Early intervention of anterior cross bite malocclusion relating to functional class iii malocclusion

This case report describes the treatment of a13-year-old boy with anterior dental cross bite, unilateral cross bite and constricted maxillary arch with removable appliance to bring the teeth into a normal position. A removable acrylic appliance with a bite plate incorporating an expansion screw was used to correct the anterior dental cross bite and align the incisors.

Effectiveness and Stability of Treatment with Orthodontics Clear Aligners: What Evidence?

Clear aligners, as a transparent and removable appliance, offer an alternative to conventional fixed appliance to patients with high demands for esthetics and comfort. Only a few investigations have focused on the efficacy of clear aligner therapy in controlling orthodontic tooth movement. Furthermore, the stability after treatment has not been thoroughly investigated. The purpose of this chapter was to update the knowledge of the available evidence about effectiveness and stability of clear aligners in non-growing subjects. Searches was made in different databases from January 2015 to January 2021. Relevant articles that met the inclusion criteria were selected. The level of evidence of the studies was moderate. The vertical movements of tooth were difficult to accomplish. Mesiodistal tipping showed the most predictability (82.5%) followed by vestibulolingual tipping. Molar distalization was also recorded as the highest accuracy. Derotation was difficult to accomplish with aligners especially of rounded teeth. The effectiveness of aligners in achieving the simulated transverse goals was 45%. The stability of clear aligner therapy was assessed by only two studies. Refinements are likely needed in almost all cases and to ensure treatment stability a retention period using a specific protocol is necessary.

A Short Update of Frankel Functional Regulator

A removable appliance is a device that modifies mandibular posture and transmits the resultant forces created by muscles and soft tissues to underlying and surrounding anatomical structures in a controlled manner. The resulting variation of the neuromuscular environment thus produces the required tooth movement along with the needed advancements in growing patterns. The necessity and requirement of early treatment is to modify the existing and developing malocclusions and muscular derangements before the attainment of growth completion of permanent dentition. Frankel Function Regulator (FR) is a device which functions on the principle of functional orthopedics in unity with muscle gymnastics (muscle exercises) and thereby results in morphological changes in both the jaws hence re-establishing the desirable normal occlusion.

Patient’s Perception of Pain and Discomfort Towards Orthodontic Treatments

Background: Patient undergoes orthodontic treatment with removable and fixed appliances will usually complaint of pain and discomfort. The level of pain and discomfort experience by patient will determined the cooperation and compliance towards the treatment. This study explores the perception of pain and type of discomfort experience by patients when undergoes orthodontic treatment. Material and method: This cross-sectional study involve a set of questionnaires regarding patient social demographic and factors contributing to pain and discomfort among patients with removable and fixed appliances. Result: This study shows that the most common discomfort experienced by patients with removable appliance are increased in saliva flow, interferes with mastication and altering speech. Apart from that, ulcers, pain in the mouth and appliance breakages are the most common pain experience by the patients with fixed appliances. Conclusion: In conclusion, majority of patients will experience some form of pain and discomfort during orthodontic treatments. Thus, information regarding pain and discomfort during orthodontic treatment should be clearly convey during the first initial appointment to prepare patient mental and physically.

The application of a new clear removable appliance with an occlusal splint in early anterior crossbite

Background The effectiveness of anterior crossbite treatment in preschool-aged children depends on the treatment design and patient compliance. Common early treatment appliances with steel wires and acrylic resin can bring about numerous problems, such as toothache, sore gums and mucous membrane injury. The aim of this study was to propose a new clear removable appliance to provide preschool-age children with an improved experience of early occlusal interference treatment. Methods Appliances were designed with the help of 3-dimensional (3D) digital reconstruction oral models and fabricated using 3D printing technology and the pressed film method. Then, the mechanical properties of the original dental coping sheet and thermoformed aligners were assessed in a simulated intraoral environment. Preschool-age participants who displayed anterior crossbite were recruited in this study. Records (photographs and impressions) were taken before the treatment (T1), during the treatment (T2) and at the end of the treatment (T3). The effects of treatment were evaluated by clinical examination and questionnaires. Results Normal degrees of overbite and overjet in the primary dentition were achieved using this new appliance. Dental and soft tissue relationships were improved. Questionnaires showed that the safety evaluation, degree of comfort and convenience grades of the appliance were all relatively high. Conclusion This explorative study demonstrates that our new clear removable appliance is able to correct early-stage anterior crossbite in a safe, comfortable, convenient and efficient way. Thus, it is a promising method to correct a certain type of malocclusion, and its clinical use should be promoted in the future.

