Comparative assessment of cephalometric with its analogous photographic variables.

Objective: The purpose of this study was to evaluate the accuracy of photographic measurements and compare it with its analogous cephalometric variables. Materials and Methods: Lateral cephalograms and standardized facial profile photographs were obtained from a sample of 120 subjects (92 females, 28 males; age 12-22 years with mean age of 17.5 years). A total of 4 linear and 7 angular measurements along with 3 ratios analogous to one another were measured on both. Descriptive statistics for all measurements were computed. Pearson's correlation coefficients were computed between analogous measurements, and regression analysis was done for each variable measured on the photograph to accurately predict the cephalometric variable. Results: The reliability of the standardized photographic technique was satisfactory. Most photographic measurements showed highly significant correlations (P < 0.001) with cephalometric variables. Among all measurements used, the A'N'B' angle was the most effective in explaining the variability of its analogous cephalometric (r2= 0.35). The Frankfort-mandibular plane angle' angle showed best results for vertical assessment (r2= 0.81) along with anterior face height (AFH) and lower anterior facial height (r2= 0.859) and ratio lower posterior facial height/AFH (r2= 0.702). Conclusions: Although we cannot rule out lateral cephalogram as the primary record in orthodontics, photographic assessment can always be used through proper standardization, as an alternative diagnostic aid, and also for large-scale epidemiological purposes and places with unavailability of cephalostat.

Nasal changes in different age groups.

OBJECTIVE: The objective of this study was to evaluate nasal changes in different age groups and to detect gender difference in nasal dimensions. MATERIALS AND METHODS: Clinical measurement and profile photographic records of 279 randomly selected subjects were obtained for the evaluation of nasal changes. Thirty-nine subjects were excluded, and the final sample consisted of 240 subjects. The subjects were divided into four groups by age: Group 1 (16-20 years), Group 2 (21-30 years), Group 3 (31-40 years), and Group 4 (41-50 years). Each group was further subdivided on the basis of gender. Data were collected and analyzed by two-way multivariate analysis of variance with Duncan's multiple range post hoc test. RESULTS: In both males and females, nasal height and breadth increased with except nasal index and nasolabial angle. More nasal changes were seen in males as compared to females of the same age group. CONCLUSIONS: Nonconsistent age-related changes were found for nasal index and nasolabial angle. The rest of the nasal parameters increased with age and differ between the genders. Larger nasal changes were seen in males as compared to females of the same age group.

Evaluation of Stress Pattern Caused by Mini-Implant in Mandibular Alveolar Bone with Different Angulations and Retraction Forces: A Three-Dimensional Finite Element Study.

OBJECTIVE: The objective of the study was to evaluate the stress pattern in cortical and cancellous bones, periodontal ligament, and in the implant itself when a mini-implant (MI) is inserted in the inter-radicular space between mandibular first molar and second premolar at various angulations and different retraction forces. METHODS: Finite element study was conducted with MI insertion at 30°, 45°, 60°, 75°, and 90° angulations in the mandibular posterior region (between second premolar and first molar). At these angulations, horizontal forces of 150, 200, and 250 g were applied to the middle of the MI head. von Mises stress values were then evaluated using the ANSYS software. RESULTS: Highest von Mises stress values were detected in the MI itself, followed by cortical bone, cancellous bone, and periodontal ligament. The von Mises stress values in cortical bone were highest at 30° angulation and lowest at 90° angulation. In the cancellous bone, the stress value was found to be maximum at 90°. The von Mises stress values in the MI were lowest at 90°. In all four structures, as the load increased from 150 to 250 g, the von Mises stress values increased. CONCLUSION: The von Mises stress values in the cortical bone, MI, and periodontal ligament were found to be lowest at 90°. Placement of the MI at 90° appears to be an ideal angulation when applied with a horizontal load. Force range used is within clinically recommended levels; however, the increase in load causes an increase in the stress values.

Serum DHEA-S levels could be used as a comparable diagnostic test to assess the pubertal growth spurt in dentofacial orthopedics.

