Extraction Of First Premolars Research Articles

Sleep disruption and premolar absence, NHANES, 2017-2020: A cross-sectional study.

Orthodontic treatment often involves four first premolar extractions. There is concern that the retraction of the anterior teeth due to extraction of first premolars may constrict tongue space and will reduce oral cavity and oropharynx space. Constricted airways are often associated with sleep disordered breathing (SDB) and sleep disruption. The aim of this study was to determine if there is an association of SDB factors with the absence of first premolars. A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 data on participants, aged 18-65 years (n = 4742). Variables of interest included self-reports of SDB (symptoms of disrupted sleep such as snoring, snorting, daytime sleepiness, and inappropriate number of hours of sleep). Data for the presence/absence of first premolars were gathered from the oral examination section of NHANES. An assumption was made that absence of four first premolars in dentate participants indicated extractions for orthodontic treatment. Data analyses were conducted with Rao Scott chi squared test. There were no significant associations of SDB and symptoms of disrupted sleep associated with the absence of four first premolars in dentate participants. Concerns of the impact of first premolar extractions on SDB were not supported with this study.

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

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

Effect of laser corticotomy on canine retraction rate: a split-mouth randomized clinical trial

BackgroundThis study assessed the effect of corticotomy with Er: YAG (erbium-doped yttrium aluminium garnet) laser on the rate of canine retraction.MethodsThis randomized split-mouth controlled clinical trial was conducted on 12 patients undergoing orthodontic treatment with extraction of maxillary first premolars. Following initial leveling and alignment, an alginate impression was made from the maxillary arch, and Er: YAG laser corticotomy was performed in one of the maxillary quadrants of each patient. Canine retraction was started immediately after corticotomy by placement of nickel-titanium (NiTi) closed coil springs at both sides. At the end of each month, alginate records were repeated for 4 months. Study models were scanned, and the anteroposterior movement of canine was quantified bilaterally. Pain was also measured by a visual analog scale (VAS). Probing depth (PPD) of canines and two adjacent teeth was also evaluated and pulp vitality was assessed by performing the cold test. Data were analyzed by paired and independent t-test and one-way ANOVA (alpha = 0.05).ResultsThe rate of canine retraction was significantly greater in the laser-assisted corticotomy quadrant than the control (P < 0.05). No significant difference existed in posterior anchorage loss, canine rotation angle, PPD, pulp vitality, or pain score between two groups (P > 0.05).ConclusionsFlapless Er: YAG laser corticotomy significantly enhanced canine retraction rate with no adverse effect on other parameters.

Soft Tissue Responses to Orthodontic Treatment: Impact of Premolar Extraction on Diverse Growth Patterns.

Alteration in facial soft tissue plays an important role in the esthetics of an individual. The first thing a patient wants from orthodontic treatment is how well he/she looks. The degree of soft tissue changes brought about by the retraction of teeth can be influenced byfactors such as extraction pattern, muscle function, age, gender, weight, etc. Aim: The aim of the study was to compare post-orthodontic soft tissue changes among different facial growth patterns in orthodontic patients undergoing extraction of first premolar teeth. Pre-treatment and post-treatment lateral cephalograms of 45 orthodontic patients who underwent therapeutic extraction of the first premolars were included in the study. They were divided into three equal groups based on their facial growth pattern, that is, average, horizontal, and vertical. Eight soft tissue cephalometric measurements were done in all the lateral cephalograms. Paired Student t-tests and analysis of variance (ANOVA) were conducted to statistically analyze the results. The significance level was set as 0.05. The paired Student t-test showed a P-value > 0.05 for lower anterior facial height in all three groupsand for facial angle in vertical growers alone. ANOVA comparing the mean soft tissue changes among the three groups resulted in a P-value > 0.05 for all the measured parameters. Facial growth patterns donot influence the extent of soft tissue profile changes in orthodontic patients treated with extraction of first premolars.

