Orthodontics and Dentofacial Orthopedics

In orthodontics, torquing, particularly in the maxillary incisors is required to overcome play between wire and bracket, for
an ideal interincisal angle, adequate incisor contact, and sagittal adjustment of the dentition in order to achieve an ideal
occlusion. Various torquing auxiliaries and twisting of rectangular wire have been tried. Most of these approaches require
increased chair side time in wire bending and patient discomfort with unguaranteed effects. To control incisor torque,
trend of bidimensional technique is increasing in labial/lingual orthodontics. The purpose of this article is to provide an
overview of the bidimensional technique.
Keywords: Torque; Ideal Occlusion; Bidimensional Technique.

The aim of this prospective study was to compare a fixed lingual orthodontic appliance with a commonly used aligner system, focusing on oral impacts and speech disturbances, during the first 3 months of orthodontic treatment. Two groups of adults were evaluated: 21 treated with Invisalign® and 26 with In-Ovation L® lingual brackets. Health-related quality of life questionnaires were used to assess the oral impacts, and speech samples were collected for speech evaluation by professionals. The levels of pain and painkiller intake were similar, increasing on the first day, and decreasing at 3 months. Subtle injuries on the lip and cheeks were initially reported in the aligner group. Lingual patients experienced more discomfort in swallowing and opening the mouth, tongue injuries and food residues, even at 3 months. The consonants “s” and “z” were mainly affected in both groups immediately after appliance insertion, but more often in the aligner group. These speech disturbances recovere...

The aim of this prospective study was to compare a fixed lingual orthodontic appliance with a commonly used aligner system, focusing on oral impacts and speech disturbances, during the first 3 months of orthodontic treatment. Two groups of adults were evaluated: 21 treated with Invisalign ® and 26 with In-Ovation L ® lingual brackets. Health-related quality of life questionnaires were used to assess the oral impacts, and speech samples were collected for speech evaluation by professionals. The levels of pain and painkiller intake were similar, increasing on the first day, and decreasing at 3 months. Subtle injuries on the lip and cheeks were initially reported in the aligner group. Lingual patients experienced more discomfort in swallowing and opening the mouth, tongue injuries and food residues, even at 3 months. The consonants "s" and "z" were mainly affected in both groups immediately after appliance insertion, but more often in the aligner group. These speech...

Complicated crown fractures that involve more than 50% tooth loss and with the fracture line extending subgingivally are of great concern to the dentist. The final restoration should be aimed to provide the adequate retention without compromising the esthetics. So, in this article 2cases were treated with rapid orthodontic extrusion and surgical crown lengthening respectively to preserve and restore the natural tooth structure.

Background: The malocclusion indices have been used routinely by researchers to gather data regarding the prevalence of orthodontic treatment needs and trait. The scoring methods of malocclusal indices can be used to generate data regarding the actual load of the malocclusion which can be used for resource and fund allocation and identify the actual orthodontic treatment needs. This article will provide an insight to the various orthodontic indices and its specific indications.

In orthodontic practice various treatment modalities have been
presented for the treatment for the class II, div 1malocclusions.
Recently a large number of young adults have been seeking
shorter, cost effective and a non surgical correction of Class II
malocclusions and they accept dental camouflage as a treatment option to mask the skeletal discrepancy .This case report presents one such case, a 15years old growing male who has Class II div I malocclusion with sever maxillary incisor proclination, convex profile ,high mandibular plane angle, incompetent lips, increased overjet& overbite, over retained upper left deciduous canine ,impacted upper left canine and a supernumerary tooth in canine region. We considered the camouflage treatment by extracting the upper right first premolar, left impacted canine, deciduous canine
and supernumerary tooth. Following the treatment, a satisfactory result was achieved with an ideal, static and a functional occlusion, facial profile, acceptable smile, competent lip and stable treatment results.

Health care services in post-independent Zimbabwe have undergone turbulence with periods of seemingly significant improvements and other periods of definite decline. This thesis looks at health-care systems in general and in particular, the way in which they are reflected through the health-care system of Zimbabwean.  Ethical issues and challenges in health care can take many forms ranging from debates and discussions on the fairness or the lack thereof in the health-care reform process, the ethics of inter-professional relationships, the ethical problems with doctor-patient relationships, the state of advocacy in health matters, and patient rights, ethical perspectives influencing discourses on health systems, the ethics of health-care funding, and debates on access to health care. This thesis reflects on the complexities of the challenges, needs and reform requirements of the Zimbabwean situation.
A critical analysis of the ethical principles, their impact on the Zimbabwe health care system, using largely the principlist approach as enunciated by Beauchamp and Childress (2013), is conducted. Other moral theories such as the social contract theory is also discussed in some detail because of its important application to issues related to health care. A whole chapter is dedicated to the principle of distributive justice and its relevance and implications for the health care systems in general, but also with particular relevance to the situation in Zimbabwe.  Lack of or inadequate insurance is the biggest economic hurdle in accessing health care in many low income countries. There are two main arguments, which appear to support some sort of moral right to a health care funded by the government – “the collective social protection” and the “fair opportunity arguments” (Beauchamp & Childress, 2013). Both of these arguments are discussed in detail. Right to health and right health care are two concepts which confuse a lot of readers because they are close but refer to different dimensions of the concept of health. They are discussed with a particular emphasis on the ethical issues involving allocation of health resources, rationing and setting of priorities. This thesis winds up by looking at the possible solutions to the health crisis in Zimbabwe. The much-flaunted National Health Insurance, amongst other possible remedies, is analyzed. A list of recommendations is outlined, in the last chapter.


