Management of an adult patient with missing one mandibular incisor, severe overjet, and midline discrepancy with asymmetric extraction, lingual appliance, and skeletal anchorage: A case report

High Prevalence of Work-Related Musculoskeletal Disorders Among Dentists: A Cross-Sectional Study From Kerala, India

BACKGROUND

 Literature on the prevalence of musculoskeletal disorders (MSD), work ability, and associated factors among dentists is limited. Therefore, this study aimed to determine the prevalence of MSD, work ability, and associated factors among dentists in Kerala, India.

METHODS

 This cross-sectional study was conducted among 290 dentists (median age: 34 years, 47% male), selected from a list of dentists in a district of Kerala. Information on MSD and work ability were collected using a structured, pre-tested questionnaire administered both online and through direct interviews. Factors associated with MSD were analyzed using multivariable regression analysis.

RESULTS

 The prevalence of MSD in the past 12 months was 86.9% (95% CI: 83.1 - 90.9), and in the past seven days was 42.4% (95% CI: 36.7 - 48.08). Among those reporting MSD in the last 12 months, 21.4% experienced it in two sites. Of the nine regions assessed, the neck was the most affected over the past 12 months, with 57.6% reporting discomfort, while the lower back was the most affected in the last seven days (21.4%). Work ability was rated as excellent by 24.5% of participants and good by 51.7%. In the regression analysis, no significant association was found between socioeconomic factors and MSD during either time period. However, bivariate analysis showed that dentists who were overweight and those aged 34 years or older reported significantly more knee-related MSD in the past seven days (p=0.033 and p=0.037, respectively).

CONCLUSION

 Despite the high prevalence of MSD among dentists, more than three-fourths reported good or excellent work ability. Implementing mandatory ergonomic assessments and interventions in dental workplaces may help reduce MSD among dentists.

Orthodontic Retreatment of an Adult Bimaxillary Protrusion Patient With Lingual Appliances and Premolar Extractions: A Case Report

Orthodontic relapse and the demand for improved esthetics often necessitate retreatment in adult patients. This case report highlights the successful management of an adult female patient with bimaxillary protrusion, previously treated with a non-extraction approach. Treatment included lingual passive self-ligating appliances, premolar extractions, and mini-screws to reinforce anchorage. The patient's facial profile and dental esthetics were significantly improved after 20 months of treatment, achieving a stable occlusion and reduced bimaxillary protrusion. This case demonstrates that lingual appliances can be an effective and esthetic treatment option for complex orthodontic retreatment in adult patients. Careful biomechanical planning and attention to specific challenges, including torque control and bowing effect, are essential for successful outcomes.

Deciphering the Mutilation: Skillful Orthodontic Treatment Using Temporary Anchorage Devices and Asymmetric Extractions for a Patient With a Knife-Edge Ridge

One of the biggest challenges in orthodontic management of adult patients is the presence of mutilated dentition, which is characterized by severe tooth loss and subsequent tipping of adjacent teeth or extruding of antagonists, worsening the malocclusion. As they offer a solid anchor for intricate tooth movement, temporary anchorage devices (TADs) have proven invaluable to orthodontic treatment. In this case study, we highlight the importance of TADs in getting the best possible treatment outcomes while describing the effective management of a patient with mutilated dentition. TADs made it possible to control tooth movement precisely, restoring esthetics and functional occlusion. This case report emphasizes the value of TADs in contemporary orthodontic practice and shows their potential for correcting mutilated dentition.

3D-printed indirect bonding trays and transfer jigs for lingual brackets: Digital workflows and two case reports

With the advancement of 3-dimensionally (3D) printing technology, orthodontists can design and fabricate 3D-printed indirect bonding trays and transfer jigs for lingual brackets independently from the laboratory. The present article describes, in detail, the digital workflows for designing and fabricating 3D-printed lingual bracket indirect bonding trays and transfer jigs. Additionally, it aims to demonstrate the effectiveness of this approach in managing common orthodontic issues in adult patients. The first case report exemplifies the successful management of moderate crowding in a Class I adult patient using a non-extraction approach with lingual brackets and flexible 3D-printed indirect bonding trays. The second case illustrates the application of lingual brackets and rigid 3D-printed indirect bonding trays in managing a skeletal Class II adult patient with mouth protrusion requiring four-bicuspid extractions. The achieved good treatment results might demonstrate the high transfer accuracy of 3D-printed lingual bracket indirect bonding trays. Additional studies with large sample sizes should be conducted to compare the effectiveness and efficiency of 3D-printed trays with other tray types.

