Evaluation of Dimensional Changes in Maxillary and Frontal Sinus in Adult Patients With Anterior Open Bite and Normal Overbite: A Retrospective Cone Beam Computed Tomography (CBCT) Study.

INTRODUCTION: An anterior open bite is a form of vertical discrepancy that presents as a lack of contact between maxillary and mandibular segments. The treatment modalities usually involve either intrusion of posterior teeth or extrusion of anterior or a combination of both. The anatomical relationship between the apex of the maxillary molar roots to the inferior wall of the maxillary sinus floor is crucial in planning posterior intrusion. The paranasal sinuses influence the growth of the facial structures that eventually get altered in various malocclusions. Studies have proven that the height of the sinus gets modified in anterior open bite owing to pneumatization. This study aims to evaluate the distance from the root apex of maxillary first molars (mesiobuccal, distobuccal, and palatal roots) to the maxillary sinus floor to evaluate the significance of the vertical pneumatization of the sinus on planning for true intrusion in anterior open bite and to assess the correlation between frontal and maxillary sinuses in an anterior open bite. METHODS: This retrospective study evaluated 30 pre-treatment cone beam computed tomographies (CBCTs) of patients out of which 15 were with anterior open bite and 15 with ideal overbite. Linear measurements were carried out using care stream software in CBCTs. RESULTS: There was a significant correlation between the distance of the palatal root and the distobuccal root of the maxillary first molar to the maxillary sinus floor bilaterally in the anterior open bite (p<0.04). A significant moderate positive correlation of the maxillary and frontal sinus height in anterior open bite (p<0.006). A significant moderate negative correlation between the distance from the palatal root to the maxillary sinus floor and maxillary sinus height in anterior open bite (p<0.001). CONCLUSION: Vertical pneumatisation of the maxillary sinus has caused a significant negative correlation between the apex of the palatal root of the maxillary first molar tooth and the maxillary sinus floor in the anterior open bite. The palatal root being the closest to the sinus floor, and the distobuccal root being second nearest. There is a significant correlation between the height of the sinuses in the anterior open bite.

Microleakage Under Orthodontic Brackets Bonded Using a Conventional Adhesive System, Nanocomposites, and Nanoionomers: A Comparative Study.

Background Microleakage under orthodontic brackets has a role in early bracket debonding and white spot lesions due to the ingress of oral fluids in the bracket-adhesive-tooth interface. This in vitro study aimed to evaluate and compare the microleakage under orthodontic brackets bonded with the conventional adhesive system, nanocomposites, and nanoionomers. Materials and methods Forty-five human premolars were extracted for therapeutic reasons and collected for this study. Teeth were randomly assigned to three groups: Group A: conventional etching with conventional adhesive, Group B: conventional etching with nanocomposite, and Group C: conventional etching with nanoionomer. Stainless steel premolar brackets were used for bonding. After thermocycling, the extracted teeth were submerged in a 0.5% solution of basic fuchsine for 24 hours. They were then cut longitudinally. A stereomicroscope was used to assess microleakage along the occlusal and gingival interfaces. Results To compare the microleakage scores between gingival and occlusal aspects within each group, the student's t-test was performed. Analysis of variance (ANOVA) and the post-hoc Tukey test were applied to the data for intergroup comparison of microleakage scores. On comparing the microleakage scores, the gingival side of interfaces depicted higher microleakage than the occlusal side gingival side across all groups, demonstrating statistically significant results (P <0.05).On intergroup comparison, the occlusal bracket adhesive interface and gingival tooth adhesive interface revealed significantly higher microleakage values for Group B followed by Group C with Group A the least. However, there was no significant difference in the microleakage scores between Group B and Group C on intergroup comparison of mean microleakage scores (P <0.05). Conclusion The gingival side showed higher microleakage scores than the occlusal side. Nanoionomers showed microleakage values higher than the Transbond XT but lower than nanocomposites. Based on the results of the present study, in terms of microleakage, Transbond XT demonstrated lower microleakage when compared to nanoionomers and nanocomposites.

Intraoral volume changes in relation to the hard tissue shape changes in asymmetric patients before and after orthognathic surgery - A retrospective CT study.

