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The Journal of Indian Orthodontic Society Official publication of Indian Orthodontic Society (Reg. No. 16920/68 Published quarterly : March, June, September, December Editor Dr. Lodd Mahendra Associate Editor Dr. P Janardhanam Consultant Editors Dr. M.R. Balasubramaniam Dr. Ashima Valiathan Dr. K. Jyothindra Kumar Dr. M.K. Prakash Dr. K. Sadashiva Shetty Dr. N.R. Krishnaswamy Assistant Editors Dr. Ashwin M. George Dr. S. Venkateswarn Dr. G. Shivaprakash Committee for reviews and abstracts Dr. Chetan V. Jayade Dr. Santha Sundari Dr. Sridevi Padmanabhan Dr. A. Nandakumar Dr. P. Navaneetha Krishnan Dr. M.S. Rani Journal Committee Dr. R.B. Sable Dr. Sanjay Ganeshkar Dr. Jayesh Rahalkar Dr. Jayaram Mailankody Dr. K. Ketan Vakil Dr. Rabindra S. Nayak Dr. P. Ganesh Dr. Sarojini Joseph Dr. M.S. Ravi Dr. Sandhya Jain Dr. Divakar Karanth Dr. Nikhil S. Vashi Dr. Vinod Krishnan Dr. K. Ravi Dr. Krishnaraj Dr. Girish Karandikar Dr. Joseph Varghese Dr. Rittu Dugai Dr. K. Uma Shankar Journal Consultative Board Dr. V.P. Jayade Dr. S. Rangachari Dr. V. Surendra Shetty Dr. A.S. Kalha Dr. Akhter Hussain Dr. O.P. Kharbanda
Office Bearers (2009-10) President Dr. Girish Karandikar Hon. Secretary Dr. E.T. Roy President - Elect Dr. N. Kumar Ahuja Immediate Past President Dr. O. P. Kharbanda Vice President Dr. Gurkeerat Singh Hon. Joint Secretary Dr. G. Sivaprakash Hon. Treasurer Dr. Kishore M.S.V. Ex–officio (Chairman IBO) Dr. Mani K. Prakash Executive Committee Members Dr. Amish Mehta Dr. Nikhilesh R. Vaid Dr. Anand K. Patil Dr. Pradeep C. Shetty Dr. Anil Singla Dr. Pradeep Jain Dr. Anup B. Kanase Dr. Rajiv Ahluwalia Dr. Ashish Gupta Dr. Rani M.S. Dr. Balvinder S. Thakkar Dr. Ravi Bhutani Dr. Chandra Sekhar G. Dr. Rohan Mascarenhas Dr. Joseph Varghese Dr. Sridevi Padmanabhan Dr. Keluskar M. Dr. Vinay S. Dua Dr. Kohli Virinder S. INDIAN BOARD OF ORTHODONTICS
The Journal of Indian Orthodontic Society (JIOS) Welcomes. . research and review articles of interest to Orthodontists in India and throughout the world. The Journal is published by the Indian Orthodontic Society. It’s aim is to publish clinical. contributions both from India and abroad.
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& “Bpd” (Bracket Positioning Device)’ Evaluation of True Incisor Intrusion Attained with Mini-implant Anchorage System for the Correction of Deep Overbite IGF-1 : A Legitimete skeletal maturity indicator Laser Etching of Enamel for Direct Bonding — An in Vitro Study Comparison of Dental and Alveolar Arch Width in Patients with Normal Occlusion. Self Ligating Stainless Steel and Self Ligating Ceramic Brackets with Stainless Steel Wire: In Vitro Study A Comparative Study of Soft Tissue Changes in Skeletal and Dental Class 11 Division 1 Cases — Treated with Removable Functional Appliance as against those Treated with Fixed Functional Appliance Management of Class II Division 2 Malocclusion – An Insight A New Equation for Predicting the Width of Unerupted Permanent Canines and Premolars for cosmopolitan Indian Population Orthodontic Conclusions of Systematic Review and Meta Analysis 3 9 18 25 29 42 48 54 58 63 76 83 89 2 .June 2010 CONTENTS Assessment of acceptability of smile esthetics with different level of gingival display by Orthodontists and general public — A comparative study An Avant-garde Indirect Bonding Technique for Lingual Orthodontics using the First Complete Digital “Tad” (Torque Angulation Device).Volume 44 Number 2 April . Metal Insert Ceramic. Class II Division 1 and Class II Division 2 Malocclusion Rectangular Wires as substitutes for the MAA and Torquing Auxiliary in the Begg treatment — A Clinical study Modified Pendulum Appliance for easy insertion and removal Comparison of Frictional Resistance between Conventional Stainless Steel.
The fact is that in social interaction. Compared to layperson orthodontists had given less score as the gingival exposure is increased. Images were scored less attractive by orthodontists and laypersons.com Phone : +91-99291 49217 Abstract : Method Purpose. Facial attractiveness and smile attractiveness appear strongly connected to each other.S.S. Udaipur. Department of orthodontics and Dentofacial Orthopedics. Professor and Head.com Phone : +91-99280 37474 Dr. third and fourth photograph by varying the amount of gingival display in increasing fashion from 4mm. 6mm and 8mm respectively. These photographs were shown to laypeople and orthodontists to give the scoring of attractiveness based on five point attractiveness scale. E-mail : kalyani. Reader. Udaipur. Tapan Shah (Corresponding Authour) Post graduate student Department of orthodontics and Dentofacial Orthopedics. Kalyani Trivedi. Darshan Dental College and Hospital. attractiveness is suggested to influence personality . Laypersons are found to be more tolerant to increased gingival display at smile. one’s attention is mainly directed towards the mouth and eyes of the 3 Results Conclusion INTRODUCTION Facial attractiveness plays a key role in social interaction. Darshan Dental College and Hospital. kinship opportunities. Comparatively more amount of gingival exposure is acceptable by the female orthodontist than the male orthodontist.ASSESSMENT OF ACCEPTABILITY OF SMILE ESTHETICS WITH DIFFERENT LEVEL OF GINGIVAL DISPLAY BY ORTHODONTISTS AND GENERAL PUBLIC – A COMPARATIVE STUDY Authors: Dr.D. As the amount of gingival display was increased during smile. Tarulatha Shyagali. development and social interaction.trivedi@rediffmail. One smiling photograph with good dental alignment.ortho@yahoo. symmetry and normal amount of gingival display( morley ratio) was used in this study and it was digitally altered to obtain Second. There is a significant difference in the scores given by the orthodontists and laypeople.D. It influences mating success. E-mail : tapan. Darshan Dental College and Hospital. M. Udaipur E-mail : deepu_taru20@rediffmail. personality evaluations. M. Female layperson did not appreciate the increased gingival exposure in comparison to male laypersons.This study was designed to determine the esthetic perception of an orthodontist and a layman to variations in gingival display during smile. performance. and employment prospects. 1–3 Furthermore. Composed photographs of smile with varying amounts of gingival exposure during smile were rated for attractiveness by laypeople and orthodontists. Department of Orthodontics and Dentofacial Orthopedics.com Phone : +91-98253 19810 Dr.
The lips are the controlling factor in which. In slide C and slide D there is no significant difference in scores given by the male and female orthodontist. and the smile plays an important role in facial expression and appearance. models and beauty contestants. as the gingival exposure is increased scores given by the orthodontist and lay man are decreased. RESULTS Overall results of this study show that. Pearson chi-square and t-test were done to compare the scores given by orthodontists and laypersons.2) 4 MATERIALS AND METHODS The overall plan was to alter the amount of visible gingival display in subjects’ smiling images and to have these images judged for smile attractiveness by a panel of laypersons and orthodontists.3 & 4) All these photographs were converted into one single presentation. STATISTICS Descriptive statistics included mean and standard deviation. Females have given less score compared to males for the slide B (p<0. in different gingival display situations above upper incisors. All these components are supposed to form a harmonic and symmetric entity. and the greater their role is in the esthetic value of the smile. 1). shape. third and forth photograph having gingival exposure of 4mm. Where as for other slides there was no significant difference.(Table-3. Conshohocken. This presentation was shown to 60 orthodontists and 60 laypeople. To preserve a realistic appearance. Where as up till slide B lay men have liked the smile(p<0. portions of the teeth. Total four photographs were made. expose gingival tissue at smile and are still considered beautiful with beautiful smiles. Influence of sex on judging the attractiveness score was also tested and compared by using the same tests. the more visible the teeth and gingiva are. Frontal smiling.05). the purpose of this study is to compare the perception of oral esthetics of person.speaker’s face.and the second. Sharp.1 & 3. size. The judges were instructed to choose the smile they preferred from each slide and mark their opinion as (1) very unattractive (2) unattractive (3) average (4) attractive (5) very attractive. but also on the amount of gingival display and the framing of the lips’ buccal corridor space . 6mm and 8mm respectively. were included at the beginning of the slide show. commonly provokes strong concern from clinicians. Females have given more score to slide B compare to males. 35-mm color slides of 10 randomly selected people were acquired.(fig 2. one with normal amount of gingival display which follows the morley’s ratio of gingival exposure.11 Therefore. To produce the varying level of gingival display. Calif) and altered to produce varying level of gingival display. (fig.9-10 The gummy smile is not necessarily unesthetic in the eyes of the public. model PG-C30XU. Selected lay persons did not have any dental training.(Table-1. as the mouth is the centre of communication in the face. Five “warm-up” slides. one photograph of the dentition with good dental alignment and symmetry was selected by the panel of 10 orthodontists. defined as gingival smile line (GSL) or gummy smile (GS). starting at 10 seconds per slide and gradually decreasing to 5 seconds per slide. Then they were projected on a monitor with all images set to the same magnification. it was decided to leave the intercanine width unaltered. out of which 30 were males and 30 were females. during smile. The high smile line. orthodontists have given less score as the gingival exposure is increased. Pa) on a white screen. All subjects were having acceptable smile with all the normal parameters. The Results of both the tests (irrespective of sex) show that when we compare scores given by the orthodontist and layperson. Orthodontists and surgeons are conditioned to see a GS as esthetically undesirable.1 & 1. Kokich et al used female smile and gingival exposure was classified as noticeably unattractive only at 4 mm. Out of them. gingiva. The dilemma whether to treat the GS or not is further emphasized by the effect of aging on gingival display.05) though the gingival exposure in slide B was increased up to 4 mm. the selected digital photograph was imported into Adobe Photoshop version 7. especially women. and colour. and oral cavity will be seen in an individual’s smile. (Table-2) There is significant difference in esthetic perception between male and female laypersons. An esthetically pleasing smile is not only dependent on components such as tooth position. (fig 1). Many actors.5 Yet the higher the upper lip is elevated while smiling. .San Jose.2) We have also found out that there is a difference in the score given by the male and female orthodontist. evaluated by orthodontists and lay evaluators. The slide show was presented with a digital projector (Notevision.0 (Adobe Systems.
40 1.15 2.75 4.00 Std.000 030 .000 p .Figure 1 Figure 2 Figure 3 Figure 4 t-test group statistics PERSON SLIDEA Orthodontist Layperson SLIDEB Orthodontist Layperson SLIDEC Orthodontist Layperson SLIDED Orthodontist Layperson N 60 60 60 60 60 60 60 60 Mean 4.54 .71 .59 .15 4.84 .36 .50 2.1 5 .05 2.313 Table – 1.10 2.66 .67 . Deviation .68 .
Score SLIDEB 2 Count of Total 3 Count of Total 4 Count of Total 5 Count of Total Total Count of Total 60 50.0 Orthodontist 18 15.0 39 32.5 3 2.5 3 2.5 3 2.5 39 32.5 15 12.5 60 50.0 Layperson
Pearson Chi-Square Value 87.429(a) df 3 P .000
Table – 1.2
SEX SLIDEA Male orthodontist Female orthodontist SLIDEB Male orthodontist Female orthodontist SLIDEC Male orthodontist Female orthodontist SLIDED Male orthodontist Female orthodontist
N 30 30 30 30 30 30 30 30
Mean 4.30 4.00 2.60 2.90 2.20 2.10 1.50 1.50
Std. Deviation .47 .00 .50 .55 .76 .55 .82 .51
Table – 2
t-test group statistics
SEX SLIDEA Male layperson Female layperson SLIDEB Male layperson Female layperson SLIDEC Male layperson Female layperson SLIDED Male layperson Female layperson N 30 30 30 30 30 30 30 30 Mean 4.00 4.10 4.50 3.70 2.50 2.30 2.20 1.80 Std. Deviation .79 .55 .51 .65 .68 .47 1.00 .61 .066 .190 .000 P .570
Table-3.1 Chi-Square Tests
PERSON 2 Layperson SEX Male Count of Total Female Count of Total Total Count of Total 3 5.0 3 5.0 3 5.0 3 5.0 3 Score 4 15 25.0 24 40.0 39 65.0 15 25.0 5 15 25.0
that is not technically perfect when seen from a dental perspective; however, when the smile fits in the face, the imperfections are not always regarded as disturbing.14 This study focused on specific aspect of smile esthetics; the amount of upper gingival exposure in dynamic state of smile. The uniqueness of this study is the differentiation by the sex of the evaluator and by the occupation of the evaluator. 7
The design of this study was relatively new in the orthodontic-psychological field. As in literature, a clear discrepancy between self-perception of facial attractiveness and judgment of others was found. Further study of self-perception of facial and oral attractiveness was clearly needed to gain more insight into the oral self-image and esthetic satisfaction. 12, 13 For example, many movie stars have an attractive smile
Laypersons and orthodontists viewed acceptability of gingival display in this study. Earlier study made by Kokich et al,15 where lay people considered smile-line heights in strangers with a general gingival display exceeding 4 mm, as unattractive. In the study of Geron and Atalia,14 laypeople considered 1 mm gingival display as unattractive. However, this study does not support the conclusion made by the author, as our result suggests more than 4 mm gingival display as unattractive. According to this study Esthetic perception for smile by the male and female orthodontist is quite different. This is because scores given to the slide B by the male and female orthodontist is different. The increased gingival exposure is less appreciated by males than females. This suggests that increased gingival exposure is acceptable by the female orthodontists. The results indicate that excessive gingival display is not accepted by female layperson compared to a male lay person, as an esthetic feature for images. It means that female lay persons are not tolerant to gingival exposure, which is a more predominant feature in women. Same way when a comparison is made between a layperson and an orthodontist, a score given by a layperson is more. So, one can conclude that increased gingival exposure is acceptable by the lay people as compared to orthodontists.
2. Bull R, Rumsey N. The Social Psychology of Facial Appearance. New York, NY: Springer Verlag; 1988. 3. Flanary C. The psychology of appearance and psychological impact of surgical alteration of the face. In: Bell WH, ed. Modern Practice in Orthognathic and Reconstructive Surgery. Philadelphia, Pa: Saunders; 1992: 3–21. 4. Thompson L, Malmberg J, Goodell N, Boring R. The distribution of attention across a talker’s face. Discourse Process. 2004;38:145–168. 5. Moskowitz M, Nayyar A. Determinants of dental esthetics: a rationale for smile analysis and treatment. Compend Contin Educ Dent. 1995;16:1164–1166. 6. Frush JP, Fisher RD. The dynesthetic interpretation of the dentogenic concept. J Prosthet Dent 1958;8:558. 7. McNamara JA. Maxillary transverse deficiency. Am J Orthod Dentofacial Orthop 2000;117:567–70. 8. Tjan AH, Miller GD, The JG. Some esthetic factors in a smile. J Prosthet Dent. 1984;51:24–28. 9. Janzen EK. A balanced smile—a most important treatment objective. Am J Orthod. 1977;72: 359–372. 10. Peck S, Peck L, Kataja M. The gingival smile line. Angle Orthod. 1992;62:91–100. 11. Kokich VO Jr, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent. 1999;11:311–324. 12. Feingold A. Good-looking people are not what we think. Psychol Bull. 1992;111:304–341. 13. Greitemeyer T, Brodbeck F. Wer scho¨n ist, ‘‘wird’’ auch gut. Z Sozialpsychol. 2000;31:73–86. 14. Kokich V, Kiyak H, Shapiro P. Comparing the perception of dentists and lay people to altered dental esthetics. J Esthet Dent. 1999;11:311–324. 15. Geron S, Atalia W. Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination. Angle Orthod. 2005;75:778–784.
1. Images were scored less attractive as the amount of gingival display was increased during smile. 2. Compared to orthodontists increased amount of gingival exposure is acceptable by the laypersons. 3. Up till 4mm of gingival exposure is acceptable by the female orthodontists where as it is not so with male orthodontists. 4. Esthetic perception of male and female layperson is different. Females are more concerned about increased gingival display.
1. Dion K, Berscheid E, Walster E. What is beautiful is good. J Pers Soc Psychol. 1972;24:285–290.
Bracket Positioning Device 9 . Lucknow. This article covers an Indirect Bonding Technique using the Torque Angulation Device (TAD) and the Bracket Positioning Device (BPD) which ensure great accuracy while minimizing the potential for error as compared to most methods available to the orthodontist today. & “BPD” (BRACKET POSITIONING DEVICE)’ Authors: Dr. and the built-in capability in the bracket design (7 th generation ORMCO brackets) to reposition the mandible and tempoeromandibular jaw when needed. The scientific practice of Lingual Orthodontics necessitates an Indirect Bonding Technique which allows us to control bracket placement in the laboratory. MDS (Corresponding Author) Associate Proffessor. RAJ KUMAR JAISWAL. Torque Angulation Device. Key words : Indirect Bonding.in Dr. Department of Orthodontics. Thushar Hegde Dr.co.Welcare Dental Center & ‘LoCUS’ Lingual Orthodontic Training Institute. Department of Orthodontics.in Dr.com Dr. India Telephone : +919935567972 Fax : +91-0522-22440335 E-mail : harishdattada@yahoo. HARISH DATTADA. While better esthetics during treatment is the most obvious. followed by a reliable and precise transfer procedure of the brackets in order to clinically bond them in the exact position which has been set at the laboratory stage. Raj Kumar Jaiswal Abstract : The advantages of Lingual Orthodontics over Labial Orthodontics are many. and the difficulty of access.66 E-mail: drtusharhegde@rediffmail. One of the primary hurdles which needs to be overcome is the irregularity and variability of lingual tooth morphology. increased expansion. Lucknow. Harish Dattada Dr. Director . like more efficient distal movement. some advantages are purely mechanical. MDS Private Practitioner.co. TUSHAR HEGDE. MDS Assistant Proffessor. This technique has been developed by taking into account the advantages and pitfalls of indirect bonding. making accuracy of Direct Bonding dubious.‘AN AVANT-GARDE INDIRECT BONDING TECHNIQUE FOR LINGUAL ORTHODONTICS USING THE FIRST COMPLETE DIGITAL “TAD” (TORQUE ANGULATION DEVICE). Sardar Patel Institute of Dental and Medical Sciences. Sardar Patel Institute of Dental and Medical Sciences. India Telephone: +919415023934 Fax: +91-0522-22440335 E-mail: drrajkumarjaiswal@yahoo. Andheri (W). much easier intrusion. Mumbai .
Accurate method of indirect bonding The positioning of the brackets in relation to the teeth is the critical factor which is crucial to all available systems. This can then be transferred on to the Bracket Positioning device (BPD). The BPD’s induction as a part of the set up makes the entire system reliable. especially for the lingual technique. Smaller inter-bracket distances 6 and smaller arch radius on the lingual aspect demand improvisation of traditionally accepted concepts used in Labial Mechanics. under trimming the area is recommended for easy placement of the bracket in the mouth. the non adjustable surveyor base is used and then the TAD is adjusted to give the best fit for angulation and torque. If the integrity of the lingual surface is in doubt. 2. continuance of the integrity of labial enamel1. Over the years. Peter Sheffield of “Precise Indirect Bonding Systems” in cooperation with “Polydee Instruments”. great strides have been taken in this direction pioneered by the ORMCO Company. the duration of which is not always predictable. the production model was finalized. 2 which is not etched bonded or scarred during debonding. The key advantage of this approach over traditional procedures is the esthetic enhancement during the treatment.INTRODUCTION: Lingual Orthodontics. a stepwise technique of indirect bonding using the TAD (Torque Angulation Device) and the BPD (Bracket Positioning Device). as the name suggests involves – Orthodontic brackets placed on the lingual surfaces of the teeth and connected by special arch-wires. which still used the Torque blades of the TARG. Also. In 1997. MATERIALS AND METHOD: This article aims to demonstrate convincingly. which accurately places the brackets on the model from which a custom tray is fabricated. Disadvantages include speech interference3. the Ormco Company devised the TARG7 (Torque Angulation Reference Guide) device for more precise bracket positioning. The technique is. conceptualized and introduced the Orthodontic Bracket Positioning Device and the Torque Angulation Device (TAD) prototype (Fig 1). cannot be overlooked. Since the inception of the technique. The following reference lines are marked: (Fig 4) • Long Axis of the Clinical Crown (LACC). Various other inventions were introduced over the years but their accuracy remains questionable. Weichmann from Germany introduced the “Professional TARG and 10 Transfer Optimized Positioning System (TOPS). Design of the Bracket (which apart from satisfying several important criteria has to confirm with the varying anatomy of the lingual aspect of the teeth). and today we have an array of bracket systems to choose from. 4 and tongue irritation4. which uses customized gold brackets. reproducible and most importantly. easy to use (Fig 3). 5 during the initial adaptation period. 2. thus creating an individualized treatment plan for each tooth. An intricate analysis into the merits/demerits and comparisons with the conventional is beyond the scope of the article. In 2004 Mr. an engineering company with no previous experience in the dental sector. After two years of intensive labor focused on making the device user friendly.10! (Fig 2) This first truly digital Torque angulation contrivance had a unique ability of surveying and measuring the torque and angulation of individual teeth with superior accuracy in comparison to any of its predecessors. So the trick to get lingual orthodontics to work was to devise a method so the brackets could be placed with proper torque and angulation in relation to the tooth already determined. In 1984. various improvements like thickness compensation and height determination in a digital measuring environment were supplemented to enhance TARG’s precision. Dr. clinically more time consuming and patients tend to be more demanding. 1. With the prepared study model and its base parallel to the Horizontal Occlusal Line in position. After this the measurements are used in reverse by changing the survey base to an adjustable one which is then oriented to the preset position of the TAD blade. which was precise to 0. The Cast and model are trimmed properly on an Orthodontic model trimmer or preferably referenced using a jig which will set the base parallel to the HOL as explained by Andrews. The distress of having visible braces not only during routine daily activities but also during social events and gatherings for all the classes of people who seek esthetics has been greatly overcome. He also invented the first CAD/CAM Incognito system. The operator thereby receives precise digital measurement data for the maloccluded teeth in the mouth so that a suitable prescription for treatment can be made. The fact that they can look better without the process significantly interfering with their way of life provides a viable option to an entire segment of individuals who were otherwise indifferent to orthodontic treatment. . Two crucial aspects play a key role in establishing the success of Lingual Orthodontics: 1.
