Craniofacial measurements in children with sella turcica shape’s anomalies

Objectives: The objective of the study is to evaluate the cephalometric measurements of Tunisian children who presented sella turcica’s (ST) shape anomalies. Materials and Methods: This cross-sectional study was conducted between January and June 2019 in the Department of Pediatric Dentistry of Monastir and Faculty of Dentistry of Tunisia. Radiographs were gathered from patients aged between 7 and 12 years old (n = 104) who had consulted for a malocclusion. The inclusion criteria were considered as follows: Good visibility of anatomic structures and absence of congenital craniofacial deformities. We excluded bad radiographs with errors and discrepancies: Double limits, deformities as well as children having hereditary craniofacial anomalies and underlying diseases. The cephalometric analysis was conducted according to Segner and Hassund’s method. ST’s shape was identified according to Axelsson’s classification modified by Becktor. The sample size was divided into groups: Group 1 with normal ST’s shape and Group 2 with sella’s anomaly. Statistics were performed using IBM SPSS STATISTICS 22. Data normality has been tested using Shapiro–Wilk test. The normality of variance was investigated too with Levene’s test, and comparison of means between groups was performed with t-test. Results: The prevalence of aberrations of ST’s form in Tunisian children is about 59.6%. The inclination of upper incisors to the maxilla differed in children with ST’s anomaly compared to normal kids. Children with sella aberration are characterized by retroclination of upper incisors to the maxilla. The variables which showed a statistically significant relationship between abnormalities of ST and cephalometric measurements were 1+NA with P = 0.03 and NL-NSL with P = 0.04. Conclusion: The prevalence of ST’s shape anomalies in Tunisian children is about two-thirds. It seems that the anomaly of ST influences the position of the maxilla to the cranial base and the position of upper incisors to the maxilla.

Evaluation of facial soft-tissue values and craniofacial morphology in obese adolescent patients with different skeletal classes

Objectives: The purpose of this study was to evaluate the facial soft tissue and craniofacial morphological structures in adolescent obese individuals with different skeletal patterns. Materials and Methods: The study was carried out on 292 adolescents examined under three groups based on their body mass indexes (BMIs) as obese, healthy, and overweight. The subjects were also categorized based on skeletal classes as Class I, Class II, and Class III. Results: The glabella, nasion, labiale inferius, labiomentale, and pogonion values of the female patients were significantly higher in obese group. In the obese and overweight groups, effective midfacial and mandibular length, anterior and posterior facial heights, and SN values of the females were higher than males. In the obese group, the mean effective midfacial and mandibular length (Co-A and Co-Gn), anterior and posterior facial heights (S-Go and N-Me), and anterior cranial base (SN) values were significantly higher than other groups. Conclusion: Soft-tissue thicknesses increase as BMI value increases. Craniofacial morphology reveals significant differences between BMI groups.

The effect of orthodontic treatment with fixed appliances on sleep quality in adults and adolescents in Saudi Arabia using Pittsburgh sleep quality index

Objectives: The aim of this study was to investigate the effect of pain caused by orthodontic fixed appliances on sleep quality of participants using the Pittsburgh Sleep Quality Index (PSQI). Materials and Methods: A previously validated Arabic version of PSQI was electronically distributed through different social media platforms and in waiting areas of orthodontic offices. Eligibility criteria included healthy adults and adolescents with orthodontic fixed appliances and with no systemic conditions that may affect sleep. The cut-off point used to determine poor sleep quality was (>5). Results: Three hundred and eighteen participants were included in the final analysis (28.9% males and 71.1% females). Both males and females with orthodontic fixed appliances had poor sleep quality with (Mean = 6.48, SD = 2.85, P = 0.000) for males, and (Mean = 7.18, SD = 2.87, P = 0.000) for females. Comparing males and females, we found that females scored higher than males in both subjective sleep quality and PSQI global score. Conclusion: Individuals undergoing orthodontic treatment with fixed appliances have poor sleep quality. Females undergoing orthodontic treatment tend to have poorer sleep quality compared to males.

