Interdisciplinary orthodontics-implants management of a challenging hypodontia case complicated by a class II division 2, bimaxillary retroclination

INTRODUCTION

The case in this study had moderate hypodontia, with both lower lateral incisors and the lower-left second premolar missing. A Class II division 2 relationship with severe crowding in the upper arch and a traumatic deep bite over a skeletal I base complicated the occlusion.

MATERIALS AND METHODS

The plan was to extract the upper first premolars to relieve upper arch crowding and the lower-left impacted second premolar to preserve the bilateral class I molar relationship. A class I occlusal relationship was achieved through space opening in the lower lateral incisors region and space closure in the upper and lower premolars regions.

RESULTS

The use of orthodontic screws for bite opening and anterior segment retraction, in conjunction with bi-metric slot size selection in bracket prescription, was effective in controlling incisor inclination and interincisal angle. The use of an implant fixture before beginning the finishing stage allowed for a reduction in total treatment time and facilitated the provision of the final prosthesis before debonding the case. As a result, the patient was able to receive a satisfactory occlusion on the day of debonding.

CONCLUSION

This case of moderate hypodontia was successfully resolved by combining space closure and space opening effectively. To solve the arch problems in such Class II division 2 cases with severe crowding, extractions were required. To complete the case, this was combined with intrusive and retractive mechanics. In hypodontia cases, implants are an excellent choice for both aesthetics and functional restoration.

Activated omega loops for anterior crossbite correction in transitional dentition

Key Clinical Message

Several approaches can correct pseudo-Class III anterior crossbite. 2 × 4 appliance, compressed open-coil springs, Class III elastics, etc. All cause either soft tissue lacerations, smile line flattening, or upper incisor overproclination. This paper describes a novel method to tip lower incisors into a normal overjet without compromising the upper dentition.

Abstract

In pseudo-class III cases, a "two by four" multibracketed appliance has been utilized to put the incisors into a typical overjet during transitional dentition. Compressing a rectangular super elastic archwire creates continuous force, but its length restricts activation and risks cheek impingement. Open-coil springs on rigid archwires advance incisors labially, although a 4-5 mm of wire distal to the molar tube may injure soft tissue. Reciprocally anchored Class III intermaxillary elastics restore anterior overjet through lower incisor lingual tipping and upper incisor proclination. Class III elastics extrude maxillary molars and mandibular incisors, rotating the dental occlusal plane counterclockwise and reducing maxillary incisor exposure and aesthetics. A unique method is reported in this report to tip the lower incisors back into normal overjet without affecting the upper dentition.

Alveolar bone exostoses following orthodontic treatment. Diagnostic considerations and clinical management

Alveolar bone exostoses (ABE) are benign localized convex outgrowths of buccal or lingual bone, which could be delineated from the surrounding cortical plate, also known as a buttress bone formation. Our review and case series demonstrate the development of alveolar bone exostoses during orthodontic therapy. It is crucial to keep in mind that every case presented had a history of palatal tori. In our clinical observations, higher precedence of ABE development was seen in participants during incisor retraction, especially with preexisting palatal tori. Additionally, we have successfully demonstrated surgical techniques to eliminate ABE in the event that self-remission does not occur once orthodontic forces are discontinued.

Modifiable and Non-modifiable Risk Factors Affecting Oral and Periodontal Health and Quality of Life in South Asia

Objectives:

The study aimed to review the prevalence of periodontal disease and associated factors among developing South Asian countries. The review was also aimed at providing an insight into how such factors play a role in affecting the Quality of life of patients with compromised oral health.

Background:

It has been observed that Oral health directly correlates with the Quality of life of an individual, so it is imperative to understand this, particularly in the developing parts of the world.

Methods:

A MeSH keyword search was carried out with the keywords: Periodontal diseases, Oral Health, Public Health, Asia, QoL, Quality of Life, Southeast Asia, Tobacco, and Risk Factors, and based on the findings, this detailed review was compiled.