Lingual bracket transfer accuracy of double vacuum-formed indirect bonding tray using 3D-printed model: an in vivo study

INTRODUCTION

This study aimed to assess the transfer accuracy of a digital indirect bonding method for lingual brackets using double vacuum-formed trays in vivo.

METHODS

Twenty-five patients in need of lingual orthodontic treatment were consecutively recruited. Bracket placement was performed on ideal setups, followed by fabricating indirect bonding trays through vacuum-forming on 3-dimensional printed models. Transfer accuracy was measured at each bracket after superimpositions of postbonding scans and reference data. One-tailed t tests were used to determine whether bracket deviations were within the limit of 0.5 mm and 2° for linear and angular dimensions, respectively.

RESULTS

A total of 611 lingual brackets were evaluated. Mean linear transfer errors were 0.06 mm, 0.09 mm, and 0.12 mm, with frequencies of deviations within the 0.5 mm limit of 99.7%, 99.8%, and 98.0% for mesiodistal, buccolingual, and occlusogingival dimensions, respectively. Regarding angular measurements, mean transfer errors were 1.28°, 1.73°, and 2.96°, with frequencies of deviations within the 2° limit of 81.0%, 68.9%, and 51.1% for rotation, tip, and torque, respectively. Mean errors fell within the clinically accepted limits for all linear dimensions and rotation but exceeded the limit for tip and torque.

CONCLUSIONS

Lingual bracket indirect bonding using double vacuum-formed trays fabricated on 3-dimensional printed models has high transfer accuracy in the mesiodistal, buccolingual, and occlusogingival dimensions and rotation. However, the transfer of tip and torque is less accurate.

Management of moderate crowding by two-arch distalization using passive self-ligating lingual brackets, in-house digital indirect bonding, and mini-screw anchorage: A case report

This case report presents the management of an adult patient with moderate crowding in both arches and anterior crossbite with passive self-ligating lingual brackets. The orthodontic setup and bracket positioning was done digitally with an in-house approach. Virtual setup and bracket placement was performed on Autolign software (Diorco, Gyeonggi-do, Korea). The indirect bonding trays were vacuum-formed on printed malocclusion models with resin brackets. Two palatal and two buccal shelf miniscrews were used for two-arch distalization to correct proclined incisors and anterior open bite after leveling and alignment stage. After 12-month treatment, normal overbite,overjet and well-aligned dentition were achieved without premolar extraction. The incisors were uprighted slightly and the protrusive lower lip was retracted with improvement of facial harmony. One-year retention records confirmed that the outcome was stable. In-house digital setup and bracket placement could be a cost-effective approach for indirect lingual bracket bonding. Two-arch distalization with miniscrew anchorage may have the possibility of managing moderate crowding cases without premolar extraction or interproximal stripping.

Skeletal Class III Malocclusion with Lateral Open Bite and Facial Asymmetry Treated with Asymmetric Lower Molar Extraction and Lingual Appliance: A Case Report

A skeletal Class III malocclusion with open bite tendency is considered very difficult to treat orthodontically without surgery. This case report describes the lingual orthodontic treatment of an adult skeletal Class III patient with mandibular deviation to the left side, lateral open bite, unilateral posterior crossbite, zero overbite and negative overjet. The lower incisors were already retroclined to compensate with the skeletal discrepancy. The patient was treated by asymmetric molar extraction in the mandibular arch to retract the lower incisors and correct the dental midline, with the help of intermaxillary elastics. Lingual appliance was used with over-torqued lower anterior teeth’s brackets to control the torque of mandibular incisors. After a 30-month treatment, satisfactory smile and facial esthetics and good occlusion was achieved. A 12-month follow-up confirmed that the outcome was stable. Asymmetric molar extraction could be a viable option to retract mandibular incisors in Class III malocclusion with lower dental midline deviation.