Maxilla Research Articles

Orthognathic Surgery Trending: Retrospective Ten Years Cases Analysis in Nineveh Province, Iraq.

The study aimed at analyzing patient's case sheets in regard to the incidence of skeletal discrepancy present in cases and its relation with the demographic profile of the sample. All these are chronicled for more than 10 years periods. This is a retrospective study analysis of the orthognathic case sheets for more than 10 years period. The total numbers of patients are 678. Patient's case sheet was already prepared by the Multi-Disciplinary Team Orthognathic Surgery Clinic in Al-Salam Teaching Hospital, which is the only authorized committee in Nineveh Health Directorate. The highest age percentage is between (18 and 27y/76%). Angle class III cases are the uppermost cases (36%) from the total. A significant P value is clear at the level ≤0.05 and ≤0.01 between surgery type and discrepancy in anterior segmental osteotomies (upper and lower) which is performed in bi-maxillary protrusion cases and Angle class II cases (0.01**). Similarly, anterior segmental osteotomies (upper jaw only) which are indicated in both open bite and Angle Class II cases documented as a statistically significant P value (0.02*). The positive correlation is shown in all variables with the disharmony or facial discrepancies. Esthetic and beauty as causes for treatment recorded more than function in relation to time series. This study documents that patients with skeletal class III accounted for the largest percentage (64%) in the study group. A high increase in patients number seeking treatment for their discrepancy is obvious with time from 2009 till 2022.

Application of sticky bone combined with concentrated growth factor (CGF) for horizontal alveolar ridge augmentation of anterior teeth: a randomized controlled clinical study.

This study was designed to estimate the effect of sticky bone combined with concentrated growth factor (CGF) on anterior alveolar horizontal augmentation during implantation. Twenty-eight patients were randomly assigned to either the test group (Group 1, n = 14) or the control group (Group 2, n = 14). Patients in Group 1 and Group 2 underwent GBR using sticky bone combined with CGF and bone powders mixed with saline, respectively. On postoperative Day 7, the patients completed the visual analogue scale (VAS). Three-dimensional models of maxillary alveolar bone were reconstructed from CBCT data at different periods, and the bone volume conversion rate was calculated with the assistance of a measurement marker guide. Labial bone thickness before and after trauma closure and bone density at six months postoperatively were also measured. The mean bone volume conversion rate for Group 1 (72.09 ± 12.18%) was greater than that for Group 2 (57.47 ± 9.62%, P = 0.002). The VAS score was lower for Group 1 than for Group 2 (P = 0.032). At six months postoperatively, greater bone density was found in patients in Group 1 than in those in Group 2, although the difference was not statistically significant (P > 0.05). The change in the thickness of the labial bone graft material in Group 1 was smaller than that in Group 2 (P = 0.025). Sticky bone combined with CGF was able to achieve better bone augmentation than conventional GBR. With excellent mechanical properties and the capacity to release growth factors, sticky bone is an ideal material for bone grafting. The study was registered at the Chinese Clinical Trial Registry on 10/04/2022 (Identification number: ChiCTR2200058500).

A clinical example of the treatment of a patient using a hybrid device for rapid palatal expansion

While using a clinical case as an example, in this article we described the usage of an expanding appliance based on palatal orthodontic mini-implants for the upper jaw.

Analysis of changes and correlation in condyle-fossa relationship after maxillary skeletal expansion.

To investigate the changes in condyle-glenoid fossa relationship after maxillary skeletal expansion (MSE) and to verify the correlation between the condyle positional changes and expansion effect. In this study, 20 patients (mean age 21.1 ± 5.7 years, 8 male, 12 female) with maxillary transverse deficiency (MTD) were treated with the MSE appliance, which contained molar bands and a expander with four micro-implants. The CBCT images were taken before expansion (T0), after expansion (T1) and after 6 months of maintenance (T2). The posterior TMJ space (PS), superior TMJ space (SS), anterior TMJ space, coronal lateral TMJ space (CLS), coronal medial TMJ space (CMS), condyle axis angle, maxillary basal bone width (BWM), inter-molars width, nasal bone width, molar inclination and molar palatal cusp height (U6H) were measured using Dolphin Imaging. At T1, compared with T0, the PS and SS significantly increased by 0.41 mm (P = .008) and 0.3 mm (P = .007). But only the SS significantly increased by 0.21 mm (P = .025) at T2. There was a significant difference of 0.37 mm (left-right, P = .014) between the left and right SS at T0, but no significant difference at T1 and T2. The increased BMW showed weak positive correlations with the change of PS (P = .015) and CMS (P = .031), and the decreased U6H showed weak negative correlations with the change of PS (P = .015) and CLS (P = .031) at T1. The use of MSE led to an increase in the SS and PS, which were weakly correlated with BWM and U6H. But this effect in the TMJ space gradually diminished after 6 months of maintenance, and the symmetry of the condyle-fossa relationship was preserved.

