Orthodontic Research Articles

Orthodontic Adhersives: Review

Orthodontic Adhersives: Review

Commoditizing orthodontics: “Being as good as your dumbest competitor?”

Commoditizing orthodontics: “Being as good as your dumbest competitor?”

A Century of Cleft Treatment- An Orthodontic Perspective

Orofacial clefting is the most common congenital deformity. Its treatment is a long drawn process with various challenges. However, successful completion of treatment is highly satisfying not just to the patient but also the team of specialists involved with it. The following article provides an overview of the evolution of cleft treatment over the past century. It briefly describes the changing views of the orthodontic specialty towards the diagnosis and treatment of this deformity over the past century. Its gradual process from the rudimentary treatment protocols of the early 20th century to the holistic approach followed currently.

Forging a New Path in Cleft Rehabilitation by Tissue Engineering – A Review

Of all the birth defects, Cleft palate is among the most common and affects about one in 1,500 births resulting in medical, physical, developmental, social and emotional problems in affected children in addition to the high health care costs. Current treatment is based on surgical closure of the cleft followed by orthodontic dental care, speech therapy, bone grafting, and requires multiple surgeries spanning over 18 years. Thus, there is a pressing need to develop more effective methods of treatment to provide young patients with a safer option that will result in a complete closure of the palatal cleft shortly after birth. In this review, the application of the field of tissue engineering, involving the use of adult stem cells, such as mesenchymal stem cells from bone marrow and Adipose-derived Stem Cells (ASCs) seeded on currently available biomaterials is presented in the context of healing craniofacial defects like the cleft palate. This article presents the concise technique to generate new bone in cleft deformities, using stem cells. It also throws light on the work done by various researchers to regenerate bone in large defects.

Cleft Lip and Cleft Palate: A Comprehensive Understanding of Etiology, Pathogenesis and an Oral Physician’s Role in Comprehensive Care

Cleft lip with or without cleft palate (CL/CP) is one of the most common structural birth defects, with treatment in multiple surgeries, speech therapy, and orthodontic treatments over first 18 years of life. Of special interest is etiology, incidence, risk factors and prevention. Better understanding of the embryology and genetics of orofacial clefting is crucial for development of a biologically relevant orofacial cleft classification system. The recent identification of specific genes involved in syndromic and non-syndromic orofacial clefting shows a correlation between both conditions with an overlapping genetic basis. However, it has limited application with screening of specific candidates, association studies and genome-wide scans in revealing the molecular basis of human clefting. With a heavy bearing of this condition on the patient and the family alike, providing care for these patients and families can be challenging. Surgically repaired clefts have residual deformity due to scarring and abnormal facial development affecting the social integration of the patient. It is of paramount importance, as the first contact professional, the oral physician must be patient, understanding and empathetic and must record a complete prenatal and natal history; urge the parents to seek immediate care and stress the importance of genetic counselling and prenatal diagnosis in the event of a future pregnancy.

Prevalence of Hypodontia in the populace of NWFP

The purpose of the study was to identify the pattern of congenital absence of teeth in a group of individuals seeking treatment of malocclusion in the Department of Orthodontics, Khyber College of Dentistry, Peshawar and to find out the gender difference and in addition the horizontal ,vertical and diagonal correlation among the missing teeth. The sample represents the population of North West Frontier Province.

A retrospective audit of population service access trends for cleft lip and cleft palate patients.

Population prevalence of orofacial clefts (OFCs) is well documented but the service utilisation patterns of these patients have received limited consideration. To analyse 10-year trends in the utilisation of subsidised OFC related services in Australia. Retrospective audit of service utilisation and claims datasets. Using state-wide hospital admission data, all persons treated for Cleft Palate Only (CPO) and Cleft Lip Only (CLO) as their primary diagnosis from 1999 to 2009 in Western Australia were included in the data frameset. Additionally, National Medicare out-of-hospital claims from 2003 to 2013 were added to the data frameset. The socioeconomic status and accessibility to services were analysed as effectors of service-mix such as age group, gender and geographic location. Of 721 in-hospital care episodes in Western Australia, 69% had CPO and 31% CLO as their principal diagnosis. Hospitalisations occurred from 0-69 years of age, but three quarters of all episodes occurred from 0-4 years of age (averaging one to two episodes per child). Whilst total hospitalisations were about four times higher for patients resident in high access areas, adjustment for population found the poorest 20% of the population having substantially lower hospital admission rates than the rest of the population. In Australia, claims for out-of-hospital cleft-related services varied between States. The overall pattern of out-of-hospital Medicare claims nationwide showed orthodontic services having the highest number of claims, followed by prosthodontic then oral surgical services. These data provide a picture of diverse service utilisation and leads to some interesting conclusions about geographic and economic access as well as cost-shifts between State and Commonwealth.

