Quantification of Titanium Release From Titanium Dioxide Impregnated Composites in Orthodontic Bonding—An In Vitro Study

Objective To evaluate the quantity of titanium dioxide nanoparticles released into the artificial salivary medium from orthodontic composite impregnated with 1% weight/weight (w/w) and 5% w/w titanium dioxide nanoparticles (TiO2 NPs) used for bonding metal brackets, thereby eventually comprehending the permissible levels. Materials and Method Eighty freshly extracted teeth for orthodontic treatment were divided into 2 groups of 40 teeth each and were bonded with brackets containing 1% w/w and 5% w/w composite containing titanium dioxide nanoparticles and placed in an artificial salivary medium. Quantification of 1% w/w and 5% w/w composite containing titanium nanoparticles was done using inductively coupled plasma mass spectroscopy for 4 timely periods 24 h, 2 months, 4 months, and 6 months. Results In the teeth that received 1% TiO2, the amount of titanium released was greatest in 2 months with no significant release at later intervals. In the second group that received 5%, there was a significant release of titanium at all intervals, with highest release at second month. On comparing the 2 concentrations at 4 different time intervals, the quantities were significantly greater in the 5% group at all time frames, thus implying a significant increase in titanium released with an increase in concentration from 1% to 5%. Conclusion Titanium release was higher in 5% w/w composite containing nanoparticles than 1% w/w composite containing nanoparticles, and 1% and 5% concentrations can be used safely and are within the permissible limits.

Modified Hyrax for Microimplant-Assisted Rapid Palatal Expansion

Temporary anchorage device-assisted rapid maxillary expansion has widened the horizon to treat adults having maxillary transverse deficiency without any surgical procedure. Three-dimensional custom modifications have also been developed, but they can be expensive. A modification of Hyrax screw with the use of lingual sheaths is suggested for microimplant-assisted rapid palatal expansion, which can be an easy to fabricate in-office and economical option.

Mini-Implant-Assisted Simultaneous Torquing Extrusion Retraction Spring for Ectopic Canines

Orthodontic management of ectopic canines is quite challenging and time consuming due to the presence of thin buccal cortical bone. Sectional mechanics provide distal and extrusive force on canine but without any torque control. So, palatal root torquing during canine retraction is needed to increase the buccal cortical bone thickness and to avoid bone dehiscence and gingival recession. This article describes an innovative spring which provides 3-dimensional control by simultaneous retraction, extrusion, and torquing of ectopic canine.

Standardization of Cephalograms Obtained From Various Imaging Systems

Objective To propose and validate a method for standardizing and printing cephalograms acquired from different imaging systems. Methods Validation of the proposed method was done using digital cephalograms, cone beam computed tomography (CBCT)-derived cephalograms, and direct measurements obtained from 3 dry human skulls. Each cephalogram was analyzed as-received and after standardization, using both manual and digital methods. 3-dimensional (3D) measurements were also computed from the CBCT images. After adequate blinding, 2 observers independently carried out all these measurements at 2 different times. Finally, the different cephalometric measurements of each skull were compared with the corresponding direct measurements (gold standard). Results The as-received digital cephalogram showed an inherent magnification of 33%, as determined from the calibration ruler. Compared to direct skull measurements, the as-received conventional and CBCT-derived cephalograms printed without standardization showed a reduction in measures of around 14% and 28%, respectively, whereas measurements obtained from cephalograms, which were standardized and printed by the proposed method, were comparable to direct measurements. Conclusions The findings of the validation study demonstrate the robustness of the proposed method in standardizing different cephalograms before printing.

Comparison of AdvanSync2® and Twin Block Appliances in Treatment of Class II Malocclusion With Retrognathic Mandible—An Observational Retrospective Study

Objectives: To evaluate the treatment outcomes between Twin Block and AdvanSync2® appliances by comparing the skeletal, dentoalveolar, and soft tissue changes. Materials and Methods: Radiographic data of 20 patients were retrospectively analyzed. Data were selected from patients in their skeletal growth spurt as evaluated by the cervical vertebral maturation method (CVMI 2, 3, and 4), with class II malocclusion characterized with retrognathic mandible (ANB > 4°, SNB < 77°, FMA = 25 ± 5°, overjet > 5 mm). There were 10 patients in each group that underwent orthodontic correction for class II malocclusion: either using Twin Block or AdvanSync2®. Independent t test and Paired t test and chi-square tests were used for the data analysis. The level of statistical significance was set at P value ≤.05. Results: The chronological and skeletal age were similar in both the groups. Records were taken for the functional treatment with mean treatment span of 8 ± 1 month. Changes in SNB (group I = 1.59°, group II = 3.11°) ( P < .01), Co-Gn (group I = 2.89 mm, group II = 5.34 mm), and U1-L1° (group I = −1.51°, group II = 2.97°) showed statistically different outcome between the groups, when the pre-post data were studied. Rest of the variables—cranial base, maxillary skeletal, mandibular skeletal, intermaxillary, vertical skeletal, maxillary dentoalveolar, mandibular dentoalveolar, and soft tissue—showed similar outcome ( P > .05). Conclusion: Both appliances lead to desirable outcomes in the correction of class II malocclusion. AdvanSync2® resulted in inducing more of changes in SNB and effective mandibular length as compared to Twin Block. Overjet and molar relation improved significantly with both the appliances. Both the appliances resulted in similar skeletal, dentoalveolar, and soft tissue changes.