Diagnosis of maxillary compression syndrome

Introduction. Upper maxillary compression syndrome is characterized by a deficit in transversal development and is recognized within the classification system of the German school. Regardless of the schools’ affiliation according to which this malocclusion is classified, the objective is to determine and select the treatment method with maximum efficiency. Thus, the compression of the upper jaw can also be included as a component in class II subdivision 1 malocclusions, presenting in 2 clinical forms. In addition, the types of palatal suture and their impact on the development of the maxilla in the transverse plane were identified. The purpose of the study was to assess the importance of cone beam computed tomography (CBCT) n providing a comprehensive diagnosis of this malocclusion and formulating an elaborate treatment plan. Material and methods. After applying the inclusion and exclusion criteria, 165 patients were enrolled in the study. The research included patients with jaw compression syndrome diagnosed orthodontically during the mixed and permanent dentition periods. The patients were divided into 3 groups according to the stages of formation of the medio-palatine suture, correlating with their biological age. The research sample was calculated using ANOVA program: fixed effects, omnibus, one-way Analysis. Results. Determining the shape and degree of formation of the median palatal suture at the ages studied in the research, favors the selection of modality, type, and speed of expansion. These factors are directly related to the stage of formation of the palatal suture, which may or may not coincide with the patient’s biological age. CBCT is the method of choice for assessing this. Furthermore, the range of movement in millimeters that can be achieved after separating the upper jaw can be determined, regardless of the type of expansion. Conclusions. Based on the analysis of the data, we can appreciate the variety of expansion methods depending on the degree of formation of the medio-palatine suture. Through a comprehensive paraclinical examination and accurate interpretation, we can establish the definitive diagnosis of this clinical entity and create a treatment plan that minimizes the chance of recurrence.

Bilateral Maxillary Bone Swelling - Comprehensive Differential Diagnosis and the Role of Impacted Wisdom Teeth

Bilateral Maxillary Bone Swelling - Comprehensive Differential Diagnosis and the Role of Impacted Wisdom Teeth

Impact of circadian clock protein Bmal1 on experimentally-induced periodontitis-associated renal injury.

To investigate the mechanism of circadian clock protein Bmal1 (Bmal1) on renal injury with chronic periodontitis, we established an experimental rat periodontitis model. Twelve male Wistar rats were randomly divided into control and periodontitis groups (n=6, each group). The first maxillary molars on both sides of the upper jaw of rats with periodontitis were ligated by using orthodontic ligature wires, whereas the control group received no intervention measures. After 8 weeks, clinical periodontal parameters, including probing depth, bleeding index, and tooth mobility, were evaluated in both groups. Micro-CT scanning and three-dimensional image reconstruction were performed on the maxillary bones of the rats for the assessment of alveolar bone resorption. Histopatholo-gical observations of periodontal and renal tissues were conducted using hematoxylin-eosin (HE) and periodic acid-Schiff (PAS) staining. Renal function indicators, such as creatinine, albumin, and blood urea nitrogen levels, and oxidative stress markers, including superoxide dismutase, glutathione, and malondialdehyde levels, were measured using biochemical assay kits. MitoSOX red staining was used to detect reactive oxygen species (ROS) content in the kidneys. The gene and protein expression levels of Bmal1, nuclear factor erythroid 2-related factor 2 (Nrf2), and heme oxygenase-1 (HO-1) in rat renal tissues were assessed using real-time quantitative polymerase chain reaction (RT-qPCR) and immunohistochemical staining. Micro-CT and HE staining results showed significant bone resorption and attachment loss in the maxillary first molar region of the periodontitis group. Histological examination through HE and PAS staining revealed substantial histopathological damage to the renal tissues of the rats in the periodontitis group. The findings of the assessment of renal function and oxidative stress markers indicated that the periodontitis group exhibited abnormal levels of oxidative stress, whereas the renal function levels showed abnormalities without statistical significance. MitoSOX Red staining results showed that the content of ROS in the renal tissue of the periodontitis group was significantly higher than that of the control group, and RT-qPCR and immunohistochemistry results showed that the expression levels of Bmal1, Nrf2, and HO-1 in the renal tissues of the rats in the periodontitis group showed a decreasing trend. Circadian clock protein Bmal1 plays an important role in the oxidative damage process involved in the renal of rats with periodontitis.

