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.

Noninvasive Multi-Disciplinary Management of Ectodermal Dysplasia with Hyposalivation – A Case Report

Ectodermal dysplasia (ED) is a rare genetic condition with nearly 200 documented traits. As the name states, ED targets tissues derived from ectoderms, such as hair, skin, nails, sweat glands, and teeth. Other orofacial structures might be affected, such as salivary glands and hard palate. Lack of teeth and diminished facial height can impact negatively on child growth and psychological well-being. Therefore, assessment and an interdisciplinary management plan of orofacial components of ED children should be installed as early as possible. Here we report an early assessment and multi-disciplinary management of ED child’s orofacial structures, which allow restoration of facial height and dental function and saliva reduction by the least invasive restorative approach in the form of the composite build-up of microdont and overdentures. It also highlights the importance of periodic evaluation of growth and treatment plan adjustment as an integral part of the transitional management until the age of a definite dental treatment.

Comparison of Two Protocols for the Treatment of Class 2 Malocclusion

Purpose: The purpose of this study was to compare the outcomes of the treatment with the twin block and modified twin block appliances in growing patients with Class 2 malocclusion. Materials and Methods: A cephalometric analysis was performed in 51 patients. The twin block sample consisted of 23 patients, 10-girls and 13-boys (mean age 10.46±0.71 years at the start of treatment, T1, and 12.84±0.78 years at the end of active treatment, T2). The modified twin block sample consisted of 28 patients, 18 girls and 15 boys (mean age 11.78±0.91 years at T1, and 13.32±0.56 years at T2). The twin block activators were used during the day, except for eating time, and the modified ones were used only at night. Duration of the treatment was 16-20 months. The changes from T2 to T1 and the differences between the groups were compared with the analysis of variance. Results: SNB angle in the twin block group showed 1.25±1.39 degrees change and in the modified twin block group, it exhibited 3.69±1.01 degrees change. Overjet in the group with twin block decreased 4.58±1.59 mm, and in the group with modified twin block it decreased 4.43±1.41 mm. In the modified twin block group, there was more retrusion of upper incisors in comparison with the twin block group. Accordingly, under the effect of modified twin block, retrusion of the upper lip was observed. Conclusion: Through modifying the twin block appliance, it is possible to ensure the comfort of the patients by reducing the daily usage, to reposition the mandibula forward and to correct overjet and sagittal dento-skeletal relationships without increasing facial height and to improve positions of upper incisors and lips.

Craniomaxillofacial Changes Using High-Pull J-Hook Headgear and Mini-Implant Anchorage in Adolescents: A Structural Superimposition Method

Objective: The aim of this study was to compare the craniomaxillofacial changes when using high-pull J-hook headgear (HPJH) and mini-implants (MIs) as maxillary anchorage in adolescents. Study Design: 40 female adolescents with dentoalvolar protrusion were divided into 2 groups; the HPJH group (n=20) and the MI group (n=20). Lateral cephalograms taken before treatment (T0) and after anterior tooth retraction (T1) were superimposed on the stable structures and then craniomaxillofacial changes were evaluated. Results: The cranial base angle, SNB, and facial angle decreased in the HPJH group but increased in the MI group. ANB decreased more in the MI group than in the HPJH group. Mandibular plane angle increased in the HPJH group but decreased in the MI group. Facial height index increased in the MI group while it showed no change in the HPJH group. Mandibular true rotation occurred clockwise in the HPJH group and counterclockwise in the MI group. Maxillary central incisors were intruded and retracted more in the MI group than in the HPJH group. Maxillary first molars were extruded in the HPJH group and were intruded in the MI group. Maxillary first molars were protracted more in the HPJH group than in the MI group. Mandibular central incisors were retracted more in the HPJH group than the MI group. Mandibular first molars were extruded more in the MI group than in the HPJH group. Conclusion: More favorable craniomaxillofacial changes occurred in the MI group than in the HPJH group.