OBJECTIVES: To evaluate Intraoral volume changes in relation to the hard tissue shape changes in asymmetric patients before and after orthognathic surgery and establish a correlation between them. MATERIALS AND METHODS: A retrospective study which evaluated 12 asymmetric patients' pre and post-surgical CT records satisfying the inclusion criteria. Borders were defined for the measurement of extraoral, intraoral and tongue volume. The volume assessment was carried out using software from 3D SYSTEMS, Colorado, US, Version 1.0.2.2055. RESULTS: Predicting changes in volume between extra-oral, intra-oral spaces and tongue, Linear regression modeling of the data revealed that for every mm3 change in post-surgical extra-oral volume the post-surgical intra-oral volume decreased by 0.684 mm3 and for every mm3 change in post-surgical intra-oral volume, the post-surgical tongue volume increased by 0.728 mm3. CONCLUSIONS: Significant decrease in the extra-oral volume, Intra-oral volume and tongue volume was evident after orthognathic surgery in patients with facial asymmetry. This volumetric approach sheds insight into achieving a muscular equilibrium between intraoral and extraoral structures, which would improve orofacial function and enhance facial aesthetics.

Evaluating the Plantar Pressure Loading and Its Correlation to Craniocervical Posture in Subjects With Skeletal Class II Malocclusion Before and After Surgical Mandibular Advancement.

Class II malocclusion is one of the most prevalent types of malocclusions following Class I. The most typical postural features observed in Class II patients are extended craniocervical posture, cervical lordosis, and increased forward loading away from the body's centre of mass for compensating the mandibular deficiency and reduced airway. Its treatment involves orthodontic, functional, and orthognathic surgery. The type of treatment regimen opted for depends upon the age, severity of malocclusion, and need of the patient. Thus, appropriate intervention brings about improvement in dentition along with an overall enhancement of the body posture and plantar loading. These variables undergo a significant change whenever there is a change in the maxillomandibular relationship. The main aim of this paper is to correlate the variation in the craniocervical angulation to the plantar pressure distribution during various phases of orthodontic treatment and bilateral sagittal split osteotomy (BSSO) advancement surgery. The craniocervical angulations were determined from the lateral cephalograms of the patients using cephalometric variables and the plantar pressure was estimated using a digital quanpressurometer device (designed and patented in India by Meenakshi Academy of Higher Education and Research; patent number 390136) at each phase, i.e., during pre-treatment, pre-surgery, post-surgery, post-treatment intervals. The outcome of this study indicated that there was a significant change in the craniocervical angulation and the plantar pressure distribution pattern of the subjects before and after orthognathic surgery and it remained constant for six months after orthognathic surgery. The limitation of the study was the limited sample size. This study reveals that there was an improvement in the craniocervical angulation and plantar pressure distribution during the course of orthodontic decompensation and orthognathic surgical treatment, thus bringing about change in the individual's overall body posture and their plantar loading pattern after orthognathic surgery. Therefore, the change in the stomatognathic system by orthodontic and orthognathic treatment influences the overall muscular and functional balance of an individual thereby improving their attitude and lifestyle.

Evaluation of pharyngeal airway volume three-dimensionally in various sagittal skeletal patterns - Systematic review.

To investigate the pharyngeal airway volume in different anteroposterior skeletal malocclusions. This study was prepared according to the Cochrane criteria for creating a systematic review and meta-analysis and confirms the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. This search was conducted to answer the patient/population, intervention, comparison and outcomes (PICO) question: To evaluate (outcome) and compare (comparison) whether there is a difference in airway volume in patients (participants) with different skeletal malocclusions diagnosed using 3D data (intervention).The first two authors extracted the data from the included studies and assessed the risk of bias in the individual studies using the Newcastle-Ottawa scale. Meta-analysis was done using STATA version 16, which compared various three-dimensional pharyngeal airway parameters in skeletal Class II and skeletal Class III malocclusions with that of skeletal class I malocclusion. Out of 370 articles from the initial search, 17 articles were included in the systematic review. Out of 17 studies, 12 eligible studies were included in the quantitative synthesis. The nasopharynx, oropharynx, hypopharynx, and total airway volume were increased in skeletal Class I malocclusion compared to that of skeletal Class II malocclusion and decreased in comparison to skeletal Class III malocclusion. The moderate quality of evidence indicates the total airway volume, oropharynx, and hypopharynx are largest in skeletal Class III compared to Class I and Class II skeletal malocclusion.