BACKGROUND: Pubertal growth spurt assessment guides the timing of intervention for correcting the skeletal discrepancies in dentofacial orthopedics. Serum hormones are being studied for the skeletal age assessment to avoid unnecessary radiographic exposure. The present study is to evaluate the relationship of serum hormones dehydroepiandrosterone-sulfate (DHEA-S), insulin-like growth factor (IGF-1), and cervical vertebral stages (CS stages) in the skeletal age assessment of orthodontics patients around the circumpubertal age. METHODS: A total of ninety subjects with age ranging from 7 to 21 years were selected and divided into two groups based on the sex (45 males, 45 females). They were further distributed in each group based on the six CS stages determined from the lateral cephalogram. Blood samples from each subject were collected to evaluate the serum DHEA-S and IGF-1 levels by using the enzyme-linked immunosorbent assay (ELISA). Collected data were analyzed in SPSS software with a test of normalcy, unpaired t test, and one-way analysis of variance (ANOVA) followed by the least significant difference (LSD) post hoc comparison test and univariate regression analysis. RESULTS: The highest mean serum hormone levels were found in CS 4 in group A (male) and CS 3 in group B (female). ANOVA results showed that there was a significant difference in the serum hormone levels among the different CS stages in both the groups for both the hormones. Statistically, a significant difference was found between each CS stages for both the hormones except in the DHEA-S levels between CS 5 and CS 6. CONCLUSIONS: The mean serum DHEA-S levels followed a typical pattern from the CS 1 till CS 6 which was comparable and similar to the mean serum IGF-1 levels in respect to CS stages. Thus, serum DHEA-S levels could be used as a possible diagnostic test for the assessment of the skeletal pubertal growth spurt in dentofacial orthopedics.

Soft tissue growth changes from 8 to 16 years of age: A cross-sectional study.

OBJECTIVE: The present cross-sectional study was conducted to evaluate and compare the soft tissue growth changes between males and females of two groups from 8 to 16 years. MATERIALS AND METHODS: One hundred sixty skeletal class I lateral head cephalograms were screened aged between 8 to 16 years-Subjects were divided into two groups. Group I (8 to 12 years) and Group II (12 to 16 years) and further these groups were subdivided into male and female subgroups. Total eight linear and four angular parameters were studied. RESULTS: All the parameters increased in their dimension while angle of total facial convexity including nose and Nasolabialangle decreases. Among the linear variables, Noseheight, Lip thickness at laberale inferious, Lip thickness at B point, Soft tissue chin thickness and Measurements of lips to E-plane were found significant for both subgroups. While rest of the linear variables like Upper lip height, Lower lip height, Nose depth and Sagittal depth also increased but this increase wasfound non-significant. Among the angular parameters angle of total facial convexity including nose and Nasolabialangle decreases and angle of facial convexity excluding nose, and Nose inclination increases with the age, and these changes were found non-significant. CONCLUSION: In this study, we observed that males showed a greater value of all parameters in comparison to females, and with the advancement of age, all the parameters increased, except for angle of total facial convexity and nasolabial angle.

A cephalometric evaluation of the effect of glenoid fossa location on craniofacial morphology.

AIM: The purpose of this study was to assess the effect of glenoid fossa location in various skeletal malocclusions on craniofacial morphology. METHODS: Cephalometric data of 84 subjects were analyzed for four linear and two angular variables for assessing glenoid fossa location in cranial base and eight linear and eight angular variables for evaluating the corresponding effect on craniofacial morphology using statistical software STATA 12 for windows. Regression analysis was done to see the effect of glenoid fossa location on the parameters measuring craniofacial morphology. RESULTS: Significant association between glenoid fossa location and craniofacial morphology was demonstrated in skeletal class I, class II, and class III malocclusion subjects by the regression analysis. CONCLUSIONS: Glenoid fossa location varies significantly among skeletal malocclusions and glenoid fossa location has a profound effect on craniofacial morphology of skeletal class I, class II, and class III malocclusions.

Evaluation of facial divine proportion in North Indian Population.

OBJECTIVE: To evaluate the facial divine proportion and its relationship with facial attractiveness in North Indian population. MATERIALS AND METHODS: For evaluation of various facial proportions, standardized frontal facial photographs of total 300 subjects between 18 and 30 years of age were obtained. Black and white copies of these photographs were presented in front of an evaluation jury for assigning scores of facial attractiveness and finally 130 attractive subjects were selected. These subjects were divided into two groups, Group I (attractive females n = 65) and Group II (attractive males n = 65) and they were further analyzed for various parameters of facial proportions. Unpaired Student's t-test was used to compare both groups. RESULTS: Group I showed that five of seven vertical facial proportions were close to divine proportion (1.618) whereas only two vertical proportions in Group II were close to it. Transverse facial proportions in both groups deviated more from divine proportion (1.618) and were closer to silver proportion (1.414). CONCLUSIONS: Most of the facial proportions of attractive females in the North-Indian population were close to the divine proportion. Thus, facial divine proportion could be an important factor in the perception of facial attractiveness of North-Indian attractive females.