Congenital Facial Infiltrating Lipomatosis: A Rare Cause of Facial Asymmetry in Infants.

Congenital facial infiltrating lipomatosis (CFIL) is a rare condition that typically affects the trunk and limbs, but can also occur in the face. Managing CFIL is a significant challenge due to its diffuse involvement in important facial structures. This case report aims to describe a rare form of lipomatosis and discuss the clinical and therapeutic aspects of this entity. The patient was a 5-year-old girl who was admitted to our department due to a right paralateronasal swelling that had been present for 5 months. During the physical examination, a swelling of the right nasolabial was observed. A computed tomography scan of the facial bone revealed an extra bony soft tissue mass near the vestibule of the right nostril in contact with the frontal process of the maxillary bone and the anterior wall of the right maxillary sinus. The patient underwent excision under general anesthesia. The histological report indicated congenital focal lipomatosis. There was no recurrence of swelling a year after initial surgery. Facial infiltrating lipomatosis is a rare congenital disorder in which mature lipocytes invade adjacent tissue. Due to its diffuse infiltration and involvement of important facial structures, complete surgical excision is often impossible. Specific management of this condition requires insight into its pathogenesis as surgical removal of the mass is usually unsuccessful.

Digitally planned surgical crown lengthening: a novel bone reduction strategy to correct a gummy smile.

This report describes the bone reduction guide which was digitally obtained to improve diagnosis, treatment outcome and follow-up. Treatment of gingival smiles due to altered passive eruption should include interdisciplinary planning and smile design to facilitate the prediction of treatment outcome. Crown lengthening surgery can be supported by digital tools to improve surgical planning and follow-up. A 30-year-old female patient was referred to a private dental clinic seeking solutions for her gingival smile. Based on the anatomical crown length, a smile design was created, and the patient was presented with a simulated smile before treatment. In the surgical phase, a full-thickness flap was raised in the upper jaw to achieve the desired outcome. Using cone-beam computed tomography to determine cementoenamel junction for smile design and treatment planning brings many benefits. Patients and clinicians can foresee treatment results. From there, appropriate changes can be made. The bone reduction guide is designed to rest on the bone to help the clinician cut the bone accurately and thoroughly follow the established plan.

Peculiarities of the clinical picture and diagnosis of dirofilariasis in the maxillofacial area: a series of cases from practice

