Assessment of upper airway changes after interpositional arthroplasty: a cephalometric analysis.

This prospective cohort study examined the changes in airway area and soft tissue parameters following interpositional arthroplasty for temporomandibular joint (TMJ) ankylosis. Ten patients with TMJ ankylosis underwent surgery, and preoperative and postoperative skeletal and soft tissue measurements were obtained. A significant rise in soft tissue parameters was observed following surgery, although only minor changes in skeletal parameters were seen. The nasoropharyngeal area, oral area, soft palate area, and tongue area were examined. After the surgery, increases in values were observed in the nasoropharyngeal area (from 3482.4 mm2 to 3618.7 mm2), the oral area (from 2731.8 mm2 to 2840.8 mm2), the soft palate area (from 204.9 mm2 to 217.3 mm2), and the tongue area (from 2577.5 mm2 to 2600.8 mm2). These findings suggest that interpositional arthroplasty can improve airway area and soft tissue dimensions, affecting the stomatognathic system's aesthetic and functional aspects. Further research is needed to validate these results and assess long-term stability.

Evaluation of changes in tongue pressure with twin-block appliance therapy in growing Class II Div 1 malocclusion. An in vivo study.

INTRODUCTION: Twin-block appliance therapy in patients with Class II Div 1 malocclusion positions the mandible anteroinferior leading to possible alterations in tongue pressure, tongue length, and the oropharynx. OBJECTIVES: To evaluate the changes in tongue pressure, tongue length and dimension of the pharyngeal airway in Class II Division 1 subjects before and after twin-block therapy. MATERIALS AND METHODS: Twenty-four subjects were selected, in the range of 10-14 years (mean-12 years). The tongue pressure was recorded at three regions with sensors placed at the incisive papilla and bilaterally at the molar region of the palate for four minutes. The root mean square (RMS) values were recorded and used for further analysis. Evaluation of tongue length and pharyngeal airway dimension was done using a lateral cephalogram. All the measurements were done before and after twin-block appliance therapy. The paired t-test was performed to compare the changes. RESULTS: Resting tongue pressures decreased from pre-treatment levels to post-treatment at all three regions. Change in ANB angle was found to have a significant negative correlation with tongue length, and pharyngeal airway dimension, a significant positive correlation with pressure at incisive papilla and left molar region and no correlation at right molar region. CONCLUSION: There was a decrease in resting tongue pressure as the malocclusion was corrected from Class II to Class I. Hence, this decrease in pressure could be a contributory factor in the maintenance of the dental equilibrium as lighter forces exist in the oral cavity.

Correction of Class II malocclusion and soft tissue profile in an adult patient.

Treatment of Class II malocclusion in nongrowing individuals is a challenging situation for the clinician. Class II malocclusion with bialveolar protrusion often dictates premolar extractions with maximum anchorage. The present article describes the case of an adult female with skeletal Class II malocclusion, bimaxillary protrusion, increased overjet, deep bite, lip protrusion, everted lower lip, deep mentolabial sulcus, and lip incompetence. To correct the malocclusion, all four first premolars were extracted. Direct anchorage from miniscrews was used for retraction of the anterior segment. The mandibular buccal segment was protracted into the extraction space using Class II mechanics. Ideal Class I canine and molar relation were achieved in 24 months. There was a significant improvement in facial profile and smile esthetics of the patient.

Effects of adhesion promoter on orthodontic bonding in fluorosed teeth: A scanning electron microscopy study.

INTRODUCTION: The objectives of the present study were to elucidate the effects of fluorosis in orthodontic bonding and to evaluate the efficiency of an adhesion promoter (Assure Universal Bonding Resin) in bonding to fluorosed teeth. MATERIALS AND METHODS: Extracted premolars were divided into two groups on the basis of Thylstrup and Fejerskov Index. Ten samples from each group were etched and evaluated for etching patterns using scanning electron microscope (SEM). The remaining samples were subdivided into four groups of 20 each on the basis of adhesives used: IA, IIA - Transbond XT and IB, IIB - Transbond XT plus Assure Universal Bonding Resin. Shear bond strength (SBS) was measured after 24 h using the universal testing machine. Adhesive remnant index (ARI) scores were recorded using SEM. Statistical analysis was conducted using a two-way analysis of variance, and Tukey's post hoc test was performed on SBS and ARI scores. RESULTS: Similar etching patterns were observed in both fluorosed and nonfluorosed teeth. No significant differences were found in the SBS values observed in both groups (8.66 ± 3.19 vs. 8.53 ± 3.44, P = 1.000). Increase in SBS was observed when Assure Universal Bonding Resin was used. Higher ARI scores were observed when adhesion promoter was used for bonding. CONCLUSIONS: Mild-moderately fluorosed teeth etch in a manner similar to the nonfluorosed teeth. Similar bond strengths were achieved in fluorosed and nonfluorosed teeth when conventional composite was used. Use of adhesion promoter increases the bond strengths in both groups of teeth.