Treatment of Bi-maxillary Protrusion with Impacted Maxillary and Mandibular Canines: Case Report.

Bi-maxillary protrusion in adolescent patients has traditionally been treated by extraction of the four first premolars and retraction ofthe anterior teeth. The ectopic eruption of the maxiIlary permanent canines is a frequently encountered clinical problem. Orthodontic treatment of the impacted teeth remains a challenge for clinicians. If it is associated with other dental and skeletalproblems, there will be further complications to the treatment plan. In such cases, if we extract canines, then problems with this approach are restricted to anatomical and functional limitations ofpremolars substitution of canines. Here, we are presenting a case report of bi-maxillary dento-alveolar protrusion with the impacted maxillary and mandibular left canines and its management.

Dynamic smile evaluation in different skeletal patterns.

OBJECTIVE: To evaluate dynamic smile in different skeletal patterns and to correlate vertical smile parameters with the underlying causative factors. MATERIALS AND METHODS: A total of 150 participants ranging in age from 16-25 years were selected and divided into one of three groups-horizontal, average, and vertical skeletal pattern-using the following three cephalometric parameters: SN-MP, FMA, and Jarabak ratio. Videographic records of smile were obtained, and measurements were recorded and analyzed at rest, including upper lip length, and during smile, including maxillary incisal display, interlabial gap, intercommisural width, change in upper lip length, and smile arc. Differences among the three groups were subjected to two-way analysis of variance and post hoc and chi-square tests for smile arc. Correlations between vertical smile variables and vertical skeletal (N-ANS, N-Me) and dental cephalometric measurements (U1 to palatal plane) were also investigated. RESULTS: Vertical parameters were significantly increased in the vertical pattern when compared with the horizontal pattern, ie, upper lip length (P < .01), maxillary incisal display (P < .001), interlabial gap (P < .001), and change in upper lip length (P < .001), whereas intercommisural width was significantly decreased in vertical pattern when compared with the horizontal pattern (P < .001). Flat smile arc was seen more frequently in the horizontal pattern. Positive correlations were found between the N-Me, U1-PP, and change in upper lip length with vertical smile parameters. CONCLUSIONS: Different skeletal patterns exhibit their characteristic smile features. Upper lip length is not responsible for increased incisal display during smile. Increased incisal display during smile is more closely associated with upper lip elevation than vertical skeletal and dental factors.

Management of a Patient with Impacted Maxillary Canine, Peg-Shaped Lateral Incisors and Transmigrated Mandibular Canine: A Case Report.

To treat morphological abnormalities, impaction, and severe malposition of the teeth, the lateral incisors are sometimes extracted, followed by orthodontic space closure. This procedure often requires special consideration, not only with regard to esthetics but also for functional issues. However, thusfar, few reports that have performed a functional evaluation in such cases. The purpose of this article is to report the successful treatment of a 23 year-old male patient with the complaint of irregular placement and abnormal shape of his teeth. The patient had an impacted maxillary unilateral left canine, peg shaped lateral incisor, and transmigrated mandibular canine. Patient was treated with extraction of the upper lateral incisors and eruption of the impacted canines was guided to the place of the lateral incisor and extraction of the transmigrated mandibular canine.

Management of Unusual Rotation of Maxillary Central Incisor with Impacted Mesiodens: Case Report.

Supernumerary teeth are frequently found in the maxillary anterior region, largely in permanent dentition (rare in deciduous dentition). Shape of the supernumerary teeth may vary from conical, tueberculate, supplemental to odontome. Mesiodens is a conical type of supernumerary teeth located in the maxillary central incisor region and is generally unerupted. Presence of mesiodens may result in rotation, uneruption, or malalignment of adjacent maxillary incisors. In this article, we present a case report of unusual rotation of maxillary central incisor with impacted mesiodens.

Single Wire with Helices to Guide Different Labially Impacted Canine Eruption -Technique Clinic.