After cleaning the bracket base (acetone is recommended to remove grease and contaminants). The indirect bonding tray is made with Memosil (Heraeus Kulzer) which is dispensed in an applicator (Fig 12). A special jig is used for this purpose (Since the jig’s inclusion increases the width between the jaws of the BPD. . 6. The shortest teeth are surveyed (Laterals and premolars) with a bracket to mark the slot line. The set-up is Light Cured. Height and thickness for each tooth. 8. stopping short of the gingival margin by 1. The bracket is engaged to the bracket holder with the calipers open. The digital value on the “Mitutoyo digimatic DTI” is zeroed. 10. 16. Light cure for 30 seconds (Fig 7). 18. The outer jaws are supported along the buccal aspect of the tooth and the desired height is adjusted to by turning the fine height adjustment to the required setting (Fig 6). 17. It is recommended not to place it too close to the bracket or the silicone will not be thick enough. Next. The model and survey base (with its programmed torque and angulation setting) are transferred to the BPD for bracket placement in accordance with the previously conducted height and thickness survey. It is advised to start from the lingual (covering the brackets entirely – Fig 13). the bonding material is applied to the bracket base (Fig 6). After 15 min the tray is rinsed under cold running water. A first order bend may sometimes be required mesial to the canine if its thickness is substantially greater than the other anteriors.• • Midline on the Occlusal and Incisal Edges Mid points on the clinical crown (LA point). During the procedure it must be ensured that the open part of the jig faces mesially (for easier removal. • • • Bracket position. which is done by sliding it out from the distal after bonding) (Fig 8) 13.5 to 2mm (Fig 10). 12. A resin separator is painted to the vestibular and occlusal surfaces of the model before the transfer tray can be constructed (Fig 9). Ensure adequate thickness of material over the brackets. Notches can be made on the silicone keys to enhance mechanical retention for the forthcoming steps. it can be matched to the scribe line in the centre of the TAD blade). A low pressure compressed air spray is used to break the seal at the distal edge. the molars tubes are positioned. Angulation and torque of each tooth. move on to the occlusal (Fig 13) and finally the labial/ buccal surfaces (Fig 13). 11. it becomes necessary to reset the reading to zero before placing the brackets). 9. 14. Increasing the resin pad thickness as a compensation to avoid this bend will result in an excessively thick resin pad and is not recommended. The outer jaw of the caliper is positioned almost at the incisal or occlusal edge by using the BPD column height adjustment (Fig 6). Often the bonding height of the posteriors needs to be more to avoid contact with the antagonist necessitating a vertical bend between the canines and pre-molars. Ensure removal of excessive bonding material around the bracket base before curing (Fig 7). It is recommended not 11 to pull out and in during this procedure to avoid creating any air space in the pad (Stop just short of the required thickness and then gently tap the last adjustment to the final reading). A pre-prepared tooth number is stuck to the key (Fig 11). The transfer tray is smoothened using the finger (which can be dipped in a viscous liquid like the dishwashing liquid which acts as a separator (Fig 14). The height is checked on the thickest anterior. A hard “Light Cure Blockout’ blue key is prepared covering most of the occlusal and vestibular surfaces. After this the fine height adjustment is manipulated to allow the caliper to touch the incisal edge lightly. 7. The models are surveyed and the height and thickness are recorded using the BPD and brackets on a worksheet (Fig 5a). The outer jaw of the BPD is approximated to the vestibular surface and the and slowly close the thickness calipers by referring to the scale for the required thickness (Fig 7). The Set up is performed beginning with the anterior teeth by using the TAD to set the torque and angulation (Fig 5b). The Memosil is applied with steady pressure on the syringe. 5. 3. Check for the following. The survey base on which the model rests is adjusted to confirm the facial/buccal surface of the tooth to the blade of the TAD by using the tilt of the base in conjunction with the fine height adjustment of the TAD (If the LA point is being used. 15. 4.
5a : Survey the models and record height and thickness using the BPD and brackets on a worksheet Fig. 1 : The prototype Torque Angulation Device (TAD) Fig.Fir. 2 : Torque Angulation Device (TAD) with key elements Fig. (not too heavily though). 4 : Mark all the reference lines needed to do the set-up. Mid-line on the occlusal. 5b : Set Torque and Angulation using the TAD 12 . the incisal edge. and the Midpoint of the clinical crowns (LA point) Fig. 3 : Bracket Placement Device (BPD) with key elements Fig. These include the Long Axis of the Clinical Crown (LACC).
8 : Special Jig for molar bonding 13 Fig. 6 : Transfer the model plus the survey base with its programmed torque and angulation setting to the BPD for bracket placement Fig. 10 : “Light-cure block out” blue keys Fig. 7 : Bonding and Curing Fig. 11 : Numbering the keys . 9 : A resin separator is painted on the vestibular and occlusal surfaces Fig.Fig.
15 : Trimming of the tray Fig. 13 : Memosil (Heraeus Kulzer) application Fig. 12 : Memosil (Heraeus Kulzer) applicator Fig. 16 : Removal of the tray Fig.Fig. 17 : Sandblasting and trimming the resin pads . 14 : Finishing the tray 14 Fig.
Each bracket is then removed from the tray. Fig. and the excess resin around the pad is trimmed with a hand piece and smoothened (Fig 17). The tray is cleaned under gentle steam \pressure. Individual brackets are then cleaned with a brush followed by acetone or isopropyl alcohol on a cotton micro-brush (Fig 19). A blunt instrument is wegded under the tray from the lingual with direct pressure under the brackets to ensure their removal along with the tray (Fig 16). 21. DISCUSSION: Lingual Orthodontics is a precision sensitive technique. The tray is light-cured from the inside to ensure maximum curing of the bracket pads. and value incorporation in the brackets are the most critical aspects in ensuring a smooth. Any extensions which may hinder insertion including inter-dental spaces are trimmed (Fig 18). 18 : Removal of undercuts Fig. 21 : Spring loaded jaws with horizontal and vertical jigs which allow it to adapt well to any slot 19. (Fig 18) 25. 19 : Cleaning and finishing of bracket bases 24. The brackets are replaced into the tray with tweezers. 26. 23. 20. A scalpel can be used to trim the margins all the surfaces till the gingival margin (Fig 15).Fig. followed by water and then dried with compressed air. efficient and uncomplicated treatment 15 Fig. Additional care should be taken to remove Memosil from under large brackets and brackets with hooks to facilitate easy removal of tray and minimize stress. The resin pads are sandblasted with a micro-blaster using 50 micron alumina (Fig 17). The tray is ready after mild steam cleaning followed by wiping with acetone (Fig 20). 20 : Finished trays . The proper positioning of. 22.
2001.. Molar tubes have a different jig for ease in placement. Am. greatly enhances the accuracy in indirect bonding procedures .F. C. Lingual Bracket Jig 12 . 6.. It allows the operator to measure the torque and angulation values of the initial malocclusion and to formulate custom prescriptions and compensations in lieu with the clinician’s requirements. pp.G.: New Indirect Bonding method for lingual orthodontics. A. The TAD on the other hand is accurate to 0. The TAD and BPD device system greatly enhances the accuracy of value incorporation and bracket positioning in comparison to any of the previously available systems. B. It has horizontal and vertical jigs for both slots (Fig 21). Sinclair. Orthod.: The Customized Lingual Appliance Set-Up Service (CLASS) System.The TAD exhibits an accuracy of up to 0. Orthod. the KIS system10.2000. BaeGi-Sun. Am. Up to 350 of positive or negative values can be incorporated depending on requirements to suit labial or lingual prescriptions. J. Fillion. which is imperative for lingual orthodontics.Part 1 . Traditional cephalometry calculates proclination values by measurements on the central incisor. J. Clinical Impressions. Decker. Volume 1997 Oct(689 .1989. The readings can be conveniently stored in a computer by push of a button. 1999.F. SMITH.: Microscopic evaluation of enamel after debonding: Clinical application. the BAS 11 . The BPD has spring loaded jaws which allow it to adapt well to any slot. clear. 96:120-137. Gwinnett. • 5. Cannito. L. Weichmann. • 7. precise and most importantly. 12. It can prove to be a useful tool in research as well as to establish normative values for different populations. P. 7:2-9. 11. The torque blades which are different for each tooth in the TARG have play of 30. 10(1)27. Clinical Impressions. 8. M. T. L.. J.10. The vertical rod is free of the horizontal sliding calipers (Mitutoyo Digimatic) unlike the TARG where the jaws hang from the vertical rod which may result in erroneous readings.A.978. Goates.C. Zachrisson.261): Keys to Success in Lingual Therapy. MS. 4.U. and Alexander. the Slot Machine8. pp. 1986. ed.D. 20:396-404. Orthod. J. Huge. Hamilton. 1998. 1979. Orthod. The laboratory procedures which are mandatory for this to be achieved require sensitive armamentarium designed to achieve exactitude.: The resurgence of lingual orthodontics. 1977.: Lingual orthodontics-its renaissance. Arthun. Kim Taeweon. DDS. B. J. L. DDS. GORMAN. Clin.procedure. Volume 1986 Apr(252 .: Patient responses to lingual appliances.J.371-394. R. by overcoming several key drawbacks of previously available techniques. The other significant advantages over other systems are: • • • Complete digital readings thereby increasing precision. 9. 1986. Geron S. 75:121-137. etc which aim to accomplish this are available commercially. D. Intensive testing and cross referencing revealed inaccuracies of up to +/-30 in the TARG. Ormco. Several systems like the TARG system 7. Clin. R. J. 3.163-173. JOHN C. J.: Modulus-Driven Lingual Orthodontics.: The Alexander Discipline: Contemporary Concepts and Philosophies. 1998. the Pearson correlation coefficient of the TAD using different operators on intra-calibration (336 data) was 0. 73:651-655.694): Improving Patient Comfort with Lingual Brackets DIDIER FILLION.. The TAD individually measures each tooth to derive true values. D. CRAVEN KURZ. 33:457-63.. 2. in Lingual Orthodontics.: The lingual bracket jig. Solomos. Gorelick. Am. DMD. CA.M.1o. Cho Jaehyung. D. Creekmore. Ont.: Enamel surface appearance after various debonding techniques. Orthod.. The armamentarium is economical and all the steps are fast. Clin.. the CLASS system9. 16 CONCLUSION: The TAD and BPD system. Orthod. MSD. D Alexander. RICHARD M. 34. easy. Flattest base among available systems (2 Micro mm).M. • • • • 10..JOHN R.Romano.. Glendora. In a previous article / study in the WJO (Crown Inclination of Northern Thai with good Occlusion: A Measurement by Orthodontic Torque Angulation Device (TAD). S. reproducible. REFERENCES: 1.6:348-350.
• Highly Experienced & dedicated Teaching Faculty for UG & PG Courses. • Large Library with National & International Publications/Journals.CHHATTISGARH DENTAL COLLEGE & RESEARCH INSTITUTE POST BOX NO. 291189. ROAD. (07744)281931. • Large & Well attended Dental OPD. New Delhi. 325459. • Well Equipped Laboratories with Ultra Modern and Sophisticated Instruments. 291188.G.) Ph No. • An ISO 9001:2000 Certified Institute.cdcri. : 25. Ft. Sq. RAJNANDGAON . Mob.com.org First College in Chhattisgarh with P.S. Ravishankar Shukla University. in Dentistry (M.491 441 (C. web : www. SUNDRA.G.cdcrirjn@gmail.D. G. 291190 Fax-281930. • Only Private College in Chhattisgarh Recognised by Ministry of Health & Family Welfare & Dental Council of India. .E. • Post Graduate Courses in Oral Medicine and Radiology & Conservative Dentistry and Endodontics with 2 Seats each from the Academic Session 2009-10. • Affiliated to Pt. Raipur • Built up Area above 2 Lac. – 94255-54244 email .) Salient Features : • The First & Foremost Dental College in Chhattisgarh.
The mean incisor intrusion achieved with mini-implants was 3. Kuttappa (Professor) Department of Orthodontics and Dentofacial Orthopedics. F. an intrusive force of 50 gms using Niti closed coil springs was applied from a mini-implant placed between the roots of the two central incisors.I.29 mm with standard deviation of 0. A. The results of this study revealed that true incisor intrusion can be achieved with the use of mini-implants. making it virtually impossible to achieve absolute anchorage in which the reaction force does not bring about extrusion of molars. incisor intrusion or a combination of both. Karnataka. India.B.B.O. forces can be applied to produce tooth movement in any direction without detrimental reciprocal forces. Shetty Memorial Institute of Dental Sciences.29mm with standard deviation of 1. In mini-implant anchorage system. U. Ashutosh Shetty (Associate Professor) Department of Orthodontics and Dentofacial Orthopedics. Farhat Godhrawala (Post-graduate student) Department of Orthodontics and Dentofacial Orthopedics.com Abstract The aim of this study was to investigate the amount of true incisor intrusion achieved using mini-implants. F.The most commonly used is the utility arch technique given by Dr Ricketts. an objective that is difficult to achieve. A. Department of Orthodontics and Dentofacial Orthopedics. F. Non surgical treatment alternatives include molar extrusion.A. . Seven patients with deep overbite and with increased upper incisor/anterior gingival displaywere the sample for our study. Shetty Memorial Institute of Dental Sciences.B. After leveling of the maxillary central and lateral incisors with a segmented arch.D.D. every action has an equal and an opposite reaction.C. Shetty Memorial Institute of Dental Sciences. Mangalore.11. The amount of intrusion was evaluated on lateral cephalograms taken at the end of leveling (T1) and 4 months later (T2).49.W. opening the bite by extruding the posterior occlusion would not be email@example.com Incisor intrusion can be achieved with various treatment modalities. true incisor intrusion is the treatment of choice.F.A. No : 09886532137 E-mail : farhat.B.S. Deralakatte. Dr.1 In patients with vertical growth tendencies and patients with increased incisal show. Dr. Shetty Memorial Institute of Dental Sciences.04. F. A. extraoral anchorage has been used to reinforce intraoral anchorage. The mean molar extrusion seen with mini-implants was 0. Tel. The mean of the change in incisor inclination is 0.N.14degrees with standard deviation of 2. But according to 18 Newton’s third law of motion. M.F.EVALUATION OF TRUE INCISOR INTRUSION ATTAINED WITH MINI-IMPLANT ANCHORAGE SYSTEM FOR THE CORRECTION OF DEEP OVERBITE Authors: Dr. Traditionally. A. For these patients. Krishna Nayak (Professor and Head) MDS. INTRODUCTION Deep overbite is a common component of malocclusion in adults and children.I. Dr. The use of extraoral anchorage ideally demands full cooperation of the patient for continuous appliance wear.P. This study was to analyze the incisor intrusion achieved skeletal anchorage system.
A force of approximately 50gms was applied from the spring to an 0. 2. Patients were treated with mini-implants in the interradicular bone in maxillary arch. The surgical procedure is as follows4. Severe craniofacial disorders. No active growth left according to cervical 3 vertebrae analysis.MATERIALS AND METHODS The sample of this study consistedof 7 patients with deep overbite and with increased upper incisor/anterior gingival display. The position of the mini-implant was documented with an IOPA.022 slot Roth prescription.016 Niti wire. The wire was cinched back on the molars to prevent flaring of the incisors. Vertical position of the maxillary incisors: perpendicular distance from the midpoint between 19 Fig. 3 : IOPA after placement of the Mini-Implant after placement of the Mini-Implant Fig. The inclusion criteria was: 1. (FIG 4) 1. Standardized lateral cephalograms were taken before the mini-implant placement at the end of leveling (T1) and at the end of intrusion 4 months later (T2).3mm lead pencil. The bone corresponding to the guide wire was drilled with a 1. miniimplants were placed. such as cleft palate or extensive prosthetic appliances. 3).5 mm. FIG 2) Under local anesthesia. A surgical guide was made from a rectangular wire segment to help identify the mini-implant location on the IOPA. 1 : Intraoral Guide Wire Placement Post-operative antibiotics and analgesics were given to the patient. (FIG 1. The implant was inserted using a miniature screw driver. 2 : IOPA to Assess the position of the Guide Wire . pilot drill using saline irrigation. 3. The sample patients were treated using PEA appliance with 0. An informed consent was taken. a punch cut was given in the region of the labial frenum in between the maxillary central incisors to denude the alveolar bone. the implant was loaded with a Niti closed coil spring. After the initial alignment of the incisors with 0. Each cephalogram was traced on acetate paper with 0. After an healing period of two weeks . Patients with deep overbite and increased incisor / anterior gingival display.018 A J Wilcock base archwire connecting the four incisors and the first molars. The mini-implants used were of the self tapping variety (Leone mini-implants 8mm in length and 2mm in diameter). The exclusion criteria was 1. Medically compromised cases. 2. Two linear and one angular measurements were selected for cephalometric analysis. Fig. Patients with active periodontal disease. as far as the length of the mini-implant. (Fig.
29 mm. DISCUSSION The purpose of this study was to quantify overbite correction achieved by mini-implants. MAXILLARY MOLAR EXTRUSION The mean molar extrusion seen with mini-implants was 0. Perpendicular distance from the mesio buccal cusp tip of the molar to the palatal plane was measured. Perpendicular distance from the midpoint between the incisal edge and the apex of the tooth along the long axis (C) to the palatal plane (PP) was measured. 4 :1. 2.29 mm with standard deviation of 0.1. RESULTS A. Therefore in nongrowing individuals. In our study the mean true incisor intrusion achieved with mini-implants was 3.5 months. CHANGE IN INCISOR INCLINATION The mean of the change in incisor inclination is 0. the incisal edge and the apex of the toothalong the long axis (C) to the palatal plane (PP) was 1 measured. 3. C. Utility arches used for incisor intrusion creates a force system that tends to elongate the molars.49. As a result. 2. the lack of posterior anchorage compromises the ability to intrude the incisors. MAXILLARY INCISOR INTRUSION The mean incisor intrusion achieved with mini-implants was 3. .29mm.29mm with standard deviation of 1. Vertical position of the maxillary first molar: perpendicular distance from the mesio buccal cusp tip of the molar to the palatal plane was measured. Angle between the long axis of the maxillary incisor and the sella-nasion plane (SN plane) was measured.04.5mm of incisor intrusion in maxillary arch and 1.9mm in the mandibular arch.14 degrees with standard deviation of 2. It is widely accepted that correction of deep bite by extrusion of posterior teeth is both more difficult to accomplish and less stable when it is performed on non growing patients than when it is attempted on those with appreciable growth remaining. it helps in the correction of unaesthetic gummy smiles. In actively growing patients with a good facial pattern this is not a major problem. Since the implants were used as a source of anchorage for the 20 Fig.92mm of upper incisor intrusion 4. However. The sample of our study consisted of 7 patients with deep bite and gummy smiles.5mm. by Ohnishi et al 6who intruded maxillary incisors by 3. According to the meta-analysis conducted by Julia NG et al 2 incisor intrusion attained during orthodontic treatment in non growing patients by the segmented arch technique was 1. 3. it is necessary to determine its cause. Change in the inclination of the maxillary incisors: angle between the long axis of the maxillary incisor and the sella-nasion plane (SN plane) was measured. molar extrusion should be avoided. In our study the mean molar extrusion seen with mini-implants was 0. The problem may be due to a reduced lower face height and lack of eruption of the posterior teeth or due to the over eruption of the anterior teeth.B. by Kanomi 4 in which the mandibular incisors were intruded by 4mm in six months. intrusion of incisors is preferred since it is more stable and along with the correction of deep bite. in non-growing patients or those with a poor facial pattern (vertical growers). Before treating a deep-bite case. by Kim et al7 who reported 4mm of maxillary incisor intrusion in 7 months and Omur PolatOzsoy8 who reported 1. Also the results of our study are similar to the ones using mini-implants done by Creekmore 5who intruded the maxillary incisors by 6mm in one year.
From the results of our study we can say that. defined as a point on the longitudinal axis of the tooth that is independent of any change in inclination. Therefore in our study we used light continuous forces to bring about the desired tooth movement. Molar extrusion is PRE-TREATMENT POST-INTRUSION SUPER IMPOSITION 21 . The mean of the change in incisor inclination is 0.9 fferent approaches to localize the centroid have been reported9. followed by surgical crown lengthening later.14degrees with mini-implants. incisal edge cannot be used as a reference since change in the inclination of the crown will change the position of the incisal edge also. the reciprocal forces were not produced at the molars and therefore the side effects like molar extrusion was not seen. This could be due the fact that the patients were asked to maintain excellent oral hygiene and clean the region of the implants with chlorhexidine mouthwash to reduce plaque accumulation and thereby control inflammation which is a crucial factor for the clinical success of the miniimplant.11. in order to reduce deep bite and gummy smiles by intruding the incisors.11.12 Mild external root resorption was seen in both groups of patients. Nanda and Costopoulos 14 that low forces can cause dental intrusion sufficient to correct a deep bite with minimal apical resorption. is the reference point of choice. The incisor centroid. If true incisor intrusion is to be calculated.10. Fig. our study we used the midpoint between the incisal edge and the apex of the upper incisor 1.incisor intrusion. The base archwire was cinched back to prevent flaring of the teeth since the point of force application was buccal to the centre of resistance. Change in the inclination of incisors can bring about relative intrusion of the teeth.9the palatal plane was used as the reference plane9. Therefore. incisal edge and the root apex are not good reference points. Park and Harris13 that incisor intrusion and apical displacement with lingual tipping are highly correlated with external root resorption compared to other types of tooth movement. implants are very effective as compared to other non-surgical treatment modalities. 5 : Case 1 None of the implants showed mobility during the course of the treatment.
Fig. 6 : Case 2
SUPER IMPOSITION Fig. 7 : Case 3
SUPER IMPOSITION 22
Fig. 8 : Case 4
not seen with implants. There is no significant change in the inclination of incisors with mini-implants provided the base arch wire is cinched back at the molars.
