Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations' adolescents

Measurement and analysis of condylar morphology and thickness of the roof of the glenoid fossa in patients with unilateral second molar scissor bite

Objective The objective of this study was to measure and analyze the joint space, condylar morphology, and thickness of the roof of the glenoid fossa (RGF) in patients with unilateral second molar scissor bite using cone beam CT (CBCT). Methods A total of 80 patients were included in this study. Forty patients with a normal posterior occlusal relationship, who attended the Department of Orthodontics at the First Hospital of Shanxi Medical University from December 2021 to August 2023, were selected as the control group. The experimental group consisted of 40 patients with unilateral second molar scissor bite during the same period. All patients underwent CBCT scanning, and the resulting images were analyzed using the NNT viewer software in multiplanar reconstruction (MPR). Axial, coronal, and sagittal adjustments were made for each patient. Results In the control group, the right and left joint spaces (PS, SS, AS), the height of the upper part of the condyle, and the depth of the glenoid fossa did not show statistically significant differences (P > 0.05). When comparing bilateral condylar morphology and joint space in the experimental group, it was found that the posterior joint space on the scissor bite side was greater than that on the normal occlusion side, while the anterior joint space on the scissor bite side was smaller than that on the normal occlusal side. Additionally, the height of the upper condyle and the depth of the glenoid fossa on the scissor bite side were greater than that on the normal occlusal side, with statistically significant differences (P < 0.05). However, there were no statistically significant differences in SS, internal and external joint diameter, as well as anterior and posterior diameters (P > 0.05). The comparison of the minimum thickness of the roof of the glenoid fossa in both the sagittal and coronal directions between the patients in the experimental group and the control group showed no statistically significant difference (P > 0.05). Furthermore, the asymmetry index of the supracondylar height in the control group was significantly smaller than that in the experimental group, displaying a statistically significant difference (P < 0.05). The differences in the asymmetry indices of the anterior and posterior diameters of the condyle, as well as the inner and outer diameters, were not statistically significant (P > 0.05). When analyzing the position of the condyle in the sagittal direction of the glenoid fossa in the patients of the control group, it was observed that the majority were in the anterior and medial positions, with only 10% and 5% being in the posterior position. However, the analysis of the condyle position in the sagittal direction of the glenoid fossa in the experimental group revealed statistically significant differences (P < 0.05), with the condyle position on the scissor bite side being more anterior. Conclusion Unilateral second molar scissor bite can result in anterior displacement of the condyle, greater height of the condyle superiorly as well as the depth of the glenoid fossa.

Is occlusal contact re-established within 6 months after bonding of a fixed anterior bite plane in adolescents with a Class II division 2 incisor relationship? A randomised controlled trial

OBJECTIVE

To determine if re-establishment of occlusal contact was achieved within 6 months after insertion of a fixed anterior bite plane in individuals with Class II division 2 incisor relationship, and to evaluate the occlusal and vertical skeletal changes and acceptance of the intra-oral scanner and bite plane.

DESIGN

Single-centre two-arm parallel group randomised controlled trial with 1:1 allocation to intervention and control groups.

SETTING

Dundee Dental Hospital and Research School, UK.

PARTICIPANTS

A total of 38 participants aged 9-16 years (11 males, 27 females) with Class II division 2 incisor relationship and increased overbite (greater than one-third incisor overlap).

METHODS

Participants were randomised to intervention (n = 19) and control (n = 19) groups using block randomisation. The intervention group had a fixed anterior bite plane, and the occlusion and vertical facial dimensions were monitored with intra-oral scans, lateral cephalograms and photographs. The control group received no treatment and occlusal and vertical facial dimensions were monitored with scans and photographs. Questionnaires were completed by participants and parents/carers. An intention-to-treat analysis was planned.

RESULTS

The overbite reduced in all participants in the intervention group (mean initial overbite: 5.07 mm, 95% confidence interval [CI] = 4.15-6.00; mean overbite after 6 months: 2.45 mm, 95% CI = 1.93-2.96). There was a mean incisor intrusion of 0.29 mm (95% CI = 0.17-0.42) and mean eruption of the first molars of 0.23 mm (95% CI = 0.09-0.37). There was no significant change in incisor inclination or vertical skeletal change. Feedback from participants and their parents/carers were generally positive.

CONCLUSION

Fixed anterior bite planes effectively reduce an increased overbite in adolescents with a Class II division 2 incisor relationship, due to a combination of incisor intrusion and molar eruption with no change in incisor inclination or vertical skeletal change. Intra-oral scanning and fixed anterior bite planes are acceptable in adolescents.

A comprehensive national survey on malocclusion prevalence among Palestinian children

BACKGROUND

This study aims to evaluate the prevalence of malocclusion and orthodontic features among schoolchildren in the West Bank, Palestine.

METHODS

A stratified cluster sample of 1278 schoolchildren (620 males, 658 females, mean age 12 years and 5 months (± 0.5)) were examined. Candidates who had not received any previous orthodontic treatment were only included. Dental anomalies like missing and ectopic teeth were recorded. The anteroposterior occlusal relationship was assessed based on Angle classification. Overjet and overbite were measured. Crowding and spacing were recorded subjectively. In addition, crossbite, openbite, and midline displacement were recorded. The chi-square test and descriptive analysis were used statistically.

RESULTS

The study found Angle Class I molar relationship in 65%, Class II div 1 in 17%, Class II div 2 in 6%, and Class III in 12% of the sample. An overjet (OJ) of more than 4 mm was present in 17%, and 4% had OJ of more than 6 mm; an OJ of at least 0 mm or less in 36%, and 6% had a reverse OJ. A normal overbite was observed in 53%, while 28% had an increase and 19% had a decreased overbite. An anterior openbite (AOB) was present in 9%, and a scissor bite or anterior crossbite in 6% and 14%, respectively. A posterior crossbite was observed in 12% (9% unilateral and 3% bilateral). Midline displacement was found in (9%). Crowding was observed in 35% and 31% and spacing in 24% and 15% of the maxillary and mandibular arches, respectively. A statistically significant relationship between gender and midline shift, a diastema, spacing in the upper arch, and most dental anomalies was found; males were more affected (p < 0.05).

CONCLUSION

This study reported a high prevalence of malocclusion among schoolchildren in Palestine. A collaborative effort should be directed to obtain more monitoring and surveillance of malocclusion more frequently to prevent and control the exacerbation of the problem.

Management of a severe skeletal open bite case using temporary anchorage devices and multiloop edgewise arch wire technique

The primary cause of complex AOB malocclusion is typically a combination of dental, skeletal, functional, and habitual factors. Open bite correction is a challenging treatment due to its complexity and the requirement for long-term stability, therefore, multidisciplinary treatment is often the best option for achieving stable esthetic outcomes.

