Pain Management Using Nano-Bio Fusion Gel in Fixed Orthodontic Therapy-Induced Gingivitis: A Split-Mouth Design Study

Nanotechnology-based products containing antioxidants may be effective adjuvants in the treatment of periodontal diseases. To assess the treatment effect of nano bio-fusion gel (NBFG) in pain perception (PP) in fixed orthodontic therapy-induced gingivitis (FOTIG). The gel contains propolis, vitamin C, and vitamin E in the form of nanoemulsion. Thirty-two patients were finally selected from the orthodontic clinic after assessments for FOTIG. Patients were allocated randomly into active and placebo-control groups. Patients were evaluated at three intervals (T1, T2, and T3). Pain perception using a numeric rating scale (NRS) was performed at baseline (T1), on the 7th day (T2) and on the 28th day (T3) on his/her visit to an orthodontic clinic. In the T1, T2, and T3 period, patients apply NBFG (active or placebo side) to their gingiva after brushing two times a day for 28 consecutive days. Results: The baseline data between the active or placebo group showed almost similar PP. From T1 to T2 and T3, the active or placebo-control group showed significant improvement in PP over time. Compared to placebo, the active group showed highly significant (p ≤ 0.001, T1 to T2 and T2 to T3) improvement in PP. The use of NBFG is an effective means of improvement in PP of FOTIG cases.

Orthodontic Therapeutic Biomarkers in Saliva and Gingival Crevicular Fluid

Several biologically active substances representing the bone deposition and resorption processes are released following damage to periodontal tissue during orthodontic movement. Biomarkers are by definition objective, quantifiable characteristics of biological processes. The analysis of saliva/salivary fluid and Gingival crevicular fluid (GCF) may be an accepted way to examine the ongoing biochemical processes associated with bone turnover during orthodontic tooth movement and fixed orthodontic treatment pain. Assessing the presence of these salivary physiological biomarkers would benefit the clinician in appropriate pain diagnosis and management objectively of various problems encountered during the orthodontic procedures and for better outcome of biomechanical therapy. Due to lack of standardized collection procedure, even though well accepted by patients, saliva is often neglected as a body fluid of diagnostic and prognostic value. A literature search was carried out in major databases such as PubMed, Medline, Cochrane library, Web of Science, Google Scholar, Scopus and EMBASE for relevant studies. Publication in English between 2000 to 2021 which estimated Saliva markers as indicators of orthodontic tooth movement was included. The list of biomarkers available to date was compiled and is presented in table format. Each biomarker is discussed separately based on the available and collected evidences. Several sensitive salivary and GCF biomarkers are available to detect the biomechanical changes occurring during orthodontic tooth movement and pain occurring during fixed orthodontic therapy. Further focussed research might help to analyze the sensitivity and reliability of these biomarkers or cytokines, which in turn can lead to the development of chairside tests to assess the pain experienced by patients during orthodontic therapy and finally the outcome of the fixed orthodontic therapy.

Restorative Management and Treatment of Pseudo-Class III Malocclusion

Introduction. One of the challenges that clinicians encounter in the dental office is treating occlusal discrepancies. Malocclusion has been classified into three main classes that were further classified by researchers into more detailed subclasses later on. Pseudo-class III malocclusion has been called apparent or positional class III malocclusion, and its treatment usually consists of different modalities depending on how early the case is treated. When early orthodontic intervention was not possible, the restorative treatment becomes an excellent alternative especially when the teeth require restorative rehabilitation. Treatment. In this case report, the patient was suffering from dental wear, multiple failed old restorations, and edge-to-edge occlusal relationship which could be classified as pseudo-class III malocclusion. The patient’s esthetic complaint was addressed with full-coverage lithium disilicate and monolithic zirconia restorations that were successful in reestablishing the patient’s occlusal relationship and were able to eliminate the biological manifestations of dental caries. Conclusion. We were able to provide an alternative to orthodontic treatment where esthetic and functional needs of the patient were met after careful diagnosis and proper management. This clinical approach will give chance to treat patients suffering from minor occlusal discrepancies that require restorative intervention without the need to go through orthodontic therapy.

