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Two-dimensional to three-dimensional: A new three-dimensional cone-beam computed tomography cephalometric analysis
Raghu Devanna
January-April 2015, 3(1):30-37
Objectives of the Study: were (1) to develop a three-dimensional cephalometric analysis scheme applicable to assessing dentofacial deformities; and (2) to create a normative database of three-dimensional cephalometric measurements for adult North Karnataka population. Materials and Methods: A cross-sectional study was conducted on 40 male and 40 female adults with normal balanced facial profile and occlusion. Cone-beam computed tomography (CBCT) images obtained in digital imaging and communications in medicine format and the anatomic Cartesian three-dimensional cephalometric reference system according to Swennen et al. was used to standardize the reference planes. Cephalometric analysis was performed using various landmarks. New three-dimensional cephalometric analyses appropriate for orthognathic surgery as well as new parameters were used in this study. Results: The cephalometric norms generated in this study were comparable with those reported in the literature for conventional two-dimensional cephalometric analysis and unique features of North Karnataka population. The results showed significant differences between males and females in most of the facial measurements (P < 0.0001). Conclusion: This is the first database of three-dimensional cephalometric norms based on CBCT of the North Karnataka population. Norms generated were comparable with those reported in the literature with the conventional two-dimensional cephalometry: More accurate and reliable. Moreover, three-dimensional cephalometric analysis has the potential of incorporating new measurement methods that are difficult if not impossible in two-dimensional cepholmetric analysis. This method of cephalometric analyses can be useful in diagnosis and treatment planning for patients with dentofacial deformities.
  3 1,564 304
Unilateral maxillary molar distalization using zygoma-gear appliance
Mevlut Celikoglu, Celal Candirli
May-August 2014, 2(2):109-112
The aim of the present case report was to present the treatment of a patient with Class II subdivision using the zygoma-gear appliance (ZGA) for unilateral maxillary molar distalization and fixed appliances for the further treatment needs. The ZGA consisted of a miniplate, an inner bow and a sentalloy closed coil spring. Three weeks after the miniplate was placed on zygomathic buttress, a distalization force of 350 g was unilaterally applied to the maxillary left first molar through the sentalloy closed coil spring. After a distalization period of 6 months, a super Class I relationship was achieved and the maxillary left first molar moved 5 mm distally without anterior movement of the anchor premolars. In addition, the maxillary left molar slightly tipped distally (2.4΀), the maxillary incisors slightly retruded (about −5΀) and the overjet decreased (−1.4 mm). Then, preadjusted fixed appliances (0.022 Χ 0.028-in, Roth system) were placed in both arches and the maxillary premolar and canine were distalized using the miniplate anchorage after the leveling and alignment procedure. Class I molar and canine relationships, acceptable overjet and overbite were established in a total treatment time of 18 months.
  2 1,727 414
Soft-tissue characteristics of Class II division 2 malocclusion in North Indian adult population: A comparative study
Rana Pratap Maurya, Vijay Prakash Sharma, Pradeep Tandon, Amit Nagar, Sneh Lata Verma
May-August 2014, 2(2):97-104
Aims and Objectives: To evaluate and compare the soft-tissue characteristics associated with Angle's Class-I normal occlusion and Angle's Class-II division-2 malocclusion in North Indian adult population. Materials and Methods: Lateral cephalograms of 70 orthodontically untreated adult subjects, 40 were having normal occlusion (Group-A) with good facial profile (20 males - mean age 22.89 years and 20 females - mean age 21.27 years) and 30 subjects with Angle's Class-II division-2 malocclusion (Group-B) (15 males - mean age 22.50 years and 15 females - mean age 20.25 years) were analyzed. All the cephalograms were taken in natural head position, traced manually and 16 linear and 6 angular soft tissue parameters were measured which were derived from the Steiner, Ricketts, Burstone and Holdaway soft-tissue analyses. All the values were compared using Student's t-test with a level of significance at P < 0·05. Results: Group-B males had significantly higher mean values for lip-line, soft-tissue thickness at labialis inferior (P < 0.05), and total facial contour angle (P < 0.01), whereas, Group-A males had significantly higher values for lower lip-chin length (P < 0.001), lower face height, soft-tissue chin-thickness (P < 0.01) and nasomental angle (P < 0.05). Group-B females had significantly higher values for lip-line (P < 0.05), soft-tissue thickness at labialis superior (P < 0.01), at labialis inferior and mandibular sulcus contour angle (P < 0.05) whereas, Group-A females had significantly higher values for upper lip length, lower lip-chin length (P < 0.01), lower face height (P < 0.001), nose length and lower lip to Sn-Pg' (P < 0.05). There was an apparent sexual dimorphism was found in soft tissue pattern of both the groups. Conclusions: Angle's Class-II division-2 malocclusion subjects have decreased lower lip-chin length and lower face height, while they have an increase lip-line, soft-tissue thickness at labrale superius, soft-tissue thickness at labrale inferius, total facial contour angle and mandibular sulcus contour angle.