OPSOMMING
Gesondheidsorgdienste in post-onafhanklike Zimbabwe het turbulensie ondergaan met periodes van oënskynlik beduidende verbeteringe en ander tydperke van definitiewe afname. Hierdie tesis ontleed gesondheidsorgstelsels in die algemee, met spesiale verwysing na die gesondheidsorgstelsel van Zimbabwiese. Etiese kwessies en uitdagings in gesondheidsorg kan baie vorme van debatte aanneem, byvoordeeld besprekings oor die regverdigheid of die gebrek daaraan in die hervormingsproses vir gesondheidsorg, die etiek van interprofessionele verhoudings, die etiese probleme met doktor-pasiëntverhoudinge, die staat van voorspraak in gesondheidsake, pasiënt-regte, etiese perspektiewe wat diskoerse op gesondheidstelsels beïnvloed, die etiek van gesondheidsorgbefondsing en debatte oor toegang tot gesondheidsorg. Hierdie tesis bespreek die kompleksiteit van die uitdagings, behoeftes en hervormingsvereistes van die Zimbabwiese situasie. ‘n Kritiese analise van die etiese beginsels en die impak daarvan op die Zimbabwiese gesondheidsorgstelsel, word hoofsaaklik gebruik deur die beginsel-benadering van Beauchamp en Childress (2013). Ander morele teorieë soos die sosiale kontrakteorie word ook bespreek as gevolg van die belangrike toepassing daarvan op probleme wat verband hou met gesondheidsorg. 'n Hele hoofstuk word gewy aan die beginsel van distributiewe geregtigheid en die relevansie en implikasies daarvan vir die gesondheidsorgstelsels in die algemeen, maar ook met betrekking tot die situasie in Zimbabwe. Gebrek aan of onvoldoende versekering is die grootste ekonomiese struikelblok in die verkryging van gesondheidsorg in baie lae-inkomste lande. Daar is twee hoofargumente wat blykbaar 'n morele reg op 'n gesondheidsorg wat deur die regering befonds word - "die kollektiewe sosiale beskerming" en die "billike geleentheidargumente" (Beauchamp & Childress, 2013) - ondersteun. Albei hierdie argumente word breedvoerig bespreek. Reg op gesondheid en regte gesondheidsorg is twee konsepte wat baie lesers verwar omdat hulle betekenisse verwant is, maar hulle tog onderskeidelik verwys na verskillende dimensies van die konsep van gesondheid. Hulle word bespreek met spesifieke klem op die etiese kwessies wat die toekenning van gesondheidsbronne, rantsoenering en die opstel van prioriteite insluit. Hierdie tesis druk ook deur na moontlike oplossings vir die gesondheidskrisis in Zimbabwe. Die veelbelowende Nasionale Gesondheidsversekering, word onder andere ontleed. 'n Lys aanbevelings word in die laaste hoofstuk uiteengesit.

The terminology “serial extraction” in Orthodontics was first described in the late 1920’s when Kjellgren [1] decided to plan the extraction of certain deciduous and permanent teeth at early stages of the dentition development. Since the extractions are under taken at the transitional dentition. This type of treatment is defined as “Early Treatment” in Orthodontics [2]. The main indication for this treatment approach is for patients with severe crowding caused by tooth size arch discrepancies [3,4]. In other words, when maxillary and/or  mandibular  arches  cannot  accommodate  teeth,  extraction  becomes an interesting option. Although  this  treatment  option  has  been  used  for  almost  a  century  in  the  contemporary  orthodontics  it’s  indication  is  very  specific.  Since  it’s  an  irreversible  approach  (permanent  teeth are  early  extracted)  the  clinician  should  carefully  diagnosis  the  case  before  selecting  this  option.  In  addition,  as  time  passed  by,  orthodontics  specialty  has  dramatically  evolved  and  developed several  options  to  gain  space  instead  of  extracting  teeth.  On  the  other hand, the idea to early extract permanent teeth continues to be  an  interesting  treatment  option  in  clinical  orthodontics  mainly  in  severely  crowded  patients.  The  aim  of  this  paper  is  to  present  a case report of a ten-year-old male patient who presented severe crowding and treatment option was to extract four first premolars at early stages of the dentition development.

Objectives: The purpose of this paper is to provide a useful critical review relating to the effects of malocclusion on the physical, social, and psychological aspects of the Quality of Life (QoL) of patients. Methods: The information presented in previous articles was reviewed. They include reviews, meta-analyses, cross-sectional studies, retrospective and prospective longitudinal studies, and randomized controlled trials. These full-text English-language papers were studied to determine the effects of malocclusion on QoL. Results: Recent studies have found that malocclusion is associated with higher levels of dissatisfaction with appearance, and have the potential to negatively impact Oral Health Related Quality of Life (OHRQoL). However, due to the differences in study designs, population demographics studied, and methods of assessment of physical, social, and psychological health, the evidence needs more analysis. Conclusion: In recent years, attention to patient-centered assess...

