Awareness and usage of mobile applications as an orthodontic diagnostic tool among Croatian orthodontic clinicians.

OBJECTIVE: To assess the impact of gender and orthodontic qualification length on the awareness, knowledge and usage of orthodontic diagnostic mobile applications, non-diagnostic mobile applications and social media platforms among orthodontic clinicians. DESIGN: Cross-sectional questionnaire-based study. SETTING: The Republic of Croatia. PARTICIPANTS: A total of 92 orthodontic specialists, members of the Croatian Dental Chamber. METHODS: This study was conducted using a questionnaire distributed via email to orthodontic clinicians between May and July 2022. RESULTS: In total, 92 respondents were divided into groups according to sex and median orthodontic qualification length: more recently qualified (MRQ) with ⩽12 years; and longer qualified (LQ) with >12 years. Nearly one-third of respondents did not have any prior knowledge of mobile applications used as an orthodontic diagnostic tool. MRQ respondents were more interested in using mobile apps as opposed to computer software for digital analysis (P < 0.05). This interest was in a negative correlation with orthodontic qualification length (P < 0.01) and was more prevalent among female respondents (P < 0.001). About one-third (32.6%) of respondents did not use non-diagnostic mobile applications and 44.6% did not use social media platforms. Nearly two-thirds (62%) of the respondents did not promote their work through social media. Male respondents and LQ promoted their work more frequently than others (P < 0.05). The usage of other mobile applications was in a positive correlation with the knowledge and awareness of orthodontic mobile applications (P < 0.05). CONCLUSION: Orthodontic clinicians lacked knowledge, awareness and the usage of orthodontic diagnostic mobile applications according to sex and orthodontic qualification length. One-third used non-diagnostic mobile applications and less than half used social platforms in daily clinical work.

Prevalence of Dental Anomalies in Orthodontic Patients.

Aim: The aim of this retrospective study was to determine the frequency of hypodontia, hyperdontia, invagination, impaction, dilacerations, peg-shaped lateral incisors, taurodontism and short or blunt and narrow or pipette-shaped roots in Croatian orthodontic patients. Material and methods: 506 orthopantomographs and study casts from 12-16 year-old orthodontic patients treated at the Department of Orthodontics, School of Dental Medicine University of Zagreb were analyzed. Results: At least one dental anomaly was present in 24.1% of patients, and more than anomaly in 1.2% of them. The frequency was not significantly different between genders. Hypodontia was the most frequent anomaly with the incidence of 7.5%, followed by teeth impaction with the incidence of 6.3%. Conclusion: The distribution and the prevalence of anomalies were similar to those described in the general Croatian population.

Knowledge and Attitude towards Orthodontic Treatment among Non-Orthodontic Specialists: An Online Survey in Croatia.

OBJECTIVES: The aim of this study was to examine the knowledge and attitudes towards orthodontic treatment among non-orthodontic specialists. METHODS: A web-based survey was formulated for non-orthodontic dental specialists to respond to statements regarding an orthodontic treatment. It contained 20 multiple-choice questions with three or more possible answers. Two hundred and fifty questionnaires were sent via email, with explanatory letters, to randomly selected non-orthodontic Croatian dental specialists. Data were assessed using IBAM SPSS 23.0. and p < 0.01 was considered significant. RESULTS: The results indicate that the majority of respondents were well informed about principles and practices in orthodontics. All the respondents (100%) were aware that malocclusions can affect a patient's facial aesthetic and masticatory function. The results also showed statistically significant differences in answers about contraindications for orthodontics therapy among different non-orthodontic specialists (p < 0.01). Private health practitioners were better informed about the ideal time for the first orthodontic appointment (74.2%) and that implants and periodontal problems are not contraindications for orthodontic treatment (over 70%), in comparison with public health practitioners. CONCLUSION: Non-orthodontic specialists in this sample exhibit encouraging awareness and knowledge of the principals and practices of orthodontic treatment. Additional improving of practitioners' knowledge and awareness can help patients with malocclusion to decide upon orthodontic treatment at earlier stages and avoid later complications in the future.

