Evaluation of the Impact of Interdisciplinary Case-Based Courses in Dental Education on Smile Evaluation Skills of Undergraduate Students.

OBJECTIVE: The purpose of the present study was to compare the perception of smile aesthetic between 3rd-, 4th-, and 5th-year dental students to identify if interdisciplinary courses have an impact on the attitudes of students. METHODS: A total of 118 dental students (3rd-, 4th-, and 5th-year; N=43, 43, and 32, respectively) assessed the aesthetic attractiveness of four smile photographs (normal, high, low, and asymmetric smile lines). To enhance the crown, length-to-width ratio and color Digital Smile Design (DSD) were applied to all photographs, and then scoring was performed by using the Visual Analog Scale (VAS). RESULTS: The VAS scores were all <60 regardless of the year of the student. The lowest scores were given for asymmetric smile line. Comparison of the scores of the different years showed statistically insignificant scores between 3rd- and 4th-year dental students (p>0.05), whereas statistical differences between 4th- and 5th-year dental students were found (Cases 1, 2, and 3: p<0.05 and Case 4: p<0.01). CONCLUSION: All students were critical in the evaluation of smiles. Hence, the motivation for critical thinking based on multidisciplinary courses until 3rd year, the skepticism, and also the perception of the students were increased. The difference between 4th- and 5th-year student aesthetic perceptions showed the impact of interdisciplinary course on enhanced judgment competency of the students.

Impact of Discipline-Based vs. Interdisciplinary Orthodontic Courses on Dental Students' Performance.

The aim of this longitudinal study was to assess the effect on dental students' grades of participating in a third-year course taught in orthodontics alone versus an interdisciplinary course taught with orthodontics and pediatric dentistry combined. In the five-year dental curriculum at Yeditepe University in Istabul, Turkey, the third-year orthodontic course was taught as a single discipline until 2010, when the course was redesigned as an interdisciplinary course in orthodontics and pediatric dentistry. This retrospective study analyzed all 540 students' grades in orthodontic courses in the third, fourth, and fifth years from 2003-04 to 2014-15 to determine the impact of the third-year course design on students' performance. Students were divided into two cohorts: group A (which experienced the single discipline course, 2003-04 to 2009-10; 181 female, 117 male) and group B (which experienced the combined course, 2010-11 to 2014-15; 152 female, 90 male). In both groups, significant differences were found for the third-, fourth-, and fifth-year orthodontic grades (p<0.05). The grades of the third-year and fifth-year students in 2014-15 were significantly higher than in 2010-11 (p<0.05) in group B. Intergroup comparison showed that the third- and fifth-year grades were significantly higher in group B than in group A (p<0.05). These results suggest that the interdisciplinary delivery of basic knowledge in the third year had facilitated the learning process and deep learning in the more advanced orthodontic courses in the fifth year.

Aesthetic Assessment of Infants With Different Cleft Types Before, During, and After Orthopedic Treatment.

OBJECTIVE: The aim of the present study is to compare the aesthetic assessments of infants with different types of cleft before (T1), during (T2), and after (T3) orthopedic therapy (OT) by orthodontists, dentists, and laypersons. METHODS: Photographs of 3 patients (incomplete lip [C1], complete unilateral [C2], and complete bilateral cleft [C3]) at T1 (C1, C2, C3 chronologic age: 5, 2, 2 days), T2 (C1, C2, C3 chronologic age: 32, 28, 35 days; using forehead anchoraged nasal stent or conventional nasoalveolar therapy plates), and T3 (C1, C2, C3 chronologic age: 80, 91, 105 days) were collected from the archive. The nasolabial region at stage T3 were masked and also added to the evaluation form (T4). Fifty-one evaluators (17 orthodontists, 17 dentists, and 17 laypersons; mean age = 30.1 ±â€Š3.63) assessed 21 frontal photographs using Asher-McDade et al's 5-point scale. RESULTS: The scores of the orthodontists for T1 photographs were statistically lower than the dentists and laypersons (P < 0.05). The scores of T3 and T4 were similar in all groups (P > 0.05). The assessment scores progressively decreased from T1 to T3 (P > 0.05). The scores of both treatment methods were similar in the orthodontist group (P > 0.05), whereas the scores were lower for forehead anchored nasal stent in the other groups (P < 0.05). CONCLUSION: Orthodontists are familiar with cleft patients. Therefore, the aesthetic of infants at any therapy stage with different treatment methods was not categorized as poor. The enhanced scores at post-OT stage and the similar scores of masked and nonmasked post-OT photographs may underline the recognition of the rehabilitation period by not only specialists but also laypersons.

