Orthodontic pain control following arch wire placement; a comparison between pre-emptive tenoxicam and chewing gum: a randomized clinical trial.

Background: Pain during fixed orthodontic treatment can have a detrimental effect on patient treatment compliance. To overcome this, there is a definite need to establish the best pain-relieving methods suitable for orthodontic patients in terms of efficacy and use. The objective of this study was to compare the effect of chewing gum and pre-emptive tenoxicam on pain after initial archwire placement and to evaluate the pain perceptions of orthodontic patients in the two groups while performing various functions at specific time intervals. Methods: Forty-two patients were selected and randomly divided into two groups: group A (chewing gum) and group B (pre-emptive tenoxicam). Pain perception was documented by patients immediately; at 4 h; at bedtime on the day of archwire placement; the next morning; at 24 h; and at bedtime on the 2nd, 3rd, and 7th day after the initial archwire placement. Pain scores were noted during fitting of the posterior teeth, biting, and chewing using a visual analog scale. The data obtained were subjected to statistical analysis. Results: Group A showed a significant increase in pain until the next morning while fitting the posterior teeth, biting, and chewing [36.2, 52.0, 33.4, respectively]], followed by a gradual decrease by the 7th day. Group B showed a significant increase in pain at bedtime on biting, with a peak value of 47.5. Pain on chewing, fitting posterior teeth, peaked the morning of the next day (100.0, 45.0). The Freidman test showed a statistically significant difference with a p-value of < 0.01. Higher pain scores were observed while chewing and biting compared with that while fitting the posterior teeth in both groups. The overall comparison of pain control between the two groups was not statistically significant [P > 0.05] between the two groups. Conclusions: Chewing gum was not inferior to pre-emptive tenoxicam. Thus, chewing gum is a non-pharmacological alternative to analgesics for orthodontic pain control that eliminates the chance of adverse reactions and can be used in the absence of adult observation.

A comparison of different osteotomy techniques with and without pterygomaxillary disjunction in surgically assisted maxillary expansion utilizing modified hybrid rapid maxillary expansion device with posterior implants: A finite element study.

INTRODUCTION: The study aims to evaluate the effect of osteotomies with and without Pterygomaxillary disjunction (PMD) during Surgical Assisted Rapid Maxillary Expansion on the displacement pattern and stress distribution of Dental and Skeletal structures of the Nasomaxillary (NM) complex by a modified rapid maxillary expansion (RME) Hybrid appliance. MATERIALS AND METHODS: A CT scan of a 20-year-old adult with maxillary constriction and the posterior bite was utilized for the restructuring of the finite element model. Five different meshed models were created individually with varying procedures of the osteotomy. A posteriorly anchored Hybrid-Hyrax appliance was utilized for RME. Groups included Group 0 - Control group without osteotomy; Group I - Only Midpalatal osteotomy; Group II - Only Subtotal Le fort I; Group III - Both Midpalatal and Subtotal Le fort I without PMD; Group IV - Midpalatal + subtotal Le fort I with bilateral PMD. The displacement pattern and stress distribution in all three dimensions were recorded and analyzed using analysis of variance and post-hoc Tukey test. RESULTS: Group IV with PMD exhibited the highest stress dissipation and displacement of the skeletal and dental structures followed by Group III osteotomies. The highest stress concentration was at midpalatal suture (292 MPa) for Group III osteotomies. There is no statistical difference between Group III and Group IV osteotomies for many of the parameters measured (P > 0.05). CONCLUSIONS: Posteriorly anchored Hybrid appliance without PMD is as effective as that with of PMD.

Clinical evaluation of neodymium-iron-boron (Ne2Fe14B) rare earth magnets in the treatment of mid line diastemas.

