Validity and reliability of the orthodontic experience questionnaire in Malayalam, an Indian language.

AIM: To translate the orthodontic experience questionnaire into Malayalam, an Indian language, and assess its validity and reliability in the Kerala population. MATERIALS AND METHODS: The original questionnaire, which was developed in English, was translated into Malayalam. Face validity was assessed, and minor changes were made, followed by a content validity assessment by an expert panel. The final version was given to 324 patients who marked their responses on a Likert scale. Internal consistency reliability was tested using Cronbach's alpha, and test-retest reliability was tested using the intraclass correlation coefficient. Principal component factor analysis was performed to regroup the valid items. RESULTS: The principal component factor analysis revealed three domains. Reliability assessed by Cronbach's alpha of the whole questionnaire was 0.799, and that of the three domains was 0.73, 0.71, and 0.71, respectively. The test-retest reliability was found to be good (0.798). CONCLUSION: The Malayalam version of the orthodontic experience questionnaire was found to be content valid with good reliability. To obtain a successful treatment result, an orthodontist must be aware of these and this questionnaire, with adequate validity and reliability, has been designed to achieve this in the Malayalam-speaking population.

Orthodontic urgencies and their management during COVID-19 pandemic-A web-based survey.

OBJECTIVES: This investigation aimed to evaluate the most common orthodontic urgencies, their management, and changes in routine biosafety measures and the total income of the dental office in South India during the COVID-19 pandemic. METHODS: A questionnaire was drafted using Google Forms with questions in four domains pertaining to orthodontic urgencies, biosafety measures, treatment duration, and income. After validation, this questionnairewas sent to 750 orthodontists via WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif) over a period of 14 days.Descriptive statistics and comparisons were performed using independent t- and Chi-square tests. RESULTS: Majority of the orthodontists (62.3%) had closed their clinics only during the first lockdown. Many (63%) had scheduled urgent appointments along with routine limited patients per day. The most frequent urgencies were related to the breakage of brackets, archwires, molar tubes, bands, and temporary anchorage devices. Aligners were the least problematic. The treatment time was also prolonged. Telephonic advice and virtual assistance via WhatsApp messages/videos were found to be successful in the management of urgencies.Most orthodontists had strengthened their routine biosafety measures.The financial impact of this pandemic was considerable, with nearly 50% reduction in total income. CONCLUSIONS: Urgencies linked to preadjusted edgewise appliances, such as breakage of brackets and tubes, and archwire-related injuries were the most common. Prolongation of treatment time and negative financial impact were the other problems encountered during this pandemic. Drastic changes had occurred in routine biosafety measures, which prevented the spread of infection among orthodontists and patients.

Development and validation of a new prognostic tool for impacted maxillary canines, 'Easy box': A cone-beam computed tomographic study.

OBJECTIVE: To develop a tool to facilitate simple, easy and rapid assessment of the level of difficulty in disimpaction of an impacted canine using cone-beam computed tomography (CBCT). DESIGN: A cross-sectional study. METHODS: A panel of four experienced orthodontists formulated a questionnaire capable of portraying the limits of a three-dimensional (3D) area around impacted maxillary canines on CBCT images, which would determine the disimpaction difficulty level. In total, 14 experienced orthodontists graded each item in the questionnaire and assigned scores in the range of 0-5. Average scores obtained outlined the limits of a 3D area, within which an impaction was deemed favourable. This area was termed 'Easy box'. The disimpaction difficulty level of 170 impacted maxillary canines was then assessed using 'Easy box' and the existing tool KPG index for convergent validation. RESULTS: Perfect inter-examiner agreement was obtained as evidenced by Fleiss kappa value of 0.984 for the tool 'Easy box' and 0.948 for the KPG index. There was also perfect agreement between the two methods of assessment (Cohen weighted kappa, k>0.86). The average time taken for assessment using 'Easy box' was 3.3 min compared to 8.8 min for the KPG index. CONCLUSION: 'Easy box' proves to be a simple, accurate and rapid assessment tool for the prognostic evaluation of impacted canines, using CBCT images. Impacted maxillary canines with cusp tips that lie beyond the limits of the 3D 'Easy box' area with a beta angle greater than 45°, were rated to be more difficult to align.