Evaluation of TMD signals and symptoms in individuals undergoing orthodontic treatment

Objetivo: verificar a presença de sinais e sintomas de DTM em indivíduos em tratamento ortodôntico. Material e Métodos: foram avaliados 28 indivíduos que estavam em tratamento ortodôntico na clínica de uma faculdade do estado de São Paulo. Para identificar a presença de DTM foi utilizado o Research Diagnostic Criteria for Temporomandibular Disorders (RDC-TMD). A dor foi avaliada pela Escala Visual Analógica (EVA). A amplitude, dor e ruído durante os movimentos mandibulares, além da dor à palpação de músculos intra e extra orais e cervicais foram aferidos pelo Índice Craniomandibular (ICM). O limiar de dor à pressão foi avaliado por meio de algômetro. Os valores médios e desvio padrão foram obtidos e a análise foi expressa em porcentagem. Resultados: o RDC-TMD demonstrou que a maioria dos indivíduos não apresentaram DTM, que 3,57% apresentaram osteoartrite, 10,71% artralgia, 3,57% deslocamento de disco sem redução, 7% dor miofascial e 14,28% dor miofascial com limitação de abertura; A EVA evidenciou dor média de 1,37 cm (DP=1,4). A média do ICM foi de 0,26 (DP=0,14). O limiar de dor à pressão aferido com algômetro foi de 3,7 (DP=1,7) para o m. temporal anterior e de 3,00 (DP=1,2) para o feixe superficial do m. masseter inferior. Conclusão: foram observados sinais e sintomas de DTM em 39,13% dos indivíduos em tratamento ortodôntico.

Diagnosis and treatment of children with sleep apnea

Sleep apnea includes obstructive sleep apnea, central sleep apnea and mixed sleep apnea.Obstructive sleep apnoea syndrome(OSAS) is affecting up to 5.7% of children, which hss adverse impact on growth, development cognitive and behavioral outcomes, and untreated OSAS increases cardiovascular risk, so paying closer attention to childhood OSAS early diagnosis and treatment seems more important.First-line treatment in OSAS children is adenotonsillectomy, although other treatment options available include continuous positive airways pressure, anti-inflammatory therapies, airway adjuncts and orthodontic appliances.Central sleep apnea may be related to respiratory regulation center immaturity or dysplasia.Central sleep apnea may be hereditary or acquired.Therefore, the treatment of central sleep apnea should be focused on primariy etiology. Key words: Sleep apnea; Sleep apnea syndrome; Obstructive sleep apnoea syndrome

Book review: Handbook of orthodontics, second edition

Book review: Handbook of orthodontics, second edition

A study of fusion of cervical vertebrae- C2 with C3

Background: Congenital anomalies are common in the vertebral column. In condition of fusion of the cervical vertebrae, two vertebrae appear not only structurally as one but also function as one. This fusion may be congenital or acquired. Vertebral fusion anomalies are likely to be associated with disturbance of Pax-1 gene expression in the developing vertebral column. Aims and Objectives: The present study is to study the fused C2 with C3 vertebrae and its clinical importance. Materials and Methods: The present study conducted on 75 dry adult human axis (C2) vertebrae of either sex in the Department of Anatomy, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka, India. The fused C2 with C3 was found and carefully studied. Results: In the present study the incidence of fused C2 with C3 is 1.33% (1out of 75). Conclusion: Fusion of C2 C3 clinically important to rule out various syndromes; Klippel-feil syndrome, Crouzons syndrome, which causes abnormalities of the neck movements with shortening of spine in the cervical region. Congenital Fused Congenital Vertebrae is one of the primary malformation of chorda dorsalis. Awareness of anomalies of cervical vertebrae is of great importance to anatomists, orthopaedicians, neurologists, neurosurgeons and even orthodontists. Also anaesthetists must be aware of these anomalies while doing endotracheal intubation, where extension of the neck is done.

