Orthodontic Procedures Research Articles

Orthodontic considerations for patients presenting with Goldenhar Syndrome: A long-term case report

Abstract Introduction The correction of facial asymmetry in patients presenting with Goldenhar Syndrome can be challenging due to the complexity of the orthodontic and surgical procedures required, the psychosocial considerations of the patient and the risk of relapse. Materials and methods A Caucasian male with Goldenhar Syndrome originally presented at age 8.2 years with concerns relating to a poor bite. He had previously undertaken surgery for the removal of pre-auricular skin tags on the right side. With ongoing skeletal growth, the facial asymmetry became more obvious and caused the patient to become socially withdrawn. Multidisciplinary treatment involving orthodontics and orthognathic surgery to correct the mandibular asymmetry was delayed until facial growth had slowed. The correction involved the use of an asymmetrical bilateral sagittal split osteotomy and an advancement genioplasty followed by a dermal fat graft and MedporR onlay to the right mandibular body and angle in addition to a refinement genioplasty. Results Follow-up has revealed a partial return of a buccal openbite illustrating the risk of occlusal relapse. Conclusion The case report illustrates the complexity of the orthodontic and surgical management of facial asymmetry, the psychosocial considerations of the patient and the risk of relapse. Multidisciplinary management is essential in the management of Goldenhar Syndrome.

Management of an impacted maxillary central incisor with surgical exposure and a 2x4 orthodontic appliance: A case Report

Dental impaction or transposition are disorders related to ectopic eruption or failure in tooth eruption, which can affect child physical, mental, and social development. This condition compromises face aesthetics, phonation, and masticatory function. The cause of impaction may vary from physical obstruction in the path of eruption, tooth material arch length discrepancy to malformation of the tooth, but supernumerary teeth are the leading cause. Failure of eruption of maxillary incisors requires early diagnosis and proper treatment planning. General principles of management of the condition include removal of physical obstruction, creation of space, and surgical exposure with or without traction. The rationale of the 2x4 orthodontic treatment of an unerupted tooth depends upon its age, position, etiology, and amount of space in the dental arch. It under the category of interceptive orthodontic procedure to prevent malocclusion near future. The present case report elaborates on case of incisor impaction with different aetiologies and varying ranges of complexity. However, it's far frequently important to continue with a surgical–orthodontic treatment. The inclination of teeth in relation to the midline and the root maturation degree determine prognosis and therapeutic timing. Thus, we are describing a case of 10 yrs. old child with, class 1 molar relationship bilaterally with missing maxillary right central incisor.

Psychological Impact on the Orthodontic Postgraduate Residents and Their Anxiety Level during the COVID-19 Pandemic.

COVID-19, a viral infection, has negatively impacted the physical and psychological health of the people worldwide. This was a descriptive, cross-sectional study, which aimed to investigate orthodontic postgraduate residents' knowledge regarding COVID-19, its association with anxiety around quality of their training, and performance of routine orthodontic procedures during the pandemic. A questionnaire was circulated online through WhatsApp to the orthodontic residents enrolled in the four-year postgraduate training program across the country which comprised the following sections: demographic data, questions to test knowledge of COVID-19, self-grading of anxiety around performing routine orthodontic procedures, academic aspects of the training program, and residents' thoughts on the current status of their training program in general during the pandemic. The residents were grouped based on their awareness on COVID-19, with >70% score taken as having adequate knowledge and ≤70% as inadequately updated. The association between COVID-19-related knowledge and the anxiety level of the residents experienced during training was assessed. Results were analyzed using SPSS (Statistical Package for Social Sciences) version 23.0. Counts and percentages were reported on baseline characteristics of studied samples. Descriptive methods were used to report the outcomes of this survey on knowledge of COVID-19, anxiety around performing orthodontic procedures, and different academic aspects of training. Statistical significance was set at p < 0.05 using the Pearson chi square test. Most of the residents (51.5%) were adequately updated about the COVID-19 virus. Increased awareness was associated with more anxiety about the following: contracting the virus (p < 0.01), performing different orthodontic procedures (p < 0.05), disturbed patients' appointments (p < 0.01), timely completion of their cases (p < 0.01), and exam's preparation (p=0.04). The group with <70% COVID-19 related knowledge opted for extension of their training period (51.8%). COVID-19 related knowledge was clearly associated with anxiety experienced by the orthodontic residents during training in the pandemic. Awareness regarding the infection led to more anxiety around working during the pandemic, preparing for postgraduate exams, and concerns about its negative influence on the overall quality of the training program.