Does the Alternate Rapid Maxillary ExpansionConstriction/Reverse Headgear Therapy Enhance Pharyngeal Airway Dimensions?

OBJECTIVE: The enhanced effect of maxillary protraction following the Alternate Rapid Maxillary Expansion-Constriction/Reverse Headgear (AltRAMEC/RH) protocol over the Rapid Maxillary Expansion/Reverse Headgear (RME/RH) protocol has been well documented. However, it is not known if the airway dimensions also follow a similar enhancement. This retrospective cohort study therefore aims to compare dimensional changes in the pharyngeal airway after maxillary protraction following RME/RH, versus AltRAMEC/RH. METHODS: Pre- and post-treatment lateral cephalograms of 46 skeletal Class III patients with maxillary retrusion, who had undergone maxillary protraction using the AltRAMEC/RH or RME/RH protocol were compared for 20 dentoskeletal and airway variables. The waiting period of 6-8 months before initiating treatment served as the control period. The results were statistically evaluated using the paired t-test, the independent t-test, and the intraclass correlation coefficient. RESULTS: The nasopharyngeal airway indicators in the AltRAMEC/RH group (PNS-ad1, PNS-ad2, UPD) showed a statistically significant mean increase of 2.09 mm, 2.74 mm, and 1.30 mm respectively. This was significantly more pronounced than the RME/RH group (P < .001). The control period did not show any significant change, thus showing the negligible effect of growth on the airway dimension. No significant changes were observed in the oropharyngeal airway indicators for both groups (P > .001). CONCLUSIONS: The AltRAMEC/RH protocol produced more significant improvement in the nasopharyngeal airway dimensions as compared to the RME/RH protocol. The changes in the oropharyngeal airway were insignificant with both the protocols.

Effect of microimplant assisted rapid palatal expansion on bone-anchored maxillary protraction: A finite element analysis.

INTRODUCTION: This study aimed to evaluate the craniofacial effects of microimplant assisted rapid palatal expansion (MARPE) on bone-anchored maxillary protraction (BAMP) through a finite element analysis. METHODS: A 3-dimensional finite element model of the skull with associated sutures was created from the computed tomography image of a 12-year-old male patient. Two protraction protocols: BAMP without MARPE (protocol 1) and BAMP with MARPE (protocol 2), were analyzed using Ansys software (Ansys, Canonsburg, Pa). Stress distribution in the sutures and displacement pattern of craniofacial structures were analyzed in the 2 protocols using finite element analysis. RESULTS: Both protocols produced changes in craniofacial structures in all the 3 planes. Displacement of the maxilla was more pronounced in protocol 2 in all directions with mild clockwise rotation. Protocol 1 displayed a translatory movement of the maxilla without any rotation and mild constriction in the anterior region. In protocol 2, an expansion of the maxilla, which increased in the superoinferior direction, was also observed. Von Mises stress in circummaxillary sutures was significantly more in protocol 2, indicating an increased displacement of craniomaxillary structures. CONCLUSIONS: The use of MARPE during BAMP enhanced maxillary protraction and reduced the counterclockwise rotation tendency of the maxilla. Hence, it may be inferred that incorporation of MARPE during BAMP protocol may prove beneficial in the treatment of patients with skeletal Class III malocclusion with open bite tendency or hyperdivergent growth pattern.

Effect of adding daytime Class III Elastics to the alternate rapid maxillary expansion-constriction and reverse headgear therapy - A randomized clinical trial.

OBJECTIVE: To evaluate the skeletal, dental and soft tissue cephalometric changes by addition of daytime Class III elastics to the Alternate Rapid Maxillary Expansion-Constriction (AltRAMEC) and Reverse Headgear (RH) protocol in skeletal Class III patients with maxillary retrusion. MATERIAL AND METHODS: 54 patients with maxillary retrusion and CVMI (Cervical vertebral maturity index)

Prevalence and gender distribution of malocclusion among 13-15-year-old adolescents of Kerala, South India.

