Parental anxiety/incompliance and patients' complications during COVID-19 pandemic regarding nasoalveolar molding treatment of infants with cleft lip/palate.

OBJECTIVES: The ideal time for nasoalveolar molding (NAM) of infants with cleft lip and/or palate (CLP) is the first weeks after birth. The burden and responsibility that this method of treatment imposes on parents may result in incompliance. The coronavirus (COVID-19) pandemic and the redirection of health resources can make the situation worse. Therefore, this study evaluated the anxiety, complications, and incompliance of parents undergoing NAM during the COVID-19 pandemic. MATERIALS AND METHODS: Demographic data of 35 infants with CLP treated during the COVID-19 pandemic, compliance and level of anxiety of both parents in addition to their complications were reported. The association between different variables and incompliance was evaluated by simple and multiple logistic regressions. The level of significance was considered at P value less than 0.05. RESULTS: The highest level of parental anxiety related to the NAM process was the delay in ending the treatment. Meanwhile, the reason for the highest level of anxiety related to attending the treatment sessions was the probability of the infant's COVID-19 infection. Fathers expressed lower levels of anxiety than mothers, significantly. The most prevalent NAM complication was skin irritation. Parents of younger infants (≤28 days) and those with a history of COVID-19 infection were more compliant. CONCLUSIONS: COVID-19 pandemic caused a significant increase in the level of anxiety in both parents, mainly due to the delay in treatment ending and the possibility of infant's infection. Moreover, considering the importance of treatment time, parents of younger infants were more compliant with the NAM process.

Concerns and Problems of Orthodontic Patients during the COVID-19 Pandemic.

OBJECTIVES: We aimed to find the main concerns of patients undergoing active orthodontic treatments and their orthodontic treatment-related (OTR) problems during the coronavirus disease-2019 (COVID-19) pandemic. MATERIALS AND METHODS: A researcher-made questionnaire addressing several aspects of the effects of COVID-19 pandemic on treatment was distributed among 181 orthodontic patients receiving active treatment. Anxiety, concern, problems, and willingness to attend orthodontic appointments and to undergo other dental procedures was questioned. The correlation of gender, age, COVID-19-related anxiety and OTR anxiety was statistically analyzed. Patient satisfaction level with different aspects of dental-clinic performance was also evaluated. RESULTS: The participants included 117 females and 64 males, of which 94% adhered to the pandemic restrictions. The mean COVID-19-related- and OTR-anxiety were 51.7% and 52.7%, respectively. Higher COVID-19-related anxiety was significantly correlated with higher OTR anxiety (P<0.001). There was an inverse correlation between general COVID-19-related anxiety and OTR anxiety and willingness to attend orthodontic appointments (P<0.05). A positive insignificant (P=0.07) correlation existed between age and willingness to attend appointments. The main concern was prolongation of treatment and the most common problem was irritation of oral soft tissues by appliances. The majority (65.3%) were willing to attend their orthodontic appointments. Orthognathic surgery (62%) had the highest while, dental restorations and radiography had the lowest refusal rates (9.9%). CONCLUSION: COVID-19 pandemic significantly affected orthodontic treatment. The level of COVID-19-related anxiety was moderately high and patients were concerned about the impact of lockdown on their orthodontic treatment outcome. Young adults demonstrated higher levels of stress than other age-groups.

Comparative assessment of the orthodontic wire's friction coated with zinc oxide nanoparticles by two methods of chemical precipitation and hydrothermal process.

INTRODUCTION: In orthodontic treatment with sliding technique, reduction of frictional forces could result in a more effective treatment. Recently, wire coating with nanoparticles were proposed to reduce frictional forces.

Miniscrew-assisted single-tooth distraction osteogenesis to align an ankylosed infraoccluded maxillary central incisor: A case report.

