Bracket Failure in Orthodontic Patients: The Incidence and the Influence of Different Factors

Failure of brackets is a common problem in orthodontics. This affects the treatment time, cost, and compliance of the patient. This study was conducted to estimate the bracket failure rate and the related factors for the long term. Methodology. This ambidirectional cohort study included 150 nonsyndromic orthodontic patients undergoing fixed appliance therapy for the last two years. The same patients were followed for 7 months. Different variables related to bracket failure were evaluated. The available data were analyzed descriptively, and the Kaplan-Meier estimate was used to measure the bracket survival rate from the date of bonding to failure. Results. A total of 180 bracket bond failures in the 150 included patients (52.2% males and 47.8% females) with a median age of 17 years (range 10-25 years). 69% of brackets failures were reported within the first 6 months after bonding. About 58.3% of bracket failure was noticed in adolescent patients before the age of 18 years. The majority of the cohort (81.1%) has good oral hygiene. The failure rate in patients with normal overbite was 41.1%, in decreased overbite cases was 15%, while in deep bite cases the failure rate was 43.9% with a statistically significant difference. Adults show less bracket failure (41.7%) than adolescent patients (58.3%). More bracket failure was noted in the lower arch (55%) than the upper arch (45%), and there were more bond failures posteriorly (61%) than on the anterior teeth (39%). Majority (41.1%) of the bracket failed on round NiTi wires. Conclusion. The bracket failure rate was 6.4%, with most bracket failure occurring in the first 6 months after bonding with individual difference. There was more incidence of bond failure in an increased overbite, adolescents, lower arch, posterior teeth, and lighter alignment wires.

Effectiveness of Visual-Tactile Examination and DIAGNOdent Pen in Detecting Early Enamel Caries and Its Remineralisation: An In Vitro Study

Background. The caries preventive effect of Colgate Duraphat® and GC Tooth Mousse Plus® has been widely studied, but the remineralisation potential of initial occlusal caries using these two remineralisation materials remains unclear. Aim. This study is aimed at evaluating and comparing the remineralisation of early enamel caries on the occlusal surface of permanent posterior teeth using ICDAS II caries scoring system and DIAGNOdent Pen (DDPen) after remineralisation with Colgate Duraphat® and GC Tooth Mousse Plus®. Materials and Methods. Extracted posterior teeth ( N = 120 ) with incipient occlusal caries were included in this study. The occlusal surface of each tooth was scored using DDPen and ICDAS II scoring before remineralisation. Then, remineralisation of the teeth of the experimental group was carried out using either CPP-ACP-F or fluoride varnish. After the remineralisation procedures, the occlusal surface of each tooth was again scored using DDPen and ICDAS II scoring. The teeth were then fixed in dental stone blocks and sectioned longitudinally for histological examination using a stereomicroscope. Statistical analysis was performed to calculate the sensitivity and specificity of DDPen and ICDAS II to detect remineralisation and compare with the gold standard histological examination. Results. According to ICDAS-II scores, a significant difference was noted in GC Tooth Mousse Plus® and Duraphat® study samples, whereas the difference between the pre-and post-remineralisation of the control group was not significant. According to the DDPen score criteria, a statistically significant difference was noted among all study groups; however, a greater significance level was noted in the GC Tooth Mousse Plus® and Duraphat® study samples compared with the control group. The Spearman’s rank correlation of ICDAS-II and DDPen with Downer’s histological score (gold standard) revealed a higher association of DDPen score (.738) as compared to ICDAS-II scores (.430). Conclusion. The study concluded that both ICDAS II and DDPen could detect remineralisation of early enamel occlusal caries. DDPen was more sensitive than ICDAS-II to detect remineralisation compared with the Downers histological scores.

Intrusion of the maxillary posterior teeth with a single buccal mini-implant positioned bilaterally in young adults with a tendency towards hyperdivergence: A clinical study