Association of orthodontic treatment and aspiration pneumonia

Foreign body aspiration or ingestion is an uncommon potential complication during orthodontic dentistry, and it can produce a medical emergency. Obstruction of the airways can be life-threatening, and delayed recognition and management can result in pulmonary complications such as recurrent pneumonia. Dental treatment has been identified as an important cause of the misplacement of foreign bodies in the airway. Objects used in orthodontic treatment are mainly used due to their manufacturing limitations, such as their shape and size, and because they are made of radiolucent materials, which make them easy to aspirate or ingest and difficult to detect with a radiograph. However, few reports have been published on orthodontic dentistry-related foreign body aspiration and pulmonary complications. Furthermore, micro-aspiration due to poor oral hygiene in patients undergoing orthodontic procedures has been investigated in this review since poor oral hygiene is a well-established risk factor for aspiration pneumonia in the elderly population. The association between the aspiration of orthodontic material and aspiration pneumonia is not well established. Aspiration pneumonia is a secondary symptom of misdiagnosis or delayed diagnosis of dental material aspiration. Additionally, poor oral hygiene can also increase the risk of aspiration pneumonia in elderly patients since poor oral hygiene during orthodontic treatment leads to plaque retention, which can lead to increased development of hyperplastic gingivitis and periodontal breakdown, established risk factor for aspiration pneumonia.

Assessment of Bone Height Changes Based on the Cone-Beam Computed Tomography Following Intentional Replantation for Periodontally Compromised Teeth.

Background and Objectives; This study aimed to evaluate the clinical outcomes and bone changes before and after intentional replantation (IR) for periodontally compromised teeth by using cone-beam computed tomography (CBCT). Materials and Methods; Fourteen periodontally involved teeth were selected for IR. A preoperative orthodontic procedure was performed to apply luxation, and the tooth was then gently extracted. Retrograde filling of the root-end canal was performed. Once the tooth was repositioned in the socket, it was splinted with the adjacent tooth. After three months, prosthetic restoration was performed. Results; Clinical parameters and CBCT images were obtained before and after the IR procedure. The height of the alveolar bone was measured on the CBCT images by using software. Most preoperative symptoms, including pain, mobility, probing depth (PD) and bleeding on probing (BOP), significantly decreased after IR (pain: 4.71 to 1.00; mobility: 1.36 to 0.29; PD: 5.60 to 2.85; BOP: 3.50 to 0.79). CBCT analysis indicated an increase in bone height after IR (the amount of change: maxilla, 4.00; mandible, 1.95). Conclusions; A previous study reported that IR for periodontally involved teeth is quite limited. However, in this study, IR of periodontally compromised teeth showed favorable results in clinical and radiographic evaluations, suggesting that IR may be an alternative to extraction of teeth with periodontal disease.

Force degradation of orthodontic elastomeric chains: A literature review

Background: Elastomeric chains are used to generate force in many orthodontic procedures, but this force decays over time, which could affect tooth movement. This study aimed to study the force degradation of elastomeric chains. Data and Sources: An electronic search on Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, LILACS, and PubMed was made, only articles written in English were included, up to January 2022.Study selection: Fifty original articles, systematic reviews, and RCTs were selected. Conclusion: Tooth movement, salivary enzymes, alcohol-containing mouthwash, whitening mouthwash, and alkaline and strong acidic (pH &lt;5.4) solutions all have a significant impact on elastomeric chain force degradation. The force level of elastomeric chains degrades rapidly over time; however, the force degradation rate is slower in thermoset chains than in thermoplastic ones. An efficient tooth movement could be achieved by using a thermoset chain type with monthly replacement. Ethylene oxide and gamma sterilization methods are preferred to avoid the risk of cytotoxicity.