Comparison of Occlusal Digital Analysis Using T-Scan in Orthognathic Surgery with Only Conventional Orthodontic Patients.

Aim and Objectives: The aims of this study were to compare the changes in occlusal parameters, TMJ status clinically in patients after the completion of orthognathic surgery, and patients undergoing only orthodontic treatment and with patients having normal occlusion, using T-Scan. Methodology: This prospective controlled clinical trial, consisting of three groups with a sample size of twelve. Group 1 consisted of patients who underwent orthognathic surgery and orthodontic treatment. Group 2 consists of patients who underwent only orthodontic treatment (camouflage). Clinical examination of the patient (TMJ and Occlusal status) and T-Scan was performed at the time of debonding of the orthodontic brackets, 6 months and 1-year after first evaluation for group 1 and 2 patients. Results: The collected data between groups are compared and interpreted. The statistical analysis was performed using STATA/IC version 16.1 statistical software. Intragroup comparison for the study variables occlusion time, disocclusion time and maximum bite force between different time periods (T1, T2, T3) for all the three intervention groups using repeated measures. Hypothesis testing for maximum bite force, occlusion time and disocclusion time in orthognathic group (Group 1) as compared to orthodontic group (Group 2) for three different time periods using repeated measures ANOVA and Bonferroni test showed P value < 0.05 which is statistically significant. Conclusion: In conclusion, evaluation of occlusion using T-Scan give us an insight of the discrepancies in occlusion which is useful during pre-operative planning and especially in the post-operative follow-up period during the retention phase. Examination of TMJ in these patients at various intervals is necessary as any minor occlusal disturbances may lead to TMJ disorders.

Surgical Camouflage as a Solution for Complete Decompensating Failures: An Interesting Experience With Class III Case Scenarios.

Dental compensations are an integral part of skeletal malocclusions. Failure to achieve optimal decompensation may lead to compromised surgical movements, thereby resulting in sub-optimal occlusion and soft tissue profile. Hence the mandibular subapical osteotomy was chosen as a minimalistic surgical alternative to the traditional combination of Le Fort 1 and bilateral sagittal split osteotomy. The choice was made by prioritizing soft tissue considerations, which offered the probability of a better post-treatment outcome. This paper highlights two such challenging case scenarios where the surgical plan was modified in accordance with the soft tissue as the primary objective.

Multi-disciplinary orthodontic camouflage treatment of a severe skeletal class III malocclusion with 1 year follow-up - A case report.

Rationale: Orthodontic camouflage serves its purpose in treating mild to moderate skeletal dysplasia and in conditions where the patient is reluctant to opt for orthognathic surgery or when it is contraindicated. Patient Concerns: A 22-year-old male was concerned about his irregular teeth. Diagnosis: Angle's dentoalveolar class III malocclusion on class III skeletal on an average mandibular plane angle with anterior crossbite, deep bite, crowding in maxillary and mandibular anteriors, proclined maxillary anteriors and retroclined mandibular anteriors with reverse overjet and congenitally missing 12, 22, palatally impacted 13 and retained deciduous 63 and palatally placed 23. Treatment: Orthodontic camouflage with a multi-disciplinary approach. Outcome: Optimal functional and dentofacial aesthetics were achieved by 22 months. Take-Away Lesson: The limitations of camouflage must be kept in mind and explained to the patient. The biomechanics need to be customized and integrating different specialties helps maximize the treatment benefits.

Surgery-First Approach: A Boon for Periodontally Compromised Patients - A Case Report.

The Rationale: The surgery-first approach (SFA) has revolutionized orthognathic surgery in recent years and in trend because it addresses the dentofacial abnormalities first, making the patient compliant and outcome more predictable. Patient Concerns: A 22-year-old female was concerned about her forwardly placed teeth. Diagnosis: She had a compromised periodontium with a skeletal Class II malocclusion and dental malocclusion. Treatment: A SFA plan was executed with the extraction of all first premolars followed by postsurgical orthodontic treatment. Outcomes: Optimal functional and dentofacial esthetics were achieved by 11 months. Take-away Lessons: Research has attributed several advantages of SFA over the conventional triphasic approach, which has proven to be beneficial in periodontally compromised individuals as it intends to relieve any traumatic occlusion primarily by stabilizing tissue integrity. It is most favorable in patients seeking a quick transformation with the least possible duration.