Results:

The South Asian population forms 24.89% of the world population, while periodontal disease is an inflammatory condition that affects 11% of the globe. Several studies previously conducted across developing countries have shown that various factors like the socioeconomic status of an individual, smoking habit, consumption of alcohol, hypertension, history of diabetes, obesity, and stress are indirectly related to the onset of periodontal disease. Characteristics associated with specific populations like ethnicity, behavioral characteristics, and environmental factors may affect causing periodontitis.

Conclusion:

Dental practitioners in this region should consider risk factors that can be altered significantly to uplift the periodontal health status of an individual, which is not being considered in many developing countries.

A new insight into the diverse facets of microRNA-31 in oral squamous cell carcinoma

Background

Micro-RNAs (miRNAs) have been reported as an emerging biomarker in many cancer types. They are used as diagnostic and prognostic biomarkers and could be considered therapeutic targets in treating the same.

Main body

Studies have proven that miRNAs play an essential role in molecular cancer pathophysiology, including oral squamous cell carcinoma. Distinct expression profiles of different miRNAs have been demonstrated in oral squamous cell carcinoma. Among the miRNAs, the miR-31 has strong potential as a unique biomarker in head and neck squamous cell carcinoma, and the increased expression was correlated to a poor clinical outcome with a likely contribution to oral carcinogenesis.

Short conclusion

The recent research on different aspects of miR-31 as a biomarker and also its potential application in the development of therapy for oral squamous cell carcinoma has been focused in this review.

Graphical abstract

Correction of anterior open bite of varying severity using clear aligner therapy—A case series

In open bite cases, a comprehensive diagnostic differentiation is crucial in determining the best corrective therapy. In non‐surgical open bite treatment, fixed appliances, either labial or lingual, are usually employed. With the addition of extra‐radicular screws, more sophisticated orthodontic movements may now be performed without the necessity for orthognathic surgery. Clear aligner therapy, on the contrary, has grown in popularity as a treatment option for more complex cases, such as open bite malocclusions. This article discusses three cases with an anterior open bite that were treated using various mechanics as dictated by the malocclusion. Case 1 was addressed wholly using clear aligner therapy, with careful consideration of attachment geometry and mechanics. Case 2 with clear aligner therapy, attachment geometry selection, and vertical elastics; and Case 3 with clear aligner therapy, attachments, and temporary anchorage devices.

Calcium Channel Blockers Induced Gingival Overgrowth: A Comprehensive Review from a Dental Perspective

BACKGROUND

Gingival overgrowth (GO) as a manifestation of calcium channel blockers (CCBs) was first introduced in the literature by Ramon et al. in 1984. Since then, the use of CCBs as a treatment modality for hypertension has been recorded extensively in the literature for its association with GO.

AIM

The aim of our study is to evaluate histopathology, treatment, and follow-up for the cases detailed in various studies and also to highlight the protocol mentioned to identify these presentations.

MATERIALS AND METHODS

A broad search was conducted from the period 1980 to 2021 using electronic databases PubMed Central, Scopus, Cochrane, and SciELO databases. About 293 articles were initially chosen. The articles further excluded did not fit the criteria for the study and eventually 50 articles which met the inclusion criteria were chosen as part of this literature review.

RESULTS

A comparative analysis was carried out regarding histopathology, treatment modalities, drug dosage, and duration to evaluate the differences in cases between 1980 and 2021. From the available studies, it was found that the histopathological and clinical findings were varied. Treatment strategies employed were different, though follow-ups in most cases were uniform.

CONCLUSION

CCBs and their relationship with GO have been widely reported in the literature. Dentists should approach this condition by taking appropriate medical and dental history and follow evidence-based treatment guidelines to provide more relevant and judicious management of this condition. Inter-disciplinary treatment approaches would provide better outcomes.

The Contemporary Management of Cleft Lip and Palate and the Role of Artificial Intelligence: A Review

Introduction:

Cleft management is an exhaustive process for the patient, the orthodontist, and the caregiver. In recent decades, a wide number of challenges have been addressed with the inclusion of various dental specialties for the detection, diagnosis, and treatment of orofacial clefts. The orthodontist plays a very pivotal role during the overall management of children with cleft lip and palate as they need to make critical decisions for when to intervene orthodontically and at what stage to set priorities for individual treatment goals.