Orthodontic Treatment Guidelines during the COVID-19 Pandemic; Mini Narrative Review

The coronavirus (COVID-19) has challenged healthiness careers and techniques and has induced several rates of reaction and forms of reaction worldwide. The responsibility of dental specialists in inhibiting the transmission of COVID-19 is seriously significant. Dental professionals suffered a proper duty to decrease routine care for fear of increasing COVID-19 among their patients and elsewhere but were understandably concerned about the economic concerns. This paper explores comments raised by orthodontists worldwide about offering safe orthodontic service during the ongoing COVID-19 pandemic, as orthodontic treatment procedures increase the possibility of transmission. As proximity between the orthodontist, dental assistant, and patient is required for treatment, it jeopardizes the health of all the parties involved. In this paper, we will highlight five issues: general principles, communication, dental clinic admission, infection control measures, and applied orthodontic treatment emergency. Upon reviewing these issues, we will then attempt to formulate appropriate orthodontic treatment guidelines applicable in this specific era.

Effectiveness of Virtual Reality (VR) technology towards pain management during initial fixed orthodontic procedures: A case-control study

The goal of this research is to see how effective virtual reality (VR) is in reducing discomfort during early fixed orthodontic operations. The research comprised 70 individuals, all of whom were between the ages of 15 to 18 years randomly divided into two groups- research group (n=35) and the control group (n=35). Patients in the experimental group received a virtual reality headset and watched interesting movies during orthodontic procedures, while those in the control group received regular care. The VR headgear was placed over the patient's eyes as the dental procedure began in the study group, whereas the controls group's eyes were kept open as they viewed the clinic and dental procedures going on around them. After adopting virtual reality movies before and after dental treatments, there was a statistically significant difference in pain levels between the control and study groups. The mean pain ratings during orthodontic treatment were 8.6 and 6.3 in the control and study groups, respectively. Following orthodontic treatment, the control and study groups reported mean pain levels of 7.4 and 6.7, respectively. VR is found to be an effective method in pain alleviation during initial fixed orthodontic procedures.

Evaluation of pain in patients undergoing fixed dental appliance

Introduction: Pain is experienced by patients during various fixed orthodontic procedures such as placement of separators, insertion of arch wire and its activations, orthopedic appliances such as headgear, and debonding of the appliance. This study was formulated with the background that the level of pain sensation differs between conventional metal and ceramic brackets, arch wire being the same pain is an important aspect of oral health-related quality of life (OHRQOL). Understanding how patients' pain experiences during their treatment affect their quality of life (QOL) is important and the absence of pain/discomfort is important for achieving a high QOL. Aim and Objective: The objective of this study was to assess the relationship between pain and OHRQOL among patients wearing fixed orthodontic appliances and to evaluate whether patient motivation and counseling had an effect on the pain and discomfort. Materials and methods: The data collection was done , the obtained data were tabulated and entered in the MS excel sheet. Data collection were imported to SPSS, variable definition process was done using tables and graphical illustration.