Objective: The objective of this study was to assess the prevalence of malocclusion specifically Class II div 1, Class II div 2 and Class III in a sample of patients in Chandigarh. Data for the patients of study were retrieved from the patient’s orthodontic records who sought orthodontic
treatment at during the period of April 2008 through December 2011.
Materials & Method:Atotal of 768 patients were screened. All the subjects had full complement of permanent teeth up to second molars. The patients with the history of previous orthodontic treatment, extractions of permanent teeth other than 3rd molars, mixed dentition, congenital malformations like Cleft lip or/and palate and systemic diseases were excluded from the study. Assigning the subjects to various occlusal traits was based purely on clinical examination, study
models, facial photographs, lateral cephalograms and orthopantomograms for assessment. Results: Class II malocclusion was more prevalent than Class III malocclusion. Out of Class II malocclusion, Divison 1 is more common among various types followed by Class II div 2. Females reported more for orthodontic treatment than males. Conclusion: Class II malocclusion is the most common malocclusion seen in the Chandigarh Population with females reporting more for orthodontic treatment than males because of esthetic reasons.

Advanced digital technology is rapidly changing the world, as well as transforming the dental profession.
The entry of computer in the eld of design and manufacturing has led to the emergence of new area known as Computer Aided Design and Computer Aided Manufacturing. The adaptation of digital technologies in dentistry allied with efcient processes and accurate high-strength material are replacing outdated techniques to improve overall patients experience and outcome. CAD/CAM systems have been used for many years in various industries, notably the automotive industry, but are now nding application development in dentistry. In this article, we review the recent history of development and application of CAD/CAM in orthodontic eld of Dentistry. The ability to consistently fabricate dimensionally accurate custom made orthodontic appliances in large quantities is a manufacturing challenge that has only recently been met through advances in CAD/CAM technology.

Class II skeletal base with vertical maxillary excess (VME) and skeletal mandibular deficiency presents a combination of several problems about function, psychology, and esthetics. The optimal treatment plan generally includes a harmonized orthodontic-surgical approach through superior repositioning (Vertical maxillary impaction) using Le-Fort I osteotomy, mandibular advancement, and genioplasty. A 23-year-old woman with severe skeletal Class II malocclusion, convex profile, and gummy smile was referred to our department. Skeletally, she presented with vertical maxillary excess, mandibular deficiency along with a hyperdivergent growth pattern. Dentally, Class II molar, and canine relationships increased overjet and overbite with proclined upper (U1-SN: 118o) and lower incisors (L1-MP: 97o). Maxillary impaction was planned to correct the gummy smile, and mandibular advancement to improve the convex profile and correct the mandibular deficiency. In adjunct, genioplasty was also planned to correct the chin deficiency. The decompensation phase involved correction of the proclination and crowding of the upper incisors by extraction of the upper first premolars and decrowding, uprighting, and retracting the lower incisors by using the molar extraction space thus increasing the overjet. Bi-jaw surgery which included a Le-fort I osteotomy for vertical maxillary impaction (4mm), bilateral sagittal split osteotomy (BSSO) for mandibular advancement (5mm), and genioplasty was done to correct the skeletal and dental Class II. This case report describes a multidisciplinary approach in the successful management of a patient with VME and mandibular advancement to achieve superior function, stability, facial esthetics, and an ideal occlusion.

Deep bite is one of the frequently seen malocclusions next to crowding. It can occur along with other associated malocclusions. It is said to be one of the most perpetuating and damaging malocclusions. It may jeopardize the periodontal support, occlusion itself or TMJ. The management of this problem demands a careful diagnostic analysis, treatment plan, and selection of appropriate treatment therapy. The treatment plan depends upon the severity and the age of the patient. Presented here is three different case reports in which deep bite was corrected by using removable anterior bite plane, myofunctional appliance and fixed orthodontic treatment using microimplants.

The archwire has been an integral part of the orthodontic appliance, ever since Dr. Edward Angle placed the first appliance into the patient’s mouth. The high esthetic demand by the patient, along with the introduction of composite and ceramic brackets initiated research for esthetic archwires to go with these brackets. Esthetic archwires available are composite, optiflex and coated archwires. In orthodontics, composite prototypes of archwires, ligatures and brackets have been made from S-2 glass fibers (a ceramic) and acrylic resins (Polymer). Optiflex archwires are made of clear optical fiber comprises of three layers: a) silicon dioxide core b) silicon resin middle layer and c) nylon
outer layer. Coated archwires can be teflon coated, epoxy coated or the nitanium tooth toned archwire. Appropriate use of all the available wire types may enhance patient comfort and reduce chairside time as well as the duration of treatment. The individual clinician must always know and understand the needs and options at every stage of therapy.

Papageorgiou SN, G€ olz L, Jäger A, Eliades T, Bourauel C. Lingual vs. labial fixed orthodontic appliances: systematic review and meta-analysis of treatment effects. Eur J Oral Sci 2016; 00: 000–000. © 2016 Eur J Oral Sci The aim of this systematic review was to compare the therapeutic and adverse effects of lingual and labial orthodontic fixed appliances from clinical trials on human patients in an evidence-based manner. Randomized and prospective non-randomized clinical trials comparing lingual and labial appliances were included. Risk of bias within and across studies was assessed using the Cochrane tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random-effects meta-analyses were conducted, followed by subgroup and sensitivity analyses. Six electronic databases were searched from inception to July 2015, without limitations. A total of 13 papers pertaining to 11 clinical trials were included with a total of 407 (34% male/66% female) patients. Compared with labial appliances, lingual appliances were associated with increased overall oral discomfort , increased speech impediment (measured using auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty, and decreased intermolar width. On the other hand, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. Based on existing trials, there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low.