Correlations between mandibular ramus height and occlusal planes in Han Chinese individuals with normal occlusion: A cross-sectional study

Objectives: The objective of the study is to determine the relationships between ramus height and occlusal planes (OPs) in Han Chinese individuals with normal occlusion. Materials and Methods: Two hundred and four participants with normal occlusion were included and their cephalograms were analyzed. The ramus height (Ar-Go), Frankfort horizontal plane-posterior OP (FH-POP), FH-anterior OP (FH-AOP) and FH-OP, anterior and posterior cranial base length, SNA, SNB, ANB, Frankfort-mandibular plane angle, SN-MP, jaw angle, and mandibular body length were measured on the subjects’ cephalograms. Pearson correlation coefficients were calculated among continuous variables. The ramus height was considered as dependent variable and the OPs as independent variables. Age, sex, and other cephalometric parameters were considered as possible confounding factors. Univariate and multivariate analyses were performed to determine whether the relationships were significant. Results: The FH-POP and FH-OP were moderately associated with ramus height, while the FH-AOP showed a weak association (P < 0.001). After adjusting age and sex, FH-POP, FH-AOP, and FH-OP showed significant negative associations with ramus height (β = −0.36, −0.28, and −0.37, respectively, P < 0.001). The OP flattened with the ramus height increased. After adjusting all the confounding factors, FH-POP and FH-OP showed significant negative associations with ramus height. The ramus height increased by 0.19 mm/1° flattening of FHPOP (β = −0.19, P = 0.002). Conclusion: After adjust age, sex, and other possible confounding factors, the FH-POP and FH-OP were associated with the ramus height. The flattening of FH-POP was associated with the increase of ramus height. The results should be treated with caution since it’s a cross-sectional study.

Effect of topical fluoride gel and fluoride varnish in the prevention of white spot lesions in patients undergoing fixed orthodontic treatment: An in vivo study

Objectives: Our primary objective was to establish the efficacy of fluoride gel and fluoride varnish in the prevention of white spot lesions (WSLs) development during fixed orthodontic treatment. Materials and Methods: The study sample consisted of 60 adult patients in a prospective split-mouth study design. Interventions, that is, topical fluoride gel and topical fluoride varnish were assigned at the time of bonding to either the right or left halves of the dentition. In all subjects, repeated evaluation of demineralization was done on the facial surfaces of sample teeth in each quadrant. Evaluation using laser fluorescence and by direct visual observation under magnification was carried out at bonding (T0), 3 months (T1), and 6 months (T2). Results: The distribution of mean DIAGNOdent score at T1 (3.14 ± 1.00 vs. 2.81 ± 0.852) and T2 (4.17 ± 1.41 vs. 3.51 ± 1.13) was observed which is significantly higher in the Gel group compared to the Varnish group. In the Gel group, the distribution of mean DIAGNOdent score at T1 (3.14 ± 1.00) and T2 (4.17 ± 1.41) is significantly higher compared to mean DIAGNOdent score at baseline T0 (2.07 ± 0.66). In the Varnish group, the distribution of mean DIAGNOdent score at T1 (2.81 ± 0.852) and T2 (3.51 ± 1.13) is significantly higher compared to the mean DIAGNOdent score at T0 (2.07 ± 0.66). Visual scores also correlated with DIAGNOdent scores. Conclusion: Fluoride varnish is more efficacious than fluoride gel in reducing enamel demineralization. Initial application of fluoride varnish around the orthodontic bracket at bonding appointment can offer significant protection against WSLs.

Evaluation of mandibular indices and cephalometric parameters in adolescents with impacted maxillary canines

Objectives: Maxillary impacted canines have an important place in orthodontics for the reason of being a common anomaly and its treatment is time consuming and difficult. The aim of this study was to investigate the mandibular indexes and cephalometric parameters in adolescents with impacted maxillary canines. Materials and Methods: The radiographs of 4026 patients aged 12–19 years old were scanned and a total of 155 patients were included in the study. Subjects were divided into three groups according to the permanent maxillary canines: Bilateral impacted canine (BIC) (52 subjects; mean age 15.02 ± 1.74 years), unilaterally impacted canine (UIC) (51 subjects; mean age 14.89 ± 1.39 years), and the control (52 subjects; mean age 14.84 ± 1.65 years) groups. Skeletal, soft tissue and dental measurements were performed on cephalometric radiographs. Mandibular index analyzes including the panoramic mandibular index (PMI), mental index (MI), antegonial index (AI), and gonial index (GI) measurements and also angular measurements of impacted maxillary canines were performed on panoramic radiographs. Data were analyzed statistically and P < 0.05 was considered significant. Results: Maxillary skeletal and dental measurements showed retrusive positioned maxillary dental arch in the sagittal direction in the impacted canine groups (P < 0.05). PMI and MI values were greater in the BIC and UIC groups than in control group (P < 0.05). There was no statistically significant difference in AI value among groups (P < 0.05). GI value of BIC group was found statistically lower than other groups (P < 0.05). Conclusion: Individuals with impacted maxillary canines have more retrusive maxillary dental arch and soft-tissue components. Furthermore, mandibular cortex was thicker in subjects with impacted maxillary canine than individuals with not and clinicians should keep in mind this when examine the panoramic radiographs in terms of early diagnosis of impacted maxillary canine teeth.