Effectiveness of low frequency vibration on the rate of canine retraction: a randomized controlled clinical trial

To investigate the effectiveness of AcceleDent Aura vibrating device on the rate of canine retraction. Thirty-two patients requiring extraction of upper first premolars and canine retraction were randomly allocated with a 1:1 ratio into either no-appliance group or the AcceleDent Aura appliance group. Canine retraction was done applying 150gm of retraction force using NiTi coil springs on 16 × 22 stainless steel archwires. The duration of the study was 4 months. Models were collected and digitized directly after extraction of upper first premolars and at monthly intervals during canine retraction for recording the monthly as well as the total distance moved by the canine. Digitized models were superimposed on the initial model and data were statistically analyzed. Anchorage loss, rotation, tipping, torque and root condition were evaluated using cone beam computed tomography imaging. Pain was evaluated by visual analog scale. No patients were dropped-out during this study. There was no statistically significant difference between both groups regarding the total distance travelled by the canine (P = 0.436), as well as the rate of canine retraction per month (P = 0.17). Root condition was the same for the two groups. Regarding the pain level, there was no statistically significant difference between the two groups at day 0 (P = 0.721), after 24 h (P = 0.882), after 72 h (P = 0.378) and after 7 days (P = 0.964). AcceleDent Aura was not able to accelerate orthodontic tooth movement. Pain level couldn’t be reduced by vibrational force with an AcceleDent device during orthodontic treatment. Root condition was not affected by the vibrational forces.

Periodontal tissue regeneration with cementogenesis after application of brain-derived neurotrophic factor in 3-wall inflamed intra-bony defect.

The purpose of this study is to investigate regenerative process by immunohistochemical analysis and evaluate periodontal tissue regeneration following a topical application of BDNF to inflamed 3-wall intra-bony defects. Brain-derived neurotrophic factor (BDNF) plays a role in the survival and differentiation of central and peripheral neurons. BDNF can regulate the functions of non-neural cells, osteoblasts, periodontal ligament cells, endothelial cells, as well as neural cells. Our previous study showed that a topical application of BDNF enhances periodontal tissue regeneration in experimental periodontal defects of dog and that BDNF stimulates the expression of bone (cementum)-related proteins and proliferation of human periodontal ligament cells. Six weeks after extraction of mandibular first and third premolars, 3-wall intra-bony defects were created in mandibular second and fourth premolars of beagle dogs. Impression material was placed in all of the artificial defects to induce inflammation. Two weeks after the first operation, BDNF (25 and 50 μg/mL) immersed into atelocollagen sponge was applied to the defects. As a control, only atelocollagen sponge immersed in saline was applied. Two and four weeks after the BDNF application, morphometric analysis was performed. Localizations of osteopontin (OPN) and proliferating cell nuclear antigen (PCNA)-positive cells were evaluated by immunohistochemical analysis. Two weeks after application of BDNF, periodontal tissue was partially regenerated. Immunohistochemical analyses revealed that cells on the denuded root surface were positive with OPN and PCNA. PCNA-positive cells were also detected in the soft connective tissue of regenerating periodontal tissue. Four weeks after application of BDNF, the periodontal defects were regenerated with cementum, periodontal ligament, and alveolar bone. Along the root surface, abundant OPN-positive cells were observed. Morphometric analyses revealed that percentage of new cementum length and percentage of new bone area of experimental groups were higher than control group and dose-dependently increased. These findings suggest that BDNF could induce cementum regeneration in early regenerative phase by stimulating proliferation of periodontal ligament cells and differentiation into periodontal tissue cells, resulting in enhancement of periodontal tissue regeneration in inflamed 3-wall intra-bony defects.

The Efficiency of Segmental Le Fort I Surgery in Clear Aligner Therapy of Skeletal Class III Deformity: A Pilot Study.

The purpose of this study was to investigate the efficiency of segmental Le Fort I osteotomy in clear aligner therapy of skeletal Class III deformities and to explore whether Le Fort I segmental osteotomy was effective for maxillary incisor axis correction and reduced the duration of perioperative orthodontics. Patients who had skeletal Class III deformities (ANB<0) treated with extraction of the maxillary first premolars, segmental Le Fort I osteotomy, and clear aligners therapy were included in this retrospective study. We measured the amount of tooth extraction space that was closed by surgery and recorded the preoperative orthodontic and total treatment duration. Lateral cephalograms were analyzed to measure changes of maxillary incisor inclination before treatment (T0), 1 week before surgery (T1), 1 week after surgery (T2), and after total orthodontic treatment (T3). Statistical analyses were performed, and the P value was set at 0.05. The sample was composed of 15 patients aged 19 to 30 (M=22.9) years. The average preoperative orthodontic treatment duration was 16.2±5.22mo, with 33.5 pairs of clear aligners. The gap at the extraction site decreased from 5.42±1.57mm to 0.80±0.62mm on average after surgery. U1-SN and U1-NA(deg) increased sparingly with preoperative decompensation, decreased in quantity after surgery, and then slightly increased with postoperative compensation (T2<T3<T0<T1; △ U1-SN, △ U1-NA: T1-T2, P <0.05; T0 - T1 and T2-T3, P >0.05). Le Fort I segmental osteotomy assisted decompensation of the upper anterior teeth and reduced the duration of preoperative orthodontics with clear aligners.