Is Incisor Compensation Related to Skeletal Discrepancies in Skeletal Class III? A Retrospective Cephalometric Study

This study investigated compensation in skeletal Class III subjects to compare various severities of abnormal jaws. A retrospective analysis of 137 skeletal Class III cephalograms (63 males and 74 females) was conducted, with cephalometric assessments determining skeletal and dental values. The results were compared with Class I cephalograms. Incisor compensation was examined by pairing normal jaws with varied abnormal jaws, classified by severity using one standard deviation (SD). Statistical analyses included Kruskal-Wallis tests, Bonferroni tests, Spearman's correlations, and multiple linear regression. Four skeletal Class III groups were identified: OMx+PMd, RMx+OMd, OMx+OMd, and PMx+PMd (P = prognathic; O = orthognathic; R = retrognathic; Mx = maxilla; Md = mandible.). The upper central incisor (U1) showed proclination, and the lower central incisor (L1) showed retroclination across all groups except for U1 in PMx+PMd and L1 in OMx+OMd, which exhibited normal inclination. U1 exhibited limited compensation even with progressive maxillary retrognathism, while L1 showed limited compensation after one SD of mandibular prognathism. Maxilla (SNA) and jaw discrepancy (ANB) were inversely related to the U1 degree, whereas only jaw discrepancy (ANB) was positively related to the L1 degree. U1 in PMx+PMd and L1 in OMx+OMd showed no incisor compensation. U1 had limited compensation even with progressive maxillary retrognathism while L1 showed limited compensation after one SD mandibular prognathism.

Genetic and environmental impact on mandibular growth in mono- and dizygotic twins during adolescence: A retrospective cohort study

INTRODUCTION

This study aimed to discover the genetic and environmental factors that contribute to the mandibular development of untreated monozygotic and dizygotic twins.

MATERIAL AND METHODS

The sample, taken from the Forsyth Moorrees Twin Study, included 52 untreated monozygotic twins (36 male, 16 female) and 46 untreated dizygotic twins (23 male, 23 female). At the ages of 12 and 17, lateral cephalograms were collected and traced to assess total mandibular length, mandibular ramus length, mandibular corpus length, gonial angle, SNB, and bony chin prominence. The genetic and environmental components of variation were assessed using multilevel mixed-effects structural equation modelling.

RESULTS

At 12 years of age, high additive genetic influences were observed for total mandibular length (74%), gonial angle (76%), SNB (41%), and bony chin prominence (64%), whereas strong dominant genetic components were observed for corpus length (72%), and mandibular ramus length was under unique environment influence (54%). At 17 years of age, only total mandibular length (45%), ramus length (53%), gonial angle (76%), and bony chin prominence (68%) were under strong additive genetic control, while the remainder were under strong dominant genetic control.

CONCLUSIONS

Although monozygotic and dizygotic twins share at least a portion of their DNA, additive, dominant, or environmental components were discovered during adolescence. Nonetheless, by the age of 17, the majority of the mandibular traits are under either additive or dominant genetic impact.

Malocclusion: Prevalence and Determinants among Adolescents of Karachi, Pakistan

OBJECTIVES

 The aim of this study was to determine the prevalence of malocclusion and its associated demographic and clinical factors in young adolescents (13-15 years) of Karachi, Pakistan.

MATERIALS AND METHODS

 An epidemiological survey included 500 young adolescents of registered schools, madrassas (Islamic education system), and shop workers of Gulshan-e-Iqbal Town. It was a cross-sectional analytical study design. Multistage random sampling technique was used to enroll participants. The pattern of occlusion was recorded with other related features using Angle's classification. Health status was recorded through World Health Organization-guided indices (decayed, missing, and filled permanent teeth [DMFT], community periodontal index of treatment needs [CPITN], and body mass index [BMI]). The information, thus, obtained was analyzed through SPSS using the chi-squared test and regression models.

RESULTS

 Forty four percent of the participants were female, while overall estimated prevalence of malocclusion in young adolescents of Karachi was 57.4%. After adjustments, participants going to any kind of education system had less malocclusion in comparison to those who were not going to any education system (adjusted odds ratio [aOR] = 0.305, 95% confidence interval [CI] = 0.12-0.73); mother's education especially higher level (aOR = 2.02, 95% CI = 1.08-3.75) and presence of periodontal disease (aOR = 1.57, 95% CI = 1.06-2.33) were significantly associated with malocclusion.

CONCLUSION

 This study showed that the class I malocclusion is prevalent in the local community. Demographic factors like gender, age, self-reported ethnicity, and BMI did not show any significant role. Education or knowledge of parents and young adolescents does play an influential role in decreasing malocclusion. Young adolescents, who are more prone to oral health problems at an early age, would have more chances to develop occlusal discrepancies.

Dual role of endoplasmic reticulum stress-ATF-6 activation in autophagy and apoptosis induced by cyclic stretch in myoblast

OBJECTIVE

Mandibular growth that is induced by functional appliances is closely associated with skeletal and neuromuscular adaptation. Accumulating evidence has proved that apoptosis and autophagy have a vital role in adaptation process. However, little is known about the underlying mechanisms. This study sought to determine whether ATF-6 is involved in stretch-induced apoptosis and autophagy in myoblast. The study also sought to uncover the potential molecular mechanism.

MATERIALS AND METHODS

Apoptosis was assessed by TUNEL and Annexin V and PI staining. Autophagy was detected by transmission electron microscopy (TEM) analysis and immunofluorescent staining for autophagy-related protein light chain 3 (LC3). Real time-PCR and western blot were performed to evaluate the expression level of mRNA and proteins that were associated with endoplasmic reticulum stress (ERS), autophagy and apoptosis.

RESULTS

Cyclic stretch significantly decreased the cell viability and induced apoptosis and autophagy of myoblasts time-dependently. Stretching stimuli activated ATF-6 pathway and induced ERS-mediated apoptosis. Moreover, using 4-PBA significantly inhibited ERS-related apoptosis, as well as partially decreasing autophagy. In addition, inhibition of autophagy by 3-MA enhanced apoptosis by affecting the expression of CHOP and Bcl-2. However, it had no obvious effects on ERS-related proteins of GRP78 and ATF-6. More importantly, knockdown ATF-6 effectively weakened apoptosis and autophagy. It did so by regulating the expression of Bcl-2, Beclin1 and CHOP, but not cleaved Caspase-12, LC3II and p62 in stretched myoblast.

CONCLUSION

ATF-6 pathway was activated in myoblast by mechanical stretch. ATF-6 may regulate the process of stretch-induced myoblast apoptosis and autophagy via CHOP, Bcl-2 and Beclin1 signaling.

Comparing the esthetic impact of virtual mandibular advancement, bichectomy, jawline, and their combination

INTRODUCTION

The purpose of this study was to compare the effects of mandibular advancement (MA), bichectomy, jawline, and their combination on facial attractiveness. The 3-dimensional (3D) visual sculpting is a method to perform the task.

METHODS

FaceBuilder software, a Blender 2.93 LTS add-on, was used to generate a 3D head and face model of a female patient with Class II Division I malocclusion. MA, bichectomy, jawline, and combination modifications were performed on the model using a 3D virtual sculpting tab, and 4 new head models were created. Five hundred thirteen participants scored lateral and frontal views of the modified and reference models. The Mann-Whitney U, Kruskal-Wallis, and Wilcoxon tests were used for statistical analysis.

RESULTS

MA modification received the highest frontal and lateral image scores. The raters found the jawline frontal photograph to be the least attractive. Significant differences were observed between the lateral and frontal attractiveness scores in all modifications except bichectomy. The combination of 3 modifications in both frontal and lateral images received the second-lowest score.

