Impact of Dental Midline Shift on the Perception of Facial Attractiveness in Young Adults.

Background/Objectives: The aim of this study was to quantify the threshold of a dental midline shift that would compromise facial attractiveness and indicate a need for treatment from the points of view of laypeople and dental professionals. Methods: Whole-face natural photographs of a male and a female model were digitally manipulated to create various degrees of upper and lower dental midline shifts through bodily movement of the upper or lower midlines as well as alteration of the axial inclination of the upper teeth. The samples were then assessed by two groups of observers (laypeople (LP) and dental professionals (DP)). Results: The lower midline shift did not negatively affect the DP and LP's perceptions of smile attractiveness. The first significant loss of attractiveness was registered by the DP with an upper midline shift of 1 mm in the female model. However, the LP registered this at 2 mm. The DP registered the necessity of treatment at a threshold of 2 mm in the female model and 3 mm in the male model. LP identified the need for treatment at 3 mm for both males and females. The female model was judged more critically than her male counterpart by both female and male observers. Conclusions: DP assess the midline deviation more critically than LP. Both DP and LP were more sensitive to midline deviations in the female model regardless of their own gender. Both groups registered the need for treatment at a higher threshold than the reduction in smile attractiveness.

The role of vitamin D in outcomes of critical care in COVID-19 patients: evidence from an umbrella meta-analysis of interventional and observational studies.

OBJECTIVES: Several meta-analyses have suggested the beneficial effect of vitamin D on patients infected with severe acute respiratory syndrome coronavirus-2. This umbrella meta-analysis aims to evaluate influence of vitamin D supplementation on clinical outcomes and the mortality rate of COVID-19 patients. DESIGN: Present study was designed as an umbrella meta-analysis. The following international databases were systematically searched till March 2023: Web of Science, PubMed, Scopus, and Embase. SETTINGS: Random-effects model was employed to perform meta-analysis. Using AMSTAR critical evaluation tools, the methodological quality of the included meta-analyses was evaluated. PARTICIPANTS: Adult patients suffering from COVID-19 were studied. RESULTS: Overall, 13 meta-analyses summarising data from 4 randomised controlled trial and 9 observational studies were identified in this umbrella review. Our findings revealed that vitamin D supplementation and status significantly reduced mortality of COVID-19 [Interventional studies: (ES = 0·42; 95 % CI: 0·10, 0·75, P < 0·001; I2 = 20·4 %, P = 0·285) and observational studies (ES = 1·99; 95 % CI: 1·37, 2·62, P < 0·001; I2 = 00·0 %, P = 0·944). Also, vitamin D deficiency increased the risk of infection and disease severity among patients. CONCLUSION: Overall, vitamin D status is a critical factor influencing the mortality rate, disease severity, admission to intensive care unit and being detached from mechanical ventilation. It is vital to monitor the vitamin D status in all patients with critical conditions including COVID patients.

The effect of vitamin D2 supplementation on vitamin D levels in humans: A time and dose-response meta-analysis of randomized controlled trials.

BACKGROUND: Inconsistencies exist regarding the influence of vitamin D2 (ergocalciferol) supplementation on serum vitamin D levels. These inconsistencies could be attributed to numerous factors, such as dosage, baseline vitamin D levels, and duration of intervention. Hence, this dose-response meta-analysis of randomized controlled trials was conducted to assess the efficacy of vitamin D2 supplementation on vitamin D levels. METHODS: Relevant studies were searched in PubMed/Medline, Web of Science, Embase, and Scopus, from their inception to 3 January 2023. Variable alterations were considered to calculate the pooled weighted mean difference (WMD) with 95% confidence interval (CI) using the random effects model. RESULTS: Pooled results from 33 study arms demonstrated that Vitamin D2 treatment significantly increases total vitamin D concentrations (WMD: 11.47 ng/mL, 95 %CI: 9.29 to 13.64, p < 0.001), 25(OH)D2 concentrations (WMD: 11.40 ng/mL, 95 %CI: 4.72 to 18.09, p = 0.001), and 1,25(OH)D concentrations (WMD: 5.61 ng/mL, 95 %CI: 0.74 to 10.48, p = 0.024), but decreases 25(OH)D3 concentrations (WMD: -4.63 ng/mL, 95 %CI: -6.46 to -2.81, p < 0.001). In subgroup analyses, increase in total vitamin D concentrations was more significant in vitamin D2 doses >2000 IU/day (WMD: 13.82 ng/mL), studies with duration ≤12 weeks (WMD: 12.53 ng/mL), participants aged ≥60 years (WMD: 14.40 ng/mL), and trials with basal 25(OH)D concentrations <20 ng/mL (WMD: 11.47 ng/mL). CONCLUSIONS: This meta-analysis indicates that the supplementation of vitamin D2 significantly increases the serum concentrations of total vitamin D, 25(OH)D2, and 1,25(OH)D, but decreases 25(OH)D3 concentrations. Careful consideration of patient characteristics, dosage, and treatment duration is recommended for vitamin D2 supplementation.