“Managing Class II Div I Malocclusion with Clear Path Aligners Utilizing an Extraction-Based Treatment Approach: A Case Report”

This case report is based on the clear aligner treatment of an adult patient presented with class II div I malocclusion. The case was treated with the extraction of upper first premolars and interproximal reduction in the lower arch. Total 35 sets of upper aligners and 25 sets of lower aligners were delivered with the wear time of 22 hours per day for 10 days. The entire treatment course spanned a period of 14 months. Thus, the case study underscores the reliability of orthodontic treatment with clear aligners for addressing class II malocclusion. The discreet nature of these aligners not only enhances periodontal health but also increases patient acceptance. As a result, they are more likely to embrace and adhere to the treatment, fostering better overall outcomes.

Does the application of autologous injectable Platelet-Rich Fibrin (i-PRF) affect the patient’s daily performance during the retraction of upper canines? A single-centre randomized split-mouth controlled trial

BackgroundPrevious studies have assessed different aspects concerning the applications of i-PRF in the oral cavity. However, nothing is known regarding patients’ perceptions of the injection of autologous platelet-rich fibrin (i-PRF).ObjectivesTo investigate patients’ perceptions after injecting platelet-rich fibrin (i-PRF) in the course of retracting upper canines.MethodsTwenty-one patients, whose treatments required extractions of both upper first premolars, were recruited. Extraction side was randomly allocated to the intervention or control sides. After the alignment phase, i-PRF was injected twice with a one-month interval on the buccal and palatal aspects of the extraction sites (intervention side). Patients’ perceptions were evaluated with two questionnaires: the first was used to assess the level of pain, discomfort, swelling, eating and swallowing difficulties as well as jaw movement restriction after 1 h (T1), 2 h (T2), 6 h (T3), 24 h (T4) and 48 h (T5) of the second injection; the second questionnaire was used to assess the acceptance of the i-PRF injection and overall satisfaction with this technique at the end of canine retraction phase. Visual Analogue Scale (VAS) was adopted for this purpose. Wilcoxon Signed Rank Test was used to compare between both sides at all time points while Friedman’s Test was the selected test for detecting variables’ changes over time. Post-hoc Wilcoxon Matched-Pairs Signed-Rank Tests were applied when any of the results were significant. As to the multiplicity of tests, Bonferroni Correction was implemented.ResultsPain and swelling levels were significantly higher on the experimental compared to the control sides at T1, T2, and T3 (P < 0.05), whereas they declined sharply and went back to almost normal values at T4 (after 24 h). At T5 they were 0. Discomfort and difficulty in mastication on intervention sides were significant only at T1 and T2. Pain, swelling, and chewing difficulties were significant (P < 0.001) during the 4 assessed time points. The increase was insignificant regarding swallowing difficulties and jaw movement limitations at all time intervals.ConclusionsInjecting autologous (i-PRF) during orthodontic canine retraction is a well-perceived and well-tolerated method due to the limited discomfort which significantly diminishes 24 h afterwards.Trial’s registrationClinicalTrials.gov (Identifier Number: NCT03399422. 16/01/2018).