Orthodontic management of a borderline case with ectopic maxillary canine by unilateral premolar extractions.

Management of orthodontic cases often requires extraction of permanent teeth. The decision making regarding extractions depends upon the arch length tooth material discrepancies, the growth pattern, general profile, and arch asymmetries. Unique orthodontic problems may command special treatment lines to be taken. The present report describes a case with unilateral buccally blocked out canine and bilateral posterior crossbite, for which unilateral premolar extractions were performed achieve esthetic and functionally stable occlusion.

Early treatment of Class III malocclusion by RME and modified Tandem appliance.

Patients with a skeletal Class III malocclusion and maxillary deficiency can be treated successfully using a combined protraction facemask and alternate rapid maxillary expansions and contractions (Alt-RAMEC). However, due to poor patient compliance during facemask therapy there has been growing interest in intraoral appliances for correcting Class III malocclusion. The tandem traction bow appliance (TTBA) is an intraoral appliance which has been used successfully for the treatment of growing Class III patients. This case report describes the management of a 10-year-old boy with a Class III malocclusion and maxillary deficiency treated with modified TTBA appliance.

An interdisciplinary management of severely resorbed maxillary anterior ridge complicated by traumatic bite using a ridge splitting technique.

Injury to the teeth and alveolar ridge of the maxillary anterior region due to trauma can cause severe alveolar ridge deficiency. Ridge augmentation is a valuable periodontal plastic surgical method for the correction of ridge defects for esthetic purpose. Although ridge augmentation can help to restore the ridge volume, the grafting procedures can significantly increase the patient morbidity, treatment time, and the cost. Among the ridge augmentation techniques, the ridge split procedure demonstrates many benefits such as no need for donor site, the rare risk of damage to underlying anatomical structures, less pain, and swelling. This case report presents a vertical split technique for increasing the bone volume. There was a remarkable healing and significant increase in bone volume. We have followed the case for 6 months.

Effect of acid etching on bond strength of nanoionomer as an orthodontic bonding adhesive.

AIMS: A new Resin Modified Glass Ionomer Cement known as nanoionomer containing nanofillers of fluoroaluminosilicate glass and nanofiller 'clusters' has been introduced. An in-vitro study aimed at evaluating shear bond strength (SBS) and adhesive remnant index (ARI) of nanoionomer under etching/unetched condition for use as an orthodontic bonding agent. MATERIAL AND METHODS: A total of 75 extracted premolars were used, which were divided into three equal groups of 25 each: 1-Conventional adhesive (Enlight Light Cure, SDS, Ormco, CA, USA) was used after and etching with 37% phosphoric acid for 30 s, followed by Ortho Solo application 2-nanoionomer (Ketac(™) N100, 3M, ESPE, St. Paul, MN, USA) was used after etching with 37% phosphoric acid for 30 s 3-nanoionomer was used without etching. The SBS testing was performed using a digital universal testing machine (UTM-G-410B, Shanta Engineering). Evaluation of ARI was done using scanning electron microscopy. The SBS were compared using ANOVA with post-hoc Tukey test for intergroup comparisons and ARI scores were compared with Chi-square test. RESULTS: ANOVA (SBS, F = 104.75) and Chi-square (ARI, Chi-square = 30.71) tests revealed significant differences between groups (P < 0.01). The mean (SD) SBS achieved with conventional light cure adhesive was significantly higher (P < 0.05) (10.59 ± 2.03 Mpa, 95% CI, 9.74-11.41) than the nanoionomer groups (unetched 4.13 ± 0.88 Mpa, 95% CI, 3.79-4.47 and etched 9.32 ± 1.87 Mpa, 95% CI, 8.58-10.06). However, nanoionomer with etching, registered SBS in the clinically acceptable range of 5.9-7.8 MPa, as suggested by Reynolds (1975). The nanoionomer groups gave significantly lower ARI values than the conventional adhesive group. CONCLUSION: Based on this in-vitro study, nanoionomer with etching can be successfully used as an orthodontic bonding agent leaving less adhesive remnant on enamel surface, making cleaning easier. However, in-vivo studies are needed to confirm the validity of present findings.

Soft tissue airway dimensions and craniocervical posture in subjects with different growth patterns.