Objectives:

The objectives of this study were to provide an in-depth review of the evolving role of various disciplines focusing on orthodontics in the management of cleft cases.

Methods:

A general search was carried out to identify the published data on cleft lip and cleft palate management on PubMed and Scopus until the 1st of June 2021 using keywords such as cleft lip, cleft palate, cleft orthodontics, naso-alveolar molding, and surgical cleft orthodontics. The related literature was then reviewed and analyzed.

Results:

With improvements in 3D modeling, CT scans of patients can be used to construct precise 3D models, and these can be utilized to demonstrate various clinical issues related to clefts. The orthodontist has a major role in the various stages and steps, follow-up, treatment care, and outcome assessment. With the advent of technological advancements and artificial intelligence, the role is only going to evolve and expand further in the management of the cleft lip and palate. Diagnostic techniques utilizing artificial intelligence to detect cleft during the prenatal period have also been tested and have been shown to have a high rate of accuracy. The evolution of distraction osteogenesis came into the limelight as a revolutionary modality for cleft treatment. Computer-assisted orthognathic surgery is a widely used modality for reshaping the osseous defects of the maxilla in patients with congenital clefts. With the development of additional modalities such as aligners, patients that need to undergo complex orthognathic surgeries can also be treated with aligners without compromising the outcomes.

Conclusion:

The cleft lip and palate can be managed by a multi-disciplinary team. Orthodontics has an important role in the overall management of a cleft affected individual as they must make critical decisions regarding orthodontic interventions as well as set priorities for each treatment goal. With the advent of technological advancements and artificial intelligence, the diagnosis and management of the cleft lip and palate have become simplified.

Evaluation of Adjuvant Systems in Non-Surgical Peri-Implant Treatment: A Literature Review

Can the use of lasers, ozone, probiotics, glycine and/or erythritol, and chlorhexidine in combination with non-surgical peri-implant treatment have additional beneficial effects on the clinical parameters? Objectives: The non-surgical treatment of peri-implant pathologies is based on mechanical debridement to eliminate bacterial biofilm and reduce tissue inflammation; some additional therapies have been studied to achieve more detailed clinical results. Materials and methods: A literature search for publications until January 2022 was conducted. The research question is formulated following the Problem, Intervention, Comparison/Control, and Outcome. Studies investigating adjunctive therapies were included. Results: In total, 29 articles were included. Most of the studies did not show any additional benefit of these therapies in the evaluation of bleeding on probing, probing pocket depth, or plaque index; among the proposed treatments, the use of laser was the one most studied in the literature, with the achievement of a reduction of bleeding and pocket depth. More studies would be needed to assess the benefit of other therapies. Conclusions: This review showed no significant improvements in the state of health in support of mechanical debridement therapy. However, the few benefits found would deserve to be considered in new clinical studies.

Evaluation of Adjuvant Systems in Non-Surgical Peri-Implant Treatment: A Literature Review

Can the use of lasers, ozone, probiotics, glycine and/or erythritol, and chlorhexidine in combination with non-surgical peri-implant treatment have additional beneficial effects on the clinical parameters? Objectives: The non-surgical treatment of peri-implant pathologies is based on mechanical debridement to eliminate bacterial biofilm and reduce tissue inflammation; some additional therapies have been studied to achieve more detailed clinical results. Materials and methods: A literature search for publications until January 2022 was conducted. The research question is formulated following the Problem, Intervention, Comparison/Control, and Outcome. Studies investigating adjunctive therapies were included. Results: In total, 29 articles were included. Most of the studies did not show any additional benefit of these therapies in the evaluation of bleeding on probing, probing pocket depth, or plaque index; among the proposed treatments, the use of laser was the one most studied in the literature, with the achievement of a reduction of bleeding and pocket depth. More studies would be needed to assess the benefit of other therapies. Conclusions: This review showed no significant improvements in the state of health in support of mechanical debridement therapy. However, the few benefits found would deserve to be considered in new clinical studies.

White Spot Lesions: A Serious but Often Ignored Complication of Orthodontic Treatment

Objective:

The objective of this narrative review is to present an overview of the prevalence, clinical manifestation, diagnosis, and latest advances on white spot lesions.