Dirofilariasis is a helminthiasis that occurs in carnivorous animals (dogs, cats, foxes, wolves, etc.) and less often in humans, although according to some authors it is believed that the number of infected animals approximately corresponds to the number of infected people. Dirofilariasis of the maxillofacial area is not a widespread condition, its cases are described in short series, therefore, the aim of this work is to share our own experience of managing patients with this rare condition.The work presents our own experience in the management of 14 dirofilariasis patients with lesions of the maxillofacial area, of them there are 3 men and 11 women aged 29 to 54. Most patients sought help in the late autumn, winter and spring periods and only 2 people in the summer period. All patients were examined by a dentist, and an ultrasound examination of the area with a formation was performed. According to the clinical manifestations, the disease began acutely in nine patients and had a picture of inflamed atheroma (2 – in the zygomatic area, 1 – in the parotid, 2 – in the infraorbital area, 2 – in the temporal area, and 2 – in the area of the nasal bridge). All patients were operated on and tumor-like formations in dense membranes were removed, inside which one live nematode 11-18 cm long was found. In 3 observations, fragments of dead, partially lysed nematodes were removed from the oral cavity, the capsules of which imitated a migrating granuloma. According to the location – 5 capsules with dirofilaria were located in the subcutaneous fatty tissue, 3 – in the submucosal layer of the gums fused to the periosteum of the upper jaw, 1 – in the submucous layer of the lower jaw, 2 – in the fibers of the temporalis muscle and 1 – in the fibers of the buccal muscle. In each case, the localization of the nematode was close to the places of accumulation of adipose tissue or large blood vessels. In the postoperative period complex therapy was prescribed, including symptomatic anti-inflammatory and desensitizing agents, and consultation with infectionist was recommended. Thus, according to our observations, dirofilariasis most often affects areas of the face in which there are large vessels and accumulation of fatty tissue. In connection with the prevalence of dirofilariosis in humans and the predominant localization of parasitic infection in the face area, dentists, ophthalmologists and otolaryngologists need to be familiar with this pathology and show definite vigilance. Treatment dirofilariosis patients should be carried out comprehensively, together with parasitologists, with surgical excision of the lesion and appropriate drug therapy.

SURGICAL TACTICS TO ELIMINATE COMPLEX VARIANTS OF CONGENITAL CLEFT PALATE

The scientific justification and practice of surgical methods ofcorrection of congenital cleft lip and palate are widely presented in the specialized literature concerning various types of lesions of the maxillofacial region [7, 13, 20, 21, 23-25]. At the same time, the results of international and domestic experienceand scientific research on these issues contribute to the development and implementation of new methods for correcting facial and jaw deformities, continuous improvement of surgical and rehabilitation techniques, the application of innovations in the pediatric healthcare system itself and the accumulation of experience in specialized areas of practice [1, 4, 17 , 19, 20, 23, 24]. In addition, the use of "additional materials" -types of implants (for example, plastic, biologically inert metal), which are surgically implanted into the destroyed structures of the maxillofacial region and meet the requirements of safety, indifference to surrounding tissues, targeted regeneration and the formation of adequate support for the restoration of the upper jaw, including using existing "classic" techniques, detailed and updated. classic" techniques, detailed and updated [5, 6, 8, 9, 15]. In most cases, the use of new surgical techniques of zygoplasty and ureteroplasty requires comprehensive medical and rehabilitation measures with the participation of highly qualified specialists of various profiles, however, it should be emphasized that the main stage of the algorithm of comprehensive care is the operation must be performed [7, 11, 13, 14, 16, 18, 21]. In parallel, theauthors of scientific research note that surgical methods for eliminating congenital clefts of the face and palate are constantly developing and becoming more rational: multi-stage surgical interventions are excluded, and the restoration of maxillofacial structures is achieved by two to three years of a child's life [2, 3, 7, 11].

Perbedaan Jumlah Hitung Osteoblas pada Pergerakan Ortodontik Gigi Setelah Pemberian Jintan Hitam

Osteoblasts are important for orthodontic tooth movement because they influence the activity of bone formation on the tension area. The administration of natural ingredients such as black cumin is proven to increase the number of osteoblasts because it contains thymoquinone as antioxidants to accelerate the process of tooth movement. The study aims to determine the differences in osteoblast count and their effect on the orthodontic movement of teeth after oral administration of black cumin. The method used in this research is experimental laboratory in vivo with a randomized post-test only control group design using 16 male Sprague-Dawley rat samples that were devided into four groups: the control group (K) with distilled water for 7 and 14 days, also the treatment group (P) with black cumin (Nigella sativa) for 7 and 14 days Elastomeric separators were placed on the upper jaw central incisors (right central incisor) using a separator applier to provide orthodontic mechanical force conditions. Alveolar bone tissue samples were taken after treatment then the number of osteoblasts was calculated histologically. Data were anaylzed using One Way Anova Test and LSD (p<0.05). Result of this research indicated that there was an increase in the number of osteoblasts in orthodontic movement after oral administration of black cumin.