OBJECTIVE: To compare the dimensions of the nasopharynx and oropharynx of subjects with different growth patterns and to determine whether any correlation exists with their craniocervical posture. MATERIALS AND METHODS: Cephalometric radiograph of 60 subjects (16-25 years old), taken in natural head position, were divided into three groups according to the mandibular plane angle: hypodivergent (SN/MP <26°), normodivergent (SN/MP 26°-38°), and hyperdivergent (SN/MP <38°). Correlations were calculated between nasopharyngeal area, oropharyngeal area, and craniocervical posture. Continuous variables were compared by one-way analysis of variance, and the significance of mean difference between the groups was done by the Tukey post hoc test. A value of P < .05 was considered statistically significant. RESULTS: Patients in the hyperdivergent group were found to have significantly smaller nasopharyngeal and oropharyngeal areas than the other groups (P < .001 and P < .05, respectively). Similarly, the oropharyngeal area in the normodivergent group was significantly smaller than that in the hypodivergent group (P < .05). However, no significant differences were found in the nasopharyngeal area between the hypodivergent and normodivergent groups and between the hyperdivergent and normodivergent groups (P > .05). Reduced pharyngeal airways were typically seen in patients with a large craniocervical angle and a large mandibular inclination. CONCLUSIONS: Smaller nasopharyngeal and oropharyngeal airways were seen in connection with a large craniocervical and a large mandibular inclination. We therefore suggest that the vertical skeletal pattern may be one of the factors that contribute to nasopharyngeal and oropharyngeal obstruction.

Long term dento-facial effects of radiotherapy in a treated patient of retinoblastoma.

Newer cancer treatment modalities have increased patient survival rate and longevity. Craniofacial and dental abnormalities occurring after radiation therapy and surgery in cancer patients may lead to severe cosmetic or functional sequelae, which may require surgical or orthodontic intervention later on. We, present a case; who was treated for retinoblastoma with enucleation of left eye and external beam radiotherapy at 26 months of age. As a result of radiotherapy there was hypoplasia of the maxilla. This case validates Von-Limborg's theory that states that local epigenetic factor like the developing eye has an important influence on the growth of adjacent structures, as with this patient there was hypoplasia of left orbit. Certain dental anomalies were also seen in the maxillary arch.

Acute gingival bleeding as a complication of dengue hemorrhagic fever.

Dengue fever is mosquito borne disease caused by dengue virus (DENV) of Flaviviridae family. The clinical manifestations range from fever to severe hemorrhage, shock and death. Here, we report a case of 20-year-old male patient undergoing orthodontic treatment presenting with acute gingival bleeding with a history of fever, weakness, backache, retro orbital pain and ecchymosis over his right arm. The hematological investigations revealed anemia, thrombocytopenia and positive dengue non-structural protein-1 antigen and also positive immunoglobulin M and immunoglobulin G antibodies for DENV. Patient was diagnosed as a case of dengue hemorrhagic fever and was immediately referred for appropriate management. This case report emphasizes the importance of taking correct and thorough medical history.

Neuromuscular dentistry: Occlusal diseases and posture.

Neuromuscular dentistry has been a controversial topic in the field of dentistry and still remains debatable. The issue of good occlusion and sound health has been repeatedly discussed. Sometimes we get complains of sensitive teeth and sometimes of tired facial muscles on getting up in the morning. Owing to the intimate relation of masticatory apparatus with the cranium and cervico-scapular muscular system, the disorders in any system, draw attention from concerned clinicians involved in management, to develop an integrated treatment protocol for the suffering patients. There may be patients reporting to the dental clinics after an occlusal restoration or extraction, having pain in or around the temporomandibular joint, headache or neck pain. Although their esthetic demands must not be undermined during the course of treatment plan, whenever dental treatment of any sort is planned, occlusion/bite should be given prime importance. Very few dentist are able to diagnose the occlusal disease and of those who diagnose many people resort to aggressive treatment modalities. This paper aims to report the signs of occlusal disease, and discuss their association with TMDs and posture.

Soft tissue cephalometric analysis applied to regional Indian population.

INTRODUCTION: Importance of soft tissue consideration in establishing treatment goals for orthodontics and orthognathic surgery has been recognized and various cephalometric analysis incorporating soft tissue parameters have evolved. The great variance in soft tissue drape of the human face and perception of esthetics exists and normative data based on one population group cannot be applied to all. The study was conducted to compare the standard soft tissue cephalometric analysis (STCA) norms with norms derived for population of western Uttar Pradesh region of India. MATERIALS AND METHODS: The sample consisted of lateral cephalograms taken in natural head position of 33 normal subjects (16 males, 17 females). The cephalograms were analyzed with soft tissue cephalometric analysis for orthodontic diagnosis and treatment planning, and the Student's t test was used to compare the difference in means between study population and standard STCA norms. RESULTS: Compared with established STCA norms, females in our study had steeper maxillary occlusal plane, more proclined mandibular incisors, and less protrusive lips. Both males and females showed an overall decrease in facial lengths, less prominent midface and mandibular structures and more convex profile compared with established norms for the White population. CONCLUSIONS: Statistically significant differences were found in certain key parameters of STCA for western Uttar Pradesh population when compared with established norms.