Efficacy of clear aligners in producing molar distalization: Systematic review

Objectives: The aim of this review is to systematically analyze the efficacy of molar distalization using clear aligners in non-growing Class II patients. Materials and Methods: A complete search across the electronic database through PubMed, Cochrane, Google scholar, LILACS, and manual search of orthodontic journals were done till 2019. Studies were selected on the basis of PRISMA guidelines. Results: A total of four articles were included in this review. The amount of molar distalization reported was 2–3 mm. Conclusion: Out of the four studies included. In all the studies a significant amount of distalization was reported. Three retrospective studies concluded that distalization with aligners is the most effective of all tooth movements. One study concluded that aligners effectively achieved distalization with an efficacy of 87%, other two studies concluded that aligners effectively distalized the molars with good control over vertical dimension and mesiodistal tipping.

Age-related osteogenesis on lateral force application to rat incisor – Part III: Periodontal and periosteal bone remodeling

Objectives: This study was aimed to compare the histological pattern of bone modeling on either periodontal or periosteal side induced by lateral orthodontic tooth movement in different age groups. Material and Methods: A total of 50 male Sprague-Dawley rats (25 rats in the adult group – 52 weeks and 25 rats in the young group – 10 weeks) were utilized in this study. Each age group was classified into the control, 3 days, 7 days, 14 days, and 21 days groups (five rats in each) by the duration of experimental device application. A double-helical spring was produced using 0.014” stainless steel wire to provide 40 g lateral force to the left and right incisors. Hematoxylin-eosin staining, proliferating cell nuclear antigen (PCNA) immunohistochemical staining, fibroblast growth factor receptor 2 (FGFR2) immunohistochemical staining, and Masson trichrome staining were performed; and the slides were subject to histological examination. Results: In 7 days, active bone modeling represented by the scalloped surface was observed on the periosteal side of the crestal and middle alveolus at the pressure side in the young group, while similar changes were observed only on the crestal area in the adult group. In the young group, the number of PCNA-positive cells increased significantly on the crestal area and middle alveolus on the 3, 7, and 14 day groups, with subsequent decrease at 21 days. In the adult group, PCNA-positive cells were localized on the crestal area throughout the period. In the young group, FGFR2-positive cells were observed mainly on the crestal and middle alveolus at 3, 7, and 14 days than the control group. In the adult group, these cells appeared on the crestal and middle alveolus in the 3 days group, but mainly on the crestal area at 14 days. In the young group, FGFR2-positive cells were observed on the crestal and middle alveolus on the 3, 7, and 14 days groups more than on the control group. In the adult group, these cells appeared on the crestal and middle alveolus in the 3 days group, but mainly on the crestal area in the 14 days group. In Masson trichrome stain, an increased number of type I collagen fibers were observed after helical spring activation in both age groups. Large resorption lacunae indicating undermining bone resorption were progressively present in both young and adult groups. Conclusion: According to these results, orthodontic tooth movement may stimulate cell proliferation and differentiation primarily on the periosteal side according to progressive undermining bone resorption on the periodontal side. This response may lead to prominent bone modeling during tooth movement in the young group, compared to the relatively delayed response in the adult group.

Evaluation of white spot lesions around orthodontic brackets using different bonding agents – An in vivo study

Objectives: The objectives of the study were to assess the white spot lesions around orthodontic bracket macroscopically using two different bonding agents – one with amorphous calcium phosphate (ACP) (Aegis Ortho) and one without ACP (Transbond XT). Materials and Methods: The study comprises 10 patients from 14 to 23 years of age. Patients were divided into control and study groups. Forty premolar teeth were then observed (20 teeth in each group). Bonding procedure was done and brackets were positioned on all four 1st pre-molars teeth and pre-treatment photographs were taken. The experimental material used was Aegis Ortho composite (study group) and Transbond XT (control group). Debonding procedure (by Wing deformation technique) was performed after 16 weeks which led to adhesive fracture at composite resin adhesive bracket interface leaving essentially all adhesive on the enamel. Then, follow-up photographs were taken to evaluate each. Results: Aegis Ortho containing ACP used for bonding purpose, provided lesser enamel demineralization than Transbond XT. Conclusion: Aegis Ortho for orthodontic bonding is significantly more beneficial and reliable, however, further investigations are also required to understand its clinical performance better.

Modified transpalatal arch to correct sagging of palatal cusp of maxillary 2nd molar

“Sagging” of the palatal cusp of upper second molars is a common finding observed during orthodontic treatment which may develop heavy balancing side contacts, which have been found to be detrimental to harmonious function of the masticatory system. Various modifications of transpalatal arch (TPA) are advocated to correct crossbite, but most of them will utilize an additional step of soldering a wire attachment to TPA. In this clinical pearl, the TPA was fabricated using a single wire component, eliminating an additional step of soldering.