Oral Hygiene Behavior of Croatian Adolescents during Fixed Orthodontic Treatment: A Cross-sectional Study.

OBJECTIVE: To investigate the impact of fixed orthodontic treatment on adolescents' oral hygiene behavior and to examine their food consuption during fixed orthodontic treatment, as well as their motivation to maintain oral hygiene. MATERIALS AND METHODS: This research was carried out in a form of a survey questionnaire consisting of 23 questions. The sample comprised 170 adolescent patients aged from 11 to 19 who underwent the fixed orthodontic treatment at the Orthodontic Clinic of the Zagreb University Hospital Centre. RESULTS: The orthodontic appliance did not interfere with the patients' maintenance of oral hygiene, but it made the consumption of certain foods more difficult. Most adolescents brushed their teeth twice a day, using medium-soft brushes (35%). Regarding additional oral hygiene aids, 72.4% of the respondents used interdental brushes, more than 50% of the respondents used antiseptic mouthwashes for mouth rinsing, whereas only 31.2% of the tested population used dental floss (4.1% of which daily). The respondents were highly motivated to maintain oral hygiene by their orthodontists (96.5%), but only a small number of the respondents were informed about the importance of an adequate diet while undergoing a fixed orthodontic treatment. CONCLUSION: Orthodontists should provide their patients with detailed instructions on hygiene maintenance and adequate diet during orthodontic treatment to minimize negative side effects of the fixed orthodontic treatment. Patients should be motivated upon each follow-up examination and encouraged to use as many oral hygiene aids in their daily routines as possible.

Changes of bite force and occlusal contacts in the retention phase of orthodontic treatment: A controlled clinical trial.

INTRODUCTION: We aimed to determine whether appliance type affects changes in maximum voluntary bite force (MVBF) and the number of occlusal contacts (NOC) during retention, controlling for sex, age, and body mass index. METHODS: The sample comprised 176 examinees (70 male, 106 female) aged 14 to 20 years: 30 had maxillary and mandibular Essix retainers, 30 had wrap-around retainers, and 30 had a combination of fixed mandibular canine-to-canine retainers bonded on each tooth separately (double twisted, 0.254 mm in diameter, stainless steel ligature wire) and Essix retainer in the maxillary arch; 86 with normal occlusion were not treated. MVBF and the NOC were measured immediately after removal of preadjusted edgewise appliances (Roth prescription), 6 weeks after that, and after the next 4 weeks. RESULTS: Increases in MVBF and the NOC were demonstrated, but subjects with 2 Essix retainers showed lower values than did the others. Changes were related to type of appliance, sex, and age (P <0.05) but not to body mass index. The increase in NOC occurred faster than the increase of MVBF, more and sooner with the wrap-around retainer and in male subjects than with the Essix and in female subjects. MVBF and NOC nearly reached the values of the control subjects. CONCLUSIONS: Settling of the occlusion depends on appliance type: it takes longer in female patients and with Essix in both dental arches than with the other tested appliances.

Maximum voluntary molar bite force in subjects with normal occlusion.