Recent advances in the management of obstructive sleep apnea: The dental perspective.

Obstructive sleep apnea (OSA) is common in adult population. OSA shows detrimental effects on health, neuropsychological development, quality-of-life, and economic potential and now it is recognized as a public health problem. Despite the availability of expanded therapeutic options, polysomnography and nasal continuous positive airway pressure (CPAP) are the gold standards for the diagnosis and treatment for OSA. Recently, American Academy of Sleep Medicine has recommended oral appliances for OSA. Hence the therapeutic interventions that are directed at the site of airway obstruction in the maxillofacial region are within the scope of dentistry. Treatment of OSA can improve vitality, social and daytime functioning, family life and mental health of a person and hence the quality-of-life. Obesity is the main predisposing factor for OSA. Other than obesity, craniofacial abnormalities such as micrognathia and retrognathia, age, ethnic background and genetic predisposition, consumption of alcohol, smoking, and sedatives may also predispose to OSA. Treatment modalities for OSA are behavior modification, diet and medication, CPAP devices, surgical (maxillo-mandibular advancement surgery), and oral appliances. Treatment of a patient with OSA not only improves the physical health of the patients but also the mental and social well-being.

Computed Tomography Evaluation of Craniomandibular Articulation in Class II Division 1 Malocclusion and Class I Normal Occlusion Subjects in North Indian Population.

Objective. The purpose of this study is to investigate the Craniomandibular articulation morphology and position of condyle in mandibular fossae in Angle's class I normal occlusion and Angle's class II division 1 malocclusion. Materials and Methods. The present study was conducted on 40 subjects with 20 subjects in each group, and the computed tomography images were obtained using spiral computed tomography technique. Each measurement was compared by two-factor analysis of variance (ANOVA) while changes in anterior and posterior joint spaces were done by paired t-test. Results. Statistically significant anterior positioning of condyle (P > 0.05) was observed in class I normal malocclusion, and it was significant only on right side in class II division 1 malocclusion. Conclusions. There was no difference found in the condylar process and joint morphology between right and left sides of both Angle's Class I normal occlusion and Angle's class II division 1 malocclusion. Evaluation of the position of the condyles in their respective mandibular fossae showed concentric position with a tendency towards anterior positioning for both right and left sides of the subjects with Angle's Class I normal occlusion as well as subjects with Angle's class II division 1 malocclusion.

Periodontal ligament distraction: A simplified approach for rapid canine retraction.

Distraction osteogenesis is a method of inducing new bone formation by applying mechanical strains on preexisting bone. The process of osteogenesis in the periodontal ligament during orthodontic tooth movement is similar to the osteogenesis in the midpalatal suture during rapid palatal expansion. A new concept of "distracting the periodontal ligament" is proposed to elicit rapid canine retraction in two weeks. At the time of first premolar extraction, the interseptal bone distal to the canine was undermined with a bone bur, grooving vertically inside the extraction socket along the buccal and lingual sides and extending obliquely toward the socket base. Then, a tooth-borne, custom-made, intraoral distraction device was placed to distract the canine distally into the extraction space. It was activated 0.5 mm/day, immediately after the extraction. Canine was distracted 6.5 mm into the extraction space within two weeks.

Natural head position: key position for radiographic and photographic analysis and research of craniofacial complex.

The Frankfort horizontal is a useful compromise for studying skulls but not for orienting the natural head position (NHP) in the living because it is normally distributed around a true extracranial horizontal. Nonetheless, orthodontists dealing with living subjects, rather than inert crania, have used this Frankfort horizontal faithfully in cephalometry. Because the cant or inclination of all intracranial reference lines is subjected to biologic variation, they are unsuitable for meaningful cephalometric analysis. Registration of head posture in its natural position has the advantage that an extracranial vertical or a horizontal perpendicular to that vertical can be used as reference line for cephalometric analysis. Purpose of this paper is to provide an updated review of various methods to reproduce and record the NHP.

Laser in dentistry: An innovative tool in modern dental practice.

The term LASER is an acronym for 'Light Amplification by the Stimulated Emission of Radiation'. As its first application in dentistry by Miaman, in 1960, the laser has seen various hard and soft tissue applications. In the last two decades, there has been an explosion of research studies in laser application. In hard tissue application, the laser is used for caries prevention, bleaching, restorative removal and curing, cavity preparation, dentinal hypersensitivity, growth modulation and for diagnostic purposes, whereas soft tissue application includes wound healing, removal of hyperplastic tissue to uncovering of impacted or partially erupted tooth, photodynamic therapy for malignancies, photostimulation of herpetic lesion. Use of the laser proved to be an effective tool to increase efficiency, specificity, ease, and cost and comfort of the dental treatment.