Determination of Most Frequent Emergencies in Patients with Fixed and Removable Orthodontic Appliances at Tertiary Care Dental Hospital

OBJECTIVES: To determine the frequency of emergencies in patients with fixed and removable orthodontic appliances at tertiary care dental hospital. METHODOLOGY: A questionnaire was designed for this descriptive cross-sectional study to be filled by the clinician (L3/L4 FCPS resident) at the end of addressing every orthodontic emergency. Sampling was done under consecutive non-probability protocols. Descriptive statistics were applied to determine the frequency of different orthodontic emergencies, and Pearson’s chi-square test was applied to determine association of emergencies with gender and etiology of emergency (patient related vs operator related). Data was analyzed on SPSS version 20. RESULTS: A total of 175 patients reported with orthodontic emergencies. The sample comprised 38.3% males and 61.7% females. Most frequent orthodontic emergency reported was deboned brackets in fixed appliances, while the most common emergency in removable appliances was traumatic PNAM. A statistically significant association (Pearson’s Chi Square=4.74, Cramer’s V=0.165, p=0.029) was seen for removable and fixed appliance emergencies with males and females. CONCLUSION: Most frequent fixed appliance orthodontic emergencies were deboned brackets while for removable appliance emergencies were trauma due to PNAM. Emergencies with removable appliances were mostly due to the operator related factors, while in fixed appliances patient related factors were dominating.

The duration of finishing and polishing of acrylic removable orthodontic appliances in the Dental Technology Study Program at Universitas Airlangga, Surabaya, Indonesia

Objective: This study was intended to quantify the duration of finishing and polishing of removable orthodontic appliances by Dental Technology Study Program students. Material and Methods: This descriptive observational study employed total sampling. Fifteen of 6th semester students participated in the study, each of them producing three removable orthodontic appliances with the duration of finishing and polishing being recorded. Data was analyzed descriptively. Results: The duration of the finishing and polishing of orthodontic plates by Dental Technology Study Program students varied widely from 9 to 420 minutes with a mean of 71.20 minutes, both between individual students and between the first, second and third orthodontic plates. Conclusion: It is concluded that the duration of finishing and polishing in the fabrication of an orthodontic plate by the students was between 9 and 420 minutes. The duration varied depending on the design of the appliances, the skill of the students in processing or when performing the finishing and polishing.

AIDS AND METHODS FOR PERSONAL ORAL HYGIENE IN PATIENTS WITH NON-REMOVABLE ORTHODONTIC APPLIANCES

The demand for aesthetic dental rehabilitation, and respectively, for a higher quality of life, is growing each year. This entails a growth in the number of orthodontic corrections employing non-removable appliances. A high risk of developing periodontal issues while undergoing treatment reveals that orthodontist need to have all-round comprehensive knowledge of the tactics, the principles and the methods of hygiene measures. A high level of the doctor’s awareness along with their ability to motivate the patient, would allow them to arrive at successful doctor-patient relationship not only when dealing with orthodontic diseases, yet also in terms of maintaining the periodontium health due to a thorough approach to the issues of preventive oral hygiene during orthodontic treatment

Perbandingan Efektivitas T-spring Berdimensi Kawat 0,5 mm dan 0,6 mm terhadap Koreksi Gigi Malposisi Individual (Kajian pada Typodont)