CONCLUSIONS

Facial esthetic modifications receive different attractiveness scores in lateral or frontal evaluations. MA outperforms bichectomy and jawline augmentation in terms of improving facial attractiveness.

Who Seeks Clear Aligner Therapy? A European Cross-National Real-World Data Analysis

A key step prior to clear aligner therapy (CAT) is the clinical examination and case selection, which includes understanding the specific orthodontic problem to be managed and the wider evaluation of oral health. Seeking CAT may further differ along sociodemographic parameters or across countries, as may perceived orthodontic treatment needs and oral health. We aimed to characterize patients seeking CAT across five European countries. Anonymized real-life data from one large CAT provider (DrSmile, Berlin, Germany) was retrospectively sampled for the period 1 November 2021−31 December 2021. A total of 15,015 patients (68.4% females, 31.6% males, with an age range of 18−81 years, median 30.0 years) were included. The cross-national comparison revealed a significant difference in gender distribution (p < 0.001/Chi-square), with the highest proportion of males in Italy (434/1199, 36.2%) and the lowest in Poland (457/1600, 28.6%); generally, more females sought CAT. The largest motivational factor in all countries for seeking CAT was crowding, in both males and females. By and large, patients paid out of pocket for CAT. The prevalence of caries, periodontitis, and craniomandibular dysfunction as well as the numbers of missing teeth were generally low, albeit with significant differences between sociodemographic groups and countries for caries and periodontitis. Patients seeking CAT showed a low prevalence in oral conditions but differed in their sociodemographic characteristics across countries. Dentists and orthodontists should consider these country-specific differences when planning CAT.

Nonsurgical Orthodontic Treatment of a Severe Open Bite Case Using Miniscrews with Modified Multiloop Edgewise Arch Wire Technique

Skeletal open bite is one of the most challenging malocclusions to treat and maintain due to the difficulty and instability of correction. Although a combination of orthodontic treatment and orthognathic surgery may be the ideal approach in most cases, the complications, risks, and costs of surgery have sparked an interest in alternative treatment options that use temporary anchorage devices to achieve orthognathic-like effects. Adult patients can be treated without the need for special compliance using temporary anchorage devices such as miniscrews. This case report demonstrates a goal-oriented strategy for nonsurgical treatment of a complex skeletal open bite malocclusion in an adult patient using miniscrews and a modified multiloop edgewise arch wire (MEAW) technique, with the results evaluated clinically and cephalometrically.

The Attitudes of Children Undergoing Orthodontic Treatment toward Face Mask Wearing during the COVID-19 Pandemic: A Cross Sectional Study

During the COVID-19 pandemic, the protective face mask has proven to be essential. The protective face masks cover the lower part of the face, including teeth and, for orthodontic patients, the orthodontic appliances. The aim of this study was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic and, especially, wearing a protective face mask had on a sample of Romanian children, and to compare the results previously obtained on a sample of Romanian teenagers with the results obtained after investigating children under the age of 12 years. The cross-sectional survey was conducted in two orthodontic offices from the city of Oradea, Romania. The study sample included children with ages between 8 and 11.9 years that were undergoing an orthodontic treatment with removable or fixed orthodontic appliances. After obtaining the results, comparisons were made with the answers provided by a group of adolescents previously investigated. The questionnaires consisted of 9 items that investigated children’ attitudes toward protective face mask wearing and other aspects related to the COVID-19 pandemic. Two hundred fifty-six children were included in the study (53.1% female patients, 46.9% male patients). Most of the children were not worried that face masks would hide their orthodontic appliances (Item 1—Never, 40.2%; Rarely, 28.9%) and did not consider that the necessity of face mask wearing negatively impacted their desire to undergo an orthodontic treatment, despite the fact that it covered the appliances (Item 2—Never, 37.1%; Rarely, 31.6%). However, 44.5% of children were not happy because they had to wear a face mask during the orthodontic treatment, considering the fact that it covered the orthodontic appliance (Item 6), and most patients (49.2%) did not want the face mask to continue to be mandatory (Item 7). Although children were not happy that they had to wear a face mask that covered the orthodontic appliances, protective face masks were generally well tolerated by Romanian children.

Prevalence of Orthodontic Malocclusions in Healthy Children and Adolescents: A Systematic Review

The purpose of this study was to systematically review the literature regarding the prevalence of malocclusion and different orthodontic features in children and adolescents. Methods: The digital databases PubMed, Cochrane, Embase, Open Grey, and Web of Science were searched from inception to November 2021. Epidemiological studies, randomized controlled trials, clinical trials, and comparative studies involving subjects ≤ 18 years old and focusing on the prevalence of malocclusion and different orthodontic features were selected. Articles written in English, Dutch, French, German, Spanish, and Portuguese were included. Three authors independently assessed the eligibility, extracted the data from, and ascertained the quality of the studies. Since all of the included articles were non-randomized, the MINORS tool was used to score the risk of bias. Results: The initial electronic database search identified a total of 6775 articles. After the removal of duplicates, 4646 articles were screened using the title and abstract. A total of 415 full-text articles were assessed, and 123 articles were finally included for qualitative analysis. The range of prevalence of Angle Class I, Class II, and Class III malocclusion was very large, with a mean prevalence of 51.9% (SD 20.7), 23.8% (SD 14.6), and 6.5% (SD 6.5), respectively. As for the prevalence of overjet, reversed overjet, overbite, and open bite, no means were calculated due to the large variation in the definitions, measurements, methodologies, and cut-off points among the studies. The prevalence of anterior crossbite, posterior crossbite, and crossbite with functional shift were 7.8% (SD 6.5), 9.0% (SD 7.34), and 12.2% (SD 7.8), respectively. The prevalence of hypodontia and hyperdontia were reported to be 6.8% (SD 4.2) and 1.8% (SD 1.3), respectively. For impacted teeth, ectopic eruption, and transposition, means of 4.9% (SD 3.7), 5.4% (SD 3.8), and 0.5% (SD 0.5) were found, respectively. Conclusions: There is an urgent need to clearly define orthodontic features and malocclusion traits as well as to reach consensus on the protocols used to quantify them. The large variety in methodological approaches found in the literature makes the data regarding prevalence of malocclusion unreliable.

Prevalence of malocclusion and orthodontic treatment needs among 15-year-old adolescents of the Arkhangelsk region

Relevance. Purpose of the study to assess the prevalence of malocclusion and orthodontic treatment needs among 15-year-old adolescents of the Arkhangelsk region.Materials and methods. This cross-sectional study is a part of the Third National dental examination of children and adolescents of the Russian Federation. The sample consisted of 1091 teenagers from 7 urban and 5 rural settlements. The study assessed the prevalence of malocclusion and calculated the Dental Aesthetic Index (DAI) to evaluate orthodontic treatment needs according to the sex and place of residence. The prevalence of malocclusion was presented by proportions with 95 % confidence intervals (CI) calculated by the Wilson method. Categorical variables were compared using Pearson’s chi-squared test. The numeric variables were analyzed by the Mann-Whitney test. Results. The malocclusion prevalence was 67% (95% CI: 64,2–69,8) without sex or location of residence differences. The mean DAI score was 24,0 (95% CI: 23,2–24,8) for the rural and 22,9 (22,5–23,4) for the urban adolescents (p < 0,001). 33,5 % of the 15-year-olds needed orthodontic treatment, with no differences in sex or place of residence. 18,7% of adolescents exhibited overt malocclusion, 9,7% had severe malocclusion, and 5,0% – very severe.Conclusions. The prevalence of malocclusion and orthodontic treatment needs in the Arkhangelsk region remain high. The mean DAI score was higher in rural than in urban adolescents. All the above mentioned indicates the necessity to prevent and timely treat orthodontic pathology in adolescents.