Table I : VERTICAL POSITION OF THE INCISORS
Serial No. 1. 2. 3. 4. 5. 6. 7. Vertical Position of Incisors-Pre 36 mm 29 mm 29 mm 31 mm 27 mm 30 mm 35 mm Vertical Position of Incisors-Post 32 mm 25 mm 28 mm 27 mm 24 mm 27 mm 31 mm Difference 4 4 1 4 3 3 4
From our present study, with an aim to quantify the amount of true incisor intrusion achieved with skeletal anchorage system we can conclude that the miniimplant technique for true incisor intrusion can be considered superior to other treatment modalities. Also considerable amount of true intrusion is achieved in a relatively short period of time. Vertical height of molars does not change with implants. Change in inclination of incisors does not change with implants provided the wire is cinched back at the molar. 23
Table II : VERTICAL POSITION OF THE MOLARS
Serial No. 1. 2. 3. 4. 5. 6. 7. Vertical Position of Molar-Pre 27 mm 25 mm 22 mm 30 mm 26 mm 28 mm 29 mm Vertical Position of Molar-Post 27 mm 25 mm 22 mm 31 mm 27 mm 28 mm 29 mm Difference 0 0 0 1 1 0 0
Table III : INCISOR ANGULATION
Serial No. 1. 2. 3. 4. 5. 6. 7. Incisor Angulation Pre (Degrees) 104 113 107 120 130 128 115 Incisor Angulation -Post4 102 113 109 117 132 130 115 Difference -2 0 2 -3 2 2 0
1. Weiland FJ, Bantleon HP, Droschl H. Evaluation of continuous arch and segmented arch leveling techniques in adult patients-a clinical study. Am J Orthod Dentofacial Orthop 1996;110: 647-52. 2. Julia NG, Major PW, Heo G, Flores-Mir C. True incisor intrusion attained during orthodontic treatment:A systematic review and meta-analysis. Am J Orthod Dentofacial Orthop 2005; 128:212-19. 3. Hassel B, Farman AG. Skeletal maturation evaluation using cervical vertebrae. Am J Orthod Dentofacial Orthop 1995;107:58-66. 4. Kanomi R. Mini-implant for orthodontic anchorage. J Clin Orthod 1997;31:763-67. 5. Creekmore TD, Eklund MK. The possibility of skeletal anchorage. J Clin Orthod 1983;17:266-69. 6. Onishi H, Yagi T, Takada K. A mini-implant for orthodontic anchorage. Angle Orthod 2005;75:444-52. 7. Kim TW, Kim H, Lee SJ. Correction of deep overbite and gummy smile by using a mini-implant with a segmented wire in a growing Class II Division 2 patient. Am J Orthod Dentofacial Orthop 2006;130:676-85. 8. Omur Polat-Ozsoy, Ayca Arman-Ozcirpici, Firdevs Veziroglu. Miniscrews for upper incisor intrusion. Eur J Orthod 2009
9. Kinzel J, Aberschek P, Mischak I, Droschl H. Study of the extent of torque, protrusion and intrusion of the incisors in the context of Class II, div 2 treatment in adults. J Orofac Orthop 2002;63:283-99 10. Hong RK, Hong HP, Koh HS. Effect of reverse curve mushroom archwire on lower incisors in adult patients: a prospective study. Angle Orthod 2001;71:425-32. 11. Mark G. Hans, Craig Kishiyama, Stephan H. Parker, Regine Noachtar. Cephalometric evaluation of two treatment stratergies for deep overbite correction. Angle Orthod 1994;64: 265-276. 12. Hyo-Sang Park, Seong-Hwa Jeong, Oh-Won Kwon. Factors affecting the clinical success of screw implants used as orthodontic anchorage. Am J Orthod Dentofacial Orthop 2006; 130:18-25 13. Parker RJ, Harris ER. Directions of orthodontic tooth movement associated with external apical root resorption of the maxillary central incisor. Am J Orthod Dentofacial Orthop 1998;114: 677-83. 14. Costopoulos G, Nanda R. An evaluation of root resorption incident to orthodontic intrusion. Am J Orthod Dentofacial Orthop 1996; 109:543-8
measurements taken from Salivary IGF-I are likely to be inaccurate because of contamination with gingival . IGF-I was first detected in serum and is a circulating growth hormone-dependent factor. Dept. Nameeta Kaur P. Research Category 13th IOS PG Convention 2009. College of Dental Sciences & Research. Davangere) Author Name : Dr. D. Professor & Head. urine and saliva. Modinagar. Keeping in view the radiographic artefacts associated with the lateral cepholograms which may mislead the practitioners. D. nearly less that 1% of serum levels. residual growth KeyWords : INTRODUCTION In 1957. Reena R. the level of which correlates with sexual maturity. of Orthodontics & Dentofacial Orthopedics. and decline to approach pre-pubertal levels after puberty.J. The levels of IGF-I in saliva are considerably low. Additionally. Student. Dept.J. IGF-I.IGF . E-mail : firstname.lastname@example.org growth factor I as a mediator of the growth hormone (GH) functions. Apart from additional radiographic exposure and subjectivity of staging the x-rays. an inherent disadvantage of cervical vertebral stages and hand wrist radiographs is that the final stage of development does not necessarily indicate the completion of growth. Precise assessment of IGF-I is useful diagnostic tool for determining GH stastus as its levels do not fluctuate throughout the day unlike the GH levels. Nameeta Kaur Dr. Salmon and Daughaday discovered IGF-I. E-mail : nameetakaur@yahoo. Modinagar. of Orthodontics & Dentofacial Orthodontics. or insulin . Kumar Dr. E-mail : email@example.com Dr. Since lateral cephalometric radiographs are routinely taken for orhtodontic patients.G. Reena R. Modinagar.com Dr.I : A LEGITIMETE SKELETAL MATURITY INDICATOR (Prize Category : 1st Prize. College of Dental Sciences & Research. Kumar Principal. It is used to diagnose growth hormone 25 deficiencies and excess. it was decided to conduct a study on 13 female and 10 male subjects to assess the skeletal maturity by testing serum insulin-like growth factor 1 (IGF-I) levels. rise sharply to their peak in puberty. In addition lateral tipping of a vertebrae by about 30* may lead to disappearance of curvature on an x-ray which accounts for the absence of curvature on the inferior borders of otherwise mature looking vertebrae. Results from this study indicate that the IGF-I levels are low in the pre-pubertal cervical skeletal stages. Skeletal maturity. Anil Miglani ABSTRACT : Assessment of skeletal maturity is critical to the modality and timing of treatment of various skeletal abnormalities. Anil Miglani Professor. using the cervical vertebrae from these radiographs to assess skeletal maturity has been especially appealing to orthodontists.com Dr. IGF-I is measurable is serum.
AIM AND OBJECTIVES 1. Sample : The present study consisted of twenty three subjects – 13 females and 10 males . and bleeding disorders. and dental implant decisions. Modinagar. The Study was cleared by the Institutional Ethical Commitee. To compare the mean IGF-I levels with Cervical vertebrae maturation Index (CVMI) MATERIAL AND METHODS A. The operators 26 Figure III : Samples being centrifuged . minimally invasive technique and the samples are stable at room temperature for up to two weeks. Serum IGF-I measurement is a relatively new. studies have shown that chronologic age and dental age are both poor predictors of the pubertal growth spurt2.I levels corresponding to the cervical skeletal maturation stages.fluid or blood. NewDelhi. were in treatment. To correlate IGF-I levels to the cervical vertebral stages for assessing skeletal maturity in males and females.I levels at Super Religare Diagnostics. The inclusion criteria were patients between the ages of 9 and 23 years. Lateral cephalograms were obtained as part of the standard treatment diagnostic protocol. Moreover. orthognathic.V). Curvatures were defined when the depth of the curvature was 1 mm or greater. who staged the cephalograms were blinded about each patients age. The samples were stored in an ice box (Fig I) and sent to the laboratory. or were in post treatment follow-up. The use of the radiographs may bias the results as curvatures of about 300 disappear on an x-ray due to lateral tipping of visibly mature vertebrae1. who were either to begin orthodontic treatment. The current use of cervical vertebral stages and hadn-wrist radiographs are subjective techniques that involve additional radiographic exposure and lack the ability to determine the intensity of the growth spurt. Correlations were performed to determine the IGF-I levels relating to the various cervical skeletal maturation stages. Figure I : Blood samples stored in an ice box Figure II : The Centrifuge B. C. where they were centrifuged (Fig II & III) to separate the serum (Fig IV) The samples were subsequently enzyme – immunoassayed for IGF . Hence serum IGF-I levels could play a role in the determination of the pubertal status of the patient and as an indicator of residual growth.3. growth abnormality. 2. D J College of Dental Sciences & Research. Statistical Analysis : Analysis of variance (ANOVA) and Spearman’s RANK correlation coefficient were used to compare mean IGF . Procedure : Blood samples were collected by using kits supplied by Super Diagnostics. and a millimetric rules was used to measure the posterior and inferior borders to determine vertebral shape (Fig. (Graph I). IGF-I levels were then subsequently correlated to cervical vertebrae stages.from the regular OPD of the Department of Orthodontics. Exclusion criteria were systemic illness. Accurate determination of skeletal maturity is crucial to the timing fo various orthodontic. pubertal status and IGF-I levels. The cervical staging technique as described by Baccetti4 was used to stage the vertebrae.
38 15. Table I & II Show the correlation of cervical staging with IGF-I levels in males and females respectively.12 304. In CS6.96 181. IGF-I levels correlated negatively with chronologic age and the number of months reported to have passed since the onset of puberty with correlation coefficients of -0.94 ng/ml).I levels in females were higher than in males at all ages. The male subjects exhibited the highest (299. 6.32 ng/ml (Table III). whereas the correlation from CS1 to CS4 showed a correlation coefficient from CS4 to CS6 was -0.66 16.66 16. The results showed a 27 Table III : Average pooled data to correlate cervical staging to mean IGF .52 295. respectively.20 144.I levels correlated to the CVS in males C. n (%) 20 20 20 20 20 Mean IGF (ngm/mL) 160.676 (p>.20 and CS6 (and 135.38 Mean IGF (ngm/mL) 169. Female subjects exhibited the highest (310.12 ng/ml) a gradual increase in CS4 (304.62 185.38 15.66 8.52 ng/ml.36 Figure V : Cervical staging technique by Baccetti used to stage the vertebrae Table II : IGF .30 177.20 135. 5.522.20 135.60 299.3 Graph I : Correlation of IGF-I levels to the cervical vertebral stages RESULTS The IGF .32 .S 1 2 3.94 222. n (%) 16.31 ng/ml at the cervical vertebrae stages CS4 and CS6 respectively. The Pearson linear correlation coefficient of +0.S 1 2 3.10 289.69 222. Table I : IGF .38 15. 5.01). A negative correlation was seen thereafter in CS5 222.I levels C.68(p>.I levels correlated to the CVS in females C. 6.52 ng/ml) a sharp increase from CS2 to CS3 (295. The mean value of IGF-I from the pooled data of the total sample was highest at CS4 with levels of 304.3 ng/ml) values at CS4 and CS6 with a mean value of 208.20 ng/ml) and the lowest values (135.01).S 1 2 3.94 ng/ml and lowest at CS6 with 135.38 15. 4. 5.531 and -0.69 ng/ml) and the lowest (126.94 300. 4. n (%) 15.38 15. 4.32 ng/ml) to approach the pre-pubertal levels (Graph I ).66 16.36 ng/ml) of IGF-I with a mean of 212.64 310.Figure IV : Separation of serum positive correlation between IGF-I levels and cervical vertebral staging from CS1 to CS4 by showing a gradual increase from CS1 to CS2 (164. 6.33 25 Mean IGF (ngm/mL) 164.96 to 181.
65-72. Fishman L. Am J Othod Dentofacial Orthop 1995. IGF-I may be used as a feasible skeletal maturity indicator and finds applicability as a virtual indicator of residual growth. Additionally. It has also been found to play a principal role in local and systemic regulation of longitudinal bone growth. : Angle Orhod. Hertel NT. Sugawara J.144:929-36. Dalgaar P. Juul A. Jorgensen K : Serum insulin-like growth factor-I in 1030 healthy children. This increased level of serum IGF-I is indicative of residual growth in this male subject. IGF-I levels have a positive correlation with cervical skeletal maturity from the pre pubertal to the late pubertal stages and a negative correlation from the late pubertal to the post pubertal stages.3 ng/ml. Kent R. Guo R. 6. stage of puberty. the radiographic artefacts associated with lateral cepholagrams justifies the need to look at serum IGF-I levels as a skeletal maturity indicator. 7. Franchi L. IGF-I levels do not fluctuate and it has an added benefit of being directly stimulated by androgens in the pre-pubertal stages. 5. Ten Cate R. Mitani H. Philadelphia:W. Masoud M. A multi-centered longitudinal study. Oral histology. Amaar Y. and adults : relation to age. Am J Orthod Dentofacial Orthop 1993. 2.L : Assessing skeletal maturity by using blood spot insulin-like growth factor I (IGF-I) testing : Am J Orthod Dentofacial Orthop 2008. sex. In the present study.S : Radiographic evaluation of Skelekal Maturation : A clinically oriented method based on hand wrist films. Post-pubertal circulating IGF-I levels continued to fall to approximately 250 g per litre at 25 years of age. Hassel B. CONCLUSION 1. and body mass index. McNamara JA Jr. BIBLIOGRAPHY 1.3 and 143. 8.82 ug/L) whereas there was a decline between CS5 and CS6 (199.107:58-66. Both GH and IGF-I are important factors for pubertal growth spurt as demonstrated by Mohan. et al. Maturation patterns and prediction during adolescence Angle Orthod. Donahue LR.11:119-29. Growth of mandibular prognathism after pubertal growth peak.DISCUSSION Cervical vertebrae stages and hand-wrist radiographs currently used to identify peak mandibular bone growth lack the ability to determine the intensity of the growth spurt and its cessation. The study conducted by Mohamed Masoud1 on Saudi Arabian population reported a sharp increase in IGF-I levels from CS3 to peak levels at CS5 (208.2 ng/ml).1996 p. The results of the present study are similar to that of the study conducted by Juul A6 which reported mean serum IGF-I concentration increased slowly in pre-pubertal children from 80 to 200 g per litre with a further steep increase during puberty to approximately 500 g per litre.389-94. both at CS6 stage of their skeletal maturity presented contrasting IGF-I levels of 126. 1998. Mohan S. with a larger sample size in the future could help to tabulate more authentic data. two female subjects.68 ug/L to 406. 9. The cervical vertebral maturation (CVM) method for the assessment of optimal treatment timing in dentofacial orthopedics.. Saunders . Insulin-like growth factor regulates peak bone mineral density in mice by both growth hormone dependent and – independent mechanisms.In contrast the present study indicated maximum levels of IGF-I in CS4. 10.75 ug/L at CS6).57: 178-93. testicular size. Enlow D. Fishman LS. 1987.78:744-52. Endocrinology 2003. This indicated the negative correlation of IGF-I to cervical skeletal maturity with increasing chronologic age. Bang P. Sato K.104: 330-6. J Clin Endocrinol Metab 1994. This variance was essentially due to the differences in the number of years post-pubertal which was five and three years respectively. adolescents. 3.1982:52. Farman AG. 4. 28 . Sem in Orthod 2005. Wergedal J. Main K. Masoud I. One of the male subjects at CS6 stage exhibited high levels of IGF-I (222. Baccetti T. Essentials of facial growth. p. Richman C. St Louis : Mosby-Year Book.B. 88-112. Skeletal maturation evaluation using cervical vertebrae.134:209-16 2. 5th ed. Hans M.etal5.
V. This bandless system which eliminates the placing of metal bands with attached brackets as a means for spatial control of teeth during orthodontic tooth movement has several advantages over the full band system. 29 The classical micromechanical method of bonding resins to enamel consists of cleaning the enamel. following which Neumann in 1965 applied it to direct bonding of orthodontic brackets. The shear bond strength of each sample was determined using a universal testing machine and the results were evaluated. rinsing and drying it. Rajesh Reddy K. MDS Professor and Head Department of Orthodontics. E-mail : kuchkullar@yahoo. the acid etch technique had several undesirable sequelae.I were subjected to conventional etching using 37% phosphoric acid for 30 seconds. which include loss of enamel.577 004. MDS. Morth RC strength of mesh shaped stainless steel Associate Professor orthodontic brackets. Road No. Associate Professor Dr. 7. 150mj and 200mj respectively for 15 seconds. Address for Correspondence : Dr. Associate Professor Dr. Mob.light curing primer and adhesive. Morth RC SEd.com Abstract : The aim of theDr. The buccal surfaces of group . 100mj. Rajesh Reddy K. This acid etching method has been used to promote adhesion since Buonocore (1955). Banjara Hills. Rajesh Reddy K. Morth RC SEd. Bapuji Dental College and Hospital. Sowbhagya Abode. bonded to acid etched enamel and laser etched enamel and to compare the shear bond strength following acid etching and laser etching.LASER ETCHING OF ENAMEL FOR DIRECT BONDING – AN INVITRO STUDY Authors: Dr. MDS. Sadashiva Shetty. Acid Etching. etching it with phosphoric acid. K. MDS. However. first described the technique to increase the bond strength of resins to enamel.500 034. Kishore determine the shear bondSEd. enamel cracks . Dr.V. while the other four groups were subjected to Nd:YAG laser etching at different power settings of 80mj. : +91 94405 63555.. Sowbhagya Dental Center. Kishore M. Key words : INTRODUCTION Orthodontic clinicians have long been interested in the development of methods by which orthodontic brackets could be attached directly to the teeth. Hyderabad . Davangere . Andra Pradesh. Laser Etching. Brackets were later bonded on to these teeth using Ultimate.S. Bond strength. study was to M. 8-2-502/1/A/B. 50 non carious extracted premolar teeth divided in to 5 groups of 10 each were employed in the study.S..
There have been conflicting reports by researcher's regarding the viability of using laser etching as an alternative to acid etching. MATERIALS AND METHODS: Fifty sound non-carious premolar teeth extracted for orthodontic purpose were selected for this study. The shear bond strength of each sample was determined with a Hounsfield universal testing instrument. The cross head speed was 1mm/min and the force values at the point of bond failure of the bracket were recorded. . The bonded specimens were stored in distilled water for one week before determining the shear bond strength. The ultimate shear bond strength was recorded in kilograms and converted to megapascals. Teeth in each group were mounted vertically on different color coded acrylic blocks for subsequent identification. They are grouped as: Group . formalin or hydrogen peroxide. Group . but. Group . AIMS AND OBJECTIVES: The following objectives are accomplished by this study. Group-IV.III: Laser etched group irradiated at 100 milli joules.V: Laser etched group irradiated at 200 milli joules. incisal and gingival margin.I: Acid etched group conditioned with 37% phosphoric acid for 30 seconds.IV: Laser etched group irradiated at 150 milli joules. The collected data was subjected to statistical analysis by using one way analysis of variance and the Newman-Keul's multiple range tests at 95% levels of confidence. devoid of cracks from extraction forceps. It was also noted that lasers induce caries resistance. with the nylon brush over an area slightly greater than that of the bracket base. which would be of interest in orthodontic bonding. be free of caries and have had no pretreatment with a chemical agent such as alcohol. The present study is aimed at evaluating the viability of using laser etching as an alternative to routine acid etching. Laser etching produces microscopic cracks. The primer was applied on each etched surface of the teeth in their respective groups and cured. They had to be grossly perfect on buccal surface. 2. Brackets were later bonded on to these teeth using Ultimate light curing primer and adhesive.I showing the highest bond strength followed by Group-V. 1. Recent advances in laser technology and research into its potential have set the stage for a revolution in dental practice. The adhesive paste was applied on to the bracket base and brackets were placed on the long axis of the tooth. enamel decalcification. The buccal surfaces of group . 30 RESULTS: One way ANOVA test revealed that different groups exhibited different bond strengths with Group . Group-III and least with Group-II. Orthodontic applications of laser treatment were based on the outcome of the earlier studies on laser effects of enamel. To compare the shear bond strength values of acid etched and laser etched enamel and thereby to determine if laser etching can be used as an alternative method. Since there is little surface absorption of the laser beam by enamel. These teeth were thoroughly cleaned of any soft tissue.I were subjected to conventional etching using 37% phosphoric acid for 30 seconds.II: Laser etched group irradiated at 80 milli joules. The samples were randomly divided into five groups consisting of 10 teeth in each group. fissures and craters in the enamel surface than conventional demineralization of enamel. To determine the shear bond strength of mesh shaped stainless steel orthodontic brackets when bonded to acid etched enamel and laser etched enamel. Shear bond strength of each sample was calculated using the formula: Bond strength = Breaking Load / Nominal area of bonding. Excess adhesive was removed with a sickle scaler and cured with visible light at 450 nm for a 20 second burst to each of the mesial. 150mj and 200mj respectively for 15 seconds. caries and retention of resin tags with indelible staining. Group . while the other four groups were subjected to Nd:YAG laser etching at different power settings of 80mj. The extracted teeth had to meet certain criteria before use. Attempts were made to overcome these problems by crystal growth solutions and sand blasting. distal. all these methods resulted in poor bond strength. it was coated with a light absorbing material as an initiator (black Indian ink).and scratches. 100mj. Group . blood and were stored immediately in distilled water to prevent dehydration.
my esteemed mentor and tutor through out my life and my colleague Dr. On the other hand there was a significant correlation between laser etching and shear bond strength. for their help in compilation of this manuscript. The bond strengths obtained at the lower power settings (80 mj. which may prove a more convenient and time saving procedure in the near technological future. without causing pulpal damage.J et al46 and Vonfraunhofer J.I. an attempt was made to use lasers as an alternative method for etching enamel.01Mpa and 8. following acid etching some amount of enamel is lost making the surface more susceptible to demineralization and initiation of caries around the brackets. the mean shear bond strength value of the acid etched group is 9. Stern et al32. Ralph. the effects on enamel morphology and physiological changes within the deeper structures. More research is needed before a potential application of lasers is justified in a clinical setting. K. However. 5. Keller & Hibst44 and Osnat Feurstein et al30). Various comparative studies between acid etching and laser etching on surface roughness and morphology of enamel have concluded that laser irradiation has caused surface changes similar to that of acid etching. (Arcoria et al3. a statistical prediction was done by taking all the laser etching values and it was found that with increase of laser power by 10 mj there was an increase of 0. Safety and efficacy must be clearly established. for every 10 mj increase in power. SUMMARY & CONCLUSION: In this study. Tables I to VIII shows the values measured and comparisons of all the groups. On an average.Group-I showed significant difference in bond strength with other groups except for Group-V which is statically not significant.5 Mpa. (White. which is the highest comparable value to the laser etched groups. Hess14. 7. . (7 mpa By Lopez. 100 mj and 150 mj) showed statistical differences while the bond strength obtained with highest laser power setting (200 mj) was less than that of acid etching but statistically insignificant. 100mj. ACKNOWLEDGEMENTS: The author would like to acknowledge Dr. the capability of ideal laser system performing hard tissue procedures consistently and effectively. Considering this. John A. the bond strength also increased. the bond strength increased by 0.5 Mpa in shear bond strength.P.S.36). From these findings it is seen that laser etching can be used as a viable method in preparation of enamel for direct bonding.A. The summary of mean shear bond strength of the enamel surfaces etched by laser irradiation and by phosphoric acid was compared. Shahabi et al40. Kishore M. await clarification. a finding consistent with previously reported works.(Dai. The results of the study show that.24 Mpa. et al45). fissures and craters on the enamel that enhance mechanical inter locking with the composite. Statistical analysis of the data indicates that.88 Mpa when etched at 80mj. Surfaces etched at higher power setting achieved the bond strength which is equal to or above the minimum 31 bond strength needed for the bracket to withstand masticatory forces.6 kg/ mm2 Vonfraunhofer J. there are significant differences between shear bond strength obtained with laser irradiation and with acid etching of enamel. The advantage of laser etching is that. The present study evaluates the effectiveness of Nd:YAG laser in conditioning dental enamel for direct bonding of orthodontic brackets and comparing it with conventional acid etch technique.V. laser itself induces caries resistance producing microscopic cracks. which is the major drawback in acid etching. the bonding of acrylic filling materials to enamel could be substantially increased by conditioning the enamel surface with 37% phosphoric acid. before concluding that. J.21 and 0.Robert Harry 9 ). This in-vitro study compared the shear bond strength of brackets adhered to Nd-YAG laser etched enamel with that of brackets adhered to acid etched enamel. 150mj and 200 mj respectively. Sadashiva Shetty. The effect of laser irradiation on the substrate tooth. DISCUSSION: Acid etch technique for bonding composite resins to enamel has revolutionized the practice of esthetic dentistry.8 Mpa.51 Mpa. The mean shear bond strength values of laser etching are 2. The shear bond strength of laser etched enamel increased with the power and energy output from the laser unit. However.A. As the laser etching power increased from 80 mj to 200 mj. laser can be used as a substitute to acid etch technique it is necessary to know. It was observed that there is an increase in the shear bond strength with an increase in the laser power. notably. Buonocore4 was the first to demonstrate that. H.
