Soft tissue lasers: An innovative tool enhancing treatment outcomes in orthodontics - A narrative review.

Lasers have been utilised in the field of dentistry for over 40 years, but their use has been limited in the field of orthodontics. The advent of lasers with accompanying computer interfaces has made them significantly user-friendly, adding to their appeal in the orthodontic profession. Knowledge regarding the laser device's capabilities and limitations is essential to optimise patient care and to make a satisfactory investment return. For the effective and successful integration of lasers in orthodontic practice, adequate training is required, limited not only to the orthodontist but the dental assistants and auxiliaries as well. Orthodontists may safely and readily execute gingivectomy, exposure of teeth, frenectomy, circumferential supracrestal fiberotomy, ankyloglossia release and uvulopalatoplasty. The current narrative review was planned to introduce the benefits and general principles of soft tissue lasers in the field of orthodontics and recent surgical research comparing different laser-assisted surgeries against conventional scalpel surgeries.

A comparison of three different modalities in improving oral hygiene in adult orthodontic patients - An open label randomized controlled trial.

INTRODUCTION: The objective of the study was to compare outcomes in terms of Bleeding index (BI), Gingival Index (GI) and Orthodontic Plaque Index (OPI) with videographic and plaque disclosing tablets (PDT) versus verbal instructions in adult orthodontic patients undergoing fixed appliance treatment (FAT). MATERIALS AND METHODS: Adult orthodontic patients were recruited form outpatient orthodontic clinic who fulfilled the inclusion criteria and were randomly allocated to three groups i.e., video, PDT AND VERBAL GROUPS: Subjects who had gingivitis as assessed by the Bleeding Index (BI), Gingival Index (GI) and Orthodontic Plaque Index (OPI) were recruited. Pre- and post-interventional measurements were taken at two intervals only for BI, GI and OPI. The primary outcome was to evaluate mean change in the BI, GI and OPI in the three study groups after six weeks. A computer-generated randomization list was used to allocate subjects to one of the three study groups using a random permuted block sampling of 6 and 9 to randomize the samples. RESULTS: A total of 99 subjects were assessed for eligibility out of which 96 participants were randomized as three of the participants declined to be part of this trial. The mean change in the oral hygiene indices score were assessed and we found no statistically significant difference among the three interventional groups. Pre- and postinterventional results showed statistically significant improvement in the oral hygiene indices for video and PDT group. No statistically significant difference for age, gender and education level on oral hygiene indices. Simple linear regression showed that video group produced significantly higher mean OPI change as compared to other groups. CONCLUSIONS: Visual aids performed better than verbal instructions. Gender, age, and education level did not have a statistically significant impact on oral hygiene indices.

Cephalometric predictors of optimal facial soft-tissue profile in adult Asian subjects with Class II malocclusion treated via maxillary premolar extraction: A cross-sectional study.

INTRODUCTION: Class II malocclusion is most commonly treated using maxillary premolar extractions. The objective of this study was to predict cephalometric parameters associated with favorable facial soft-tissue profiles in adult Asian subjects with Class II malocclusion treated via maxillary premolar extractions. METHODS: A cross-sectional study was performed with 46 patients equally divided into favorable (FG) and unfavorable groups. The sample was divided on the basis of subjective and objective criteria. Subjectively, pretreatment and posttreatment facial silhouettes were shown to the panel of orthodontists to rate via the visual analog scale. Objectively, posttreatment soft-tissue cephalometric variables were taken. The sample receiving 60% visual analog scale and ideal posttreatment soft-tissue measurements were included in FG. Paired t test and independent t test were applied to determine the significant changes within and between both groups. To predict the cephalometric and occlusal variables associated with FG outcome, the Cox regression analysis was applied. RESULTS: On the evaluation of pretreatment cephalometric variables, the independent t test showed statistically significant differences for UI-NA (P = 0.42), Wits appraisal plane (0.010), upper lip to E-line (0.047), and interincisal angle (P = 0.049). Evaluation of the pretreatment occlusal variables the independent t test and chi-square test showed overjet (P = 0.018) and molar relationship (P = 0.045) to be statistically significant. The Cox regression analysis showed no cephalometric or occlusal variables to be statistically significant to predict the soft-tissue outcomes. A statistically significant strong correlation was also observed between the subjective and objective evaluation methods. CONCLUSIONS: Cephalometric analysis may be more valuable as a diagnostic rather than a predictive tool for favorable soft-tissue outcomes.

Influence of incisor inclination and anterior vertical facial height on facial attractiveness in an adult Asian male.