Radiography of the hand & wrist is the commonest modality used to calculate bone age. Automated methods for evaluation of hand
and wrist radiographs are also being developed which reduce inter rater variability compared to manual methods. Non radiation
based techniques of visualizing hand & wrist bones such as ultrasonography for bone age calculation have been theorized but are not
as accurate as radiographic methods. MRI based methods are being developed but require more research. Dental age is an alternate
form of bone age determination, which also gives an estimate of skeletal maturity. The accurate age assessment is required for
applying correct treatment modality in pediatric patient as well as for forensic purpose. The hand wrist radiograph is considered to be
the most standardized method of skeletal assessment. In the present review we will discuss about the various methods of hand wrist
skeletal maturity assessment.

Background: Although the headgear appliance has been used extensively to correct anteroposterior discrepancies, its treatment effects have not yet been adequately assessed in an evidence-based manner. Objective: Aim of this systematic review was to assess the therapeutic and adverse effects of early headgear treatment from controlled clinical trials on human patients in an evidence-based manner. Search methods: An unrestricted electronic search of six databases from inception to December 2015. Selection criteria: Randomized and prospective non-randomized controlled trials assessing the effects of headgear treatment on human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs) and relative risks (RRs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of 18 unique studies with a total of 930 (56% male/44% female) patients were included. Headgear treatment was associated with a posterior translation of the anterior maxilla border in the short term, as seen by the mean annualized change in the SNA angle (MD = −1.63°/ year; 95% CI = −2.20 to −1.06°/year; high quality evidence) compared to untreated patients. This effect was independent of the rotation of the palatal plane and the inclination of the upper incisors, while a proportional relationship with the initial discrepancy in SNA was seen. The clinical significance of this improvement diminished in the long term, although only limited evidence existed. Additionally, early headgear treatment might decrease the risk of dental trauma during the following years (RR = 0.34; 95% CI = 0.14 to 0.80; moderate quality evidence). Low quality evidence on the effect of headgear on the rotation of the palatal plane, the nasolabial angle, the occlusal outcome, and signs of temporomandibular disorders precluded robust assessments, due to risk of bias, inconsistency, imprecision, and small-study effects. Conclusions: Based on existing trials, headgear is a viable treatment option to modify sagittal growth of the maxilla in the short term in Class II patients with maxillary prognathism. Registration: PROSPERO (CRD42015029837). Funding: None.

Background: Permanent canines are amongst the teeth most affected by impaction and ectopic eruption. Although impacted canines are often subjected to surgical exposure and alignment with either the open or the closed technique for many decades, their treatment effects have not yet been systematically asssessed. Objectives: The aim of this systematic review was to critically assess whether significant differences exist in the outcomes of the open or closed surgical exposure of impacted canines. Search methods: An unrestricted electronic search of nine databases from inception to December 2016 was performed. Selection criteria methods: Included were randomized or prospective non-randomized studies comparing open versus closed exposure of impacted canines in human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs) and odds ratios (ORs), including their 95 per cent confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of eight unique studies and a total of 433 (30.1% male/59.9% female) patients were included, with an average age of 15.2 years and a total of 453 impacted canines (48.6% and 51.4% in the open and closed exposure, respectively). Open exposure of impacted canines was associated with reduced duration of canine alignment (two studies; MD = –2.14 months; 95% CI = –4.23 to –0.05 months; P < 0.05; moderate heterogeneity and moderate quality) and lower odds of tooth ankylosis (one study; OR = 0.15; 95% CI = 0.03–0.83; P < 0.05; low quality) compared to closed exposure; both findings being independent of canine localization. However, initial alignment of palatally impacted canines took overall significantly longer than labially impacted canines (8.87 versus 4.17 months). Conclusions: Based on existing evidence, open surgical exposure seems to be superior in treatment duration and ankylosis risk over the closed technique. Due to the limited number of small included trials, further research is needed for robust clinical recommendations. Registration: PROSPERO (CRD42016051916).

Abstract
Purpose Although several prescriptions and techniques exist for comprehensive fixed appliance treatment, their treatment effects have not yet been adequately assessed in an evidence-based manner. The aim of this systematic review was to assess the therapeutic and adverse effects of various prescriptions or techniques for orthodontic appliances from randomized clinical trials on human patients.
Methods Eight databases were searched up to July 2016 for randomized trials assessing any orthodontic prescriptions or techniques in human patients. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses with mean differences (MD) and their 95% confidence intervals (CIs) were performed.
Results Compared to Roth preadjusted appliances, both Begg and modified Begg appliances were associated with statistically significantly worse occlusal outcome assessed with Peer Assessment Review (PAR) scores (1 trial, MD 3.1 points, 95% CI 1.9–4.3 points and 1 trial, MD 2.4 points, 95% CI 1.2–3.6 points, respectively) with low quality of evidence, due to bias and imprecision. Compared to a partially programmed fixed orthodontic appliance, a fully programmed appliance was associated with a statistically significant, but clinically irrelevant increase in treatment duration (1 trial, MD 2.4 months, 95% CI 0.6–4.2 months), supported by high quality of evidence. However, caution is needed in the interpretation of these results as only a limited number of small trials with methodological issues were available.
Conclusions Based on existing trials, there is limited evidence to support any robust clinical recommendation
regarding the prescriptions or techniques for fixed orthodontic appliances.
Registration: PROSPERO (CRD42016042727).
Funding: None.