  2 2,193 294
Real-time cell analysis of cytotoxicity of orthodontic cements on gingival fibroblasts
Firat Ozturk, Ebubekir Toy, Erdem Hatunoglu, Buket S Bozkurt, Sema S Hakki
January-April 2014, 2(1):32-37
Introduction: To evaluate the cytotoxicity of four different orthodontic cement materials using the real-time xCELLigence system. Materials and Methods: Four orthodontic glass ionomer cements (GICs) were selected for this study, namely: GC Fuji (GC Cooperation), Ultra Band Lok (Reliance), Multi Cure (3M Unitek), and Meron (Voco). Ten test cylinders (measuring 5 Χ 2 mm) of each material were fabricated, making a total of 40 cylinders. The samples were incubated in Dulbecco modified Eagle medium (DMEM) culture medium for 72 hours. Human gingival fibroblasts (HGFs) were maintained with DMEM containing 10% fetal bovine serum. A real-time cell analyzer (RT-CES, xCELLigence) was used to evaluate cell survival. After seeding 200 μL of the cell suspensions into the wells (10,000 cells/well), gingival fibroblasts were treated with bioactive components released from cement materials and were monitored every 15 minutes for a period of 88 hours. For proliferation experiments, the statistical analyses used were one-way analysis of variance (ANOVA) and Tukey-Kramer multiple comparisons tests. Results: When the data were evaluated at 24 and 48 hrs, all tested materials showed statistically significant decreases in HGF cell index compared to the control group (P < 0.001). Conclusion: According to the results of this study, all tested cements were found to have cytotoxic effects to the HGFs.
  2 1,567 296
Bond strength of aged lingual retainers
Sertac Aksakalli, Bayram Corekci, Celal Irgin, Bora Ozturk, Siddik Malkoc
January-April 2016, 4(1):13-17
Introduction: The purpose of this study was to examine the tensile bond strength (TBS) of two different lingual retainer (LR) composite systems and three LR wires after they were aged by loadcycling and thermocycling. Materials and Methods: A 15 mm length of wire was bonded to the lingual surfaces of pairs of human incisors using two bonding techniques. Seventy-two pairs of incisors were placed into six groups, and loadcycling (50,000 times) and thermocycling (10,000 times) were performed. The failure characteristics examined included the maximum force for debonding and the site of failure. The adhesive remnant index scores were calculated. Data were compared by two-way analysis of variance and Tukey highly significant difference analysis. Results: All groups generally showed statistically significant differences in TBS score (P < 0.05). For each group, the highest average TBS score (P < 0.05) was obtained from a Transbond LR + Remalloy LR combination. The main failure type was a mixed failure. Conclusions: Retainer wire and composite combinations had significant differences. One of the best selection criteria for LRs is the determination of the bond strength needs of a case.
