Effect of Second and Third Molar Eruption Stages on First Molar and Maxillary Arch Distalization With Modified Palatal Anchorage Plate and Beneslider: A 3D Finite Element Analysis.

AIM: To analyze the effects of the maxillary second molar and third molar eruption stages on the distalization of first molars with a modified palatal anchorage plate (MPAP) and Beneslider using three-dimensional (3D) finite element analysis. MATERIALS AND METHOD: Six finite element models (FEMs) of individual maxillary molar distalization and six FEM models of en-masse maxillary arch distalization (EMAD) at different stages of the maxillary molar eruption were created from cone-beam computed tomography (CBCT) images of the maxillary complex, and 3D displacements of the maxillary first and second molars were evaluated with MPAP and Beneslider. RESULTS: On individual molar distalization, Beneslider showed first molar distal translation during the second and third molar follicular stages, while MPAP showed distal tipping of the first molar. With EMAD, either of the appliances showed distal tipping of the first molars. There was palatal rolling and extrusion of the first molars. The second molar showed buccal drifting with intrusion, and the incisors showed palatal displacement along with extrusion. CONCLUSIONS: Second and third molar eruption stages had no adverse influence on first molar and en-masse maxillary arch distalization. Beneslider showed distal translation of the first molar, while distal tipping was seen with MPAP.

The effectiveness of the total-maxillary-arch-distalization approach in treating class II division 1 malocclusion: A systematic review.

OBJECTIVE: The objective of this review is to assess the effect of total maxillary arch distalization (TMAD) treatment on the dental, skeletal, soft tissues, and airways during non-extraction camouflage treatment of class II division 1 patients. METHODS: We performed a systematic review of the published data in four electronic databases up to April 2023. We considered studies for inclusion if they were examining the effects of TMAD during treatment of class II division 1 malocclusion in the permanent dentition. Study selection, data extraction, risk of bias assessment, and assessment of the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool were performed in duplicate. RESULTS: Out of the 27 articles that met the initial eligibility criteria, 19 studies were finally selected. Fair to relatively good quality evidence was identified after the risk of bias assessment of the included studies. Out of the 19 selected studies, 5 studies used inter-radicular TADs, 10 studies used modified C- palatal plate (MCPP), 3 studies used infra zygomatic crest (IZC) TADs, 1 study compared buccal TADs versus MCPP, and 1 study compared between cervical headgear and MCPP. The maximum amount of maxillary arch distalization using buccal TADs, MCPP, IZC TADs, and headgear was 4.2mm, 5.4mm, 5mm, and 2.5mm respectively. Different results regarding the amount of dental, skeletal, and soft tissue changes were observed. CONCLUSIONS: The current low to very low certainty level of evidence suggests that TMAD is effective in camouflaging class II division 1 malocclusion. Future well-conducted and clearly reported randomized controlled trials that include a control group are needed to make robust recommendations regarding the effect of TMAD with different appliances on dental, skeletal, and soft tissue structures. CLINICAL RELEVANCE: TMAD should be given priority with caution in class II patients who refuse the extraction of premolars. TMAD may be considered an adjunctive approach to solve cases associated with high anchorage need or anchorage loss.

Strategic Intervention: Ectopic Premolar Management for Preventing Molar-Premolar Transposition in Class III Malocclusion.

Class III malocclusion often leads to the ectopic eruption of premolars in the upper arch, posing unique challenges for orthodontic practitioners. This case report explores the clinical implications of ectopic maxillary premolars in a Class III malocclusion patient, emphasizing the importance of early intervention and comprehensive treatment strategies. Factors contributing to ectopic eruption, including genetic predisposition and anatomical variations, are discussed, guiding orthodontists in effective diagnosis and management. A 14-year-old patient with Class III malocclusion, anterior crossbite, and ectopic maxillary premolars sought orthodontic consultation. The treatment plan involved extracting the deciduous second molar, realigning the ectopic premolar, and addressing arch length discrepancies. Utilizing fixed orthodontic appliances and strategic force application, the patient achieved Class I molar and canine relationships, resolving the ectopic premolar alignment within 10 months. Ectopic eruption of maxillary premolars, especially in Class III malocclusion, is a critical concern for oral health. Genetic predisposition, arch crowding, and developmental disturbances contribute to this condition. Early intervention, as demonstrated in this case, plays a pivotal role in restoring dentoskeletal harmony. The study underscores the need for a multidisciplinary approach, combining orthodontic, surgical, and restorative interventions for optimal outcomes. Thus, this case report highlights the successful management of ectopic maxillary premolars in a Class III malocclusion patient through strategic orthodontic intervention. Understanding the etiological factors and employing a comprehensive treatment approach facilitate timely diagnosis and prevent complications. Orthodontists must navigate the complexities of ectopic eruption, considering occlusal effects and collaborating with other specialists for holistic patient care.

