAnalyzer analysis program. The movements of Mx3 and Mx1 were measured, and the alignment efficiency was assessed using Little's Irregularity Index. The Shapiro-Wilk test was used to test the data for a normal distribution. T1 and T0 measurements within the group and T1 and T0 differences between groups were compared using a paired samples t-test. The significance level was set to P < .05. The linear movements of Mx3 in the distal direction significantly increased, and Little's Irregularity Index values statistically significantly decreased in both groups. Distal movements of Mx3 were significantly higher in the control group than in the study group (P< 0.01 and P< 0.05). The movements of Mx1 and Little's Irregularity Index measurements did not show statistically significant differences between the groups (P > 0.05). A +10° Mx3 bracket angulation increased the inclination of Mx3 to the mesial, but it decreased the Mx3 distal linear movement and the retraction of Mx1, with no difference in terms of alignment efficiency between the+10° and 0° Mx3 bracket angulations.

Evaluation of buffered local anaesthesia in dental extraction: A randomized controlled study

AbstractBuffering of Local anaesthesia (LA) has been suggested as a mechanism to improve injection comfort and hasten the onset of anaesthesia.AimThis study aimed to evaluate the effectiveness of buffered LA in the extraction of maxillary premolars and molars.Materials and MethodsThis randomized controlled study included 100 patients who were indicated for extraction of maxillary posterior teeth, they were randomly divided into two groups; a study group that received infiltration of buffered 2% lidocaine hydrochloride with 1:80,000 epinephrine LA, and a control group that received non‐buffered 2% lidocaine hydrochloride with 1:80,000 epinephrine LA. The buffering was performed using the Onset® LA buffering system (Onpharma®). The outcome variables included the pain during injection buccally and palatally assessed by pain Numerical rating scale, the onset of anaesthesia, the volume of local anaesthesia used, and the patient satisfaction for the whole procedure.ResultsThere were statistically significant differences in pain during injection buccally and palatally in favour of the study group (p &lt; 0.0001) with a large effect size for the palatal injection and moderate effect size for the buccal injection. The onset of anaesthesia on the buccal and palatal sides was significantly faster in the study group (p values 0.02 and 0.01, respectively). There was a non‐significant difference between the groups with respect to the volume of anaesthesia (p = 0.07). The patients in the study group reported a significantly higher satisfaction score (p &lt; 0.0001).ConclusionsBuffered LA significantly reduced the onset of action of anaesthesia and pain during injection, especially on the palatal side, and resulted in better satisfaction with the extraction procedure.