  2 2,277 650
Protrusive arch wire using for correction of pseudo class III in early mixed dentition
Maen Mahfouz
September-December 2014, 2(3):168-172
The timing at which orthodontic treatment starts, has always been a debatable matter. Pseudo Class III malocclusion is highly recommended to be treated early as this type of malocclusion worsens by age. If left untreated it may lead to serious problems like abnormal wear of the lower incisors, dental compensation of mandibular incisors leading to thinning of labial alveolar plate and/or gingival recession. There are different methods for solving this problem. The case report describes an effective method which corrects pseudo class III malocclusion in a short time in early mixed dentition by using a protrusive arch wire.
  1 2,001 463
Interception of a developing Class III malocclusion with facemask therapy
Prathapan Parayaruthottam, Vincy Antony, PG Francis, KM Muhamed Shaloob, K Jubin Hassan
January-April 2014, 2(1):38-41
Developing skeletal Class III malocclusion is one of the most challenging problems for the practicing orthodontists. Whether to start early treatment or wait for growth to be over is an ongoing debate. Interception of mild to moderate cases should be carried out as early as possible before it becomes severe. The protraction facemask has been widely used in the interception of developing Class III malocclusion with maxillary deficiencies. We present a patient with a developing skeletal Class III malocclusion with maxillary deficiency for whom a protraction facemask was given and there was successful interception of the skeletal malocclusion.
  1 1,617 389
Orthodontic extraction of a mandibular third molar to avoid nerve injury: A case report
Enver Yetkiner, Ersin Mutlu, Gulcan Coskun Akar
January-April 2014, 2(1):42-45
Surgical removal of impacted mandibular third molars is a common procedure with the potential of causing side-effects such as inferior alveolar nerve (IAN) injury and damaging of adjacent tissues. Orthodontic extrusion of such molars is an alternative treatment modality that reduces unwelcome risks. This case report presents the orthodontic extrusion and consequent surgical extraction of an impacted mandibular third molar intersecting the IAN canal and the 6-month follow-up status. A 41-year-old female with facial pain on the left side as the main complaint was diagnosed with a severely impacted mandibular third molar that required extraction. Radiographic evaluation revealed the critical proximity of the tooth to the IAN. The impacted third molar was surgically exposed and closed orthodontic extrusion protocol with light forces was administered. The third molar was surgically extracted following a 9-month traction period and bone healing was monitored for 6 months. The facial pain reduced gradually following the extrusion of the impacted molar. No neurological complications were observed immediately after and during the long-term follow-up the surgical extraction. Clinically and radiographically, significant healing distal to the second molar was obtained at the end of follow-up period. Orthodontic extrusion and surgical extraction of severely impacted third molars may be an alternative treatment modality that facilitates easier surgical procedures with lower neurological risks.
  1 1,849 276
Piezocision-assisted canine distalization
Ozlem Aylikci, Caglar Sakin
May-August 2013, 1(2):70-76
An increasing number of adult patients are seeking orthodontic treatment to improve their smile or their masticatory function. One of the biggest challenges an adult orthodontic patient faces is the time spent wearing brackets because time and esthetics have become increasingly important in this time. Over the years, several surgical techniques have been developed to address this issue and reduce overall treatment time. Although very effective, these techniques have proven to be quite invasive. A new, minimally invasive surgical procedure [piezocision] is presented in this case report that combines microincisions and localized piezoelectric surgery to achieve similar results rapidly and with minimal trauma.
  1 3,511 868
Relative comparison and assessment of patient's attitude and discomfort between two different types of fixed functional appliances: A comprehensive survey
Pooja Gandhi, Meenu Goel, Puneet Batra
September-December 2013, 1(3):83-88
Objective: The aim of this study was to assess the patient's attitude and follow the progress of patient's adaptation to discomfort between two types of fixed functional appliances. Materials and Methods: A total of 16 patients undergoing treatment with either fixed functional appliance, i.e., forsus fatigue resistant device (FFRD) (hybrid) and mandibular protraction appliance (MPA) IV (rigid) rated their experiences during the 1 st day of treatment and after 7 days, 14 days and 30 days of appliance insertion. Results: There were no significant differences in patient's attitude toward both the appliances. Soft-tissue laceration was the most serious side-effect (about 50% in MPA IV and 25% in FFRD). Soft-tissue laceration and other negative effects generally decreased over time. Conclusion: The results of the study indicate that there is no considerable difference in acceptance of FFRD and MPA IV by the patients. Most patients experience some discomfort and functional limitations; however, the effect generally diminishes with time and patients adapt to the appliance.