Evaluation of Sexual Dimorphism Using Dental Dimensions - An Observational Study.

Aim: In our study, we evaluated the gender dimorphism among dental measurements of selected people in a South Indian district. Methodology: In our research, 500 participants between 17 and 25 years of age were included after taking their maxillary arch impressions. Utilizing Korkhaus compass and digital caliper, depth of palatal area as well as maxillary arch as a whole was done. T-test was done to initiate the comparative analysis between the palatal arch and complete maxillary arch depths where P < 0.05 was denoted significant statistically. Results: It was recorded that complete maxillary arch depth measurements were increased in case of men as compared to women, whereas the measurements related to depth of the palatal arch were not statistically significant. Conclusion: In our research, we found that complete maxillary arch depth can be utilized for gender segregation accompanied with other auxiliary methods. The mean value for both these measurements can be utilized as a standard measurement for advance research.

Palatal Morphology After Treatment of Children With Obstructive Sleep Apnoea Using the Modified Twin-Block Appliance.

OBJECTIVE: To investigate changes in the upper maxillary palates of children with obstructive sleep apnoea (OSA) and mandibular retraction who were treated using modified twin-block appliances (MTBAs). METHODS: Thirty-five OSA children (age: 6-12 years) with mandibular retraction were included as the experimental group and 35 children who were Angle's class I but without mandibular retraction were included as the control group. The experimental group was treated with MTBA. Plaster models were made before the treatment and at the end of the 6-month treatment period. Plaster models of the control group were made at inclusion and after 6 months. Some plaster models were excluded because of damage or their failure to exhibit sufficiently clear marks, which left 26 pairs each for the experimental and control groups. The gender and age of the experimental group were matched with those of the control group at the end of the treatment. Three-dimensional (3D) digital model information was gathered using the external oral scanning model, and the data were extracted and analysed statistically to clarify the morphologic improvement in the maxillopalatine in OSA children treated using MTBAs. RESULTS: After the OSA children with mandibular retraction were treated with MTBAs, the maxillary intercusp width, intermolar width, anterior palate width, posterior palate width, and surface area and volume of the maxillary palate significantly increased (*P < .05). By contrast, the anterior palatal height-apex level (H3) significantly decreased (*P < .05). CONCLUSIONS: Compared with the control group, the narrow maxillary arch and basal bone were significantly enlarged after the OSA children with mandibular retraction were treated using MTBAs. The palatal surface area and volume increased, thereby allowing more space for accommodating the tongue and relieving transverse dissonance of the dentition.

Development of Artificial Neural Network-Based Prediction Model for Evaluation of Maxillary Arch Growth in Children with Complete Unilateral Cleft Lip and Palate.

INTRODUCTION: Cleft lip and palate (CLP) are the most common congenital craniofacial deformities that can cause a variety of dental abnormalities in children. The purpose of this study was to predict the maxillary arch growth and to develop a neural network logistic regression model for both UCLP and non-UCLP individuals. METHODS: This study utilizes a novel method incorporating many approaches, such as the bootstrap method, a multi-layer feed-forward neural network, and ordinal logistic regression. A dataset was created based on the following factors: socio-demographic characteristics such as age and gender, as well as cleft type and category of malocclusion associated with the cleft. Training data were used to create a model, whereas testing data were used to validate it. The study is separated into two phases: phase one involves the use of a multilayer neural network and phase two involves the use of an ordinal logistic regression model to analyze the underlying association between cleft and the factors chosen. RESULTS: The findings of the hybrid technique using ordinal logistic regression are discussed, where category acts as both a dependent variable and as the study's output. The ordinal logistic regression was used to classify the dependent variables into three categories. The suggested technique performs exceptionally well, as evidenced by a Predicted Mean Square Error (PMSE) of 2.03%. CONCLUSION: The outcome of the study suggests that there is a strong association between gender, age, and cleft. The difference in width and length of the maxillary arch in UCLP is mainly related to the severity of the cleft and facial growth pattern.

