Orthodontic Options Research Articles

Knowledge, attitude, and practices of clear aligners among general dentist and non-orthodontic postgraduates – A cross-sectional questionnaire survey

Background. Over the past few years, there has been a discernible surge in the demand for orthodontic treatments involving clear aligners. Although orthodontists have long held expertise in offering braces treatments, the advent of clear aligners has put out the curiosity of general dental practitioners. This study is thus centered on the assessment of general dentists' knowledge, attitudes, and approaches in incorporating clear aligners in their practice. Materials and methods. A Google Form with a questionnaire was created which consisted of 25 multiple choice closed-ended questions. Results. A total of 156 participants responded to the questionnaire. The comparative analysis showed a highly significant difference in knowledge, attitude and practice scores between general dentists and non-orthodontic postgraduates. No significant correlations were observed, except for the specialty and qualification related to orthodontic knowledge and found that most of them were familiar with aligners. The results of the study showed that nearly 50% of participants were not aware of aligner material, type of tooth movements easier with aligners, the use of composite attachments, retention protocols followed and case preference and only 56% of participants held the view that Orthodontists' involvement was imperative for clear aligner treatment. Conclusion. The study revealed a moderate level of knowledge and a favorable attitude towards clear aligner treatment among both general dentists and non-orthodontic postgraduates. Equipping these professionals with the requisite knowledge and competencies holds the potential to enhance their ability to deliver efficient orthodontic options to their patients down the line.

Palatal Anterior Teeth Retraction Assisted by Temporary Anchorage Devices - A Review

Successful orthodontic resolution of bimaxillary dentoalveolar protrusion depends on successful retraction of anterior dentition, which also involves acquiring proper buccolingual inclination and vertical position of anterior teeth. To fulfill these requirements, clinicians have devised numerous biomechanical and surgical orthodontic options. A palatal retractor for retraction of maxillary anterior dentition is the result of clinician’s long-time creative endeavors and an evolution of the biomechanical design. A palatal retractor splints the maxillary anterior dentition on the lingual side with bonded mesh plates connected by a supporting wire. Two long palatally extended arms are soldered to the supporting wire where adequate retraction force can be applied. Palatal retractors have several advantages over conventional bracket/wire systems. The two most prominent ones are biomechanical superiority and esthetic invisibility. As the palatal retractor is positioned on the lingual surface of the maxillary anterior dentition, it is not visible from the frontal view and since the anterior dentition retraction constitutes a significant portion of the total treatment time in extraction orthodontic treatment, it is a distinct esthetic advantage. Biomechanical disadvantage of the conventional bracket/wire system lies in its innate ineffectiveness of the torque and vertical control because of the long distance between the point of force application and the center of resistance of the anterior dentition. A combination of TADs and palatal retractors provides the possibility of maximizing control of both the torque and vertical position. This article aims to describe clinical considerations, applications, and results of palatal retractor use in clinical cases. Keywords: extraction treatment, anterior teeth retraction, palatal retractors, temporary anchorage devices.

Obstructive Sleep Apnea: A complete Review for Dentists

Obstructive Sleep Apnea is a complex disorder and has the characteristic finding of collapse of the upper airway during sleep. The effects of OSA may be widespread and can affect the cardiovascular, pulmonary, and neurocognitive systems. OSA has higher prevalence in men than women. The clinical symptoms can help to identify patients with OSA but it is also common to have no signs and symptoms in the initial stages. Obesity can be a contributing factor for OSA. OSA is identified as a major factor for cardiovascular morbidity such a systemic and pulmonary hypertension, heart failure, atrial fibrillation, and other arrhythmias. The screening for OSA includes the use of symptom questionnaire, CBCT for airway measurements, and confirmed by polysomnography. The management primarily includes the use of continuous positive airway pressure, orthodontic options, and surgical options.

Replacing buried teeth: A Review of primary failure of eruption of permanent teeth and case report

Primary failure of eruption is a condition that has variable presentation and can be difficult to diagnose. This article provides an overview of the condition and discusses the management of an unusual case of primary failure of eruption of permanent teeth in a 37-year-old adult. CPD/Clinical Relevance: Where surgical and orthodontic options are unpredictable, restorative management alone may achieve successful functional and aesthetic outcomes for cases involving primary failure of eruption of permanent teeth.

Tooth autotransplantation part 4: Alternative treatment options

Tooth autotransplantation is a versatile and successful technique if used in suitable cases; however, it is not always the optimal treatment choice. This article will explore alternative treatment strategies for managing failing or missing teeth, including methods for managing the bone, orthodontic options and techniques for tooth replacement. These methods may be considered as an adjunct to tooth transplantation, or an alternative, if transplantation is not deemed appropriate. Indications for alternative treatments are discussed with illustrations from treated cases.CPD/Clinical Relevance: A number of approaches are available for managing failing or missing teeth and are dependent on the clinical situation. It is important for dental specialists to understand these options and to work collaboratively to determine the best option for patients on an individual basis.

