Comparative evaluation of effectiveness of three versus four mini-implants for simultaneous intrusion and retraction of maxillary anterior teeth: A 3D FEM study.

OBJECTIVE: To evaluate and compare the displacement pattern of maxillary anterior teeth in the sagittal and vertical planes and evaluate the stress distribution in pdl, bone, teeth of the maxillary anterior region, and around the mini-implants during simultaneous en-masse retraction and intrusion using two, three, and four mini-implants combinations. METHODS: A three-dimensional FEM model of maxillary teeth and periodontal ligament housed in the alveolar bone with extracted first premolarswasgenerated. The models were broadly divided into three groups according to the number of mini-implants. Mini-implants were placed bilaterally between the second premolar and molar in group I, and along with bilateral implants, an additional mid-implant was placed between the central incisors as in group II, whereas in group III, anterior mini-implants were placed in between lateral incisors and canine bilaterally. RESULTS: The two mini-implant model showed the maximum amount of retraction in the sagittal plane followed by three and four mini-implant models. In the vertical plane, all six anterior teeth showed intrusion only in the four mini-implant model. The stress in cortical bone, cancellous bone, PDL, around the mini-implants, and in lateral incisor was maximum in the three mini-implant model, followed by four mini-implants with the least stress in the two mini-implant model. CONCLUSION: The four mini-implant model is better than the three and two mini-implants model as there is a more even distribution of force in the four mini-implants model as compared to the three mini-implants model.

An Innovative Way to Retract Anteriors in Noncompliant Patient: A Case Report.

Aim: To design and fabricate an innovative appliance for the purpose of diminishing treatment duration and enhancing patient compliance in non-complaint patients. Background: A patient reported to the orthodontic department for conventional orthodontic treatment but as the treatment progressed, he started loosing motivation which was followed by the deficiency in adherence to the treatment protocol and became less concerned. In few months, he stopped following proper instructions on taking care of the appliances leading to increase in the chances of frequent appliance breakage at every appointment. Case description: A patient reported with Class I molar and end-on canine relationship on both sides, retained deciduous second molar in upper and lower arches, increased overjet, mild generalized spacing in upper anteriors with severe crowding in lower arch anterior region and incompetent lips. On Cephalometric analysis, it showed Class I skeletal pattern with bimaxillary dentoalveolar protrusion. Conclusion: Orthodontic Retractor (innovative appliance) effectively helped in completing the orthodontic treatment in a non-complaint patient without delay as was seen during the retraction phase of the treatment. Clinical significance: "Orthodontic Retractor" can be used and advised for patients who are either less motivated or non-complaint. This appliance is simple and does not require any use of mini-implants, which is an invasive surgical procedure, which many patients does not consent for. How to cite this article: Jain S, Jain A, Raghav P. An Innovative Way to Retract Anteriors in Noncompliant Patient: A Case Report. Int J Clin Pediatr Dent 2023;16(1):180-185.

Effect of micro-osteoperforations on the rate of orthodontic tooth movement and expression of biomarkers: a randomized controlled clinical trial.

INTRODUCTION: Micro-osteoperforation is a minimally invasive technique that has been used to accelerate orthodontic tooth movement and reduce treatment duration. However, literature presents conflicting reports about this technique. OBJECTIVE: To evaluate the effectiveness of micro-osteoperforations on the rate of canine retraction and expression of biomarkers in gingival crevicular fluid (GCF). METHODS: This was a randomized clinical trial with split-mouth study design. Thirty adult subjects with age above 18 years (20.32 ± 1.96) who required fixed orthodontic treatment and extraction of maxillary first premolars were enrolled and randomly allocated to either the experimental or control group. Randomization was performed by block randomization method, with a 1:1 allocation ratio. The experimental group received three micro-ostoperforations (MOPs) distal to maxillary canine, using the Lance pilot drill. The retraction of maxillary canine was performed with NiTi coil-spring (150g) in both experimental and control groups. The primary outcome was the evaluation of canine retraction rate, measured on study models from the baseline to 16 weeks of canine retraction. Secondary outcomes were the estimation of alkaline and acid phosphates activity in GCF at 0, 1, 2, 3, and 4 weeks. RESULTS: There was a statistically significant difference in the rate of canine retraction only after the first 4 weeks. Subsequently there was no statistically significant difference from the eighth to the sixteenth weeks between MOPs and control group. There was a statistically significant difference in alkaline and acid phosphates activity in GCF between MOPs and control groups during the initial 4 weeks of canine retraction. CONCLUSION: Micro-ostoperforation increased the rate of tooth movement only for the first 4 weeks; thereafter, no effect was observed on the rate of canine retraction during 8, 12 and 16 weeks. A marked increase in biomarker activity in the first month was observed.