COMBINED ORTHODONTIC AND SURGICAL TREATMENT IN PATIENT WITH CLASS III AND FACIAL ASYMMETRY

Severe skeletal Class III and facial asymmetry requires combined orthodontic and surgical procedure In order to correct of sagittal and transversal deviations between upper and lower jaw. Aim: The aim of this case was to present effects of combined orthodontic and surgical treatment on craniofacial morphology and whole facial aesthetics. Material and method: In this case a 17-year-old female patient years was treated. Patient had severe skeletal Class III caused by mandibular prognathism, latherognathism, open bite and crossbite. At the beginning of the treatment overbite was - 3.5mm and overjet - 6mm. Parameters on lateral cephalogram at the beginning of the orthodontic procedure were: SNA 83°, SNB 88°, ANB -5°, SN/SpP 9°, SN/MP 38°, SpP/MP 29°, sum of angles of Björk’s polygon 396°, Jarabak ratio 63.26%, I/SpP 47°, i/MP 98°. Orthodontic preparation for surgical treatment lasted 21 months with upper and lower fixed appliance. Surgical procedure was done on both jaws and lower wisdom teeth were extracted. Orthodontic treatment was finished 6 months after surgical intervention. Results and conclusion: Parameters on control lateral cephalogram at the end of treatment were: SNA 83°, SNB 85°, ANB -2°, SN/SpP 10°, SN/MP 32°, SpP/MP 22°, sum of angles of Björk’s polygon 394°, Jarabak ratio 64,20%, I/SpP 47°, i/MP 94°. Patient had stable occlusion in Class I with overjet 1.5mm and overbite 3mm. Both segment of treatment improved significantly facial aesthetics in profile and en face and provided correct occlusion in all three directions.

Treatment of impacted or retained second molars with the miniscrew-supported pole technique: a prospective follow-up study

BackgroundEruption disturbances of permanent molars are uncommon; however, it is important to treat them as soon as they are diagnosed. The main objective was to analyze the effectiveness of the “miniscrew-supported pole technique,” a surgically assisted orthodontic procedure to force the eruption of impacted/retained second molars (M2s) when there are indicators of complex molar inclusion. An observational prospective study was carried out during a 2-year period. Sociodemographic, clinical and low-dose scanner variables were taken at baseline (T0). Follow-up variables (T1) were the time between surgery and tooth eruption, radiographic measurements, debonding of buttons, failure rate of miniscrews and success rate of eruption.ResultsA total of 21 patients (mean age of 13.9 years) with 24 retained/impacted M2s were recruited; 13 molars were maxillary (54.2%) and 11 (45.8%) were mandibular. Six (25%) were impacted molars and 18 (75%) primarily retained. At T0, molar angulation was mesial in six molars (25%), distal in five molars (20.8%) and 13 molars were vertically positioned (54.2%). Infraocclusion degree was moderate in four (16.7%) molars and severe in 20 (83.3%). Only three (12.5%) third molars were removed due to lack of space. All M2s managed to erupt, achieving a success rate of 100%; however, two molars of the same patient did not achieve occlusion. The period of eruption after surgery was 126.8 (117.3) days. Anatomical radicular alteration was the only variable independently related to a longer time of treatment (p = 0.027).ConclusionsThe pole technique, using one mesial miniscrew and simple orthodontic mechanics, applies forces that succeed in erupting complicated retained/impacted M2s in a short period of time and with a low failure rate.

Comparison of the Effectiveness of Orthodontic Treatment with Adenotonsillectomy Procedures in Children with Obstructive Sleep Apnea (OSA)

Background: Obstructive Sleep Apnea Syndrome (OSA) is a syndrome of total or partial obstruction of the airways, leading to significant disturbances with varying clinical impact. In children, the main cause is thought to be overgrowth (hypertrophy) of the tonsils and adenoids, as well as structural abnormalities in Pierre Robin and Down Syndrome. The airway structures are significantly narrowed in children with head-face bone abnormalities or craniofacial anomalies, causing them to experience airway obstruction even in the absence of adenoid hypertrophy. The incidence of OSA in children needs to be observed as well as rising risk factors such as obesity. Pediatric obstructive sleep apnea (OSA) is typically treated with an adenotonsillectomy and the use of orthodontic procedures including rapid maxillary expansion and mandibular advancement devices. Each approach has different treatment advantages. Systematic reviews and meta-analysis of OSA treatments have been reported, however there have been relatively few comparisons of various treatments. In a systematic review of the evidence for the efficacy of AT and orthodontic treatment, Templier et al. concluded that combined AT orthodontic treatment (RME and/or MAD) was more effective than either therapy alone for treating OSA in pediatric patients. Objective: To systemically analyze the literature on the effectiveness of orthodontic treatment with adenotonsillectomy surgery in children with obstructive sleep apnea (OSA) and to identify differences in the two treatments’ effectiveness. Conclusion and implications: The effectiveness of adenotonsillectomy, orthodontic treatment, and orthodontic treatment combined with adenotonsillectomy was assessed in children with mild OSA and mandibular retrognathia. That study, which needed a large sample size (352 children) and had a high dropout rate, revealed that combine orthodontic adenotonsillectomy (RME and/or MAD treatment) was more effective when given simultaneously than when given individually for treating OSA in pediatric patients. To date, the effectiveness of these two treatments cannot currently be compared due to a lack of strong evidence. If the treatment outcomes were unsatisfactory at 7 months after the initial treatment, subjects could receive further treatment following assessment by a stomatologist and ear, nose, and throat (ENT) specialist. Limitations: Of the 10 publications included in this review, 8 were randomized controlled trials, the remaining 2 non-randomized research journals were vulnerable to many biases that impair the certainty of the evidence gained, especially by confounding factors and the lack of control groups.