Treatment effects after maxillary expansion using invisalign first system vs. acrylic splint expander in mixed dentition: a prospective cohort study.

BACKGROUND: Invisalign First System (First) is a new type of orthodontic appliance for maxillary arch expansion in mixed dentition children. Till now, few studies have evaluated the expansion effects of First versus other appliances. What's more, most studies of arch expansion did not include a natural group to rule out growth effects. This prospective cohort study aimed to evaluate the dental and dentoalveolar effects using First or acrylic splint rapid maxillary expander (RME) in adolescents excluding growth factors. MATERIALS AND METHODS: After screening by strict inclusion criteria and propensity score matching (PSM), fifty-one patients were included: First group (n = 17), RME group (n = 17), and natural growth (NG) group (n = 17). Nine indicators including dental arch width, dentoalveolar arch width, and inclination of the molars were measured on digital dental casts at baseline (T0) and six-month follow-up (T1). Paired t-tests were used for intra-group results, and two-sample independent t-tests were used for inter-group comparisons. RESULTS: There was no significant increase in all indicators within six months in the NG group (p > 0.05). In the First group and RME group, all width indicators were significantly increased after treatment (p < 0.05). The RME group exhibited greater expansion than the First group in intercanine width, first interpremolar width, second interdeciduous molar width, first intermolar width, arch perimeter, intercanine dentoalveolar width, intermolar dentoalveolar width, and inclination of the molars (p < 0.05). Whereas, there was no significant difference in arch depth between the two treated groups. CONCLUSIONS: Both First and RME can expand the maxillary arch in mixed dentition. In case of mild to moderate maxillary transverse deficiency (MTD), Invisalign First System could be a reasonable option. RME shows significant better efficiency of dental arch expansion than First, recommended for patients with severe MTD. TRIAL REGISTRATION: This prospective study was registered on ClinicalTrials.gov (01/02/2022, registration number: ChiCTR2200056220). The trial was approved by the Ethical Committee of the Hunan Xiangya Stomatological Hospital Central South University (20,200,088), and informed consent was obtained from all subjects and their legal guardian(s).

Effect of Maxillary Expansion on the Maxillary Arch Width in Patients with Bilateral Cleft Palate: A Review.

OBJECTIVES: To perform a comprehensive review of the literature to compare the effects of slow maxillary expansion (SME) and rapid maxillary expansion (RME) on maxillary arch width in patients with bilateral cleft palate. METHODS: The databases include Medline, PubMed, Cochrane (CENTRAL) and (CDSR), OpenGrey, and ClinicalTrials.gov were searched for relevant studies that met the eligibility criteria published before or on 31 October 2022. The search was confined to the English language. The selection of eligible studies and collection of data were performed independently. Risk of bias assessment was conducted using the Cochrane Risk of Bias tool 2.0. RESULTS: Two randomized controlled trials were available based on the search in the published literature. Both studies compared arch width between SME and RME in cleft palate patients and digitals casts and three-dimensional images used for the evaluation. A moderate risk of bias was evident in the available studies. CONCLUSIONS: Both SME and RME can achieve similar amounts of maxillary expansion in patients with bilateral cleft palate.

Maxillary arch dimensions, occlusion assessment and space conditions in patients with cleft palate in the period of deciduous dentition-A retrospective study.

PURPOSE: The aim of this study was to evaluate the maxillary arch dimensions, dentoalveolar relationships and spacing conditions in patients with cleft palate in comparison with the control group. METHODS: The subjects consisted of 31 children with cleft palate only (CP) aged 5.5 ± 0.51 (20 with a cleft of hard and soft palate (SHPC group) and 11 with a cleft of soft palate only (SPC group)). In the control group 30 subjects had a normal occlusion at age 5. Maxillary arch dimensions, dentoalveolar relationship according to the Huddard Bodenham index (HBI) and space conditions were compared with the control group. RESULTS: In all variables of maxillary arch dimensions except for total arch height the control group exhibited greater values. Most of the significant differences were on account of differences between the control and the SHPC group, with only three comparisons yielding significant results when comparing the two groups of children with clefts (SHPC vs SPC, IV-IV central: pDunnett T3= 0.0002, 95%CIDifference=-9.9-(-3.18); V-V distopalatal cusps: pDunnett T3= 0.0002, 95%CIDifference=-9.97-(-3.17); Total arch length: pDunnett T3= 0.0014, 95%CIDifference=1.74-7.85). The three groups differed significantly in anterior HBI only (HKruskal-Wallis=15.56, p = 0.0067). The spacing conditions in both jaws were also shown to be significantly dependent on the group of subjects studied (Upper jaw: χ2omnibus= 16.79, p = 0.0018; lower jaw: χ2omnibus= 13.75, p = 0.0102). CONCLUSIONS: The growth of the upper dental arch at the age of five is impeded in participants with CP in comparison to a control group. It is important to assess the effect of cleft subtypes on growth and development to get a better understanding.