OBJECTIVES: To determine the prevalence and gender distribution of malocclusion in 13-15-year-old adolescents of Dravidian ethnicity, residing in urban and rural areas of Kerala, South India. MATERIALS AND METHODS: A total of 1554 children (779 males, 775 females), from both urban and rural areas were examined in school settings. Survey proforma for personal details and occlusal registration according to Bjork et al. (1964) were used. Chi-square test was used for analysis. RESULTS: Overall prevalence of malocclusion was 89.9% which included Angle's Class I, Class II (17.6%) and Class III (8%) malocclusions. Other anomalies detected were increased overjet (11.8%), anterior crossbite (27.5%), anterior open bite (1.6%), posterior crossbite (5.1%), scissor bite (4.4%), midline deviation (6.8%), bimaxillary protrusion (BMP-21.3%), crowding (66.6%), spacing (15.3%), rotations (45.4%), ectopic eruptions (11.1%), peg laterals (2.4%) and missing teeth (6.6%). Males showed a higher predilection for increased overjet, deep bite, spacing and missing teeth. Class III, BMP, midline deviations and rotations were found to be more prevalent among the rural group, whereas Class II, increased overjet, deep bite and ectopic eruptions were more prevalent among the urban. CONCLUSION: Information regarding the detailed pattern of malocclusion prevalence and the high prevalence of BMP among South Indian population of Kerala may provide a baseline data for planning orthodontic services.

Effect of Sagittal Dentoskeletal Discrepancies on the Vermilion Height and Lip Area.

OBJECTIVE: A frontal evaluation of the lips could provide important information during a routine clinical evaluation of facial aesthetics. There is a lack of ample evidence in the literature regarding variations in the vermilion height and lip area in various sagittal discrepancies when assessing facial aesthetics. The aim of this cross-sectional study was to evaluate and compare the vermilion height and lip area in dentoskeletal Class I, Class II, and Class III malocclusions. METHODS: Subjects included female patients divided into four groups (Angle's Class I bimaxillary proclination [Class I BMP], Class II Division I [Class II Div 1], Class III and Class I normal [Class I N]) with 36 samples each. Standardized frontal facial photographs were taken at rest and during a posed smile. Thirty-five landmarks on the upper and lower lips were identified for measurements of the vermilion height and lip area. A one-way analysis of variance was used to identify overall differences, and the post-hoc Bonferroni test was applied for multiple comparisons. RESULTS: Class III showed a significantly smaller upper-lip area and significantly higher ratios of the upper-to-lower lip vermilion height/area. The ratios displayed an increasing trend from the midline to the corners of the mouth. Class I BMP and Class II Div 1 had significantly larger upper and lower-lip areas. CONCLUSION: Morphology of the lips is significantly correlated with underlying anteroposterior dentoskeletal discrepancies. During a clinical examination, a critical frontal evaluation of the lips is important as it is apparently indicative of the underlying sagittal discrepancy, especially in skeletal Class III malocclusions.

Effect of oral environment and prescribed fluoride mouthwashes on different types of TMA wires - An in-vivo study.