Incisor Malocclusion Using Cut-out Method and Convolutional Neural Network

Malocclusion is a condition of misaligned teeth or irregular occlusion of the upper and lower jaws. This condition leads to poor performance of vital functions such as chewing. A common procedure in orthodontic treatment for malocclusion is a conventional diagnostic procedure where a dental health professional takes dental x-rays to examine the teeth to diagnose malocclusion. However, the manual orthodontic diagnostic procedure by dental experts to identify malocclusion is time-consuming and vulnerable to expert bias that results in delayed treatment completion time. Recently, artificial intelligence technology in imageprocessing has gained attention in orthodontics treatment, accelerating the diagnosis and treatment process. However, several issues concerning the dental images as input of the classification model may affect the accuracy of the classification. In addition, unstructured images with varying sizes and the problem of a machine learning algorithm that does not focus on the region of interest (ROI) for incisor features bring challenges in delivering the treatment. This study has developed a malocclusion classification model using the cut-out method and Convolutional Neural Network (CNN). The cut-out method restructures the input images by standardising the sizes and highlighting the incisor sections of the images which assisted the CNN in accurately classifying the malocclusion. From the results, the implementation of the cut-out method generates higher accuracy across all classes of malocclusion compared to the non-implementation of the cut-out method.

Oral health–related quality of life changes during phase 1 Class II malocclusion treatment using Frankel 2 and Twin-block appliances: A short-term follow-up study

Orthodontic treatment procedures affect oral health-related quality of life. This study analyzed and compared the patients using the Frankel 2 Regulator (FR2) and Twin-block (TB) orthodontic appliances. This follow-up observational study comprised adolescents aged 10-16 years with Class II malocclusion seeking orthodontic treatment, between April and December 2019, in a private orthodontic clinic. Following the finalization of orthodontic clinical decisions, 88 patients, in a 1:1 ratio, using FR2 (n= 44) and TB (n= 44) appliances, were invited to participate in this study. An Oral Health Impact Profile-14 (OHIP-14) questionnaire was answered by the participants at 5-time points: before treatment, 1 week, 1 month, 3 months, and 6 months after wearing functional appliances. A mixed model for repeated measurements tested the OHIP-14 score mean differences over time among appliance groups and group by time interaction. The TB group consisted of 15 males and 29 females, and the FR2 group included 21 males and 23 females. The mean age of participants was 12.18 ± 1.29 years. The mean of OHIP-14 scores in FR2 users was significantly lower than the TB appliance group at all intervals (P<0.05). Although the total score of OHIP-14 increased 1 week after appliance wearing, it declined during the 1, 3, and 6 months after wearing appliances in both groups. The results can help orthodontists better select treatment approaches by considering their effect on oral health-related quality of life.

Success rate of infrazygomatic miniscrews considering their design and insertion techniques. A review.