  1 2,016 1,916
Assessment of skeletal maturity using the permanent mandibular canine calcification stages
Sandeep Goyal, Sonia Goyal, Neeraj Gugnani
January-April 2014, 2(1):11-16
Aim: The aim of this study is to assess, (1) the relationship between cervical vertebrae maturation and mandibular canine calcification stages; and (2) whether the mandibular canine calcification stages can be used as indicators to determine skeletal maturity. Materials and Methods: A descriptive, retrospective, and cross-sectional study was designed. A null hypothesis was proposed that there was no relationship between cervical vertebrae maturation and the mandibular canine calcification stages. Pre-treatment orthopantomograms (OPGs) and lateral cephalograms of 99 males and 110 females of Rwanda ethnicity were selected. The cervical vertebrae maturation index (CVMI) proposed by Hassel and Farman was used to evaluate the skeletal maturation level, and the mandibular canine calcification stages were assessed with the Demirjian Index (DI). Results: A significant association was found between the CVMI and DI stages, as evaluated by the Pearson contingency coefficient values (0.599 for males and 0.719 for females). Canine stage F in males and canine stage E in females could represent the CVMI 2 stage and indicate the onset of a period of accelerating growth. Conclusions: The mandibular canine calcification stages might be clinically used as maturity indicators of the pubertal growth period, but only during the onset and accelerating phases.
  1 3,163 552
Comparison of axial and sagittal views for angulation, cuspal tip distance, and alveolus width in maxillary impacted canines using CBCT
NM Uday, Prashanth Kamath, Vinod A R Kumar, Arun B R Kumar, Rajat Scindhia, MB Raghuraj, Joe Rozario
January-April 2014, 2(1):21-26
Introduction: Three-dimensional (3D) cone-beam computed imaging allows localization of impacted canines, using spatial relationships with excellent tissue contrast. The aim of this study was to compare different views to assess exact localization of impacted maxillary canine using Kodak 9000 (France). Materials and Methods: In this study, 24 consecutive subjects with seven bilateral (considered as two samples) and 17 unilateral impacted maxillary canines were selected and subjected to cone-beam computed tomography (CBCT); axial and sagittal views were captured to localize the exact position of the impacted canine to the occlusal plane and its relation with adjacent incisors. Results: Mean angulation of 37.57° and 40.27° for axial (horizontal) and sagittal (vertical) views, respectively. A correlation was found between the proximity of the impacted canine to the incisors and their resorption (c2: 19.584). Cuspal tip distance was higher in sagittal view than in the axial view (P < 0.05). Conclusion: Depending upon the type of impaction both sagittal and axial views showed significant variation with axial view having predominant values. Therefore, CBCT images can allow the operator to assess the direction of impacted canine, amount of surrounding alveolus bone, local anatomic considerations, resorption, and condition of adjacent teeth; thereby, improving quality of orthodontic treatment planning and as well as surgical approach.
