Evaluation of pre- and post-treatment masticatory and bite force efficiency in patients undergoing fixed orthodontic treatment and orthognathic surgery using T-Scan Novus occlusal analysis: A factorial randomized controlled trial.

Introduction and Background: Orthodontic and orthognathic surgical treatment require quantified occlusion finish to rule out any temporomandibular disorders. Hence, the present study was proposed to analyze the occlusal efficiency in patients undergoing fixed orthodontic and combined orthodontic-orthognathic surgery using digital occlusal analysis. Methodology: A randomized multi-arm controlled trial was conducted on 55 patients divided into four groups, that is, group I: class I crowding/proclination required extraction for fixed orthodontic treatment, group II: class II div 1 required orthodontic treatment and/or myofunctional therapy, group III: skeletal class II required combined orthodontic and orthognathic surgical treatment, and group IV: skeletal class III required combined orthodontic and orthognathic surgical treatment. The pre-treatment, before debonding, and 1 year after debonding assessment of occlusion were carried out using T-Scan. The repeated analysis of variance (rANOVA) test along with post-hoc analysis was carried out for intra-group and inter-group assessments using SPSS (version 21, USA). The significance level was set at a 'P' value less than 0.05. Results: rANOVA measurement in groups I, II, and III showed a significant difference with respect to maximum bite force difference between right and left sides, anterior and posterior region, and left lateral disclusion time. However, group IV showed a significant difference with respect to maximum bite force in the anterior and posterior region as well as right and left lateral disclusion time only. Further application of the post-hoc Tukey test found a significant difference between the To value to T1 and T2 among all four groups. Conclusion: Improved bite force was found in all malocclusion groups which was gradual in improvement from pre-treatment to post-treatment and a subsequent retention phase. The study also reported the utility of digital occlusal assessment devices as reliable, repeatable, reproducible, and user-friendly in the determination of dynamic occlusion.

Natal and neonatal teeth: Clinically relevant findings in a retrospective analysis.

BACKGROUND: Teeth present at the time of birth are called natal teeth while the teeth which erupt within 30 days of birth are neonatal teeth. The natal and neonatal teeth are an uncommon occurrence causing extreme anxiousness among the parents because of various myths related to their occurrence in our society. METHODS: A retrospective analysis of 12 patients who reported to the dental center between 2012 and 2015 with natal or neonatal teeth was carried out. RESULTS: Our study sample comprised of 12 patients. The age group ranged from 4 to 27 days in which there were eight male and four female infants. Out of 12 cases, eight cases had history of a physiologic delivery, while four were delivered by C-section. All the teeth were white to yellowish white in color, grade III mobile, and were devoid of roots. Except difficulty in feeding, only one case had a complication because of the tooth which was the development of a small lingual ulcer. Eleven cases were managed by extraction of the natal or neonatal teeth, and in one case, the parents did not consent for extraction. Six infants below 10 days of age were administered inj Vit K prior to the extraction. On follow-up of all the patients families reported that the child was feeding much better after the treatment and there were no complications. CONCLUSION: Natal and neonatal teeth have been causing dilemmas in the minds of pediatricians and dentists world over. Thus, it is important to know the basics about such teeth so that proper guidance can be given to parents and a suitable case specific treatment plan can be formulated.

Management of skeletal class II malocclusion using bimaxillary skeletal anchorage supported fixed functional appliances : A novel technique.

