The success rate of mini-screws for incisors intrusion and patient age, gender, and insertion angle in the maxilla using CBCT and implant-guided surgery. A split-mouth, randomized control trail.

BACKGROUND AND OBJECTIVES: The intrusion of anterior teeth is a routine procedure in orthodontics, which has been performed efficiently with the help of mini-screws in the anterior region, especially the upper maxilla. This study aimed to investigate the effect of insertion angle and sociodemographic features on the success rate of mini-screws at the anterior maxillary region. MATERIALS AND METHODS: Twenty-nine patients (18 Females and 11 Males) aged 18-40 years old were involved in the current study. A split-mouth design was carried out in which recruited patients needed bilateral anterior screws at the labial bone in the region of the incisor for the intrusion of upper anterior incisor teeth as part of their orthodontic treatment with a fixed appliance (upper right side received 90-degree insertion angle mini-screw and 45° for left side) using a surgical guide fabricated from patients CBCT and intraoral scans. The mini-screws were inserted at the attached gingiva bilaterally to achieve intrusion of upper anterior teeth with a power chain ligated from the main archwire to the anterior min-implants. The patient was recalled monthly for orthodontic appliance activation and screw assessment for 6 months. The intrusion force was 15 g on each side. RESULTS: The results of the study showed that screw stability was higher in the male group than the female group at the 6th monthly follow-up visit with a statistically significant difference between both genders (P = .044). Concerning insertion angle, results showed a statistically significant difference between 45° and 90° as an insertion angle with a P-value <.01 in most of the follow-up months. CONCLUSION: This study found that male patients with mini-screws inserted at 90° showed greater screw stability over time.

Interdisciplinary orthodontics-implants management of a challenging hypodontia case complicated by a class II division 2, bimaxillary retroclination.

INTRODUCTION: The case in this study had moderate hypodontia, with both lower lateral incisors and the lower-left second premolar missing. A Class II division 2 relationship with severe crowding in the upper arch and a traumatic deep bite over a skeletal I base complicated the occlusion. MATERIALS AND METHODS: The plan was to extract the upper first premolars to relieve upper arch crowding and the lower-left impacted second premolar to preserve the bilateral class I molar relationship. A class I occlusal relationship was achieved through space opening in the lower lateral incisors region and space closure in the upper and lower premolars regions. RESULTS: The use of orthodontic screws for bite opening and anterior segment retraction, in conjunction with bi-metric slot size selection in bracket prescription, was effective in controlling incisor inclination and interincisal angle. The use of an implant fixture before beginning the finishing stage allowed for a reduction in total treatment time and facilitated the provision of the final prosthesis before debonding the case. As a result, the patient was able to receive a satisfactory occlusion on the day of debonding. CONCLUSION: This case of moderate hypodontia was successfully resolved by combining space closure and space opening effectively. To solve the arch problems in such Class II division 2 cases with severe crowding, extractions were required. To complete the case, this was combined with intrusive and retractive mechanics. In hypodontia cases, implants are an excellent choice for both aesthetics and functional restoration.

MH-SETUP, combining Kesling wax-setup with indirect bonding and custom-made brackets for labial/lingual techniques to eliminate the finishing phase.

OBJECTIVE: A novel technique, named the MH setup (MH is an abbreviation for the author's name), was developed to provide an accurate yet simplified method to produce custom-made brackets without bonding errors. This setup aimed to simplify the treatment and eliminate the finishing phase, so that the orthodontist was able to provide better care with less time and lower costs. MATERIALS AND METHODS: The setup was performed in two major steps: direct bonding on the cast followed by cutting and setting the teeth into precise positions using brackets. The first set of brackets, bonded directly onto casts, oriented the teeth by setting them ideally into wax rims with full control over first-, second-, and third-order bends. The fully engaged archwire used allowed for precise control over the arch symmetry and form. Setting teeth in wax allowed the clinician to refine the occlusion and correct any minor errors that arose during the initial bonding. The second set of brackets, mounted on the fully engaged archwire, featured custom-made composite bases. The transfer tray combined the benefits of its soft inner and hard outer layers, providing control over bonding and later ease of peeling from the brackets. RESULTS: The patient was satisfied with a full bonding procedure lasting 15 min that remained simple without unnecessary stress. The clinician was confident that the procedure allowed the precise positioning of brackets and simple bonding for all teeth in the arch, combined with the elimination of the finishing phase. CONCLUSION: The MH technique offered a simple, precise, and inexpensive improvement to the Kesling wax setup. The process allowed for precise bonding without errors or expensive armamentarium. The brackets were transformed into custom-made prescriptions and could be used with labial or lingual techniques. The method allowed for teeth addition, trimming, or overcorrection according to the clinician's preferences. The MH setup facilitated visualization of the treatment objectives with precise locations and the opportunity to revise the treatment plan or to discuss further options with the patient.

Alveolar bone exostoses following orthodontic treatment. Diagnostic considerations and clinical management.

Alveolar bone exostoses (ABE) are benign localized convex outgrowths of buccal or lingual bone, which could be delineated from the surrounding cortical plate, also known as a buttress bone formation. Our review and case series demonstrate the development of alveolar bone exostoses during orthodontic therapy. It is crucial to keep in mind that every case presented had a history of palatal tori. In our clinical observations, higher precedence of ABE development was seen in participants during incisor retraction, especially with preexisting palatal tori. Additionally, we have successfully demonstrated surgical techniques to eliminate ABE in the event that self-remission does not occur once orthodontic forces are discontinued.