White spot lesions during orthodontic clear aligner therapy: A scoping review.

BACKGROUND: White spot lesions (WSL) are an unsightly and a rather frequent drawback of orthodontic treatment. The complex design of fixed orthodontic appliances (FAs) makes it difficult to perform proper oral hygiene, which amounts to white spot lesions being three times more prevalent in patients wearing orthodontic appliances. As clear thermoplastic aligners (CAs) are removable appliances, it has been speculated that they allow better oral hygiene maintenance and thus less incidence of WSLs. OBJECTIVES: This evidence-based scoping review aims to identify the scope and nature of the evidence on white spot lesions during orthodontic clear aligner therapy. TYPES OF STUDIES REVIEWED: Strategic and thorough search of the literature for randomized Controlled Trials, Case-Control, Cohort studies, Case reports, full research articles, and review papers on humans published in English in five major databases was undertaken till July 2021 using free text and Medical Subject Headings (MESH) terms, followed by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to identify five studies for data extraction. RESULTS: Evidence was summarized for study characteristics, diagnostic methods for the detection of white spot lesions, and incidence of white spot lesions during clear aligner therapy. The literature supports that orthodontic treatment with CAs was associated with a low incidence of WSLs when compared with fixed mechanotherapy, with a major role of patient education, motivation, and compliance in maintaining oral hygiene. PRACTICAL IMPLICATIONS: The general perception is that clear aligners are more hygienic and show no incidence of white spot lesions. However, our scoping review supports that WSLs can occur with this form of orthodontic treatment also. WSLs in clear aligners could be attributed to the practice of having composite attachments that cover a significant portion of the tooth surface. Thus, regardless of the type of appliance used, a periodic reinforcement by the orthodontist to maintain oral hygiene is necessary for patient motivation, allowing for better oral hygiene practice, and as a result, leads to prevention of WSLs.

Effect of customized vibratory device on orthodontic tooth movement: A prospective randomized control trial.

AIMS: The primary purpose of the present trial was to evaluate the effect of low-frequency (30Hz) vibrations on the rate of canine retraction. SETTING AND DESIGN: Single-center, split mouth prospective randomized controlled clinical trial. METHODS AND MATERIAL: 100 screened subjects (aged18-25 years) were selected; out of which 30 subjects having Class I bimaxillary protrusion or Class II div 1 malocclusion, requiring upper 1st premolar therapeutic extractions, were selected for the study. A split-mouth study design was prepared for the maxillary arch of each selected individual and was randomly allocated into vibration and nonvibration side (control) groups. A customized vibratory device was fabricated for each subject to deliver low-frequency vibrations (30 Hz). Scanned 3D models were prepared sequentially to assess the amount of tooth movement from baseline (T0),(T1), (T2), (T3), and (T4)-4th month of canine retraction. STATISTICAL ANALYSIS USED: Independent "t" test. RESULTS: There was no statistically significant differencein the rate of individual canine retraction among the experimental and control groups when the intergroup comparison was done using independent "t" test at T1-T0, (P = 0.954), T2-T1 (P = 0.244), T3-T2 (P = 0.357), and T4-T3 (P = 0.189). CONCLUSION: The low-frequency vibratory stimulation of 30 Hz using a customized vibratory device did not significantly accelerate the rate of orthodontic tooth movement. TRIAL REGISTRATION: Registered at ctri.nic.in (CTRI/2019/05/019043).

Effect of micro-osteoperforations on the rate of orthodontic tooth movement and expression of biomarkers: a randomized controlled clinical trial