Background:

White spot lesions have been defined as the earliest stage of demineralization on enamel surfaces that are easily discernible to the human eye.

Methods:

Relevant articles on white spot lesions were searched and reviewed from March 1975 till May 2021 in Pubmed, Scopus, Google Scholar, and ScienceDirect and were included in this review.

Results:

Even though the orthodontic field has seen several advances over the last few years, this is one complication that persists. White spot lesions are very commonly seen after completion of fixed orthodontic therapy when brackets are debonded. Previously conducted research has shown that there is a high prevalence rate of white spot lesions, which ranges from 50 to 90%. On intra-oral examination, a white spot can be seen as a matte-textured, opaque white lesion. Since the demineralization process takes place below the enamel surface, the outer layer only demonstrates pores that affect the natural light refractory properties of a tooth. This is what leads to the characteristic appearance of these lesions. One of the goals of modern dentistry is to treat non-cavitated lesions by promoting remineralization without the involvement of any invasive procedures.

Conclusion:

Fixed orthodontic therapy is usually a lengthy process and requires active cooperation between the orthodontist and the patient. However, it is the responsibility of the treating orthodontist to examine the tooth surfaces at each appointment to diagnose a developing white spot lesion as early as possible. With recent advances in diagnostic techniques, it has become much easier to identify these initial lesions and prevent their progression to cavitated lesions.

Review and case report of the treatment in a young girl with primary failure of eruption

Any localized non‐eruption of teeth can be attributed to myriad of factors. A failure of a permanent tooth to erupt or cessation of initial eruption with no obvious local/systemic causative factor is said to be primary failure of eruption (PFE). The etio‐pathogenesis of PFE is due to the mutation of PTH1R gene. Clinical features such as infra‐occluded teeth, posterior open bite, lack of any cause or habit are usually attributed to diagnosing the condition, and a confirmatory diagnosis is done by the gene analysis of PTH1R gene. Treatment of such a condition is tricky as any application of orthodontic traction to teeth affected by PFE will not be successful and may cause ankylosis. This correspondence reviews and demonstrates the treatment of a case of PFE to restore function and esthetics to the best possible outcome.

Accuracy of Sterile and Non-Sterile CAD/CAM Insertion Guides for Orthodontic Mini-Implants

Aim

The aim of this study was to measure the transfer accuracy of computer-aided design/computer-aided manufacturing (CAD/CAM) insertion guides using mini-implants. The target value is the virtual planned position (100%). It is also clinically mandatory to use sterilised surgical guides (autoclaved at 137°C). The results obtained using sterilised and non-sterilised insertion guides were compared. In addition, the actual position of the mini-implants, as implemented, was compared with the digitally planned positions.

Materials and Methods

Following CAD/CAM planning and production of 60 insertion guides made from synthetic resins that had been previously tested for suitability, 120 mini-implants were inserted in pairs and in blocks of the bone of the substitute material. Half of the insertion guides were sterilised, while the other half were non-sterilised. Compared with the position of the mini-implants in the digital plans, deviations in the apical and coronal distances between the mini-implants and insertion depth, as well as the included angle of the mini-implants to one another and to the surface of the bone substitute material, were determined.

Results

In post-sterilisation, the dimensional and material changes were observed. When compared, the deviations to the virtual planned position were achieved when the performed insertion using sterilised insertion guides were lower than those achieved when using non-sterilised insertion guides. The heat treatment during the sterilisation process improved the accuracy of the insertion guides. When comparing sterile insertion guides to the digital planned position (100%), the mean coronal deviation was 0.057 mm (0.81%), the apical deviation was 0.428 mm (6.11%), and insertion depth mean deviation at the right side was 0.15 mm (2.15%), while that on the left was 0.073 mm (1.04%).

Conclusion

The CAD/CAM TAD insertion guide could not achieve 100% accuracy in translating the digitally planned position into the real anatomic location. Deviations to the ideal position between 0.81 and 6.11% were observed. Clinically, for appliances that fit post-mini-implant insertion, the coronal distance of the mid-mini-implant head is the most important. At this point, the mean deviation to the planned positions is 0.81%, which is clinically acceptable and most likely reproducible by using CAD/CAM insertion guides.