Three-dimensional evaluation of mandibular lingula: Comparisons of skeletal angle classifications and growth patterns.

OBJECTIVES: This study aimed to evaluate the position of the mandibular lingula (ML) in adult patients (aged between 18 and 35 years old) with different skeletal and growth patterns using cone-beam computed tomography (CBCT). DESIGN: Cross-sectional. SETTING: Dentistry department of University. SUBJECTS: Subjects comprised CBCT images of 150 adult patients, including 300 rami. METHODS AND MATERIALS: In total, 150 CBCT aged between 18 and 35 were selected and divided into three main groups of 50 samples based on their skeletal relationships (classes I, II and III). Patients were subdivided based on their growth pattern (vertical vs. horizontal), resulting in 25 samples per subgroup. Distances between the mandibular lingula and occlusal plane (ML-OP), sigmoid notch (ML-SN), external oblique ridge (ML-EOR), internal oblique ridge (ML-IOR), posterior border of the ramus (ML-PBR), inferior border of the ramus (ML-IBR), and horizontal and vertical distances to the mandibular foramen (ML-hMF and ML-vMF). One-way ANOVA variance analysis was employed to compare different angle classifications, and Bonferroni analysis was used for multiple comparisons. The Student's t-test was also used to compare growth patterns within each main group and genders within the subgroup. RESULTS: The study revealed statistically significant differences in the position of the mandibular lingula between different angle classifications, growth patterns, and genders. Class II samples showed a more anterior position of the ML, whereas Class III samples displayed a more posterior position of the ML. Patients with horizontal growth patterns and Angle Class III had a more posteriorly positioned ML. Gender differences were observed, particularly in Class I and Class III classifications, suggesting that gender may influence the variability of ML position in these specific classifications. CONCLUSION: The position of the mandibular lingula showed high variability among individuals with different angle classifications, growth patterns and genders.

Are Virtually Designed 3D Printed Surgical Splints Accurate Enough for Maxillary Reposition as an Intermediate Orthognathic Surgical Guide.

Background and Aim: The accuracy of the virtually-designed 3D-printed surgical splints requires investigation for the practical use of surgical plan in the operating room. This study aimed to compare the validity of the 3D-printed and the conventional intermediate splints and evaluate the outcomes after the surgical application of the 3D-printed splint compared with the predicted values. Methods: In this study, ten patients with dentofacial deformity were recruited. Participants were analyzed by the conventional surgical planning and virtual surgical planning. The intermediate surgical splints were created by the conventional and 3D-printing methods. Maxillary movements in 3 spatial directions were measured in an articulator after the application of both splints. Correlation and agreement between the two methods were tested by intraclass correlation coefficient (ICC). After the confirmation of 3D printed splint validity for each patient, the surgery was performed using 3D printed splints. It is assumed that ideally cephalometric prediction values are going to be obtained using conventional acrylic splints (gold standard). So, as a second objective, the outcome of the surgically-applied 3D-printed splint was evaluated and compared with the predicted values and finally analyzed by the paired t-test. Results: Based on the observations, there was an excellent agreement between the virtually-designed 3D-printed and conventional intermediate surgical splints (ICC ranged between 0.83 and 0.99 for linear values). There was a good cumulative agreement of ICC greater than 0.80. Overall, the mean linear measurements were not different between conventional and 3D-printed splint on the articulator. Also, there were no significant differences between the linear and angular measurements of 2D-cephalometric prediction and postoperation values. Conclusion: The results showed cautiously the acceptable accuracy of the 3D-printed splints for several parameters in three spatial dimensions within the laboratory and clinical settings.

Posttreatment stability following therapy using passive self-ligating brackets: extraction vs. nonextraction.

