Treatment Effect of Combined Surgical Maxillary Expansion and Mandibular Setback in Skeletal Class III.

The purpose of this case report is to describe and discuss a combined surgical and orthodontic technique for the management of transverse maxillary deficiency and mandibular prognathism in the treatment of skeletal Class III malocclusion in a mature patient. Skeletal Class III malocclusion can present with maxillary deficiency or retrognathism, mandibular excess or prognathism, or a combination. The maxillary arch is narrow and often requires expansion. A 25-year-old patient presented with a constricted maxilla, a skeletal Class III malocclusion with a large mandible, Angle's Class III malocclusion, retroclined lower incisors, proclined upper incisors, crowding of maxillary and mandibular teeth, and bilateral posterior crossbite. The case report shows that an adult patient with Class III malocclusion (constricted maxilla and large mandible) can be treated with rapid maxillary expansion accompanied by bilateral maxillary osteotomies, followed by a reduction bilateral sagittal split osteotomy (BSSO). As the patient was 25 years old with a bilateral crossbite, a surgically assisted rapid maxillary expansion procedure was performed. As the diastema space was available at the end of expansion, it proved to be beneficial for the presurgical decompensation of Class III, thus creating a negative overjet, followed by which a BSSO setback was done.

Assessment of salivary interleukin-1ß (IL-1ß), prostaglandin E2 (PGE2) levels and pain intensity in children and adults during initial orthodontic treatment.

OBJECTIVES: To investigate pain intensity, interleukin-1ß and prostaglandin E2 values in saliva during initial orthodontic treatment among varying age groups and their correlation between these mediators. MATERIALS AND METHODS: Twenty healthy patients distributed equally in age and gender groups were chosen. Unstimulated saliva was collected before the placement of orthodontic fixed appliance (T0), 1 hour after the placement of the appliance with 0.014" nickel titanium archwire (T1), 1 month after the first visit (T2), and 1 hour after the placement of 0.016" nickel titanium archwire (T3). The saliva samples were then analyzed for prostaglandin E2 and interleukin-1ß using enzyme-linked immunosorbent assay. Pain intensity was measured using a numerical rating scale. RESULTS: Prostaglandin E2 and interleukin-1ß levels had increased at T1 followed by a drop at T2 and a subsequent increase at T3. The prostaglandin E2 and interleukin-1ß levels were higher in adults than children. There was an insignificant correlation between the interleukin-1ß and prostaglandin E2 changes in all the patients. No significant differences were seen in pain scores between adults and children. Insignificant correlation was seen between pain scores and prostaglandin E2 and interleukin-1ß. CONCLUSION: Prostaglandin E2 and interleukin-1ß can be detected in saliva and are increased in during the initial orthodontic treatment but are higher in adults than children. Pain intensity was not significantly different between adults and children.

Influence of conventional and skeletal anchorage system supported fixed functional appliance on maxillo-mandibular complex and temporomandibular joint: A preliminary comparative cone beam computed tomography study.

AIM: Fixed functional appliance (FFA) used in the treatment of Class II malocclusion, lead to mandibular anterior teeth proclination, thus limiting the skeletal effects of the appliance. To counter this side effect, FFA is anchored in the lower anterior region of the mandible using the skeletal anchorage system. This pilot study was done to evaluate treatment and one-year post-treatment maxillo-mandibular, and temporomandibular joint (TMJ) effects of conventional fixed functional appliance (FFA) and skeletal anchorage system supported fixed functional appliance (SAS-FFA) using cone beam computed tomography (CBCT) images. MATERIAL AND METHOD: Sixteen Class II individuals were equally divided into Group I (FFA) (mean age 13.11±0.38 years) and Group II (SAS-FFA) (mean age 12.96±0.38 years). CBCT scans taken, before treatment (T0), at the end of comprehensive treatment (T1), and after one-year post-treatment (T2), were evaluated for changes in maxillo-mandibular complex and TMJ. Intraclass correlation coefficient and independent "t" test were used for repeated measures, and inter-group (mean) changes respectively. RESULTS: After one-year post-comprehensive treatment, SAS-FFA showed significant maxillary restriction (SNA, -1.93°, P<0.05) with significant increase in mandibular length (Go-Pog, 3.25mm, P<0.001) (Co-Gn, 7.87mm, P<0.001). SAS-FFA groups showed significant upward and backward increase in condylar volume (571 mm3, P<0.001) with anterior translation of glenoid fossa. FFA group showed significant lower dentition and vertical relationship relapse, along with non-significant changes at TMJ. CONCLUSION: SAS-FFA is an effective combination, which brings favourable changes on maxillo-mandibular complex and temporomandibular joint with non-significant relapse in comparison to FFA at one-year post-treatment.

Low-level laser therapy increases interleukin-1ß in gingival crevicular fluid and enhances the rate of orthodontic tooth movement.