Review Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta-analysis Konstantonis D, Vasileiou D, Papageorgiou SN, Eliades T. Soft tissue changes following extraction vs. nonextraction orthodontic fixed appliance treatment: a systematic review and meta-analysis. Eur J Oral Sci 2018; 00: 1–13. © 2018 Eur J Oral Sci The aim of this systematic review was to assess the effect of systematic extraction protocols during orthodontic fixed appliance treatment on the soft tissue profile of human patients. Nine databases were searched until December 2016 for controlled clinical studies including premolar extraction or nonextraction treatment. After elimination of duplicate studies, data extraction, and risk-of-bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MD) or standardized mean differences (SMD) and their 95% CIs were performed, followed by subgroup, meta-regression, and sensitivity analyses. Extraction treatment was associated with increased lower lip retraction (24 studies; 1,456 patients; MD = 1.96 mm), upper lip retraction (21 studies; 1,149 patients; MD = 1.26 mm), nasolabial angle (21 studies; 1,089 patients; MD = 4.21°), soft-tissue profile convex-ity (six studies; 408 patients; MD = 1.24°), and profile pleasantness (three studies; 249 patients; SMD = 0.41). Patient age, extraction protocol, and amount of upper incisor retraction during treatment were significantly associated with the observed extraction effects, while the quality of evidence was very low in all cases due to risk of bias, baseline confounding, inconsistency, and imprecision. Although tooth extractions seem to affect patient profile, existing studies are heterogenous and no consistent predictions of profile response can be made.

Objectives Aim of this systematic review was to assess the effect of orthodontic treatment with fixed appliances on the tooth color of patients. Methods Nine databases were searched up to May 2017 for clinical cohort studies on the effect of fixed appliance treatment on tooth color. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses of mean differences (MD) or means and their 95% confidence intervals (CIs) were performed, followed by GRADE (Grading of Recommendations Assessment, Development and Evaluation) assessment of the quality of evidence. Results Three nonrandomized and one randomized study with a total of 138 patients (46% male, 54% female) with average age of 15.7 years were included. Tooth color of treated patients was significantly altered during or after orthodontic treatment (4 studies; average of 3.2 E units; 95% CI = 2.0–4.4 E units), which was more than the variation among controls (1 study; MD = 1.9 E units; 95% CI = 1.7–2.2 E units). However, the quality of evidence was very low, due to the inclusion of nonrandomized studies, bias, and imprecision. Re-analysis of raw study data indicated that significant differences in clinically discernable treatment-induced color changes were seen between chemically and light-cured adhesives and among the various tooth categories. Conclusion Existing evidence of very low quality indicates that orthodontic treatment might be associated with alterations of tooth color, which are however not consistently clinically discernible. Treatment-induced color alterations might be dependent on bonding material and tooth type, but evidence supporting this is weak.

Aim: To assess the effectiveness of zygomatic anchorage for the intrusion of maxillary pos- terior teeth. Method: A male patient, 20 years 5 months of age, with 3-mm anterior open bite with excessive maxillary posterior growth, was accepted for treatment. Titanium mini- plates were fixed bilaterally to the zygomatic buttress area and 200 g of force was applied unilaterally with 9-mm nickel-titanium coil springs between the vertical extension of the miniplate and the first molar buccal tube. Later, the zygomatic site was used for maxillary canine distalization. Results: The maxillary posterior teeth were intruded effectively and the canines were distalized bodily, without anchorage loss, with the help of zygomatic anchor- age. The patient was advised to maintain good oral hygiene throughout the treatment. This noninvasive surgical procedure eased and reduced the operation time and did not require headgear wear nor anterior box elastics for anterior open bite correction. Conclusion: The zygomatic area was found to be a useful anchorage site for the intrusion of the molars over a short period of time. Long-term stability of the bite closure should be assessed in future studies. World J Orthod 2002;3:147–153.

Various treatment strategies are adopted to correct a Class II malocclusion depending on the age, the amount of remaining growth and severity of malocclusion. Single arch extraction of the lowers is rarely done in a Class II malocclusion. The following case report describes an alternate treatment approach of an adolescent Class II patient treated with a combination of headgear, fixed functional appliance (forsus), and single arch extraction only in the lower arch. The case was finished in a Class III molar and a Class I canine relationship. The results were stable in 3 years follow‑up.