Orthodontic, Maxillofacial Surgery, and Prosthodontic Rehabilitation Supported by Miniscrew in a Patient with Cleft Lip and Palate

Aim. This paper is aimed at reporting the clinical case of a patient with cleft lip and palate treated with a multidisciplinary approach. Case Report. An 11-year-old patient presented cleft lip and palate, with persistent oronasal communication, tooth displacement, and upper and lower crowding with a deep curve of Spee. He was treated with metal bracket orthodontic therapy, graft surgery, and prosthetic rehabilitation supported by miniscrews. Conclusions. Cleft lip and/or palate patients require adequate management of the case to resolve the anomalies connected to their condition and to improve their quality of life.

Biofilm formation following chitosan-based varnish or chlorhexidine-fluoride varnish application in patients undergoing fixed orthodontic treatment: a double blinded randomised controlled trial

Background Orthodontic treatment poses an increased risk of plaque accumulation and demineralisation of enamel leading to white spot lesion around the brackets. This parallel arm trial aims to assess the degree of bacterial plaque formation adjacent to orthodontic brackets, following the application of a chitosan-based varnish or chlorhexidene-fluoride varnish. Methods A total of 200 teeth from 20 patients undergoing fixed orthodontic therapy were assessed and biofilm formation around the brackets were recorded using the Bonded Bracket Index (Plaque index) at baseline and weekly for 6 weeks. The bacterial count and plaque pH at corresponding weekly intervals were also recorded. Following bracket bonding, the patients were cluster randomised to receive chitosan-based varnish-CHS (UNO Gel Bioschell, Germiphene corp., Brantford, Canada) or chlorhexidine-fluoride varnish-CFV (Cervitec F, Ivoclar Vivadent, Schaan, Liechtenstein) every week on the representative teeth respectively. BBI proportions were compared between groups at all time intervals using Chi square test. Mean plaque bacterial count and plaque pH were compared using Mann Whitney U test and Tukey’s HSD test respectively. Results Baseline characteristics were similar between the groups: Mean age was CHS = 23 and CFV = 21; male to female ratio was CHS = 5/5, CFV = 7/3. At the end of 6 weeks, chitosan-based varnish performed equal to chlorhexidine-fluoride varnish (P > 0.05) with 98% and 95% of teeth with acceptable scores respectively. The plaque bacterial count significantly reduced at 6 weeks for both varnish compared to the baseline; The value for CHS was 0.43 ± 0.4 × 104 and CFV was 0.77 ± 0.64 × 104 CFU (P < 0.05), with no difference between both the varnishes. Both varnishes had no effect on the plaque pH that remained neutral. Conclusion This trial showed that both chitosan-based varnish and chlorhexidine-fluoride varnish reduced bacterial count, while the plaque pH remained neutral over a period of six weeks in patients undergoing fixed orthodontic therapy. The anti-plaque effects of the natural biopolymeric chitosan-based varnish was similar to that of chlorhexidine-fluoride varnish, a known chemotherapeutic agent. Registration: This trial protocol was registered with https://www.ctri.nic.in (CTRI/2019/05/018896). (Date of registration 02/05/2019). Protocol: The protocol was not published before trial commencement.

Diet and orthodontics- A review

During the course of fixed orthodontic therapy, patients should be instructed to eat specific food stuffs and beverages in order to maintain good health for the dentition and supporting structures and prevent frequent attachment debonding that prolong the treatment duration. After searching and collecting articles from 1930 till July 2021, the current review was prepared to emphasize various types of foods that should be taken during the course of fixed orthodontic therapy and to explain the effect of various food stuffs and beverages on the growth and development of craniofacial structures, tooth surfaces, root resorption, tooth movement, retention and stability after orthodontic treatment and the effect on the components of fixed orthodontic appliance.