INTRODUCTION: Balanced facial proportions and hard tissue relationships are important factors in facial attractiveness. The objective of this study was to determine the most pleasing maxillary incisal inclination (MII) on the lateral profile and the impact of various lower anterior facial height (LAFH) ratios (at rest and with a smile) on facial attractiveness. METHODS: This cross-sectional study was performed with 66 raters equally divided into 3 panels: general dentists (GD), orthodontic residents (OR), and laypersons (LP). Lateral profile view photographs of an Asian man were modified using Photoshop software (Adobe Systems, San Jose, Calif) to show altered MII and LAFH ratios at rest and when smiling. Subjective evaluations of facial attractiveness were performed by raters using a visual analog scale. Kruskal-Wallis test was used to compare esthetic scores among raters, and the Mann-Whitney U test was applied to compare ES between groups. RESULTS: Kruskal-Wallis test showed significant differences in esthetic scores among raters for -10° (P = 0.028) and -15° MII (P = 0.030). Similarly, significant differences were found in ES for 8% LAFH ratio (P = 0.022), and 4% LAFH ratio (P = 0.035) at rest. Mann-Whitney U test showed significant differences between raters for -10° and -15° MII and between 8% and 4% LAFH ratio at rest. CONCLUSIONS: All groups rated -5° inclinations to be most attractive. General dentists and orthodontic residents found normal LAFH to be the most attractive, whereas long facial height was less attractive with smile. In addition, smile had a camouflaging effect on LAFH.

Effect of Direct versus Indirect Bonding Technique on the Failure Rate of Mandibular Fixed Retainer-A Systematic Review and Meta-Analysis.

INTRODUCTION: Fixed retainer failure is a common cause of relapse and may require additional orthodontic treatment. The two main methods for bonding the mandibular fixed retainer include direct and indirect techniques. This topic has not been explored previously in a systematic review. Therefore, the objective of this systematic review was to evaluate the effect of direct versus indirect bonding technique on the failure rate of mandibular fixed retainer. METHODS: Online databases (PubMed, Dental and Oral Science, CINAHL, and Cochrane Central Register of Controlled Trials, Scopus) were systematically searched electronically for articles up until April 2021. Google Scholar and clinicaltrials.gov databases were utilized for hand searching. Randomized, non-randomized clinical trials and cohort studies on human subjects were considered regardless of language or year of publication. Orthodontic patients in their retention phase (mandibular 3×3 fixed retainer), in which the retainer was bonded using direct bonding technique as control and indirect as intervention were included. The outcome assessed was retainer failure rate. Two authors independently examined and extracted the data from the studies that satisfied the inclusion criteria. Risk of bias in clinical trials was assessed using the Cochrane Collaboration's tool, whereas risk of bias in cohort studies was assessed using the Newcastle-Ottawa Scale. The meta-analysis was conducted using the RevMan software V.5.3.5.22. The outcome was estimated using weighted average difference and 95% confidence intervals (CIs). The studies' heterogeneity was assessed using Cochrane's heterogeneity test (I2 Test). RESULTS: Four articles fulfilling the inclusion criteria were included in qualitative and quantitative synthesis. Retainer failure rates were analysed in a total number of 266 patients bonded with mandibular 3×3 retainers after orthodontic therapy. Direct bonding technique of fixed retainer on 131 patients was compared with indirect technique on 135 patients. There was no statistically significant difference in the rate of retainer failure between the two methods (95% CI, 0.67, 1.40). CONCLUSIONS: Within the limitations of insufficient evidence this systematic review and meta-analysis concluded that there is no difference in the failure rate of mandibular fixed retainers between direct and indirect bonding techniques. Due to the scarcity of available data, further studies are needed to establish definitively one's clinical benefit over the other.

Effect of class II extractions and functional appliance treatment on smile esthetics.

BACKGROUND: Class II malocclusion is routinely observed in orthodontics. Its treatment usually revolves around the growth modification or the extractions of the teeth. Identifying treatment that leads to the greatest improvement can aid clinicians in providing the desired smile esthetics. OBJECTIVES: The aim of the study was to compare smile esthetics between treatment groups by measuring various smile variables and the esthetic perceptions of 3 panels of raters. MATERIAL AND METHODS: A cross-sectional study was performed on 66 patients equally divided into the functional appliance (FA) and upper first premolar extraction (UPE) groups. Eight smile variables were measured on post-treatment photographs using the Adobe Photoshop® software. Ten orthodontic residents, general dentists and laypersons performed the subjective evaluations of smiles using the visual analog scale (VAS). The Mann-Whitney U-test was applied to compare smile variables between the groups. The Kruskal-Wallis test was used to compare esthetic scores (ES) among the raters. The simple linear regression analysis, followed by the multiple linear regression analysis was applied to determine the smile variables associated with the ES values. RESULTS: Statistically significant differences were found between the FA and UPE groups for the buccal corridor ratio (BCR) (p = 0.046), the visible dentition width ratio (VDWR) (p = 0.019) and the arch form index (AFI) (p < 0.001). The Kruskal-Wallis test showed significant differences in ES among the raters for the FA (p < 0.001) and UPE (p = 0.004) groups. The simple linear regression analysis showed significant associations between ES and the patient's age (p = 0.002), BCR (p = 0.020) and VDWR (p = 0.006). The multiple linear regression analysis showed that age (p = 0.008) and VDWR (p = 0.021) were significantly associated with the ES values. CONCLUSIONS: The FA group had narrower buccal corridor spaces, a greater visible dentition width and a wider arch form in their smiles. The UPE group showed an increase in the buccal corridor width. Each panel rated the FA appliance group as superior.