3 : Nd : YAG Laser Unit Fig. 2 : Orthophosphoric Acid Gel (37%) Fig.Fig. 1 : Specimens used in the study Fig. 4 : Universal Strength Testing Machine (Hounsfield) 32 .
15 1.65 9.37 7.84 9.19 33 .20 Mpa 10.73 9.26 7.38 8.14 7.95 10.65 9.72 9.TABLE -I ENAMEL BOND STRENGTH EVALUATION OF GROUP -1 (Acid etched) Machine Parameters of Test a) Crosshead Speed b) Grip Distance Specimen No.43 7.84 10. = = 1 mm / min 12 mm KgF 10.87 10.05 7.32 7.94 10.46 8.24 1. 1 2 3 4 5 6 7 8 9 10 Mean S.D.54 9.94 9.81 9.
25 2.21 2.24 2.80 0.85 3.TABLE .51 1. KgF 4.48 1.82 3.22 3.86 3.72 2.25 3.36 1.83 0.96 2.21 2.38 1.99 2.D. 1 2 3 4 5 6 7 8 9 10 Mean S.18 2.21 2.73 Mpa 4.83 3.72 34 .II ENAMEL BOND STRENGTH EVALUATION OF GROUP -2 (Laser etched at 80mj) Machine Parameters of Test a) b) Crosshead Speed Grip Distance = = 1 mm / min 12 mm Sample Specimen No.74 2.
83 4.57 1.49 8.93 Mpa 7.35 4.D.30 3.87 4.22 7.25 3.91 35 . ` 1 2 3 4 5 6 7 8 9 10 Mean S.86 7.66 3.22 5.22 3.94 7.53 8.62 3.27 4.III ENAMEL BOND STRENGTH EVALUATION OF GROUP -3 (Laser etched at 100mj) Machine Parameters of Test a) b) Crosshead Speed = Grip Distance = 1 mm / min 12 mm Sample Specimen No.27 7.21 3. KgF 7.18 5.32 5.51 1.TABLE .23 5.
24 6.01 1. KgF 7.48 6.82 7.41 8.98 6.03 6.32 6.03 Mpa 7.TABLE .50 8.01 36 .32 6.28 7.IV ENAMEL BOND STRENGTH EVALUATION OF GROUP -4 (Laser etched at 150mj) Machine Parameters of Test a) b) Crosshead Speed Grip Distance = = 1 mm / min 12 mm Sample Specimen No.55 6.D.21 4. 1 2 3 4 5 6 7 8 9 10 Mean S.41 6.27 5.89 7.63 8.21 7.71 8.82 7.08 1.89 7.
1 2 3 4 5 6 7 8 9 10 Mean S.V ENAMEL BOND STRENGTH EVALUATION OF GROUP -5 (Laser etched at 200mj) Machine Parameters of Test a) b) Crosshead Speed Grip Distance = = 1 mm / min 12 mm Specimen No.53 7.TABLE .34 9.02 9.33 9.82 9.90 9.26 8.82 8.93 9.72 . KgF 7.26 8.86 10.04 37 .96 10.23 9.84 9.42 7.05 Mpa 7.97 1.57 7.92 9.47 7.88 1.35 8 8.D.
5 P 0.01 PO.01 NS 1.72 - PO. LE200mj 7.91 - - PO.54 9.04 - - - - One way ANOVA (F = 44.98-9.55.VI SHEAR BOND STRENGTH FOR ACID ETCHING AND DIFFERENT LASER POWER SETTINGS Shear Bond strength (Mpa) Groups Range Mean SD II Difference between groups III IV V I.21 2.01 - - - PO.01 P<0.01 III.51 1. PO. Acid Etching II.05 PO.9 P< 0.Keul's Range test (Pair wise comparisons): Minimum significant Range = 1.15 1.05 V.49-8.01 I > V > IV > III > II NS Other comparisons are statistically significant *NS: Not Significant 38 .42 8.19 P<0.23 5.80 0.01 1.01 PO.TABLE .05 = 1.01 IV.88 1.01) New man .38-10.01 PO. LE 150 mj 4. LE 80 mj 7.04 7. LE lOOmj 3.26-10.72-4.
16 + 0.05 ± 2.54 <0.66 Within Groups 44.55 39 .30 45 1.94 49 TABLE .5 + 47.VII ANOVA TABLE Source of variation Sum of squares Degree of freedom Mean sum of squares Variance of ratio.64 04 68.001 Total 343. F-value P-value Between groups 274.84 0.046 (Laser Etching Power) .04 Shear Bond strength (Mpa) 6.TABLE .58 69.046 Shear bond strength = 0.0.VIII CORRELATION BETWEEN LASER ETCHING POWER AND SHEAR BOND STRENGTH Relationship between Mean±SD Correlation coefficient V Regression coefficient 'b' Prediction equation (prediction of Shear Bond Strength for given Laser Etching Laser Etching 132.
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1975.51:901-912." Am.. 1965 . and Walsh J. 1975: 13-39. Reynolds I. 1990. Orthod.H. 1991.J. 49. Osorio R.D. Goodis H. Orthop. 124:65-70. Br. Retief D.B. "Effect of tooth-related factors on the shear bond strength obtained with Co2 laser conditioning of enamel" Aust. and Maijer R. 1999.R.252) 47. Matsuda K. Brockhurst P. 19:25-30. Rose C. Wigdor H. Br. 1975. Sadowsky P. (Abs-7).. and Sandowsky P.. 68:645-655. "A comparison of three bracket bases : An invitro study". "The effect of lasers on dental hard tissues" JADA.L.J.Res." Am.J.. A progress report. Hernandez O..M. 1974 . "The effects of adhesive systems on tooth surfaces. 39.. Newman G. Dentofac. 48. Cox P.Paul. Orthod.. Von Fraunhofer J. and Reynolds I.23:45-48. 46. Shahid Ashrafi. 2:171-180. J. Smith N. Osnat Feurstein. 83: 181-186. Sognnaes "Lased Enamel : Ultra structural observations of pulsed Carbon Dioxide laser effects" J. "The pulsed Nd:YAG laser: Review of clinical applications" J. Lasers Surg. Dentofac. 1993. "A laboratory investigation to enamel preparation by sand blasting or acid etching prior to bracket bonding." Br. Retief D.R.R. Med. Silverstone L. Sargison A. St. "Clinical experience with the acid etch technique in Orthodontics". 1970. 31. "Yag Laser effect for acid resistance on tooth enamel" J. Asbill S. Fux brunner. 98: 417-421.Dent. 4:243-250 43.H.A comparative study of adhesives" Br.Stern.T. "Shear bond strength of Nd:YAG laser treated dentin". 40.Dent. 1988. and Toledano "Bracket bounding with 15 and 60 second etching and adhesive remaining on enamel after debonding". 18: 29-35. and Millet D. 42. 33. 50.R." Am.R. Orthod 1976.V. 32." Am. and McDaniel J. Ooya. and Walsh L. Am.27. Retief D. Am.Orthod.. Goodis H.J. Minn: North Central publishing . Ulrich Keller and Raimund Hibst. Elliot A. and Von Fraunhofer J.J. and Okabe H. Orthod.124:37-47.Orthod. Pick "Using lasers in clinical dental practice" JADA. 44. White J. 36. 37. Dent. J. Orthod. 29. 1991. D.Orthod. "Laser etching of enamel for direct bonding" Angle orthod.F.. 3: 143-146. 12:471-477. 59:67-75. 1093." J. and Ackerman J. and Watanabe L. 35. "Tensile and shear bond strengths of orthodontic direct bonding adhesives. "The acid etch technique: In vitro studies with special reference to the enamel surface and the enamel surface and the enamel resin interface" An international symposium on the acid etch technique.J. Daniel Palanker.Dent. Med.G. "Orthodontic bracket bond strength to Nd: YAG laser etched enamel" J. 51:455-460. 38.F.. "Experimental studies of the application of the Er:YAG Laser on dental Hard substances: Light microscopic and SEM investigations". Allen. Wheeler J. Ralph H.R.A. 1989. 1983. Asron Lewis and Dan Deutsh "Effect of the ArF Laser on human enamel" Lasers Surg.L.Res. Newman and John M. Myers T.T.Dent. 1992. Dreyer C.Dent.. (Abs-1048). 34.Res. White J.26:141-146. Robert M.. J. and Orbell G. 1997. " A review of direct orthodontic bonding. 28.. Shahabi S.Dent. Joseph T.R. 41 ..E.J. Johanna Vahl and Reidar F. 1993 . Khosrovi P and Hornberger B. 1970. 1991... Assoc.A.Mater.R.70:297 (Abs . Smith D.H. 63: 73-76. 45. Orthop. 70:379. 42: 81-84... 1999.. and Bradley E.58:21-40.K. J.J. 41.G.J.. 9:345-351. "The direct bonding of orthodontic attachments to teeth by means of an epoxy resin. "Epoxy adhesives for orthodontic attachments.D. 30. Rape W.A. 1993 . "Effects of etchant concentration and duration on the retention of orthodontic brackets: An in Vivo study".C.Dent. McCabe J.J.Res. "Bond strength of thermally recycled brackets... Orthod.J. Orthod. Yamamoto E.M.J.L. Reynolds I.53.J. and Gavron." Br. 1971. Calif.J. " Direct bonding of orthodontic brackets . 1991.
and 30 Class II division 2 (mean age: 20. Faridkot (Pb. narrow anterior cranial bases that affect the nasomaxillary complex and result in long. CLASS II DIVISION 1 AND CLASS II DIVISION 2 MALOCCLUSION Authors: Dr. This study was performed using measurement on dental casts of 60 normal occlusion (mean age: 20.) Dr.5 years) malocclusion subjects. intermolar. narrow palates and maxillary arches.S. Staley et al8 stated that patients with Class II division 1 malocclusion had narrower maxillary intercanine. Where as Class II division 2 patients showed less mandibular intercanine and intermolar width than the Class I and Class II division 1 patients. Dasmesh Institute of Research and Dental Sciences. Sukhdeep Singh Kahlon. and expansion was needed during or before treatment.COMPARISON OF DENTAL AND ALVEOLAR ARCH WIDTH IN PATIENTS WITH NORMAL OCCLUSION. although maxillary intermolar widths were larger in the normal occlusion sample. Department of Orthodontics and Dentofacial Orthopedics. A posterior crossbite tendency in the Class II group was also found. Sayin and Turkkahraman7 compared the arch and alveolar widths of patients with Class II division 1 malocclusion and subjects with Class I ideal occlusion 42 in the permanent dentition and found that mandibular intercanine widths were significantly larger in the Class II division 1 group. and molar regions of Class II division 1 and Class II division 2 malocclusion groups with normal occlusion subjects. Rohit Duggal. .D. Faridkot (Pb. Enlow and Hans9 reported that Class II patients have long.D. Sumit Bansal.2 years). Department of Orthodontics and Dentofacial Orthopedics. Department of Orthodontics and Dentofacial Orthopedics. Sudhir Munjal. 60 Class II division 1 (mean age: 20. He did not find much difference in the absolute arch widths of the Class II children in comparison with normal occlusion.D. Maxillary arch has been found to be narrower in patients with Class II division 1 malocclusion.) Dr.S. Fröhlich6 compared intercanine and intermolar widths of both arches from 51 children with Class II malocclusion with normal occlusion. Dasmesh Institute of Research and Dental Sciences. M. Faridkot (Pb. Professor and Head.) Abstract The aim of this study was to compare the transverse dimensions of the dental arches and alveolar arches in the canine. M. Senior Lecturer.3 years). Dasmesh Institute of Research and Dental Sciences.D.) Dr. Associate Professor. In previous studies1-5.S. and alveolar widths. Dasmesh Institute of Research and Dental Sciences. INTRODUCTION Arch size and shape affect stability of the dentition and plays an important role in diagnosis and treatment planning. Professor. Student’s t-test was performed for statistical analysis. M. M. It has been seen that transverse component in Class II patients is of great importance as compared to sagittal and vertical components. Faridkot (Pb.S. Buschang et al10 found that Class II division 2 patients had greater maxillary intercanine and intermolar distances than Class II division 1 patients. premolar. Department of Orthodontics and Dentofacial Orthopedics.
and no previous orthodontic. and 30 Class II division 2 malocclusion subjects of Dasmesh Institute of Research and Dental Sciences. MATERIALS AND METHODS This study was performed using the dental casts of 60 normal occlusion. Class II division 2. and no previous orthodontic. third molars. (3) all teeth present except 43 Fig. If the second measurement differed by more than 0. (3) well-aligned upper and lower dental arches. (2) normal growth and development. and no significant medical history.01 mm.The Objective of this study was to compare the transverse dimensions of the dental arches and alveolar widths of Class II division 1 and Class II division 2 malocclusion groups with the transverse measurements of untreated normal occlusion subjects. maxillofacial or plastic surgery. (5) good facial symmetry determined clinically. maxillofacial or plastic surgery.4 and 5. A single investigator measured each arch twice. standard deviation) and statistical comparison of dental and alveolar width measurements for dental casts in the three groups is shown in Table 2.2 mm from the first measurement. (3) no significant medical history. The criteria used to select Class II division 2 samples was (1) Class II molar relationship on at least one side in centric occlusion. All the measurements were done by one investigator. statistically significant differences were found in maxillary and mandibular dental arch and alveolar width dimensions among Class II division 1. prosthodontic treatment.3. The inclusion criteria used to select Class II division 1 samples was 1. and normal occlusion samples. bilateral Class II molar relationship in centric occlusion with the distobuccal cusp tip of the maxillary first molar within one mm (anterior or posterior) from the buccal groove of the mandibular first molar and protrusive maxillary incisors. According to the independent samples t-test. Student’s t-test was used to find the difference in the mean maxillary and mandibular dental arch and alveolar width dimensions among Class II division 1. the measurement was redone. and (4) no history of trauma. Faridkot. (2) Class II permanent canine relationship and retroclination of two or more maxillary incisors. Independent-samples t-test was applied for comparison of the groups. 1 : Maxillary dental cast measurements LM-M MOLAR LP-P PREMOLAR CANINE LAC-C LAP-P LAM-M Fig. UAM-M UAP-P UAC-C CANINE PREMOLAR UC-C UP-P MOLAR UM-M Normal occlusion sample Dental casts of 60 adult subjects (30 male and 30 female) with normal occlusion were selected that met the following criteria (1) Class I canine and molar relationship with minor or no crowding. 2 : Mandibular dental cast measurements . prosthodontic treatment. (2) all teeth present except third molars. (6) no significant medical history. (4) all teeth present except third molars. and (7) no history of trauma. Malocclusion sample A sample of 60 subjects (30 male and 30 female) with Class II division 1 malocclusion and a sample of 30 subjects (15 male and 15 female) with Class II division 2 malocclusion were selected. 60 Class II division 1. and normal occlusion sample. Class II division 2. RESULTS Descriptive statistics (mean. Digital calipers were used to measure dental and alveolar arch width to the nearest 0. prosthodontic treatment. maxillofacial or plastic surgery. and no previous orthodontic. and (4) no history of trauma.
67 39.Measurements are in mm. Mandibular premolar alveolar width (LAP-P): the projection of UAP-P point in the lower jaw.54 2. 9.68 2.53 1.86 59. Mandibular intermolar width (LM-M): the distance between the mesiobuccal cusp tips of the right and left first molars. 11.57 59.75 44 3. Maxillary molar alveolar width (UAM-M): the distance between two points at the mucogingival junctions above the mesiobuccal cusp tips of the maxillary first molars.not significant.51 3. Mandibular canine alveolar width (LAC-C): the projection of UAC-C point in the lower jaw.001 MALE MALOCCLUSION ARCH ARCH WIDTH CLASS I CLASS II DIVISION 1 CLASS II DIVISION 2 Normal Occlusion vs Class II Division 1 TEST Normal Occlusion vs Class II Division 2 Class II Division 1 vs Class II Division 2 MEAN SD MEAN SD MEAN SD C-C AC UPPER 35. Maxillary interpremolar width (UP-P): the distance between the buccal cusp tips of the right and left first premolars.65 41. 7.34 1.TABLES : TABLE 1.45 3.90 3. Mandibular molar alveolar width (LAM-M): the projection of UAM-M point in the lower jaw. Maxillary canine alveolar width (UAC-C): the distance between two points at the mucogingival junctions above the cusp tips of the maxillary right and left canines. 2. 4.33 3.32 56.01 3.48 4. Table 2 : The mean arch widths.26 4.01.12 46.76 4. Maxillary premolar alveolar width (UAP-P): the distance between two points at the mucogingival junctions above the interdental contact point of the maxillary first and second premolars.04 34.38 51.46 1.24 41.80 1.17 30.06 2. 6.34 35.68 2.14 46.01 3.23 45.96 46. SD indicates standard deviation. 3.91 33.41 35.90 2.05.80 57.44 41.62 2.07 38.21 40.08 NS ** ** * NS NS NS NS ** NS NS NS ** * ** ** NS *** ** NS *** *** NS NS * * *** * NS ** ** NS NS *** NS NS P-P AP M-M AM C-C AC LOWER P-P AP M-M AM .16 40.60 38.46 47.36 2. * P < 0.35 25.65 4.13 46.80 4.12 33.88 52.19 3.48 62.12 51.31 3.44 2.42 27. 1.16 26. Mandibular intercanine width (LC-C): the distance between the cusp tips of the right and left mandibular canines. 8.87 30.90 31.68 2.80 38.09 3.30 56. NS.82 2. Maxillary intercanine width (UC-C): the distance between the cusp tips of the right and left canines or the center of the wear facets in cases of attrition. 5.70 2. ** P < 0.74 2. standard deviation of different teeth in different malocclusion groups in Male. Maxillary intermolar width (UM-M): the distance between the mesiobuccal cusp tips of the right and left first molars.92 2. *** P < 0.21 2.86 3. 10.82 2.04 2. Maxillary and Mandibular Dental and Alveolar Width measurements used in the study.
67 24.88 3.41 37. *** P < 0.29 2.90 40.71 NS NS ** NS NS NS NS ** NS NS NS NS NS ** NS NS NS NS NS ** NS NS NS NS NS ** NS NS NS NS NS NS NS NS NS NS P-P AP M-M AM C-C AC LOWER P-P AP M-M AM Table 4 : P-value Upper Arch (Male vs Female) S.52 42.61 4.15 2.03 32.37 38.86 2.80 53.25 3.20 4.57 1.58 35.70 25.96 3.24 3. NS-not significant.12 2.37 2.86 1.18 3.06 4 3.90 2.01.54 49.04 3. standard deviation at different teeth in the different malocclusion groups in Female.64 25.42 40.72 29.78 43.38 3.54 3.44 1.NO.28 53.94 3.17 2.Table 3 : The mean arch widths.05 8.76 2.82 44.19 45. Measurements are in mm.SD indicates standard deviation.05.001 MALE MALOCCLUSION ARCH ARCH WIDTH CLASS I CLASS II DIVISION 1 CLASS II DIVISION 2 Normal Occlusion vs Class II Division 1 TEST Normal Occlusion vs Class II Division 2 Class II Division 1 vs Class II Division 2 MEAN SD MEAN SD MEAN SD C-C AC UPPER 33.43 3.86 56.94 56.54 52.94 3.95 28.37 32.89 37.82 3.34 35. ** P < 0.34 34. 1 2 3 4 5 6 ARCH WIDTH C-C AC P-P AP M-M AM CLASS I *** *** * *** ** *** 45 CLASS II DIVISION 1 NS *** NS *** *** ** CLASS II DIVISION 2 NS NS NS *** * *** .37 44.00 33.66 35.75 38.15 3.90 3.* P < 0.49 2.83 56.89 3.58 2.68 34.16 2.12 2.34 29.23 2.61 49.92 4.63 44.87 1.
There was significant difference in dental and alveolar width among different malocclusions between male and female group.12. Buschang et al10 found that Class II division 2 patients showed smaller mandibular intercanine and intermolar widths than the Class I and II division 1 patients. In the normal occlusion sample only subjects with minor or no crowding were included. Maxillary intercanine and interpremolar dental and alveolar width was significantly narrower in the Class II division 1 and Class II Division 2 groups when compared with the normal occlusion sample in males. Therefore. but no difference was found in mandibular canine widths. Knott VB11. Staley et al8 stated that the maxillary dental arch as a whole is narrower in adults with Class II division 1 malocclusion than it is in adults with normal occlusion and that the subjects with normal occlusion had larger maxillary canine widths than the malocclusion subjects. In a cross-sectional study. we assumed that the arch widths of the subjects studied were fully developed. 46 Walkow and Peck16 indicated that mandibular canine width was significantly less in Class II division 2 deepbite patients and suggested that the extreme deep bite may inhibit anterior development of the mandibular dentoalveolar segment.NO. The minimum ages of the subjects measured in this study were chosen on the basis of these previous studies. premolar width was significantly narrower in the Class II division 1 group when compared with the normal occlusion sample (male). nasal obstruction. Maxillary canine and premolar alveolar widths was narrower in the Class II division 1 and Class II division 2 groups when compared with the normal occlusion sample (male).e. . CONCLUSION Maxillary intercanine width. Moorrees CFA15 studied growth changes in the transverse arch width found that molar and canine arch widths did not change after age 13 in female subjects and age 16 in male subjects. There was statistically no difference in the mandibular dental and alveolar width in different malocclusion groups in males and females . 1 2 3 4 5 6 ARCH WIDTH C-C AC P-P AP M-M AM CLASS I * *** NS ** *** *** CLASS II DIVISION 1 NS * NS *** *** *** CLASS II DIVISION 2 *** NS NS NS * ** DISCUSSION This study was carried out to compare the dental arch and alveolar base widths of Class II division 1 and Class II division 2 malocclusion groups with untreated normal occlusion groups . low tongue position.Table 5 : P-value Lower Arch (Male vs Female) S. except interpremolar dental and alveolar width in male was statistically significant in the Class II division 1 and Class II division 2 groups when compared with the normal occlusion group . and abnormal swallowing and sucking behaviors. In this study. finger habits. DeKock WH13 . Several reasons have been put forward for narrower maxillary arch widths in Class II division 1 malocclusions in comparison with a normal occlusion sample i. tongue thrusting. Sillman JH14 . whereas the absence of crowding was not a criterion in the Class II groups.