The aims of this investigation were to determine whether stabilization of maximum voluntary bite force (MVBF) occurs between 15 and 18 years of age in subjects with a normal occlusion, and to assess the influence of gender, body mass index (BMI), morphological occlusion, and jaw function measured by the number of occlusal contacts, overjet, overbite, maximal mouth opening, mandibular deflection during opening, sagittal slide between the retruded contact position and the intercuspal position, and number of dental restorations. The sample comprised 60 Caucasian subjects aged 15 (15 males and 15 females) and 18 (14 males and 16 females) years with a neutral occlusion, balanced facial profile, and absence of a previous orthodontic history. Bite force measurements were undertaken using a portable occlusal force gauge on both the left and the right sides of the jaw in the first molar region during maximal clenching. Two independent samples t-tests and multiple regression were used for statistical analysis. MVBFs were age and gender related (P<0.05). Males showed a significant increase in bite force between 15 and 18 years of age (P=0.002), but gender differences were significant only in the 18-year-olds (P=0.003). In subjects with a neutral occlusion, MVBF could best be predicted using multiple regression from age and gender. The regression model accounted for 31.3 percent of the variance in MVBF (P=0.031), with gender contributing 17.9 percent and age 7.9 percent. Morphological occlusion, jaw function, and BMI explained the remaining 5.5 percent of variance. While controlling for all other parameters, the independent contribution of gender to the prediction of MVBF was 16.2 percent, age 6 percent, number of occlusal contacts 3.2 percent, and BMI 1.3 percent.

Analysis of the soft tissue profile in Croatians with normal occlusions and well-balanced faces.

The aim of the study was to test the hypothesis that there is no difference between the soft tissue profile of Croatian and white North American adults. Facial profile photographs were taken of 110 Croatians (52 males and 58 females) with normal occlusions and well-balanced faces (age 22-29 years). The findings were also compared with a white Brazilian group. An independent Student's t-test (P < 0.05) was used to compare the soft tissue parameters of Croatians with those of North Americans and to assess gender differences. The soft tissue profile measurements that showed significant gender dimorphism (P < 0.001) were the true vertical line [(TVL)-nasal tip (NT)] and TVL-point B, indicating that the males had slightly greater nasal prominence (mean difference: 1.32 mm) and deeper labial sulci (mean difference: 2.04 mm) compared with the females. The upper lip was the same for both genders (1.25 mm), while the lower lip was 0.97 mm more prominent in females than in males. All soft tissue variables, except TVL-NT showed significant differences between Croatian and white American female subjects (P = 0.096). For male subjects, nasolabial angle was the only variable that showed no statistically significant difference between the two populations. A universal standard of facial aesthetic is not applicable to diverse white populations. These differences should be considered in diagnosis and treatment planning for Croatians, together with their individual characteristics.

Dental and occlusal features in patients with palatally displaced maxillary canines.

The aim of the present study was to determine the dental and occlusal features that could contribute to the aetiology of palatally displaced canines (PDCs). The material consisted of pre-treatment dental casts of 50 patients (36 females and 14 males) with unilateral and bilateral PDCs aged 14-16 years (mean 15.6 +/- 1.6 years). These were compared with a control group of 50 treated subjects (25 males and 25 females) of the same age with normally erupted maxillary canines. The following parameters were measured on the dental casts: the mesiodistal (MD) and buccolingual (BL) width of each maxillary tooth, the maxillary interpremolar and intermolar widths, overjet and overbite, dentoalveolar arch relationship (based on incisor classification), and missing or anomalous teeth. The differences between the PDC group and controls were determined using a Student's t-test. P values less than 0.05 were considered significant. PDCs occurred most frequently in subjects with a Class I occlusion. Sixteen per cent of the PDC subjects had congenital absence or peg-shaped lateral incisors or congenital absence of the second premolar, demonstrating a clear association between palatal impaction of the maxillary canine and anomalous or congenital tooth absence. The overjet was significantly smaller in the PDC female subjects, especially in those with unilateral impaction (P < 0.05). Overbite was significantly greater in PDC male subjects compared with the controls, especially in bilateral impaction cases. There was no statistically significant difference between the groups with regard to the maxillary transverse dimensions, maxillary MD widths, or palatal height for either gender.

Type of archwire and level of acidity: effects on the release of metal ions from orthodontic appliances.

