The Link Between Obstructive Sleep Apnea and Orthodontic Anomalies in Obese Adult Population.

INTRODUCTION: Obstructive sleep apnea (OSA) is characterized by the cessation of air flow during sleep due to an obstruction in the nasopharyngeal/oropharyngeal region. The consequences that untreated obstructive sleep apnoea might have on patient's health include symptoms like sudden awakening with a sensation of suffocation, morning headache, daytime sleepiness and fatigue, lack of concentration, and it is commonly connected to hypertension, coronary artery disease, depression, obesity and other medical conditions. AIM: The purpose of this review study is to enlighten the role of an orthodontic professional in prevention and treatment of obstructive sleep apnea syndrome to the general public. METHODS: Data search was determined by the following keywords: sleep apnea, orthodontic abnormalities, orthodontic prevention, sleep apnea syndrome, obstructive sleep apnea, cephalometric analysis, AHI index, BMI index and obesity. Electronic data search was performed on platforms Pubmed and Google Scholar. RESULTS: After reading and analyses, twenty-one articles with similar procedural criteria were selected, and among them only 6 were recognized as meeting the criteria of being completely accessible, having the selected keywords in their name, using the cephalometric analysis and BMI index and discussing the obese adults sleep apnea. In all the examined studies, it is proven that craniofacial morphology is a major anatomical risk factor for OSA. CONCLUSION: The role of the orthodontic specialists might be crucial in prevention of the development of obstructive sleep apnea, not only considering the orthodontic devices treament options, it can be especially important when obesity appears as a factor in the sense of informing and advising the patient and cooperating with other specialists who treat and prevent obstructive sleep apnea syndrome.

Perception of Dentofacial Aesthetics in School Children and Their Parents.

OBJECTIVE: The aim of this research was to examine the attitudes and perceptions of dentofacial aesthetics among different age groups. MATERIALS AND METHODS: The sample consisted of elementary-school students from the city of Sarajevo, Bosnia and Herzegovina, and their parents. This study included 314 subjects: 157 children and 157 parents. The children's group consisted of 85 (54.14%) males and 72 (45.85%) females, aged 9 to 15 years. STATISTICAL ANALYSIS: Descriptive statistics were used to determine frequency distribution and percentages for all variables. A chi-squared (x 2) test was used to determine the association between variables and a p-value < 0.05 was considered significant for all the differences and associations. RESULTS: For the dentofacial appearance with no teeth irregularity or with severe teeth irregularity, an analysis of variance (ANOVA) (post-hoc tests-Tukey's HSD) indicated that the difference is not statistically significant (p = 0.06) relative to rank matching between all three subject groups.For dentofacial appearance with mild teeth irregularity, an ANOVA (post-hoc tests-Tukey's HSD) showed statistical difference (p = 0.07) between the teenage group of subjects relative to pre-teenage group of subjects and adult group of subjects. CONCLUSION: Attitudes about desirable and acceptable dental aesthetics differ in younger children compared with older children and parents. Ten years old children find good function with poor aesthetics more pleasing, while 14 years old children find aesthetics with bad function as more pleasing.

The Prevalence of Hypodontia and Hyperdontia in Orthodontic Patients.

OBJECTIVE: The aim of this study was to assess the prevalence of hypodontia and hyperdontia among a group of orthodontic patients. MATERIALS AND METHODS: This cross sectional study was conducted using radiographs of 4256 patients (2032 males and 2224 females) who attended the Department of Orthodontics, School of Dental Medicine, University of Sarajevo. Radiographs were examined for the prevalence of hypodontia and hyperdontia in permanent dentition. Hypodontia was recorded when a tooth was absent on the panoramic radiograph and hyperdontia was recorded as an increased number of teeth above that described by normal dental formula. All data were analyzed using descriptive statistics including frequency and percentage, and differences between groups were tested using the χ2 test, or Fisher exact test. RESULTS: In the sample of orthodontic patients, 4.08% subjects had a least one dental anomaly, hypodontia or hyperdontia. The observed prevalence of hypodontia was in 3.42% subjects, and it was more prevalent in females than in male subjects. The observed prevalence of hyperdontia was in 0.65% subjects and hyperdontia was more common in males than female subjects. CONCLUSIONS: By early diagnosis of a reduced or increased number of teeth, various modes of therapy with a multidisciplinary approach may be performed to correct the aesthetic and functional problems caused by hypodontia or hyperdontia.

Heritability of Craniofacial Characteristics in Twins - Cephalometric Study.

INTRODUCTION: The growth and development of the craniofacial complex are under the influence of genetic and environmental factors, which determine its morphological and functional characteristics. Twin studies provide significant insight into how many genetic and environmental factors determine dental and craniofacial characteristics. AIM: The aim of the study was to determine the genetic influence on craniofacial complex using a twin study model. METHODS: The study sample comprised 52 pairs of twins who were referred to the Orthodontic Department, School of Dental medicine, University of Sarajevo. Informed consent was obtained by the parents of the children included in the study. Twenty pairs of twins were diagnosed as monozygotic while 32 pairs were diagnosed as dizygotic. Zygosity was diagnosed by physical characteristics similarity. Nineteen variables were measured: 10 dental variables, 9 cephalometric. RESULTS: Based on the findings of this study, t-test showed significant genetic effect on the length of cranial base (p = 0.03), corpus of maxilla (p = 0.02) and mandibular length (p = 0.03), and also for B-angle (p = 0.04). Environmental factors are more involved in determining dental traits (e.g., the inclination of the incisors). CONCLUSION: There is a significant genetic effect on the linear cephalometric variables: the length of the cranial base, maxillary length and mandibular length.