AIM: To evaluate the treatment effects in growing skeletal class II patients subjected to a novel treatment technique, i.e., bimaxillary miniplates supported fixed functional appliance. The null hypothesis was that there is no statistically significant difference in skeletal changes of patients with class II malocclusion treated with bimaxillary skeletal anchorage supported fixed functional appliance and those who were not provided any intervention. METHODS: The sample comprised 32 skeletal class II subjects (17 males and 15 females) with a Cervical Vertebrae Maturity Index (CVMI) demonstrating peak of pubertal growth spurt. Sixteen patients (12.37 ±1.09 years of age) were treated with bimaxillary skeletal anchorage supported fixed function appliance, while 16 well-matched subjects (12.06 ± 1.34 years of age) were included as controls. For both groups, cephalograms (T1, T2) were taken with a matched observational interval of about 7.5 months; 17 linear and 10 angular measurements were recorded. The intraclass correlation coefficient (ICC) was used to determine reliability of measurements recorded. Student t test was carried out to determine the changes produced by the treatment relative to control. RESULTS: When compared with the control group, the treatment group demonstrated significant maxillary retrusion. No significant changes were seen in mandibular growth pattern, whereas mandibular length increased significantly more than in the control group (B-VP: 3.05 mm; Co-Gn: 2.65 mm). Treatment mechanics had minimal effects on maxillary dentition. Mandibular incisors proclined by an average of 3.06°. Maxilla-mandibular relation improved significantly (ANB: -4.29°; NA-Pog: -3.76°). CONCLUSION: The new bimaxillary skeletal anchorage supported fixed functional appliance technique was found to be highly effective in the treatment of class II malocclusion with significant skeletal changes.

Full-mouth Rehabilitation of a Ventriculoperitoneal Shunt-treated Hydrocephalic Pediatric Patient: A Case Report.

Hydrocephalus is characterized by accumulation of cerebrospinal fluid in the lateral ventricles of the brain, which results in progressive ventricular dilatation and an increased intracranial pressure. A ventriculoperitoneal shunt (VPS) is the most common treatment for hydrocephalus. Delayed development, behavioral disturbance, chronological changes in the eruption of their teeth, changes in the occlusion, greater accumulation of plaque, and increased caries prevalence are some of the clinical manifestations in these patients, which are encountered by a pediatric dentist. Behavioral disturbance in these patients makes sedation or general anesthesia the most feasible behavior management technique. During dental treatment of shunt-treated patients, care should be taken to avoid applying excessive force on the catheter. A referral to a neurosurgeon is recommended for patients with shunts undergoing invasive dental procedures for assessment of the need for prophylactic antibiotics. The present case report discusses full-mouth rehabilitation of a pediatric patient under general anesthesia who presented with severe early childhood caries and a medical history of ventriculoperitoneal shunt-treated hydrocephalus. How to cite this article: Poonia A, Chengappa MMD, Mitra R, et al. Full-mouth Rehabilitation of a Ventriculoperitoneal Shunt-treated Hydrocephalic Pediatric Patient: A Case Report. Int J Clin Pediatr Dent 2020;13(1):103-106.

Quality control in the orthodontic department of a Tertiary Military Dental Centre: A decade clinical audit.

BACKGROUND: The objective of the study was to analyze the quality control of the treatment within the orthodontic department by determining the workload, type of treatment, and quality of outcome. METHOD: Two hundred eighty patients were selected from departmental archives, who underwent orthodontic treatment since January 2010 and assessed using index of complexity, outcome and treatment need. Descriptive statistics was performed by SPSS, version 21 (IBM, USA). Mann-Whitney U test was applied to assess the difference between complexity and improvement grade. RESULT: Orthodontic treatment was provided to 56.43% of female and 43.57% male patients with a mean age of 16.91 years. Angle's class I type malocclusion was the highest with 35.71%. Preadjusted edgewise metal appliance with 95% dominated the mechanics. About 12.14% and 3.57% patients got benefited with myofunctional and orthopedic treatment, respectively. Ten percent of patients were treated with orthognathic surgery. The mean duration of treatment was 31.19 months with a range of minimum of 17 months to a maximum of 46 months. Among 87.14% patients treated by faculty, 47.95% had difficult complexity grading and 22.95% had very difficult complexity grading. Residents had provided treatment with 63.88% difficult and 19.44% very difficult grade. Mann-Whitney U test of overall complexity and improvement grade showed Z score of -9.25715 which was highly significant. CONCLUSION: The present study concludes that fair quality control is being maintained by the department considering the number of patients, its severity, and excellent outcomes. However, being the premier institute of Indian Armed Forces, regular clinical audit should be conducted to fulfill demand and supply ratio in appropriation.