Impacted canines vary greatly in the inclination and location and can lead to resorption of neighboring teeth depending on their location. Occasionally labial impaction of the maxillary canine may occur over the maxillary lateral incisor, over the first premolar, and sometimes over the alveolus in between the lateral incisor and premolar. In this article, we will discuss a multipurpose single wire with 3 helices or 2 helices to guide the labially impacted canine, positioned in different inclinations and located differently on the labial side, so as to provide traction force in proper direction.

Asymmetric Extraction: How to Use Smartly.

This case report summarizes the use of asymmetric extraction to smartly relieve crowding without increasing the total treatment time, with the added advantage of not using any complicated mechanics.

An in vitro scanning electron microscope study to evaluate the efficacy of various root conditioning agents.

AIM: The purpose of present study was to investigate the scanning electron microscopic alterations produced on scaled and root planed dentin surfaces after application of different etching modalities namely citric acid, tetracycline hydrochloride and ethylenediaminetetraacetic acid (EDTA). MATERIALS AND METHODS: Eighty specimens of teeth were collected and categorized into four groups. In group 1, control group specimens were treated with normal saline for 3 min, group 2 specimens were treated with citric acid, group 3 specimens were treated with tetracycline hydrochloride for 3 min and group 4 specimens were treated with 15% EDTA. RESULTS: Opening of dentinal tubules was seen in all specimens except for control group that was treated with normal saline. The total number of tubules seen was highest in citric acid group as compared to tetracycline hydrochloride and EDTA Group. The total number of patent tubule opening was highest in citric acid as compared to EDTA and tetracycline. The diameter of patent dentinal tubules in citric acid group was more than EDTA and tetracycline. CONCLUSION: The study showed that all the three agents were effective in removing the smear layer however number of patent and wider diameter dentinal tubules was seen in vitro best in citric acid than EDTA and then in tetracycline hydrochloride. Hence, citric acid group is more efficient than EDTA and tetracycline HCl group in removing the smear layer and in opening of number of patent dentinal tubules.

Modified Transpalatal Arch (m-TPA) for Vertical Control and Anchorage.

Transpalatal arch (TPA) is commonly used, but it has some limitations; like, it can be used as an anchorage appliance in extraction cases with minimal to moderate anchorage requirement, but, for maximum anchorage cases TPA needs to be supported by extraoral traction. In cases where expansion greater than 1-2 mm is required, other expansion appliances seem to be more efficient. To overcome the drawbacks of TPA we designed modified transpalatal arch (m-TPA) for various purpose.

A comparative clinico-radiographic study of guided tissue regeneration with bioresorbable membrane and a composite synthetic bone graft for the treatment of periodontal osseous defects.

AIM: The aim was to evaluate the bonefill in periodontal osseous defects with the help of guided tissue regeneration, bioresorbable membrane (PerioCol) + bone graft (Grabio Glascera) in combination and with bonegraft (Grabio Glascera) alone. MATERIALS AND METHODS: The study involved total 30 sites in systemically healthy 19 patients. The parameters for evaluation includes plaque index sulcus bleeding index with one or more periodontal osseous defects having (i) probing depth (PD) of ≥ 5 mm (ii) clinical attachment loss (CAL) of ≥ 5 mm and (iii) ≥3 mm of radiographic periodontal osseous defect (iv) bonefill (v) crestal bone loss (vi) defect resolution. The study involved the three wall and two wall defects which should be either located interproximally or involving the furcation area. The statistical analysis was done using Statistical Package for Social Sciences, the Wilcoxon signed rank statistic W + for Mann-Whitney U-test. RESULTS: The net gain in PD and CAL after 6 months for Group I ([PerioCol] + [Grabio Glascera]) and Group II (Grabio Glascera) was 3.94 ± 1.81 mm, 3.57 ± 2.21 mm and 3.94 ± 1.81, 3.57 ± 2.21 mm, respectively. The results of the study for Group I and Group II with regards to mean net bonefill, was 3.25 ± 2.32 (58%) mm and 5.14 ± 3.84 (40.26 ± 19.14%) mm, crestal bone loss - 0.25 ± 0.68 mm and - 0.79 ± 1.19 mm. Defect resolution 3.50 ± 2.34 mm and 5.93 ± 4.01 mm, respectively. CONCLUSION: On comparing both the groups together after 6 months of therapy, the results were equally effective for combination of graft and membrane versus bone graft alone since no statistical significant difference was seen between above parameters for both the groups. Thus, both the treatment modalities are comparable and equally effective.