OBJECTIVE: The aim of this study was to investigate the effect of intraoral conditions and fluoride mouthwashes on mechanical properties and surface characteristics of different types of titanium molybdenum alloy (TMA) wires. MATERIALS AND METHODS: Three types of TMA wires of dimension 0.017" × 0.025" [1. Standard TMA (TMA), 2. ion-implanted, low-friction TMA (LF) and 3. Colored, Honey Dew TMA (HD)] were tested in three conditions as three groups; A) Control (as received), B) No fluoride (following intraoral use without fluoride) and C) Fluoride (following intraoral use with fluoride rinses). Surface roughness was evaluated using 3D Optical Profilometer. Three point bending tests were done to evaluate load deflection characteristics (LDR), ultimate tensile strength (UTS), and Young's modulus (E). Statistical evaluation was done using one-way analysis of variance (ANOVA), Bonferroni multiple comparison, and paired t-tests. RESULTS: Control group TMA exhibited significantly higher surface roughness, peak height, and LDR as well as lower UTS and E when compared to LF and HD (P < 0.001). In nonfluoride group, the surface roughness and LDR increased significantly for all three types of wires (P < 0.001). The UTS and E showed a significant decrease (P < 0.001). Additional use of fluoride mouthwashes (fluoride group) further increased surface roughness and LDR and decreased the UTS and E (P < 0.001). CONCLUSION: The ion-implanted LF/HD varieties had better surface smoothness, lower LDR, higher UTS, and higher E than standard TMA in the control group, pointing towards a better efficiency of these wires. Intraoral conditions significantly increased surface roughness and deteriorated mechanical properties of all types of TMA wires. With the use of daily fluoride mouthwashes, the deterioration was much worse.

Comparative evaluation of the efficiency of canine retraction using modified Marcotte and T-loop retraction springs - A split-mouth, randomized clinical trial.

OBJECTIVE: The aim of this study was to compare the efficiency of canine retraction using modified Marcotte and T-loop retraction springs. MATERIALS AND METHODS: Twenty-four subjects with a treatment plan involving bilateral extractions of upper first premolars were included in the study. A split-mouth design was used to randomly allocate opposite quadrants to either modified Marcotte spring (MS) or T-loop spring (TLS) for canine retraction. Cephalometric radiographs and models were used to measure the rate of canine retraction (primary outcome) and compare the angular/rotational changes in the canines and anchorage loss in molars (secondary outcomes) following retraction. Subjective assessment of pain and discomfort was compared using visual analog scale (VAS). Paired and independent t-tests were used to evaluate changes. RESULTS: The mean amount and rate of retraction of the canine were found to be significantly higher for MS (3.56 ± 0.696 mm and 1.188 ± 0.232 mm, respectively) when compared with TLS (2.125 ± 0.472 mm and 0.71 ± 0.157 mm, respectively). Distopalatal rotation of the canine was also significantly lesser for MS (2.42°±1.868°) than TLS (5.65° ±2.84°, P < 0.001). However, the amount of anchorage loss and canine tipping were significantly higher for MS. Statistically significant higher values in the VAS score for TLS indicated greater discomfort. CONCLUSION: MS exhibited increased rate of retraction and rotation control when compared with TLS during sectional canine retraction. Patient comfort was better for MS as evidenced by the VAS scores. However, the amount of tipping and anchorage loss obtained with MS were significantly higher than TLS.

Profile changes following orthodontic treatment of class I bimaxillary protrusion in adult patients of Dravidian ethnicity: A prospective study.

AIM: To prospectively evaluate soft and hard tissue responses to orthodontic treatment of bimaxillary protrusion (BMP) in Dravidian population using McLaughlin, Bennett, and Trevisi (MBT) mechanics of the preadjusted edgewise appliance. METHODS: Thirty-one adult (18-30 years) Class I BMP patients were treated using the above mechanics after extraction of four first premolars. Forty-five pre- and post-treatment variables on lateral cephalograms were compared using paired t-test and Pearson's correlation coefficient. RESULTS: All linear and angular parameters pertaining to hard and soft tissues showed significant changes, indicating retraction of incisors, upper and lower lips; increase in nasolabial angle; and decrease in circumoral convexity, interlabial gap, and lip thickness. Various correlations established were (1) upper lip to upper incisor retraction 1:2.01, (2) lower lip to upper incisor retraction 1:1.5, (3) lower lip to lower incisor retraction 1:1, and (4) upper incisor retraction to nasolabial angle 1:2.02. CONCLUSIONS: Orthodontic therapy using MBT mechanics is very useful in achieving favorable hard and soft tissue changes, following four first premolar extractions in BMP. The various correlations established between incisor retraction and soft tissue parameters could prove useful to the discerning clinician.