Introduction: Aim of this study was to assess the registration of orthodontic systematic reviews in PROSPERO. Method: Seven databases were searched for orthodontic systematic reviews published in 2012-2016. After duplicate study selection and data extraction, descriptive statistics, followed by chi-square/Fisher exact tests were calculated. Finally, bivariable/multivariable regression with relative risks (RR) and 95% confidence intervals (CIs) was used. Results: A total of 182 orthodontic systematic reviews were identified, 37 (20.3%) of which were registered in PROSPERO, with registration rates ranging from 4.3% in 2012 to 37.0% in 2016. Differences in review registration were found according to publication year, geographic origin, multicentre status, funding, and journal category. After controlling for confounders, each additional year was associated with increased registration probability (RR = 1.51; 95% CI = 1.19– 1.93). Reviews from South America were more likely to be registered than reviews from Europe (RR = 1.49; 95% CI = 1.06–2.11). Finally, reviews published in orthodontic specialty journals were more likely to be registered than reviews in general dentistry journals (RR = 1.87; 95% CI = 1.02– 3.49). Conclusions: A small percentage of orthodontic systematic reviews was registered a priori, although improvement signs have been seen since the initiation of PROSPERO.

An impacted tooth is defined as partially or completely unerupted tooth which lies against adjacent tooth, overlying soft tissues or bone so that its further eruption is unlikely. One of the rare or infrequent tooth that is impacted in the oral cavity is mandibular canine. The current case report demonstrates a simple way to treat an impacted right mandibular
canine using lingual arch made up of 19 gauge round stainless steel arch wire with soldered spring (19  2500 stainless steel). Closed eruption technique with a Begg’s bracket bonded on the labial surface of impacted canine was chosen as it facilitates the preservation of the
attached gingiva around the newly erupted tooth.

ABSTRACT
Objective: There is an increasing tendency to prescribe maxillary orthopaedic treatment with skeletal anchorage, with the goal of enhancing the skeletal and minimizing the dentoalveolar effects – offering a management option for skeletal Class III dysmorphoses that otherwise they received surgical treatment in their adulthood. An update is provided to evaluate the effects on maxilla, mandible, dentoalveolar part, soft-tissue and airway of intra-oral skeletally anchored maxillary protraction (I-SAMP) for correction of skeletal Class III malocclusion. Method: A literature review has been made to consolidate the supporting scientific evidence in this field of Intra-oral skeletally anchored maxillary protraction (I-SAMP) in growing children having Class III malocclusion. A Medline (PubMed) search was made using the following MeSH terms: Malocclusion Class III therapy, Intraoral traction appliances, Bone plates, Skeletal anchorage, Maxillary protraction. Results: At present, many articles show that the incorporation of surgically inserted bone anchorage appliances (miniplates and miniscrews) has been seen to afford a lesser relapse rate and greater dentofacial orthopaedic correction due to its lesser dentoalveolar impact. Nevertheless, further randomized clinical studies are needed to firmly establish the quantifiable differences in terms of maxillary advance, mandible and TMJ effects, optimum traction appliance, optimum traction chronological age, and potential side effects.

Background: Although Rapid Maxillary Expansion (RME) has been used for over a century, its effect on upper airways has not yet adequately been assessed in an evidence-based manner. Objective: To investigate the volumetric changes in the upper airway spaces following RME in growing subjects by means of acoustic rhinometry, three-dimensional radiography and digital photogrammetry. Search methods: Literature search of electronic databases and additional manual searches up to February 2016. Selection criteria: Randomized clinical trials, prospective or retrospective controlled clinical trials and cohort clinical studies of at least eight patients, where the RME appliance was left in place for retention, and a maximum follow-up of 8 months post-expansion. Data collection and analysis: After duplicate data extraction and assessment of the risk of bias, the mean differences and 95 per cent confidence intervals (CIs) of upper airway volume changes were calculated with random-effects meta-analyses, followed by subgroup analyses, meta-regressions, and sensitivity analyses. Results: Twenty studies were eligible for qualitative synthesis, of which 17 (3 controlled clinical studies and 14 cohort studies) were used in quantitative analysis. As far as total airway volume is concerned patients treated with RME showed a significant increase post-expansion (5 studies; increase from baseline: 1218.3 mm 3 ; 95 per cent CI: 702.0 to 1734.6 mm 3), which did not seem to considerably diminish after the retention period (11 studies; increase from baseline: 1143.9 mm 3 ; 95 per cent CI: 696.9 to 1590.9 mm 3). Limitations: However, the overall quality of evidence was judged as very low, due to methodological limitations of the included studies, absence of untreated control groups, and inconsistency among studies. Conclusions: RME seems to be associated with an increase in the nasal cavity volume in the short and in the long term. However, additional well-conducted prospective controlled clinical studies are needed to confirm the present findings.

Mandible articulates with the cranium via the TMJ, all the component of the TMJ, including the TMJ disc, seems to be associated with altered characteristics of the craniofacial complex and its growth, but it is not clear yet the exact role of the TMJ disc thickness during the process of the facial growth. Aim The aim of this study is to investigate the association between the TMJ disc thickness and the facial growth determined according to Jarabak in adult male subjects with no clinical or MRI symptoms of Temporomandibular Joint Disorders. Materials and methods: 20 males from 19 to 25 years of age, were selected as volunteers from pretreatment patients undergoing orthodontic evaluation at the Department of Orthodontics and Dentofacial Orthopedics at Tishreen University with no clinical or MRI symptoms of TMDs., cephalometric growth study was performed according to Jarabak. MRI study was performed of both TMJ for calculating disk thickness Pearson's Correlation Coefficient was calculated to investigate the relationship between the TMJ disc thickness's measurements (left & right) and cephalometric measurements determined according to Jarabak's analysis for estimating facial growth. Results: no significant relationship between the measurements of TMJ disc thickness (left &right) with the cephalometric measurements determined according to Jarabak for estimating facial growth in adult male subjects with no clinical or MRI symptoms of TMDs. Conclusions No relationship between the measurements of TMJ disc thickness (both sides) with the cephalometric measurements determined according to Jarabak for estimating facial growth in adult male subjects with no clinical or MRI symptoms of TMDs Key Words: Facial growth cephalometric evaluating by Jarabak , TMJ disc thickness, male subjects with no clinical or MRI symptoms of TMDs.