Comparison of Different Energy Levels of Er:YAG Laser Regarding Intrapulpal Temperature Change During Safe Ceramic Bracket Removal.

OBJECTIVE: This study was done to compare the intrapulpal temperature change generated by different energy levels of Er:YAG laser used during debonding of ceramic brackets and find the most suitable level for clinical use. MATERIAL AND METHODS: Eighty polycrystalline alumina brackets were bonded on bovine incisor teeth, which were randomly divided into 4 groups of 20. One group was assigned as control. In the study groups, after laser exposure with 2, 4, or 6 Watt energy levels, brackets were debonded using an Instron Universal Testing machine. Adhesive remnant index (ARI) scores were recorded to evaluate the site of debonding. To assess intrapulpal thermal increase, 60 human premolar teeth that were prepared in the same way, at the same energy levels, by a thermocouple were used. RESULTS: When the debonding forces, intrapulpal temperature increases, and ARI of the groups were examined, statistically significant difference was observed between the groups. Mean temperature increases of 0.67°C ± 0.12°C, 1.25°C ± 0.16°C, and 2.36°C ± 0.23°C were recorded for the 2, 4, and 6 Watt laser groups. The mean shear bond strength was 21.35 ± 3.43 megapascals (MPa) for the control group, whereas they were 8.79 ± 2.47, 3.28 ± 0.73, and 2.46 ± 0.54 MPa for the 2, 4, and 6 Watt laser groups, respectively. CONCLUSIONS: Four watts is the most efficient and safe energy level to be used, utilizing Er:YAG laser with water cooling spray for 6 sec by scanning method during debonding of polycrystalline alumina brackets without any carbonization effects and detrimental temperature changes at debond sites.

Evaluation of corrosion resistance and surface characteristics of orthodontic wires immersed in different mouthwashes.

BACKGROUND: Patients use mouthwashes in addition to mechanical cleaning during orthodontic treatment. The effects of mouthwashes on the archwires have not been examined yet. OBJECTIVE: To compare the corrosion resistance of four different arch wires and corrosion effects of different mouthwashes to formulate a biocompatible and mechanically useful arch wire and mouthwash combination. METHODS: Each group comprised of 4 wire samples of 2 cm 0.016 × 0.022 inch. 1st group: ion implanted nickel titanium (INT), 2nd group: nickel titanium, without ion implantation (NT), 3rd group: micro layered esthetic nickel titanium (ENT), 4th group: stainless steel (SS) wires. They were immersed inside 2 ml of artificial saliva solutions (AS) for the control, or AS (9%) combined with 1 of the 3 mouthwashes (91%) for study groups, for 24 hours. These mouthwashes were essential oil (EO), chlorhexidine (CHX), sodium-fluoride (NaF). An electrochemical analyzer was used for electrochemical impedance spectroscopy measurements. RESULTS: High corrosion resistance was obtained for ENT than the other wires. The corrosion potentials are 0.007, -0.042, 0.074 and -0.015 V (Ag/AgCl) for ENT, INT, SS and NT in the artificial salivary, respectively. In NaF containing mouthwash Rp value of ENT is significantly high in comparison to others. The impedance responses of all materials increased significantly in the presence of NaF mouthwash as well as in the CHX mouthwash. Low frequencies are seen at all materials in EO mouthwash. Diameters of loops are 22, 5.9, 5.9 and 3.7 MΩ at ENT, INT, SS and NT. CONCLUSIONS: In this study, micro layered esthetic nickel titanium wires are found biocompatible among other wires and NaF and CHX mouthwashes can be recommend for their good corrosion resistance during fixed orthodontic therapy.

The Effect of Awareness of American Board of Orthodontics Criteria on Treatment Outcomes in a Postgraduate Dental Clinic.