Z-plasty: An esthetic eraser for labial frenum

Maxillary labial frenum is capable of creating diastema and recession, affecting esthetics by compromising the orthodontic result in the midline diastema cases, thus causing a recurrence after the treatment. This case report demonstrates the removal of the abnormal labial frenum attachment with midline diastema in a 28-year-old male through the technique of basic Z-plasty. Z-plasty is a common procedure in plastic surgery, but not so common in the field of dentistry. It appears complex, but is really rather simple, safe, and reliable. The main aim is to promote the use of this surgical technique; which helps to release scar contracture, relieve soft-tissue tension, and facilitates healing by primary intention. Frenectomies commonly fail due to a high risk of re-occurrence and hypertrophic scarring with other techniques that can be reduced by the use of Z-plasty. Moreover, it is cost-effective and results in better functional and esthetic appearance.

Tooth Size Discrepancy Importance as a Diagnostic Tool for Orthodontic Treatment Planning : A Review

The main goal in comprehensive orthodontic treatment is to obtain an optimal functional occlusion, overbite and overjet. Tooth size discrepancies of the maxillary and the mandibular arches are an important factor for achieving this goal. Inadequate relationships between the maxillary and the mandibular teeth can pose problems in achieving the ideal occlusion. Early treatment planning and proper diagnosis of tooth size discrepancy minimizes problems attained at finishing stage. Bolton’s ratios set an ideal relationship of maxillary tooth width to mandibular tooth width. This article shows the significance, validity as a diagnostic tool and the methods of measuring tooth size discrepancy. Resume Le principal objectif du traitement orthodontique est d’obtenir une occlusion fonctionnelle, un recouvrement et un surplomb optimaux. La difference dans la taille entre dents maxillaires et dents mandibulaires est un facteur important pour la realisation de cet objectif. Les rapports inter-arcades inadequats peuvent poser des problemes dans la realisation de l’occlusion ideale. La planification du traitement et le diagnostic correct de la difference des dimensions des dents reduisent les problemes au stade final du traitement. Le rapport de « Bolton » etablit une relation ideale entre la largeur des dents maxillaires et celle des dents mandibulaires. Cet article montre l’importance et la validite des methodes de mesure de la divergence des tailles des dents.

Innovations in adjunctive orthodontics and implant dentistry

Innovations in adjunctive orthodontics and implant dentistry

Orthodontic brackets removal: morphological in vitro evaluation

Debonding procedure is a fundamental stage in the orthodontic treatment (1). Adhesive removal should lead to a complete polished enamel in order to prevent the plaque accumulation and enamel injures (2). Aim of this study is to evaluate in vitro by use of Scanning Electron Microscopy (SEM) the enamel surface after the bracket removal and the enamel polishing with four different techniques. Two groups of teeth, group A (n=12) and group B (n=12) were evaluated. The images were analyzed by the Image J software. After the debonding procedure the two groups were subcategorized in four groups (1A, 1B, 2A, 2B 3A, 3B and 4A, 4B, n.=3). The discriminant between the two main categories was the use of a magnification system (Group A) during the polishing stages. From the qualitative and quantitative images analysis the most conservative technique resulted to be the use of tungsten carbide bur, followed by the final polishing using the soft-polisher tip for composites. In group A, the percentage of the residual adhesive resulted 8% and the damages on the enamel surface showed to be 7%. In group B the percentage of the residual adhesive resulted 35% and the damages on the enamel surface showed to be 15%. This analysis showed how the use of a magnification system aids in significant way during the debonding procedures in the enamel surfaces’ preservation.The authors are grateful to Dr. M. Gianmatteo and to Dr. E. Nazaj, University of L’Aquila, for their help in the sampling and microscopy procedures.