Malocclusion can trigger various health problems in the oral cavity. The simplest form of malocclusion is individual dental malposition which can be corrected by removable orthodontic appliances with active components T-springs made of 0.5 mm or 0.6 mm wire dimensions. This study was aimed to compare the effectiveness of the T-spring with wire dimensions of 0.5 mm and of 0.6 mm on the correction of individual dental malpositions. This was a pre-experimental study using a one-shot case study design. Study samples were divided into two groups, T-spring with wire dimensions of 0.5 mm and of 0.6 mm on removable orthodontic appliances attached to typodonts. The samples were activated, and the typodonts were immersed in warm water until the individual tooth malpositions were corrected. The number of activations and the average tooth movement each time the activation were calculated and analyzed. The numbers of T-spring activations with 0.5 mm and 0.6 mm wire dimensions were analyzed with the Mann-Whitney test that showed a p-value of 0.042 (p<0.05). The data of the mean tooth movement each time the T-spring was activated were analyzed with the independent sample t-test that obtained a p value of 0.016 (p<0.05). In conclusion, the T-spring with wire dimension of 0.5 mm is more effective in correcting individual dental malpositions than the T-Spring with wire dimensions of 0.6 mm.Keywords: tooth malposition; removable orthodontics; effectiveness of T-spring Abstrak: Maloklusi dapat memicu berbagai masalah kesehatan pada rongga mulut. Bentuk sederhana dari maloklusi yaitu malposisi gigi individual yang dapat dikoreksi dengan alat ortodonti lepasan dengan komponen aktif pegas T (T-spring) yang terbuat dari kawat berdimensi 0,5 mm atau 0,6 mm. Penelitian ini bertujuan untuk mengetahui perbandingan efektivitas T-spring dengan dimensi kawat 0,5 mm dan 0,6 mm terhadap koreksi malposisi gigi individual. Jenis penelitian yaitu pre-experimental dengan menggunakan one-shot case study design. Sampel penelitian dibagi menjadi dua kelompok yaitu T-spring dengan dimensi kawat 0,5 mm dan 0,6 mm pada alat ortodonti lepasan yang dipasang ke typodont. Sampel diaktivasi dan typodont direndam dalam air hangat hingga malposisi gigi individual terkoreksi. Jumlah aktivasi serta rerata jarak perpindahan gigi setiap kali T-spring diaktivasi dihitung dan dianalisis. Data jumlah aktivasi T-spring dimensi kawat 0,5 mm dan 0,6 mm dianalisis menggunakan uji Mann Whitney yang menunjukkan nilai p=0,042 (p<0,05). Data rerata jarak perpindahan gigi setiap kali T-spring diaktivasi dianalisis menggunakan uji independent sample t-test dan memperoleh nilai p=0,016 (p<0,05). Simpulan penelitian ini ialah T-spring dengan dimensi kawat 0,5 mm lebih efektif dalam mengoreksi malposisi gigi individual dibandingkan T-spring dengan dimensi kawat 0,6 mm.Kata kunci: malposisi gigi; ortodonti lepasan; efektivitas T-spring

Perbandingan Efektivitas Z Spring dengan Coil dan Z Spring tanpa Coil terhadap Koreksi Malposisi Gigi Individual

Malocclusion problem is often found in the community. Z spring, one of the springs of the active component of removable orthodontic appliances, is divided into two types, namely Z spring with coil and without coil. Both can move teeth in a labial direction, therefore, they can be used to correct simple cases of malocclusion such as malposition of individual tooth. The addition of coil can increase the resilience and effective length of the spring which further increases the force, hence the malposition of the tooth can be corrected more quickly. This study was aimed to analyze the differences between the effectiveness of Z spring with coil and of Z spring without coil in correction of individual tooth malposition. This was a pre-experimental study with a one-shot case study method. There were two treatment groups, namely Z spring with coil and without coil. Each sample was activated by 1 mm per activation to correct tooth with 5 mm linguoversion in typodonts. After that, the number of activations required and the average value of the measurements of both groups were compared. The independent sample T-Test test on the average value of the displacement distance of each tooth showed that there was a significant difference in effectiveness between the Z spring with coil and the Z spring without coil groups (p=0.000; p<0.05). The Mann Whitney test showed that there was also a significant difference in the value of the number of activations for each Z spring sample between the two groups (p=0.000; p<0.05). In conclusion, Z spring with coil is more effective in correction of malposition of individual tooth than Z spring without coil.Keywords: removable orthodontic appliance; Z spring with coil; Z spring without coil Abstrak: Maloklusi merupakan permasalahan kesehatan gigi dan mulut yang banyak dijumpai dalam masyarakat. Z spring merupakan salah satu pegas dari komponen aktif alat ortodontik lepasan yang terbagi menjadi dua, yakni Z spring dengan coil dan Z spring tanpa coil. Keduanya dapat memindahkan gigi ke arah labial sehingga dapat digunakan untuk mengoreksi kasus maloklusi sederhana seperti malposisi gigi individual. Penambahan coil dapat meningkatkan kelentingan dan panjang efektif spring yang meningkatkan gaya sehingga malposisi gigi dapat terkoreksi lebih cepat. Penelitian ini bertujuan untuk menganalisis perbedaan efektivitas Z spring dengan coil dan tanpa coil dalam mengoreksi malposisi gigi individual. Jenis penelitian ini pre-experimental dengan metode one-shot case study. Terdapat dua kelompok perlakuan, yakni Z spring dengan coil dan tanpa coil. Masing-masing sampel penelitian diaktivasi sebesar 1 mm per aktivasi untuk mengoreksi gigi dengan linguoversi 5 mm pada typodont kemudian dibandingkan jumlah aktivasi yang dibutuhkan dan nilai rerata perpindahan gigi kedua kelompok. Hasil uji independent sample t-test pada nilai rerata jarak perpindahan masing-masing gigi menunjukkan terdapat perbedaan efektivitas yang bermakna antara kelompok Z spring dengan coil dan tanpa coil (p=0,000; p<0,05). Hasil uji Mann Whitney terhadap nilai jumlah aktivasi tiap sampel menunjukkan terdapat perbedaan bermakna pula antara kedua kelompok penelitian (p=0,000; p<0,05). Simpulan penelitian ini ialah Z spring dengan coil lebih efektif dalam mengoreksi malposisi gigi individual dibandingkan Z spring tanpa coil.Kata kunci: alat ortodontik lepasan; Z spring dengan coil; Z spring tanpa coil