Miniscrews offer the possibility of performing dental movements, minimizing unwanted side effects and enhancing effectiveness. Extra-alveolar miniscrews are ideal as they provide excellent primary stability and avoid anatomical structures. However, in some cases the primary stability is lost before achieving the success of the mechanics used and thus, the most likely causes of failure should be determined. The purpose of this review was to analyze the success rate of infrazygomatic miniscrews, considering their design and the insertion techniques used. Data collection of this literature review was carried out by searching PubMed, Wiley, Google Scholar sites, SCIELO, Elsevier and Dialnet for publication made from 2003 to June 2022. The search was carried out on June 10th, 2022 and the following keywords were used; infrazygomatic crest, miniscrews, anchorage and stability. Different topics were analyzed and discussed highlighting their clinical relevance. After analyzing the 798 articles, 566 were excluded. The remaining articles were re-analyzed and 153 articles were excluded for the title or abstract and 33 articles were excluded for the methodology. Finally, 46 items remained. After thoroughly analyzing all the articles included, this study concluded that the alloy of the miniscrew (stainless steel or titanium), perforation of the maxillary sinus and the placement area (adhered mucosa or mobile mucosa) do not influence the survival of the miniscrew. The evidence also indicates that the percentage of failure is lower in infrazygomatic compared to intraradicular miniscrews. Orthodontists can confidently and safely include infrazygomatic miniscrew in different orthodontic procedures.

Analysis of Coating Loss from Coated Stainless Steel Orthodontic Wire

The leaching of metal ions from orthodontic appliances into the oral cavity is problematic for metal-allergic patients. Non-metal orthodontic appliances, such as plastic and ceramic brackets and elastomeric materials, have been clinically used and are effective for treatment of metal-allergic patients. However, only a few types of orthodontic wire are available for use in patients with metal allergies, thus restricting the establishment of orthodontic force systems in these patients. Wire surfaces can be coated with various substances to prevent leaching of metal ions. However, detachment of the coating may occur during orthodontic procedures, resulting in metal ion leaching from the substrate material. This study was performed to examine the resilience of various types of coated stainless steel wire to low pH, bending, and brushing. Wire surface characteristics were examined by stereomicroscopy and scanning electron microscopy. The degree of coating detachment due to bending of the wire was quantified by determining the change in the amount of metal ions eluted from the site of the bend immersed in hydrochloric acid. Exposure of the substrate metal by brushing was investigated by energy dispersive spectrometry. The results indicated that polyethylene naphthalate (PEN)-coated wire is resilient to bending, while gold (Au)-coated and titanium nitride (TiN)-coated wires are resilient to brushing.

Forced orthodontic extrusion for an apparently hopeless anterior tooth by using a simplified approach

When restoring severely compromised teeth, respecting the supracrestal tissue attachment and retaining the most coronal and radicular tooth structure is essential to achieving a sufficient ferrule. Forced orthodontic extrusion is a minimally invasive method that allows hard- and soft-tissue conservation. This article describes the treatment of a severely damaged maxillary central incisor that was managed by using a simplified orthodontic extrusion method with intracoronal elastic and metal ligatures applied through a palatal bar and followed by the biologically oriented preparation technique (BOPT). This orthodontic procedure reduces a forward clockwise advance during vertical extrusion, thus maintaining the buccal bone plate.

Automated three-dimensional quantification of external root resorption following combined orthodontic-orthognathic surgical treatment. A validation study