BACKGROUND: To evaluate the closure of midline diastema using the Neodymium-Iron-Boron magnets and to compare the treatment duration of midline diastemas with the use of magnets compared to regular orthodontic treatment. MATERIAL AND METHODS: Thirty patients with age group 12 to 30 years with the midline diastema ranging from 0.5 to 3mm were selected. These patients were divided into two groups. Diastema closure in one group was accomplished by conventional method, in other group was done with Ne2Fe14B magnets. These magnets were fitted to the labial surfaces of the maxillary central incisors such a way that the opposite poles of the magnets face each other. At each appointment, study models and radiographs were taken for study subjects and the midline diastema was measured using digital vernier calipers on the study models obtained. Descriptive statistics carried out using Paired t-test. RESULTS: Subjects treated with Ne2Fe14B magnets showed a significant difference compared to fixed orthodontic appliance subjects with respect to time of closure, rate of space closure and incisal inclination. Significant difference between 2 groups with reduction of 64.6 days in time to diastema closure in subjects treated with Ne2Fe14B magnets (P<0.05). CONCLUSIONS: Ne2Fe14B magnets more efficient in complete closure of mid line diastema in less duration of time. KEY WORDS: Midline diastema, Ne2Fe14B magnets, rare earth magnets, space closure.

The Effects of In-Office Reconditioning on the Slot Dimensions and Static Frictional Resistance of Stainless Steel Brackets.

INTRODUCTION: Orthodontists are commonly faced with the decision of what to do with loose brackets, and with inaccurately located brackets that need repositioning during treatment. One solution is to recycle the brackets. The potential effects of reconditioning a bracket are dependent upon many factors which may result in physical changes like alteration in slot tolerance, which may influence sliding mechanics by affecting frictional resistance. AIM: To study and compare the dimensional changes in the bracket slot width and depth in reconditioned brackets from unused brackets under scanning electronic microscope and to study and compare any consequent effects on the static frictional resistance of stainless steel brackets after reconditioning and in unused brackets. MATERIALS AND METHODS: Dentarum manufactured 90 stainless steel central incisors edgewise brackets of size 0.22 X 0.030″ inch and 0° tip and 0°angulation were taken. 60 samples for measuring frictional resistance and 30 samples for measuring slot dimensions. Ortho organizers manufactured stainless steel arch wires 0.019 X 0.025″ straight lengths 60 in number were considered for measuring static frictional resistance. RESULTS: The mean slot width and depth of new brackets were 0.0251″ and 0.0471″, which exceeded the manufacturers reported nominal size of 0.022″ X 0.030″, by 0.003″ and 0.017″. The reconditioned brackets demonstrated a further increase in mean slot width and depth to 0.028″ and 0.0518″ that is by 0.0035″ and 0.0047″ which is statistically significant (p=0.001, 0.002). The mean static frictional forces of the reconditioned brackets was nearly similar to that of new brackets that is 0.3167N for reconditioned brackets and 0.2613 N for new brackets. CONCLUSION: Although the reconditioning process results in physical changes to bracket structure this does not appear to result in significant effect on ex-vivo static frictional resistance.

A comparative in-vivo evaluation of the alignment efficiency of 5 ligation methods: A prospective randomized clinical trial.

OBJECTIVES: To conduct a prospective randomized study comparing the efficiency of 5 different ligation systems (ELL; elastomeric ligature, SSL; stainless steel ligature, LL; leone slide ligature, PSL; passive self-ligation and ASL; active self-ligation) over the duration of mandibular crowding alleviation. MATERIALS AND METHODS: Fifty consecutive patients (54.2% male, 45.8% female; mean age: 16.69 years) satisfying the inclusion criteria were randomly allocated to 5 ligation groups with an equal sample size of 10 per group. The 5 groups received treatment with 0.022-inch MBT pre-adjusted edge-wise technique (ELL: Gemini 3M Unitek, SSL: Gemini 3M Unitek, LL: Gemini 3M Unitek, PSL: SmartClip 3M Unitek and ASL: In-Ovation R Euro GAC International). The models and cephalograms were evaluated for anterior arch alignment, extraction space closure, and lower incisal inclinations at pre-treatment T1 and at the end of initial alignment T2. Analysis of variance (ANOVA) and Post-hoc tests were used for data analysis. RESULTS: Forty-eight participants completed the study, and SL systems showed a significant difference over CL groups in time to alignment, passive space closure, and incisal inclination. Multiple regression showed a reduction of 5.28 days in time to alignment by changing the ligation group in the order of ELL to ASL group and 1 mm increase in initial irregularity index increases time to alignment by 11.68 days. CONCLUSION: Self-ligation brackets were more efficient than conventional ligation brackets during initial leveling and alignment.