Background: Skeletal anchorage systems have been used for intrusion of the posterior teeth with satisfactory results. To achieve this, mini-implants are placed at anatomically challenging sites such as the palate or require several mini-implants to produce the desired effect. Objective: To determine the magnitude of intrusion of the maxillary posterior teeth achieved on a continuous arch wire using a single buccal mini-implant placed bilaterally in young patients with a tendency towards hyperdivergence and to evaluate its influence on the skeletal, dental and soft-tissue structures. Methods: A total of 17 patients with proclination of the anterior teeth, tendency towards hyperdivergence and clockwise rotation of the mandible were selected. First premolars were extracted as part of treatment protocol. A 0.022-MBT bracket prescription was used. Mini-implants were placed bilaterally on the buccal aspect at the mucogingival junction or slightly gingival to it between the maxillary second premolar and first permanent molar. A total of 200 g of intrusive force was placed from a continuous 0.019 × 0.025 inch stainless-steel arch wire to the mini-implant by means of an elastomeric thread on both sides. Lateral cephalograms and study models were taken before the start of intrusion and six months later. Parametric and non-parametric tests were done to assess treatment results. Results: Significant intrusion was observed in the maxillary molar and premolar region with tendency towards intrusion in the anterior region. There was significant decrease in lower anterior facial height (LAFH) with anti-clockwise mandibular rotation, decrease in facial proportion index and total facial height. No changes were observed in the transverse plane. Conclusion: Intrusion of the permanent maxillary molar can be achieved on a continuous arch wire with a single buccal mini-implant placed bilaterally with improvement in facial aesthetics, especially in the vertical plane. This method may be beneficial in patients with borderline vertical discrepancy treated with conventional friction mechanics during space closure after first premolar extractions.

Survival of Prosthodontic Restorations Luted with Resin-Based versus Composite-Based Cements: Retrospective Cohort Study

The purpose of this study was to evaluate clinical performance, survival, and complications of indirect composite inlays, onlays, and overlays on posterior teeth. Digital records of 282 patients treated between 2014 and 2018 were accessed and analyzed retrospectively. The included patients received 469 composite restorations luted with seven different resin-based types of cement, i.e., Filtek Ultimate Flow, Enamel Plus, Relyx Ultimate, Harvard Premium Flow, Relyx Unicem, Filtek Bulk Fill Flowable, and Filtek Ultimate. The restorations had been clinically and radiographically evaluated annually. The mechanical and clinical complications, e.g., debonding, fracture, and secondary caries, were evaluated and recorded. The examined restorations exhibited a high survival rate (84.9%), and failure was found in only 71 cases. Fracture was the most common cause (n = 36), followed by prosthetic work release (n = 19) and secondary caries (n = 16). There was a statistically significant difference between failure and cement material (Sig. < 0.001); the composite-based cements (87.2%) had a high survival rate compared to the resin-based cement (72.7%). Similarly, the cements with high viscosity (90.2%) had significantly higher survival rates than the low-viscosity cements (78.9%). Moreover, onlays showed higher longevity compared to overlays (Sig. = 0.007), and patients aged under 55 years showed less complications (Sig. = 0.036). Indirect composite restoration was a successful solution to tooth structure loss. The material of the cementation is an important part of the success. Higher survival rate was found in our study when the fixation materials with high viscosity were used, thus suggesting using these materials with indirect restorations. Composite-based cements had significantly higher survival rate than resin-based cements.

THE EFFECT OF DIFFERENT COMBINATIONS OF CALCIUM HYDROXIDE FOR MANAGEMENT OF POST-OPERATIVE PAIN IN ACUTE APICAL PERIODONTITIS

Objective: To find the effect of different combinations of Calcium Hydroxide for the management of post-operative pain in acute apical periodontitis. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Operative Dentistry Armed Forces Institute of Dentistry, Rawalpindi. from Jun to Nov 2019. Methodology: A total of 282 patients presenting with acute apical periodontitis in their mandibular posterior teeth were selected for this study and were randomly divided into three equal groups with the help of scientific random number table. Group-A patients were given intracanal dressing of Calcium Hydroxide mixed with Chlorhexidine, group-B patients were given intracanal dressing of Calcium Hydroxide mixed with Saline and group-C patients were given intracanal dressing of Calcium Hydroxide mixed with Dexamethasone. Endodontic therapy was initiated after application of rubber dam, following pulpectomy and disinfection with frequent irrigation, canals were prepared and intra-canal dressings were placed according to the allotted group and the cavity was restored till the next appointment. Post-operative pain was recorded at 24 hours, 48 hours and one week using the visual analogue scale. Results: The three intra-canal combinations of Calcium Hydroxide used in the study were found to be equally effective in reducing pain. Overall, the result between the three groups after 24 hours proved to be insignificant (p=0.40), after 48 hours (p=0.84) and 1 week (p=0.45) were also insignificant. Conclusion: Calcium Hydroxide mixed with Saline, Chlorhexidine and Dexamethasone are all effective for pain reduction with dexamethasone being the most effective.