The British Orthodontic Society MOrth Cases Prize 2019

This paper describes the orthodontic treatment of two cases that were successful in winning the British Orthodontic Society (BOS) Membership in Orthodontics (MOrth) Cases Prize in 2019. The first case describes the management of a 12-year-old girl with a Class II division 2 malocclusion complicated by moderate upper and lower arch crowding, multiple unerupted teeth, restored lower first permanent molars, pseudo-transposition of the lower left lateral incisor and canine, and diminutive upper lateral incisors. Treatment involved a combination of an upper removable appliance followed by upper and lower preadjusted edgewise fixed appliances. Anteroposterior correction and overbite reduction was achieved with triangular Class II elastics with posterior occlusal disengagement. Both upper permanent canines were exposed and aligned, and the diminutive upper incisors built up with resin-based composite. Treatment was completed over a period of 23 months. The second case describes the management of a 13-year-old boy with a Class II division 2 malocclusion complicated by severe upper and lower arch crowding with unerupted UR5, UL4, LR3, rotated LR5, an increased overbite complete to tooth, buccally displaced upper canines and hypoplastic upper first premolars. Treatment involved a first phase of functional appliance therapy, followed by the extraction of UR4, UL4, LL5, LR4 and upper and lower preadjusted edgewise fixed appliances over a 28-month period.

Retention Protocols and Factors Affecting Retainer Choice among Iraqi Orthodontists

Background. To identify the most common retention protocols practiced by Iraqi orthodontists using a specially designed e-survey. Furthermore, this study aimed to assess the effect of sociodemographic factors on the participant’s choice. Methods. Two hundred and twenty-five questionnaires with 23 multiple choice questions were sent to members of the Iraqi Orthodontic Society. The questionnaire was organized into four sections representing information about sociodemographic status of the orthodontists, factors affecting the selection of the retention system, commonly used retainers in the upper arch and lower arch, and duration of the retention system. The chi-square test was used to test the significant association between different variable and sociodemographic factors. Results. The response rate was 87.5%. The majority of the respondents considered the original malocclusion (80.2%) and clinical experience (49.7%) as the main factors for choosing the retention protocol. In the maxillary arch, a combination of vacuum-formed retainer and fixed retainer (35%) was mostly applied; in the mandibular arch, a fixed retainer was mainly used (46.7%). Most of the respondents recommended initial full-time wearing of a removable appliance (78.2%), especially in the first 3–6 months (47.2%). According to the respondents, bonding a fixed retainer to all anterior teeth was most common (79.7%), fabricated, and adapted directly inside the patient’s mouth (75.1%). More than half used flowable composite (54.8%) and recommend leaving the retainer forever (53.8%). Most of the variables showed a statistically significant association between the sociodemographic factors and type, duration, and fabrication of the retainer used. Conclusions. A combination of removable and fixed retainers was commonly used in orthodontics retention, and sociodemographic factors significantly affected retainer choice.

Case Study: Management of Failing Maxillary Bridgework

The current trend, and often gold standard, for replacement of missing teeth is implant-retained fixed or removable prostheses. These, however, are not always suitable, whether due to financial constraints, or the patient wishing to avoid the associated surgical treatment. Utilizing crowns as retainers for partial removable dental prostheses in such cases can provide a favourable aesthetic and functional outcome, whilst avoiding many of the retentive pitfalls that patients fear are associated with a removable appliance. CPD/Clinical Relevance: A systematic approach is required when approaching failing bridgework in order to overcome the unique challenge involving unpredictable abutment status, which often cannot be appraised until the bridgework is dismantled.

Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation

Summary Background Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance. Materials/methods The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire. Results In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7–23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type. Limitations Study assessed a relatively small number of patients. Conclusions/implications Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.