CLINICAL IMPLICATIONS OF ANTHROPOMETRIC STUDY OF FACIAL INDEX IN FIRST YEAR MEDICAL STUDENTS OF SKIMS MEDICAL COLLEGE

Introduction:The structure of face is dependent on various attributes such as gender, ethnic background, race,climate , socioeconomic status and genetics. The facial index is the ratio of facial height (distance between Nasion and Gnathion) and maximum facial breadth(distance between two zygomatic prominences from Right zygonion to Left zygonion). Methods:A total of one hundred and twelve (112) First year medical students studying at Sheri Kashmir Institute of Medical Sciences Bemina Srinagar, Kashmir were chosen as the subjects for the present study. The study was carried out at Department of Anatomy, Sheri Kashmir Institute of Medical Sciences Bemina Srinagar Kashmir. Results:The conducted research provides important information concerning the total facial index (TFI), face shape, and facial phenotype in the adult population. The mean values of the morphological facial height and facial breadth in males were, respectively150mm and 155.5mm.while in females, respectively were: 142.5 mm and 170.0mm . Conclusion:Keeping in view the results obtained in this study we concluded that the dominant facial phenotype in the medical students of sheri Kashmir Institute of medical sciences is EuryproscopicandLeptoproscopic in male students and in male students.The results obtained may be harnessed as a reference for facial analysis that will be further useful in Orthodontics, anthropological research, forensics, genetic research and reconstructive surgery.

The Relationship between Dentofacial Vertical Pattern and Bite Force Distribution among Children in Late Mixed Dentition

Background: Digital bite measurement systems such as the T-Scan III allow for the computerized measurement of occlusal force distribution. This study aimed to establish the relationship between dentofacial vertical pattern and bite force distribution among children in late mixed dentition. Materials and Methods: In total, 86 children (45 male, 41 female) aged between 9 and 11 years with short (n = 28), medium (n = 28), and long (n = 30) facial heights were included in this study. The height, weight, age, and gender were recorded. Occlusal bite force distribution and time of occlusal cycle were recorded using a T-Scan III device (Tekscan Corp. Boston, MA, USA). The bite force distribution was compared among facial types using a One-Way ANOVA and post hoc test, a linear regression model with time of occlusion as dependent variable was developed. Results: No significant differences were observed in occlusion time between genders. Children with long facial height had a significantly lower anterior bite force distribution (p < 0.05) and significantly higher posterior bite force distribution (p < 0.05) than those with average or short facial height. Age, gender, height, and weight had no significant association with time of the occlusal cycle. Conclusion: Children with an increased vertical facial height have a more posterior distribution of force than children with average or short facial heights in the late mixed dentition.

Gender and Stature Estimate Based on Facial Measurements: an Anthropometric Study in Southwest Iranian Population

This study was aimed to evaluate the facial dimensions and their relation with gender and stature in the Iranian southwest population. A cross-sectional study was conducted among 300 southwest Iranian cases age 20-50 years (150 males and 150 females). Studied variables through physical anthropometry in both genders were Upper facial height (UFH), Total facial height (TFH), Facial Height (FH), Facial Width (FW), and intercanthal width (IC) using a standard sliding caliper and Collis. Regarding the sex and age of the individuals, general descriptive analysis of facial dimensions was determined. All measurements, except TFH and FH, were different between men and women (p≤ 0.01). In male subjects, the Pearson’s correlation coefficient (r) revealed that IC (0.72 ⃰ ⃰ ), FW (0.58 ⃰ ⃰ ) and UFH (0.18 ⃰⃰ ⃰ ) parameters had a positive correlation with stature. In the female group, none of the facial parameters had a significant correlation with stature. Regarding the value of each facial diameter in discriminating male and female stature and gender, the highest discriminative value was specified to the FW (cutoff: 11.89, sensitivity: 89%, specificity: 11%) and IC (cutoff: 2.26, sensitivity: 98%, specificity: 0.04%) respectively. This study showed a significant association of some facial measurements with stature and gender in the southwest Iranian population. IC and FW had the most diagnostic value for gender and stature definition. It is shown a useful reference for the adult southwest Iranian population for facial recognition and that the subject’s sex should be considered during body identification procedures.