Evaluation of volume change in oral cavity proper before and after mandibular advancement.

OBJECTIVES: To evaluate the tongue and oral cavity proper volume in pre- and post-bilateral sagittal split osteotomy (BSSO) patients, and to establish whether there was a correlation between them. MATERIALS AND METHODS: A retrospective study that evaluated 12 patients' pre- and post-surgical computed tomography records satisfying the inclusion criteria. Borders were defined for measurement of tongue and oral cavity proper volume. The volume assessment was carried out using 3D slice software. RESULTS: The mean difference of tongue volume was 5.7 ± 1.7 cm3, which showed high statistical significance. The mean difference of oral cavity proper volume (OCVP) was 6.9 ± 3.4 cm3 and indicated high statistical significance. A very strong positive correlation existed between pre- and post-surgical tongue volume. Positive correlation was also evident between pre and post - surgical OCVP. Medium positive correlation was noted when the difference between pre- and post-surgical tongue and OCVP were assessed. CONCLUSIONS: There was a significant change in volume of tongue and oral cavity proper after BSSO advancement surgery. The space around the tongue, position of tongue, and maxillary and mandibular relationship influence the volume of tongue and oral cavity proper.

Management of supraerupted maxillary molars in an adult patient using orthodontic miniscrew implants: A pre-prosthodontic therapy.

The sequelae of chronic edentulous space is the supraeruption of the opposing teeth which hinders prosthodontic replacement. Molar intrusion of overerupted teeth can be done using miniscrew implants which serves as a promising technique, especially in adult patients. This case report highlights pre-prosthodontic therapy by pure molar intrusion using Temporary Anchorage Device (TAD) in an adult patient seeking prosthesis to enhance chewing efficiency.

An Interdisciplinary Management of Severe Facial Asymmetry Due to Hemifacial Microsomia.

This case report outlines the importance of an interdisciplinary approach and a patient centric outcome for the treatment of facial asymmetry resulting from hemifacial microsomia. Different treatment modalities are available to treat asymmetries. However, the best treatment outcome can be achieved only when the treatment plan is individualized for every patient. This report portrays an adult patient with hemifacial microsomia, who had facial asymmetry from the level of supraorbital region with a Class II skeletal base. Orthodontic treatment, along with surgical management, was required to transform the patient into a symmetrical profile, which is esthetically pleasing. A sound knowledge of the various technologies and resources that are available to us and making the best use of it to bring out a drastic change in the patient's life. Combined effort of the orthodontists and oral surgeons are required to manage patient's with hemifacial microsomia that has caused the severe facial asymmetry. Moreover, special attention has to be given to a patient-centric outcome.

Surgical Management of Hyperdivergent Class II Malocclusion with Vertical Maxillary Excess: A 2-year Follow-up.

Skeletal Class II malocclusions with vertical maxillary excess (VME) present with an amalgamation of several problems pertaining to psychological, esthetics, and function. The optimal treatment plan in such cases includes a synchronized orthodontic-surgical approach through superior repositioning and setback of maxilla by means of Le Fort I osteotomy and augmentation genioplasty. This case report describes a multidisciplinary approach in the successful management of a patient with VME to achieve superior esthetics and function.

A Comparative Evaluation of Changes in Soft Tissues After Single-Jaw Surgery and Bimaxillary Surgery in Skeletal Class III Patients.