Factors That Guide the Diagnosis and Treatment Planning for Impacted Canines Using Three-Dimensional Cone-Beam Computed Tomography: A Cross-Sectional Study.

Objective: Impacted canines are one of the significant challenges in orthodontics that should be appropriately assessed to provide the best treatment to the patients. Materials and Methods: In the present study, 57800 patients were examined over six years to investigate the prevalence, diagnostic procedures, and treatment methodologies for impacted canine cases. Prevalence and diagnosis were tested using history taking, clinical examination, and three-dimensional cone-beam radiographs. The cases were tested for impaction site, gender, age, signs, and symptoms. The groups were classified for impaction location according to Mupparapu's classification. Result: The causative factors and the treatment methodology selected were plotted according to age and gender distribution. The total prevalence was 3.9% of canine impaction cases in relation to the total sample cases. The results showed a strong correlation between the site of impaction toward the upper arch and with distribution following Mupparapu's classification. The pain was the most detectable complication in all age groups, while root resorption was the least. Conclusion: Most of the younger age groups were sent for exposure and orthodontic traction, while the mid-aged groups elected for observation, and follow-up as their primary concern was esthetics. However, the adult patients were into exposure and traction to improve their function.

TAD's for the Derotation of 90° Rotated Maxillary Bicuspids.

It is undeniable that the advent of extra-alveolar mini-implants for anchorage purposes has revolutionized the field of Orthodontics. This case report sheds light on an innovative anchorage plan using TADs, to carry out treatment for a 15-year-old female patient. The patient reported to the clinic with a chief complaint of rotated second premolars, crowding, and a deep bite. On examination, it was seen that the patient had a Class I skeletal pattern, Class II subdivision molar relationship, 90-degree maxillary second premolar rotations, crowding in both the arches, and a deep bite. In this case, the clinicians decided to use TADs for premolar derotation as it not only provides a pure rotational couple without any deleterious effects on the adjacent teeth but also helps shorten the overall treatment time. The total treatment time for this case was 10 months.

A Female Hair Clip and Orthodontists' Neck-Back Pain Perception: A Survey.

This study aimed to clarify the effect of large hair clips on patient head posture on the dental chair headrest and its harmful impact on orthodontist body posture and neck-back pain. One hundred orthodontists voluntarily participated in a web-based questionnaire designed and distributed online by using the Google form posted in the Telegram group of Iraqi orthodontists to assess the opinions of orthodontists regarding the effect of a large hair clip on the patient's position on the dental chair and site of pain perception during different stages of orthodontic treatment. Ninety percent of the orthodontists get bothered by the large hair clip. About 92% of the responses preferred their patients to remove the large hair clip; 99% of them responded that the large hair clip does affect the position of the patient's head on the chair's headrest. Eighty-nine percent responded that a large hair clip could disturb the operator during taking intraoral photographs, and 64% disturbed while taking dental impressions. Orthodontists reported that 4% had "back pain," 28% had "neck pain," and 60% had both "back and neck pain" during bonding appointment, while only 8% reported "no pain." Regarding the activation appointments, 4% had "back pain," 26% had "neck pain," and 48% had both, while only 22% reported "no pain." During the debonding appointments, 7% of the respondents had "back pain," 29% had "neck pain," and 44% had both "back and neck pain," yet 20% stated absence of pain. Wearing a hair clip and changing patient position on dental chair and orthodontist posture during different stages of orthodontic work such as bonding, regular recall, and depending on the procedure may be directly related to the neck-back pain perception to an orthodontist.

Pattern of distribution and etiologies of Midline diastema among Kurdistan-region Population.

BACKGROUND: Aim of study was to evaluate the prevalence and etiological factors that contribute in midline diastema in Kurdistan region-Iraq population among different age groups and genders. MATERIAL AND METHODS: Orthodontic patients sample of (EX: 1021orthodontic patients (537 males and 484 females) were randomly selected from Kurdistan-region population, attending to orthodontic department of khanzad polyclinic teaching center (General directorate of hawler / Ministry of health/ Kurdistan region- Iraq) during 2018-2019 period. Aged (13-35 years) with mean age ± SD was 19.6 ± 4.8 years, with a median of 19 years. The examination included patient history taking, intraoral examination, photograph, intraoral periapical radiography of incisors area and panoramic radiographic. Diastema consider positive when the space between central incisors is 0.5mm and more, width was measured clinically used digital Vernier calipers at one millimeter above the incisors edge. RESULTS: The prevalence of midline diastema was 23.2%. located in the maxilla (97%), in mandible (1.3%) and in both was (1.7%). The prevalence of midline diastema differs significantly between the age groups (p< 0.001). The highest prevalence (55.8%) was among patients aged ≥ 30 years, and it was also high (37.7%) among those aged < 15 years. The prevalence among females (26.4%) was significantly higher than the prevalence (20.3%) among males (P= 0.020). The main causes of midline diastema in females was thumb sucking and missing lateral incisors (14.1% and 12.5% respectively) and in males was high labial frenum and super numerally teeth (39.4% and 30.3% respectively). CONCLUSIONS: Prevalence of diastema in Kurdistan regional- Iraq area was (23.2%), the location mostly in maxilla (97%). The prevalence of diastema in females more than males. The main causes of diastema in females was thumb sucking and missing lateral incisors while in the males was high labial frenum and super numerally teeth. Key words:Prevalence, midline diastema, high labial frenum, thumb sucking.