The aims of this study were to evaluate the posttreatment outcomes in a postgraduate orthodontic clinic following a course on American Board of Orthodontics Cast and Radiograph Evaluation (ABO-CRE); to compare the outcomes of postgraduate students who took the course before and after finishing treatment of their cases; and to assess if the need for orthodontic treatment as determined by the Index of Orthodontic Treatment Need (IOTN) at the beginning of treatment affected students' final scores. A course on ABO-CRE was given to second- (group A), third- (group B), and fourth- (group C) year postgraduate students at Yeditepe University, Istanbul, Turkey, in 2012. Pre- and posttreatment plaster models of 253 cases (group A) were treated by students in 2011-12. An additional 251 (group B, 2012-13) and 341 (group C, 2013-14) cases were evaluated in the first and second years after the course, respectively. The models were graded retrospectively using the ABO-CRE and IOTN. The results showed that the total mean scores on the posttreatment plaster models were significantly higher in the pre-course group than the first- and second-year post-course group (p<0.05 and p<0.01, respectively). The borderline cases (grade 3) received a lower score on the ABO-CRE than the cases with need (grade 4) (p<0.01) and severe need (grade 5) (p<0.01) for orthodontic treatment. Increasing awareness by giving information about the ABO-CRE significantly improved the posttreatment success of these postgraduate students. After the course, treatment outcomes in the following year were better than two years later, suggesting it may be useful to teach the course annually to refresh students' knowledge.

Which Orthodontic Wire and Working Sequence Should be Preferred for Alignment Phase? A Review.

The key to a successful orthodontic therapy depends not only on manual skills and knowledge about treatment steps, but also on knowledge and choice of materials used. One of the major components of fixed orthodontic therapy is the choice of wires. Orthodontic wires are defined as devices consisting of a wire conforming to the alveolar or dental arch, used as an anchorage in correcting irregularities in the position of the teeth. The history of these materials is as old as that of fixed orthodontic treatments and they present different features. With proper general knowledge, doctors can differentiate between wires and use the sufficient wire sequence suitable for each patient. This can increase the quality of treatment. Therefore, the aim of the present review is to focus on the differences in features of wires as well as the sequence of leveling wire selection according to the treatment plan.

Metal ion release from silver soldering and laser welding caused by different types of mouthwash.

OBJECTIVE: To compare metal ion release from samples welded with silver soldering and laser welding when immersed into mouthwashes with different ingredients. MATERIALS AND METHODS: A total of 72 samples were prepared: 36 laser welded and 36 silver soldered. Four samples were chosen from each subgroup to study the morphologic changes on their surfaces via scanning electron microscopy (SEM). Each group was further divided into four groups where the samples were submerged into mouthwash containing sodium fluoride (NaF), mouthwash containing sodium fluoride + alcohol (NaF + alcohol), mouthwash containing chlorhexidine (CHX), or artificial saliva (AS) for 24 hours and removed thereafter. Subsequently, the metal ion release from the samples was measured with inductively coupled plasma mass spectrometry (ICP-MS). The metal ion release among the solutions and the welding methods were compared. The Kruskal-Wallis and analysis of variance (ANOVA) tests were used for the group comparisons, and post hoc Dunn multiple comparison test was utilized for the two group comparisons. RESULTS: The level of metal ion release from samples of silver soldering was higher than from samples of laser welding. Furthermore, greater amounts of nickel, chrome, and iron were released from silver soldering. With regard to the mouthwash solutions, the lowest amounts of metal ions were released in CHX, and the highest amounts of metal ions were released in NaF + alcohol. SEM images were in accord with these findings. CONCLUSIONS: The laser welding should be preferred over silver soldering. CHX can be recommended for patients who have welded appliances for orthodontic reasons.

Pulpal thermal changes following Er-YAG laser debonding of ceramic brackets.

Lasers are effective in debonding ceramic brackets. Unfortunately, while reducing the adhesive bond strength, lasers are also reported to increase pulpal temperature. The aim of this study was to evaluate the shear bond strengths and temperature increase levels after debonding ceramic brackets using an Er-YAG laser with or without water-cooling. Sixty polycrystalline upper premolar ceramic brackets were placed on the labial surface of sixty human premolar teeth which were randomly divided into three groups of twenty. A laser pulse at 5 W for 9 seconds was delivered to each bracket in both study groups either with water-cooling (water group) or without water-cooling (waterless group) using an Er-YAG laser. Debonding was performed 45 seconds after laser exposure and shear bond strengths were measured. Data comparison revealed a statistically significant difference between the groups. Mean temperature increases of 2.41°C and 4.59°C were recorded for the water and waterless laser groups, respectively. The shear bond strength value for the control group was 22.76 MPa and 10.46 and 6.36 MPa for the water and waterless laser groups, respectively. The application of Er-YAG laser with water-cooling was an efficient and safe method of debonding ceramic brackets.