  1 2,340 389
Anti-microbial efficacy of Allium sativum against Streptococcus mutans biofilm formation on orthodontic mini-implants
Lubna Khan, Even Grace Miranda Paulino, Dennis Lim, Federico Nadela, Rajiv Yadav, Ourvind Jeet Singh Birring
September-December 2014, 2(3):129-134
Introduction: The aim of this study was to examine the effect of Allium sativum (garlic) extract on the biofilm formation by Streptococcus mutans on the surface of orthodontic mini-implants. Materials and Methods: Three brands (Dentos, Forestadent and Hubit) of titanium mini-implants were used as samples, which were divided into four groups each containing S. mutans along with four different concentrations of garlic extract-0 mg/ml, 16 mg/ml, 32 mg/ml, 64 mg/ml and 1 mini-implant from each of the three brands. The amount of viable S. mutans bacteria, as well as its biofilm formation on the surface of mini-implants was determined quantitatively as well as qualitatively using microbial viability assay, electron dispersive X-ray spectroscopy and scanning electron microscopy analysis. ANOVA test was done. Results: 32 mg/ml and 64 mg/ml concentration of garlic extract showed a considerable antimicrobial efficacy against S. mutans and effectively prevented the biofilm formation by S. mutans on the surfaces of all the mini-implants with 32 mg/ml being the lowest effective concentration of garlic extract to prevent S. mutans biofilm formation and 64 mg/ml being the most potent concentration. Conclusion: Garlic extract can be a promising alternative to other chemical agents used in mouthwashes to prevent bacterial biofilm formation on the surface of orthodontic mini-implants and can thus help in the reduction of mini-implant failure due to biofilm formation. It has a potential to serve as a herbal substitute to chlorhexidine, which has been shown to exhibit several side-effects during long-term use.
  1 2,128 422
Comparison of effects of preoperative piroxicam and ibuprofen on pain after separator placement: A randomized controlled trial
Siddarth Shetty, Nandita Shenoy, K Ashok Shenoy, B Unnikrishnan, Subraya Mogra
May-August 2013, 1(2):57-61
Introduction: Orthodontic therapy causes significant pain for a large percentage of patients. It is one of the main reasons that discourage patients from seeking orthodontic treatment. Pain during orthodontic treatment may have a negative influence on cooperation and can also reduce the compliance. This study assessed the effectiveness of a single dose of preoperative Piroxicam in reducing the incidence and severity of pain after orthodontic separator placement when compared to ibuprofen. Materials and Methods: The study was a randomized, placebo-controlled, double-blind, parallel-arm study. Sixty eight patients were recruited for this study and were randomly assigned to one of the three experimental groups: 1. 20 mg of Piroxicam followed by two doses of multivitamin placebo (n = 30); 2. 400 mg of Ibuprofen in three doses (n = 20) and 3. A multivitamin placebo (n = 18). All the three groups were administered the first dose of the respective medication one hour prior to separator placement, the successive two doses were given at 3 hours and 7 hours after separator placement. The pain experienced by the patient was assessed at the time intervals 2 hours, 4 hours, 6 hours, bedtime, on awakening the following day and 24 hours after administration using a visual analogue scale. Results: A comparison of pain perception between all three groups with the repeated measures analysis of variance (ANOVA) and a comparison of pain perception between the first and second group using the Student t test revealed that preemptive Piroxicam therapy significantly lower pain levels experienced at all-time intervals starting from 2 hours after separator placement till 24 hours after placement. Conclusion: A single dose of Piroxicam taken 60 minutes before separator placement reduces pain due to separator placement experienced in the first 24 hours following separator placement.
  1 2,401 377
Comparison of rate of retraction and anchorage loss using nickel titanium closed coil springs and elastomeric chain during the en-masse retraction: A clinical study
Charushila Vinay Chaudhari, Suchita Madhukar Tarvade (Daokar)
May-August 2015, 3(2):129-133
Introduction: The aim of this study was to compare the clinical effectiveness of nickel titanium (NiTi) closed coil spring and elastomeric chain on rate of space closure in terms of anterior retraction and anchor loss. Materials and Methods: A total of 40 patients with first premolar extraction were randomly divided into two groups for space closure. Group 1 consisted of 20 patients in whom space closure was done with NiTi closed coil springs whereas in group 2 consisted of 20 patients with elastomeric chain. The amount of anterior retraction, anchor loss and rate of space closure was measured before start of retraction and at end of 4 months clinically and radiographically. Results: The observations obtained in the study were subjected to statistical analysis, so as to get their interpretation. All qualitative variables were compared using Fisher exact test. All quantitative variables were described using mean ± standard deviation and compared using unpaired t-test. P < 0.05 was considered as significant. The unpaired t-test, when applied, revealed there was a faster rate of space closure by NiTi closed coil springs when compared with elastomeric chain. Furthermore, anchor loss was more with NiTi springs as compared with elastomeric chain. Conclusion: The results of this study demonstrated faster space closure (with anterior retraction) along with significant anchorage loss was achieved by using NiTi closed coil springs when compared to the elastomeric chain.