OBJECTIVE: To examine the effects of three different parameters-pH value, type of archwire, and length of immersion-on release of metal ions from orthodontic appliances. MATERIALS AND METHODS: Simulated fixed orthodontic appliances that corresponded to one-half of the maxillary arch were immersed in artificial saliva of different pH values (6.75 +/- 0.15 and 3.5 +/- 0.15) during a 28-day period. Three types of archwires were used: stainless steel (SS), nickel-titanium (NiTi), and thermo NiTi. The quantity of metal ions was determined with the use of a high-resolution mass spectrophotometer (HR-ICP/MS). RESULTS: The release of six different metal ions was observed: titanium (Ti), chromium (Cr), nickel (Ni), iron (Fe), copper (Cu), and zinc (Zn). Repeated measures statistical analysis of variance (ANOVA) was used. Results showed that (1) the appliances released measurable quantities of all ions examined; (2) the change in pH had a very strong effect (up to 100-fold) on the release of ions; and (3) the release of ions was dependent on wire composition, but it was not proportional to the content of metal in the wire. The largest number of ions was released during the first week of appliance immersion. CONCLUSION: Levels of released ions are sufficient to cause delayed allergic reactions. This must be taken into account when type of archwire is selected, especially in patients with hypersensitivity or compromised oral hygiene.

Presence of third molar germs in orthodontic patients with class II/2 and class III malocclusions.

The aim of this study was to determine the presence of third molar germs in patients with Class II/2 and Class III malocclusions. The study comprised 146 examinees from Zagreb and Istria. Examinees with Class II/2 malocclusions amounted to 77 and those with Class III 69. With regard to development of dentition the examinees were divided into two groups: Group I subjects with early mixed dentition (23 subjects with Class II/2 and 21 subjects with Class III), and Group II subjects with late mixed dentition (54 subjects with Class II/2 and 48 subjects with Class III). Assessments were made from panoramic radiographs and lateral cephalograms. The Pearson chi2-test and Fisher's exact test was used to determine statistical significance in differences. Assessments showed that third molar germs were present significantly more often in the upper jaw in Class II/2 (58% vs. 44%) and in the lower jaw in Class III (83% vs. 69%). In subjects with Class II/2 all third molar germs were present statistically more often in late mixed dentition, which was also determined for maxillary third molar germs in Class III. The presence of mandibular third molar germs in Class III examinees was almost equal in both periods of mixed dentitions. The study confirmed correlation between the presence of third molar germs and sagital maxillomandibular relationship and encourages investigation of the differences in calcifications of all permanent teeth in such malocclusions.

Teeth eruption in children with normal occlusion and malocclusion.

The aim of this study was to assess the differences in eruption of permanent teeth (C, P1, P2 and M2) in a group of children with and without malocclusion. A sample of 1758 children (921 boys and 837 girls), aged 8-13 was randomly selected. The subjects were grouped by chronological age (11 groups) and by presence of malocclusion. Statistically significant differences were found for both, upper and lower canines in the age group 11 (p<0.01). Statistically significant difference was found in the age group 8.5 for upper first (p<0.05), upper second premolars (p<0.01) in the age group 10, and the lower second premolars in the age group 11 (p<0.05). Premature loss of deciduous teeth caused early eruption of succedaneus permanent teeth, possibly leading to development of a malocclusion.

Soft tissue facial profile of normal dental and skeletal subjects in Croatian population aged 12 to 15 years.

This study was carried out on 40 lateral cephalograms of Croatian subjects aged 12 to 15 years with dental and skeletal class I. The purpose of this investigation was to determine the means and standard deviations of the soft tissue parameters in the sample of Croatian population exhibiting dental and skeletal class I and to find the correlations between investigated parameters. The investigation included a total of 11 variables of which 4 were angular and 7 linear. Linear and angular measurements were made to the nearest 0.5 mm or 0.5 degree with dial calipers and a standard protractor with 0.5 degree increments. Data from this investigation could serve to determine the norms of 11 soft tissue variables for Croatian population with dental and skeletal class I, and to define craniofacial morphology of the soft tissue profile in patients with normal occlusion. Significant correlations were found between thickness of upper and lower lip, and between the distance of upper and lower lip to the Ricketts esthetic line, and Holdaway angle.