The ankylosis of permanent incisors is usually caused by trauma. In a growing patient, the ankylosed tooth fails to move along with the vertical growth of the remaining alveolar process, which results in an infraoccluded tooth, gingival margin disharmony and unaesthetic smile.This case report presents an 23-year-old female patient whose maxillary right central incisor (tooth number 11) had been traumatised eight years earlier. A vertical discrepancy of about 4 mm was exhibited between teeth 11 and 12. To reposition the crown and gingival margins of the ankylosed tooth to an ideal level, single-tooth dento-osseous osteotomy and distraction of the block of bone containing the tooth was planned. In order to separate the roots of adjacent teeth for opening a space for osteotomy incision, fixed orthodontic treatment with multibracket appliances was initiated on her maxilla. After five weeks, a single-tooth dento-osseous osteotomy was performed using a piezoelectric device. To move the tooth in occlusal and buccal directions, two temporary anchorage devices (miniscrews) on her mandible and interarch elastics were applied. Approximately three weeks later, the ankylosed tooth successfully had an ideal position-relative to the adjacent teeth-and a harmonious gingival margin was achieved by minor gingivoplasty on all incisors.

Esthetic preferences of orthodontists, oral surgeons, and laypersons for Persian facial profiles.

INTRODUCTION: The patient's perception of facial esthetics is not necessarily consistent with that of the practitioner. The aim of this study was to compare the perceptions of Persian orthodontists, oral surgeons, and laypersons with regard to facial profile attractiveness and the most favorable mandibular position. METHODS: Software (Dolphin Imaging and Management Systems, Chatsworth, Calif) was used to alter the mandibular position depicted on profile photographs of a young man and a young woman. Nine construction profile photos were produced with incremental changes of the G'-Sn-Pg' angle at 2° intervals (6° to 22°). Thirty-two orthodontists, 32 maxillofacial surgeons, and 32 laypersons were asked to score all 18 profiles on a 1-to-10 visual analog scale. They also evaluated whether each profile needed orthognathic surgery for improvement of facial esthetics. Actual agreement and intraclass correlation coefficient tests were used to assess reliability. The data were analyzed using 2-way repeated measures analysis of variance and Wilcoxon signed-rank tests. RESULTS: The intraparticipant reliability was acceptable (intraclass correlation coefficient >72%; actual agreement, >79%). The sex of the participants was not a significant factor influencing the scores, although the sex of the models was a discriminating factor for the most acceptable mandibular horizontal position. The scores given by the 3 groups were different, especially for the female model. The orthodontists had similar opinions and preferred a slightly more protrusive mandible (G'-Sn-Pg', 12°-14°). Laypersons' scores were the most inconsistent, and they generally preferred a retrusive profile (G'-Sn-Pg', 14°-18°). There was no significant correlation with regard to the necessity of orthognathic surgery for G'-Sn-Pg' angles over 20° in men and below 8° in women. CONCLUSIONS: Although the laypersons' perceptions were slightly different from those of the clinicians, most participants preferred a more protrusive mandible for male models compared with female models.

Antimicrobial properties of poly (methyl methacrylate) acrylic resins incorporated with silicon dioxide and titanium dioxide nanoparticles on cariogenic bacteria.

AIM: To assess the effects of adding nano-titanium dioxide (nano-TiO2) and nano-silicon dioxide (nano-SiO2) and their mixture to poly (methyl methacrylate) (PMMA) to induce antimicrobial activity in acrylic resins. MATERIALS AND METHODS: Acrylic specimens in size of 20 mm × 20 mm × 1 mm of 0.5% and 1% of nano-TiO2 (21 nm) and nano-SiO2 (20 nm) and their mixture (TiO2/SiO2 nanoparticles) (1:1 w/w) were prepared from the mixture of acrylic liquid containing nanoparticles and acrylic powder. To obtain 0.5% and 1% concentration, 0.02 g and 0.04 g of the nanoparticles was added to each milliliter of the acrylic monomer, respectively. Antimicrobial properties of six specimens of these preparations, as prepared, were assessed against planktonic Lactobacillus acidophilus and Streptococcus mutans at 0, 15, 30, 45, 60, 75, and 90 min follow-up by broth dilution assay. The specimens of each group were divided into three subgroups: Dark, daylight, or ultraviolet A (UVA). The percent of bacterial reduction is found out from the counts taken at each time point. STATISTICAL ANALYSIS: Data were analyzed using one-way analysis of variance and Tukey's post hoc analysis. RESULTS: Exposure to PMMA containing the nanoparticles reduced the bacterial count by 3.2-99%, depending on the nanoparticles, bacterial types, and light conditions. Planktonic cultures of S. mutans and L. acidophilus exposed to PMMA containing 1% of TiO2/SiO2 nanoparticles showed a significant decrease (P < 0.001) (98% and 99%, respectively) in a time-dependent manner under UVA. The S. mutans and L. acidophilus counts did not significantly decrease in PMMA containing 0.5% nano-TiO2 and PMMA containing 0.5% nano-SiO2 in the dark. No statistically significant reduction (P > 0.05) was observed in the counts of S. mutans and L. acidophilus in PMMA without the nanoparticles exposed to UVA. CONCLUSIONS: PMMA resins incorporated with TiO2/SiO2 nanoparticles showed strong antimicrobial activity against the cariogenic bacteria.