Outcome differences after orthodontic camouflage treatment in hypo- and hyperdivergent patients – A retrospective cephalometric investigation

ObjectivesTo compare differences in outcome in skeletal and dental parameters in hypo- and hyperdivergent Class II patients after extraction of upper first premolars and comprehensive orthodontic treatment.Materials and methods37 Class-II-patients with dental camouflage treatment were divided into a hypo- (n = 18) or a hyperdivergent (n = 19) group depending on the mandibular plane angle (hypo: < 34° or hyper: ≥ 34°). Lateral cephalograms were available before (T1) and after (T2) treatment and were analyzed with customized measurements. Data from a growth survey served as a control and were used to calculate the actual treatment effect. Data were analyzed by one-sample Student’s t-tests and independent Student’s t-tests. Statistical significance was set at p < 0.05.ResultsThe measurements showed similar changes in both groups. The effects were mainly dentoalveolar. Hypodivergent patients showed an almost equal increase in anterior and posterior facial height, while hyperdivergent patients only showed an increase in anterior facial height.ConclusionsIn hyperdivergent patients, the anterior facial height increases despite camouflage treatment. This indicates a tendency towards bite opening and backward rotation of the mandible. Hypodivergent patients do not experience deepening of the bite.Clinical relevanceIn hyperdivergent patients with upper first premolars extraction the anterior facial height increased differently than in hypodivergent patients. This should be considered if a bite opening is a possible contraindication to treatment.

Posttreatment stability following therapy using passive self-ligating brackets: extraction vs. nonextraction.

This study aimed to evaluate the effects of lower premolar extraction on posttreatment stability one year following fixed orthodontic treatment with passive self-ligating brackets (Damon system, Ormco, Orange, CA, USA). All patients were treated with fixed orthodontic appliances using passive self-ligating brackets (Damon). For retention, removable Hawley retainers were used. Two groups of patients were included in the study. Each group consisted of 23patients: group Ex consisted of 10male and 13female patients (13.4 ± 1.6years old) with extraction of lower first premolars and group NonEx consisted of 11male and 12female patients (13.4 ± 3.9years old) without dental extractions. The patients' dental models and photographs were assessed at T0(pretreatment), T1(the end of active orthodontic treatment: 3.3 ± 1.0years in the Ex and 2.3 ± 0.8years in the NonEx group) and at T2(1year posttreatment). All lower casts were scanned and the following dental parameters were recorded and compared between the two groups: intercanine width (ICW), anterior arch width (AAW), intermolar width (IMW), Little's irregularity index (LII) and gingival recessions. An increase in ICW (group Ex: 1.20 ± 2.51 mm and group NonEx: 0.84 ± 1.48 mm) by the end of active treatment (T1; P < 0.05), as well as arelapse regarding the ICW (group Ex: -0.1 ± 0.47 mm and group NonEx: -67% ± 0.38 mm) one year post-treatment (T2) were recorded in the samples. Relapse in the non-extraction group was statistically and clinically significant, whereas ICW values remained relatively stable in the extraction group during the posttreatment period (T1-T2). The irregularity index decreased during treatment (group Ex: -8.79 ± 6.36 mm and group NonEx: -5.24 ± 2.99 mm) and relapsed in both groups (group Ex: 0.57 ± 90 mm and group NonEx: 0.27 ± 0.53). The rate of relapse in LII was correlated to the relapse rate of ICW. Areduction of IMW was recorded in the Ex group (-1.89 ± 1.82 mm) during active treatment (P < 0.05), which remained stable 1year posttreatment. AAW increased in both groups (group Ex: 2.77 ± 1.77 mm and group NonEx: 1.77 ± 2.04 mm) throughout active treatment and remained stable at T2. Intergroup comparison revealed that ICW remained stable 1year posttreatment in the Ex group, whereas high relapse of ICW was recorded in the NonEx group. Furthermore, risk of arelapse of LII appears to be higher in cases with arelapse of the ICW.

Effect of power arm length combined with additional anterior torque on the axial orientation of the maxillary incisors during en-masse retraction: A finite element analysis

This study aimed to clarify the effect of power arm length combined with additional torque incorporated into the archwire on the controlled movement of the anterior teeth using the finite element method. An adult patient requiring medium anchorage after extraction of the maxillary first premolars was selected for this study. The power arms were placed between the lateral incisor and the canine at 3 levels: 3 mm, 6 mm, and 9 mm. A 150 g of retraction force was applied from each height of the anterior hook to the first molar tube, with 0°, 5°, and 10° of applied lingual root torque on the incisors. A 3-mm hook with 10° of applied torque, a 6-mm hook with 5° of applied torque, or a 9-mm hook with no extra torque constituted the best combinations targeted at controlling the inclination of incisors during retraction. Extrusion and distal tipping of the canine were observed. Moreover, mesial tipping and mesiopalatal rotation of the molar were unavoidable. Finally, intercanine and intermolar widths were decreased. Adding extra torque on the incisors or using high torque brackets is recommended for patients with maxillary first premolar extraction.

