Evaluation of the effects of cotton roll-biting on debonding pain: a split-mouth study

Introduction: Debonding pain is an unpleasant sensation that is frequently encountered during debonding procedure. Aim of the study: To investigate the effectiveness of cotton roll-biting on pain caused by the debonding procedure. Materials and methods: 102 patients (61 females, 41 males) who were at the debonding stage in orthodontic treatment were included in the research. The study was planned using a split-mouth design: one side of the jaw was the study, and the other side was the control. The anxiety level of participants was measured before debonding. On the study side, debonding was performed while patients were biting a cotton roll. On the control side, debonding was implemented as a routine debonding procedure. Study and control sides were assigned differently in each successive patient. The debonding pain of each tooth was recorded using the Visual Analog Scale prepared separately for each tooth. Shapiro–Wilk and Mann–Whitney U tests were used for statistical analysis. For both gender groups, patients were sequenced according to the average amount of pain per tooth. Subsequently, statistical analysis was repeated by using 50% of patients suffering more pain. Results: In the lower second premolar tooth, a statistically significant difference was detected. Pain scores were statistically higher in the study side for this tooth. No statistically significant differences were found for all other teeth. Conclusions: Cotton roll-biting has no alleviating effect on debonding pain. When debonding is performed gently using a squeezing action without applying torsional forces, additional pain relief methods are not required.

Skeletal effects of mini-implant assisted rapid palatal expansion (MARPE) on the sagittal dimensions of the maxilla an in-vivo cone-beam computed tomography (CBCT) study

Introduction -Transverse discrepancies of the maxilla are one of the most prevalent skeletal problems. Due to drawbacks of conventional RPE and invasive surgical expansion methods alternative methods were developed such as Mini Implant-supported rapid maxillary expansion (MARPE).Haas17 , Davis and Kronman18, Akkaya et al19 and many other studies have reported the maxillary response after MARPE on the sagittal dimensions, but their results were inconclusive. Aim - This study analyzed the effects on the maxilla in the sagittal dimension after Mini Implant assisted rapid palatal expansion (MARPE) in adolescents using CBCT. Material and method -A pretreatment CBCT image (T1) was taken as a standard initial record for all patients and post treatment CBCT (T2) was taken after three months in retention. The parameters SNA angle, Frankfort horizontal plane to NA angle, A-N perpendicular, ANS –PNS were measured and calculated for evaluation of the sagittal maxillary changes. Comparisons were then made between the two treatment groups (T1, T2). Result -There was a positive increase in both angular and linear measurements from pretreatment to post treatment measurements showing significant skeletal changes in sagittal dimension. Conclusion -The study concludes that there was statistically significant forward displacement of maxilla after transverse skeletal expansion in patients with transverse problems achieved through MARPE in adolescent patients.

Management of Class II Division 1 Subdivision malocclusion using unilateral bicuspid extractions and fixed functional appliance: A Two Year Follow-Up

Introduction: Management of Class II Subdivision cases pose a clinical dilemma and require a careful diagnosis to ascertain the source of asymmetry. Various treatment modalities involving: different protocols of tooth extractions; molar distalization; fixed functional appliances or orthognathic surgery have been proposed for the same. Objective: This article reports a unique approach for management of a severe skeletal Class II with Angle’s Class II Division 1 subdivision malocclusion using unilateral bicuspid extractions in mandibular and maxillary arches and a fixed functional appliance. Results: A 13 year 1 month old male in CVMI transition stage was successfully treated. Extraction of #44 was done to alleviate crowding in the mandibular anterior region and #15 was extracted to protract #16 to achieve a Class II molar relationship. A pre-functional Class II molar and canine relationship with co-incident midlines was achieved. The functional phase consisted of a fixed functional appliance (Forsus FRD) for mandibular advancement to correct the severe skeletal Class II. Class I molar and canine relationships were achieved with reduction of facial convexity and overjet. Result remained stable 24 months after treatment. The improvement can be quantified by the reduction in scores of orthodontic indices measured pre and post treatment. Conclusions: Management of Class II subdivision malocclusion requires careful planning. This paper presents a unique approach utilizing unilateral extractions and fixed functional appliance to address severe skeletal Class II discrepancy and the subdivision dilemma.

Herbst Appliance palatally anchored in the treatment of dental class II malocclusion

In this case report, Authors describe the correction of a class II malocclusion using only an Herbst appliance palatally anchored with miniscrews. Before sagittal correction in the same appliance we applied a palatal screw to obtain maxillary expansion. The device were removed after 12 months of treatment. The final result included the correction of Class II malocclusion by lower dentoalveolar compensation mainly. The lip function favorite the spontaneous correction of upper frontal torque with consequent improvement of facial esthetics. After a follow up of 12 months the clinical result is satisfactory in terms of occlusion and esthetics. This clinical case showed a simple orthopedic and dentoalveolar approach to correct transversal discrepancy, dental class II malocclusion and also frontal proclination only with one appliance in a very short treatment time.