Changes of the Mandible after Orthodontic Treatment with and without Extraction of Four Premolars.

OBJECTIVES: This study was designed to assess the changes of the mandible of patients who underwent orthodontic treatment with or without extraction of four premolars. MATERIALS AND METHODS: Eighteen Class I bimaxillary protrusion patients treated with extraction of four first premolars and retraction of anterior teeth and 18 Class I non-extraction patients with a mean age of 16.38±0.4 years were selected. Cephalometric analysis was performed before and after treatment. Twenty-four variables for analyzing the hard and soft tissues of the mandible were compared between the two groups. Repeated measures ANOVA was used for the comparison of the two groups fallowed by paired t-test. The relationship between the soft and hard tissue variables was studied using the Pearson's correlation coefficient. RESULTS: In both groups, the mean value of angular measurements related to B point and Pogonion (Pog) decreased with treatment (P<0.05). Similarly, the symphysis depth of soft tissue decreased (P=0.008). The mean angular value of Y-axis increased in both groups after treatment (P=0.007). The mean changes in hard tissue symphysis depth after treatment were different in the two groups (P=0.021). Vertical, horizontal and rotational changes in soft tissue B point (B') and Pogonion (pog') followed their underlying hard tissue changes (P<0.05). CONCLUSIONS: Points B and Pog showed backward movement after orthodontic treatments in both extraction and non-extraction patients. Changes in B' and Pog' were directly influenced by the changes in the corresponding points of the underlying hard tissue. Orthodontic treatments with and without extraction of premolars produced insignificant changes in vertical facial dimension.

Fixed versus Removable Appliance for Palatal Expansion; A 3D Analysis Using the Finite Element Method.

OBJECTIVE: Several appliances have been used for palatal expansion for treatment of posterior cross bite. The purpose of this study was to evaluate the stress induced in the apical and crestal alveolar bone and the pattern of tooth displacement following expansion via removable expansion plates or fixed-banded palatal expander using the finite element method (FEM) analysis. MATERIALS AND METHODS: Two 3D FEM models were designed from a mesio-distal slice of the maxilla containing the upper first molars, their periodontium and alveolar bone. Two palatal expanders (removable and fixed) were modeled. The models were designed in SolidWorks 2006 and then transferred to ANSYS Workbench. The appliance halves were displaced 0.1 mm laterally. The von Mises stress in the apical, crestal, and PDL areas and also the vertical displacement of the cusps (palatal and buccal) was were evaluated. RESULTS: The total PDL stress was 0.40003 MPa in the removable appliance (RA) model and 4.88e-2 MPa in the fixed appliance (FA) model and the apical stress was 9.9e-2 and 1.17e-2 MPa, respectively. The crestal stress was 2.99e-1 MPa in RA and 7.62e-2 MPa in the FA. The stress in the cortical bone crest was 0.30327 and 7.9244e-2 MPa for RA and FA, respectively and 3.7271 and 7.4373e-2 MPa in crestal area of spongy bone, respectively. The vertical displacement of the buccal cusp and palatal cusp was 1.64e-2 and 5.90e-2 mm in RA and 1.05e-4 and 1.7e-4 mm in FA, respectively. CONCLUSION: The overall stress as well as apical and crestal stress in periodontium of anchor teeth was higher in RA than FA; RA elicited higher stress in both cortical and spongy bone. The vertical displacement of molar cusps was more in removable than fixed palatal expander model.

Comparison of residual monomer loss from cold-cure orthodontic acrylic resins processed by different polymerization techniques.