Comparison of GUMMETAL® and stainless steel alloy during canine retraction: A pilot split-mouth randomized controlled trial

A TiNb alloy wire (GUMMETAL® [GM], Toyota Central R&D Labs, Inc., Nagakute, Japan) was recently developed with unique properties for orthodontic applications. This pilot split-mouth randomized controlled trial compared maxillary canine retraction during space closure using sliding mechanics on GM vs. stainless steel (SS) archwires. Subjects who met the inclusion criteria were treated with fixed appliances and maxillary first-premolar extractions between September 2020 and March 2022. After leveling and aligning, maxillary archwires, fabricated by crimping together segments of 0.016×0.022" GM and SS archwires, were placed and canine retraction initiated using nickel-titanium coil springs. Digital models of the maxillary arch were superimposed at 0, 4, 8 and 12 weeks and the amount of canine movement (mm), rate of movement (mm/month), and 3-dimensional changes (rotational, vertical extrusion, tip) were measured and compared statistically. Of the 12 subjects recruited, only six completed the study with a median age of 15.8 years (12.0-17.4 years). At 12 weeks, the median canine retraction was 3.41mm (IQR: 2.10, 4.76) with GM versus 3.71mm (IQR: 1.62, 6.45) with SS. The retraction rate was 1.14mm/month (IQR: 0.69, 1.59) with GM, versus 1.24mm/month (IQR: 0.54, 2.15) with SS. The median rotational, vertical and tip changes of the canine were 7.90̊, 0.59mm and 6.15̊ with GM, and 7.25̊, 0.29mm and 2.05̊ with SS. Intergroup differences with all measurements were not statistically significant. No significant differences were found between GM and SS during maxillary canine retraction. GM demonstrated clinical potential for space closure mechanics, however, future larger studies are needed.

Effectiveness of Flapless Cortico-Alveolar Perforations Using Mechanical Drills Versus Traditional Corticotomy on the Retraction of Maxillary Canines in Class II Division 1 Malocclusion: A Three-Arm Randomized Controlled Clinical Trial.

Both invasive and minimally invasive surgical methods have recently gained popularity in accelerating orthodontic tooth movement. Traditional corticotomy (TC) was one of the first effective invasive surgical techniques in shortening orthodontic treatment time, whereas the flapless cortico-alveolar perforations (FCAPs) technique is a modern minimally invasive method that has recently shown good results in different types of orthodontic tooth movement. Therefore, this study aimed to compare the effectiveness of TC versus FCAPs in maxillary canine retraction when treating Class II division 1 malocclusion patients. This was a single-blinded, single-center, three-arm randomized controlled trial. A total of 51 patients (22 males, 29 females, mean age 20.98 ± 1.95) whose treatment planning included the extraction of maxillary first premolars were enrolled and randomly divided into three groups: the TC group, the FCAPs group, and the control group. The assessed outcomes were the amount of canine retraction, anchorage loss, and canines' rotation, which was evaluated at five-time points till the completion of canine retraction. There were statistically significant differences in the amount of canine retraction between the three groups in the first two months (p < 0.001), with greater mean values in the TC group (p < 0.001) in the first month. However, the amount of canine retraction in the FCAPs group was significantly greater in the second month compared to the TC group (p = 0.003) and the control group (p < 0.001). In the first month of canine retraction, anchorage loss, and canine rotation were significantly lesser in the TC and FCAPs groups than in the control group (p < 0.001). On the contrary, the canines' rotation amount after the completion of retraction was greater in the TC group than in the other two groups (p < 0.001). TC and FCAPs are efficient adjunctive surgical methods for accelerating canine retraction. At the end of the first month, the TC accelerated canine retraction by 59.85% and FCAPs by 44% compared to the conventional retraction. At the end of the second month, the acceleration was less than recorded in the first month (35.44% and 50.20%, respectively).The acceleration effect of the surgical interventions appeared transient and did not last in the following observation period.