2004. 8. Buschang PH. A longitudinal study of untreated Class II type malocclusion. Moorrees CFA. division 1 subjects and their clinical implications. Early intervention in the transverse dimension: is it worth the effort? Am J Orthod Dentofacial Orthop. Am J Orthod. Sillman JH. Am J Orthod Dentofacial Orthop.1972. McNamara JA Jr. Stroud J. A comparison of arch widths in adults with normal occlusion and adults with Class II division 1 malocclusion. Ann Arbor.19: 263. 15. Eur J Orthod. 13. 1985.88:163-169 Enlow DH. Longitudinal comparisons of dental arch changes in normal and untreated Class II. McNamara JA Jr. Peck S.REFERENCES 1. Am J Orthod. 2001: 63-84. Walkow TM. Am J Phys Anthropol.11:502-509. McNamara JA Jr. 4. 1996. 1996. Brudon WL. Knott VB. Franchi L. Philadelphia. 1961. Tollaro I. Role of posterior transverse interarch discrepancy in Class II. Pa: WB Saunders. 2002. 11. 6. Sayin MO. Dental arch width in Class II division 2 deep-bite malocclusion. 47 . Angle Orthod. 1994. Am J Orthod Dentofacial Orthop. 1996:1-280 9. Baccetti T. Franchi L. 12. Longitudinal study of dental arch widths at four stages of dentition. 1997. Bishara SE.110:417-422. Mich: Needham Press. Cambridge. Turkkahraman H. Early dentofacial features of Class II malocclusion: a longitudinal study from the deciduous through the mixed dentition. 16. Mass: Harvard University Press. division 1 malocclusion during the mixed dentition phase. 1961. Am J Orthod. Knott VB. 3.37:137-159. Peterson LC. Fro¨hlich FJ. 2002.42:387-394. Dental arch depth and width studied longitudinally from 12 years of age to adulthood. Comparison of dental arch and alveolar widths of patients with Class II division 1 malocclusion and subjects with Class I ideal occlusion. Orthodontics and Dentofacial Orthopedics.16: 47-52. Size and form of the dental arches in children with good occlusion studied longitudinally from age 9 years to late adolescence. Bayati P. 50:824-842. Stuntz WR. Alexander RG. The Dentition of the Growing Child. Jakobsen JR. Baccetti T. Tanesescu CD. 10. Trans Eur Orthod Soc.74:356-360. Essentials of Facial Growth. Dimensional changes of the dental arches: longitudinal study from birth to 25 years.62:56-66. Am J Orthod Dentofacial Orthop. 121: 572-574. 1972. 14. DeKock WH. Kokich VG.122:608-613. Am J Orthod Dentofacial Orthop. Tollaro I. Differences in dental arch morphology among adult females with untreated Class I and Class II malocclusion. Staley RN. 1964.110:483-489. Hass MG. 2.284. 5. 7. 1959:87-110. Angle Orthod.
and were fitted with 0. Sectional ribbon rectangular wires. Tatyasaheb Kore Dental College and Research Centre. India. instead of the MAA.D. and were treated with braided stainless steel or super elastic NiTi sectionals in 0.017" braided NiTi (Turbo) sectionals. Dharwad.017" braided stainless steel or super elastic NiTi sectional is a useful substitute for the four spur torquing auxiliary in the third stage of Begg mechanics. while the 5th patient insisted on premature appliance removal for personal reasons.017" braided stainless steel or 0. E-mail : tejashripradhan@hotmail. and 0. Department of Orthodontics and Dentofacial Orthopedics. The first group consisted of those who were in the Stage I or stage II. Tejashri Pradhan Tejashri Pradhan.025" x 0.025" x 0. New Pargaon. India. Presently Professor Emeritus. Andhra Pradesh.017" size is efficient in bringing about controlled tipping. Materials and Methods: Results: Conclusion : KEY WORDS: 48 . College of Dental Sciences. in the root control or active torquing of root apices respectively. Guntur. with the root apices practically maintained at the same place.025" x 0. Sibar Institute of Dental Sciences. Vijay Jayade ABSTRACT : Objective: To evaluate clinically the efficacy of 0.017" size. The study was conducted on 10 patients. during retraction of maxillary anterior teeth. MDS Former Professor and HOD.025" x 0.5mm in the form of controlled tipping.416 137. and 0. 1 In the first group. controlled tipping. The patients were divided into 2 groups of 5 patients each.025" x 0.M. S. MAA and Four spur Auxiliary substitutes.com Phone : 99605 11444 Vijay Jayade.025" x 0.017" super elastic NiTi ribbon sectional wires as substitutes for the Begg torquing auxiliary. 2. instead of a torquing auxiliary. The second group included 5 patients who were ready for the stage III. MDS Professor. In the second group.017" braided NiTi (Turbo) ribbon sectional as a substitute for the MAA. torque.RECTANGULAR WIRES AS SUBSTITUTES FOR THE MAA AND TORQUING AUXILIARY IN THE BEGG TREATMENT – A CLINICAL STUDY Authors: Dr.025" x 0. two more showed good improvement in the root inclinations. Photographs and lateral cephalograms were obtained before the placement of rectangular sectionals and at the end of 6 months. Dr. two patients attained ideal inclinations. retraction of upper incisors ranged from 2 to 4. Maharashtra. Department of Orthodontics and Dentofacial Orthopedics. A braided NiTi (Turbo) wire sectional in 0.
In all these 5 patients. Patient needing Controlled Tipping Patient's name : Miss.025" x 0.018" premium plus base wires were engaged piggy-back over the sectional wires using hook pins and medium elastic force was used. 5 were in the stage I or stage II. The cephalograms were traced and analyzed to study the changes in the positions of the upper incisors. The III stage mechanics of the remaining 5 patients was attempted in two slightly different manners. S.017" size was found to have similar force values to those of the MAA.017" size was comparable to a four spur torquing auxiliary in its force generation.017" braided stainless steel sectionals and the remaining one patient was given the 0.025" x 0. The refined Begg approach attempts to overcome these problems by applying labio-lingual root control from the first stage using Mollenhauer's aligning auxiliary (MAA) for controlled tipping. This made the third stage involving root corrections unduly prolonged. The observation period for all the patients was 6 months. the sectionals were engaged before the 0. College of Dental Sciences and Hospital.025" x 0.020" premium base wire and secured with the hook pins (or the ligature wires when the tooth also had to receive an uprighting spring) and light elastic force was used. superimpositions and photographs. All the patients were treated by the first author. Methodology The first group of 5 patients needing further retraction of upper anteriors by controlled root movement in the stage I and II of Begg therapy were given 0. Archana Chougle. The relative heavy torquing and uprighting forces employed during the third stage created many mechanical problems.025" x 0. Lateral cephalograms and photographs were taken for all the 10 patients at the time the sectional wires were engaged and after 6 months of treatment. Torquing element for controlled tipping : 0.M.INTRODUCTION Correct inclinations of teeth is one of the important objectives of orthodontic treatment. Previously.D.025" x 0. Further. Stage of treatment : II. Traditional Begg practice led to excessive uncontrolled tipping during the first two stages resulting in excessive retroclination of incisors. Materials The sample consisted of 10 patients (2 male and 8 female) undergoing treatment with the Begg appliance 49 . These were engaged in the brackets and the 0. Dharwad. Observation period : 6 months. we reported the findings of our experiment in which the rectangular sectional wires in ribbon mode were tested to compare their force values against those of the MAA and torquing auxiliaries. A braided NiTi ("Turbo" from Ormco Company) sectional wire in 0. Hence the present study was aimed at clinically evaluating these wires as substitutes for the MAA and the Begg torquing auxiliary respectively. and the remaining 5 had completed the pre-stage III. Out of the 5 patients.017" super elastic NiTi sectional in the place of a torquing auxiliary. Pre and post changes in the cephalometric values. of two patients one from each group are presented below MATERIALS AND METHODS The study was conducted at the Department of Orthodontics and Dentofacial Orthopedics. the torquing auxiliary used in the third stage provides optimum force to torque the maxillary anterior teeth from their lingual inclination to the desired labio-axial inclination. Out of these. while a braided stainless steel or super elastic NiTi wire sectional in 0.017" braided NiTi sectionals.025" x 0. This has also been emphasized by Andrew in his six key features to ideal dental occlusion. 4 received 0. besides enhancing the root resorption possibility.017 Braided NiTi. after premolar extractions.
I : Cephalometric changes and superimposition Upper incisor inclinations 1.3.Npog Pre 85° 4. 2.5mm 9°/1. 4.5mm 92. UI .NF UI . 1 : Before starting the use of a rectangular Sectional substitute for MAA Fig.SN UI .5°/0mm 10. 5.5° .5 mm Torquing element : 0.5mm effect -2.A Pog UI . 2 : At the end of the use of a rectangular Sectional substitute for MAA 50 .5mm 3.5°/2.Table No.5 -1.5°/3.NA UI .5°/-2 -2.025" x 0.5° -1.N ⊥ perpendicular UI .5 mm -2. 6.5mm 6mm Post 82.5° 2.017" Braided NiTi (equivalent to MAA) Fig.5° 1mm 90° 1°/-2. 3.
5mm 85° 1°/ -1.5°/2.025" x 0. 2. 5. Torquing element for active torque : 0.5 mm 10.5° 3.Npog Pre 79° -4. Observation period: 6 months. 4.5mm 4mm Post 92.5°/1. II : Cephalometric changes and superimposition Upper incisor inclinations 1.025" x 0.5 mm 16° 15°/2 14.NA UI .5° 1mm 101° 15° / 0mm 25°/4mm 6 mm effect 13. 3. UI .NF UI .017 Braided Stainless Steel.5 2 mm Torquing element: 0. 4 : At the end of the use of rectangular Sectional .017" Braided Stainless Steel (equivalent to a four spur auxiliary) Fig.N⊥ perpendicular UI . Stage of treatment : III.A Pog UI .Patient needing Root Torquing Patients name : Miss Vani Patil.SN UI . 6. 3 : Before starting the use of rectangular Sectional 51 Fig. Table No.
025"x 0.5mm -1.5° / 0.8235 1.0840 1.5 mm -2.5mm S. UI .decrease in linear and angular measurement 52 . UI .NA 5.0/0.NF 4.N⊥ 3.2/0. 2. UI .5° to -6° -1.NA 5.Npog -3.RESULTS Table No.2.7 0.D.6mm 1.4° 9.9mm -4.2450 3.8° / 1. UI .8mm -2.SN 2.017" Braided NiTi (equivalent to the MAA) Upper incisor inclinations Effect on Inclinations Mean Range -1° to -6° -1 to -3. UI .5 mm 8.5 3. 1.SN 2.6mm Table No.5mm -3.3076 1.Npog 11.5 to . UI .3° 2.1/0.5°to -6°/-1 to .5° to -6°/-1.025"x 0.5° to 16° 3°to 15°/ 1 to .4169 4. UI .A Pog 6.2mm 7° to14.5477 1.5 to 3.1° 3.7°/1.A Pog 6.NF 4.6 2.increase in linear and angular measurement -ve .5mm S.5 to 2.N⊥ 3.D.6 /0. III : Summary of effects of 0.6°/-1. UI . UI .5° 0. IV : Summary of effects of 0. UI .5mm -2 to .7583 +ve .2.5mm 10.017" Braided Stainless Steel and Super elastic NiTi (equivalent to four spur auxiliary) Upper incisor inclinations Effect on Inclinations Mean 1.5mm 1 to 2.3.4318 2.4 0.8mm Range 9° to 13.4 mm 12. UI .6°/-1.3° -1. UI .
The increase in inclination of UI to Sn was by 80 130 (Table No .DISCUSSION No study can be considered complete till the experimental laboratory findings are validated by a corresponding clinical study. The rate of change of inclination was approximately 20 per month.Philadelphia: W. Saunders Company 1971.017" braided stainless steel or 0. the time and the efforts involved in bending the MAA or a torquing auxiliary.5 to 2. while the 5th patient insisted on premature appliance removal due to personal reasons. and 0. for applying root control in the I & II stages and lingual root torque in the III stage respectively.017" braided NiTi ribbon sectional and the 0.025" x 0.025" X 0. 11:219-226. The root apices were practically maintained at the same place.025" x 0. The present study will help in overcoming one major hurdle in the proper practice of the Begg treatment namely. d. Specific rectangular wires bent in an edgewise mode but engaged in the ribbon mode can be successfully substituted for the MAA or a torquing auxiliary as under. higher force such as 0.B. Pradhan. 2. In case the above mentioned wires are not available. bending the conventional auxiliaries for suitable reciprocal effect will still be necessary. The increase in overjet and overbite was 1-2.IV) b.025"x 0. the rectangular wire is inserted first and the round base wire is inserted piggyback. would solve this difficulty is worth investigating.017" braided stainless steel can be substituted for the MAA.019" CuNiTi can be substituted for the torquing auxiliary by placing these rectangular sectionals piggyback over the round base wire. CLINICAL IMPLICATIONS 1. 4. Jayade. a small part of the rectangular sectional projects outside the slot in this mode of application.V.5mm and 1.025" x 0. In both the above situations. However. Begg P R. Kesling P C.017" braided NiTi sectional wire substitutes nicely for the MAA.025" X 0.5mm respectively which resulted in favorable dental relations.Six keys of normal occlusion. (Table No.025" x 0. b.017" super elastic NiTi sectional is an effective substitute for the four spur torquing auxiliary in the third stage of Begg mechanics. 3.p130-139.F . Aust Orthod J 1990. An aligning auxiliary for ribbon arch brackets: rectangular boxes from ultra fine high tensile wires. Begg orthodontic theory and technique.025" x 0. Whether the brackets with built-in-torque (as developed by Kameda) in combination with the rectangular sectional torquing wire. (As we stated in our previous article. Rectangular Wires as substitutes for the MAA and Torquing Auxiliary in the Begg treatment . when lingual root torque is needed on some of the anterior teeth and labial root torque on the remaining (for instance instanding lateral incisors). 2nd ed. J Ind Orthod Soc 2008.017" braided NiTi (Turbo) sectional wire is efficient in bringing about controlled tipping. The end result was that two patients had attained the ideal inclinations. therefore the force generation reduces slightly). A 0. c. This demonstrated the efficacy of the braided NiTi sectionals in achieving controlled tipping similar to the MAA.017" braided stainless steel or the 0. was conducted over a period of 6 months in 10 patients.025" x 0.017" super elastic NiTi sectional were substituted for the conventional 4 spur auxiliary. a 0.5 mm. III) over a period of six months. rectangular wires producing slightly 53 REFERENCES 1. A 0. encouraging results were seen in the 5 patients who underwent the third stage mechanics wherein the 0.P. two others showed good improvement but needed some more torquing with continued IIIrd stage mechanics. Mollenhauer B. The changes noted after 6 months were as follows: a. a combination of 0. It is hoped that all the Begg practitioners will make use of the above findings to elevate the standards of their treatment. CONCLUSION A clinical study substituting rectangular sectional wires equivalent to the MAA and four spur auxiliary. 42:7-15 . In the 5 patients who were in the first and second stage of Begg treatment. Am J Orthod 1972. Similarly.62:296-309 2.An Experimental study.018" base wire brought about retraction of upper incisors to the extent of 2 to 4. a.017" braided stainless steel or 0.025" x 0.025" x 0.Tejashri. Andrews L. It was observed that the 0. In the next group also.017" super elastic NiTi sectional can be substituted for the III stage torquing auxiliary. 3.
they need to be activated intra orally which cannot be done with precision. Mathura . Since then many modifications of this appliance have been proposed 1-5 However most of these appliances hamper maintenance of oral hygiene and since they are fixed. The easy removal of the appliance will also aid in cleaning of the tissue surface of the palatal button. Chhatikara. Mathura. which allows for easy removal and insertion of the 54 appliance so that extra oral activation can be done with ease and precision. where the accumulation of food debris over the tissue surface of the palatal button could be a source of tissue irritation. 04B]. D Dental College and hospital. 03A and Fig. 03B].G student Department of orthodontics and dentofacial orthopedics. Ankur Gupta Dr. India. K. Dr. Manjunath Hegde Dr. K. For extra oral activation the bands have to be removed and recemented which in turn increases the chair side time.036" tubes.com Dr. Neelima Anand Dr.281 001. However. Our modification of the Pendulum Appliance consists of round 0. APPLIANCE DESIGN: The conventional Pendulum Appliance consisted of bands on the first molars and premolars with the retaining wire soldered to the lingual side of the first premolar bands. [Fig. 05] has a removable sliding retaining wire on the first premolars and removable . D Dental College and hospital. A removable version of the Pendulum Appliance was proposed by Scuzzo et al 4 in which the Pendulum springs could be removed for extra oral activation. INTRODUCTION The Pendulum Appliance given by James Hilgers1 is perhaps the most easy and widely used intra oral appliance for molar distilization. The completed appliance [Fig. This creates a removable sliding retaining joint. Mathura. which are soldered on the lingual surface of the first premolar bands so that the retaining wires will slide into these tubes [Fig. India. the remaining part of the appliance was still fixed. [Figure.MODIFIED PENDULUM APPLIANCE FOR EASY INSERTION AND REMOVAL Authors: Dr. 04A and Fig. D Dental College and hospital. Neelima Anand. Mobile No : 0091-99975 07042 E-mail : hegde21@yahoo.The spring of the pendulum was then inserted into the lingual sheath of the molar bands. Manjunath Hegde (Corresponding Author) Associate Professor Department of orthodontics and dentofacial orthopedics. K. 01 and Fig. MDS (ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS) Professor and Head of Department Department of orthodontics and dentofacial orthopedics.which created a fixed soldered joint. Ankur Gupta P. With these shortcomings in mind we propose a new modification. 02].
2. 4.Zafer.P.Clin.C.34: 244-246. H. [Fig. 3.Orthod.76:650-659. allows easy insertion and removal.Takemoto..Cirelli. 06B) 2.Clin.: The Pendulum Appliance for class II non -compliance therapy. This allows for easy removal and insertion of the appliance..26: 706-714. J. 07A and Fig.2000. The springs of the pendulum can alternatively be made in stainless steel as compared to the conventionally used TMA wires with this type of modification.Pendulum springs which slide into the lingual sheaths of the first molar bands. K. 1 and Fig. Beyza. as the appliance can be removed easily and smaller and more frequent activations can be given to compensate for the high force decay of stainless steel wires. Scuzzo.O. Ecchari. This modification Fig. 5.Angle Orthod. G. (Fig. which in turn has the following advantages: 1.: Modified Pendulum Appliance with removable arms. which permits precise extra oral activation and aids in cleaning the tissue surface of the Nance palatal button where the accumulation of food for long duration can lead to tissue irritation. G. J. Hilgers J.37: 352-359. Permits easy cleaning of the appliance on the palatal surface of the Nance holding button.Orthod. It allows precise extra oral activation. REFERENCES: 1. J. P.A modified Pendulum Appliance for anterior anchorage control. which is a site for food accumulation.:Maxillary molar distilization with a bone anchored Pendulum Appliances. G.Clin. 07B] Shows the appliance insertion and the molar distilization after 3 months of treatment using the modified Pendulum Appliance. K.2003.J. N. Pisani. J.Orthod.33: 645-650.2006.1999 .K.1992.: Maxilary molar distilization with a modified Pendulum Appliance.Scuzzo. CONCLUSION: The Pendulum Appliance is one of the most versatile appliances for molar distilization.Orthod. Scuzzo.and Takemoto. 2 : Hilgers conventional Pendulum Appliance having fixed soldered retaining wire on the first premolar bands 55 .Clin. F.Kircelli. 06A and Fig.
Fig. 3B : Retaining wires and Pendulum springs made to slide into the lingual attachments Fig. 3A : 0. 5 : The completed modified removable Pendulum Appliance for easy insertion and removal 56 . 4B : The modified Pendulum Appliance showing the removable sliding retaining joint Fig. 4A and Fig.036" round tubes soldered on the premolar bands Fig.
7A : Appliance being fitted intra orally Fig.Fig. The tissue surface of the palatal button can be cleaned off the food debris at the same time Fig. 6A : Appliance can be easily removed and activated extra orally without the need to remove bands. 7B : Molar distilization 3 months after treatment 57 . 6B : Extra oral activation allows spring force to be measured before insertion Fig.
Sivaram Subbiah PG Student...52± 8.86g metal insert ceramic brackets showed a frictional resistance of 77. SELF LIGATING STAINLESS STEEL AND SELF LIGATING CERAMIC BRACKETS WITH STAINLESS STEEL WIRE : INVITRO STUDY Authors : Dr. frictional resistance.76g Self ligating ceramic brackets had a frictional resistance of 72. Stoner 2 58 Key words : INTRODUCTION Most fixed appliance techniques involve some degree of sliding between bracket and arch wire. SRM Dental College Dr.Ravi. The earliest recorded experiments on friction were carried out by the versatile genius Leonardo da Vinci approximately 450 years ago. one needs to understand the impact of friction between brackets and arch wires to apply the . metal insert ceramic. : 044 24466156.COMPARISON OF FRICTIONAL RESISTANCE BETWEEN CONVENTIONAL STAINLESS STEEL. the Self ligating stainless steel brackets had a frictional resistance of 40. Balasubramanian. metal insert ceramic. Chennai . METAL INSERT CERAMIC. appropriate force to obtain optimal biologic tissue response and adequate tooth movement during sliding mechanics. SRM Dental College Dr. This study was conducted to compare the frictional resistance of conventional stainless steel. Several innovations have been made to reduce friction and thereby get predictable and faster tooth movements. Parameswari Nagar. sliding. SRM Dental College Abstract : Friction is an integral part of fixed orthodontic treatment. In 1960. self ligating brackets . frictional resistance is encountered. +91984054230 Dr. Ceramic Self ligating brackets introduce recently have the added advantage of aesthetics. The conventional stainless steel brackets showed a frictional resistance of 66.21±7. SRM Dental College Harmony Flats.76 g Self ligating ceramic brackets do have slightly lesser friction than metal insert ceramic brackets but significantly more than metal brackets . Self ligating brackets are one such innovation which is said to offer the possibility of a significant reduction in average treatment times and also in anchorage requirements.600 020.47±7. Dilip. MDS Professor. In orthodontics.67±5.friction. 11/5-B.019x0.59g . MDS Dean. Whenever sliding occurs. K. SRM Dental College Dr. MDS Vice Principal. MDS Professor.022 Roth prescription) were tested against 0. Phone No. Self ligating stainless steel and Self ligating ceramic brackets against a common stainless steel wire.025 stainless steel wire using Lloyd universal testing machine.. S. Adyar. Fifteen premolar in each group (0. Self ligating ceramic. P. No. 2ndStreet. Krishna Raj.