INTRODUCTION: This investigation aimed to assess and compare the amount of residual monomer (RM) released from removable orthodontic appliances constructed by sprinkle-on and dough techniques. MATERIALS AND METHODS: One hundred and twenty acrylic samples were prepared from orthodontic autopolymerized acrylic resins and divided into three groups, according to the processing method: sprinkle-on with polyclave, sprinkle-on without polyclave and dough technique. After polymerization, the specimens of each group were immersed in distilled water for 24 h, 48 h, 72 h and 1 week. High-performances liquid chromatography (HPLC) was utilized to measure residual monomer content. RESULTS: Maximum observed RM was 1284·91±129·07 ppm measured for sprinkle-on technique without polyclave after 24 h of water immersion. At this time, the level of RM was significantly different among the three applied techniques (P<0·05). In all soaking time groups, sprinkle-on technique with polyclave released the least amount of RM. Within each group, the maximum monomer releasing was observed after the first 24 h and decreases were observed in subsequent time groups. The reduction over the time was not significant in the polyclave groups (P>0·05). CONCLUSION: The sprinkle-on technique with polyclave and longer water immersion reduced residual monomer released from acrylic orthodontic appliances.

The effect of TiO2 and SiO2 nanoparticles on flexural strength of poly (methyl methacrylate) acrylic resins.

PURPOSE: TiO(2) and SiO(2) nanoparticles are products of nanotechnology which have been incorporated to acrylic resins (AR) in order to induce antimicrobial properties. However, as additives they can affect the mechanical properties of the final product. The aim of this study was to survey the effects of TiO(2) and SiO(2) nanoparticles on flexural strength (Fs) of poly (methyl methacrylate) acrylic resins. METHODS: Acrylic specimens (Selecta Plus) in size of 5×10 (±0.2)×3.3 (±0.2)mm were prepared and divided into 7 groups: AR containing nanoTiO(2), SiO(2) and TiO(2) with SiO(2) in two concentration of 1% and 0.5%, in addition to a control group. To prepare nano AR, nanoparticles were added to the monomer. All specimens were stored in 37°C distilled water and underwent Fs test by universal testing machine (Zwick). RESULTS: The maximum mean flexural strength (43.5 MPa) belongs to the control group and AR containing 0.5% of both TiO(2) and SiO(2) demonstrated the minimum mean Fs (30.1 MPa). Resins contained TiO(2), demonstrated lower values of Fs than those contained SiO(2) with the same concentration, but the differences were not significant (P>0.05). CONCLUSION: Incorporation of TiO(2) and SiO(2) nanoparticles into acrylic resins can adversely affect the flexural strength of the final products, and this effect is directly correlated with the concentration of nanoparticles.

Correlation between dental arch width and sagittal dento-skeletal morphology in untreated adults.

OBJECTIVE: Dental arch form is one of the most important characteristics of dentition. However, this dimension usually receives less attention in diagnosis or treatment planning and orthodontic patients are traditionally classified with regard to their sagittal characteristics. The objectives of this study were to investigate if a relationship exists between the dental arch width (transverse dimension) and sagittal skeletal and dental parameters in orthodontic patients. MATERIALS AND METHODS: Dental casts and lateral cephalograms of 108 consecutive untreated Iranian patients (47 males and 61 females) between 16 and 31 years of age were evaluated. Arch width (AW) parameters including upper and lower inter-molar width (UIMW and LIMW) and upper and lower inter-canine width (UICW and LICW) were measured by a digital caliper. Sagittal parameters included SNA and SNB angle and Wits' appraisal obtained from lateral cephalograms in addition to upper and lower arch length (UAL and LAL) obtained from dental casts. The correlation between the aforementioned parameters was evaluated applying Pearson correlation coefficients. Molar and canine relationship according to Angle's classification was also recorded and the means of all parameters were compared between three occlusal relationship classes and two gender groups by means of two-way ANOVA. RESULTS: According to statistical analysis a significant positive correlation between sagittal parameters and arch width measures exists between SNA and UICW and between LICW and LAL. Upper and lower ICW were significantly correlated, the relationship between upper and lower IMW and between UAL and LAL were significant. Among sagittal measures, both UAL and LAL were correlated with the ANB angle. The means of arch width parameters in three occlusal classes were not significantly different. CONCLUSION: The only significant correlation between arch width and sagittal parameters existed between UICW and SNA angle and between LICW and LAL. No significant difference of the arch width parameter was observed between the three occlusal classes.