Evaluation of Patient-Centered Outcomes Associated With the Acceleration of en-Masse Retraction of Upper Anterior Teeth Assisted by Flapless Corticotomy Compared to Traditional Corticotomy: A Two-Arm Randomized Controlled Trial.

This study aimed to assess the levels of pain, discomfort, and functional impairment associated with the en-masse retraction of the upper anterior teeth when treating Class II division 1 malocclusion patients using traditional corticotomy or flapless corticotomy. In addition, an assessment of patients' satisfaction with the selected surgical intervention wasundertaken at one-month post-operatively. The study sample comprised 40 patients with Class II division 1 malocclusion, randomly assigned to either the traditional corticotomy group (n=20) or the flapless corticotomy group (n=20). Patients underwent extraction of the maxillary first premolars, and orthodontic mini-screws were placed between the maxillary second premolars and the first molars for skeletal anchorage. An en-masse retraction was accomplished in both groups. Patients were asked to fill in a questionnaire at 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) after the surgical intervention using standardized questionnaires. Most questions were answered on a visual analog scale where zero scores meant the absence of pain, discomfort, or functional impairment, and 100 scores meant the worst feelings of these traits. All patients in both groups entered data analysis with no dropouts. All measured levels were significantly greater in the traditional corticotomy group during the first two weeks following the corticotomy intervention in terms of pain perception (P˂0.001), discomfort (P=0.004), and difficulty in chewing (P=0.015). Additionally, during the first week following corticotomy, levels of perception of discomfort (P˂0.001), difficulty in swallowing (P=0.001), and limitation of jaw movement (P˂0.001) were significantly greater in the traditional corticotomy group. Patient satisfaction, the recommendation to a friend, and acceptance of flapless corticotomy were significantly greater than traditional corticotomy (P=0.002, P=0.001, respectively). 78% of patients in the traditional corticotomy group considered it more discomfort than a tooth extraction, while 50% of patients in the flapless corticotomy group considered tooth extraction more discomfort, with a significant difference between the two groups (P=0.001). The levels of negative patients' reported outcomes were significantly smaller with flapless corticotomy than with traditional corticotomy. Traditional corticotomy was associated with mild to moderate levels of pain, swallowing difficulty, moderate levels of discomfort, chewing difficulty, and jaw movement limitation after 24 hours of the surgical procedure. In contrast, flapless corticotomy was less problematic and associated with mild pain, swelling, chewing difficulty, jaw movement limitation, and swallowing difficulty at the same assessment time. Patient satisfaction, acceptance, and recommendation to a friend were greater for flapless corticotomy than traditional intervention.

Effect of leukocyte platelet-rich fibrin on the rate of canine movement – A prospective and randomized control trial

Objectives: The present study was conducted to investigate the effects of leukocyte and platelet-rich fibrin (L-PRF) on the rate of maxillary canine retraction for a period of 5 months. Material and Methods: A split-mouth study was conducted on 16 patients (32 extraction sockets) (Nine males and seven females; age ranging 17–25 years) with Class II Div 1 malocclusion or Class I bimaxillary protrusion, requiring therapeutic extraction of bilateral maxillary first premolars. After the initial leveling and alignment, L-PRF plugs were placed immediately in the randomly selected socket (Experimental Group) and the other side served as control for secondary healing (Control Group). This was followed by the activation of nickel-titanium closed coil springs for canine retraction. The rate of canine movement, canine rotation, tipping, root resorption, and molar movement was assessed at monthly intervals for 5 months (T0–T5). Data were collected from study models. Assessment of pain accompanying the procedure was done using a Likert scale. The trial was registered at the Clinical Trials Registry of India (REF/2022/02/051837). Results: The study revealed that there was a significant increase in the rate of canine movement on the experimental side in the first 2 months and significant molar anchorage loss was seen only in the 1st month. There were statistically non-significant differences in canine rotation, tipping, probing depth, root resorption, and pain perception between the groups. Conclusion: The use of L-PRF plugs in the extraction sockets enhanced the rate of canine movement in the first 2 months of treatment with less anchorage loss and no deleterious effects on periodontium.

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.