PURPOSE: This study aimed to evaluate the effects of lower premolar extraction on posttreatment stability one year following fixed orthodontic treatment with passive self-ligating brackets (Damon system, Ormco, Orange, CA, USA). METHODS: All patients were treated with fixed orthodontic appliances using passive self-ligating brackets (Damon). For retention, removable Hawley retainers were used. Two groups of patients were included in the study. Each group consisted of 23 patients: group Ex consisted of 10 male and 13 female patients (13.4 ± 1.6 years old) with extraction of lower first premolars and group NonEx consisted of 11 male and 12 female patients (13.4 ± 3.9 years old) without dental extractions. The patients' dental models and photographs were assessed at T0 (pretreatment), T1 (the end of active orthodontic treatment: 3.3 ± 1.0 years in the Ex and 2.3 ± 0.8 years in the NonEx group) and at T2 (1 year posttreatment). All lower casts were scanned and the following dental parameters were recorded and compared between the two groups: intercanine width (ICW), anterior arch width (AAW), intermolar width (IMW), Little's irregularity index (LII) and gingival recessions. RESULTS: An increase in ICW (group Ex: 1.20 ± 2.51 mm and group NonEx: 0.84 ± 1.48 mm) by the end of active treatment (T1; P < 0.05), as well as a relapse regarding the ICW (group Ex: -0.1 ± 0.47 mm and group NonEx: -67% ± 0.38 mm) one year post-treatment (T2) were recorded in the samples. Relapse in the non-extraction group was statistically and clinically significant, whereas ICW values remained relatively stable in the extraction group during the posttreatment period (T1-T2). The irregularity index decreased during treatment (group Ex: -8.79 ± 6.36 mm and group NonEx: -5.24 ± 2.99 mm) and relapsed in both groups (group Ex: 0.57 ± 90 mm and group NonEx: 0.27 ± 0.53). The rate of relapse in LII was correlated to the relapse rate of ICW. A reduction of IMW was recorded in the Ex group (-1.89 ± 1.82 mm) during active treatment (P < 0.05), which remained stable 1 year posttreatment. AAW increased in both groups (group Ex: 2.77 ± 1.77 mm and group NonEx: 1.77 ± 2.04 mm) throughout active treatment and remained stable at T2. CONCLUSION: Intergroup comparison revealed that ICW remained stable 1 year posttreatment in the Ex group, whereas high relapse of ICW was recorded in the NonEx group. Furthermore, risk of a relapse of LII appears to be higher in cases with a relapse of the ICW.

Reliability of qualitative and quantitative assessment of adhesive remnants after debonding of ceramic brackets bonded with Transbond™XT on human molar teeth: An in vitro study.

OBJECTIVE: To test the hypothesis that there are any differences between qualitative and quantitative methods of adhesive remnants index (ARI) scores on the buccal surfaces of the upper molar. MATERIALS AND METHODS: The study included 34 upper first human molars. After etching for 20seconds by using 35% orthophosphoric acid (Ultra-Etch, Ultradent Products Inc., USA) and then rinsed with distilled water for 15seconds, the adhesive (Transbond™XT, 3M™, USA) was applied and cured with the polymerization lamp (Bluephase Style, Ivoclar Vivadent, Liechtenstein) for 10seconds. Ceramic brackets (Damon® Clear™, Ormco, USA) were placed by composite (Transbond™XT, 3M™, USA) on the buccal surface of the molars. Following 24-hour storage of the samples in distilled water (WB-12, Phoenix Instrument, Gabsen, Germany) at 37°C, the brackets were debonded using a debonding plier (Damon Clear Debonding Plier, Ormco, USA). ARI and a modified ARI-scoring system were used. Three independent observers scored the ARI with the naked eye under 10x, 20x, and 32x magnifications using Stereomicroscope Stemi DV4 (Zeiss, Germany). Afterward, the digital microscope VHX-5000 (Keyence, Japan) under 50x magnification was used for the quantitative analysis of the adhesive remnants by just one evaluator. The Fleiss' Kappa-coefficient test was used to assess interrupter reliability. RESULTS: Fleiss' Kappa-coefficient test show that the highest amount of agreement between observers is observed using the naked eye for both of the scoring methods P<0.001. Increasing the magnification led to the moderate decrease of inter-observer agreement. For evaluations with naked eye, a higher agreement is observed for the modified ARI score compared to the ARI scored. The agreement between the quantitative and qualitative evaluation of the ARI score rose with increasing magnification. CONCLUSION: The assessment of adhesive remnants should be done either with naked eye or under 10x magnification, as they showed the highest rate of intra-observer agreement.