In vitro effects of two topical varnish materials and Er:YAG laser irradiation on enamel demineralization around orthodontic brackets.

The aim of this in vitro was to evaluate the effects of tricalcium phosphate (TCP) and amorphous calcium phosphate (ACP) containing varnish materials and Er:YAG laser irradiation on enamel demineralization around orthodontic brackets. Forty extracted human premolar teeth were randomly divided into four treatment groups (i.e., 10 in each group): (1) 5% NaF-ACP varnish, (2) 5% NaF-TCP varnish, (3) Er:YAG laser, and (4) control (no treatment). Er:YAG laser was operated at a wavelength of 2.94 µm and the energy output was 80 mJ per pulse; a pulse duration of 200 µsec and and a frequency of 2 Hz were used with water cooling. All samples were then put into pH cycles. Surface microhardness values and representative SEM images were assessed. Surface microhardness values were evaluated using Kruskal-Wallis and Mann-Whitney U tests. The results revealed that demineralization was significantly lower in the TCP and ACP varnish groups, whereas mean surface microhardness values of the TCP varnish were found higher than the ACP (P < 0.05). TCP and ACP varnish materials were found effective for reducing enamel demineralization around orthodontic brackets. Use of Er:YAG laser irradiation as described in this study for inhibition of demineralization was found not satisfactory.

Effects of fixed functional therapy on tongue and hyoid positions and posterior airway.

OBJECTIVE: To evaluate how therapy with a fixed functional appliance affects airway dimensions, dentoalveolar changes, and tongue and hyoid positions. MATERIALS AND METHODS: A retrospective study was carried out on 46 pre- and posttreatment lateral cephalometric radiographs of 23 post-peak Class II patients (12 girls, 11 boys) treated with a Forsus Fatigue Resistant Device (FRD) appliance. The radiographies were taken at the start and at the end of Forsus FRD appliance therapy when a Class I or overcorrected Class I canine and molar relationship was achieved. The process took an average of 5 months 13 days ± 1 month 4 days. Skeletal and dental parameters were measured using Dolphin software, and the sagittal airway area was measured by AutoCAD software. RESULTS: Analyses of the pre- and posttreatment means revealed that there was no statistically significant skeletal correction of the sagittal malocclusion; increase of lower incisor inclination, decrease of upper incisor inclination, decrease of interincisal angle, and rotation of occlusal plane all contributed to the reduction of overjet. The tongue area and intermaxillary space area increased in response to these dentoalveolar changes; however, there was no statistically significant change in the hyoid position or the oropharyngeal area between the two time points. CONCLUSIONS: The dentoalveolar changes produced by Forsus FRD appliance did not cause any significant posterior airway changes in young adult patients.

Prevention of demineralization around orthodontic brackets using two different fluoride varnishes.

OBJECTIVE: This in-vitro study was done to evaluate the effects of two different seal materials, Duraflor™ and Enamel Pro(®) Varnish, on enamel demineralization adjacent to orthodontic fixed appliances. METHODS: Seventy-two extracted solid premolars were allocated to three groups as one control and two study groups after brackets were placed and bonded with Transbond™ XT. The control group received no topical fluoride application after bonding, whereas in the study groups two fluoride varnishes, Enamel Pro(®) Varnish and Duraflor™ were applied on the teeth adjacent to brackets. All specimens were then immersed separately in demineralization solution for 96 hours at constant temperature. Demineralization of the enamel surface was evaluated quantitatively by cross-sectional microhardness testing: indentations were made at the edge of the bracket base (0 µm) and at 100 and 200 µm distant from it. In all of these positions, 5 indentations were made at 10, 20, 40, 70 and 90 µm of depths from the external surface of the enamel. RESULTS: The results revealed that, Enamel Pro(®) Varnish and Duraflor™ group values are higher than the values of control group at every depth. The differences between the depths showed that the microhardness values decreased significantly when the depth increased. In the control group, more demineralization occurred in every indentation compared to the study group. CONCLUSION: Duraflor™ and Enamel Pro(®) Varnish can be considered for use in clinic as an effective method to prevent or reduce demineralization during orthodontic treatment, especially in patients with poor oral hygiene.

Effects of a newly designed apparatus on orthodontic skeletal anchorage.