Evaluation of nasal morphology in predicting vertical and sagittal maxillary skeletal discrepancies'.

OBJECTIVE: The purpose of this prospective observational study was to evaluate the relationship between nasal morphology and maxillary skeletal pattern. The clinical significance was to emphasize the importance of role of nasal pattern in diagnosis and treatment planning. MATERIALS AND METHODS: The sample included the pre-treatment lateral cephalometric radiographs of 180 South Indian adults (94 women, 86 men), aged 18 to 28 years. Six maxillary and six nasal soft tissue parameters were measured. Pearson correlation coefficients and Analysis of variance were used for statistical analyses. RESULTS: There were significant correlations between maxillary vertical and sagittal, skeletal and soft tissue parameters. The Mean and standard deviations were correlated between low insignificant range to high significant levels with nasal length, nasal depth and columella convexity. Nasal length also showed significant correlation with inclination of palatal plane. Significant influence of gender was seen on nasal length, nasal depth, columella convexity and nasal tip angle. A statistically significant difference was seen regarding nasal length between males and females, with nasal length being more in males (50.26 ± 4.18) than in females (48.86 ± 3.45), nasal depth being more in males (18.64 ± 2.56) than in females (16.63 ± 2.16), columella convexity being greater in males (4.31 ± 1.26) than in females (3.41 ± 1.13), nasolabial angle decreased in males (87.26° ±13.79°) than in females (89.38° ±15.72°) and nasal tip angle being more in females (80.18° ±9.44°) than in males (73.60° ±10.24°). There was no statistically significant difference in nasal hump between males (-2.01 ± 1.76) and females (-2.02 ± 1.62). CONCLUSION: Long nose with increased nasal prominence were seen with increase in the anteroposterior length and vertical height of maxilla. Male and female genders had a varied amount of nasal length, nasal depth and columella convexity along with nasal tip angle.

Effect of moisture, saliva, and blood contamination on the shear bond strength of brackets bonded with a conventional bonding system and self-etched bonding system.

BACKGROUND: The success of bonding brackets to enamel with resin bonding systems is negatively affected by contamination with oral fluids such as blood and saliva. The new self-etch primer systems combine conditioning and priming agents into a single application, making the procedure more cost effective. OBJECTIVE: The purpose of the study was to investigate the effect of moisture, saliva and blood contamination on shear bond strength of orthodontic brackets bonded with conventional bonding system and self-etch bonding system. MATERIALS AND METHODS: Each system was examined under four enamel surface conditions (dry, water, saliva, and blood), and 80 human teeth were divided into two groups with four subgroups each of 10 according to enamel surface condition. Group 1 used conventional bonding system and Group 2 used self-etched bonding system. Subgroups 1a and 2a under dry enamel surface conditions; Subgroups 1b and 2b under moist enamel surface condition; Subgroups 3a and 3b under saliva enamel surface condition and Subgroup 4a and 4b under blood enamel surface condition. Brackets were bonded, and all the samples were then submitted to a shear bond test with a universal testing machine with a cross head speed of 1mm/sec. RESULTS: The results showed that the contamination reduced the shear bond strength of all groups. In self-etch bonding system water and saliva had significantly higher bond strength when compared to other groups. CONCLUSION: It was concluded that the blood contamination showed lowest bond strength from both bonding systems. Self-etch bonding system resulted in higher bond strength than conventional bonding system under all conditions except the dry enamel surface.

Establishment of norms of the beta angle to assess the sagittal discrepancy for Nellore district population.