The World Wide Web of orthodontics- A comprehensive narrative on teledentistry pertaining to the orthodontics of the 21st century

Teledentistry has proven effective in practically all dental fields. It also allows access to inaccessible and underdeveloped locations. Better treatment outcomes were documented in patients treated by an orthodontist supervised by teledentistry than by a general dentist with minimal orthodontic experience alone. It may also help to focus referrals to specialists and weed out those who do not need them. But, on a critical note, a doctor-patient relationship is much more than a business transaction. A face-to-face initial consultation instills trust that a remote session cannot. Teledentistry includes professional networking of doctors. This contact includes digital information exchange, CPD programs, case discussions, and analysis that bring dentists from all around the world together to improve patient care. Teledentistry has not only spanned the distance between dentists worldwide, but has also served as a conduit between customer (patient) and manufacturer. This spawned Direct to Consumer (DTC) dentistry, sparking substantial debate among dentists worldwide. In DTC dentistry, inadequately trained customers conduct complex procedures on themselves with minimal guidance of a dentist. One of the major issues today is the general availability of clear aligners to patients without the requirement for an intermediary skilled orthodontist. The American Association of Orthodontists (AAO) has publicly questioned the validity of Smile Direct Club, a private firm that dominates the DTC industry. European Federation of Orthodontic Specialists Association, on the other hand, has sponsored a joint declaration with the representative orthodontic associations in Europe to highlight and alert patients about the potential risks of DTC products. Unfortunately, public shaming hasn't slowed commercialization of DTC firms. Teledentistry has been a boon for healthcare, but a nightmare for our profession, raising fundamental questions like what is the difference between a customer and a patient? Is dentistry a just another discipline of cosmetics? Is teledentistry making us less connected with our patients?

Impaction caused by a rare erupted peripheral compound odontoma

Odontomas are common occurrences in the oral cavity and can be classified as complex or compound. Erupted peripheral compound odontomas are rare and present in the extra-osseous soft tissues. In this case, the odontoma led to the impaction of permanent teeth, due to which removal of the lesion was advised.

The Exponential Rise of Teledentistry and Patient-Oriented Protective Measures in Southeast Asian Dental Clinics: Concerns, Benefits, and Challenges

In the Southeast Asian region, various policies have been advocated by health regulatory bodies that entail protective measures such as face masks, gloves, maintaining distance in public areas, and more. These protective measures are aimed at helping reverse the growth rate of the coronavirus. Dentists in this region have incorporated several changes to their practices to help minimize risks of person-to-person transmission inside dental offices. This narrative review aimed to provide an in-depth overview of the current situation in the Southeast Asian region regarding the use of teledentistry during the pandemic. Teledentistry involves the transfer of patient information across remote distances for online consultation and treatment planning. A few years back, it used to be a lesser-known entity but has seen an exponential rise in its incorporation into dental practices all around the Association of Southeast Nations (ASEAN) region. Many clinics in the Southeast Asian region have started using online consultations to ensure that patients can be diagnosed or followed up during their treatment. Teledentistry is the clear answer in the coming months as it will help reduce the risk of virus transmission and help patients get access to oral healthcare and dentists to see their patients. This article reviews the current pandemic situation in the ASEAN region, the recent evidence, and the scope of teledentistry. It also provides recommendations for the future and sheds light on the different types of teledentistry and how it can be incorporated into practices by regulatory authorities in this region.

Benefits of Using Fluorescence Induced Theragnosis in Fixed Orthodontic Therapy: Status, Technology and Future Trends