The Facial Aesthetic index: An additional tool for assessing treatment need.

OBJECTIVES: Facial Aesthetics, a major consideration in orthodontic diagnosis and treatment planning, may not be judged correctly and completely by simply analyzing dental occlusion or osseous structures. Despite this importance, there is no index to guarantee availability of treatment or prioritize patients based on their soft tissue treatment needs. Individuals having well-aligned teeth but unaesthetic convex profiles do not get included for treatment as per current malocclusion indices. The aim of this investigation is to develop an aesthetic index based on facial profiles which could be used as an additional tool with malocclusion indices. MATERIALS AND METHODS: A chart showing typical facial profile changes due to underlying malocclusions was generated by soft tissue manipulations of standardized profile photographs of a well-balanced male and female face. A panel of 62 orthodontists judged the profile photographs of 100 patients with different soft tissue patterns for assessing profile variations and treatment need. The index was later tested in a cross-section of school population. Statistical analysis was done using "irr" package of R environment version 2.15.1. RESULTS: The index exhibited very good reliability in determining profile variations (Fleiss kappa 0.866, P < 0.001), excellent reproducibility (kappa 0.9078), high sensitivity, and specificity (95.7%). Testing in population yielded excellent agreement among orthodontists (kappa 0.9286). CONCLUSIONS: A new Facial Aesthetic index, based on patient's soft tissue profile requirements is proposed, which can complement existing indices to ensure treatment to those in need.

Bridging the Gap: Sella Turcica in Unilateral Cleft Lip and Palate Patients.

OBJECTIVES: The aims of this study were to analyze the prevalence of sella turcica bridging and to measure the size of the sella turcica on profile cephalograms in a homogenous group of surgically repaired unilateral cleft lip and palate (UCLP) patients. SETTING: Tertiary care center. DESIGN: Retrospective cross-sectional study. PATIENTS: Preorthodontic lateral cephalometric radiographs of 64 UCLP individuals between the ages of 16 and 29 years along with an equal number of age- and sex-matched skeletal Class I controls. MAIN OUTCOME MEASURES: The extent of calcification of the interclinoid ligament was quantified (completely calcified, partially calcified, no calcification) and mean values compared. Length, depth, and diameter of the sella turcica were also measured. The results were statistically analyzed using paired t test and Wilcoxon signed ranks test. RESULTS: Complete sella bridging of both type A (4.6%) and type B (21.7%) was significantly higher in UCLP patients. This has not been reported previously. Partial sella bridging was also higher in cleft patients as evaluated by two methods (42.18%, 39.06%). This study demonstrated a statistically significant decrease in all dimensions of sella turcica in UCLP patients. CONCLUSIONS: The UCLP patients apparently had higher predilection for sella turcica bridging. The dimensions of sella turcica were also seen to be significantly smaller than the control group. Defective proliferation and deviated pathways of neural crest cell migration as well as premature rupture of contact between neuroepithelium and oral ectoderm as postulated causes are discussed.

Jaw - winking phenomenon: Report of a case with review of literature.

Jaw-winking or the Marcus Gunn phenomenon (MGP), a congenital uncommon condition characterized by involuntary elevation of a drooping upper eyelid concomitant with various movements of the mandible, is well-documented in medical literature, but very little information is available in dental literature. This is an interesting case report of a 17-year-old female with MGP, who reported for orthodontic treatment of her proclined upper anterior teeth, severe lower crowding, and mandibular micrognathia. Review of the literature revealed only two reported cases of dental anomalies in conjunction with MGP. The patient also gave a positive family history of MGP with a maternal cousin having a similar problem. Dentists and other oral health professionals can play a significant role in detection and diagnosis of this rare condition and should take protective measures during dental and oral surgical procedures.

Unusual foreign body in a routine lateral cephalogram.