ABSTRACT Introduction: Micro-osteoperforation is a minimally invasive technique that has been used to accelerate orthodontic tooth movement and reduce treatment duration. However, literature presents conflicting reports about this technique. Objective: To evaluate the effectiveness of micro-osteoperforations on the rate of canine retraction and expression of biomarkers in gingival crevicular fluid (GCF). Methods: This was a randomized clinical trial with split-mouth study design. Thirty adult subjects with age above 18 years (20.32 ± 1.96) who required fixed orthodontic treatment and extraction of maxillary first premolars were enrolled and randomly allocated to either the experimental or control group. Randomization was performed by block randomization method, with a 1:1 allocation ratio. The experimental group received three micro-ostoperforations (MOPs) distal to maxillary canine, using the Lance pilot drill. The retraction of maxillary canine was performed with NiTi coil-spring (150g) in both experimental and control groups. The primary outcome was the evaluation of canine retraction rate, measured on study models from the baseline to 16 weeks of canine retraction. Secondary outcomes were the estimation of alkaline and acid phosphates activity in GCF at 0, 1, 2, 3, and 4 weeks. Results: There was a statistically significant difference in the rate of canine retraction only after the first 4 weeks. Subsequently there was no statistically significant difference from the eighth to the sixteenth weeks between MOPs and control group. There was a statistically significant difference in alkaline and acid phosphates activity in GCF between MOPs and control groups during the initial 4 weeks of canine retraction. Conclusion: Micro-ostoperforation increased the rate of tooth movement only for the first 4 weeks; thereafter, no effect was observed on the rate of canine retraction during 8, 12 and 16 weeks. A marked increase in biomarker activity in the first month was observed.

RESUMO Introdução: As micro-osteoperfurações (MOPs) são uma técnica minimamente invasiva que tem sido utilizada para acelerar a movimentação dentária ortodôntica e reduzir o tempo de tratamento. No entanto, existem relatos conflitantes sobre o uso dessa técnica. Objetivo: Avaliar a eficácia das MOPs em acelerar a taxa do movimento de retração de caninos e na expressão de biomarcadores no fluido crevicular gengival (FCG). Métodos: Esse foi um ensaio clínico randomizado com desenho de estudo do tipo boca dividida. Trinta indivíduos adultos com idade acima de 18 anos (20,32 ± 1,96 anos) que necessitavam de tratamento ortodôntico fixo e extração de primeiros pré-molares superiores foram incluídos e aleatoriamente alocados para o grupo experimental ou grupo controle. A randomização foi realizada pelo método de randomização em bloco, com proporção de alocação de 1:1. O grupo experimental recebeu três MOPs distais ao canino superior, utilizando uma broca piloto em formato de lança. A retração do canino superior foi realizada com mola helicoidal de NiTi (150g) nos dois grupos, experimental e controle. O desfecho primário foi a avaliação da taxa de retração dos caninos, medida em modelos de estudo do início da retração até 16 semanas depois. O desfecho secundário foi a estimativa da atividade da fosfatase alcalina e ácida no FCG após 0, 1, 2, 3 e 4 semanas. Resultados: Houve uma diferença estatisticamente significativa na taxa de retração dos caninos somente após as quatro primeiras semanas. Após isso, não houve diferença estatisticamente significativa entre os grupos experimental e controle entre a oitava e a décima sexta semanas. Houve uma diferença estatisticamente significativa na atividade da fosfatase alcaline e ácida no FCG entre os grupos experimental e controle durante as quatro primeiras semanas de retração dos caninos. Conclusão: As micro-osteoperfurações aumentaram a taxa de movimentação dentária apenas nas primeiras quatro semanas; depois disso, nenhum efeito foi observado na taxa de retração dos caninos após 8, 12 e 16 semanas. Houve aumento considerável na atividade do biomarcador no primeiro mês.

Effect of micro-osteoperforations on rate of space closure by mini-implant supported maxillary anterior en-masse retraction: A randomized clinical trial.