Comparative evaluation of anchorage reinforcement between orthodontic implants and conventional anchorage in orthodontic management of bimaxillary dentoalveolar protrusion.

BACKGROUND: Increased upper lip procumbency is commonly associated with maxillary dentoalveolar protrusion with the major goal of reducing maxillary dentoalveolar protrusion. The treatment plan usually includes extraction of the maxillary first premolars, followed by retraction of anterior teeth with maximum anchorage. Dental implants have been widely accepted as successful adjuncts for obtaining maximum anchorage in orthodontic treatment. METHODS: 50 subjects between the ages of 13 and 17 years having bimaxillary dentoalveolar protrusion were included in the study. The patients were divided into two groups. Both groups received treatment with 0.022″ MBT prescription preadjusted edgewise appliance system. In addition, subjects of Group 'I' received the Nance button and lingual arch as anchorage reinforcement in the upper and lower arches, respectively. Subjects of Group 'II' received self-drilling titanium OI for anchorage reinforcement. RESULTS: Significant retraction was achieved in all cases with good vertical control. Anchor loss was observed in both groups. Anchor loss was much higher in Group I compared to Group II, and an intergroup comparison for anchor loss was highly significant. CONCLUSION: Implants as anchorage, for en masse retraction, can be incorporated into orthodontic practice. The use of orthodontic implants for anchorage is a viable alternative to conventional molar anchorage.

Management of Skeletal Class II Malocclusion by Surgery-First Approach.

Surgery-first approach (SFA) has been a paradigm shift in the field of orthognathic surgery. Majority of the published cases that have been managed by this approach are of skeletal class III. This communication describes a patient of 18-year-old male diagnosed with skeletal class II malocclusion due to mandibular retognathism. He was managed with SFA and was using skeletal anchorage system to prevent postsurgical relapse. Bilateral saggital split ramus osteotomy was carried out to achieve the mandibular advancement of 7 mm. Using this approach good esthetic result, functional occlusion was achieved. Patients were benefited with marked improvement in profile at a very early stage of treatment and shorter total treatment time of about 7 months.

Prevalence of malocclusion and orthodontic treatment need in schoolchildren - An epidemiological study.

BACKGROUND: To ascertain the prevalence of malocclusion and orthodontic treatment need in schoolchildren dependent on armed forces personnel. To review the overall oral health using DMFT index and to evaluate any relation between increased DMFT index to existing orthodontic problems. METHOD: Five schools were randomly selected among Army/KV/AF schools and a random sample of 1200 children aged 10-15 years old attending these schools dependant on armed forces personnel were selected. A survey form was filled up after the examination of children by the principal worker and need for orthodontic treatment was assessed using index for orthodontic treatment need (IOTN) and overall oral health status by DMFT index and totaled. Frontal intra oral photograph in centric occlusion were taken. Dental Health Component (DHC) of IOTN for all the patients was marked by one set of orthodontists. The most severe occlusal trait was identified by the examiner for any particular patient and the patient was then categorized according to this most severe trait. AC of the IOTN was assessed by second orthodontist, individual and a layperson. RESULTS: It was observed that prevalence of malocclusion in the sample was 53.7%. 32.8% (239 males & 154 females) of samples are in need of orthodontic treatment. 55.1% of samples shown no caries risk, 38.1% had moderate caries risk and 6.8% had high caries risk. CONCLUSION: Significant percentage of the samples are in need for orthodontic treatment. There is significant relation between higher DMFT index and orthodontic treatment need. It was found that IOTN is a reliable and user-friendly index, which can be used for orthodontic surveys.

Are bleaching and desensitizing agents contraindication for patients seeking orthodontic treatment?