Perubahan profil jaringan lunak bibir sebelum dan setelah perawatan ekspansi lengkung gigi menggunakan alat ortodonti lepasanChanges of the lip soft tissue profile before and after dental arch expansion treatment using removable orthodontic appliances

ABSTRAK Pendahuluan: Penggunaan alat ortodonti lepasan dengan sekrup ekspansi bertujuan untuk memperoleh ruangan pada kasus gigi berjejal dengan cara melebarkan lengkung gigi. Pergerakan gigi yang dihasilkan dapat berpengaruh pada salah satu komponen estetika wajah yaitu profil jaringan lunak. Tujuan penelitian ini untuk mengevaluasi perubahan profil jaringan lunak bibir sebelum dan setelah perawatan ekspansi lengkung gigi menggunakan alat ortodonti lepasan. Metode: Jenis penelitian ini adalah deskriptif analitik menggunakan metode purposive sampling pada subjek yang merupakan pasien ortodonti di Klinik Profesi Dokter Gigi RSGM Unpad yang dirawat menggunakan alat lepasan akrilik dengan sekrup ekspansi lateral maksila dan mandibula. Terdapat 4 subjek yang memenuhi kriteria inklusi yaitu sepuluh kali aktivasi yang dilakukan setiap minggu dalam waktu tiga bulan. Subjek dilakukan foto lateral wajah dengan posisi standar sebelum dan setelah aktivasi. Pengukuran dilakukan menggunakan jangka sorong digital dari bibir atas (Ls) terhadap E-line (Ns-Pog), bibir bawah (Li) terhadap E-line (Ns-Pog), dan busur derajat digital untuk mengukur sudut nasolabial(Ns-Sn-Ls). Hasil dan Pembahasan: Nilai rerata perubahan jarak bibir atas terhadap E-line yaitu 0,59 mm, nilai rerata perubahan jarak bibir bawah terhadap E-line yaitu 0,63 mm dan nilai rerata perubahan sudut nasolabial yaitu -2,03o. Penelitian ini menunjukkan adanya perubahan posisi bibir menjadi lebih ke anterior setelah dilakukan aktivasi sekrup ekspansi lateral rahang atas dan rahang bawah sebanyak 10 kali. Simpulan: Hasil penelitian menunjukkan adanya perbedaan yaitu posisi bibir atas dan bibir bawah yang menjadi lebih ke anterior dan tidak terdapat perbedaan pada sudut nasolabial setelah dilakukan 10 kali aktivasi sekrup ekspansi lateral pada alat ortodonti lepasan.Kata kunci: perbedaan profil jaringan lunak; alat ortodonti lepasan; ekspansi lengkung gigi; sekrup ekspansi. ABSTRACT Introduction: The use of removable orthodontic appliance with expansion screws aim to gain a space in crowding teeth by expanding the dental arch. The resulting tooth movement can affect one of the aesthetic components of the face, the soft tissue profile. The aim of this study to evaluate the change of lip soft tissue profile before and after treatment of dental arch expansion using removable orthodontic appliance. Method: The research method used is descriptive analysis and purposive sampling in patients of Rumah Sakit Gigi dan Mulut Universitas Padjadjaran’s Orthodontic Clinic treated by using removable appliance with lateral expansion screw in maxilla and mandible. There are 4 patients who meet the inclusion, namely the srew is activated 10 times, once every week in 3 months. Subjects photographed in lateral position before and after activation. Measurement is done by using a calipers from upper lip to E-line, lower lip to E-line, and nasolabial angle using a digital protractor. Results and Discussion: The average of the changes in upper lip to E-line distance are 0,59 mm, the average of the changes in lower lip to E-line distance are 0,63 mm, and the average of the changes in nasolabial angle are -2,03o . This study showed a lip position that became more anterior after 10 times the activation of the maxillary and mandibular expansion screws. Conclusions: The results showed a difference in the position of the upper lip and lower lip which became more anterior and there is no difference in nasolabial angle after 10 times the activation of lateral screws in removable appliances.Keywords: soft tissue profile differences; removable orthodontic appliances; dental arch expansion; expansion screws.