Cinnamaldehyde as antimicrobial in cellulose-based dental appliances

AIMS

In the context of minor orthodontic intervention using clear aligner technologies, we determined antimicrobial properties of a cellulose-based material loaded with essential oils such as cinnamaldehyde.

METHODS AND RESULTS

Isothermal microcalorimetry was used to assess the growth of bacterial biofilms at the interface between the tested material and the solid growth medium. The calorimetric data were analyzed using conventional growth models (Gompertz and Richards), and inhibition at 12 and 24 h was calculated.

CONCLUSIONS

The tested material showed antimicrobial properties against Staphylococcus epidermidis as well as Streptococcus mutans and Streptococcus mitis clinical isolates. The inhibition was more pronounced against S. epidermidis, for which growth rate was reduced by 70% and lag phase was extended by 12 h. For S. mutans and S. mitis, the decrease in growth rate was 20% and 10%, and the lag phase increased by 2 and 6 h, respectively.

SIGNIFICANCE AND IMPACT

Clear aligners for minor teeth alignment are becoming very popular. As they must be worn for at least 22 h per day for up to 40 weeks, it is important that they remain clean and do not promote caries formation or other oral infections. Therefore, introducing material with antimicrobial properties is expected to maintain oral hygiene during the aligner therapy. Here, we demonstrate the use of cinnamaldehyde for reducing microbial growth and biofilm formation on cellulose-based dental clear aligners.

Effect of Lactobacillus reuteri on Gingival Inflammation and Composition of the Oral Microbiota in Patients Undergoing Treatment with Fixed Orthodontic Appliances: Study Protocol of a Randomized Control Trial

The effect of probiotics in improving or maintaining oral health in orthodontic patients is understudied. The aim of this study is to evaluate the effect of probiotic administration in addition to tooth brushing on clinical gingival inflammation, plaque formation, subgingival microbiota composition, and salivary biomarkers of inflammation in adolescents with fixed orthodontic appliances. The present study is a 6-month, double-blind, two-arm, placebo-controlled, single-center trial, in which 116 adolescent volunteers aged 12-16 years will be recruited from the patients of the orthodontics clinic of the University Hospital of Lille, France. Subjects who meet the eligibility criteria will be allocated to one of the following groups: (i) control: two placebo lozenges per day for 90 days together with regular oral hygiene, (ii) test: two probiotic lozenges per day for 90 days together with regular oral hygiene. Clinical assessment and biological sample collection will be performed at baseline, 3 and 6 months. In addition, compliance outcomes and adverse events will be monitored.

Malocclusion and occlusal traits among dental and nursing students of Seven North-East states of India

BACKGROUND

Any irregularity of the teeth or a mal-relationship of the dental arches is known as malocclusion. Among all the oro-facial problems, tooth decay is considered the most prevalent one followed by periodontal disease and dental malocclusion. Dental malocclusion is not a life-threatening condition. However, it is closely related to an individual's self-esteem and psychosocial wellbeing. The prevalence of malocclusion varies among different ethnic groups, age-groups, and gender.

OBJECTIVES

This study was conducted with the objective to find out the prevalence of normal occlusal traits and to identify the proportion of different types of malocclusions among dental and nursing students of Seven North-Eastern states studying at a tertiary care Medical Institute.

METHODS AND MATERIALS

This cross-sectional study included 432 students with a mean age of 21.42 years, who satisfied the inclusion criteria. Inclusion criteria consisted of the presence of all permanent teeth with or without third molars. The oral cavity was examined using a sterile mouth mirror and flashlight followed by evaluation of all the occlusal relationships in centric occlusion position (COP). COP was achieved by asking the participant to swallow, and then to bite on his or her teeth together. The occlusion traits were assessed as normal occlusion or malocclusion using the first permanent molars as described by E.H. Angle and deviation from line of occlusion. Descriptive statistics like mean and proportions were calculated.

RESULTS

The prevalence of normal occlusal traits was 48.4%, and that of malocclusion was 51.6%. Class I malocclusion was most prevalent occlusal trait followed by Class II malocclusion and Class III malocclusion showed the least prevalence.

CONCLUSIONS

Class I malocclusion was most prevalent followed by Class II malocclusion and Class III malocclusion showed the least prevalence.

Descriptive epidemiology of dental malocclusion in Najran patients seeking orthodontic treatment

Background

Untreated malocclusion can lead to compromised aesthetic function, depression, and low self-esteem. The aim of this study was to evaluate dental malocclusion in Najran, Saudi Arabia as no data existed before.

Method

This was a retrospective study analyzing the casts of all patients in Najran, Kingdom of Saudi Arabia, seeking orthodontic management for malocclusion between 2017 and 2019.

Measurements

The consultant orthodontist is the single investigator involved in collecting the details of demographics followed by molar relationships, overjet, overbite, crowding and spacing using digital caliper on each dental cast. Data were analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp.

Results

A total of 326 patients sought treatment for different types of malocclusion. There were 143 males and 183 females with an M:F ratio of 1:1.3. Age ranged from 6 to 55 years with a mean SD of 22.6 ± 8.98. The prevalence for Class I, II and III malocclusions at 95% CI was (0.76 (0.757, 0.774)), 0.251 (0.243, 0.260) and 0.529 (0.519, 0.539) respectively. Fifty-one (15.6%) patients had reversed overjet, 65 (19.9%) reduced overjet, and 86 (26.4%) increased overjet. One hundred and sixty-four (50.3%) cases of reduced overbite and 99 (30.4%) cases of deep overbite were also observed. Tooth size arch length discrepancy were noticed with crowding and spacing in 83 (26.4%) and 71 (21.8%) patients, respectively.

Conclusions

This study has shown the prevalence of Class I, Class II, and Class III malocclusion to be 72.7%, 11.6% and 15.6% respectively. Increased over jet and crowding was demonstrated in more patients, though it is not statistically significant.

Prevalence of Occlusal Features and Their Relation to Sociodemographic Variables in Northwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Malocclusion affects the chewing, dental aesthetics, jaw development, and overall attractiveness of individuals. The negative impact of malocclusion is high, particularly in adolescents who can be the target of teasing, intimidation, and name-calling. Even if, malocclusion is a common problem in developing countries, there was a paucity of data in Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of malocclusion in northwest Ethiopia.

METHODS

This cross-sectional study was done at the University of Gondar comprehensive hospital from December 1, 2019, to October 30, 2020. Four hundred seventy-six study participants were selected using a systematic random sampling method. Data collection was done using a structured interviewer-administered questionnaire. Qualified dental professionals examined malocclusion traits according to the WHO oral health survey tool and evaluated for the presence of malocclusion in terms of angles classification, open bite, crossbite, spacing, and crowding. Data entry was done using Epi-Info 7, and analyzed by SPSS 26. Descriptive statistics and logistic regression was done to analyze the data.