Analysis of the soft tissue facial profile by means of angular measurements.

An aesthetically pleasing and balanced face is one of the objectives of orthodontic treatment. An understanding of the soft tissues and their normal ranges enables a treatment plan to be formulated to normalize the facial traits for a given individual. The aim of this study was to evaluate the variables defining the soft tissue facial profile of a Croatian (Caucasian) sample, by means of angular measurements typically used for aesthetic treatment goals. Additionally, gender differences were tested. The soft tissue facial profiles of 110 dental students (52 males and 58 females) between 23 and 28 years of age at the University of Zagreb, Croatia, with a dental Class I occlusal relationship and harmonious soft tissue profile were studied by means of standardized photographs taken in the natural head position (NHP). To compare males and females, a Student's t-test was used. The reliability of the method was analysed using Dahlberg's formula. There were distinct gender differences. All angles were larger in females: nasofrontal (G-N-Nd, females = 139.11 degrees; males 136.38 degrees; P = 0.030), nasolabial (Cm-Sn-Ls, females = 109.39 degrees; males = 105.42 degrees; P = 0.018), mentolabial (Li-Sm-Pg, females = 134.5 degrees; males = 129.26 degrees; P = 0.019), and nasal tip angle (N-Prn-Cm, female = 84.12 degrees; male = 79.85; P = 0.001). The greatest variability was found for mentolabial angle. The findings demonstrate a distinct profile trait for female Croatian patients compared with male subjects.

[Combined surgical-orthodontic therapy for compound odontoma]. / Kombinacija kirurske i ortodontske terapije rastavljeno slozenog odontoma (compound odontoma).

Odontogenic tumor is a rare condition in dental medicine that mostly proceeds unrecognized until the occurrence of clinical symptoms such as delayed eruption, or is incidentally detected on routine x-ray examination. The exact cause is not known, however, previous dental trauma and infection have been postulated as the potential factors in the development of odontogenic tumor. The earliest possible operative extirpation of the tumorous growth is recommended to eliminate permanent tooth impaction and to enable normal growth of the teeth. In some cases, corticotomy, including complete removal of the bony coat of the tooth, may be needed to additionally facilitate and precipitate its eruption. Orthodontic therapy is also of great importance in correct alignment of the teeth 'n the dental arch as well as in the management of other anomalies that may be associated with odontogenic tumor. A patient with compound odontoma is presented, along with the course of combined surgical-orthodontic therapy. The patient reported previous intrusion trauma that had occurred at the age of 4 years, which may have been the potential factor in the development of odontoma. In this case, there was a massive odontogenic tumor which had compromised the growth of permanent teeth, and the growth impulse was almost at the end since the patient was 11 years old and the apexes of the upper incisors were partially closed. The first operation included complete removal of the tumorous mass that had interrupted spontaneous eruption of the upper permanent incisors. It did not result in immediate spontaneous tooth eruption, so an additional operation was needed. The objective of the second operative procedure was complete removal of the covering bone over the unerupted upper permanent incisors in order to eliminate the physical barrier to tooth growth and eruption. The objective of fixed orthodontic therapy was full eruption of the partially erupted upper incisors. After 16 months, the upper incisors were regularly located in the dental arch. In this case, orthodontic therapy had another objective, i.e. to ensure rotation of the first upper premolar, to provide space for the upper permanent canine eruption and to establish regular intercuspidation after upper second premolar hypodontia. In colclusion, combined operative and orthodontic therapy can be recommended irrespective of the stage of the impacted tooth development because any treatment to precipitate tooth eruption has favorable effects. Impacted teeth should always be provided all treatment options for faster eruption, as demonstrated in our case where a good clinical result was achieved within 2.5 years. The role of regular clinical and x-ray controls for assessment of the impacted tooth eruption should also be emphasized.