Progressive systemic sclerosis with unilateral osteolysis of the mandible: a unique case report and review

Objectives: This case report is aimed to discuss case findings of Progressive Systemic Sclerosis (PSS), an overview of the characteristics in the form of osteolysis on one side of the mandible, and a theoretical review. Case Report: A 30-year old male patient came to an oral surgeon after tooth extraction. Clinical extraoral examination revealed hyperpigmentation on the right side of the face. A radiological study showed widening periodontal space on posterior teeth, and the angles of the mandibular arch, the jaw branch and the mandibular condyle neck were dissolved in the form of bone resorption. Conclusion: Characteristics of Progressive Systemic Sclerosis (PSS) in radiographs appear in the form of expansion of the periodontal space and osteolysis of the mandibular angle, branch, and even condyle. This disease is caused by an autoimmune disease that affects the entire body, but it can manifest on one side of the body.

Bruxismo Infantil: Uma Revisão de Literatura / Children's Bruxism: A Literature Review

Resumo: O objetivo do presente estudo foi discutir aspectos do bruxismo infantil através de uma revisão de literatura, abordando os fatores etiológicos bem como sinais, sintomas e características clínicas desta condição. É de grande importância o domínio dos sinais e sintomas para um diagnóstico mais preciso pelos profissionais da odontopediatria. O tratamento é multidisciplinar para esta condição parafuncional. Os resultados demonstraram ser o bruxismo um hábito não funcional da função mastigatória, que se caracteriza , pelo ato de apertar ou ranger os dentes, ocorrendo tanto durante o dia como no momento do sono. A etiologia é multifatorial e a literatura apresenta diversos, tais como fatores associados: dentário, fisiológico, psicológico e neurológico. O sinal mais comum é um certo desgaste nas faces incisais, principalmente dos dentes anteriores e, oclusais nos dentes posteriores. Também tende a ocasionar hipersensibilidade dentária, fratura de cúspides e restaurações e hipertonicidade dos músculos mastigatórios. Concluiu-se que conhecer os fatores etiológicos e as características clínicas do bruxismo na infância é importante para um diagnóstico o mais rápido possível, permitindo um tratamento precoce que favoreça o bem-estar da criança. Palavras-chave: bruxismo; crianças; odontopediatria. Abstract: The aim of this study was to discuss aspects of childhood bruxism through a literature review, addressing the etiological factors as well as signs, symptoms and clinical characteristics of this condition. It is very important to master the signs and symptoms for a more accurate diagnosis by pediatric dentistry professionals. Treatment is multidisciplinary for this parafunctional condition. The results showed that bruxism is a non-functional habit of the masticatory function, which is characterized by the act of squeezing or grinding the teeth, occurring both during the day and during sleep. The etiology is multifactorial and the literature presents several, such as associated factors: dental, physiological, psychological and neurological. The most common sign is some wear on the incisal surfaces, especially on the anterior teeth, and occlusal on the posterior teeth. It also tends to cause tooth hypersensitivity, fracture of the cusps and restorations, and hypertonicity of masticatory muscles. It was concluded that knowing the etiological factors and clinical characteristics of bruxism in childhood is important for a diagnosis as quickly as possible, allowing an early treatment that favors the child's well-being.Keywords: bruxism; kids; pediatric dentistry.

Zirconia Inlay on Vital Teeth with Profunda Caries

Background: Dental caries has historically been considered the most critical component of the global burden of oral disease. Health facilities and dental health education counselling have been conducted, but public knowledge about dental caries is still low. The increasing number of dental caries is currently influenced by one of the factors of community behaviour. Most people do not realize the importance of taking care of oral and dental health. The ignorance of the community results in a decrease in productivity due to the influence of the perceived illness. Advances in dentistry since the last decade has allowed the use of conservative dental care. Modern restorative dentistry offers many methods for restoring teeth, both direct and indirect. The need for restoration of posterior teeth is related to aesthetic purposes and functional, biocompatibility and biomechanical aspects of the remaining tooth structure. Some materials that are widely used as tooth-coloured indirect restorations in posterior teeth are zirconia. Zirconia has its characteristics, especially in terms of functionality, such as mechanical strength, physical strength and aesthetics. Purpose: This study aims to determine the management of indirect restoration treatment using zirconia inlay on upper premolar. Case(s): A 46-yearold male patient complained that the filling of his upper left tooth was often loose and uncomfortable when used for eating because the food was stuck in it. The patient wants his teeth treated. The history of treatment on the tooth in question has been patched two times, but it often comes off partially. Case Management: From the examination that has been carried out, a clinical diagnosis of reversible pulpitis was established. The treatment plan that will be carried out is indirect pulpcapping using MTA and resin-modified glass ionomer cement as the base material. The planned restoration treatment is a fixed inlay restoration made of monolithic zirconia. Conclusion: Recently, zirconia has also been developed staining with improved translucency so that it becomes more aesthetic. Zirconia has a higher level of material resistance than otherrestorative materials such as composites. This is what makes zirconia the choice, especially for use as a framework for all-ceramic and partially-fixed crowns dental prosthesis.