Tanaka-Johnston’s Mixed Dentition Analysis among Orthodontic Patients in Tanzania

Background: Lower incisors are the first teeth to erupt, their sizes are reliable and little changes occur on the lower arch during mixed dentition. These teeth can be used to predict the size of remaining unerupted teeth. Tanaka Johnston's analysis is the most widely used method of mixed dentition analysis worldwide. The aim of the study was to assess the accuracy of Tanaka-Johnston’s methods of mixed dentition analysis among orthodontic patients in Tanzania. Methods: A cross-sectional study design was carried out at MUHAS dental clinic involving models from orthodontic patients. Data collection involved actual teeth size measurement and prediction using Tanaka-Johnston’s method. Comparison between the actual measurements and the predicted measurements was assessed using students' paired t-tests. Prediction equations for the present study were generated using a simple linear regression analysis. Results: Tanaka Johnston's method significantly overestimated the combined width of upper canines and premolars in the female group (p=0.000). However, the method underestimated the lower jaw measurements in both sexes (p<0.05). New prediction equations for the present study were generated for each sex and arch separately. For the upper jaw, it was Y=11.97+ 0.56X for males and Y = 10.97+0.49X for females. While for the lower jaw, it was Y= 10.8 +0.51X for males and Y=11.39+0.47X for females. Conclusion: Tanaka-Johnston’s methods of mixed dentition analysis was found to be inaccurate in estimating the size of unerupted canines and premolars in the study sample. Therefore, new prediction formulas were generated.

A Finite Element Analysis Study of Edentulous Model with Complete Denture to Simulate Masticatory Movement.

The purposes of this study are to establish and validate a finite element (FE) model using finite element analysis methods and to identify optimal loading conditions to simulate masticatory movement. A three-dimensional FE model of the maxillary and mandibular cortical bone, cancellous bone, and gingiva was constructed based on edentulous cone-beam-computed tomography data. Dental computer-aided design software was used to design the denture base and artificial teeth to produce a complete denture. Mesh convergence was performed to derive the optimal mesh size, and validation was conducted through comparison with mechanical test results. The mandible was rotated step-by-step to induce movements similar to actual mastication. Results showed that there was less than a 6% difference between the mechanical test and the alveolar bone-complete denture. It opened 10° as set in the first stage, confirming that the mouth closed 7° in the second stage. Occlusal contact occurred between the upper and lower artificial teeth as the mouth closed the remaining angle of 3° in the third stage while activating the masseter muscle. These results indicate that the FE model and masticatory loading conditions developed in this study can be applied to analyze biomechanical effects according to the wearing of dentures with various design elements applied.

Follicular Ameloblastoma of Maxillary: A Case Report

Introduction: Ameloblastoma is a benign odontogenic tumor that appears in the mandible and maxilla. Ameloblastoma has slow growth that takes several years for symptoms to appear, but ameloblastoma in the maxilla has a more aggressive clinical course compared to the mandible. The lack of initial symptoms leading to diagnosis at an advanced disease when the tumour has already extended beyond maxilla. The cancellous structure of the maxillary bone makes it easier for tumors to spread to the nasal cavity, paranasal sinuses, orbitals, parapharyngeal tissue and skull base. This article reports a case of resection of maxillary ameloblastoma. Case Report: A 63 year old female patient came with complaints of a lump on her right cheek since 2 years back that gradually increased in size. Since 2 months ago, pus and blood have been coming out of the lump. Extra oral examination revealed a well-defined mass with a solid and hard consistency, there were no ulcers or fistulas. Intraorally, a mass measuring 5x5x3cm was found in the region of teeth 12 to 15 which extended to the buccal-palatal area. History of allergies and weight loss was denied. Supporting examinations including panoramic radiography, PA chest radiography, CT-Scan, FNAB, and biopsy resulted in a diagnosis of ameloblastoma. Treatment was carried out by resection of the right maxillary tumor mass under general anesthesia. Discussion: In this case, the patient's clinical examination showed a hard and large palpable swelling in the right maxilla area which extended from the region of tooth 12 to tooth 15 which caused facial asymmetry and no tooth mobility was found. This hard and painless swelling takes about 2 years before the patient experiences symptoms of pus and blood discharge. The post-maxillectomy defect in this case was covered with an intraoral prosthesis in the form of a post-surgical obturator made of acrylic resin. The obturator functions to hold the surgical packing, and prevent food or dirt contamination in the defect area which can cause infection and slow healing. The use of a prosthesis also helps restore swallowing and speech function to the patient. Conlussion: In principle, the treatment for ameloblastoma is resection of the involved bone, as in this case the action taken is a maxillectomy. Maxillectomy can result in facial and oral cavity deformities characterised by facial disfigurement and alterations in oral functionality.Therefore, maxillary reconstruction is needed to treat maxillary defects after surgical procedures involving the loss of part or all of the maxilla.