RESULTS

A total of 476 subjects were included in the study with a mean age of 29.83 (SD±14.013). The prevalence of malocclusion was 55.9% (95% CI: 51.39-60.28). The common occlusal traits were class-I malocclusion with minor discrepancy (34.9%), anterior crowding (22.9%), and anterior open bite (21.6%). The prevalence of anterior crossbite, posterior crossbite, class-II, and class-III malocclusion was 5.9%, 3.8%, 10.9%, and 8.0%, respectively. Males (AOR=1.6, 95% CI: 1.11, 2.30), urban residents (AOR=1.64, 95% CI: 1.06, 2.56), monthly income of ≤2500 Ethiopian Birr (AOR=1.27, 95% CI: 1.02, 1.59) and mouth breathers (AOR=2.50, 95% CI: 1.72, 2.63) were significantly associated with malocclusion.

CONCLUSION

Significant amount of the study participants had malocclusion. Males, urban residents, low monthly income, and mouth breathing habits were independent factors for a malocclusion. Therefore, early attention to the development of the dentition and occlusion, and necessary functional correction during childhood are important to reduce its prevalence and lifelong adverse effect. Moreover, publicly financed orthodontic treatment should be scheduled, and supplied to individuals in desperate need of orthodontic care.

Cephalometric predictors for optimal soft tissue profile outcome in adult Asian class I subjects treated via extraction and non-extraction. A retrospective study

OBJECTIVE

The aim of this retrospective study was to identify cephalometric predictors associated with favourable soft tissue profile outcomes after premolars extraction and non-extraction in class I malocclusion subjects.

MATERIALS AND METHODS

A total of 80 subjects, treated with non-extraction and premolars extraction (40 subjects each), were equally divided into favourable (FG) and unfavourable (UFG) groups using subjective and objective soft tissue profile outcome assessment methods. An independent t-test was utilized for the comparison of cephalometric measurements between the non-extraction (NE) and premolars extraction (PME) treatment modalities. Cox proportional hazard algorithm regression analysis was performed to identify cephalometric factors associated with favourable soft tissue outcomes.

RESULTS

The pre-treatment mean age of the NE group was 20.2±2.3 and PME group was 20.2±2.5 years. After dividing the sample of the NE and PME groups according to subjective and objective soft-tissue outcome assessment criteria, FG and UFG consisted of 20 subjects each. Cox proportional hazard algorithm regression analysis found upper incisor to NA angle (95% CI: 1.033, 1.196) to be associated with FG in NE and upper incisor to SN (95% CI: 1.018, 1.206) and ANB angle (95% CI:1.165, 3.608) in PME. There was a statistically significant strong correlation between subjective and objective evaluation methods (P≤0.001).

CONCLUSIONS

Cephalometric analysis is a valuable tool to predict soft-tissue outcomes after NE and PME. Increased upper incisors inclinations at the start of NE treatment result in favourable soft tissue profile outcomes. Slightly convex profile and proclined maxillary incisors are the predictors of favourable soft tissue profile outcome after PME. There was a statistically significant association between subjective and objective evaluation criteria of soft tissue outcomes.

The efficiency of mandibular mini-implants in reducing adverse effects of class II elastics in adolescent female patients: a single blinded, randomized controlled trial

BACKGROUND

Excessive proclination of lower incisors and other undesirable consequences usually result from the use of class II elastics during orthodontic treatment. The purpose of this study was to attempt to limit the adverse effects of class II elastics by the use of mini implants placed in the mandibular arch in adolescent class II female patients.

METHODS

The sample comprised 28 patients, (a mean age of 15.66 ± 2 years for intervention group and 15.1 ± 2.2 years for conventional group) with one-fourth or one-half unit class II canine relationship. The sample was divided into two equal groups. Randomization was carried out by a computer sequence generator with a 1:1 allocation ratio. In the intervention group, the mini implants were inserted between the lower second premolar and first molar, while the conventional group underwent regular class II elastics therapy. The active elastics treatment time was 8 months for both groups. Results were assessed by measurements from pre- and post-elastics lateral cephalometric radiographs.

RESULTS

The change in L1 inclination (0.97 ± 0.92°) and L1 AP position (0.31 ± 0.63 mm) did not show a statistically significant difference between the two groups, but a statistically significant difference was found in the U1 retroclination (5.23 ± 1.92°) and U1 distal movement (4.05 ± 1.4 mm) [P ˂ 0.001] and [P ˂ 0.05] respectively in favor of the intervention group.

CONCLUSION

Mini-implants in conjunction with class II elastics had no skeletal effect, mainly dentoalveolar and it did not prevent the proclination of lower incisors. There was more distal movement in the upper incisors in the skeletal anchorage group which helped in enhancing the camouflaging of class II malocclusion.

TRIAL REGISTRATION

Trial registered "FUE.REC (10)/10-2018" at the FUE registration council for clinical trials/IOP Orthodontic Program October 2018.

Prevalence of malocclusion and assessment of orthodontic treatment needs among Syrian refugee children and adolescents: a cross-sectional study

Background

There is a scarcity of data concerning the prevalence and pattern of malocclusion and orthodontic treatment needs in Syrian refugee. In this study, extra and intra-oral features of malocclusion and the dental health component of the Index of Orthodontic Treatment Need (IOTN) were reported.

Methods

Examination of 606 Syrian children/adolescents refugees attending Zaatari clinic was carried out (males = 280, females = 326, mean age = 11.84 ± 2.1 years). Subjects not within the age limit, with a history of orthodontic treatment, or with craniofacial anomalies were excluded. Both extra and intra-oral features of malocclusion were assessed. Intra-oral features included inter- and intra-arch occlusal characteristics: crowding, spacing, crossbite, overjet, overbite, molar and canine relationship, incisor relationship, and centerline shift. In addition, the dental health component (DHC) of the Index of Orthodontic Treatment Need (IOTN) was recorded. Gender and age variations in malocclusion characteristics and IOTN grading were tested using chi-square and nonparametric tests respectively (P < 0.05).

Results

The prevalence of malocclusion was 83.8% (52.6% class I, 24.2% class II, 7% class III). The most common features of malocclusion were crowding (71.1%) followed by centerline shift (52.1%), increased overjet (36.1%), high vertical proportions (34%) and deep overbite (31.2%); there were significant gender and age differences for a number of occlusal traits. The prevalence of moderate to severe need for orthodontic treatment was 67.7%.

Conclusions

This study provides baseline data on the prevalence of malocclusion in Syrian refugee children/adolescents in Zaatari camp where data concerning oral health of this population are lacking. The prevalence of orthodontic treatment need was high warranting the need for a comprehensive interceptive orthodontic program to prevent increasing oral health problems in the future. This high burden of oral diseases has a negative financial impact on the hosting country which can be reduced through public health interventions and implementing community-based dental healthcare for this underprivileged population.

Skeletal and dental changes after maxillary expansion with a bone-borne appliance in young and late adolescent patients

INTRODUCTION

Rapid palatal expansion is a common therapy during orthodontic treatment and could be a preliminary step for correcting different malocclusions; furthermore, this treatment could be necessary at any age. Different anchorage approaches have been proposed to obtain an effective skeletal result, although every device produces both dental and skeletal effects. This study aimed to compare the dentoskeletal effects of a bone-borne palatal expander considering 2 groups of patients of different ages.