ObjectiveThree-dimensional (3D) quantitative assessment of external root resorption (ERR) following combined orthodontic-orthognathic surgical treatment is vital for ensuring an optimal long-term tooth prognosis. In this era, lack of evidence exists applying automated 3D approaches for assessing ERR. Therefore, this study aimed to validate a protocol for 3D quantification of ERR on cone-beam computed tomography (CBCT) images following combined orthodontic-orthognathic surgical treatment. Material and MethodsTwenty patients who underwent combined orthodontic-orthognathic surgical treatment were recruited. Each patient had CBCT scans acquired with NewTom VGi evo (NewTom) at three time-points i.e., 4-weeks prior to surgery (T0), 1-week (T1) and 1-year after surgery (T2). Patients were divided into two groups, group A (surgical Le Fort I osteotomy group: 10 patients) and group B (orthodontic group without maxillary surgical intervention: 10 patients). Root resorption was assessed by measuring length and volumetric changes of maxillary premolar to premolar teeth (central and lateral incisors, canines, 1st and 2nd premolars= 10 teeth) at T0-T1 and T0-T2 time intervals in both groups. The protocol consisted of convolutional neural network based segmentation followed by surface-based superimposition and automated 3D analysis. ResultsThe intra-observer intra-class correlation coefficient (ICC) was found to be excellent (1.0) with an average error of 0 mm and 0 mm3 for assessing root length and volume, respectively. The entire protocol took 56.8 ± 7 s for quantifying ERR. Both group of patients showed negligible changes in length and volumetric ratio at T0-T1 time-interval. Furthermore, group A had lower ERR ratio with decreased root volume and length compared to group B at T0-T2 time-interval. ConclusionsThe proposed protocol was found to be time efficient, accurate and reliable for 3D quantification of ERR on CBCT images. It could act as a viable automated option for assessing ERR. Clinical significanceThe automated protocol could provide a time efficient method to allow a reliable and accurate 3D follow up root resorption after orthognathic and orthodontic treatment procedures. These new insights could allow clinicians to implement strategies for minimizing the risk of root resorption and to further enhance treatment predictability.

Risk factors and diagnosis of iatrogenic damage of periodontal structures and roots during orthodontic Mini-Implants implantation procedures - a systematic literature review

Introduction and purpose&#x0D; In recent years, Mini-Implants (MI) have gained popularity and new complications have emerged with them. The article assesses the current reports on the scale of the problem, factors and diagnostic possibilities related to iatrogenic injuries of periodontal tissues and roots.&#x0D; &#x0D; Description of the state of knowledge&#x0D; The incidence of complications was estimated to be 13.5%. Complications are more common in the mandible and are estimated at 20-27.1%. Periodontal and root damage are an important risk factor for treatment failure. The fact that the implant does not interfere with the alveolus structure gives the treatment effectiveness in 90%, and the contact with the alveolar “lamina dura” is 62.5%. Interference with the root structure is successful in only 31.2%.&#x0D; Risk factors for failure include: young age, poor hygiene, smoking, area of mandibular molars, contact with the root, thickness of the bone and lack of experience. The implant between the roots is a risk of root trauma, as the location close to the tooth cemento-enamel junction, no preparation for surgery, not using surgical templates, strenuous implantation or implant migration under the influence of orthodontic forces. Radiographs are the gold standard in the diagnosis of complications, but they do not allow for a full assessment of the three-dimensional structures of the implant. A promising method is the evaluation of the torque as the implant is placed in its final location. The patient's subjective feelings are questionable in diagnosis and require further research.&#x0D; Summary&#x0D; There are many complications in using MI and the most important of these is damage to the structures of the periodontium and the tooth root. Despite the low failure rate, failure should be prevented by pre-operative evaluation, in-operative monitoring, and post-operative diagnostics.

The Impact of COVID-19 on Dental Treatment in Kuwait-A Retrospective Analysis from the Nation's Largest Hospital.

Background: The COVID-19 pandemic has changed the way dentistry has been practiced the world over. This study sought to assess the impact of the COVID-19 pandemic on the patterns of attendance for dental treatment in a large hospital in Kuwait through comparisons with data from the year prior to the pandemic. Methods: A total of 176,690 appointment records from 34,250 patients presenting to the AlJahra specialist hospital in Kuwait for dental treatment from April 2019 to March 2021 were analyzed. The types of procedures and the departments in which they presented were analyzed, and the patterns of attendance before and during the pandemic were compared. Results: While there was a significant reduction in the number of orthodontic, endodontic, and periodontal procedures, there were no impacts on oral surgery, restorative procedures, or pediatric dentistry. Conclusions: There has been a return in the number of patients obtaining dental treatment; however, there has been a definite shift in the use of certain dental procedures.