During the last decade. more information is required about the magnitude and clinical significance of frictional resistance. increased frictional resistance in sliding mechanics being one of them. Several variables have been found to affect the levels of friction between bracket and wire.019 x 0. These variables may be either mechanical or biologic. and also during continuous arch mechanics. metal insert ceramic. These developments offer the possibility of a significant reduction in average treatment times and also in anchorage requirements.recognized the fact that sometimes applied force is dissipated by friction or improper application and it is important to control and to determine the amount of force that is being received by the individual tooth. A wire of about 30 mm length is taken and placed in the bracket and ligated with stainless steel ligatures twisted until taut and then untwisted a quarter turn4. . Sixty arch wire segments. they deliver most of the potential advantages of this type of bracket. The other end of the acrylic plate was mounted on to the lower grip of universal LLOYD testing machine. The free end of the arch wire was fixed to the upper grip of universal LLOYD testing machine which was connected to the load cell. As early as 1935. the point of intersection of these two lines was taken as a point of bracket placement. slot size. All the tests were done in dry conditions. At one end of the plate a horizontal and vertical line was drawn. The arch wire and the bracket were tested such that a new bracket and wire is used for every test and then discarded. Mechanical variables include bracket material. metal insert ceramic. and corrosion have been implicated as some of the biologic factors that affect bracket. METHODOLOGY A prefabricated commercial 4 inch x 2 inch acrylic plate is used.3M).022 x 0. wire and ligature was cleaned with 95% alcohol and air dried5. The brackets were placed in this point and then stabilized by means of an industrial adhesive. Before testing each bracket. Self ligating brackets have an inbuilt metal labial face. wire shape. four different types of brackets 15 each were used: conventional stainless steel(Gemini. Ceramic brackets are especially popular among adult patients who have expressed a desire for more esthetic appliance. ceramic brackets are associated with several problems. self ligating stainless steel(Claritysl. The purpose of this study was to compare the frictional resistances of conventional stainless steel. To overcome this drawback.025 stainless steel wire. particularly in cases requiring large tooth movements.025 inch stainless steel were used. Each wire was pulled through the bracket slot by a distance of 7 mm at a speed of 5mm per min.3M).3M) and self ligating ceramic brackets (Smartclip. ceramic brackets have become the esthetic alternative to polycarbonate brackets.010 inch stainless steel ligature. with a . Brackets of this type have existed for a surprisingly long time in orthodontics . All brackets were maxillary first premolar with 0. and Selfligating stainless steel and Self ligating ceramic brackets against a common stainless steel wire. RESULTS The present study was conducted to compare the frictional resistance between four different types of brackets namely conventional stainless steel. Since friction plays a major role during alignment and leveling. self ligating stainless steel and self ligating ceramic brackets against 0. metal insert ceramic(Clarity. which can be opened and closed. Therefore a comparative was undertaken to measure the frictional resistance of conventional stainless steel. Currently available self-ligating brackets offer the very valuable combination of extremely low friction and secure full bracket engagement and at last. Self-ligating stainless steel and Self ligating ceramic brackets with stainless steel arch wire. 59 MATERIALS AND METHODS In this study. Totally sixty samples of brackets comprising fifteen of each type were tested to evaluate frictional resistance. a fresh ligation is used for each combination. metal insert ceramic brackets were introduced recently to have lesser frictional resistance.3M). The monocrystalline and polycrystalline ceramic brackets provide excellent color fidelity and stain resistance.The Russel Lock edgewise attachment being described by Stolzenberg in 1935.wire friction3. wire size and wire material as well as ligature material and force of ligation. Saliva. the force levels were recorded from the digital marker. acquired pellicle. bracket width and angulation.028 slot size. Arch wire was ligated to the bracket slot with 0. This was done in order to eliminate the influence of dimensional changes.019 x . the idea of self-ligating brackets began to take shape. However. plaque. LLOYD Universal testing machine was used with 500 kg load cell to determine the frictional force levels.
ligating mechanism consist of two nickel titanium (Nitinol) clips that opens and closes through elastic deformation of the material when the arch wire exerts a force on the clip. The advantage of a stainless steel slot are to minimize the superficial friction and to help strengthen the bracket to minimize routine orthodontic torque force11.LLOYLD UNIVERSAL testing machine was used to test the frictional resistance. The new bracket had metal insert slot.019 x .52± 8.59g .76g Self ligating ceramic brackets had a frictional resistance of 72. They were first made available commercially in the late 1980’s. particularly with space closure in fixed appliance. forces applied for retraction. But their drawback lies in that they offer little in terms of aesthetics7 and they can cause nickel hypersensitivity in some patients. The smartclip brackets self. The tests showed that the results were statistically significant. This size of wire gives good overbite control while allowing free sliding through buccal segments. cross sectional shape and size 2) Ligation of arch wire to bracket: ligature type. or plaque build-up that are associated with other types of self ligating brackets. thickness. Ceramic rotation arm extends from the mesial-distal side of the bracket body to hold the clips. Though there are many studies comparing stainless steel and self ligating stainless steel brackets. very few studies have actually been carried out to evaluate the frictional resistance of the ceramic self ligating brackets. largely to overcome the esthetic limitations of plastic brackets as they are quite durable and resist staining. The cap at the end of the rotation arm retains the clip in mesial direction12. The need for introduction of newer materials which have higher aesthetic values in orthodontics has been triggered by the rise in demands from the patient. The feature of no moving doors can eliminate problems such as sticking. width 4) Orthodontic appliances: inter bracket distance.86g metal insert ceramic brackets showed a frictional resistance of 77. Clarity SL is truly a self ligating bracket. The self ligating stainless steel brackets used in this study is Smartclip. The ceramic bracket with metal reinforced slot seems to be a promising option to lessen the clinical complication of ceramic brackets.019x . The conventional stainless steel brackets showed a frictional resistance of 66. The factors are such as 11) Arch wires: active torque. bracket wire angulations. The wire used in this study is rectangular . and point of force application contribute to the frictional forces. anchor teeth usually feel the reaction of anchorage loss by frictional resistance and tooth movement forces. so controlling and minimizing friction is an important aspect of anchorage control7. Thinner wires tend to give less overbite and torque control. The success of Self ligating brackets led to the development of ceramic Self ligating brackets which have the advantage of both esthetics and less friction. They are widely used as it is economical and corrosion resistant. The recorded values which were obtained in Newton’s represented the clinical force of retraction that would be applied to the tooth frictional resistance obtained in Newton was converted to grams by multiplying by 101. One factor which can be controlled by the orthodontist is the choice of the bracket.21±7. Several variables exist that can directly or indirectly contribute to the frictional force levels between the bracket and the wire. The ceramic self ligating bracket used in this study is clarity SL. Unfortunately. Thicker wire sometimes restricts free sliding of molars and premolars7 . The statistical tests done are One-way Anova analysis and Bonferroni post HOC multiple comparison analysis. spontaneous opening.67±5. Controlling the position of anchor teeth is accomplished best by minimizing the reaction force that reaches them. .47±7. The bracket contains no moving door. the Self ligating stainless steel brackets had a frictional resistance of 40.025 have been found to perform well as these wires are less flexible and hence shows less deflection and binding during 60 DISCUSSION Friction is a factor in orthodontic anchorage control. level of bracket slots between adjacent teeth. (3) (9) In 1996 a new ceramic bracket was introduced to the market in an attempt to minimize some of the problems that were encountered by the clinician. force 3) Brackets: material.76 g Self ligating ceramic brackets do have slightly lesser friction than metal insert ceramic brackets but significantly more than metal brackets . Ceramic brackets were introduced in orthodontics to meet the increasing esthetic demands. They have a pair of Nitinol clip as its primary ligating mechanism. Previous studies have indicated that stainless steel brackets have an advantage of having the least friction. community and the practitioners. The friction forces acting at the bracket arch wire interface are due to the complex interaction of various factors.9.025 stainless steel wire.
They stated that the stainless steel brackets in general produce lesser friction than ceramic brackets and friction. J clin Orthod 1992. The results clearly indicate that the bracket material providing the least to highest frictional resistance is Self ligating stainless steel (40. Mosby. Evaluation of titanium brackets for orthodontic treatment. Orthodontic materials. St. J Orthod Dentofac Orthop 1990. Aust Orthod J 2006. Evaluation of friction between stainless steel brackets and wires.21gms) followed by conventional stainless steel brackets (66. 8. Nishio c.67gms) and metal insert ceramic (77. Olenakravchuk. 10. Christopher T C. Hamid M Omana. John F.3morthdontics.47gms). Upper premolar brackets (3M Orthodontics) were chosen to eliminate the effect of 2nd order friction. Angolkar.52gms) brackets. The influence of ligation on frictional resistance to sliding during repeated displacement. Kapila. Am. Nathawut Sirisaowaluk. Brantley William. Athanasiou A E.space closure. part II the active configuration. Benett J C. 2000.com 12. This was attributed to the lower surfaces roughness of stainless steel. BIBLIOGRAPHY 1. A comprehensive review. Trevisi M J. Am J Ortho Dentof Orthop 1997: 112: July: 34-40. Comparison of frictional forces. SUMMARY AND CONCLUSION The mean value of the four brackets with the least to highest frictional resistance is Self ligating stainless steel followed by conventional stainless steel brackets. Friction force between ceramic brackets. 118. 26. The Self ligating stainless steel have the least frictional resistance because the two nickel titanium (Nitinol) clips that open and close through elastic deformation of the material when the archwire exerts a force on the clip. In 1997 Karamousoz et al 13 reviewed extensively about the properties of ceramic brackets and friction. sep: 96:249-54. Karamousoz A. British J Orthod (1995). Louis. and Nanda. Self ligating ceramic and metal insert ceramic brackets. Mccabe & Peter. Am J Orthod Dentofac Orthop 1989. Clinical characteristics and properties of ceramic brackets. www. Duncanson. and Moore. we conclude that Self ligating ceramic brackets have the advantage of aesthetics as well as less friction compared to other ceramic brackets.The effect of artificial saliva on the 61 . systematic orthodontic treatment mechanics. Mosby inc. Alison Downing. 11. O Grady PW. Self ligating ceramic (72. Kusy RP.22:141-146. They suggested the development of ceramic brackets with smoother slot surfaces and metal inserts to overcome friction. 9. Am J Orthod Dentofac Orthop 2000. Frictional properties of metal and ceramic brackets. Garner. Gordon. Am J Orthod dentofacial Orthop. 98: Aug: 117-26. Frictional forces in fixed appliances. 5. Mc Laughlin RP. The outcome of this study correlates well with previous study did by Omana et al12 who compared the frictional forces of ceramic brackets with stainless steel brackets and found that ceramic brackets again demonstrated significantly higher frictional forces compared to the stainless steel brackets. da Motta AF. Tidy. 4. Allai. The statistically significant results obtained clarify the view that metal insert ceramic brackets and Self ligating ceramic brackets have more frictional resistance when compared to conventional and Self ligating stainless steel brackets. 675-684. Am J Orthod Dentofac Orthop 1986: 90: sep: 99-2003 3. Papadopoulous N A. 2001. William R Proffit. From this study. Mosby. Mucha. 2. 125 (1): 56-64. 6. This later was confirmed by Nishio et al in 200414. 13. 2004 Jan. Micheal D Bagb. They also reported that injection molded ceramic brackets created less friction than other ceramic brackets. Robert N Moore. 425-432. Contemporary orthodontics. 22: 41-46. frictional forces between orthodontic brackets and arch wire. They stated that the stainless steel brackets in general produce lesser friction than ceramic brackets. H. 7. 2007. ceramic with metal-insert slot and stainless steel brackets. Elias Cn.
5 : Smartclip wire disengagement appliance Fig.4 : Stainless steel bracket Fig.21 ± 7.86 77.B & C0 Fig.59 72.1 : Self ligating stainless steel bracket Fig.76 40.7 : Distribution Of Mean Values Between Different Brackets 62 .3 : Metal insert ceramic bracket Fig.D 66.52 ± 8. Significant groups at 5 % level # Group A v/s Group B Group D vs Group A.Table 1 : Comparison of mean value between different groups Group Group A Group B Group C Group D Mean ± S.6 : Smartclip wire engagement appliance Fig.2 : Self ligating ceramic bracket Fig.76 P value * <0.47 ± 7.67 ± 5.001) sig.
Standard Bionator. Vivek Patni Reader MGM Dental College and Hospital Kamothe.L. Dr. Sample size consisted ideal Angle’s Class 11 Division 1 patients. 63 Among the various types of malocclusion found in the human population. V. Serial lateral cephalometric radiographs were taken before treatment and after 10 months in all the 3 groups. Charles Tweed. After 1950’s soft tissue measurements were quickly recognized as an important factor in treatment planning.E’s Institute of Dental Sciences Belgaum. Venkaiah Professor K. Jumper. Thus to bring about mandibular advancement various functional appliances have been routinely used as it is a proven fact that functional appliances take advantage of inherent growth potential and cause skeletal changes. Dr. Angle’s Class 11 Division 1. Vijay Dikshit Professor MGM Dental College and Hospital Kamothe. One of the most commonly used Removable Functional appliance is the Bionator and the most common Fixed . James McNamara 13 has started that mandibular skeletal retrusion was the single most common characteristic of Class II Division 1 malocclusion in children between 8 to 10 years of age. In the modern orthodontic era. Soft tissue profil. the Bionator and the Jasper Jumper were equally effective in bringing about correction of convex soft tissue profile as against the untreated Control sample. Class II Division 1 is the most common. Various Cephalometric analyses were introduced by various authors : but these were restricted to dental and skeletal tissues. etc in their literature. Jasper. The changes observed were documented in tabular form and comparative statistical analysis was carried out. Dhiren Gaitonde Associate Professor MGM Dental College and Hospital Kamothe. Dr. Orthodontics entered a new era with the advent of Cephalometrics. Lower anterior facial height. Keywords : INTRODUCTION Facial esthetics is a subject of immense interest which embraces all people everywhere. William Downs. 10 of which were treated with a Standard Bionator. 10 treated with Jasper Jumper and 10 Untreated Control. However the Jasper Jumper showed a slightly more effectiveness in achieving adequate lip competency without undue increase in lower anterior facial height as compared to the Bionotor.A COMPARITIVE STUDY OF SOFT TISSUE CHANGES IN SKELETAL AND DENTAL CLASS 11 DIVISION 1 CASES – TREATED WITH REMOVABLE FUNCTIONAL APPLIANCE AS AGAINST THOSE TREATED WITH FIXED FUNCTIONAL APPLIANCE Authors: Dr. the importance of soft tissues in Orthodontics was emphasized by Dr. Dr. Navi Mumbai Abstract : This study was carried out to determine and compare the changes in the soft tissue profile brought about by a removable functional appliance to those brought about by a fixed functional appliance. Navi Mumbai. Dr. Edward H Angle. Results showed that both. Navi Mumbai Dr.
Labrale Inferius (Li) – A point indicating the mucocutaneous border of the lower lip 8. 3. Subnasale (Sn) – The point at which the nasal septum merges with the upper cutaneous lip in the mid . Age Group : 8 – 12 years with a mean age of 10 years 5 months Sex : No Criteria Case Selection criteria : 1. This study is limited to the soft tissue changes as seen in the facial profile of a standard Lateral Cephalometric radiograph. No significant medical or dental histories 8. Angle ANB > 50 3. Complete records available including Lateral Cephalogram. Positive overbite 6. Columella (Cm) – The most anterior point on the columella of the nose 6. Positive VTO Serial lateral cephalometric radiographs were taken before initiation of treatment and again repeated after successful treatement in cases of treated group. Glabella (G’) – The most prominent point in the mid-sagittal plane on the forehead. While these appliances affect the hard tissues. To determine the treatment effects of Fixed functional appliance i. Soft tissue Pogonion (Pog’) – The most anterior point on the soft tissue chin 12.e. Soft tissue Nasion (N’) – The soft tissue counterpart of the hard tissue Nation (N) 3. they also have an effect on the soft tissues. Sample Size : Bionator group : 10 patients Jasper Jumper group : 10 patients Control group : 10 patients Control group consisted of those individuals or children who had not undergone any kind of orthodontic treatment in the past. To compare the treatment effects caused by Removable functional appliance on the soft tissues to those causes by Fixed functional appliance on the soft tissues. 4. compare and document the results in soft tissue facial esthetics brought about by the above two appliances. Stomion Superius (Stms) – The lowermost point on the vermilion of the upper lip 9.Functional appliance is the Jasper Jumper.e. Skelekal and Dental Class II Division 1 malocclusion 2.sagittal plane. 5. Bionator on the soft tissues. Overjet = 6 to 10mm 5. AIMS AND OBJECTIVES 1. 7. Successful treatment was defined as achievement of a Class I molar relationship and acceptable soft tissue profile at the time when the lateral cephalograms were repeated. Stomion Inferius (Stmi) – The uppermost point on the Vermillion of the lower lip. The Present study was planned to evaluate. Cephalometric analysis The following points were traced on the soft tissue profile as seen on the lateral cephalogram Soft tissue Landmarks 1. Mentolabial sulcus – The point of greatest concavity in the midline between the lower lip and the chin 11. 10. Angle FMA < 250 4. To determine the treatment effects of Removable Functional appliance i. during a specific treatment period of 10 months. Labrale Superius (Ls) – A point indicating the mucocutaneous border of the upper lip 7. Fixed Funtional appliance used – Jasper Jumper. The average treatment time taken to achieve this objective was 10 months. OPG and Hand wrist radiographs . Lateral cephalograms were also taken of the Untreated Control group before and at the end of the observation period. Soft tissue Menton (Me’) – The most inferior point on the soft tissue chin 64 MATERIALS AND METHODS Removable Functional appliance used – Standard Bionator. 2. Jasper Jumper on the soft tissues. Point ‘P’ – The most prominent point on the tip of the nose. 2.
‘H’ line joins Pog’ to tip of the upper lip. ‘p’ value < 0.001 The 3 study groups were compared in the following manner : Group T1 to Group C. and C.05 denoted a significant difference. Student ‘t’ test was carried out to determine the statistical significance of the average difference between the treatment groups and the control group and also between the two treatment groups.Pog’ line Lower Lip Lower lip length (mm) Lower lip thickness (mm) ‘B’ thickness Lower lip – S line (mm) Lower lip – E line (mm) Mentolobial sulcus (mm) Nose Prominence Chin Pog’ thickness (mm) “Z” Angle The difference in the Pre and Post treatment values for each parameter was calculated. The difference for each parameter was compared for the three study groups. Bionator Group To Control Group 2.88 – 3. Differences with a ‘p’ value < 0. T2. ‘H’ Angle is formed by ‘H’ line to N’. The Significance was documented in the following manner : If ‘t’ Value < 2.The three groups were compared in the following manner : 1. Jasper Jumper Group To Control Group 3.05 If ‘t’ Value = 2.05 were considered statistically significant. T1 – Bionmator Group T2 – Jasper Jumper Group T3 – Control Group Paired ‘t’ test was carried out to study the significance of the changes between the pre and post treatment values. Group T2 to Group C Group T1 to Group T2 The following tables show the results which are obtained after comparison between the 3 groups : 65 Maxilla Maxillary prognathism (mm) Upper Lip Upper lip length (mm) Upper lip thickness (mm) Upper lip – S line (mm) Upper lip – E line (mm) Nasolabial Angle H Angle – First described by Reed Holdaway 11. Bionator Group To Jasper Jumper Group STATISTICAL ANALISIS The mean value and the standard deviation were calculated for each difference in the pre and post treatment measurements.01 If ‘t’ Value > 3. .42 – Highly significant at p<0. Pre and Post – treatment lateral cephalometric radiographs of 3 groups of 10 patients each were studied. Paired ‘t’ test was performed to determine the significance of difference between the pre and post treatment values of each of the study groups. Cephalometric Measurements Skeletal Measurements Angle ANB Lower anterior facial height (ANS–Me) ERROR ANALYSIS Five cephalograms from each group were randomly selected in order to determine the combined degree of tracing and measurement error. Students ‘t’ tests were used to compare the difference between the Treatment groups and the Control group and between the two treatment groups.10 – 2. Soft Tissue Measurement Facial Facial Convexity (Angle G–Sn–Pog’) Inter labial gap (Stms – Stmi) mm Lower anterior facial height (Soft tissue Sn–Me) RESULTS This study was conducted to compare the soft tissue changes in the facial profile brought about by the Bionator to those brought about by Jasper jumper in Angle’s Class II Division 1 cases.88 – Significant at p<0.10 – Non-significant If ‘t’ Value = 2. These 3 groups were named T1.42 – Very significant at p<0.