Two different designs of mini-screw assisted maxillary expanders, using FEM to analyse stress distribution in craniofacial structures and anchor teeth.

OBJECTIVE: The objective of this study was to analyse the displacement, strain, and stress distribution of various craniofacial structures after applying maxillary expansion with two different bone-borne Haas-inspired miniscrew-assisted maxillary expander (BB HIMAME) and bone-tooth-borne miniscrew-assisted rapid palatal expander (BTB MARPE) using three-dimensional finite element analysis (3D FEA). MATERIAL AND METHODS: two expanders including bone-anchored maxillary expander and bone tooth-borne were designed to simulate expansion in a 3D FEA. Expanders were activated transversely for 0.2mm. The stress distribution and displacement of various craniofacial structures and anchor teeth were calculated. RESULTS: The finding showed that the amount of stress in all sutures was greater in BB than BTB expander. The greatest stress was induced in the fronto-maxillary suture in the BB expander, which was 4.45MPa. While it was 0.7MPa in BTB. Anchor tooth showed tipping movement in BTB expander, although the crown and apex of the anchor tooth moved in the same direction with BB device. CONCLUSIONS: It is recommended that the BB expander is used when bodily movement of anchor tooth is needed. BTB may serve as an effective modality for cases with low-quality bone conditions. BTB appliance creates some extent of tipping on anchor teeth.

Three-dimensional assessment of airway volumes in patients with unilateral cleft lip and palate.

BACKGROUND: Considering the adverse consequences of respiratory insufficiency in cleft lip and palate (CLP) patients, this study aimed to assess the pharyngeal airway dimensions in 9-12-year-old patients with unilateral CLP. This historical cohort evaluated the cone-beam computed tomography (CBCT) scans of 30 patients with non-syndromic unilateral CLP between 9 and 12 years and 30 age- and sex-matched non-cleft controls. Three-dimensional (3D) images were reconstructed by the Mimics software, and the nasopharyngeal, oropharyngeal, and total airway volumes, as well as the minimal cross-sectional area of the airway (minAx), and posterior airway length (PAL) were all measured in the sagittal plane. Data were analyzed by the Student's t test. RESULTS: The oropharyngeal and the total airway volumes, as well as the minAx and PAL in CLP patients, were significantly smaller than the corresponding values in the control group (P < 0.05). Despite smaller nasopharyngeal airway volume in CLP patients than controls, this difference was not statistically significant (P > 0.05). CONCLUSIONS: Nine- to twelve-year-old non-syndromic unilateral CLP patients have smaller pharyngeal airway dimensions than non-cleft controls, and are therefore at higher risk of respiratory insufficiency.

The ideal insertion angle after immediate loading in Jeil, Storm, and Thunder miniscrews: A 3D-FEM study.

OBJECTIVE: The miniscrew is effectively used to provide additional anchorage for orthodontic purposes. The aim of this study was to identify an optimal insertion angle for Jeil, Storm, and Thunder miniscrews on stress distribution at the bone miniscrew interface. MATERIALS AND METHODS: To perform 3-dimensional finite element model analysis, a 3-dimensional model with a bone block was constructed with type D2 of bone quality, and with miniscrews of Storm, Thunder, Jeil, with the diameter of 2, 1.5. 1.6mm and length 15.9, 12.4, 14.4mm respectively. The miniscrews were inserted at 15° 30°, 45°, 60°, 75° and 90° to the bone surface. A simulated horizontal orthodontic force of 200 gram was applied to the centre of the miniscrews head in all models, and stress distribution and its magnitude were evaluated with a 3-dimensional finite element analysis program. RESULTS: In the cancellous bone, minimum stress was found at placement angles of 90° for Jeil and Storm, which was 0.37 and 0.39MPa respectively, and 15° for Thunder, which was 0.85MPa. The maximum von Mises stresses in the cancellous bone for Jeil was at 60°, which was 0.92MPa, and for Thunder at 90°, which was 1.3MPa. CONCLUSION: Each miniscrew has an ideal insertion angle, optimal insertion positions were found within 90° for Jeil and for Storm but 15° for Thunder. Clinical significance 3-dimensional finite element analysis confirmed that each miniscrew has an ideal insertion angle according to its characteristics.