Abstract: NAM Vs Lip Adhesion: A Cephalometric Comparison

BACKGROUND: Patients with cleft lip and palate frequently undergo nasoalveolar molding (NAM) or lip adhesion (LA) to guide the cleft segments together in preparation for definitive repair. This study reports the effect of these primary interventions on eventual permanent incisor inclination. METHODS: This is a retrospective study at a tertiary craniofacial center. Patients with unilateral or bilateral cleft lip and palate, who had undergone LA or NAM, with follow-up imaging between ages of 7–9 were included. Patients were further categorized based on gingivoperiostioplasty (GPP) status. Patients with phase one orthodontic therapy were excluded. Cephalogram analysis used Dolphin software (©Dolphin imaging and management solutions). Measures taken: U1-NA(mm) and U1-SN, U1-FN, U1-NA, SNA, SNB, ANB (°) and were compared to Bolton normative measurements. RESULTS: Inclusion criteria yielded 50 children who received NAM (22 patients with GPP) and 18 children who received lip adhesion (2 patients with GPP). U1-SN angle was 73.6° for NAM and 88.4° for lip adhesion (p<0.0033). U1-FH angle was 83° for NAM and 96.3° for lip adhesion (p<0.0057). U1-Na angle was -2.1° for NAM and 10° lip adhesion (p<0.025). U1-Na distance was not significantly different between treatment groups. Differences in angles ANB, SNB and SNA were non-significant. Overjet (mm) was -7.07 and-1.65 for NAM and LA, respectively (p<0.028). Proportion of patients with overjet was 10 and 35.3%, respectively and for underjet 78 and 47.1%, respectively (P<0.002). Combining NAM and lip adhesion patients: U1-SN angle, U1-FH angle, U1-NA angle were 82.3, 91.1 and 7.6° respectively for unilateral cleft patients and 69.4, 78.8 and -9.4° respectively for bilateral cleft patients (p<0.05). ANB was 0.79 and 3.53 degrees for unilateral and bilateral clefts, respectively (p<0.0156). No other significant differences were identified. None of the parameters above showed any significant correlation with patient age at time of scan nor the use of GPP (p>0.05). CONCLUSION: LA and NAM cause deviation from normal in U1-SN, U1-FH, U1-NA and overjet with NAM having a greater effect. Bilateral clefts treated with NAM or LA deviated more in these parameters than unilateral clefts. Age at cephalometry and history of GPP had no significant affect. This may have significant implications for the phase I orthodontic options, time in treatment and potential dental morbidity due to traumatic occlusion and functional occlusal shifting.

Orthognathic surgery for the Invisalign patient

Orthognathic surgery has continued to evolve, with increasing utilization of digital imaging and software to facilitate both the pre-surgical orthodontics via Invisalign therapy, as well as virtual surgical planning (VSP). While offering the advantage of comprehensive and patient-specific analysis, these novel technologies have also inadvertently introduced challenges in execution of the surgical plan, causing select providers to question their utility in surgical cases. Through elimination of traditional orthodontic appliances, which have historically served to provide anchoring hardware for intraoperative splint stabilization, patients managed pre-surgically with Invisalign necessitate modification of the operative techniques. Here we provide an overview of several alternative methods to facilitate maxillomandibular repositioning and stabilization, including utilization of Erich arch bars, Ivy loops, intermaxillary fixation (IMF) screws and hybrid arch bar systems. Application of these techniques in orthognathic surgery, expanded and adapted from arena of maxillofacial trauma, allows optimization of scope of indications for the Invisalign system and may increase case acceptance for surgical patients seeking esthetic and minimally invasive orthodontic options.

Remodeling of Mineralized Tissues, Part II: Control and Pathophysiology

Based on a review of literature, the bone remodeling concepts, as defined by Harold Frost, are extended to the molecular level to help explain common bone physiopathology. Remodeling of mineralized tissue is an inflammatory response to accumulated tissue damage. Inflammation activates (A) the localized cell population, which attracts circulating osteoclast precursors, and initiates foci of vascular invasion. Coordination of these cybernetic events results in formation of a cutting/filling cone (cortical bone) or a hemicutting/filling cone (trabecular bone). Damaged bone is resorbed (R) creating a self-limited resorption cavity that is then filled by bone formation (F). A genetic mechanism (RANK/RANKL/OPG) is proposed for coupling bone formation to resorption during the remodeling process. Following surgery and/or initiation of orthodontic tooth movement, a regional acceleratory response (RAP) occurs throughout the affected alveolar process. Undermining resorption during the initial stage of tooth movement is analogous to initiation of a bone remodeling cycle (A→R→F). Understanding the cell dynamics of the ARF sequence is fundamental for appreciating common remodeling disorders such as osteoporosis, Paget's disease, hypo- and hyperparathyroidism, metastases, and external apical root resorption. Depending on the physiopathologic context, remodeling may enhance or limit the orthodontic options for management of a malocclusion.