METHODS

Twenty-four patients consecutively treated were included in the study; patients were divided into 2 groups according to their age: group 1 with age ≤16 years and group 2 patients >16 years. All patients had a preexpansion cone-beam computed tomography scan; a second scan was required at the end of activations. All patients received a bone-borne appliance anchored on 4 miniscrews.

RESULTS

Significant intragroup differences were found for maxillary width and dental diameters. No significant differences were found between groups with regard to longitudinal changes, except for the maxillary right plane.

CONCLUSIONS

The use of bone-borne maxillary expansion was effective in generating palatal widening both in growing and young adult patients. No significant skeletal or dental differences were found between groups.

Novel Sub-Clustering of Class III Skeletal Malocclusion Phenotypes in a Southern European Population Based on Proportional Measurements

Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using principal component analysis and cluster analysis. Radiometric data from 212 adult subjects (115 women and 96 men) of southern European origin affected by Class III skeletal malocclusion were analyzed. A total of 120 measurements were made, 26 were proportional skeletal measurements, which were used to perform principal component analysis and subsequent cluster analysis. The remaining 94 supplementary measurements were used for a greater description of the identified clusters. Principal component analysis established eight principal components that explained 85.1% of the total variance. The first three principal components explained 51.4% of the variance and described mandibular proportions, anterior facial height proportions, and posterior-anterior cranial proportions. Cluster analysis established four phenotypic subgroups, representing 18.4% (C1), 20.75% (C2), 38.68% (C3), and 22.17% (C4) of the sample. A new sub-clustering of skeletal Class III malocclusions that avoids gender influence is provided. Our results improve clinicians' resources for Class III malocclusion and could improve the diagnostic and treatment approaches for this malocclusion.

Craniofacial characteristics of Syrian adolescents with Class II division 1 malocclusion: a retrospective study

Background

Malocclusion characteristics vary across different ethnic groups and populations. Limited data are available regarding the characteristics of Syrian adolescents with Class II division 1 (Class II-1) malocclusion, and the recent inflow of Syrian refugees and immigrants into Europe and many areas worldwide demonstrate the need for updated studies to discover the craniofacial characteristics of these new immigrants.

Objectives

The present compound cephalometric and tooth-size study sought to assess the dentofacial morphology, upper-airway dimensions, and tooth-size characteristics of Syrian adolescents with Class II-1 malocclusion and compare the results with established Syrian population norms.

Materials and Methods

The study sample consisted of 43 Syrian patients including 24 females and 19 males with Class II-1 malocclusion (age: 14.3 (±1.5) years, mean (±SD)). Cephalometric radiographs and orthodontic casts were analyzed using special orthodontic software (OnyxCeph3^™) and a universal digital caliper, respectively. Statistics were calculated using the SPSS software.

Results

In Syrian adolescents with Class II-1 malocclusion, the position of the mandible relative to the nasion perpendicular (mean (95% confidence interval)) was −11.01 (−12.45, −9.57) mm. Facial axis angle showed a negative value: −6.25 (−7.65, −4.85) degrees. An obtuse nasolabial angle was observed: 104.05 (101.77, 106.33) degrees. The average width of the upper pharynx was 11.50 (10.53, 12.47) mm; however, there was no prevalence of an upper-pharyngeal width of 5 mm or less. The average value of the anterior tooth-size ratio was 80.69 (79.85, 81.53) percent. In total, 39.5% of the investigated subjects had anterior ratios outside two standard deviations from Bolton’s norm, while 25.6% of the investigated subjects had anterior ratios outside two standard deviations from Syrian population norm.

Conclusions

In this study, the inter-maxillary discrepancy of Class II-1 Syrian adolescents was a consequence of their hyperdivergent facial pattern. The observed small pharyngeal widths were not clinically significant, while the anterior tooth-size discrepancy might be clinically relevant.

Controlling incisor torque with completely customized lingual appliances

PURPOSE

To test the null hypothesis of no significant deviation between the center of rotation (C_ROT) and the center of resistance (C_RES) during space closure in Angle class II division 2 subjects achieved using a completely customized lingual appliance (CCLA) in combination with class II elastics and elastic chains.

METHODS

This retrospective study included 29 patients (male/female 11/18; mean age 15.6 [13-27] years) with inclusion criteria of an Angle class II/2 occlusion of least of half of a cusp, maxillary dental arch spacing, completed CCLA treatment (WIN, DW Lingual Systems, Bad Essen, Germany) in one center with a standardized archwire sequence and use of class II elastics and elastic chains only. Maxillary incisor root inclination was assessed by X‑ray superimpositions of the maxilla at the beginning (T1) and the end (T3) of CCLA treatment. Using Keynote software (Apple®, Cupertino, CA, USA), the incisor's C_ROT was assessed with the point of intersection of the incisor axes (T1; T3) following vertical correction of overbite changes. C_RES was defined at 36% of the incisor's apex-incisal edge distance.

RESULTS

The null hypothesis was rejected: the mean C_ROT - C_RES difference was 52.6% (p < 0.001). The mean C_ROT was located at 88.6% (min-max 51-100%) of the incisor's apex-incisal edge distance. Although 6.9% of C_ROT were located between the C_RES and the alveolar crest, the vast majority (93.1%) were assessed between the alveolar crest and the incisal edge, or beyond.

CONCLUSION

CCLAs can create upper incisor palatal root torque even in cases in which lingually oriented forces applied incisally to the center of resistance of the upper incisors counteract these intended root movements.

Orthodontics and Genetics

Introduction:

Genetics has been suggested as an explanation for the etiology of malocclusions, although some questions, due to the perception that genetic inheritance is tied to a monogenic or Mendelian form of inheritance.

Objective:

This paper describes the inheritance of malocclusions, highlighting the areas of knowledge where research has explored mechanisms that explain deviations in patterns of craniofacial growth.

Conclusion:

Malocclusions have a complex or multifactorial pattern of inheritance, where more than one gene is involved in the development of the phenotype. There is also the possibility that the environment influences malocclusions.

The global prevalence of dental healthcare needs and unmet dental needs among adolescents: a systematic review and meta-analysis

OBJECTIVES

Access to dental healthcare services is a major determinant of dental health in communities. This meta-analysis was conducted to estimate the global prevalence of dental needs and of unmet dental needs in adolescents.

METHODS

PubMed, Web of Science, and Scopus were searched in June 2018. The summary measures included the prevalence of met and unmet dental needs. A meta-analysis was performed using the inverse variance method to obtain pooled summary measures. Out of 41,661 retrieved articles, 57 were ultimately included.

RESULTS

The pooled prevalence of orthodontic treatment needs was 46.0% (95% confidence interval [CI], 38.0 to 53.0), that of general treatment needs was 59.0% (95% CI, 42.0 to 75.0), that of periodontal treatment needs was 71.0% (95% CI, 46.0 to 96.0), and that of malocclusion treatment needs was 39.0% (95% CI, 28.0 to 50.0). The pooled prevalence of unmet dental needs was 34.0% (95% CI, 27.0 to 40.0).