The effect of Alexander, Gianelly, Roth, and MBT bracket systems on anterior retraction: a 3-dimensional finite element study.

OBJECTIVES: The aims of this study were to compare the effect of 4 bracket systems including Alexander, Roth, MBT, and Gianelly on upper anterior retraction and to quantify the amount of torque loss ratio in sliding mechanics by help of a 3-dimensional (3D) finite element method. METHOD AND MATERIALS: 3D FEM models were constructed in order to simulate anterior incisor retraction in first premolar extraction case. Displacement, stress, and strain on the incisal edge and apex of maxillary central incisor were calculated when 1-, 2-, and 3-N retraction forces were applied. Torque loss ratio was calculated by measuring the displacement of the teeth at crown tip and root apex in all 4 bracket systems on upper central incisor. RESULTS: Uncontrolled lingual crown tipping of the incisor was observed in all bracket systems. The crown moved lingually by 9.5 µm and the root labially by 4.5 µm in MBT system with 3-N retraction force. The amount of crown movement was 8 µm and the root displacement was 4 µm in Gianelly system with the same retraction force. Torque loss ratio was 1.46 in Alexander and Gianelly with 3-N retraction force. However, the amount of torque loss ratio was 1.47 in MBT and Roth with the same retraction force. CONCLUSIONS AND CLINICAL RELEVANCE: Uncontrolled tipping was the least in Gianelly and was the highest in MBT. The amount of torque loss ratio was the lowest in Gianelly and Alexander systems and the amount of torque loss ratio was the highest in MBT system.

3-dimensional finite element analysis of the outcomes of Alexander, Gianelly, Roth and MBT bracket prescription.

The purpose of this study was to compare the effect of a 4-bracket system including Alexander, Roth, MBT (Maxillary Transverse Bioadaptation), and Gianelly on the upper anterior tooth movement in sliding mechanics with the help of a 3-Dimensional (3D) Finite Element Method. METHODS: Displacement, stress, strain, centre of rotation and resistance on the incise edge and apex of the maxillary central incisor were calculated when 100, 200, 300, 400grams of retraction force were applied. RESULTS: The amount of incise edge displacement was 2.609×10-4mm 2.682×10-4mm 2.875×10-4mm and 2.881×10-4mm in Alexander, Gianelly, Roth and MBT respectively with 100gr of retraction force. The value of apex root movement was 3.485×10-4mm 3.547×10-4mm 3.852×10-4mm and 3.864×10-4mm in Alexander, Gianelly, Roth and MBT respectively with 400g of retraction force. CONCLUSIONS: The MBT system had the maximum apex root and incisal edge movement in all 100, 200, 300, 400grams of retraction force. The Alexander system had the lowest apex and incisal edge movement in all retraction forces.

Treatment decision in adult patients with class III malocclusion: surgery versus orthodontics.

BACKGROUND: One of the most controversial issues in treatment planning of class III malocclusion patients is the choice between orthodontic camouflage and orthognathic surgery. Our aim was to delineate diagnostic measures in borderline class III cases for choosing proper treatment. METHODS: The pretreatment lateral cephalograms of 65 patients exhibiting moderate skeletal class III were analyzed. The camouflage group comprised of 36 patients with the mean age of 23.5 (SD 4.8), and the surgery group comprised of 29 patients with the mean age of 24.8 years (SD 3.1). The camouflage treatment consisted of flaring of the upper incisors and retraction of the lower incisors, and the surgical group was corrected by setback of the mandible, maxillary advancement, or bimaxillary surgery. Mann-Whitney U test was used to compare the variables between the two groups. Stepwise discriminant analysis was applied to identify the dentoskeletal variables that best separate the groups. RESULTS: Holdaway H angle and Wits appraisal were able to differentiate between the patients suitable for orthodontic camouflage or surgical treatment. Cases with a Holdaway angle greater than 10.3° and Wits appraisal greater than - 5.8 mm would be treated successfully by camouflage, while those with a Holdaway angle of less than 10.3° and with Wits appraisal less than - 5.8 mm can be treated surgically. Based on this model, 81.5% of our patients were properly classified. CONCLUSIONS: Holdaway H angle and Wits appraisal can be used as a critical diagnostic parameter for determining the treatment modality in class III borderline cases.