A Novel Method to Accelerate Orthodontic Tooth Movement Using Low-Intensity Direct Electrical Current in Patients Requiring en-Masse Retraction of the Upper Anterior Teeth: A Preliminary Clinical Report.

Shortening the duration of orthodontic treatment by speeding up the rate of tooth movement has become an essential goal for both orthodontists and patients. This preliminary report aimed to investigate the safety and effectiveness of a new intraoral removable electrical device in accelerating the en-masse retraction of the upper anterior teeth using low-intensity direct electrical current. This prospective preliminary interventional clinical study was conducted at the Department of Orthodontics, Faculty of Dentistry, Damascus University, Syria, between March 2019 and February 2020. The sample consisted of six patients (four females and two males; mean age: 19.55 ± 0.89 years) whose initial diagnosis was class II division I malocclusion, and their treatment plansuggested the extraction of upper first premolars followed by en-masse retraction. The electrical stimulation was applied on the maxillary anterior region during the en-masse retraction phase using a specially fabricated removable device that was designed by two coauthors of this manuscript (RIS, MYH). Patients were asked to wear their own electrical devices inside their mouths for five hours daily. The primary outcomes were the en-masse retraction rate and duration. The secondary outcomes were safety and patient acceptance. The average total retraction rate during the treatment period was 0.97±0.06 mm/month. The total amount of retraction achieved during follow-up was 5.65 ± 0.85 mm, which was about 91.86% of the space resulting from the extraction of the upper first premolars. The mean treatment duration to complete the en-masse retraction was 5.66±0.81 months. No side effects of the electrical stimulation were found during the follow-up. Low-intensity direct electrical current could be an effective method to accelerate orthodontic movement. The electrical accelerating device used in this study effectively increased the en-masse retraction rate of the upper anterior teeth without any side effects and with high patient acceptance.

Class III Malocclusion Camouflage Treatment Using a Conventional Orthodontic Appliance in a Non-Growing Patient

The treatment of skeletal and dental Class III malocclusions is a challenge for orthodontists, and one of the treatment alternatives for a non-growing patient is orthodontic camouflage treatment. Different approaches may result in different outcomes; therefore, a proper diagnosis and treatment plan are needed to avoid undesirable effects. In this case, a 21-year-old female patient presented with a skeletal Class III malocclusion, with a normal maxilla, prognathic mandible, moderate crowding, and an acceptable facial profile. The treatment modality for orthodontic camouflage treatment was a conventional orthodontic appliance with the extraction of mandibular first premolars to resolve crowding. At the end of the treatment, a Class I canine and incisor relationship was achieved while maintaining a Class III molar relationship. After 25 months of treatment, the patient had a more pleasant smile with improved functional occlusion.

Ortho-Surgical Management of An Adult Patient with Gummy Smile

Aim: This case report represents the clinical management of a Skeletal Class II adult patient with gummy smile treated by Orthognathic surgery. Background: Vertical maxillary excess (VME) is the most common skeletal deformity in Skeletal Class II which is treated by Anterior Maxillary Osteotomy (AMO) and Gummy Smile is the characteristic feature of VME in which the anterior part of maxilla is superiorly repositioned. Case Description: A 19-year-old patient reported our clinic with the complaint of forwardly placed upper front teeth. On extra oral examination, she had convex profile with posterior divergence and interlabial gap of 10mm and everted upper lip. The patient had a gummy smile of 8mm. Intra orally, she had Class II canine relationship on both sides with missing irt 16, 36, 46. Cephalometric values showed Class II skeletal base with protrusive upper and lower incisors and acute nasolabial angle. Initially orthodontic treatment was done and extraction of upper first premolars was planned during surgery. AMO was done with superior impaction of 4mm and posteriorly by 6mm. After 4 weeks of post surgery, the settling of occlusion using intermaxillary elastics was done. At the end of the treatment, the patient had Class I canine relationship on both sides with Skeletal Class I and overjet and overbite was 2mm. The patient gummy smile was reduced to 4mm which was accepted by the patient. Fixed retention was given in both the arches. The total treatment time was around 30 months. Conclusion: The proper diagnosis and appropriate treatment planning is the main key to achieve stable results in Orthodontics. An interdisciplinary approach with the orthodontist and surgeon will lead to achieve stable, functional and esthetic results.