Evaluation of maxillary arch width and palatal volume and depth in patients with maxillary impacted canine by CBCT.

Introduction: Canines are the second most common tooth in terms of impaction. Impacted teeth can be associated with some different indices of dental arch and dentoalveolar structures. The aim of this study was to evaluate maxillary arch width as well as volume and depth of palate in patients with maxillary impacted canine by cone beam computed tomography (CBCT). Methods: In this cross-sectional study, 45 CBCT images of patients with unilateral maxillary impacted canines were examined. All patients had palatally impacted canines. Three parameters of maxillary arch width, palatal volume and palatal depth were assessed using axial and sagittal incisions on the CBCT images. Then all the measurements on the impacted side were compared with the non-impacted side. Data were entered into SPSS software and paired sample t-test and Student's t-test were used to comparison. The significance level of 0.05 was considered. Results: The maxillary arch width on the impacted side was significantly less than the normal side (P < 0.001). The mean depth of the palate was 14.86 ± 3.53 mm. There was a significant correlation between canine impaction and Palatal volume (R = 0.728 and P-value< 0.001), but no significant correlation between canine impaction and Maxillary arch width was shown (R = 0.15 and p-value = 0.326). Conclusion: The impacted canine was significantly associated with a reduction in the width of the maxillary arch on the affected side, and it made no difference if the impacted side was left or right. Also, impacted canine teeth were significantly associated with volume reduction on the affected side.

The relationship of maxillary arch dimension with vertical facial morphology in proto-malay race.

OBJECTIVE: To determine the relationship between the dimensions of the maxillary arch and vertical facial morphology within the Proto-Malay race. DESIGN: A cross-sectional study. SETTING: Orthodontics Department, Faculty of Dentistry, Universitas Sumatera Utara, Medan, Indonesia. PARTICIPANTS: Proto-Malay individuals aged ≥18 years without orthodontic treatment history (n = 104). METHODS: Lateral cephalometric radiographs and maxillary study model were obtained from 104 subjects who had never received orthodontic treatment (45 males and 59 females), aged 18 years, belonging to the Proto-Malay race, with skeletal class I malocclusion, normal overjet and overbite, and complete dentition (except the third molar). The vertical facial morphology was obtained by measuring the Jarabak's ratio on lateral cephalometric radiographs by using CorelDRAW. The study model was used to measure the dimensions of the maxillary arch, which are intercanine width, intermolar width, arch length, and palatal height, by using the Korkhaus modification device. RESULTS: The results showed a significant positive correlation between intercanine and intermolar width and a negative correlation between arch length and palate height with vertical facial morphology in the male and female groups within the Proto-Malay race. CONCLUSION: There is a relationship between the maxillary arch dimension with vertical facial morphology in the male and female groups in the Proto-Malay race.

Morphometric analysis of maxillary arch dimensions using Cone Beam Computer Tomography (CBCT).

Knowledge of morphology of the maxillary arch is important in many spacialities of dentistry. This retrospective cross-sectional study was performed using 109 randomly selected maxillary CBCT images of patients in the age range of 18-60 from the archives in Faculty of Dental Sciences, University of Peradeniya, Sri Lanka. EzDent software was used for measurements. Measurements related to the width were acquired from coronal sections while the measurements related to antero-posterior dimensions were performed on axial sections. A majority had an oval shaped maxillary arch (64.8%) followed by V shaped one.(29.2%). The mean height of the alveolar ridge at the upper canine position was 8.9 mm and the mean height of the alveolar ridge at the first molar level was 20.1 mm. Mann Whitney U test was used to compare measurements of variables between males and females. Difference in the height of alveolar ridge at the junction of soft and hard palate, width of the alveolar ridge at the canine, first molar and second molar and also the antero-posterior distance of the arch at the inter canine distance and junction between the hard and soft palate were statistically significant. Kruskal Wallis test was used to compare the differences between age groups. Chisquare values didnot indicate significant differences of measurements according to the age group of the participants. In conclusion, there is a significant difference in all maxillary arch parameters between the different genders. No significant differences in arch parameters were observed among the different age groups.