Several biologically active substances representing the bone deposition and resorption processes are released following damage to periodontal tissue during orthodontic movement. Biomarkers are by definition objective, quantifiable characteristics of biological processes. The analysis of saliva/salivary fluid and Gingival crevicular fluid (GCF) may be an accepted way to examine the ongoing biochemical processes associated with bone turnover during orthodontic tooth movement and fixed orthodontic treatment pain. Assessing the presence of these salivary physiological biomarkers would benefit the clinician in appropriate pain diagnosis and management objectively of various problems encountered during the orthodontic procedures and for better outcome of biomechanical therapy. Due to lack of standardized collection procedure, even though well accepted by patients, saliva is often neglected as a body fluid of diagnostic and prognostic value. A literature search was carried out in major databases such as PubMed, Medline, Cochrane library, Web of Science, Google Scholar, Scopus and EMBASE for relevant studies. Publication in English between 2000 to 2021 which estimated Saliva markers as indicators of orthodontic tooth movement was included. The list of biomarkers available to date was compiled and is presented in table format. Each biomarker is discussed separately based on the available and collected evidences. Several sensitive salivary and GCF biomarkers are available to detect the biomechanical changes occurring during orthodontic tooth movement and pain occurring during fixed orthodontic therapy. Further focussed research might help to analyze the sensitivity and reliability of these biomarkers or cytokines, which in turn can lead to the development of chairside tests to assess the pain experienced by patients during orthodontic therapy and finally the outcome of the fixed orthodontic therapy.

Obesity is a widespread chronic inflammatory disorder characterized by an increased overall disease burden and significant association with periodontitis. The aim of this prospective clinical cohort study was to investigate the effect of obesity on orthodontic tooth movement. Fifty-five adolescent patients (27 males, 28 females) with a mean (SD) age of 15.1 (1.7) years and mean (SD) body mass index (BMI) of 30.2 (3.5) kg/m2 in obese and 19.4 (2.2) kg/m2 in normal-weight groups were followed from start of treatment to completion of tooth alignment with fixed orthodontic appliances. Primary outcome was time taken to complete tooth alignment, while secondary outcomes included rate of tooth movement and change in clinical parameters (plaque/gingival indices, unstimulated whole-mouth salivary flow rate, gingival crevicular fluid biomarkers). Data collection took place at baseline (start of treatment: appliance placement), 1 h and 1 wk following appliance placement, and completion of alignment. Results were analyzed by descriptive statistics followed by generalized estimating equation regression modeling. There were no significant differences between groups in time taken to achieve tooth alignment (mean [SD] 158.7 [75.3] d; P = 0.486). However, at 1 wk, initial tooth displacement was significantly increased in the obese group ( P < 0.001), and after adjusting for confounders, obese patients had a significantly higher rate of tooth movement compared with normal-weight patients (+0.017 mm/d; 95% confidence interval, 0.008-0.025; P < 0.001) over the period of alignment. Explorative analyses indicated that levels of the adipokines leptin and resistin, the inflammatory marker myeloperoxidase (MPO), and the cytokine receptor for nuclear factor kappa-B ligand (RANKL) were significantly different between obese- and normal-weight patients and associated with observed rates of tooth movement. This represents the first prospective data demonstrating a different response in obese patients compared with normal-weight patients during early orthodontic treatment. These differences in the response of periodontal tissues to orthodontic force in the presence of obesity have potential short- and long-term clinical implications.

Objective: The aim of this systematic review was to assess the occlusal outcome and duration of fixed orthodontic therapy from clinical trials in humans with the Objective Grading System (OGS) proposed by the American Board of Orthodontics. Methods: Nine databases were searched up to October 2016 for prospective/ retrospective clinical trials assessing the outcomes of orthodontic therapy with fixed appliances. After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of the mean OGS score and treatment duration were performed and 95% confidence intervals (CIs) were calculated. Results: A total of 34 relevant clinical trials including 6,207 patients (40% male, 60% female; average age, 18.4 years) were identified. The average OGS score after treatment was 27.9 points (95% CI, 25.3–30.6 points), while the average treatment duration was 24.9 months (95% CI, 24.6–25.1 months). There was no significant association between occlusal outcome and treatment duration, while considerable heterogeneity was identified. In addition, orthodontic treatment involving extraction of four premolars appeared to have an important effect on both outcomes and duration of treatment. Finally, only 10 (39%) of the identified studies matched compared groups by initial malocclusion severity, although meta-epidemiological evidence suggested that matching may have significantly influenced their results. Conclusions: The findings from this systematic review suggest that the occlusal outcomes of fixed appliance treatment vary considerably, with no significant association between treatment outcomes and duration. Prospective matched clinical studies that use the OGS tool are needed to compare the effectiveness of orthodontic appliances. [Korean J Orthod 2017;47(6):401-413]