Cephalometric changes in nasopharyngeal area after anterior maxillary segmental distraction versus Le Fort I osteotomy in patients with cleft lip and palate.

OBJECTIVE: The present study was designed to compare the effects of two surgical methods, anterior maxillary segmental distraction (AMSD) versus conventional Le Fort I osteotomy, on cephalometric changes of velopharyngeal area of patients with cleft lip and palate. MATERIALS AND METHODS: This study was conducted on 20 CLP in two groups. The first group had classic Le Fort I maxillary advancement and the second group had AMSD with a modified hyrax as an intraoral tooth-borne distractor. In the second group, 1 week after the surgery, activation of hyrax screw was started with the rate of 2 times a day for about 10 days. Initial and final lateral cephalograms were traced and analyzed by OrthoSurgerX software. RESULTS: The changes in variables evaluating velopharyngeal status showed a significant difference between the two groups. In Group A (conventional), the mean of nasopharyngeal area and Nasopharynx floor length showed a significant increase (P < 0.05) after the surgery, while in Group B (DO), the trend of changes was vice-versa. The changes in SNA, overjet, and soft-tissue convexity were similar in both groups. CONCLUSION: AMSD can improve facial profile, almost similar to the conventional Le Fort I advancement, while there is a significant decrease in nasopharyngeal; hereby there is no increase in the velopharyngeal sphincter.

Tooth-borne distraction osteogenesis versus conventional Le Fort I in maxillary advancement of cleft lip and palate patients.

BACKGROUND: Distraction osteogenesis (DO) is rapidly becoming a mainstream surgical technique for correction of maxillary deficiency. The aim of this study was to compare the effectiveness of a newly designed tooth-borne osteogenic distraction device with conventional Le Fort 1 osteotomy in maxillary advancement of cleft lip and palate patients. METHODS: The DO group consisted of 10 subjects (7 males, 3 females) with a mean age of 21.2 (SD 4.2) years. In these patients, the newly designed distraction device which exerted force anteroposteriorly was cemented after mobilization of the maxilla. After a latency period of 7 days, the distractor was activated twice daily by a total amount of 0.5 mm per day. The activation was continued for 3 weeks. After an 8-week consolidation period, the distraction appliance was removed. Cephalograms of DO patients were obtained at the start of distraction and at the end of consolidation. The Le Fort 1 group consisted of 11 subjects (6 males, 5 females) with a mean age of 22.3 (SD 3.7) years. Pre and postsurgery lateral cephalograms were obtained. t-test and paired t-test were used to evaluate the data. RESULTS: At the end of treatment, the SNA angle of Le Fort 1 patients increased by 5.5° (SD 2.3) (P<0.001) and the SNA angle of DO patients increased by 3.4° (SD 2) (P<0.001). CONCLUSIONS: Current evidence suggests that both conventional Le Fort 1 and tooth-borne osteogenic distraction device can effectively advance the maxilla forward in patients with cleft lip.

Family history and risk factors for cleft lip and palate patients and their associated anomalies.

BACKGROUND AND AIMS: Several environmental and genetic issues have been suspected as risk factors for oral clefts; and many studies have been conducted in this regard; however, large socioeconomic impacts of cleft lip and or palate (CL/P) justifies the need for further multifactorial researches. Current study aimed to assess parental risk factors for CL/P and its associated malformations. MATERIAL AND METHODS: Hospital records of 187 consecutive syndromic and non-syndromic children with cleft lip and or palate (103 boys and 84 girls) with a mean age of 1.7 (SD 2.2) years and 190 consecutive non-cleft children (103 boys and 87 girls) with a mean age of 2.8 (SD 2.2) years formed this study. Parental risk factors and abnormalities and physical problems and anomalies were evaluated in all subjects. RESULTS: Family history of clefts (OR 7.4; 95% CI), folic acid consumption (OR 7.3; 95% CI) and consanguineous marriage (OR 3.2; 95% CI) were quite strongly associated with increased risk of CL/P. In addition, all congenital abnormalities and physical problems had significantly higher incidence in CL/P patients. CONCLUSIONS: The findings of this study suggest that expecting mothers of consanguineous marriage and families with a history of CL/P should be extra cautious about the occurrence of CL/P.

Effect of Bionator and Farmand Appliance on the Treatment of Mandibular Deficiency in Prepubertal Stage.