BACKGROUND AND OBJECTIVES: In orthodontic diagnosis and treatment planning, assessment of anteroposterior discrepancy is of importance to the orthodontist. Both angular and linear measurements have been incorporated into various cephalometric analyses to help the clinician diagnose anteroposterior discrepancies and establish the most appropriate treatment plan. Hence the present study is designed to establish the norms of Beta angle to assess the sagittal discrepancy for Nellore district population. MATERIALS AND METHODS: The sample was screened from the old records of the Orthodontic department of Narayana Dental College and Hospital. One hundred and fifty pretreatment cephalometric radiographs (50 each of Class I, II, and III) were subdivided based on ANB, Wits appraisal, and Beta angle into skeletal Class I, II, III. The same cephalograms were again classified into skeletal Class I, II, and III based purely on Beta angle. Each group was again divided into 2 subgroups consisting of 25 male and 25 female subjects with a mean age limit between 15 and 45 years old. RESULTS: The Newman-keuls post hoc test and ANOVA showed that the 3 groups were significantly different (P ≤ 0.001). The Newman-keuls post hoc test also found the groups to be significantly different. CONCLUSIONS: There was statistically significant difference for, the mean values and the standard deviation for Beta angle within the three skeletal patterns (Class I, Class II and Class III skeletal patterns). There was no statistically significant difference among the mean values of beta angle between Nellore district population and Caucasian norms and between male and female sex groups.

Median mandibular flexure at different mouth opening and its relation to different facial types: A prospective clinical study.

OBJECTIVE: To measure the arch width and Median mandibular flexure (MMF) values at relative rest and maximum jaw opening in young adults with Dolichofacial, Mesofacial, and Brachyfacial types and tested whether the variation in the facial pattern is related to the MMF values in South Indian population. MATERIALS AND METHODS: This Prospective clinical study consisted of sample of 60 young adults. The subjects were grouped into 3 groups: Group 1: Brachyfacial, Group 2: Mesofacial and types, Group 3: Dolichofacial. Impressions were taken for all the 60 subjects and the casts were scanned and digitized. The intermolar width was measured for Dolichofacial, Mesofacial, and Brachyfacial subjects at relative rest (R) and maximum opening (O). RESULTS: The statistical analysis of the observations included Descriptive and Inferential statistics. The statistical analysis was executed by means of Sigma graph pad prism software, USA Version-4. Kruskal wallis (ANOVA) followed by Dunns post hoc test was performed. Mann Whitney U-test was performed to assess the difference in MMF values between Males and Females of the three groups. The Mean (SD) Mandibular flexure in individuals with Brachyfacial type was 1.12 (0.09), Mesofacial type was 0.69 (0.21), and Dolichofacial type was 0.39 (0.08). CONCLUSIONS: The Mean intermolar width was maximum in Brachyfacial type and minimum in Dolichofacial type. MMF was maximum at the maximum mouth opening position and was maximum in individuals with Brachyfacial type.

A comparison between cervical vertebrae and modified MP3 stages for the assessment of skeletal maturity.

OBJECTIVE: Evaluation of skeletal maturity in human individuals is an important aspect in orthodontics and dentofacial orthopedics because, growth guidance and fundamental structural changes are essential for treatment of skeletal discrepancies in all the three planes. Among various growth assessment methods, cervical vertebra maturation stages and hand wrist have been correlated with the individual growth changes during puberty. The purpose of this study is to determine correlation of the CVM index with the modified median phalanx index (MP3) as described by Rajagopal and Kansal. MATERIALS AND METHODS: 200 subjects (100 males and 100 females) of Nellore, Indian origin boys aged between 10 to 19 years and girls of 8 to 16 years were selected for the study. The subjects are selected randomly from patients visiting the Departments of Orthodontics and Dentofacial Orthopedics, Pediatric dentistry and Oral medicine and Radiology at Narayana Dental College and Hospital. Nellore. Radiographs of left hand MP3 and lateral cephalogram were taken. RESULTS: Cohen's kappa statistic was used to assess the agreement between the two measurements based on categorical variables. CONCLUSIONS: There was a good concordance between 6 stages of CVMI (Hassel and Farman) and the 6 stages of MP3 (Rajagopal and Kansal). Physiological maturity was earlier in females than in males when compared to the individuals of opposite sex of same chronological age. Chronological age was not a valid predictor of assessing the skeletal maturity because of significant variations in the distribution of CVMI and MP3 stages with respect to individual chronological age distribution.

Evaluation of arch width variations among different skeletal patterns in South Indian population.