Comparison of Oral Health-Related Quality of Life in Treated and Non-Treated Orthodontic Patients.

INTRODUCTION: Malocclusion as an oral disorder can cause negative impact on individuals oral conditions, social interactions and self-esteem. AIM: The aim of this study was to compare oral health-related quality of life (OHQoL) of patients who had received fixed orthodontic treatment and patients who had not received fixed orthodontic treatment. MATERIALS AND METHODS: Data were collected from 178 participants attended at professional dental office (mean age 22.71 years) in two groups (experimental and control). The experimental group comprised of 90 subjects who were in the retention phase, after their orthodontic treatment, and the control group comprised of 88 untreated subjects. Oral Health Impact Profile (OHIP-14) was used to assess the patients oral health related quality of life (OHQoL). RESULTS: The control group had significantly higher OHIP-14 scores than experimental group (p < 0.001). Participants with treatment need reported a significantly greater negative impact on the overall OHRQoL score. CONCLUSION: Subjects with no history of orthodontic treatment had more negative oral health related quality (OHRQoL), than subjects who had completed orthodontic treatment. Dental malocclusion has significant negative impact on OHRQoL.

Dental Age in Orthodontic Patients with Different Skeletal Patterns.

Objective. To evaluate the difference between chronological and dental age, calculated by Willems and Cameriere methods, in various skeletal patterns according to Steiner's ANB Classification. Methods. This retrospective cross-sectional study comprised the sample of 776 participants aged between 7 and 15 years (368 males and 408 females). For each participant, panoramic images (OPT) and laterolateral cephalograms (LC) were collected from the medical database. On LC ANB angle was measured; on OPT dental age (DA) was calculated while chronological age (CA) and sex were recorded. The sample was divided into three subgroups (Class I, Class II, and Class III) with similar distribution based on the chronological age and ANB angle. CA was calculated as the difference between the date of OPT imaging and the date of birth, while DA was evaluated using Willems and Cameriere methods. ANB angle was measured on LC by two independent investigators using the cephalometric software. Differences between sexes and the difference between dental and chronological age were tested by independent and paired samples t-test, respectively; one-way ANOVA was used to test differences among ANB classes with Tukey post hoc test to compare specific pairs of ANB classes. Results. The significant difference was found between Class III and other two skeletal classes in males using both dental age estimation methods. In Class III males dental age was ahead averagely by 0.41 years when using Willems method, while Cameriere method overestimated CA for 0.22 years. Conclusion. In males with Class III skeletal pattern, dental development is faster than in Classes I and II skeletal pattern. This faster development is not present in females.

Dose- and time-dependent effects of clodronate on orthodontic tooth movement.

Orthodontic tooth movement is the result of bone remodeling that occurs in periodontal ligament and alveolar bone tissue as a response to mechanical loading of the tooth. The aim of this study is to investigate the time- and dose-response effects of locally administered clodronate on tooth movement. Sixty Wistar rats were randomly assigned to 4 groups of 15 specimens: E1 - application of 10 mMol of clodronate in 3-day intervals; E2 - application of 2.5 mMol of clodronate in 3-day intervals; E3 - application of 10 mMol of clodronate in 7-day intervals; E4 - application of 2.5 mMol of clodronate in 7-day intervals. A 50 µL clodronate solution was injected into a subperiosteal area to the right maxillary incisor. The left maxillary incisor served as a control, with an injection of saline solution. In 3-day interval application regime, there was no effect of clodronate dosing on tooth movement. In 7-day interval application regime, decreased tooth movement was observed with 10 mMol compared with 2.5 mMol clodronate concentration. However, decreased tooth movement was also observed when 2.5 mMol of clodronate was applied in 7-versus 3-day intervals. Conversely, no difference was observed when 10 mMol concentration was applied in 3- versus 7-day intervals. When clodronate is applied subperiosteally in the root area, it decreases the tooth movement. Tooth movement is impeded by the higher clodronate dosing, as well as by shorter application interval even with lower dosing. The purpose of future trials should, therefore, be to determine a safe therapeutic dose/interval application of clodronate in humans and their potential side effects.

Skeletal maturity assessment using mandibular canine calcification stages.