Cone Beam Computerized Tomography Preoperative Guidance under Feature Point Extraction Algorithm Combined with Autologous Concentrated Growth Factors in Maxillary Dental Implantation with Insufficient Bone Mass

ABSTRACT Objective It was to assess the efficacy of preoperative guidance using cone beam computed tomography (CBCT) and the application of autologous concentrated growth factors (CGF) for implantation in maxillary teeth with inadequate bone mass. Methods An eigenvector-based multimodal elasticity algorithm was developed. Eighty patients with insufficient bone mass in the maxillary dental region were rolled into control group (n = 40, Bio-Oss bone powder treatment) and observation group (n = 40, autologous CGF and Bio-Oss bone powder treatment). The scale-invariant feature transform (SIFT) algorithm and the hierarchical attribute matching mechanism for elastic registration (HAMMER) were introduced, whose registration time and mutual information value were compared. Therapeutic outcomes of patients were also compared. Results The eigenvector-based multimodal elastic algorithm exhibited a significantly shorter registration time versus SIFT and HAMMER algorithms, and superior accuracy, sensitivity, and specificity (p < .05). Observation group demonstrated greater alveolar ridge elevation and bone augmentation versus control group, implying superior healing outcomes. Conclusion The feature point extraction algorithm is applicable for CBCT image processing in patients with insufficient maxillary bone mass. Autologous CGF exhibited superior therapeutic efficacy.

A hybrid robotic system for zygomatic implant placement based on mixed reality navigation

BackgroundsZygomatic implant (ZI) placement surgery is a viable surgical option for patients with severe maxillary atrophy and insufficient residual maxillary bone. Still, it is difficult and risky due to the long path of ZI placement and the narrow field of vision. Dynamic navigation is a superior solution, but it presents challenges such as requiring operators to have advanced skills and experience. Moreover, the precision and stability of manual implantation remain inadequate. These issues are anticipated to be addressed by implementing robot-assisted surgery and achieved by introducing a mixed reality (MR) navigation-guided hybrid robotic system for ZI placement surgery. MethodsThis study utilized a hybrid robotic system to perform the ZI placement surgery. Our first step was to reconstruct a virtual 3D model from preoperative cone-beam CT (CBCT) images. We proposed a series of algorithms based on coordinate transformation, which includes image-phantom registration, HoloLens-tracker registration, drill-phantom calibration, and robot-implant calibration, to unify all objects within the same coordinate system. These algorithms enable real-time tracking of the surgical drill's position and orientation relative to the patient phantom. Subsequently, the surgical drill is directed to the entry position, and the planned implantation paths are superimposed on the patient phantom using HoloLens 2 for visualization. Finally, the hybrid robot system performs the processed of drilling, expansion, and placement of ZIs under the guidance of the MR navigation system. ResultsPhantom experiments of ZI placement were conducted using 10 patient phantoms, with a total of 40 ZIs inserted. Out of these, 20 were manually implanted, and the remaining 20 were robotically implanted. Comparisons between the actual implanted ZI paths and the preoperatively planned ZI paths showed that our MR navigation-guided hybrid robotic system achieved a coronal deviation of 0.887 ± 0.213 mm, an apical deviation of 1.201 ± 0.318 mm, and an angular deviation of 3.468 ± 0.339° This demonstrates significantly better accuracy and stability than manual implantation. ConclusionOur proposed hybrid robotic system enables automated ZI placement surgery guided by MR navigation, achieving greater accuracy and stability compared to manual operations in phantom experiments. Furthermore, this system is expected to apply to animal and cadaveric experiments, to get a good ready for clinical studies.

Effects of occlusal wear on 16-year progression of non-carious cervical lesions-Results of the study of health in Pomerania (SHIP-START).