Clinical Profile of Rapid Maxillary Expansion—Outcome of a National Inquiry

Rapid maxillary expansion (RME) is a therapeutic orthodontic option with a long history, and there are many reports in the literature reporting widely divergent results concerning the appliance efficacy and many different treatment protocols. We aimed to evaluate the treatment protocols and clinical experiences with RME via a national inquiry of orthodontists to identify the status quo of RME in clinical daily routine. Within the framework of an anonymous questionnaire, 2003 orthodontists and members of the German Orthodontic Society (DGKFO) were asked to report on their clinical experiences with RME. The standardized questionnaire covered clinical indications, dentition period at the time of insertion, mode of activation, retention time, observed side effects, and the reasons for requiring surgical assistance. The data from 487 questionnaires could be evaluated. The only indication for RME named by a large majority of responders was transversal maxillary deficiency. The average extent of the transversal deficiency amounted to 5.29 +/- 2.25 mm (median 5 mm). Most orthodontists (87.7%) employed RME in the permanent dentition of adolescents; it was significantly less frequently applied in the primary dentition or adults. Answers regarding the mode of activation varied greatly. The most frequent mode of activation was "1-2 activations a day" independent of the dentition period. 64.5% of the orthodontists reported buccal tipping of the anchorage teeth. No correlation was detected between mode of activation, time of insertion and observed side effects. 60% of the orthodontists reported a retention period of between 3 and 6 months (median 4.5 months). With an average age of 19.28 years, 79.3% assessed chronological age as a limiting factor for conventional RME. It was not possible to identify a homogeneous diagnostic procedure for the indication of surgical assistance. Although RME has a long clinical history, no standardized treatment protocols exist. Randomized clinical trials are necessary to make clear-cut clinical recommendations on the use of RME, as required by the tenets of evidence-based medicine and quality assurance.

Facial aesthetics in Orthodontics

Abstract Current trends in orthodontic care emphasise alternatives to the extraction of premolars, despite a lack of support from the refereed literature for many of the non-extraction treatments. Anecdotal reports published in non peer-reviewed journals have called into question the aesthetic effects of extraction treatment. As calls for evidence-based treatments increase throughout dentistry, reports on the effects—both positive and negative— of different orthodontic options have appeared in growing numbers. Given the results of a variety of reports in the peer-reviewed literature, it may be concluded that orthodontic treatment involving extractions can produce improved aesthetics for many patients who have some combination of crowding and protrusion. However, careful diagnosis followed by evidence-based treatment decisions should be the accepted clinical norm as the specialty of Orthodontics embarks on its second century.

MORE THAN LIP SERVICE: FACIAL ESTHETICS IN ORTHODONTICS

Current trends in orthodontic care emphasize alternatives to the extraction of premolars, despite a lack of support from the refereed literature for many of the nonextraction treatments. Anecdotal reports published in non-peer-reviewed journals have called into question the esthetic effects of extraction treatment. As calls for evidence-based treatments increase throughout dentistry, reports on the effects--both positive and negative--of different orthodontic options have appeared in growing numbers. Given the results of a variety of reports in the peer-reviewed literature, it may be concluded that orthodontic treatment involving extractions can produce improved esthetics for many patients who have some combination of crowding and protrusion. However, careful diagnosis followed by evidence-based treatment decisions should be the accepted clinical norm as the specialty of orthodontics embarks on its second century.

The multidisciplinary management of median diastema

Maxillary midline diastemas are a common esthetic problem that dentists must treat. Many innovative therapies have been used, varying from restorative procedures to surgery (frenectomies) and orthodontics. The importance of the presence of a maxillary midline diastema resides in its position and the concern it causes to patients. This specific diastema has been attributed to genetic and environmental factors, even though it is often a normal feature of growth, especially in primary and mixed dentition. The need for treatment is mainly attributed to esthetic and psychological reasons, rather than functional ones. Although it is often the case, treatment plans should not be selected empirically but rather should be based on adequate scientific documentation. This paper reviews different treatment techniques to manage the situation and presents three cases to illustrate a range of restorative, prosthetic and orthodontic options. Keywords: Midline diastema; dental spacing; etiology; treatment; relapse. DOI: 10.3329/bjms.v9i4.6691Bangladesh Journal of Medical Science Vol.09 No.4 July 2010 pp.234-237