BACKGROUND: Micro-osteoperforations is one of the non-invasive surgical techniques used in attempt to accelerate OTM. Conflicting reports on its effectiveness has been reported in the literature. OBJECTIVES: The objectives of this trial were to investigate the effect of micro-osteoperforations on the rate of space closure and on molar anchorage loss during mini-implant supported maxillary anterior en-masse retraction. TRIAL DESIGN: A single center, parallel arm, randomized controlled trial was conducted. METHOD: Sixty, male and female subjects (age range 16-25 years) having Class I bimaxillary protrusion or Class II div 1 malocclusion, who required fixed mechanotherapy with either upper 1st premolar or all four 1st premolar extractions were allocated into two groups using 1:1 allocation ratio. The allocation was done by block randomization method with a block size of 6. In the experimental group, 5 MOPs per side were performed only once just before the en-masse anterior retraction. Mini-screws were placed in order to obtain maximum anchorage. Impressions were taken every month till 4 months and rate of space closure was measured on 3D study models. RESULTS: Data of 27 subjects in control (attrition â€‹= â€‹3) and 28 subjects in experimental group (attrition â€‹= â€‹2) were analyzed at the end of this trial. There was a statistically significant increase in the rate of en-masse retraction for the 1st month(p â€‹= â€‹0.001,95%CI, 0.17, 0.37 â€‹mm) but there was no statistically significant difference for the subsequent 2nd (p â€‹= â€‹0.450,95%CI,0.13,0.43 â€‹mm), 3rd(p â€‹= â€‹0.204,95%CI,0.23,0.47 â€‹mm) and 4th month (p â€‹= â€‹0.680,95%CI,0.21,0.41 â€‹mm) between experimental and control groups. There was also no difference (p â€‹> â€‹0.05) in molar anchorage loss between both groups at all time intervals. CONCLUSION: Micro-osteoperforations (MOPs) did not accelerate the rate of anterior en-masse retraction over a period of 4 months; however, it temporarily increases the rate of retraction only for first month and no affect on molar anchorage. TRIAL REGISTRATION: The trial was registered at www.ctri.nic.in with CTRI No- CTRI/2019/03/018140).

Sequential Utilization of E-space for Correction of Moderate Crowding: A Case Report.

Leeway space and E-space plays a crucial role in the late transition phase from primary dentition to permanent dentition. Leeway space is normally 0.9 mm and 1.5 mm in upper and lower arch respectively. E-space is the difference in the mesiodistal width of deciduous second molar and permanent second premolar which is 2.3 in upper arch 2.5 mm in lower arch 1. E-space and leeway space are normally utilized by permanent first molars to establish class I molar relation in permanent dentition. We can also utilize this E-space during fixed orthodontic treatment for reliving of crowding in late mixed dentition. Thus, here in this article, we are presenting clinical technique along with case series of sequential utilization of E-space for correction of anterior crowding without extractions. HOW TO CITE THIS ARTICLE: Reddy M, Jain S, Raghav P, Mohan S, Wadhawan A. Sequential Utilization of E-space for Correction of Moderate Crowding: A Case Report. Int J Clin Pediatr Dent, 2018;11(6):519-525.

Treatment of Maxillary Impacted Canine using Ballista Spring and Orthodontic Wire Traction.

In orthodontic practice, impaction of maxillary permanent canines is a frequently encountered clinical problem. After the third molar, the canine is the most frequently impacted tooth. For functional occlusion, bringing the impacted canine into occlusion is important to achieve final esthetic in orthodontic practice. This article illustrates a distinct case in which the three permanent canines maintained their unerupted status till the age of 18 years. The three impacted canines were surgically exposed, attachment bonded, traction given with ballista spring for vertical and labial movement, and ideally positioned with fixed orthodontic mechanotherapy. HOW TO CITE THIS ARTICLE: Raghav P, Singh K, Reddy CM, Joshi D, Jain S. Treatment of Maxillary Impacted Canine using Ballista Spring and Orthodontic Wire Traction. Int J Clin Pediatr Dent 2017;10(3):313-317.

Anterior Sectional Twin Bracket Appliance - Innovative Use for Correction of Single Tooth Crossbite: A Case Report with Biomechanics.

Anterior sectional twin bracket appliance (ASTBA) is a sectional mechanism that involves two brackets on upper central incisors. This appliance is previously been used for correction of rotated incisors and midline spacing. But, detail biomechanics for single tooth crossbite correction is not previously explained. Here, in this article, we are presenting a detailed biomechanics of ASTBA for anterior single tooth crossbite correction along with case report. How to cite this article: Verma RK, Raghav P, Reddy MC, Kanwal R. Anterior Sectional Twin Bracket Appliance- Innovative Use for Correction of Single Tooth Crossbite: A Case Report with Biomechanics. Int J Clin Pediatr Dent 2015;8(1): 66-69.

Assessment of tooth proportions in an aesthetically acceptable smile.