It is still discussed whether occlusal wear (OW) affects the formation of non-carious cervical lesions (NCCLs). To estimate effects of OW on the presence and development of NCCLs, using 16-year follow-up data from a cohort study. Occlusal and cervical defects were measured in 728 cast models (one from the upper jaw and one from the lower jaw) of 364 participants. Adjusted mixed-effects ordinal logistic models analysing estimated cross-sectional (N = 1308 teeth/291 subjects) and longitudinal (N = 718 teeth/226 subjects) associations of OW with NCCLs using tooth level data. OW size was cross-sectionally (OR = 1.74; 95% CI: 1.27-2.38 for OW size; OR = 0.97; 95% CI: 0.94-0.99 for squared OW size), but not longitudinally (OR = 1.14; 95% CI: 0.99-1.30) associated with odds of higher NCCL sizes. For cross-sectional analyses, predicted probabilities of an NCCL size of 0 decreased from about 0.996 to 0.010 for OW sizes of 0 to 25. Results suggest an association between OW and NCCL size. However, as longitudinal results were non-significant, while consistent in direction, large-scaled cohort studies are demanded to more precisely estimate effect strength.

Management of Xerostomia and Hyposalivation in Hypertensive Patient's Using Candesartan Cilexetil

Saliva’s disorder and dry mouth (xerostomia) are related to routine medication as antihypertensives. Candrsartan cilexetil is an angiotensin receptor blocker (ARB) hypertension drug that indirectly affects saliva by changing fluid and electrolyte balance. To examine the management of xerostomia and hyposalivation in hypertensive patients due to use of candesartan cilexetil. A 70 year old female patient complained her mouth felt dry since 1 year ago when she was diagnosed with hypertension. The patient consumes candesartan cilexetil once daily, 8 mg. Intra oral showed were edentulous areas on the entire upper and lower jaw with the patient's oral mucosa being dry, saliva thick, sticky and frothy. In this case, saliva’s rate measurement showed a result of 0.16 mL/minute. After intervention using dry mouth gel for two weeks, a saliva rate of 0.38 mL/minute. During the control, patient didn’t complaining dry mouth. This is accordance with the literature, dry mouth gel can improve signs and symptoms of dry mouth and increase the patient's ability to swallow. Patient’s take antihypertensive drugs have manifestations in form of xerostomia. The treatment carried out to improve the condition of patient's oral cavity is providing education on maintaining healthy teeth and mouth as well as using dry mouth gel applied to the entire oral mucosa. In this case, an increase salivary rate from 0.16 mL/minute to 0.38 mL/minute. The concluded, use of dry mouth gel is effective in treating xerostomia and can increase the rate of saliva in the oral cavity

Treatment of Tooth Relapse Using Removable Orthodontics Appliances

At present, fixed orthodontic appliances treatment is extensively utilized with excellent outcome. Nevertheless, complications frequently arise following the conclusion of orthodontic treatment, predominanly relapse. Relapse refers to repositioning teeth to their pre-treatment state; its progression is stochastic, thereby rendering relapse possible for each individual. Patients who fail to wear retainers consistently will relapse of the affected teeth after orthodontic treatment. Therefore, this case report details the successful treatment of tooth relapse with a removable orthodontic appliance. A 22-year-old female patient complained of irregular alignment of her lower front teeth. The patient received two years of treatment with fixed orthodontics; however, she ceased using retainers regularly after treatment concluded. An objective examination indicated that the teeth in the upper jaw teeth remain in a well-aligned position; however, the lower jaw exhibited that tooth 32 was mesiolabiotorsiversion, tooth 33 was distolinguotorsiversion, tooth 41 was labioversion, tooth 42 was mesiolinguotorsiversion, with an overjet of 3 mm and an overbite of 2 mm. Afterward, the malposition of the lower jaw teeth was corrected with an expansion plate for a removable orthodontic appliance. Following 20 follow-up treatments over five months, the malposition of the lower jaw teeth has been corrected. As a result, it can be deduced that removable orthodontic appliances continue to be efficacious in rectifying mild malposition caused by dental relapse, thereby obviating patients' need to reapply costly fixed orthodontic appliances.