Background: Torque of the maxillary incisors is crucial to occlusal relationship and esthetics and can be influenced by many factors. The aim of this study was to assess the relative influence of the material of the orthodontic appliance (adhesive, bracket, ligature, and wire) on tooth displacements and developed stresses/strains after torque application. Methods: A three-dimensional upper right central incisor with its periodontal ligament (PDL) and alveolus was modeled. A 0.018-in. slot discovery® (Dentaurum, Ispringen, Germany) bracket with a rectangular 0.018 x 0.025-in. wire was generated. The orthodontic appliance varied in the material of its components: adhesive (composite resin or resin-modified glass ionomer cement), bracket (titanium, steel, or ceramic), wire (beta-titanium or steel), and ligature (elastomeric or steel). A total of 24 models were generated, and a palatal root torque of 5° was applied. Afterwards, crown and apex displacement, strains in the PDL, and stresses in the bracket were calculated and analyzed.

Background: Whether to band molars or bond them during Orthodontic treatment has now become a dilemma to many Orthodontists practicing across the country. Both banding and bonding have their pros and cons.The terminal attachments of fixed appliances are placed on molar teeth; most commonly the first permanent molars. These attachments can take the form of a cemented molar band or a bonded molar tube. The active phase of fixed orthodontic appliance treatment takes an average of two years to complete. To reduce the likelihood of emergency visits, improve patient experience and avoid lengthy treatment times it is important that these attachments have low failure rates.
Aim: This questionnaire based survey aims to evaluate whether orthodontists prefer molar banding or bonding in their routine clinical practice.
Methodology: A sample of 157 participants (orthodontists) was taken after assessing the sample size within the age group of 27 - 50 years of age. The participants comprised of orthodontists practicing in various parts of India. A Questionnaire was created on Google forms and circulated to participants using various social media platforms.The data of responses of participants were analyzed and evaluated with the help of pie charts.
Results: This survey analyzed Orthodontists' choice during banding / bonding of molars and tried to evaluate the common problems faced during either banding molars or bonding them with bondable molar tubes. Majority of Orthodontists preferred bondable molar tubes over banding in routine orthodontic practice. The most common problem faced by majority orthodontists associated with banding was increased chair-side time and increased gingival impingement and irritation, whereas the most common problem faced by them associated with bonding with bondable molar tubes was increased tendency of breakages. Majority of Orthodontists felt that banding in orthodontics was unnecessary as it took up a lot of clinical time and they also asserted that in their experience, frequency of breakages were mostly associated with bondable tubes than bands. However the most striking and highlighting feature of this study was that participants believed that banding molars did not have any added advantage over using bondable molar tubes.
Conclusion: This questionnaire based survey clearly helped in proving that Orthodontists preferred using bondable molar tubes over molar banding in their routine clinical practice as they believed that it saved a lot of clinical time, provided benefits that outweighed its drawbacks and moreover were in no way inferior to molar banding when used during routine fixed orthodontic treatment.

There is no consistent relationship between malocclusion and periodontal disease but certain characteristics of malocclusion can promote a pathologic environment conducive to periodontal disease. One of the dramatic means available to improve the local environmental factors is through orthodontic tooth movement. The pretreatment periodontal conditions can include excessive tooth mobility, advanced crestal bone loss, infrabony defects, tipped molars, furcation involvement , and hard and soft tissue dehiscences. Movement of teeth in the presence of periodontal inflammation can result in an increased loss of attachment and irreversible crestal loss. Although absolute reduction in bone and attachment levels does not contraindicate orthodontic correction, it does increase the difficulty of delivering controlled orthodontic mechanics that would potentially minimize further bone loss. The present review article discusses the various factors that are associated with orthodontic tooth movement in periodontally compromised patients namely: 1) tooth movement into infrabony pockets; 2) tooth movement into compromised bone areas; 3) tooth movement through cortical bone; 4) extrusion (eruption); 5) intrusion; 6) tipping.

Background: The aim of this study was to compare the torque efficacy of square and rectangular wires in
0.018- and 0.022-in. conventionally ligated brackets.
Methods: Brackets of the same prescription were evaluated in both slot dimensions. Identical acrylic resin
models of the maxilla were bonded with the brackets and mounted on the Orthodontic Measurement and
Simulation System. Ten 0.018 × 0.018 in., 0.018 × 0.022 in., and 0.018 × 0.025 in. stainless steel wires were
evaluated in the 0.018-in. brackets and ten 0.019 × 0.019 in., 0.019 × 0.025 in., and 0.019 × 0.026 in. stainless
steel wires were evaluated in the 0.022-in. brackets. A 15° buccal root torque was gradually applied to the
right central incisor bracket, and the moments were recorded at this position. One-way ANOVA was applied
for both bracket slot sizes along with post hoc analysis for the various archwire sizes.
Results: The mean measured moments varied between 10.78 and 30.60 Nmm among the assessed wire-and-bracket
combinations. Both square and rectangular archwires in the 0.018-in. bracket system exerted statistically significantly
higher moments in comparison with their counterparts in the 0.022-in. bracket system. Rectangular archwires exerted
statistically significantly higher moments than square archwires, both for the 0.018- and the 0.022-in. bracket system.
Conclusions: Rectangular archwires seem to be more efficient in torque exertion, especially in 0.018-in. brackets.