Dental biofilm is often found to be the source of bacteria that releases toxins, peptides, lipopolysaccharides as well as organic acids, which lead to gingival inflammation and tooth caries. Further, the persistent plaque may result in the continued destruction of the surrounding soft and hard tissues. During fixed orthodontic therapy, arch-wires, brackets, and elastic modules have been shown to be sites of significant plaque accumulation, making it difficult for a patient to maintain proper oral hygiene. The problem most dentists face is that they cannot visualize this biofilm completely to be able to carry out efficient plaque removal. Visual assessment is, to date, the most common method for plaque visualization, and various indexes have been demonstrated to be sufficient for quantification of the amount of plaque present. However, the problem is that visual assessments are inconsistent, operator dependent and often subjective, which can lead to inconsistency in results. Fluorescence is one such method that can be explored for its use in effective plaque identification and removal. Literature has it that dentists and patients find it particularly useful for monitoring oral hygiene status during treatment. Fluorescence has the capability of offering clinical orthodontists and researchers a new method of detection of demineralization during orthodontic treatment, furthermore, for efficient removal of orthodontic adhesive cements, fluorescent light may be used in conjunction with high-speed burs to deliver fast, less time consuming, and safer results. The benefit of direct visual treatment using fluorescence enhanced theragnosis is that the patient receives controlled and guided therapy. It has multiple benefits, such as early diagnosis of caries, biofilm identification, and even helps to achieve improved treatment outcomes by better resin selection for esthetic procedures.

The Use of Technology in the Management of Orthodontic Treatment-Related Pain

Orthodontic pain is one of the negatives associated with fixed orthodontic treatment that cannot be avoided. This pain usually comes around the wire placement period and gradually decreases once the endogenous analgesic mechanisms start functioning. Over the years, several treatment modalities have been utilized for relief from orthodontic pain, and these include mechanical, behavior modification, and pharmacological methods. However, in the last decade, there are several newer methods employing the use of technology that have come up and are being used for alleviating pain. From computerized indirect bonding to virtual treatment planning, technology has slowly become a vital part of an orthodontist's repertoire. The digital age is here, and orthodontics must embrace the use of technology to help improve the quality of life of patients.

Sagittal Jaw Relationship of Different Types of Cleft and Non-cleft Individuals

To investigate whether the craniofacial sagittal jaw relationship in patients with non-syndromic cleft differed from non-cleft (NC) individuals by artificial intelligence (A.I.)-driven lateral cephalometric (Late. Ceph.) analysis. The study group comprised 123 subjects with different types of clefts including 29 = BCLP (bilateral cleft lip and palate), 41 = UCLP (unilateral cleft lip and palate), 9 = UCLA (unilateral cleft lip and alveolus), 13 = UCL (unilateral cleft lip) and NC = 31. The mean age was 14.77 years. SNA, SNB, ANB angle and Wits appraisal was measured in lateral cephalogram using a new innovative A.I driven Webceph software. Two-way ANOVA and multiple-comparison statistics tests were applied to see the differences between gender and among different types of clefts vs. NC individuals. A significant decrease (p < 0.005) in SNA, ANB, Wits appraisal was observed in different types of clefts vs. NC individuals. SNB (p > 0.005) showed insignificant variables in relation to type of clefts. No significant difference was also found in terms of gender in relation to any type of clefts and NC group. The present study advocates a decrease in sagittal development (SNA, ANB and Wits appraisal) in different types of cleft compared to NC individuals.

Periodontally compromised severe skeletal Class III with open bite corrected by orthodontic camouflage using temporary anchorage devices

A variety of treatment options may be implemented on a Class III malocclusion associated with skeletal discrepancy ranging from functional orthopedics at an early age to orthognathic surgery in adults. In the current scenario, many Class III malocclusion patients are referred for orthognathic surgery without even considering the options of an orthodontic camouflage, as orthodontists do not want to burden themselves with the tedious treatment planning and risks involved with treating such cases. This case report describes a 27-year-old female diagnosed with a skeletal Class III malocclusion, severe open bite, and periodontally compromised dentition. Although orthognathic surgery was proposed as the best treatment modality, it was denied by the patient due to financial and psychological constraints. She was treated with mild upper arch expansion using archwires and upper premolar intrusion using temporary anchorage devices (TADs) alongside retraction of lower anterior teeth using TADs and intermaxillary elastics. At the end of 18 months of active treatment, a decent result was achieved with good occlusion and facial esthetics. Post-treatment results showed an improved profile and Class I canine relationships, with optimal overjet and overbite. The anterior open bite was corrected, and the overall facial balance was greatly improved. Extraoral photographs displayed a relaxed lip closure and an esthetic smile meeting the patient’s expectations. Two-year follow-up records demonstrated a stable occlusion and optimal facial esthetics.