  1 2,124 567
Establishing lateral cephalometric norms for Nalgonda children with mixed dentition
Manjula Meka, Thabitha Rani Sandipamu, Rajendra E Reddy, Sreelakshmi Natta, Rajesh Aduri, Sandeep S Dande
May-August 2015, 3(2):134-137
Aim: The aim was to establish lateral cephalometric norms among Nalgonda children with mixed dentition and also to compare these norms with the established value of Caucasian norms. Materials and Methods : A total of 100 children (50 girls and 50 boys), aged between 8 and 12 years was selected based on the following inclusion criteria: Class I molar relationship without any crowding, no skeletal abnormality and no previous orthodontic treatment. A new custom made software was developed into which the subject's data were uploaded for cephalometric analysis of skeletal, dental angular and linear measurements. Results: Nalgonda children demonstrated forwardly placed maxillary and mandibular incisors in relation to NA and NB planes giving an acute interincisal angle of 116.1°. A statistical difference was observed between boys and girls in few variables which include ANB. Lower incisor-NB (linear), angle of convexity, occlusal cant and gonial angle. Conclusion: These children displayed horizontal growth pattern and Class II skeletal tendency with acute interincisal angle which varied from Caucasians. The values provided here would aid in the diagnosis and treatment planning for orthodontic interventions among Nalgonda children.
  1 1,532 219
Rapid prototyping: A future in orthodontics
Avinash Kumar, Hajra Ghafoor
January-April 2016, 4(1):1-7
Rapid prototyping (RP) is the name given to the host of related techniques that are used to fabricate the physical models based on computer-aided design and computer-aided manufacturing. RP technology allows the building of a medical model layer by layer, reproducing almost every form of the external and internal anatomic structure. It has rapid speed, better design communication, and easy detection of flaws. Data for RP is obtained from the magnetic resonance image/computed tomography scan slice images and they are converted into digital image which in turn is transformed to standard triangulation language file and afterward layer by layer construction is done by different techniques such as stereolithography, fused deposit modeling, selective laser sintering and inkjet printing to form the physical model. The applications of this digital technology in orthodontics includes diagnosis and treatment planning, fabrication of orthodontic removable appliances, impression trays for indirect bonding, and surgical template for implant placement, prototype model is employed in various orthognathic surgeries, it has been used for the custom manufacture of lingual orthodontics appliances and also to produce a distractor during distraction osteogenesis. Its advantages include rapid fabrication, minimal time, easy handling, better visualization, reuse of design, and repeated verification, however, the clinical judgment still remains vital. This article reviews the use of RP in the field of orthodontics; it improves a valuable insight at the time of preoperative treatment planning and enhances the quality of treatment effect. There is a divergence in the applications of RP for an orthodontist, and the future looks more promising if we use it innovatively.
  1 4,831 2,937
Diagnosis and management of facial asymmetries
Sandhya Maheshwari, Sanjeev Kumar Verma, Aditi Gaur, Sushma Dhiman
May-August 2015, 3(2):81-87
Facial esthetics evaluation is the most important part of the orthodontic treatment-planning procedure. The attainment of the best facial esthetic appearance for a given patient is a primary goal of orthodontic treatment. The evaluation of a patient's frontal symmetry is the most critical aspect of diagnosis because this is most appreciated view for any individual. Even the most esthetic faces are associated with mild forms of facial asymmetry. The individuals who report for an orthodontic treatment are often associated with facial asymmetry that may be greater than the acceptable norms. Such asymmetries may have a skeletal or dental etiology. The diagnosis, treatment planning, and the mechanics for the asymmetric patient require the identification of the cause of the asymmetry. A careful differential diagnosis together with a thorough treatment plan can ensure successful treatment outcomes in the management of such cases.
  1 6,948 1,598
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