CONCLUSIONS

The highest and lowest prevalence of unmet dental needs were found in Southeast Asia and Europe, respectively. The prevalence of dental needs was higher in the countries of the Americas and Europe than in other World Health Organization (WHO) regions. The prevalence of unmet dental needs was higher in Southeast Asia and Africa than in other WHO regions.

[Prevalence of malocclusion among 5 387 12- to 14-year-old adolescents in Jiangxi province, China: an epidemiological study]

OBJECTIVE

We provided baseline data for oral public health through epidemiological surveys to investigate the prevalence of malocclusion and orthodontic treatment proportion in 12- to 14-year-old adolescents in Jiangxi province, China.

METHODS

Multi-stage random cluster sampling was used. A total of 5 387 12- to 14-year-old adolescents were examined by three professional dentists according to Angle's classification of malocclusion. The subjects were recruited from 30 secondary schools in five counties in Jiangxi Province. Results were statistically analyzed by SPSS19.0.

RESULTS

The prevalence of malocclusion was 79.67% among adolescents aged 12-14 years in Jiangxi province. The composition ratios of ClassⅠ, Class Ⅱ Division 1, Class Ⅱ Division 2, and Class Ⅲ malocclusion were 30.96%, 16.36%, 12.78%, and 19.13% respectively. ClassⅠmalocclusion had the highest composition ratio, and the most common clinical manifestation of malocclusion was dentition crowding with a prevalence of 91.30%. The prevalence rate of malocclusion was higher in boys than in girls at 81.16% and 78.21%, respectively (P<0.05). This condition had different prevalence rates in Nanchang, Yichun, Jiujiang, Shangrao, and Ganzhou (P<0.05) with the highest in Nanchang and lowest in Ganzhou. Malocclusion was related to caries, and its prevalence rate was higher in patients with caries than in those without caries (P<0.05). The orthodontic rate of malocclusion was 2.63%, and the value was higher for girls than that for boys (P<0.05). The rate of orthodontic in urban areas was higher than that in rural areas (P<0.05).

CONCLUSIONS

Compared with local and international findings on malocclusion of adolescents, high prevalence and low orthodontic rate were found in Jiangxi province. Strengthening the combination of prevention and treatment is important for the physical and mental health of adolescents. We should actively conduct oral health education, popularize the knowledge of malocclusion, and actively treat caries.

Global distribution of malocclusion traits: A systematic review

OBJECTIVE

Considering that the available studies on prevalence of malocclusions are local or national-based, this study aimed to pool data to determine the distribution of malocclusion traits worldwide in mixed and permanent dentitions.

METHODS

An electronic search was conducted using PubMed, Embase and Google Scholar search engines, to retrieve data on malocclusion prevalence for both mixed and permanent dentitions, up to December 2016.

RESULTS

Out of 2,977 retrieved studies, 53 were included. In permanent dentition, the global distributions of Class I, Class II, and Class III malocclusion were 74.7% [31 - 97%], 19.56% [2 - 63%] and 5.93% [1 - 20%], respectively. In mixed dentition, the distributions of these malocclusions were 73% [40 - 96%], 23% [2 - 58%] and 4% [0.7 - 13%]. Regarding vertical malocclusions, the observed deep overbite and open bite were 21.98% and 4.93%, respectively. Posterior crossbite affected 9.39% of the sample. Africans showed the highest prevalence of Class I and open bite in permanent dentition (89% and 8%, respectively), and in mixed dentition (93% and 10%, respectively), while Caucasians showed the highest prevalence of Class II in permanent dentition (23%) and mixed dentition (26%). Class III malocclusion in mixed dentition was highly prevalent among Mongoloids.

CONCLUSION

Worldwide, in mixed and permanent dentitions, Angle Class I malocclusion is more prevalent than Class II, specifically among Africans; the least prevalent was Class III, although higher among Mongoloids in mixed dentition. In vertical dimension, open bite was highest among Mongoloids in mixed dentition. Posterior crossbite was more prevalent in permanent dentition in Europe.

Stretching magnitude-dependent inactivation of AKT by ROS led to enhanced p53 mitochondrial translocation and myoblast apoptosis

Previously, we had shown that high magnitude stretch (HMS), rather than low magnitude stretch (LMS), induced significant apoptosis of skeletal muscle C2C12 myoblasts. However, the molecular mechanism remains obscure. In this study, we found that p53 protein accumulated in the nucleus of LMS-loaded cells, whereas it translocated into mitochondria of HMS-loaded cells. Knocking down endogenous p53 by shRNA abrogated HMS-induced apoptosis. Furthermore, we demonstrated that overaccumulation of reactive oxygen species (ROS) during HMS-inactivated AKT that was activated in LMS-treated cells, which accounted for the distinct p53 subcellular localizations under HMS and LMS. Blocking ROS generation by N-acetylcysteine (NAC) or overexpressing constitutively active AKT vector (CA-AKT) inhibited HMS-incurred p53 mitochondrial translocation and promoted its nuclear targeting. Moreover, both NAC and CA-AKT significantly attenuated HMS-induced C2C12 apoptosis. Finally, we found that Ser389 phosphorylation of p53 was a downstream event of ROS-inactivated AKT pathway, which was critical to p53 mitochondrial trafficking during HMS stimuli. Transfecting p53-shRNA C2C12s with the mutant p53 (S389A) that was unable to target p53 to mitochondria underwent significantly lower apoptosis than transfection with wild-type p53. Altogether, our study uncovered that mitochondrial localization of p53, resulting from p53 Ser389 phosphorylation through ROS-inactivated AKT pathway, prompted C2C12 myoblast apoptosis during HMS stimulation.

The prevalence of malocclusion and orthodontic treatment need in Omani adolescent population

OBJECTIVE:

To determine the prevalence of malocclusion and orthodontic treatment need in a sample of Omani adolescents aged 11–16 years.

MATERIALS AND METHODS:

The total sample included 854 adolescents with 387 boys and 467 girls between the age of 11 and 16 years with no previous orthodontic treatment history. The study design was cross-sectional. The parameters studied were skeletal relationship, lip competency, teeth impactions, missing teeth, contact point displacement, crowding, spacing, incisors and molars classification, overjet, overbite, crossbite, oral hygiene and caries. The Index of Orthodontic Treatment Need (IOTN) was used to study the need for orthodontic treatment for the total sample.

RESULTS:

There was a high prevalence of Class I jaw relationship (86.2%). About 81.6% of the sample studied had Class I molar relationship and 73.8% had Class I incisors relationship. About 61.4% of the sample had no contact displacement, while 5.2% had contact displacement >4 mm. Severe crowding in the maxilla was found in 2.3% while spacing was found in 24.2%. Around 11% of the sample studied had Class II div 1 incisors relationship, 13.5% Class III and only 1.8% had Class II div 2 incisors relationship. Only 8.6% of the sample studied had an overjet >6 mm while 16.3% had a deep bite and 0.2% had anterior open bite of >4 mm. Teeth impaction was found in 11.7% while permanent missing teeth was present in 1.8%. The results showed that 13.9% had a very great need for treatment while 43.2% of the sample did not need any treatment.

CONCLUSION:

Among the Omani adolescents, there was a high prevalence of Class I jaw relations and Class I molar relationship. The prevalence of malocclusion and treatment need in Omanis shows some variation when compared to other ethnicities.