Bullying and malocclusion in adolescence: a case report

Adolescents with bad malocclusion can more often be victims of bullying and the improvement of their facial appearance through oral rehabilitation is nowadays an important issue. The aim of this case report was to describe the orthodontic treatment in a teenager with a dentoskeletal malocclusion exposed to bullying to correct his occlusal problems and improve facial esthetics and quality of life. The patient, a boy aged 13.5 years, had a class II, division 1, malocclusion with hyperdivergent pattern, mandibular asymmetry, constricted maxillary arch and molar crossbite, increased overjet, lower mild crowding and lip sucking. A two-phase approach was necessary to achieve proper occlusion, better esthetics and promote the patient's self-esteem with consequent greater serenity of his family.

Relationship between Obstructive Sleep Apnea(OSA) and Orthodontic malocclusion in non-obese adults

INTRODUCTION:Obstructive Sleep Apnea (OSA)represents the complete or partial obstruction of the airway.Clinically OSA manifests as sleepness during the day,heavy snoring as well as waking up during the night dues the lack of air.Obesity,gender and orthodontic malocclusion are mentioned in the literature as the etiologic factor for Obstructive Sleep Apnea. AIM: The aim of this study was to find the relationship in the analyzed studies between the Obstructive Sleep Apnea and orthodontic malocclusion at non-obese adults. MATERIAL AND METHODS:The electornic search of the database was performed,using PubMed and Googlescholar,with the aim to find the relevante articles which correlate the OSA and orthodontic malocclusion.Keyword included:obstrucitve sleep apnea,orthodontic malocclusion,cephalometric analysis,impact,association,body mass index,obesity,adults,non obesity. Inclusion criteria were:nonobesity,orthodontic malocclusion,adults,articles published from 1999 to 2019,articles in English,full articles avaiable. RESULTS:Two hundred papers included keywords.The number of articles that included the fully set criteria was nine.These nine articles were analyzed in detail. CONCLUSION:Analyzed articles showed that there is relationship between the Obstructive Sleep Apnea and orthodontic malocclusion in non-obese adults.It was also showed that orthodontic malocclusion is etiological factor for OSA in non-obese adults.

Assessment of facial landmarks for bone asymmetry in geometric morphometric studies: A review

Background Anthropometrical points or landmarks are key for facial shape analysis using geometric morphometrics. In the early 1990s Fred Bookstein created a classification system with landmarks type 1., type 2., type 3. based on anatomical landmark homology. However, thirty years later, a uniform referece index of landmarks that can be used for assessing facial asymmetry still does not exist. The criteria for selecting landmark points are not fully defined, which makes classification of homology and and landmarks prone to arbitrary interpretations. A systematic review of literature indicates that authors of studies do not provide explanation for choosing exact points. Most of them also do not provide a clear definition of landmarks and landmarks classification according to homology. Objective The objective of this systematic review was to assess, in an evidence based manner, which landmarks inside the Bookstein groups of on facial hard tissues can be reccomended for facial asymmetry assessment using geometric mophometrics. Search methods An electronic search of 9 databases up to March 2020 by two reviewers was conducted to identify relevant articles. Selection criteria Prospective randomized, non-randomized controlled trials and cross sectional studies reporting on facial asymmetry using three-dimensional images and geometric morphometric methods. The reasons for assessing facial asymmetry were not considered. Data collection and analysis The 23 selected studies were categorized according to the number and specification of the research subjects, types of three-dimensional images, number of landmarks, and the craniofacial region of interest. All landmarks were extracted with the following data: name, abbreviation, and the author’s definition of the location. Results The craniofacial region is divided into neurobasic cranial part, ethmomaxillar part and the mandible. Assessment of neurobasic cranial asymmetry was conducted in 6 studies and 45 different landmarks were recorded, of which 11 were medial and 34 bilateral. Bregma and Lambda occur most frequently and according to homology both belong to type 1 landmarks. Assessment of ethmomaxillary asymmetry was conducted in 21 studies and 68 different landmarks were recorded, of which 16 were medial and 52 bilateral. Nasion and Jugale occur most frequently and according to homology Nasion belongs to type 1 landmarks and Jugale to type 2 landmarks. Conclusion The selection and definition of craniofacial hard tissue landmarks is one of the most important tasks in the design of morphometric studies, and thus for the purpose of assessing facial asymmetry. The review provides an extensive cross-section of possible landmarks with the definition of the location as well as the possible location variation. The list of these landmarks should be observed through the classification of landmarks according to their homology, as well as possible variations of the classification.