OBJECTIVE: An appliance was designed to increase the cortical bone surface contact area of miniscrew implants (MSIs). The purpose of this in vitro study was to evaluate the effects of this appliance on the anchorage force resistance and the stability of orthodontic MSIs. MATERIALS AND METHODS: A total of 48 MSIs were placed into bone specimens prepared from the ilium of bovines. Half were placed with the newly designed apparatus and half were placed conventionally. All the specimens were subjected to tangential force loading perpendicular to the MSI with lateral displacement of 0.6 mm, using an Instron Universal Testing machine. The maximum removal torque of each tested specimen was also recorded. Both study and control groups were divided into two subgroups based on whether they had thin and thick cortical bone. RESULTS: The test group had statistically higher force anchorage resistance and maximum insertion torque values than the control group (P < 0.001). The results were found to be more significant in cases in which the cortical bone was thin (P < 0.001). CONCLUSIONS: Within the limits of this in vitro study, the present findings suggest that the newly designed apparatus might have a favorable effect on MSI stability in patients presenting with thin cortical bone. Clinical studies are necessary to confirm the results that were observed in vitro.

A cephalometric comparative study of class II correction with Sabbagh Universal Spring (SUS(2)) and Forsus FRD appliances.

OBJECTIVE: The purpose of this clinical prospective study was to compare the dentofacial changes produced by the Sabbagh Universal Spring (SUS(2)) and Forsus FRD appliances in late adolescent patients with Class II malocclusion, and quantify them in comparison with an untreated group. METHOD: The study was carried out on 59 patients with skeletal and dental Class II malocclusion due to retrognatic mandible. Among these, 20 were treated with SUS(2), 20 were treated with FRD, and no treatment was done to 19 subjects as the control group. 36 cephalometric landmarks were identified on each lateral cephalometric radiograph. RESULTS: The effects of both appliances were dentoalveolar and no significant vertical and sagittal skeletal effect on maxilla and mandible was achieved. The retrusion and extrusion of the maxillary incisors as well as the protrusion and intrusion of mandibular incisors were found to be statistically significant in both treatment groups. Soft tissue profile improvement was limited in both treatment groups. CONCLUSIONS: Both appliances corrected Class II discrepancies through dentoalveolar changes; however lower incisor proclination was more prominent with the Forsus FRD.

FEM analysis of a new miniplate: stress distribution on the plate, screws and the bone.

OBJECTIVES: Non-homogeneous force distribution along the miniplates and the screws is an unsolved question for skeletal anchorage in orthodontics. To overcome this issue, a miniplate structure was designed featuring spikes placed on the surface facing the cortical bone. The aim of this study was to examine and compare the force distribution of the newly designed plate-screw systems with the conventional one. METHODS: A model of bone surface with 1.5 mm cortical thickness, along with the two newly designed miniplates and a standard miniplate-screw were simulated on the three-dimensional model. 200 g experimental force was applied to the tip of the miniplates and the consequential effects on the screws and cortical bone was evaluated using three-dimensional finite element method. RESULTS: As a result of this finite element study, remarkably lower stresses were observed on the screws and the cortical bone around the screws with the newly designed miniplate when compared with the conventional one. CONCLUSION: The newly designed miniplate that has spikes was found effective in reducing the stress on and around the screws and the force was distributed more equivalently.

Effects of different application durations of ER:YAG laser on intrapulpal temperature change during debonding.

This study was done to determine the amount of lasing time required to remove ceramic brackets safely without causing intrapulpal damage by using Er:YAG laser with the scanning method. Part 1: 80 bovine mandibular incisors with ceramic brackets were randomly assigned into four groups of 20 as one control and three study groups. In the study groups, brackets were debonded after lasing for 3, 6, and 9 s, whereas debonding was performed without lasing in the control group. Shear bond strengths and ARI scores were also measured. Part 2: 30 human premolars with ceramic brackets were randomly divided into three groups of ten, as 3, 6, and 9 s of lasing durations. Intrapulpal temperature was measured at the same lasing times by a thermocouple. Statistically significant lower shear bond strengths were found in study groups compared to the control. A negative correlation was seen between the bond strengths and ARI scores in such a way that, as the shear bond strengths decreased, the ARI scores increased. Temperature increases for all the study groups were measured below the 5.5°C benchmark. All lasing times were effective for debonding without causing enamel tear outs or bracket failures. The temperature proportionally increased with the extension of the lasing duration. Six-second lasing by the scanning method using Er:YAG laser was found to be the most effective and safest way of removing the ceramic brackets without causing damage to the enamel and pulpal tissues.