2.Lip .550 +3.4mm +4.1714 66 +3. 3.4mm 1.35mm 60.3229 ≤0.55mm +9.5703 1.001 NS NS NS NS NS NS NS NS NS NS NS ≤0.2mm 1.4140 NS NS ≤0.0087 1.1607 1. 3.150 -2.65mm +18.25 +2. B.8679 +13.35mm 80.Anlge LOWER LIP Length Thickness ‘B’thickness Procumbency 1 lip to ‘S’ line 1 lip to ‘E’ line Mento labial sulcus Mentolabial Angle NOSE Prominence CHIN Pog’ thickness ‘Z’ -Angle +19.1541 +2.1329 1. 2.0877 -4.2mm 1.25mm 103. MEAN DIFF.7329 1.15mm +2.001 ≤0.55mm 1.0409 2.8540 1.8mm 68. Prognathism MANDIBLE Mand.0409 0.3344 1.2960 2. c. SKELETAL Angle ANB LAFH (ANS-Me) SOFT TISSUE FACIAL Facial convexity Interlabial Gap LAFH (Sn-Me) MAXILLA Max.2mm 1.8020 1.6mm +10.001 +3.5537 0.7737 2.9907 -3. d.‘S’ line U.7mm +1mm +6.25mm 1.35mm +3.15mm 5.75mm -10. 2.1765 +1.2030 5.0916 0.5554 1.850 -3.4138 0.50mm +7.70 1.0014 1. ‘t’ VALUE ‘p’ VALUE +7.35 0 +2.001 +3.001 0.5135 13.1999 -2.50 21.0071 0.5604 ≤0.35mm +1.001 NS ≤0.0916 1.9524 1.001 ≤0.4420 +0.7524 0.5507 4.7329 0.6134 1.2mm -1.4072 1.1mm 0.D.95mm 87.8524 +1.0495 4.33 0.35mm -5.25mm 4. Prognathism UPPER LIP Length Thickness Procumbency U. II III IV 1.80 59.1240 3.001 .2010 +15.45mm +1.‘E’ line Nasolabial Angle H.1426 1.15mm +5.8324 +4.1136 1.30 3.65mm 1. 3.Lip .2mm 1.35mm 0.1005 1.0495 1. S.7071 1.80 1. 4.5mm +8. 2.850 +1.2mm 4.19999 +9. 1.250 +11. 2.8449 -2.3125 +2.05 ≤0.15mm +1.0877 1.45mm +20. 1.55mm +3.50 +6mm 65.56 1.D.35mm 66. I.75mm 2.TABLE 1 COMPARISION OF PRE AND POST TREATMENT VALUES IN THE BIONATOR (T1) GROUP PRE-TREATMENT Mean A.350 17.0495 1.10 +13. b.0216 1.7534 0.6559 1.6mm -5.1mm +22.55mm 1.25mm 1. a.8005 2. a.5537 1.4mm +10mm +4.50 62.6065 ≤0.0514 1.25mm 80.2mm +9.7071 12.9407 2.7534 4.1 0 1.50 +11. b c d V 1.3677 -1.5mm 13.0103 1.8449 1.8450 +0.25 0 MEASUREMENT POST-TREATMENT Mean S.3mm +6. VI VII 1.
Lip .43mm 66.9762 1. d.0913 4.8360 0.15mm 63.1498 3.Anlge LOWER LIP Length Thickness ‘B’thickness Procumbency 1 lip to ‘S’ line 1 lip to ‘E’ line Mento labial sulcus Mentolabial Angle NOSE Prominence CHIN Pog’ thickness ‘Z’ -Angle +20.‘S’ line U.0534 0.8920 1. SKELETAL Angle ANB LAFH (ANS-Me) SOFT TISSUE FACIAL Facial convexity Interlabial Gap LAFH (Sn-Me) MAXILLA Max.‘E’ line Nasolabial Angle H.9820 1.35mm +2.1643 ≤0.55mm 106.8mm 5.35mm 2.001 ≤0. 1.2612 0.199 +0.001 ≤0.1607 +1.8679 2.750 63.5mm +9.5mm +5.2225 S.001 +8.25mm 0.55mm +2. a.15mm 87.250 +0.2610 0.450 3.5516 1.6670 17.70 1.26 0.8809 +4.05mm +4.4407 1.8670 2.9420 +1.6905 1. 2. c.9514 +13.7mm 11.3821 -2.805 +1.1 0 1.450 17.5320 3. 3.2024 -1.05 NS NS NS NS ≤0.6503 1.9575 10. 2.550 -4.2mm 68.7mm +4.001 ≤0.6mm 12.10 22.9310 2. 2.2163 2.9mm 1.63 1. 1.9610 1. VI VII 1.8mm -5.0320 1.0877 1. I.150 +6.3mm +2.65mm 10.D.7mm +27.9326 0.350 -4.TABLE 2 COMPARISION OF PRE AND POST TREATMENT VALUES IN THE JASPER JUMPER (T2) GROUP PRE-TREATMENT Mean A. POST-TREATMENT Mean S.0964 +16.35mm +2. 4. ‘t’ VALUE ‘p’ VALUE MEASUREMENT +2.4701 0.05mm 82.7mm 1.25mm 0.9724 ≤0. b.4mm +15.2 0 +3. b.23mm 64.25mm 79.9mm +0.2mm 0.55mm 0.9mm +3.2550 1.75mm 0.15mm -1. II III IV 1.4702 2.4940 0.30 +13.5324 -4. 2.01 +1.60 1.35mm +1.001 ≤0. Prognathism UPPER LIP Length Thickness Procumbency U. a.1053 1.6742 1.0410 2.8mm +10.1136 1.45mm -2.380 +1.2201 1.7329 67 .2217 0. c.0367 +10.61 1.001 NS NS ≤0.9mm +5.95mm 5.3mm +19.55mm -12.4995 2.2050 0.7071 1. MEAN DIFF.4mm +2.D.8809 1.5532 5.0572 1.4013 -3.4361 -6.1 0 0. Prognathism MANDIBLE Mand.3933 1.Lip .05mm +8.60 +1.5910 4.947 1.55mm +1. 3. d.75mm 0.5601 2.05mm 3.4095 1.61 0. 2. B.95mm 3. 3.25mm 0.01 NS ≤0. V 1.9mm +2.55mm +17.7210 +15.8801 2.450 11.20 1.5mm +5.20 61.001 NS NS NS NS NS NS ≤0.
c.61 0. V 1.25mm -0.04 1.D.1541 0.90mm +4.9906 1.05mm -0.7534 1.70 -0. ‘t’ VALUE ‘p’ VALUE MEASUREMENT +210 +5.32 NS NS S.90 0.4740 1.6504 1.0160 NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS NS +0.9320 1.4420 +8.22 1.6916 5.4755 1.Lip .1820 0.41 +0.30 +10.9910 0.1714 0.55mm 9. 2.40 1.212 1.75mm 0. 1 2. 3.65 1. I. b.60mm 14. II III IV 1. Prognathism UPPER LIP Length Thickness Procumbency U.9960 1.9720 -0.7956 2.TABLE 3 COMPARISON OF FIRST AND SECOND OBSERVATION VALUES IN THE CONTROL (C) GROUP PRE-TREATMENT Mean A.274 1.9321 4. 1 2.88 1. d.850 +10.6559 1.0504 2.05mm +4.8910 0.45mm +16.75mm 11.4340 -0. a.2620 0.4740 1.850 11. Prognathism MANDIBLE Mand.95mm -0.74 2.56 1.75mm 14.05mm +2.8819 1. d.55mm 1.90mm 63.7880 1.3524 1.0310 68 .6324 0.5560 0. 4.50mm 81.3mm 8.5516 0.Anlge LOWER LIP Length Thickness ‘B’thickness Procumbency 1 lip to ‘S’ line 1 lip to ‘E’ line Mento labial sulcus Mentolabial Angle NOSE Prominence CHIN Pog’ thickness ‘Z’ -Angle +8.9924 +0.0314 +21.7564 0. SKELETAL Angle ANB LAFH (ANS-Me) SOFT TISSUE FACIAL Facial convexity Interlabial Gap LAFH (Sn-Me) MAXILLA Max.10 -0.D.1mm +2.1mm +0.05mm 1.9435 1.40 +5.75mm 1.30 21.333 +3.05mm +2.9321 1.350 1. a.750 57.5904 2. 2.55mm +2mm +7.0546 1.72 +0. b.1mm 58.8mm 1. B. VI VII 1.0320 1.1mm 77. 2.950 11.80 1.6950 2.95mm 64.30 58.69 0.Lip .450 -0.9mm +2.5350 1.25 +0.2740 1.35mm -3.3mm -3.5904 2.05mm 1. 3.95mm +1.9540 2.45mm 62.0912 +0.3mm +4.85mm +4.5640 0.0935 1.45mm -13.0540 2.150 1. POST-TREATMENT Mean S.48 2.1mm +0.25mm 0.‘E’ line Nasolabial Angle H.5mm +15.15mm -0. 3.0305 1.4mm +9.05mm +8mm +74.5mm +0.70mm -10.450 0. c.8mm 0.6320 1.65mm -0.35mm 820 21.2mm +10.‘S’ line U.15mm -0.5mm 11. MEAN DIFF.76 1.5519 2.6740 1.
5375 S.Anlge LOWER LIP Length Thickness ‘B’thickness Procumbency 1 lip to ‘S’ line 1 lip to ‘E’ line Mento labial sulcus Mentolabial Angle NOSE Prominence CHIN Pog’ thickness ‘Z’ -Angle -4. 3.8819 0. B.001 .25mm +1.7748 0.Lip .0372 ≤0.95mm -1.25mm -1. 0.8760 1.0446 0.2035 NS ≤0.15mm +4.001 0.2mm +2.75mm +3.0mm +25.60mm -3.2mm -1.1mm +22.7472 1.850 +1. (T1) Mean A.2mm +0.5838 ≤0.2960 1.6146 1.95mm 4.8 0 0.20mm -1.7246 1.45mm 0 +1.7528 0.8mm +0.0554 1. VI VII 1.4916 1. 3.6749 1.7835 1.001 0. d.3823 1.5mm +0.1mm +2.9579 0 1. 0.850 3.4138 1.5869 2.5297 0.6687 0.‘E’ line Nasolabial Angle H.001 ≤0.05mm -0.25mm -0. V 1.05 14. I.001 17.35mm +0.450 +0.45mm +1. 2.9910 1.15mm +0.2mm +3.005 1.6mm -5.15mm -3.25mm +0.1mm +0.001 0.4743 MEAN DIFF.3761 0. ‘t’ VALUE ‘p’ VALUE -3.25mm +2.1832 1.9mm -2. a.9796 NS NS ≤0.750 +3.5676 0.05mm +0.3389 ≤0. a.4347 0.3591 0.45mm +7.15mm -0. II III IV 1.8433 1.30 +3.8256 4.2065 -4.40 -0.5530 1.0028 4.3084 6. c.3176 1. 2. SKELETAL Angle ANB LAFH (ANS-Me) SOFT TISSUE FACIAL Facial convexity Interlabial Gap LAFH (Sn-Me) MAXILLA Max. 1 2.70 +2.4216 0. Prognathism UPPER LIP Length Thickness Procumbency U.7379 0.9846 0.D.65mm -9.70 -0.4916 2.550 -3.70mm +1.9 0 4.6308 1.85mm +1.0493 0.8679 0. 1 2.40mm -1. 4. (C) Mean +0.I COMPARISON OF SOFT TISSUE CHANGES BETWEEN BIONATOR & CONTROL GROUPS TREATMENT GRP.005 69 -0.6852 0.60 +2.450 -0.8135 2.1365 1.Lip .2629 1.554 0.8529 0.0390 ≤0.001 NS NS NS NS NS NS NS NS NS NS NS 11.6908 0.7898 1.2mm +1.8882 0.4085 1.001 23.4246 ≤0.8mm S.1793 5.3mm +6.05mm -0. c.95mm -0.35mm -3.3834 1. d.10 -0.1mm +0. b.150 -2.550 -2.1 0 MEASUREMENT CONTROL GRP.25mm -2.4743 0.TABLE .5318 2.350 +1.85mm -8.D.4337 1. Prognathism MANDIBLE Mand.35mm +9.3687 ≤0. 2.05mm +0.6865 0. b. 3.7mm +1mm +6.‘S’ line U.6433 0.65mm -2.
2.4794 NS 1.9763 0.700 +0.8mm +2.15mm -1.950 -4.7976 0. I.3266 +1.3056 ≤0.4916 2.4216 0.20mm -1.15mm +0.050 -4.0659 1.1738 3.9427 21.2294 NS 0.001 11.D.10 -0.9mm +5.550 -4.2167 1.250 +0.8960 1.9796 0.1891 0.50 6. CONTROL GRP.9189 0.70 -0.9mm +2.001 ≤0. B.85mm +8.6754 0.3823 1.4227 1.8595 ≤0.80 0.1mm +0.2017 NS S. c.35mm -3.75mm +2.75mm 0.9846 0. II III IV 1.15mm -0.85mm -0.3834 1.4137 70 .1005 1.25mm -1.Anlge LOWER LIP Length Thickness ‘B’thickness Procumbency 1 lip to ‘S’ line 1 lip to ‘E’ line Mento labial sulcus Mentolabial Angle NOSE Prominence CHIN Pog’ thickness ‘Z’ -Angle -6.8mm 1.8679 0.2470 0.7mm +1.1136 NS NS NS NS ≤0.75mm 6.4916 1.9mm +1.90 0.9934 2.350 -4.7mm +27.8mm 0.10 1.1005 1.6mm +29.450 +1.Lip .95mm +1.2319 1.1mm +0.900 +2. 1 2.4972 1.05mm +1.001 3.7472 1.80mm -2.7748 0. 2.6852 0.8819 0.55mm +1.4794 +1.7246 1.55mm +1.2065 -4mm +2.5055 2.05mm +0. a.7534 1.6433 0.001 0.95mm 0.8mm +0.2295 ≤0.50mm 3.450 -0. ‘t’ VALUE ‘p’ VALUE MEASUREMENT -3.1068 1.0446 -4.95mm -0. 4.01 NS NS NS NS ≤0.5503 +0. (C) Mean S.50mm 5. Prognathism MANDIBLE Mand.7167 ≤0. d.3176 1.‘S’ line U.5mm +5.65mm -0. VI VII 1. 3.3244 1.6483 1.7834 +0.01 11.9187 ≤0.5869 1.2563 13. 3.9944 +3.1547 0.25mm +0. (T1) Mean A.D.25mm 0.65mm +0.7835 1.001 -4. 1 2.001 +3.5mm +0.7379 0.5986 0. MEAN DIFF. d.5676 0.25mm -2. 3. b. a.8014 ≤0.0069 1.05mm +0.25mm -0. 2.55mm +2.60 +3.1547 6.Lip . V 1.40 -0.145mm 0.001 +1. Prognathism UPPER LIP Length Thickness Procumbency U. b.5869 2.45mm -2.001 NS NS ≤0.‘E’ line Nasolabial Angle H. SKELETAL Angle ANB LAFH (ANS-Me) SOFT TISSUE FACIAL Facial convexity Interlabial Gap LAFH (Sn-Me) MAXILLA Max.II COMPARISON OF SOFT TISSUE CHANGES BETWEEN JASPER JUMPER & CONTROL GROUPS TREATMENT GRP.05mm -0.450 +0.3375 -1.TABLE .9mm +0.05mm +6.9775 2.40mm -3.05mm -0.3591 0. c.5375 -3.
25mm +1.3m -1mm -0. SKELETAL Angle ANB LAFH (ANS-Me) SOFT TISSUE FACIAL Facial convexity Interlabial Gap LAFH (Sn-Me) MAXILLA Max.55mm +1. 1 2. b.9mm +5.1005 1.150 +1.7976 0.60 +3.8246 2.5055 2.2415 0.6mm +1. a.250 +0. Prognathism MANDIBLE Mand.9mm -0.75mm +0. VI VII 1.III COMPARISON OF SOFT TISSUE CHANGES BETWEEN BIONATOR AND JASPER JUMPER GROUPS BIONATOR GROUP (T1) Mean A.350 -4.1742 1.15mm -1.001 -4.6mm +1.8882 0.35mm +0.450 +1. a.65mm -2.6031 0.70 +2.D.35mm +1.2326 2.4337 1.6mm -5.20mm +1.7mm +1mm +6.2mm +2.05 ≤0.9733 0.2234 NS ≤0.05mm +0.0554 1.4743 0.9796 0.35mm -1. 3.1738 3.850 +1.Lip . V 1.6mm +4.550 -4.5mm +5.0784 1. 0.1198 4.850 -3.Lip . 1 2.65mm +0.7mm +27.10mm 0.0659 1.2576 5.4972 1.9934 2.3244 1.35mm -1.10 0.8135 2.1891 0. b.95mm S.45mm -2. 3.0028 4.8mm +0.TABLE .3mm +6.4743 JASPER JUMPER GROUP (T2) Mean -3.‘S’ line U.7834 1. 3.1832 1. d.2mm +1.400 -2.15mm S.10mm -0. Prognathism UPPER LIP Length Thickness Procumbency U.40 +0.8529 0. 2.3176 1.9mm +1. 2.9944 -0.2167 1.55mm +1. I.0203 0.5439 2.1365 1. 0.‘E’ line Nasolabial Angle H.5mm +10 0. 4.9189 0. c.1mm +22.10 0.1547 0.001 NS NS NS NS NS NS NS NS NS NS NS NS NS ≤0.8433 1.8256 4.9775 2.2mm +3.05mm +0.5869 1. d.5297 0.2mm +0.7mm +1.500 -0. 2.5503 MEAN DIFF. c.25mm -1.6624 NS ≤0.25mm -2.3344 0.2960 1. B.150 -2.1mm +2.7528 0.90 +1.25mm -2.05 ≤0.8122 0.45mm +0.5614 0. II III IV 1.6865 0. ‘t’ VALUE ‘p’ VALUE MEASUREMENT -0.20mm -0.6865 1.4216 0.2922 2.5986 0.2mm -1.254 0.4216 0.25mm -6.30 +3.0069 1.2212 1.4347 0.95mm +1.5223 0.6687 0.0679 1.Anlge LOWER LIP Length Thickness ‘B’thickness Procumbency 1 lip to ‘S’ line 1 lip to ‘E’ line Mento labial sulcus Mentolabial Angle NOSE Prominence CHIN Pog’ thickness ‘Z’ -Angle -3.2553 0.8mm +2.05 NS NS NS 71 .1541 0.D.6749 1.6146 1.1068 1.005 -4.
1891 +1.‘S’ line 9.D 0.4972 -0.005 +0.5869 4.5mm 2.1mm +2. Inter Labial Gap -4.6749 1.U.65mm -2.7mm +1mm +6.9796 +0.9934 2.6852 0. LAFH (ANS .25mm +2.15mm -1.882 -4.10 1.6687 +2.10 0.80 -0.5mm +5.7472 1. Lip .0659 1.8529 0.1068 1.8760 -0.95mm +1.25mm 2.9189 +0. B’ Thickness 15.5986 0. Facial Convexity 2. Lip thickness 8.8819 +3.5375 Bionator from Control Jasper Jumper from Control Bionator from Control Jasper Jumper from Control Bionator from Jasper Jumper Bionator from Control Jasper Jumper from Control Bionator from Control Jasper Jumper from Control Bionator from Jasper Jumper Bionator from Control Jasper Jumper from Control Bionator from Jasper Jumper None Bionator from Control Jasper Jumper from Control None None None None None None Jasper Jumper from Control None None None None Bionator from Control Jasper Jumper from Control Bionator from Jasper Jumper Bionator from Control Jasper Jumper from Control Bionator from Jasper Jumper None None Bionator from Control Jasper Jumper from Control 0. U.45mm 0.35mm -3.15mm +0.25mm 0.350 -4.3176 1.1005 1. Pog’ Thickness 21.4337 1.9775 +1.7528 0.9mm -2.1738 3. Lip . Lip Thickness 14. L.2167 +1.15mm S.U.75mm 2.TABLE .60 1.7448 0.2mm -1.Anlge 12. ‘H’ . Max Prognathism 5.2065 72 .8mm 0.‘E’ line 10.3244 -2.1mm +0.0554 1.550 -4.0069 +0.‘Z’ .4216 -3.10 -0.1365 1. L. L.7mm 0.0446 +3.5055 +0.5869 1.850 0.8433 1.35mm +0.3591 -0.95mm 0. Mand Prognathism 6.450 0.9mm +5.5297 0.450 0.3823 0.IV COMPARISON OF THE TREATMENT EFFECTS BETWEEN THE THREE STUDY ROUPS BIONATOR GROUP JASOER JUMPER GROUP MEASUREMENT CONTROL GROUP SIGNIFICANCE Mean Skeletal 1.9mm +0.1547 0.5503 0.95mm -0.1832 1.2mm +2.2mm -3.9846 +0.‘S’ line 16. Lip .4743 0.Me) Soft Tissue 1.80mm S.7379 0.25mm 1.55mm 1.8135 2.4743 +1.1mm +0.05mm 0.5676 0.U.6mm -5.4916 1.65mm -0.9mm 1.850 -3.Angle +1.7246 19.05mm 0.3mm +6.3823 2.30 +3.25mm 1.35mm 0.80mm 0.150 -2.25mm 1.40 -0.250 0.450 -0.4916 -0.7976 -2.05mm 0. Anlge ANB 2.15mm 1. L.1005 1.1mm +22. Lip Length 13.2mm +0.‘E’ line 17.3176 +1.0028 4.6865 1.8256 4.D 0.7mm +27. Nasolabial Angle 11. Lip . Nose Prominence 20.3834 .55mm 2. Lip length 7.700 -0.D Mean S.4347 +0.9944 +0.2960 1. Mentolabial Angle +1.7835 1.2mm +1.6146 1.9733 -1.05mm 0.7 +2. Mentolabial Sulcus 18. LAFH (Sn-Me) +3.7834 -6.6433 3.25mm -1.4216 Mean +0.
Anderson J. Comparison between the two treatment groups showed that both. SOFT TISSUES 1. William Lange12 who reported a significant increase in the advancement of Soft tissue Pogonion by Activator and Bionator therapy respectively. The nasolabial angle did not show any statistically significant increase in both. Bionator as well as Jasper Jumper were equally effective in bringing about an improvement in the facial profile convexity by significant forward movement of the mandible but without any restricting effect on the maxilla 2. Paul et al1 had stressed the importance of ‘H’ line in evaluating facial profile.001) in the Bionator group and by 3. SKELETAL Angle ANB decreased by 3.DISCUSSION In the present study. However. Before Bionator treatment After Bionator treatment Upper Lip Before Jasper Jumper treatment After Jasper Jumper treatent There were no significant changes in the length and thickness of the upper lip in the Bionator as well as the Jasper Jumper group when compared to the Control group. the Bionator and the Jasper Jumper groups as compared to the Control group. no statistically significant difference was observed in the decrease in Angle ANB when the Bionator group was compared to the Jasper Jumper group. this decrease was not the forward movement of the Pog’point and the Jasper Jumper groups showed significant changes in the soft tissue facial complex as compared to the untreated Control group A.45° in the Control group. The ‘H” Angle. the Bionator as well as the Jasper Jumper groups as compared to an increase in the Control group. These findings corretate well with those of Forsberg and Odenrick8 and also with those of D. The difference between the pre and post treatment values were obtained and subjected to statistical analysis. Facial: Angle of Convexity (G-Sn-Pog’) showed a significant post-treatment decrease in both. Lips: Dr Charles Burstone5 concluded that lips show very significant changes in the soft tissue profile after orthodontic treatment.3° (≤0. each comprising of 10 patients each were compared. due to the Subnasale being restricted in it’s forward movement. This decrease in Angle ANB was more because of the forward movement of the mandible rather than restriction of the maxillary growth.45° (≤0. This decrease in the facial convexity was mainly due to the soft tissue Pogonion coming forward and to a lesser extent. 3 groups of Angle’s Class II Division 1 malocclusion. thus indicating that both these appliances bring 73 Lower Lip There was a significant increase in the length of the lower lip after treatment with the Bionator and with the Jasper Jumper as compared to a slight decrease as . Statistically insignificant retrusive effect on the upper lip was observed when measured from the ‘S’ line and ‘E’ line. Results showed that the Bionator about a marked improvement in the skeletal jaw relationship from Class II to Class 1 by virtue of a significant increase in the forward growth of the mandible rather than by restriction of maxillary growth B.001) in the Jasper Jumper group as compared to an increase of 0. although it as compared to a minimal effect seen in the Control group.