The Effect of Removable Orthodontic Appliances on Oral Microbiota: A Systematic Review

Background (1): Removable orthodontic appliances may favor plaque accumulation and oral microbe colonization. This might be associated with intraoral adverse effects on enamel or periodontal tissues. The proposed systematic review was carried out to evaluate qualitatively and quantitatively the microbiological changes occurring during orthodontic therapy with removable orthodontic appliances. Methods (2): PubMed, Cochrane Library, Embase, Web of Science, Scopus, Ovid Medline, and Dentistry and Oral Sciences Source were searched. The research included every article published up to January 2020. The Preferred Reporting Items for Reporting Systematic reviews and Meta Analyses (PRISMA) protocol and the "Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies" (SBU) method were adopted to conduct this systematic review. Results (3): The current study has a moderate evidence, demonstrating that removable appliances do influence the oral microbiota. Significant alterations occur just 15 days after the beginning of therapy, independently from the type of appliance. Furthermore, the levels of oral pathogens decrease significantly or even returned to pre-treatment levels several months later the therapy end. Conclusions (4): This review suggests that orthodontic treatment with removable appliances induces changes to oral microflora, but these alterations might not be permanent.

Orthodontic treatment in times of Covid-19

During the first two months of the Coronavirus Disease 2019 (Covid-19) pandemic, Romania was in lockdown, and all dental practices were closed, so orthodontic patients had to postpone their check-ups for at least eight weeks. This led not only to a delayed end of treatment but also to accidents and complications. The present study tried to evaluate the orthodontic situation both from the patient’s and orthodontist’s point of view, so the patients were given a few questions to answer, and the orthodontist analyzed each treatment before and after the two-month lockdown and decided if it was mildly or severely affected by the absence of check-ups. The study group consisted of 105 patients evaluated by three orthodontists in the same private practice. Patients that have gotten worse after the lockdown or who had problems were included in the study. Also, all the patients were given a 7-question form in order to find out their opinion. After two months without check-ups, our orthodontists found that 9.52% got worse because of the lack of intermaxillary elastics, broken brackets, broken removable orthodontic appliances, and others. Most of the patients believe that their treatment was delayed by the Covid-19 pandemic, but none of the patients felt unsafe when visiting the clinic. The Covid-19 pandemic had severe effects on orthodontic treatments. Orthodontists noticed a delay for about one-third of their patients. However, from the patient’s point of view, half believe that their treatment was negatively affected by the Covid-19 pandemic in different degrees.