Investigating the effect of bruxism on maxillary arch length and width in children using three-dimensional digital model analysis.

BACKGROUND: Bruxism is defined as repetitive jaw-muscle activity characterized by the grinding and clenching of teeth. The prevalence of bruxism in children is extensive, and it can cause irregularities in dental arches. The study aimed to investigate the presence of any effects of bruxism on maxillary arch length and width in children using three-dimensional (3D) digital model analysis. METHOD: This study evaluated 30 children with bruxism. For every child with bruxism, a case control without bruxism was selected and matched for gender, age, and dentition. Digital models of the patients' maxilla were obtained with a 3D intraoral scanner, and width and length measurements between the reference points on the maxilla were obtained on the digital models. RESULTS: The mean age of the study group was 9.13 ± 1.27. Insignificance differences were found between females and males within and between groups in terms of maxillary width and length. Insignificant difference was found between the control and study groups when the lengths of 3R-3L, 4R-4L, 5R-5L, 6R-6L, and IP-M were compared (p > 0.05). CONCLUSION: Based on the study results, there were no differences in the maxillary arch length and width in patients with bruxism and patients without bruxism.

Prevalence of Class V caries in maxillary and mandibular canines of 3-5-year-old children: A retrospective study.

Caries in primary teeth are a major health concern in socially disadvantaged populations and may alter the eruption pattern and function of their successor. The aim of the study is to find the prevalence of Class V caries in maxillary and mandibular canines in 3-5-year-old children. A single-centered retrospective study was conducted in a private dental institution, Chennai. The data were collected from the Dental Hospital Management System of Saveetha Dental College (DIAS). A test for significance was done with the help of the Chi-square test. The most prevalent caries in canines of children between the age group of 3 and 5 years were cervical caries or Class V caries. 5, 35,951 patient details that were available in DIAS, and 2,35,841 were details of pedodontic patients, 200 patients who fulfilled the inclusion criteria were analyzed. It was observed that the prevalence of caries on the right maxillary and mandibular canines (80.00%) was higher than the left counterpart (20.00%) of the same arch. Maxillary canines (70.00%) had more prevalence of caries as compared to mandibular canines (30.00%). Caries prevalence on the right maxillary and right mandibular primary canine was higher than their left counterparts. Maxillary primary canines had more prevalence of caries as compared to mandibular primary canines.

Evaluation of the Clinical Effectiveness of Nasoalveolar Molding (NAM) Using Grayson Method Versus Computer-Aided Design NAM (CAD/NAM) in Infants With Bilateral Cleft Lip and Palate: A Randomized Clinical Trial.

OBJECTIVE: The aim is to compare between the clinical effectiveness of nasoalveolar molding (NAM) versus the computer-aided design NAM (CAD/NAM) in patients with bilateral clefts. DESIGN: The trial is a randomized comparative trial with 1:1 allocation ratio. PARTICIPANTS: Thirty infants with bilateral complete cleft lip and palate were recruited. INTERVENTIONS: Patients were randomized between NAM and CAD/NAM groups. The treatment steps described by Grayson were followed for the NAM group. In the CAD/NAM group, digitized maxillary models were made to create series of modified virtual models which were used to fabricate the molding plates using 3-dimensional printing technology. The nasal stents were then added to the plates following Grayson method. The study lasted for 4 months. MAIN OUTCOMES: The primary outcome was to evaluate the changes in the intersegment cleft gap. Secondary outcomes included the analysis of the maxillary arch in transverse, anteroposterior, and vertical dimensions as well as the premaxillary deviation and rotation. Chair side time was assessed for both methods. RESULTS: Both modalities decreased the intersegment cleft gap. The CAD/NAM plates caused more reduction in the total arch length by 1.99 mm (-3.79 to 0.19, P = .03) as compared to the NAM treatment. No differences were found between groups in the transverse and vertical maxillary arch changes. CONCLUSIONS: Both interventions were effective in narrowing the cleft gap. Similar maxillary changes were found in both groups. The CAD/NAM modality required less chair side time compared to the NAM treatment.