Classification and operation in the treatment of maxillary retrusion of adult patients with cleft lip and palate

To classify the patients with cleft lip and palate who need orthognathic surgery and to propose the corresponding operations. From January 2005 to May 2015, 121 patients with cleft lip and palate diagnosed as maxillary retrusion were treated by orthognathic surgery. Inclusion criteriar: (1) male aged over 16, female aged over 14; (2) diagnosed as non-syndromic cleft lip and palate without systemic disease and other genetic diseases; (3) without previous orthodontic and orthognathic treatment; (4) having no other craniofacial malformation. Maxillary features and repaired types were recorded. 93 patients were included and divided into two categories depended on the dental crowding. Class I: the teeth quantity and bone quantity is coordinated, space analysis ≤ 4 mm (mild dental crowding). The forward distance of maxillary less than 6 mm was defined as Class I a (36 cases) more than 6 mm as Class I b (28 cases). Class II: the teeth quantity and bone quantity is not coordinated, space analysis > 4 mm ( moderate or severe dental crowding). After the simulation of distraction osteogenesis, the anterior crossbite was corrected defined as Class II a (23 cases), not corrected defined as Class II b (6 cases). Class I a were corrected by conventional orthognathic surgery. While Class I b were corrected by Le Fort I maxillary advancement using distraction osteogenesis. Class II a were repaired just by anterior maxillary distraction. While Class II b need to combine conventional orthognathic surgery with anterior maxillary distraction. All the patients were satisfied with the treatment effect. The patients of cleft lip and palate with maxillary retrusion who need orthognathic surgery can be classified as the method mentioned above, and then choose the appropriate operations.

Supernumerary teeth in the maxilla and mandible-an interdisciplinary challenge. Part 1: epidemiology, etiology, classification and associated complications

Supernumerary teeth develop in addition to the normal dentition and are a therapeutic challenge for pedodontists, orthodontists and oral surgeons alike. Therefore, interdisciplinary treatment concepts are needed for the benefit of the patient. In the present, two-parted literature review on supernumerary teeth, current classification, associated complications, diagnostic steps and different therapeutic approches are presented and discussed. Supernumerary teeth are diagnosed in the primary and permanent dentition. Supernumerary incisors, canines, premolars, and molars, as well as distomolars and mesiodentes can be seen according to the location of the supernumerary teeth. Furthermore, based on the morphology of the supernumeraries four different types can be differentiated: conical, tuberculate, supplemental, and odontoma. Supernumerary teeth often remain asymptomatic, and are only diagnosed incidentally during a routine dental visit on radiographs (often intraoral). Nevertheless, various complications have been reported in the literature for supernumerary teeth such as disturbed eruption, malpositioning/rotation, root resorption of neighbouring teeth, and development of dentigerous cysts in impacted supernumeraries. Root resorption of neighbouring teeth can be radiographically diagnosed in up to 22.8% of the cases.

Essentials of Orthodontics

Essentials of Orthodontics

Effects of QCC on improving the compliance of tooth brushing in adolescent patients with orthodontic treatment of fixed appliance

Objective To explore the methodology and effects of quality control circle (QCC) on improving the compliance of tooth brushing in adolescent patients with orthodontic treatment of fixed appliance. Methods A QCC activity conducted from February to August in 2014, focused on improving the compliance of tooth brushing in adolescent patients with orthodontic treatment of fixed appliance. The study investigated 90 participants and compared their compliance of tooth brushing, plaque index (PLI) and gingival index (GI) before and after QCC. Results After the activity, the score of tooth brushing compliance was (10.68±2.78), PLI (1.29±0.41) and GI (0.86±0.37). All the assessment indexes and the comprehensive quality were significantly improved after QCC (P<0.05). Conclusions QCC is efficient to promote the compliance of tooth brushing and oral hygiene, and to improve the comprehensive ability of adolescent patients with orthodontic treatment of fixed appliance. Key words: Quality control circle; Orthodontic treatment; Youngsters; Oral hygiene; Compliance

The influence of preloading on stress relaxation of orthodontic elastic polymers.

The main objective of the investigation was the determination of whether prestretching would decrease the rapid force loss of the elastic polymers. The results indicated that Alastik CK chains showed a significant decrease in force loss whereas the C2 chains were unaffected. Since overextending the chain to compensate for force loss during clinical placement could result in capillary bed ischemia, increasing the force loss of the CK chains must be done before application. To accomplish this the chains should be prestretched by the manufacturer or operator. An improvement in the material component or manufacturing process would provide a more lasting solution to a material for which orthodontists have found increasing use.