Evaluation of the Immediate Dentofacial Changes in Late Adolescent Patients Treated with the Forsus(™) FRD.

OBJECTIVES: The purpose of this study was to evaluate the short-term dentoalveolar and soft tissue changes in late adolescent patients treated with the Forsus™ FRD. METHODS: A prospective study was carried out on 54 lateral cephalometric radiograms that were taken before placement and after removal of the appliance in the treatment group (15 subjects) and at the beginning and six months after in the control group (12 subjects). The patient selection criteria were as follows: skeletal and dental Class II malocclusion due to retrognatic mandible, normal or low-angle growth pattern, post-peak growth period, no extracted or congenitally missing permanent teeth, and minimum crowding in the lower dental arch. RESULTS: THE STATISTICAL ASSESMENT OF THE DATA SUGGESTED THE FOLLOWING RESULTS: No sagital and vertical skeletal changes were induced. The mandibular incisors were protruded and intruded, while the maxillary incisors were retruded and extruded. The occlusal plane was rotated in clockwise direction as a result of these dentoalveolar changes. Overbite and overjet were reduced in all patients. Soft tissue profile slightly improved. CONCLUSIONS: The results revealed that, in late-adolescent patients Forsus™ FRD corrected Class II discrepancies through maxillary and mandibular dentoalveolar changes.

Debonding of ceramic brackets by a new scanning laser method.

INTRODUCTION: The purpose of this in-vitro study was to develop a new method to debond ceramic brackets by scanning with an Er:YAG laser. METHODS: Sixty bovine mandibular incisors were randomly divided into 2 groups of 30. Polycrystalline ceramic brackets were placed on their labial surfaces by using the orthodontic composite adhesive Transbond XT (3M Unitek, Monrovia, Calif) and light cured for a total of 40 seconds. The first group was the control group, with no laser application performed. The Er:YAG laser was used on each bracket in the study group at 4.2 W for 9 seconds with the scanning method. The force required for debonding the brackets was applied 45 seconds after laser exposure. Shear bond strengths were measured in megapascals with a universal testing machine, and adhesive remnant index scores were assigned to each specimen. RESULTS: Statistically significant (P <0.001) lower shear bond strengths were found in the laser group (9.52 MPa) compared with the control group (20.75 MPa). Likewise, the adhesive remnant index scores were statistically different (P <0.001); the laser group had twice as many samples with adhesive, with the adhesive remnant index scores of 2 or 3. CONCLUSIONS: The application of the Er:YAG laser with the scanning method is effective for debonding ceramic brackets by degrading the adhesive through thermal softening.

Perception of pain and discomfort during tooth separation.

OBJECTIVES: To evaluate patients' perceptions of pain and discomfort during tooth separation and to compare the effectiveness of brass wire and elastomeric separators. METHODS: The participants were 87 adults with a mean age of 22.1 +/- 1.9 years. Elastomeric and brass wire separators were inserted mesial and distal to upper right (elastomeric separators) and upper left first molars (brass wire separators) in each subject. After seven days, the amount of tooth separation was measured with a leaf gauge, and pain perception and discomfort were evaluated with a visual analogue scale and questionnaire. RESULTS: The elastomeric separators produced significantly more separation than the wire separators. There was a statistically significant difference in the subjects' perceptions of pain and discomfort at rest and during chewing between the different separators (p < 0.001). In general, the brass wire separators caused the greatest pain and discomfort immediately after insertion. Pain from the wire separators subsided over seven days, whereas elastomeric separators caused the greatest pain on the first two days after insertion. Eating was negatively influenced by the separation in 61 per cent of the subjects on the first day. On the other hand, other daily activities were affected minimally. CONCLUSIONS: The different levels of pain and discomfort caused by these separators, together with their advantages and disadvantages, can help the clinician to choose an appropriate separator. Patients should be warned that pain due to separation may affect their chewing, social life, school work and sleeping. Analgesics and soft food are recommended following placement of separators.

Interdisciplinary management of a patient with skeletal anteroposterior discrepancy, impacted canine, and missing teeth.

For patients with complex dentofacial problems, orthodontic treatment is often not enough to obtain optimal esthetic and functional results. This case report demonstrates the treatment of a patient with skeletal anteroposterior discrepancy through an interdisciplinary approach and emphasizes the importance of collaboration with other dental disciplines to achieve the desired esthetic results.