Anthropometric and Physiologic Parameters in Cleft Neonates: A Hospital-Based Study.

The oro-facial morphology is greatly affected in neonates with a cleft lip and palate. The initial evaluation of neonate's body and maxillary arch dimensions is important for treatment planning and predicting growth in cleft patients. The objective of this study was comparative evaluation of the anthropometric and physiologic parameters of cleft and non-cleft neonates in a hospital-based set up. This cross sectional study was conducted on 88 cleft and non-cleft neonates (n = 44 in each group) aged between 0 and 30 days after obtaining approval from the institutional ethics committee and positive written informed consent from their parents. Neonates' body weight, body length, head length, head circumference, and maxillary arch dimensions were measured. Maxillary arch dimensions were measured on dental casts with digital sliding calipers. Statistical analyses performed using the independent t-test and one-way ANOVA analysis were followed by Bonferroni correction for post-hoc comparison. The results showed statistically significant differences in birth weight (p < 0.0001), head length (p < 0.01), head circumference (p < 0.007), and maxillary arch dimensions (p < 0.0001) between cleft and non-cleft neonates. These findings suggest that cleft neonates had significant anthropometric and physiologic variations than non-cleft neonates.

Sex estimation from maxillary arch measurements in Egyptian populations: cross-sectional study / Estimación sexual a partir de mediciones del arco maxilar en poblaciones egipcias: estudio transversal

SUMMARY: Sex estimation is an essential step in personal identification and a cornerstone for developing biological profile from skeletal remains. The present study aimed to evaluate the role of maxillary arch widths and lengths as unique parameters in the estimation of sex in Egyptian populations. Maxillary arch measurements were collected from 1410 subjects where palatal impressions were obtained from each participant. Fourteen maxillary inter-teeth widths and lengths that excluded teeth dimensions were included The current study revealed that among the studied population, Egyptian men showed significant differences (p34.57 mm, it could predict the sex with sensitivity of 69.8 %, specificity of 58.8 % and p<0.05. The first molar could be considered as one of the most valid and reliable teeth in estimating sex in Egyptian populations. These measurements may be used as a reference in different populations in cases of mass disaster or relevant events.

RESUMEN: La estimación del sexo es un aspecto esencial en la identificación personal para desarrollar el perfil biológico a partir de restos óseos. El presente estudio tuvo como objetivo evaluar el papel del ancho y longitud del arco maxilar como parámetros únicos en la estimación del sexo en poblaciones egipcias. Se obtuvieron medidas del arco maxilar de 1410 sujetos, además de las impresiones palatinas de cada participante. El estudio actual reveló que entre la población estudiada, los hombres egipcios mostraron diferencias significativas (p 34,57 mm, podría predecir el sexo con sensibilidad de 69,8 %, especificidad de 58,8 % y p <0,05. El primer molar podría considerarse como uno de los dientes más confiables para estimar el sexo en las poblaciones egipcias. Estas mediciones se pueden utilizar como referencia en diferentes poblaciones en casos de desastres masivos o eventos relevantes.

Maxillary Arch Dimensions in 6-Year-Old Cleft Children in Northern Finland: A Cross-Sectional Study.

The aim was to cross-sectionally examine the maxillary arch dimensions in 6-year-old children with cleft lip and/or palate and to compare them with the initial cleft sizes among patients with cleft palate. The study included 89 patients with clefts treated at the Oulu University Hospital. The subjects were divided into three groups: cleft palate, cleft lip, and cleft lip and palate. Study casts were scanned, and the maxillary arch dimensions were examined using a 3D program (3Shape Orthoanalyzer, Copenhagen, Denmark). The statistical methods Student's t-test and one-way ANOVA were used to compare the means (SD) between the groups. Spearman's correlation coefficient was used to determine the correlation between cleft severity and maxillary dimensions. A significant difference was found between different initial cleft sizes in terms of distance between the second deciduous molar and the first incisor on the right side. The intermolar width showed a negative correlation with the initial cleft size. The dimensions were shorter for clefts affecting the palate and largest for clefts affecting only the lip. Larger clefts resulted in a shorter maxilla on the right side. Many dimensions became shorter when the initial cleft was larger. Clefts of the palate resulted in smaller maxillas.