INTRODUCTION: The aim of this investigation was to evaluate the effects of low-level laser therapy on interleukin-1ß (IL-1ß) levels in gingival crevicular fluid and its correlation with orthodontic tooth movement. METHODS: A split-mouth design was used in 10 subjects (6 female, 4 male) aged 14 to 25 years, whose maxillary first premolars were extracted. A gallium-aluminum-arsenide semiconductor diode laser (wavelength, 940 nm; energy density, 8 J/cm2; power output, 100 mW) delivered low-level laser therapy to the experimental canine undergoing distalization at 10 points. The control canine was distalized without low-level laser therapy. The experimental and control canines were distalized using a force of 150 g provided by nickel-titanium closed-coil springs. Gingival crevicular fluid was collected at 5 time points from the control and experimental sides, and the levels of IL-1ß were analyzed by enzyme-linked immuno-sorbent assay (ELISA). The distal movements of the maxillary canines were measured and compared. RESULTS: Increased levels of IL-1ß were observed in the experimental canines compared with the control canines (P <0.001). Cumulative tooth movements over an 8-week experimental period were greater for the experimental canines (occlusogram and software, 4.450 and 4.4903 mm, respectively) compared with the control canines (occlusogram and software, 2.025 and 2.0501 mm, respectively). A positive correlation existed between the IL-1ß levels and the amounts of tooth movement across all time intervals. CONCLUSIONS: In combination with light orthodontic force, application of low-level laser therapy increased the levels of IL-1ß in gingival crevicular fluid and accelerated orthodontic tooth movement.

Facile Stabilizer for Lingual Retainer Wires.

To overcome the challenge of maintaining the perfect adaptation of the retainer wire to the lingual surfaces of an anterior tooth while bonding, we have designed a facile method which will aid in accurate and precise placement of lingual retainer wire to ensure longterm stability ofan orthodontic treatment result.

Comparison of the effects of ibuprofen and acetaminophen on PGE2 levels in the GCF during orthodontic tooth movement: a human study.

BACKGROUND: Pain is among the most cited negative effects of orthodontic treatment. Non-steroidal anti-inflammatory drugs seem to be an effective option for minimizing this but can have adverse effects on tooth movement owing to their ability to block prostaglandin synthesis. Acetaminophen has been suggested as the analgesic of choice during orthodontic treatment as it showed no effect on orthodontic tooth movement in previous animal studies. The purpose of this study was to compare the effects of ibuprofen and acetaminophen on the prostaglandin E2 (PGE2) levels of the gingival crevicular fluid (GCF) during orthodontic tooth movement in human subjects. METHODS: A total of 42 patients (mean age 18±4.5 years) were randomly divided into three equal groups: ibuprofen, acetaminophen, and control groups. Maxillary canines were distalized with 150 g of force delivered by NiTi coil springs. GCF samples were obtained before (baseline) and after spring activation at 24, 48, and 168 h. The PGE2 content of the GCF was determined using enzyme-linked immunosorbent assay. RESULTS: PGE2 levels in all groups increased significantly by 24 and 48 h of force application and decreased to baseline levels by 168 h. No significant difference was found between the acetaminophen and control groups at any time point. There was a significant decrease in PGE2 levels in the ibuprofen group at 24 and 48 h when compared to the other two groups. CONCLUSIONS: Acetaminophen showed no significant effect on prostaglandin synthesis and may be the safe choice compared to ibuprofen for relieving pain associated with orthodontic tooth movement.

Understanding the advances in biology of orthodontic tooth movement for improved ortho-perio interdisciplinary approach.

This article provides an insight on detailed current advances in molecular understandings of periodontal ligament cells and the influence of orthodontic force on them in the light of recent advances in molecular and genetic sciences. It sequentially unfolds the cellular events beginning from the mechanical force initiated events of cellular responses to bone remodeling. It also highlights the risks and limitations of orthodontic treatment in certain periodontal conditions, the important areas of team work, orthodontic expectations from periodontal treatment and the possibility of much more future combined research to improve the best possible periodontal health and esthetic outcome of the patient.

Non-extraction treatment of skeletal class II malocclusion.

Every orthodontist at some point in his clinical practice has faced the dilemma of how 'best' to manage a mild to moderate Class II malocclusion. To demonstrate the efficacy of Forsus™ Fatigue Resistant Device in the management of Class II malocclusion. A patient having Class II division 1 malocclusion with functional jaw retrusion was treated using MBT 0.022" prescription and Forsus FRD appliance. Pre- and post-treatment photographs and lateral cephalograms were taken. Cephalometric analysis was done, and results were superimposed. 7-8 months of Forsus wear obtained stable and successful results with improvement in facial profile, skeletal jaw relationship, and mild increase in IMPA. Greater forward displacement of the mandible was the predominant factor for successful treatment Class II patient. Forsus gives good results for class II management, and it would be wise to consider treating such cases by non-extraction approach rather than contemplating extractions.