Routine radiographs made in the orthodontic office can often give way to detection and diagnosis of unusual syndromes, signs or foreign bodies. A case report of one such accidental detection of a very unusual foreign body within the nasal cavity of an orthodontic patient has been presented here to emphasize the importance of routine radiographic views, which over and above aiding in Orthodontic diagnosis, can also often detect potentially life threatening problems in the Oro-facial region.

Reliability of Beta angle in assessing true anteroposterior apical base discrepancy in different growth patterns.

INTRODUCTION: Beta angle as a skeletal anteroposterior dysplasia indicator is known to be useful in evaluating normodivergent growth patterns. Hence, we compared and verified the accuracy of Beta angle in predicting sagittal jaw discrepancy among subjects with hyperdivergent, hypodivergent and normodivergent growth patterns. MATERIALS AND METHODS: Lateral cephalometric radiographs of 179 patients belonging to skeletal Classes I, II, and III were further divided into normodivergent, hyperdivergent, and hypodivergent groups based on their vertical growth patterns. Sagittal dysplasia indicators - angle ANB, Wits appraisal, and Beta angle values were measured and tabulated. The perpendicular point of intersection on line CB (Condylion-Point B) in Beta angle was designated as 'X' and linear dimension XB was evaluated. RESULTS: Statistically significant increase was observed in the mean values of Beta angle and XB distance in the vertical growth pattern groups of both skeletal Class I and Class II patients thus pushing them toward Class III and Class I, respectively. CONCLUSIONS: Beta angle is a reliable indicator of sagittal dysplasia in normal and horizontal patterns of growth. However, vertical growth patterns significantly increased Beta angle values, thus affecting their reliability as a sagittal discrepancy assessment tool. Hence, Beta angle may not be a valid tool for assessment of sagittal jaw discrepancy in patients exhibiting vertical growth patterns with skeletal Class I and Class II malocclusions. Nevertheless, Class III malocclusions having the highest Beta angle values were unaffected.

The Begg's uprighting spring - Revisited.

Uprighting springs, an integral part of the Begg ligsht wire differential force technique is gaining more and more popularity, as a useful adjunct in contemporary preadjusted edgewise appliance systems as well. It can be used with brackets containing vertical slots for mesiodistal crown uprighting, or as braking auxiliaries providing additional anchorage while protracting posteriors. Here, we present a simple and quick chair side method of fabricating and customizing uprighting springs according to the required crown/root movement for correction. This communication would serve as a ready reckoner during fabrication of the springs, thus dispelling the confusion that usually arises regarding direction and position of the coil and active arm.

Glenoid fossa position in surgically repaired unilateral cleft lip and palate patients.

BACKGROUND: Relative position of the glenoid fossa would play a significant role in the morphology of lower face. The aim of the present study was to cephalometrically evaluate the position of the glenoid fossa in a group of unilateral cleft lip and palate (UCLP) patients in order to better clarify the role of this craniofacial component in skeletal disharmonies associated with this anomaly. METHODS: Lateral cephalometric radiographs of 59 patients (32 males and 27 females) with surgically repaired UCLP (mean age 19.5±1.4 years) along with an equal number of age and gender matched skeletal Class I controls were analyzed for sagittal and vertical position of the glenoid fossa as well as lower anterior face height (LAFH), mandibular plane and length. RESULTS: Paired samples t-test revealed a statistically significant anterior positioning of the glenoid fossa in UCLP subjects. A more cranial positioning of the glenoid fossa, basion, pterygomaxillary fissure, and posterior nasal spine were also seen to be associated with the cleft group on vertical evaluation. Effective length of mandible was normal with significantly steeper mandibular plane and increased LAFH. LIMITATIONS: Further investigations using three dimensional imaging techniques is necessary for better clinical interpretation. CONCLUSIONS: The glenoid fossa is positioned more cranially and anteriorly in UCLP individuals, clinically contributing to the mandibular prominence and concave facial profile inspite of their mandibular length being normal. Steep mandibular planes and increased LAFH reportedly associated with a cranially positioned glenoid fossa is observed in UCLP patients also.