BACKGROUND: Anterior cranial base can be taken as a reference line (SN) to determine the steepness of mandibular plane. Subjects with high mandibular plane angle tend to have a long face and one with low MP-SN angle has a shorter face. OBJECTIVE: This study was done to investigate if dental arch widths correlated with vertical facial types and if there are any differences in arch widths between untreated male and female adults in South Indian population. MATERIALS AND METHODS: Lateral cephalogram and dental casts were obtained from 180 untreated South Indian adults (90 males and 90 females) above 18 year old with no cross bite, minimal crowding and spacing. The angle between the anterior cranial base and the mandibular plane was measured on lateral cephalogram of each patient. Dental casts were used to obtain comprehensive dental measurements including maxillary and mandibular inter canine, inter premolar and inter molar widths, as well as amount of crowding or spacing. RESULTS: The results showed that male arch widths were significantly larger than those of females (P < 0.05) and there was a significant decrease in inter arch width as the MP-SN angle increased in untreated adult South Indian population. The results obtained in our study when compared with studies done in other population groups showed that there is difference in inter arch widths according to ethnicity and race. CONCLUSION: It was concluded that the dental arch width is associated with gender, race and vertical facial morphology. Thus using individualized arch wires according to each patient's pre treatment arch form and width is suggested during orthodontic treatment.

Serum PTHrP level as a biomarker in assessing skeletal maturation during circumpubertal development.

INTRODUCTION: Many investigators have studied the cellular organization and the local and systemic factors regulating endochondral bone growth in the growth plate and condylar cartilage. Parathyroid hormone-related protein (PTHrP) and Indian hedgehog protein have been reported to regulate multiple steps during such skeletal morphogenesis. The aims of this study were to quantify serum PTHrP levels at 6 cervical vertebral stages and to correlate serum PTHrP levels to the 6 skeletal maturation stages for use as a biologic indicator of skeletal maturation. METHODS: Mean serum PTHrP levels were measured in 90 subjects categorized into 6 cervical vertebral stages. RESULTS: Mean serum PTHrP levels were significantly higher in the late pubertal stages than in the early pubertal stages. Pearson correlation showed that serum PTHrP levels had a positive correlation with cervical vertebral maturation stages from the prepubertal to the late pubertal stages, and a negative correlation from the late pubertal to the postpubertal stages. CONCLUSIONS: Peak serum PTHrP levels do not correlate with early pubertal stages characterized by maximum growth increments. Hence, the validity of using serum PTHrP levels to predict peak growth velocity is questionable.

Comparison of sagittal and vertical dental changes during first phase of orthodontic treatment with MBT vs ROTH prescription.

OBJECTIVE: The present study was to evaluate and compare anchorage loss in sagittal, vertical dimension in incisal, molar segments and distal tipping of upper canine after first phase of orthodontic mechanotherapy utilizing MBT and ROTH philosophies. MATERIALS AND METHODS: Thirty patients with class I dentoalveolar malocclusion requiring extraction of all first premolars were randomly assigned into group I and group II. Set of two lateral cephalograms (T1) and (T2) were obtained with appliance in place and after sufficient leveling and aligning respectively. Linear measurements were recorded on the tracings using Pancherz analysis. A Wilcoxon t-test was use to assess the linear changes. RESULTS: In group I sample, upper and lower incisors retroclined during T1 - T2; by mean (SD) value of 2.267 (1.0032) mm, 2.4 (0.98) mm, respectively. Group II sample showed upper incisor proclination by -0.4 (1.404) and lower incisal retroclination by 0.06 (1.48). Upper and lower molars in group I remained stationary and group II upper and lower molars moved mesially by -1.133 (0.351) and -0.002 (0.005). In group I, upper and lower incisors extruded by -0.867 (0.611) and -0.67 (0.703), respectively, and group II the upper and lower incisors extruded by -0.9 (0.507) and -0.133 (0.639). Upper canine tipped distally during T1 - T2 in group I by -0.33° (2.609) and group II there was a change in distal tip of upper canine by -3° (3.184). CONCLUSION: Results from this random clinical trial showed that MBT technique effectively addressed perceived inadequacies of ROTH philosophy.