OBJECTIVE: The present study aimed to compare dentoskeletal changes in mandibular-deficient patients treated with Bionator and Farmand appliances. METHODS: This study included 54 subjects treated for class II division I malocclusion. All subjects fulfilled the following criteria: ANB>5°, SNB<77°, and overjet >5 mm. The Bionator group consisted of 27 patients (15 girls, 12 boys) with the mean age of 11 (SD 1) years and the Farmand group consisted of 27 patients (17 girls, 10 boys) with the mean age of 11.1 (SD 1.4) years. Statistical analyses were performed using t-test, paired t-test, Wilcoxon, and Mann-Whitney test. RESULTS: In the Farmand group, SNB significantly increased from 74.3° (SD 1.7) to 77.6° (SD 2.3) and ANB decreased by 3.2° (SD 1.7) (p<0.001). In the Bionator group, SNB significantly increased from 75.5° (SD 0.9) to 79° (SD 0.9), and ANB decreased by 3.3° (SD 1.3) (p<0.001). The increase in IMPA showed that the lower incisors were significantly tipped using both appliances. T-test did not show any significant differences between the two groups. CONCLUSION: Despite the different designs of the appliances, both were successful in the treatment of class II division 1 malocclusion in mandibular-deficient patients.

In vivo confocal microscopy analysis of enamel defects after orthodontic treatment: A preliminary study.

After orthodontic treatment with fixed appliances, bonded brackets and residual adhesive must be removed. This procedure should lead to restitutio ad integrum of the enamel or, at least, restore the enamel surface as closely as possible to its pre-treatment conditions. The purpose of this study is the in vivo assessment at a microscopic resolution of enamel surfaces after bracket debonding while avoiding the tooth extraction. Nine orthodontic patients who had brackets removed at the conclusion of orthodontic treatment were enrolled. In vivo reflectance confocal microscopy imaging of dental enamel surface after debonding was performed for each patient. Eighteen upper incisors were analyzed, 10 in which the enamel demineralization appeared after the treatment and 8 in which the demineralization was present before the treatment. RCM analyses showed some speckled or roundish dark areas within the enamel. Moreover enamel alterations were detected at different levels of depth. The present in vivo microscopic study allowed for highlighting structural features in dental enamel, after debonding, at a microscopic resolution in real-time and in a non-invasive way, without the need for extraction or processing of the samples.

Orthodontic Treatment of Malocclusion and its Impact on Oral Health-Related Quality of Life.

OBJECTIVES: Malocclusion, though not life-threatening, has vast impact on individual's social interactions and self-esteem. Therefore, the aim of the current study was to assess whether orthodontic treatment of adolescents with malocclusion had any association with their oral health-related quality of life (OHRQoL). METHODS: The subjects for this study were recruited at a state-funded university clinic. Data were collected from 100 participants aged 17 to 21 with moderate to severe malocclusion. Experimental group comprised of 50 subjects who were in the retention phase of their orthodontic treatment and the control group comprised of 50 untreated subjects. The shortened version of the Oral Health Impacts Profile (OHIP-14) as used to assess the subjects' oral health-related impact. T-test, Kruskal-Wallis, and Mann Whitney tests were used to analyze the data and p-value was set at P < 0.05. RESULTS: In general, oral health-related quality of life of all subjects significantly improved after orthodontic treatment. (p<0.001) Subjects with moderate malocclusion showed better improvement than severe malocclusion subjects. (P<0.001). CONCLUSION: This study showed that oral health-related quality of life improves with the treatment of malocclusion.

Cleft sidedness and congenitally missing teeth in patients with cleft lip and palate patients.

BACKGROUND: The aim of this study was to investigate the prevalence of cleft sidedness, and the number of congenitally missing teeth in regard to cleft type and gender. METHODS: The charts, models, radiographs, and intraoral photographs of 201 cleft patients including 131 males with the mean age of 12.3 ± 4 years and 70 females with the mean age of 12.6 ± 3.9 years were used for the study. T test, Chi-square, and binomial tests were used for assessment of the data. RESULTS AND CONCLUSIONS: One hundred forty-eight of the subjects suffered from cleft lip and palate followed by 41 subjects who suffered from cleft lip and alveolus. Chi-square test did not show any significant difference between the genders. Binomial test showed that left-sided cleft was more predominant in unilateral cleft lip and palate patients (P < 0.001). This study also showed that the upper lateral incisors were the most commonly missing teeth in the cleft area.