A randomized clinical trial to assess the sagittal effects of Transforce transverse appliance (TTA) and NiTi palatal expander (NPE) on skeletal class II malocclusion in growing patients during retention phase - A cephalometric study using a historical control group.

OBJECTIVES: To evaluate and compare the skeletal changes during the retention period after expansion with "Transforce Transverse lingual or palatal Appliance®" (TTA) and "NiTi Palatal Expander®" (NPE) in growing subjects with class II division 1 malocclusion and to compare these changes with a matched historical control. SUBJECTS AND METHODS: A unicentric two arm, parallel randomized clinical trial with additional historical control group was conducted over a period of six years. The subjects in the age group of 9-13 years were screened and recruited as they reported. The inclusion criteria were: late mixed/early permanent dentition, class II or end on molar relationship, posterior transverse inter-arch discrepancy 4-8mm, overjet≥5mm, cephalometrically ANB>4° and CVMI stage CS2-CS3. Subjects were randomly allocated to two study groups (SG), TTA and NPE using block randomization. Appliances in both SG were managed and followed by a single clinician with equal standards of care. The lateral cephalograms in digital form were obtained at the beginning of the treatment (T1), post-expansion (T2) and after ten months retention period (T3). Linear positional change>1mm and angular change>0.75° were considered as a clinically significant change. Due to the ethical reasons a historical control of ten patients (CG) comparable to the SG for age and inclusion criteria was used to rule out the growth changes on serial lateral cephalograms. All Cephalometric measurements were done by a single operator blinded for the group allocation. Operator's measurement error was estimated. The study was single-blinded in regard to statistical analysis. Inter-group comparisons between SG were made by using an unpaired Student's t-test. ANOVA with post-hoc analysis was used for comparison among the study and control groups. RESULTS: A total of 36 subjects were recruited, 18 in each SG. Average time required to achieve the desired expansion in the TTA and NPE group was 13.6 weeks and 9.8 weeks respectively. The TTA group showed significant increase in SNB (1.54±0.33°) when compared with the control group (0.53±0.37°) and with the NPE group (0.74±0.29°) (P<0.0001). Significant differences were observed when post-retention changes in SNB, ANB, Wits appraisal, and N perpendicular to Pogonion, were compared among the three groups (ANOVA, P<0.0001). Tukey's multiple comparison showed that these mandibular sagittal changes were significantly greater in the TTA group than in NPE and the control group (P=<0.007, Bonferroni corrected value). CONCLUSION: Cephalometrically significant sagittal advancement of mandible took place after expansion with TTA and NPE compared to untreated control. TTA appears to be more efficient for the sagittal positional changes than the NPE. Additional studies with larger samples are warranted to elucidate individual variations in skeletal response to the expansion protocol with these appliances.

Awareness of Specialties of Dentistry among Medical Trainees and Teaching Faculty of Medical College in the Central West India.

OBJECTIVE: The purpose of this study was, to assess and create awareness of specialties of dentistry among medical trainees and teaching faculty. MATERIALS AND METHODS: Printed and validated questionnaires were given personally to a total sample of 180 patients, including 60 interns, 40 postgraduate (PG) trainees and 80 teaching staff of Government Medical College. Their responses were collected and the results were tabulated using Micro-Soft Excel 2010. Data obtained was analyzed using the GraphPad Prism 7 statistical software. To compare the responses between the study groups a Pearson's Chi-square test was used. RESULTS: About 96.11% of the sample replied that they are not aware of the different specialties of dentistry and 89.44% of the sample refers their patients to the general dentist without knowing the specialty. About 70% of the interns marked orthodontics as a specialty dealing with fractures of the jaw, whereas 82.5% of the PGs and 95% of the faculty advised referral of the fracture mandible case to the Oral and Maxillofacial Surgeon. Percentage of correct response for interns, PGS and staff, was 53.33%, 78.75%, and 92.34%, respectively (P ≤ 0.05). CONCLUSION: A large number of interns are not aware of the differences among the branches in Dentistry, specifically between orthodontics, oral-maxillofacial surgery, community dentistry, and Pedodontics. Many medical doctors have misbelief that all of their dental-related issues can be solved by the general dental practitioner. It is the present need to spread the awareness among the medical trainees and doctors about different subspecialties of dentistry to ensure proper referral practices of the dental patients they come across.

Early correction of unilateral scissor bite using transforce appliance and modified twin block appliance.

Early treatment of scissor bite has been advocated mainly to prevent function jaw shift that can eventually lead to permanent skeletal asymmetry and temporomandibular joint pathosis. Although unilateral scissor bite is more common, most of the times, bilateral mandibular expansion is indicated. Lingual transforce appliance can be useful in such cases. This article presents a patient with unilateral scissor bite in mixed dentition with alveolar narrowing. Transforce appliance was used for scissor bite correction followed by modified twin block appliance for stabilization and settling of occlusion till the eruption of premolars. The case was finished with fixed mechanotherapy. Two years after completion of treatment, results were well maintained. Our results suggest that lingual transforce appliance along with careful management of occlusion is effective in the early management of severe unilateral scissor bite.