A Cross-Sectional Evaluation of Self-Perceived Orthodontic Treatment Needs Amongst Tribal Adolescent With Remote Access to Orthodontic Treatment Using a Simplified Malocclusion Index

Background: Self-perceived orthodontic treatment need is strongly influenced by what is perceived to be the esthetic norm amongst a community, and reluctance toward treatment amongst adolescents with clinically ascertained malocclusion may often be due to readily remediable factors. Of particular interest is the prevalence of malocclusion amongst such communities as a probable indicator of the role of diet and genetics in establishing a predominant clinical phenotype that may also play a role in the construct of what is perceived as the esthetic norm amongst the community, thereby influencing the self-perceived need for treatment. Studies aimed at evaluating the association between self-perceived esthetics, and self-perceived treatment need have not been performed amongst a population with no prior exposure to orthodontic treatment Objectives: The purpose of this study was to evaluate the self-perceived orthodontic treatment need amongst the tribal adolescents belonging to regions with remote access to orthodontic treatment by way of a verbally assigned index and to also identify the reasons of reluctance toward treatment to better understand how to make orthodontic treatment readily accessible to such populations. Participants, Materials, and Methods: The agency areas of Paderu located at 18.0833°N 82.667°E and Parvathipuram located at 18°46'N 83°25'E are 2 revenue districts of Visakhapatnam and Vizianagaram, respectively, in the state of Andhra Pradesh, India, that are home to various tribal populations with remote access to orthodontic treatment. A total of 2,016 school-going tribal adolescents of the Paderu revenue division and 819 tribal adolescents of the Parvathipuram revenue division were examined to ascertain the prevalence of malocclusion. Necessary consent and permissions were obtained from the tribal authorities, the school authorities, parents, and the institutional ethical clearance committee. The screening was done utilizing natural daylight in compliance with infection prevention and control protocol. Clinical examination aimed at categorizing the observed occlusion into either ideal occlusion or one of the three classes of Angle’s class I, II, and III malocclusions. The Simplified Malocclusion Index For Layperson Evaluation (SMILE) was verbally assigned in the vernacular language while interacting with each child and the findings made note of for calculation of relevant scores related to their orthodontic awareness, self-esteem as related to self-perceived esthetics, and their self-perceived need for treatment. Reasons for reluctance to undergo treatment were noted down if expressed. An initial group of 31 adolescents categorized as presenting with clinical malocclusion were randomly picked up and assigned the SMILE index a second time to assess the reliability of the index by way of Cohen’s kappa statistic. Results: The initial test group of 31 individuals assigned the SMILE twice showed a Cohen’s kappa of 0.93 validating almost perfect intraoperator agreement. The SMILE index revealed that 80.95% of the adolescents of Paderu revenue division had orthodontic awareness and 79.51% had self-perceived esthetics but only 15.97% felt a need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 1,371] = 19.71, P < .001). The Index assigned to the Parvathipuram division revealed that 77.04% had orthodontic awareness and 78.38 had self-perceived esthetics but only 6.95% felt the need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 764] = 4.95, P = .02). Conclusion: The self-perceived need for orthodontic treatment is often based on the self-perceived esthetics of an individual or the self-esteem as influenced by the perceived esthetic norm of the community. Orthodontic treatment of adolescents with borderline malocclusion derangements requires careful ascertaining of the actual perceived need of the patient to enable the rendering of a justifiable orthodontic treatment with the complete trust of the young patient. This helps build community trust in regions where orthodontic treatment has not yet made in roads and may help ensure higher end of treatment satisfaction levels.

Maximum Voluntary Molar and Incisor Biting Force and Morphological Variables in Subjects With Different Vertical Skeletal Patterns

Objective: To estimate the maximum voluntary molar biting force (MBF) and incisor biting force (IBF) and their relationship to morphological variables in subjects with different vertical skeletal patterns. Materials and Methods: Maximum voluntary MBF, IBF, and morphological variables were recorded in 120 subjects (60 males and 60 females) with skeletal class I pattern in the age range of 14 to 24 years. All subjects were divided into 3 groups: Normodivergent, hypodivergent, and hyperdivergent, according to the maxillomandibular plane angle and Jarabak ratio. Bite force measurements were undertaken using a custom-made portable digital gnathodynamometer on the left and the right sides of the jaw in the molar and incisor regions during maximal clenching. Statistical analysis was performed using independent t-test, chi-square test, and ANOVA test using SPSS version 22.0.0.0 software. Results: MBF and IBF are influenced by gender with higher values obtained for male subjects in all groups in the following order: hypodivergent > normodivergent > hyperdivergent. No significant changes were seen with morphological variables in different groups. Conclusion: Molar and incisor biting forces are highest in hypodivergent subjects and least in hyperdivergent subjects as a reflection of jaw morphology and muscular efficiency. In all groups, males exhibit higher force values than females, underlining a strong gender influence on biting force and facial pattern.

Andy’s Facial Growth Indicator

Facial growth indicator line was originally developed by Dr John RC Mew. Dr Mew discloses a facial growth indicator in his textbook, Bioblock Therapy published in Great Britain by Dr Mew. The indicator line—this is defined as the distance from the tip of the nose to the incisal edge of the lowest upper central incisor. Andy’s facial growth indicator is a modification of facial growth indicator, which was originally developed by Dr Mew.

Indian Board of Orthodontics Case Report: Management of Class II Skeletal Malocclusion Using 2-Phase Treatment

KL, a 12-year-old boy, presented with a class II Div I malocclusion on a class II skeletal base (retrognathic mandible) with a 7-mm overjet and a horizontal growth pattern. He had a convex profile, incompetent lips, lip trap, deep mentolabial sulcus, everted lower lip, and positive visual treatment objective (VTO). KL had a CS2 cervical maturation stage, which indicates 65% to 85% adolescent growth remaining. Treatment involved growth modification using a removable Twin Block with midpalatal expansion screw. This was followed by upper and lower fixed appliance using 0.022” × 0.028” slot Mclaughlin Bennet and Trevisi (MBT) prescription. The retention protocol involved upper wrap around and lower lingual bonded retainer.