OBJECTIVE: The aims of this study were: to investigate the relationship between mandibular canine calcification stages and skeletal maturity; and to evaluate whether the mandibular canine calcification stages may be used as a reliable diagnostic tool for skeletal maturity assessment. MATERIALS AND METHODS: This study included 151 subjects: 81 females and 70 males, with ages ranging from 9 to 16 years (mean age: 12.29±1.86 years). The inclusion criteria for subjects were as follows: age between 9 and 16 years; good general health without any hormonal, nutritional, growth or dental development problems. Subjects who were undergoing or had previously received orthodontic treatment were not included in this study. The calcification stages of the left permanent mandibular canine were assessed according to the method of Demirjian, on panoramic radiographs. Assessment of skeletal maturity was carried out using the cervical vertebral maturation index (CVMI), as proposed by the Hassel-Farman method, on lateral cephalograms. The correlation between the calcification stages of mandibular canine and skeletal maturity was estimated separately for male and female subjects. RESULTS: Correlation coefficients between calcification stages of mandibular canine and skeletal maturity were 0.895 for male and 0.701 for female subjects. CONCLUSIONS: A significant correlation was found between the calcification stages of the mandibular canine and skeletal maturity. The calcification stages of the mandibular canine show a satisfactory diagnostic performance only for assessment of pre-pubertal growth phase.

USE OF ORTHODONTIC TREATMENT NEEDS INDICES FOR ORAL HEALTH SURVEY.

AIM: The aim of our study is to compare incidence of orthodontic malocclusion based on occlusal indices and Index of Orthodontic Treatment Need (IOTN), and to evaluate the most commonly used method among the dentists for orthodontic treatment in Sarajevo. MATERIAL AND METHODS: The sample consisted of 110 (31 female and 79 male)subjects older than 16 years with complete permanent dentition. Subjects were examined according to Occlusal Index (Angle classification of malocclusion, overjet, overbite, dental arch crowding and tooth rotation) and IOTN index. We conduct survey regarding which indexes are used in deciding on orthodontic treatment need, among primary health care and Orthodontist. RESULTS: The present study show differences between the presence of malocclusion and treatment need as assessed by these two used indices. Based on the survey that we conduct all primary health care doctors use Occlusal Index to decide need for orthodontic treatment, more than 95% of orthodontic specialist use Occlusal Index for treatment need estimation. CONCLUSION: When measuring and grading treatment needs we should rely on Index of orthodontic treatment need. In such high demand for orthodontic treatment need it is necessary to establish need for the orthodontic treatment as fundamental, so that individuals with greatest treatment need can be assigned priority.

Computer Based Assessment of Cervical Vertebral Maturation Stages Using Digital Lateral Cephalograms.

OBJECTIVE: This study was aimed to investigate the reliability of a computer application for assessment of the stages of cervical vertebra maturation in order to determine the stage of skeletal maturity. MATERIAL AND METHODS: For this study, digital lateral cephalograms of 99 subjects (52 females and 47 males) were examined. The following selection criteria were used during the sample composition: age between 9 and 16 years, absence of anomalies of the vertebrae, good general health, no history of trauma at the cervical region. Subjects with lateral cephalograms of low quality were excluded from the study. For the purpose of this study a computer application Cephalometar HF V1 was developed. This application was used to mark the contours of the second, third and fourth cervical vertebrae on the digital lateral cephalograms, which enabled a computer to determine the stage of cervical vertebral maturation. The assessment of the stages of cervical vertebral maturation was carried out by an experienced orthodontist. The assessment was conducted according to the principles of the method proposed by authors Hassel and Farman. The degree of the agreement between the computer application and the researcher was analyzed using by statistical Cohen Kappa test. RESULTS: The results of this study showed the agreement between the computer assessment and the researcher assessment of the cervical vertebral maturation stages, where the value of the Cohen Kappa coefficient was 0.985. CONCLUSION: The computer application Cephalometar HF V1 proved to be a reliable method for assessing the stages of cervical vertebral maturation. This program could help the orthodontists to identify the stage of cervical vertebral maturation when planning the orthodontic treatment for the patients with skeletal disharmonies.

Antimicrobial activity of chlorhexidine inpatients with fixed orthodontic appliances

Oral environment of orthodontic patients undergoes changes, such as pH reduction, largernumber of sites available for Streptococcus mutans collection, and increased accumulation of foodparticles, which may lead to an increased number of S. mutans colony-forming units (CFU) insaliva. Chlorhexidine gluconate (CHX) is the most potent documented antimicrobial agent againstMutans streptococci and dental caries. The aim of this work was to assess efficiency of CHX-basedmouthwashes in patient with fixed orthodontic appliances. Methods: Twenty patients with fixedappliances were selected for this study. They were undergoing full-bonded non extraction treatmentwith metal brackets (Roth 0.22, Discovery Dentaurum) on their teeth and bands on their molars.Each patient was provided with a toothbrush and toothpaste. The mouthwashes were used bypatients according to the manufacturers’ directions 15 min after toothbrushing: 5 mL of 0.2% CHX(Corsodyl, GlaxoSmithKline) was applied for 60 s in the morning and before bedtime for 2 weeks.Results: The data were analyzed according to the nonparametric Wilcoxon signed rank test (SPSSsoftware). Statistical significance level was set at p<0.05. Conclusions: The use of CHX-basedmouthwashes in patients with fixed orthodontic appliances led to reduction in the level of S. mutans.