AIMS AND OBJECTIVES: The aim of this study was to compare cephalograms for the hard and soft tissue changes observed in skeletal Class III patients of Indian origin who had undergone either single-jaw mandibular setback (BSSO) or bimaxillary surgery (Le Fort I advancement + BSSO setback) and also to derive a correlation between the changes brought about in the soft tissues by the surgical alteration in hard tissue. MATERIALS AND METHODS: The study included records comprising 18 treated skeletal Class III patients, who were divided into two groups based on the surgical procedures advocated: Group I: single-jaw procedure comprised of only mandibular set back, Group II: bimaxillary surgery. Presurgical and post-treatment cephalograms were calibrated and traced using Ilexis FACAD AB-2014 Version 3.8.0.0 software and analyzed with COGS hard tissue analysis and soft tissue analysis. All values for the hard tissue and soft tissue measurements were compared with the norms prescribed for the Indian population. RESULTS: Upper lip changes were evident in both groups but greater significance was observed in bi-jaw group. Single-jaw patients showed positive correlation for hard to soft tissue mandibular position. Bi-jaw surgical cases exhibited positive correlations between changes Wits variable to soft tissue convexity as well as mandibular position. CONCLUSION: The soft tissues changes between Class III patients treated by single-jaw surgery and those treated by bimaxillary surgery when compared revealed that significant differences were observed only in relation to certain measurements such as facial convexity, maxillary prognathism, and upper lip protrusion.

Orthognathic Surgical Approach for Management of Skeletal Class II Vertical Malocclusion.

The current era of orthodontics has evolved from regular dental corrections to achieve the most needed harmony between functional stability and esthetics enhancement of craniofacial structures. The "desire" for attaining this harmony led to the birth of orthognathic surgeries. The orthognathic approach has undergone a paradigm shift through the years, from correcting the skeletal component to addressing the soft tissues, thus optimizing esthetic outcome. This present case report is of a patient with skeletal Class II malocclusions with vertical maxillary excess (VME), managed by multidisciplinary treatment approach. The treatment progressed through presurgical orthodontics with premolar extraction followed by bi-jaw surgery. The outcome resulted in a phenomenal change in the profile by establishing a Class I skeletal base with a stable occlusion.

Assessment of Skeletal Maturation in Concordance to Statural Height and Body Weight in 12-Year-Old Children - A Cross-Sectional Study.

INTRODUCTION: To analyse the importance of bodily characteristics of growing children and its correlation towards skeletal maturity. This further aids orthodontists in proper treatment planning. AIM: The purpose of this study was to assess the correlation between cervical vertebrae maturation, statural height and body weight as measured in 12 -year-old children. MATERIALS AND METHODS: Lateral cephalograms were taken as a part of treatment records in 94 children along with their statural height and body weight. The Cervical Vertebrae Maturation Index (CVMI) was used to trace the C2, C3 and C4 vertebrae respectively and the data were then correlated to the chart provided by the Indian Council for Medical Research (ICMR). RESULTS: The overall sample showed a statistically significant correlation between CVMI and height (p=0.047). Girls showed significant correlation in their mean heights to the CVMI staging (p=0.012) while the boys exhibited a maximal mean height value in Cervical Stage (CS) 5 followed by CS3. There was no significant correlation between weight and CVMI. The mean CVMI stage seen in boys and girls were CS2 and CS3 respectively. CONCLUSION: There exists a definitive correlation between height and CVMI stages in growing children. Girls showed an advanced level of skeletal maturity in comparison to boys. CVMI staging should be used along with statural height and body weight when considering growth modification procedures.

Relationship of Anterior Alveolar Dimensions with Mandibular Divergence in Class I Malocclusion - A Cephalometric Study.

INTRODUCTION: One of the major limiting factors in retraction of proclined teeth is the width of the alveolus both in maxilla and mandible. AIM: The objective of this study was to assess the maxillary and mandibular anterior alveolar dimensions and to correlate with mandibular divergence in Class I bi-dento-alveolar protrusion patients. MATERIALS AND METHODS: Pretreatment lateral cephalograms (n=88) were analysed using a composite analysis with cephalometric software. Both maxillary and mandibular anterior alveolar widths and heights were measured and correlated with mandibular divergence. One-way analysis (ANOVA) and Pearson correlation test were used to compare and establish the significance between groups. RESULTS: Segregation of the data based on variation in the bi-cortical widths and heights showed that lesser alveolar widths and greater alveolar heights were associated with the high angled subjects and greater alveolar widths and lesser heights were associated with low angled subjects. CONCLUSION: Patients with hyperdivergent mandible exhibited thin anterior alveolar width and greater alveolar height whereas low angled subjects had wider alveolar width and lesser alveolar height. Orthodontic treatment plan for retraction of anterior teeth must be based on these differences caused by variations in mandibular divergence.