INTRODUCTION: Aesthetic facial animation is mostly reported to be due to a close relationship between soft and hard tissue i.e. dynamic smile with appropriate tooth proportions. But variations in tooth size have been seen among various ethnic populations globally. AIM: To evaluate the size and morphology of maxillary anterior teeth, the tooth with maximum variation both mesiodistally and cervicoincisally. Also, the tooth to tooth ratio in percentage of the mean tooth sizes in both genders in patients with aesthetically acceptable smile decided by a panel in North Indian population. MATERIALS AND METHODS: A total of 100 subjects (50 males and 50 females) were taken and a video clip of their dynamic smile was captured .The smiles were analyzed by a panel and the tooth proportions of the selected attractive smiles were evaluated in both males and females separately. STATISTICAL ANALYSIS: Data obtained was subjected to statistical analysis using Microsoft Excel 2007 software; test used was Unpaired t-test and also Mean ± S.D., Variance, Ratio of W/L and its ranges were calculated. Significance is assessed at 5% level of significance. RESULTS: The mesiodistal width and cervicoincisal length of maxillary central incisor was greater compared to lateral incisor and canine in both males and females. There was a statistically significant difference between the width/length ratio of maxillary anterior teeth between males and females.Canine and Lateral incisor showed maximum variation mesio-distally and cervico-incisally. CONCLUSION: A smile is more pleasing if the visible teeth are in proper morphological proportions. Thus, it relates that teeth play a vital role in increasing the attractiveness of a smile. The mean coronal width/length ratio displayed a more square like tooth form for both males and females.

Kansal Separator As an Effective Fixed Retainer Stabilizer.

Fixed bonded retainers are increasingly being recommended as the only way to ensure long-term stability of an orthodontic treatment result. However, frequent debonding of the fixed bonded retainer is a constant source of frustration for the orthodontist. Bond failure is most commonly attributed to the difficulty encountered in stabilizing the retainer wire in the precise position during the bonding process. This paper presents a clinical approach that makes use of Kansal Separator; a self-secured orthodontic spring separator as a simple, efficient, and dependable fixed retainer stabilizer.

Why WITS? Why not a way beyond?

INTRODUCTION: WITS appraisal is a common parameter in cephalometrics to assess maxillo-mandibular skeletal relationship as an adjunct to angle ANB. The high variability of the WITS appraisal is attributable to difficulties or inaccuracies in identifying the occlusal plane or variations due to tooth eruption, dental development or treatment changes by vertical movement of incisors, molars, or both. AIM: An extracranial reference line common to both denture bases, instead of the occlusal plane is proposed to assess antero-posterior jaw relationships. MATERIALS AND METHODS: A true vertical obtained by plumb line was recorded, while taking the cephalogram for 40 subjects. A line drawn perpendicular to this true vertical gave a stable and reproducible extracranial true horizontal (HOR) reference line. The linear distance between perpendiculars from points A and B was measured as an adjunct to angle ANB. RESULT: The Pearson's product moment correlation coefficient calculated for the entire sample indicated higher correlation coefficient (r = 0.8712) for the linear measurements on HOR (AH-BH) with respect to the angle ANB when compared with the WITS readings (AO-BO) (r = 0.549). CONCLUSION: The horizontal appraisal method proposed eliminates the demerits of the occlusal plane and has the merits of simplicity and accuracy in comparison to WITS appraisal.

Lip prints: The barcode of skeletal malocclusion.

INTRODUCTION: In orthodontics, apart from essential diagnostic aids, there are so many soft tissue analyses in which lips are major part of concern. However, lip prints have never been used in orthodontics as diagnostic aid or forensic tool. Therefore, this study was designed to explore the possible association of lip prints with skeletal malocclusion. MATERIALS AND METHODS: A sample of 114 subjects in the age group of 18-30 years, from North Indian adult population were selected on the basis of skeletal class I, class II and class III malocclusion, each comprising of 38 subjects with equal number of males and females. Lip prints of all the individuals were recorded and digital soft copies of lateral cephalograms were taken. Lip prints were compared between different skeletal malocclusions. RESULTS: It was found that branched lip pattern was most common in North Indian adult population with no sexual dimorphism. The Z-test for proportion showed that the prevalence of vertical lip pattern was significantly higher in subjects having skeletal class III malocclusion. CONCLUSION: A definite co-relation of vertical lip patterns with skeletal class III malocclusion was revealed.

Modified Intraoral Repositioning Appliance in Complete Bilateral Cleft Lip and Palate.

OBJECTIVE: The purpose of the modified repositioning appliance was to overcome the shortcoming of existing design for repositioning protruded premaxilla in a child with bilateral cleft lip and palate. METHODS: The basic principles of design were similar to Latham's appliance but the surgical pinning of premaxillary segment was avoided and instead acrylic splint was prepared. CONCLUSIONS: This technique avoids any invasive procedure, is useful to reposition protruded premaxillary segment in bilateral cleft lip and palate cases specifically in child who reports late with deciduous dentition.