Effect of lip thickness and competency on soft-tissue changes.

INTRODUCTION: Improvement in facial esthetics is a major reason for seeking orthodontic treatment. Soft tissues responsible for esthetics show a variable response to the movement of underlying teeth during orthodontics. METHODS: The purpose of this cross-sectional study was to analyze the response of soft tissues and compare it among groups presenting with different lip thickness and competence. It was carried out on 37 patients with Class I and Class II Division 1 malocclusion who had undergone extractions of maxillary first premolars and had completed their orthodontic treatment. Data were obtained by corresponding lateral cephalometric radiographs taken before and at the end of orthodontic treatment. Association was analyzed with a Pearson correlation test. Differences among groups exhibiting varying competency and lip thickness were tested with an independent sample t test. A P value of ≤0.05 was considered statistically significant. RESULTS: Pearson correlation revealed significant associations among incisor tip retraction with lip base retraction (r = 0.68), lip base thinning (r = 0.41) and vermilion retraction (UV) (r = 0.73). Regression analysis showed a moderate increase in lip length (AB) and thickness at vermilion, which were 0.11 mm and 0.15 mm for each mm of incisor retraction at the tip, whereas stronger effects were observed for UV (0.38 mm) and lip base retraction (0.55 mm). There was significantly more lip base thinning (P = 0.03) and UV (P = 0.04) in the incompetent group compared with the competent group. The AB increased significantly in the sample with thicker lips (P = 0.01). Pearson correlation coefficient showed a strong association of lip retraction at the base and vermilion with the incisor movement at the cervical area, for competent and incompetent lips, and thicker and thinner lips. CONCLUSIONS: Lip retraction at vermilion and lip base thinning was significantly more in patients with incompetent lips, whereas the AB increased significantly more in the group with thicker lips.

Reasons for refusing orthognathic surgery by orthodontic patients: A cross-sectional survey.

Objective: To find out the most common reasons for refusing orthognathic surgery and to compare the responses along gender lines and in terms of open-ended and closed-ended approaches. METHODS: The cross-sectional retrospective study was conducted from August to December 2020 at the Orthodontics Department of Bahria University Medical and Dental College, Karachi, Pakistan, and comprised of patients who were planned for but refused orthognathic surgical treatment between January 2018 and July 2020. Data was collected through telephone-based interviews to record reasons of avoiding orthognathic surgery. The data-collection tool had both open-ended and closed-ended questions. Data was analysed using SPSS 23. RESULTS: Of the 60 patients, 42(70%) were females and 18(30%) were males with a mean age range of 23.25±2.19years. Overall, 19(31.7%) patients avoided surgery due to additional expense, while post-operative pain was cited as a reason by 35(58.3%) patients. Males were 9 times more concerned about their dental alignment compared to females (p=0.005). Fear of tooth injury (p<0.0001) and intra-operation and post-operation bleeding (p<0.0001) were found twice in males than females. Conclusion: The most common reasons for refusal to have orthognathic surgery were increased cost and post-operative pain. Males were more concerned about dental alignment and had higher fear of post-surgical tooth injury and intra- and post-operative bleeding compared to the females.

Pain perception of orthodontic treatment - A cross-sectional study.

OBJECTIVES: The objectives were to evaluate the intensity of pain perceived 24 hours following insertion of fixed orthodontic appliance components i-e separators, bands and brackets. METHODS: This cross-sectional study conducted at a Dental College in Karachi (July 2017-March 2018) investigated the amount of pain perceived during different stages of fixed orthodontic treatment. The inclusion criteria were healthy individuals without systemic disease, age 13-26 years, fixed orthodontic treatment candidates having healthy permanent first molars. The exclusion criteria were missing permanent first molars, patients requiring brass wire separators instead of elastomeric separators and molar tubes instead of bands, ongoing or previous periodontal disease and syndromic patients. Pain intensity was assessed in ninety eight patients using a Numeric Rating scale (NRS) at baseline (T0) before insertion, and 24 hours after insertion (T1) of a component. This procedure was repeated six times, twice each for separators, bands and brackets. Scoring was done on the NRS from 0 to 10 where 0 indicated no pain and 10 indicated worst pain possible. RESULTS: A significant difference in perceived pain was found between baseline and after 24 hours of placement of all components (P-value 0.000). Odds ratio indicated that males were at a greater risk to feel pain than females at baseline and after 24 hours of insertion of all components. Mann-Whitney U test showed that the most painful components at baseline were bands (Mean value=0.56) and after 24 hours were brackets (Mean value 6.25). CONCLUSIONS: Significant increase in pain was noted 24 hours after insertion of separators, bands and brackets. The most painful components were bands at baseline and brackets after 24 hours of insertion. There were no significant variations in pain perception based on age. However, males perceived higher pain than females both at baseline and after 24 hours.

Assessment of the changes in the oral health related quality of life 24 hours following insertion of fixed orthodontic appliance components - An observational cross-sectional study conducted at Bahria University Medical and Dental College Karachi.

OBJECTIVE: To evaluate the changes in Oral Health Related Quality of Life 24 hours following insertion of fixed orthodontic appliance components, and to compare the results between different age groups and genders. METHODS: The observational cross-sectional study was conducted from July to December 2017 at Bahria University Medical and Dental College, Karachi, and comprised patients from the Orthodontics outpatient department enrolled via convenience sampling. Oral Health Impact Profile questionnaire was used to assess the Oral Health Related Quality of Life after placement of separators, bands and brackets. Patients were assessed before the appliances were placed and 24 hours after the insertions. Changes were evaluated and age and gender groups were compared using SPSS 17. RESULTS: Of the 70 patients, 20(28%) were males and 50(72%) were females. The overall mean age of the sample was 18.3}3.8 years. Oral Health Impact Profile scores showed significant deterioration of oral health quality 24 hours after the placement of brackets (p<0.05). However, there was no significant deterioration of lack of self-confidence (p=0.19), avoid smiling (p=0.11) and embarrassment (p=0.62) after the placement of separators and bands. There was no significant difference across genders (p>0.05), but young adults had significantly higher mean difference compared to adolescents after placement of bands (p<0.05). CONCLUSIONS: The Oral Health Related Quality of Life significantly deteriorated 24hours following the insertion of separators, bands and brackets.

Orthodontic Management of Multiple Dilacerations.

Orthodontic alignment of un-erupted dilacerated teeth is challenging, as the bent roots resist forces applied to move them through the bone. Various treatment options are now available to treat this condition including providing prosthesis after extractions and apicectomies. However, to maintain alveolar bone in the area of the un-erupted tooth, especially if the involved tooth is in the anterior segment, the ideal treatment would be to try and bring the tooth in the arch orthodontically. Treatment requires increased time duration, compliance of the patient, and consistent force mechanics. This case report is of a 9-year boy with un-erupted and dilacerated teeth. Orthodontic treatment of prolonged duration was provided to bring these teeth into the arch, improving the esthetics and function.