AIM: To compare in vitro the effects on shear bond strength of the application of a dental bleaching and desensitizer agent prior to bonding metallic orthodontic brackets to extracted human teeth. METHOD: Sixty therapeutically extracted human premolars without any visible defects were collected and stored in 0.1% thymol solution at room temperature. All teeth were randomly assigned to one of four groups (each n = 15): group I, teeth were treated with bleaching gel containing 10% carbamide peroxide; group II, teeth were treated with a desensitizer containing 26% potassium oxalate; group III, teeth were treated as in group I followed by application of the desensitizer agent as in group II; and group IV, control group. The teeth from all the four groups were then bonded with 0.018-inch Roth premolar brackets. The shear bond strength was tested in a Hounsfield material testing machine. RESULTS: In group I, 10% carbamide peroxide gel alone did not affect the shear bond strength significantly compared with the unbleached specimens in the control group. The use of the desensitizer agent alone in group II significantly reduced the shear bond strength. In group III, further significant reduction of the mean shear bond strength occurred compared with all the three groups. CONCLUSION: The use of 10% carbamide peroxide prior to bonding orthodontic metallic brackets does not significantly alter shear bond strength. Application of desensitizer agent alone or in combination with bleaching agent significantly lowers the shear bond strength of orthodontic brackets. Application of desensitizer agent alone or in combination with bleaching agent does not lower the shear bond strength below the recommended value for orthodontic bonding procedure. As a result, their use is not a contraindication before orthodontic fixed mechanotherapy.

Management of a severe Class III malocclusion with extreme dentoalveolar compensations.

This case report describes the treatment of a 21-year-old woman with a severe Class III malocclusion, 9-mm anterior crossbite, extremely proclined maxillary anterior incisors associated with decreased buccolingual alveolar width, and a malformed supernumerary tooth. The treatment plan included fixed appliances to align and level the teeth, en masse retraction of maxillary anterior incisors after a labial and palatal corticotomy using temporary anchorage devices, high Le Fort I maxillary osteotomy for maxillary advancement, and bilateral sagittal split osteotomy for mandibular setback. Ideal overjet and overbite relationships were established, and the final esthetic result was pleasing. Occlusal stability was excellent in the 1-year follow-up.

A comparative evaluation of rate of space closure after extraction using E-chain and stretched modules in bimaxillary dentoalveolar protrusion cases.

BACKGROUND: Aim of this study was to compare the rate of space closure between E-chain mechanics in one side of upper arch and by elastomeric module with ligature wire on the contralateral side in same patient. METHODS: Thirty bimaxillary dentoalveolar protrusion cases were taken up for comprehensive fixed orthodontic treatment after extraction of all first premolars to retract both upper and lower anterior teeth. After initial alignment and levelling, alginate impressions were made for upper and lower arches and models constructed. In the upper arch model a vernier caliper was used to measure the extraction space in both sides from middle point of distal surface of canine to the middle most point of mesial surface of second premolar. This is the amount of space present before the onset of retraction mechanics. During space closure procedure two different retracting components were applied in right and left sides of each case. On right side elastic chain (E-chain) applied in both upper and lower arches and on left side elastomeric module with steel ligature (0.010") stretched double its diameter fixed in both arches. Both the mechanisms produced approximately 250-300 g of force as measured by a tension gauge. After onset of retraction mechanism all patients were recalled after every six weeks for three visits. In all these three visits modules and E-chains were changed. In all three visits impression was made, models constructed, and the remaining available space was measured by a vernier caliper up to 0.1 mm level variations. RESULTS: Mean value for total space closure in case of E-chain was 2.777 mm whereas in case of module with ligature wire the value increased to 3.017 mm. Mean value for rate of space closure in case of E-chain was 0.2143 mm, whereas in case of module with ligature wire the value increased to 0.2343 mm with a standard deviation of 0.001104 and 0.001194, respectively. The standard deviation for total space closure was 0.1305 for E-chain and 0.1487 for module with ligature wire. CONCLUSION: Space closure by elastomeric module with ligature wire is better than the E-chain.