Comparative Characteristic of Using Removable and Non-Removable Prostheses Appliances for Replacement of Dentition Defects in Children during the Mixed Occlusion Period

The purpose of the study was to increase the effectiveness of orthopedic and orthodontic treatment of children with dentition defects during the period of mixed occlusion to prevent secondary dento-maxillaire deformities. Material and methods. 47 patients aged from 6 to 11 years with dentition defects in the frontal and lateral areas were examined and treated to conduct comparative evaluation of the effectiveness of using removable and non-removable prostheses appliances in patients with dentition defects during the period of mixed occlusion. All the patients were divided into two clinical groups by the design type of a prosthesis appliance, the choice of which depended on the results of a complete clinical research taking into account the location and the length of dentition defects. For group I patients (n=29), we used removable orthodontic prostheses appliances (standard mechanically-operated appliances with artificial teeth), in areas with missing teeth, to regulate the size of upper and lower dentition and replace dentition defects. For group II patients (n=18), we used non-removable orthodontic prostheses appliances (bands with a spacer and a non-removable prosthesis appliance of our own design). At the beginning of treatment and after 3 and 6 months, the assessment of oral hygiene was conducted using Yu. A. Fedorov and V. V. Volodkina indices. Follow-up examinations of patients in both groups were conducted once a month. However, every 3 and 6 months, patients of group I (with removable prosthesis appliances) received repetitive jaw impressions and made control diagnostic models, which measured the size of a dentition defect area to monitor the treatment. The data on control measurements was compared with data obtained at the beginning of the treatment. The criteria for completion of orthodontic treatment were considered to be the regulation of the size of upper and lower dentition and the position of individual teeth, as well as the preservation of the place in the dental arch until the physiological change of prematurely lost teeth. Results and discussion. The main causes of dentition defects occurrence in patients of both groups were the following: premature removal of temporary and permanent teeth due to complications of caries – 39 patients (83.0%), the loss of teeth due to a trauma – 5 patients (10.5%). Dentition defect was caused by adentia – in 2 people (4.3%), by retention – in 1 person (2.1%). We determined that 30 people (63.8%) had defects of the upper jaw, which was the most prevailing dentition defects. Dentition defects in the lateral areas were recorded in 32 people (68.1%). The largest number of dentition defects was of short size – 29 (61.7%). To restore the integrity of the dentition, we made 29 removable prostheses appliances with artificial teeth for group I patients, 9 (31.0%) of them served to replace dentition defects of the frontal area and 20 (69.0%) replaces dentition defects of the lateral area. In order to replace the dentition defect and preserve the place in the dental arch, we made 18 non-removable prostheses appliances for group II patients, 6 (33.3%) of them were of our own design to replace the dentition defect in the frontal area, and 12 (66.7%) replaced teeth gap bands with a spacer for the lateral one. Based on the analysis of these indicators in people with dentition defects who used removable and non-removable appliances, we can conclude, that there is a clear connection between the impact of orthodontic appliances on oral hygiene, depending on its type. The negative dynamics of changes in the hygiene index according to Fedorov-Volodkina in patients with non-removable prostheses appliances can be explained by the deterioration of oral hygiene conditions due to the design features of the appliances and the inability to remove the appliance yourself. Therefore, the use of non-removable appliances requires additional hygienic measures. Removable appliances had almost no effect on the state of oral hygiene, but worked less predictably by reducing the time of their active action in the oral cavity. If children refused to wear removable prostheses and prosthesis appliances, there quickly developed secondary dento-maxillaire deformities, which over time became more stable, and pathological changes were more significant. In group I patients, 6 months after the start of treatment with removable prostheses appliances, the shortening of dentition defects was detected in the frontal area by 1.3±1.1 mm and in the lateral area by 1.2±0.9 mm. Negative changes in the length of the dentition defect in patients of group I before treatment and after 6 months are specifically connected with irresponsible attitude to treatment. Not all patients in this group fully wore removable prostheses appliances, and some of them did not wear at all. Conclusion. Our research showed that removable orthodontic appliances for replacement of dentition defects and prevention of secondary dento-maxillaire deformities could be used in patients of different ages, their special effectiveness was observed in pediatric-age patients, however, only in those who responsibly followed the recommendations of an orthodontist. The use of non-removable orthodontic appliances for replacement of dentition defects and prevention of secondary dento-maxillaire deformities is a more rational choice of dental prosthesis. The prosthesis appliance for the upper jaw developed by us doesn’t inhibit the growth of the jaw, meets all the esthetic and functional requirements applied to these appliances. During treatment with non-removable appliances patients cannot control the time when the appliance “works”, which leads to a more predictable result of treatment