Efficacy of Infrazygomatic Crest Implants for Full-arch Distalization of Maxilla and Reduction of Gummy Smile in Class II Malocclusion.

AIM: The purpose of the study was to evaluate the efficacy of infrazygomatic (IZ) implants along with mini-implants for full-arch distalization of maxilla and reduction of gummy smile in patients with class II division I malocclusion. MATERIALS AND METHODS: Ten orthodontic patients were taken from the department of orthodontics and dentofacial orthopedics. Each patient required distalization and intrusion of the complete maxillary arch as a part of the treatment plan. Patients were of class II malocclusion with gummy smile. Initial leveling and alignment were done by using 0.22″ slot Mclaughlin Bennett Trevisi (MBT) prescription. Fav Anchor infrazygomatic crest (IZC) implants of 2 mm of head diameter and 14 mm length were inserted between first and second molar and 2 mm above the mucogingival junction in the alveolar mucosa and in the anterior region, two titanium mini-implants of 1.4 mm head diameter and 6 mm length. The screws were loaded immediately with e-chain with a minimal force from mini-implants in the anterior region to crimpable hook placed between lateral and canine and continuing the same till the IZ implants. To measure the amount of distalization and reduction of gummy smile, pre- and postlateral cephalograms were taken and assessed. Pre- and postdistalization and intrusion readings of all patients were obtained and calculated statistically for quantifying the amount of distalization of maxillary arch and intrusion for reduction of gummy smile. RESULTS: The distalization of the maxillary arch achieved was 4.6 mm which is clinically and statistically significant. The anterior teeth in the study were intruded with a minimum of 3.8 mm which is clinically and statistically significant; the gingival smile line was reduced with a mean of 3.4 mm which is clinically and statistically significant. Overbite correction of 4 mm was done with the mean difference of 4 mm which is also statistically significant. CONCLUSION: The IZ bone screws can be effectively used as an absolute anchorage to correct class II skeletal discrepancy with gummy smile devoid of premolar extraction with noninvasive procedure. CLINICAL SIGNIFICANCE: The use of IZC implants along with anterior implants, a biomechanical approach is effective in achieving full-arch distalization of maxilla and intrusion as the force vectors allow that the line of action passes through the center of resistance (Cr) of the entire maxillary arch, facilitates the distalization and intrusion of the maxillary arch, establishes ideal occlusion, and improves the smile esthetics.

Comparison of Fit of Dentures Fabricated by Traditional Techniques Versus CAD/CAM Technology.

PURPOSE: To compare the shrinkage of denture bases fabricated by three methods: CAD/CAM, compression molding, and injection molding. The effect of arch form and palate depth was also tested. MATERIALS AND METHODS: Nine titanium casts, representing combinations of tapered, ovoid, and square arch forms and shallow, medium, and deep palate depths, were fabricated using electron beam melting (EBM) technology. For each base fabrication method, three poly(vinyl siloxane) impressions were made from each cast, 27 dentures for each method. Compression-molded dentures were fabricated using Lucitone 199 poly methyl methacrylate (PMMA), and injection molded dentures with Ivobase's Hybrid Pink PMMA. For CAD/CAM, denture bases were designed and milled by Avadent using their Light PMMA. To quantify the space between the denture and the master cast, silicone duplicating material was placed in the intaglio of the dentures, the titanium master cast was seated under pressure, and the silicone was then trimmed and recovered. Three silicone measurements per denture were recorded, for a total of 243 measurements. Each silicone measurement was weighed and adjusted to the surface area of the respective arch, giving an average and standard deviation for each denture. RESULTS: Comparison of manufacturing methods showed a statistically significant difference (p = 0.0001). Using a ratio of the means, compression molding had on average 41% to 47% more space than injection molding and CAD/CAM. Comparison of arch/palate forms showed a statistically significant difference (p = 0.023), with shallow palate forms having more space with compression molding. The ovoid shallow form showed CAD/CAM and compression molding had more space than injection molding. CONCLUSION: Overall, injection molding and CAD/CAM fabrication methods produced equally well-fitting dentures, with both having a better fit than compression molding. Shallow palates appear to be more affected by shrinkage than medium or deep palates. Shallow ovoid arch forms appear to benefit from the use of injection molding compared to CAD/CAM and compression molding.