RETENTION OF MINI SCREWS IN ORTHODONTICS – A COMPARATIVE IN VITRO STUDY ON THE VARIABLES

Objectives: To correlate between the different lengths, angles of insertion and the mini-implant material and find out the most retentive combination. Materials and methods: 48 mini-implants (24 Titanium and 24 stainless steel) of lengths 6mm, 8mm and 1.5 mm diameter were inserted into humerus bone of goat at two different angulations, 600 and 900. To insert the mini-implant in the respective angulations, custom made template was made and the angles were confirmed with digital radiographs. Force was applied on to the mini-implants with a universal testing machine and the compressive load to failure was measured. Results: Results revealed that stability of the implant was positively correlating with the length of implant. A perpendicular angulation produced more stability. Moreover, titanium mini-implants had more resistance to compressive load than stainless steel mini-implants. Conclusion: Length of mini-implant, its angulation in the bone and the material of mini-implant were factors affecting its stability. In this study, titanium mini-implant of 8mm length angulated at 900 were stable than their counterparts.

The Relation between the Position of Maxilla and Rapid Maxillary Expansion Failure

Introduction: The palatal expansion may be a challenging treatment in late adolescents who has passed the peak of skeletal growth. The success rate of palatal expansion in these patients decreases due to decreased growth potential. Aim: It was aimed to determine any clinical/radiological indicator to be used as a predictor in the failure of rapid maxillary expansion (RME) in late adolescence. Materials and methods: The records of the patients who had undergone RME therapy between the years 2013-2019 were evaluated. The patients were allocated into two groups according to expansion success: successful (S-RME) and failed (F-RME) RME groups. Fifty systemically healthy patients in the cervical vertebral maturation stage 5/6 were enrolled (35 females, 15 males). Eleven patients were (10 females, one male) in the F-RME group, and 39 patients were (25 females, 14 males) in the S-RME group. Five cephalometric (related to maxillary position) and three clinical variables (age, gender, and CVMS) were evaluated. Variables were subjected to multiple logistic regression analysis for setting a prediction model and detecting predictors. Results: Patients with CVMS-6 had a 16.8-fold higher risk of palatal expansion failure than CVMS-5. 1 mm anterior position of PNS increased the risk of failure 2.9 times. 1 mm reduction in the distance between the PNS and cranial base in the vertical direction increased 60% the risk of RME failure. Conclusion: The CVM stage of the patient, along with the vertical and sagittal position of the PNS, were found to be the possible predictors of RME success in late adolescence.

Comparison of Transversal Effects of Different Expansion Protocols: Alt-RAMEC versus RME

Objectives The aim of this study is evaluate the transversal effects of the Alt-RAMEC(Alternate Rapid Maxillary Expansion and Constriction) protocol on both craniofacial and dentoalveolar structures and to compare the transversal effects of the RME(Rapid Maxillary Expansion) protocol. Materials and Methods In our archive, selected patients were divided into two groups. Group 1 included 22 patients(12boys,10girls, mean age 11.61±2.11years) who had been treated with 5 weeks of Alt-RAMEC. Group 2 comprised 21 patients(11boys,10girls, mean age 11.66±1.23years) who had been treated with 1 week of RME. Transversal measurements were also performed on the study models pre-(T0) and post-treatment(T1) with digital caliper. Internasal, interzygomatic, interjugular and intergonial width measurements were made on posteroanterior radiographs. The initial measurements and the mean changes within the groups were analysed using a student’s t test. Results According to the results of the study, there was no statistically significant difference between the groups in terms of chronological age, gender distribution and initial values. The expansion protocols showed a statistically significant increase in the widths of intercanine, interpremolar, intermolar and alveolar base widths in the maxilla(p<0.05). No statistically significant changes were observed in both groups(p>0.05) in mandible. The changes in maxillary intercanine, interpremolar widths between the two groups were statistically significant(p<0.05). In the posteroanterior measurements, only statistically significant difference was found between the groups in internasal width(p<0.05). Conclusions Alt-RAMEC and RME protocols are effective treatment protocols for correction of transverse deficiency in growing patients. 5-weeks Alt-RAMEC protocol significantly increased intercanine and interpremolar widths compared to 1-week RME. Clinical Relevance Since there are no studies in the literature comparing the effects of two different expansion protocols in the transverse direction, this is both the first. Most importantly, clinicians will see which of these two protocols is more singular in the treatment of transversal problems. Keywords: RME, Alt-RAMEC, tranversal measurements