Subclustering in Skeletal Class III Phenotypes of Different Ethnic Origins: A Systematic Review

OBJECTIVE

We aimed to systematically review articles investigating the efficiency of the clustering of skeletal class III malocclusion phenotypic subtypes of different ethnic origins as a diagnostic tool.

METHODS

The review protocol was structured in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and registered in Prospero (CRD42016053865). A survey of articles published up to March 2018 investigating the identification of different subgroups of skeletal class III malocclusion via cluster analysis was performed using 11 electronic databases. Any type of study design that addressed the classification of subclusters of class III malocclusion was considered. The Newcastle-Ottawa scale for cohort and cross-sectional (modified) studies was used for quality assessment.

RESULTS

The final selection included 7 studies that met all the criteria for eligibility (% overall agreement 0.889, free marginal kappa 0.778). All studies identified at least 3 different types of class III clusters (ranging from 3 to 14 clusters; the total variation of the prevalence of each cluster ranged from 0.2% to 36.0%). The main shared variables used to describe the more prevalent clusters in the studies included were vertical measurements (Ar-Go-Me: 117.51°-135.8°); sagittal measurements: maxilla (SNA: 75.3°-82.95°), mandible (SNB: 77.03°-85.0°). With regard to ethnicity, a mean number of 8.5 and 3.5 clusters of class III were retrieved for Asian and Caucasian population, respectively.

CONCLUSIONS

The total number of clusters identified varied from 3 to 14 to explain all the variability in the phenotype class III malocclusions. Although each extreme may be too simple or complex to facilitate an exhaustive but useful classification for clinical use, a classification system including 4 to 7 clusters may prove to be efficient for clinical use in conjunction with complete and meticulous subgrouping.

CLINICAL SIGNIFICANCE

The identification and description of a subclustering classification system may constitute an additional step toward more precise orthodontic/orthopedic diagnosis and treatment of skeletal class III malocclusion.

Orthodontic treatment for deep bite and retroclined upper front teeth in children

BACKGROUND

A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (deep overbite), which can cause oral problems and may affect appearance.This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. Most types of functional appliances are removable and this treatment approach does not usually require extraction of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth.If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed bar placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out from the middle of the upper arch (one on each side).

OBJECTIVES

To establish whether orthodontic treatment that does not involve extraction of permanent teeth produces a result that is any different from no orthodontic treatment or orthodontic treatment involving extraction of permanent teeth, in children with a Class II division 2 malocclusion.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following electronic databases: Cochrane Oral Health's Trials Register (to 13 November 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 10), MEDLINE Ovid (1946 to 13 November 2017), and Embase Ovid (1980 to 13 November 2017). To identify any unpublished or ongoing trials, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch) were searched. We also contacted international researchers who were likely to be involved in any Class II division 2 clinical trials.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the search results to find eligible studies, and would have extracted data and assessed the risk of bias from any included trials. We had planned to use random-effects meta-analysis; to express effect estimates as mean differences for continuous outcomes and risk ratios for dichotomous outcomes, with 95% confidence intervals; and to investigate any clinical or methodological heterogeneity.

MAIN RESULTS

We did not identify any RCTs or CCTs that assessed the treatment of Class II division 2 malocclusion in children.

AUTHORS' CONCLUSIONS

There is no evidence from clinical trials to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children. This situation seems unlikely to change as trials to evaluate the best management of Class II division 2 malocclusion are challenging to design and conduct due to low prevalence, difficulties with recruitment and ethical issues with randomisation.

Challenges in Treating the Class II Edentulous Patient

With a significant portion of edentulous patients presenting with a skeletal Class II relationship, specific denture needs for this patient group need to be considered. This paper examines the factors that need to be taken into account to prevent common problems from occurring when providing full dentures for a Class II edentulous patient.

Orthodontic treatment for deep bite and retroclined upper front teeth in children

BACKGROUND

A Class II division 2 malocclusion is characterised by upper front teeth that are retroclined (tilted toward the roof of the mouth) and an increased overbite (deep overbite), which can cause oral problems and may affect appearance.This problem can be corrected by the use of special dental braces (functional appliances) that move the upper front teeth forward and change the growth of the upper or lower jaws, or both. Most types of functional appliances braces are removeable and this treatment approach does not usually require extraction of any permanent teeth. Additional treatment with fixed braces may be necessary to ensure the best result.An alternative approach is to provide space for the correction of the front teeth by moving the molar teeth backwards. This is done by applying a force to the teeth from the back of the head using a head brace (headgear) and transmitting this force to part of a fixed or removable dental brace that is attached to the back teeth. The treatment may be carried out with or without extraction of permanent teeth.If headgear use is not feasible, the back teeth may be held in place by bands connected to a fixed bar placed across the roof of the mouth or in contact with the front of the roof of the mouth. This treatment usually requires two permanent teeth to be taken out (one on each side).

OBJECTIVES

To establish whether orthodontic treatment that does not involve extraction of permanent teeth produces a result that is any different from no orthodontic treatment or orthodontic treatment involving extraction of permanent teeth, in children with a Class II division 2 malocclusion.

SEARCH METHODS

Cochrane Oral Health's Information Specialist searched the following electronic databases: Cochrane Oral Health's Trials Register (to 10 January 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2016, Issue 11), MEDLINE Ovid (1946 to 10 January 2017), and Embase Ovid (1980 to 10 January 2017). To identify any unpublished or ongoing trials, the US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform (apps.who.int/trialsearch) were searched. We also contacted international researchers who were likely to be involved in any Class II division 2 clinical trials.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened the search results to find eligible studies, and would have extracted data and assessed the risk of bias from any included trials. We had planned to use random-effects meta-analysis; to express effect estimates as mean differences for continuous outcomes and risk ratios for dichotomous outcomes, with 95% confidence intervals; and to investigate any clinical or methodological heterogeneity.

MAIN RESULTS

We did not identify any RCTs or CCTs that assessed the treatment of Class II division 2 malocclusion in children.

AUTHORS' CONCLUSIONS

It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children. Trials should be conducted to evaluate the best management of Class II division 2 malocclusion.

USE OF ORTHODONTIC TREATMENT NEEDS INDICES FOR ORAL HEALTH SURVEY

Aim:

The aim of our study is to compare incidence of orthodontic malocclusion based on occlusal indices and Index of Orthodontic Treatment Need (IOTN), and to evaluate the most commonly used method among the dentists for orthodontic treatment in Sarajevo.

Material and Methods:

The sample consisted of 110 (31 female and 79 male)subjects older than 16 years with complete permanent dentition. Subjects were examined according to Occlusal Index (Angle classification of malocclusion, overjet, overbite, dental arch crowding and tooth rotation) and IOTN index. We conduct survey regarding which indexes are used in deciding on orthodontic treatment need, among primary health care and Orthodontist.

Results:

The present study show differences between the presence of malocclusion and treatment need as assessed by these two used indices. Based on the survey that we conduct all primary health care doctors use Occlusal Index to decide need for orthodontic treatment, more than 95% of orthodontic specialist use Occlusal Index for treatment need estimation.

Conclusion:

When measuring and grading treatment needs we should rely on Index of orthodontic treatment need. In such high demand for orthodontic treatment need it is necessary to establish need for the orthodontic treatment as fundamental, so that individuals with greatest treatment need can be assigned priority.