The depth of the Mentolabial sulcus decrease by 2. This increase in LAFH was observed more in the Bionator group (3.1(0. The uncurling effect on the lower lip leading to a mor vertical positioning of the profile line is shown by an increase in the ‘Z’ angle by 6. the posterior teeth were allowed to erupt.05) after treatment with the bionator and by 4. This increase was observed more after Bionator treatment than after Jasper Jumper treatment.001) in Bionator group and by 27. thus increasing the lower facial height.01) whereas that caused by the Bionator was not statistically significant.85° (≤0. The Control group showed minimal changes in the pre and post treatment values. There lesser increase in LAFH in Jasper Jumper group was due to the fact that this appliance works on the expansion principle due to which the resultant force vector is along the Y axis.001) in Jasper Jumper group as compared to a decrease of 2.1mm in Bionator group and by 2. One of the major effects seen with the Bionator and the Jasper Jumper treatment was the uncurling of the lower lip. This was more due to forward positioning of the mandible in both the treatment groups No restraining effect on the maxilla was observed in both the treatment groups There was an appreciable increase in lower anterior facial height after Bionator and Jasper Jumper treatment.observed in the Control sample.8mm (≤0. This shows that these appliances help achieve lip competency which is showed more effectiveness in achieving lip closure than the Bionator.al12 There was a reduction in the Interlabial gap by 2. based on the sample of this study. Comparison of treatment results in Bionator to the Jasper Jumper group showed no significant difference.8 observed in the Control group. This is due to the fact that functional appliance treatment leads to uprighting of Similar findings were reported by D. This effect was more pronounced after Jasper Jumper treatment than after Bionator treatment.9mm in the Control group. leading to minimal molar extrusion. The increase in lip length by the Jasper Jumper was considered statistically significant when compared to the Control group (p≤0.7mm in Jasper Jumper group as compared to an increase of 0. thus causing very little downward rotation of the mandible.001) after treatment with the Jasper Jumper. Whereas the resultant force vector of the Bionator has a strong vertical component which leads to significant molar extrusion thus causing significant increase in LAFH CONCLUSION The purpose of this study was to compare the changes in the soft tissue profile brought about by Removable Functional appliance (Bionator) as against those brought about by a Fixed functional appliance (Jasper Jumper) Thus.05) LOWER ANTERIOR FACIAL HEIGHT (LAFH) There was a significant post-treatment increase in the skeletal lower anterior facial ehight in both the treatment groups as compared to a minimal change observed in the Control group. This angle showed a dramatic increase by 22.45° in the Control group. thus leading to an increase in lip consistency and a decrease in depth of the Mentolabial sulcus. This was due to the fact that during functional appliance treatment. This achievement of lip competency was appreciated more after Jasper Jumper therapy than after Bionator therapy • • ‘Z’Angle As described by Merrifield15 this angle gives an accurate description of the lower face relationship and eliminates the vagueness of eye judgement.01) in the Jasper Jumper group as compared to a decrease of 3. resulting in downward rotation of the mandible. This is due to the fact that the functional appliance treatment by the forward movement of Pog’. the following conclusions can be drawn: • Treatment with Bionator as well as Jasper Jumper leads to an appreciable decrease in the soft tissue facial convexity.25mm) than in the Jasper Jumper group. The Mentolabial Angle showed most significant change after treatment with functional appliances. 74 • . Comparison of Bionator and Jasper Jumper group showed an increased efficiency of Jasper Jumper in having an uncurling effect on the lower lip (≤0.001) in the Bionator group and by 5. thus increasing the Mentolabial Angle.1(0. Treatment with Bionator as well as Jasper Jumper leads to an increased lip competency due to the uncurling effect and increase in length of the lower lip.2mm (p≤0. William Lange et.25° (≤0.
Orthod. 11. Roos Nills. 1. 4. 1-20 12. 20. 65. Bloom Leonard A. 11. Orthod. Dentofac. Burstone Charles J : 1958 “ The Integumental Profile” Am. J. Graber T. Morris David. Holdway Reed A. 1995 “Radiographic Cephalometry. J.107. REFERENCES 1. J. Orthod. Orthop. Orthod. 84. Orthod. J. 1966 “ The profile line as an aid in critically evaluating facial esthetics” Am. 6. 1995 “ A Computerassisted photogrammetric analysis of soft tissue changes after Orthodontic treatment. Heather M. 193-199 13. Andreson Paul J. Orthod. 52. E. Jacobson Alexander. 1995 “ A Computer-assisted photogrammetric analysis of soft tissue changes after Orthodontic treatment.• Ultimately one can conclude that both. Koch. Orthop. Lange William D. 423-430 14. Orthod. Bionator and Twin Block appliances. Orthod. J. Merrifield Levern. 52. Part 11. Lars Odenrick. Joondeph. Gonzales. 1995 “Changes in soft tissue profile following treatment with the Bionator” The Angle Orthodontist. et al. 1988 “The prospective evaluation of Bass. 1979 “Changes in the relationship between the lips and the esthetic line from eight years of age to adulthood” Eur. J. Part 11: Results” Am.265-270 8. 1973 “A Cephalometric study of profile changes in Orthodontically treated cases ten years out of retention” Am.1-25 5. O. J. Forsberg Carl-Magnus. Inc.. J. Las Odenrick. Dentofac.Soft tissues” Eur. 1983 “ A soft tissue cephalometric analysis and it’s use in orthodontic treatment planning” Am. Orthod. J. Forsberg Carl-Magnus.From Basics to Videoimaging” Ouintessence Publishing Co. 1979 “Profile and soft tissue changes during and after Orthodontic treatment” Eur..324-336 2. A. David L. Robert T Lee. Saunders Company. 1. M. Bedrich Neumann. Bishara Samir. Orthop. 804-822 16.247-253 9. J. 1. 357-375 10. 262-284 6. 633-684 17. 1981 “Components of Class 11 malocclusion in children 15. 1984 “Removable Orthodontic Appliances” W. Donald R. 1981 “Skeletal and soft tissue response to Activator treatment” Eur. Orthod. Bionator as well as Jasper Jumper are more or less equally effective in bringing about an improvement in facial balance and harmony in Class 11 Division 1 malocclusion cases if treatment is brought about in the growth phase. Dentofac.72. 1977 “Soft tissue changes in Class 11 treatment” Am. Turpin. 1961 “Perioral profile changes in Orthodontic treatment” 4. 3. et al. McNamara James Jr.165-175 75 . Witt. 44. L...B. 3847 7. et al. Orthod.2. Orthod. llling. R. Cummins David M. J.633-639 3.1. Part 1: Methodology and Reliability” Am. 108.43. J. Burstone Charles J : 1967 “Lip posture and its significance in treatment planning” Am.
MANAGEMENT OF CLASS II DIVISION 2 MALOCCLUSION – AN INSIGHT Author: Prof. Dr. Infraocclusion of buccal segment and counter clockwise rotation of the mandible leads to an excess of soft tissue in the lower face and results in an upward shift of the lip line and this influences the maxillary incisors to get retroclined which is demonstrated as in the figures 1 to 4. a lot is documented on the etiology and treatment approach. Intrusion and Torqueing of incisors. AECS Maaruti Dental College & Research Center.S. It could also possibly be explained by a polygenic model with a simultaneous expression of a number of genetically determined morphological traits rather than controlled by a single gene1. of Orthodontics. Certain studies point to an incontestable genetic influence probably autosomal dominant with incomplete penetration and variable expressivity. Principal. C. reduction of inter incisal angle and non extraction approach to improve lip support could be some of the factors leading to successful outcome. Bangalore. Ramachandra Diplomat Indian Board of Orthodontics Professor & Head Dept.5 to12. Centroid and class II division 2. Dr. Familial occurrence of Class IIdiv2 has been documented in great deal and there is strong evidence of genetics as the main etiological factor in the development of this type of malocclusion. retroclined maxillary centrals. This article tries to compile such information and present cases treated by infusing them in to the treatment regime. The following are the characteristics to reckon with: • Increased lower lip pressure on the upper incisors and increased masticatory muscle forces 2 • Deep bite. In this type of malocclusion upper central incisors could have large collum angle. which make their behavior more predictable. Deep bite. 76 fig :1 fig: 2 fig:3 fig:4 Fletcher has convincingly established that the upper incisors retroclined in Class II div 2 after their emergence in to the oral cavity. The project involved a serial study of early development and tooth eruption between the ages of 4. proclined laterals and even morphologically different upper incisors such as thinner crowns labiolingually 3 and high collum angle 4 • Class II skeletal discrepancy with counter clock wise rotation which adds to the problem of deep bite. It is possible to believe that unlike in other forms of malocclusions the incisors in class II div 2 malocclusion occupy a predetermined position which could make one think to be by a divine guidance. When one browses through the literature. INTRODUCTION Class II div2 malocclusion is characterized by the manifestation of a group of features which make it qualified to be termed as a syndrome. chin prominence and reduced lower facial height. Ramachandra Abstract : Class II Div 2 malocclusion has been a challenging clinical entity in terms of treatment and more so in terms of stability of the result.S.5 years6 . C. On the contrary the local environmental factors influence the erupting incisors. After evaluating 114 class II div 2 cases Markovic observed that the monozygotic twins showed 100% concordance and 90% of the dizygotic twins showed discordance5. which can pose problems in intrusion . Lip line. Key Words : Inter incisal angle.
It could be argued that people with class II division 2 malocclusion look smart and it could be one reason for their not seeking treatment.4% world wide. Incidence of class II div2 malocclusion is lowest amongst all. It is necessary to establish correct incisal relation to preserve the health of the oral structures.7 College. In our department at Maaruti Dental 77 3. It is challenging to treat such syndrome like entity which demands the clinician to target/treat all the features responsible so as to achieve pleasing and stable outcome. determining the possibilities and limitations of the treatment. Higher the lip line. . Selwyn and Barnett while highlighting the significance of pressure exerted by soft tissue. But Salzmann has categorically stated that extraction should be considered rarely. Inadequately trained doctors and poor choice of appliance could result in unstable results creating an impression among general public that this type of malocclusion is untreatable. Figures rang form 3% to6. Reduction in inter incisal angle to 125-130 degrees : This would mutually prevent the incisors from supra erupting and there by preventing the relapse of division 2 pattern.8 Crowding associated with this type of malocclusion appears to be on the higher side and very often clinicians are tempted to advice premolar extractions. 1.4 Many clinicians hypothesize that retroclination of the maxillary central incisors in class II Div 2 malocclusion is caused by increased resting lip pressure. De crowding and Aligning: This would be the priority to every one and the main force behind patient motivation.9 Mills in a study of sixty treated cases found that over bite commonly relapses and showed that the best treatment results are obtained where there is a combined reduction in inter incisal angle and over bite(10). Eliminate the high pressure exerted by the lower lip on maxillary incisors and consequently reduce the post orthodontic relapse. have stressed on its role in evaluating the situation. 2. Limitations imposed by the soft tissues enveloping the dentition were thought to be inviolable. which is the only means of eliminating the high pressure exerted by the lower lip on them.and torqueing movements. Torqueing of these teeth with pronounced collum angle are likely to have their roots positioned closer to the palatal cortical plate than expected and could be a factor responsible for relapse. Treatment rationale: Following could be the list of our objectives. and achieving this will ensure a stable outcome. Bangalore it is only 3% amongst the patients seeking treatment. The best therapeutic approach is certainly the intrusion and torqueing of the maxillary incisors. This has inhibited the clinicians in treating class II div 2 malocclusions. Overbite reduction: Deep over bite results in breakdown of both hard and soft tissues. Fig: 5 Lapatki et al have concluded that Orthodontic treatment of class II Div2 cases should include: • • Intrusion and torqueing of maxillary incisors. the lower lip exerts more pressure on the incisal half resulting in the retroclination of the maxillary incisors as demonstrated in figure 5. Lapatki et al revealed that the retroclination of maxillary central incisors are primarily due to high lip line and not due to hypertonic peri oral musculature.
016 Niti. vacuum molded retainer and for mandibular teeth bonded lingual retainers were given. philosophy followed. Correct the buccal segment to Class I : Many a time opening the bite eliminates the restrictive effect on the mandible allowing forward shift of the .same which can be aided by forwardly directed forces. Support the facial profile : Positioning of incisors as directed in rationale no 3 & 4 would help in straightening the profile and eliminate the sunken face appearance and aged look. . Self ligating brackets were used in the maxillary arch for this case.022 slot pre adjusted system was used for their effectiveness in establishing required torque to the maxillary incisors and induce bodily movement of mandibular anterior teeth. but the third case had an impacted mandibular canine which was removed. Class II elastic forces are used to achieve inter arch correction. 4. b) Torqueing the maxillary centrals enough. Maxillary teeth are addressed initially and once enough clearance is achieved brackets are bonded to mandibular teeth. CASE REPORT: The clinician can be influenced by factors such as the training availed.Retention Protocol : Preferably bonded lingual retainer for the mandibular anteriors and for the upper arch Hawley’s or molded clear retainers would be advisable. 6. For the maxillary teeth. (Since there was Bolton’s excess in the mandibular anteriors. These patients had all the classical features of class II div2 malocclusion. Bring the centroid of the maxillary incisor lingual to the mandibular incisal tip : The maxillary centrals tend to revert back to their previous position which is typical to this malocclusion after treatment. 7. One should even contemplate surgical advancement of mandible in adult cases so as to achieve class 1 situation. and facility available in selecting the appliance. so as to direct the occlusal forces generated by the mandibular incisors labial to the centroid of the maxillary central incisors. This type of relapse could be prevented bya) Getting the mandibular anteriors bodily forward and not merely tipping. with out which achieving correct incisal relation would be a dream. 78 5. Three cases treated by me are presented where an effort is made to satisfy the listed objectives which are crucial in the stability of the results achieved. this did not matter). for first two months followed by 16*22 RCS Niti and progressively filling the slot up to 21*25 SS wires. The arch wire sequence was similar in all these cases-started with . The first two cases are treated with out any extractions.
0 ANALYSIS: Steiner Norm SNA Angle SNB Angle ANB Angle U 1 to NA dist U 1 to NA angle L 1 to NB distance L 1 to NB angle Pog to NB distance Interincisal angle Occlusal to SN angle Go-Gn to SN angle 79 82 80 2 4 22 4 25 Measured 74.4 23.3 5.9 10.5 32 21.4 131 -1.6 2.6 -4.3 14.CASE 1: Pre treatment: Progress : Finish: ANALYSIS: Steiner Measurement Norm SNA Angle SNB Angle ANB Angle U 1 to NA dist U 1 to NA angle L 1 to NB distance 4 L 1 to NB angle Pog to NB distance Interincisal angle Occlusal to SN angle Go-Gn to SN angle Mechanotherapy : Measured 82 76.0 131 123.4 10.7 2 3.6 30.0 14 20.9 72.4 22 1.9 4 -3.5 14 15.3 32 20.2 .5 80 72.3 25 1.
4 Go-Gn to SN angle 32 17.6 14 6.5 131 160.0 Pog to NB dist 8.3 ANB Angle 2 2.2 5.6 L 1 to NB dist 4 6.1 -5.5 L 1 to NB angle 25 20.1 1.6 Occl to SN angle 14 10.1 SNB Angle 80 83.3 80 82 80 2 4 22 4 25 Measured 9.1 U 1 to NA angle 22 28.1 10.3 1.0 32 15.0 Interincisal angle 131 128.2 84.8 U 1 to NA dist 4 6.CASE 2: Pre treatment: Progress : Finish: ANALYSIS: Steiner Norm SNA Angle SNB Angle ANB Angle U 1 to NA dist U 1 to NA angle L 1 to NB dist L 1 to NB angle Pog to NB dist Interincisal angle Occl to SN angle Go-Gn to SN angle Mechanotherapy : ANALYSIS: Steiner Norm Measured SNA Angle 82 86.9 .7 13.
4 Go-Gn to SN angle 32 32.5 L 1 to NB angle 25 12.5 U 1 to NA angle 22 23.5 Pog to NB dist 3.3 L 1 to NB dist 4 -0.6 Mechanotherapy : Norm ANALYSIS: Steiner Norm Measured SNA Angle 82 78.6 Interincisal angle 131 121.8 SNB Angle 80 74.7 Occl to SN angle 14 22.8 ANB Angle 2 6.6 81 .2 L 1 to NB dist 4 11.3 U 1 to NA angle 22 0.8 SNB Angle 80 72.CASE 3: Pre treatment: Finish: ANALYSIS: Steiner Measured SNA Angle 82 79.1 Pog to NB dist 5.1 Interincisal angle 131 173 Occl to SN angle 14 19.7 L 1 to NB angle 25 29.7 U 1 to NA dist 4 -7.0 U 1 to NA dist 4 3.6 Go-Gn to SN angle 32 33.1 ANB Angle 2 5.
E . Salzmann. Angle orthodontist 35. Markovic. Fletcher. 3.1991.2006 Angle Orthodontist.DISCUSSION: Orthodontic treatment mechanics has evolved over the time enabling operators to provide better results while treating malocclusions.R.A.J.Lip Shape and Position in class II div 2 malocclusion. as shown in the cases presented if the treatment is undertaken during the early permanent dentition.The importance of the level of the lip line and resting lip pressure in class II div 2 malocclusion .Practice of Orthodontics. Declan. 661. Robertson. R. 737. Mills J. J Dent Res 81. Delivanis et al. 6.18. Milan D. 7. Lapatki. 5.1992 European Journal of Orthodontics 14.1965. T. 4.26.Rationale of treatment for class II Div 2 malocclusion. B. Most of the clinicians would achieve the best form of finish by de crowding and aligning and partially opening the bite but may not go to the extent of looking into the reduction of inter incisal angle and bringing the centroid of maxillary incisor behind the mandibular incisal edge.BJO.2002. 8. 438-443. It is important to ensure stability of what is achieved to claim long term success. 1999 BJO. 1980 AJO-DO. 76. Mclntyre.J. 1975.The retroclined upper incisor. Helen P. 2. 1966. 10. 173. REFERENCE: 1. In sever cases of inter arch discrepancy. Most of the time the class 2 situation gets corrected with the unlocking of the mandible aided by class 2 elastic forces.The problem of overbite in Class II Division 2 malocclusions.Feature of the upper central incisor in class II div 2.5. 1. T. et al. 5. If we attain the former and fail in the later. surgical options can be considered.At the crossroads of oral facial genetics. 2. it mandates us to investigate in to the structural flaws which caused the relapse. B.Variation in morphology of the maxillary central incisors found in class II div2 malocclusion. . 51-53. Mossey. BJO. 207-216.E.G. 1973.181.742. N. Millett.P.. 9.The heritability of malocclusion. Roy Hilton. GGT. BJO. It is advisable to practice bonded lingual retainer in the mandibular arch and vacuum molded retainers for the maxillary teeth which can precisely hold the teeth in their corrected position. Grant.Selwyn-Barnett. 195-203.323328. 469-481. 34-48 82 .
Keywords : INTRODUCTION: Predicting the size of unerupted teeth during the mixed dentition period is a critical factor in managing the developing occlusion of a growing child. The ability to predict the sizes of unerupted canine and premolars in the mixed dentition is of prime importance. Maharashtra . The most commonly used prediction method of Tanaka and Johnston is based on data from a sample of children of Northern European descent. The accuracy of this method when applied to a different ethnic population is questionable. Dental College and Hospital Nashik. Dental casts of I00 subjects were used to formulate the linear regression equation. Mixed dentition space analysis. Jaju Post Graduate student Dept. Dental College and Hospital Nashik. Tanaka and Johnston's equations were modified in order to improve the accuracy of the prediction for the cosmopolitan Indian population. as reported by Ballard and Wylie 5. Huckaba 8. Ferguson et al 10. The method showed good prediction accuracy and was easy to use.422003. This study aimed to determine a linear regression equation that would predict the sum of the mesiodistal widths of unerupted mandibular and maxillary permanent canines and premolars based on the sum of the widths of the four mandibular permanent incisors and first permanent molars. Shrikant S. Abstract : Predicting the size of unerupted teeth during the mixed dentition period is a critical factor in managing the developing occlusion of a growing child.H.com Mobile No. India.B. The second uses prediction tables based on measurements of other erupted permanent teeth. Orthodontics and Dentofacial Orthopaedics M. Chitko Professor & Head of the Department Dept. Tanaka and Johnston equation.V’s K.422003. The first employs direct measurements of the teeth from radiographs with or without the use of a prediction formula as reported by Nance 2. Maharashtra . India. The difference found between the actual and predicted values of the canine and premolars was not found to be significant.V’s K. Carey 6.Nitin D. Chitko Dr. E-mail : drkjaju@gmail. Tanaka and Johnston 9. and Staley et al 4. The third method involves .422003.G. Jaju (Corresponding Author) Dr. India. Orthodontics and Dentofacial Orthopaedics M.G. Moyers 7 .1 Many methods of predicting the mesiodistal width of unerupted canines and premolars in the mixed dentition 83 have been reported. Moorrees et al 3.B. Dr. Orthodontics and Dentofacial Orthopaedics M. Gulve Dr. Gulve Professor & Guide Dept.G. These methods use three distinct ways to achieve their purposes.Nitin D.A NEW EQUATION FOR PREDICTING THE WIDTH OF UNERUPTED PERMANENT CANINES AND PREMOLARS FOR COSMOPOLITAN INDIAN POPULATION Authors: Dr. A paired Student t test was used to compare the actual and predicted sums of the permanent canines and premolars. Maharashtra .V’s K.H. Krishnakumar R. Krishnakumar R. Dental College and Hospital Nashik.H. Shrikant S.B. : 09665863863 Dr.
Y1 – sum of width of maxillary canine and premolars. Sum of width of mandibular canine and premolars showed higher correlation with sum of mandibular incisors and mandibular molar. Staley and Kerber 12. morphological anomalies. Later. Paula et al 16.01 mm accuracy) with modified pointed beaks was used to measure the mesiodistal widths of all the teeth (Fig:1). The beaks were then closed until gentle contact with the contact points of the tooth was made. 3.e. Sum of width of mandibular incisors and maxillary first molar. Ingerval and Lennartsson 14. missing teeth. Y2 . The measurements were made as carefully as possible to avoid any damage to the casts. Nourallah et al included maxillary first permanent molar in addition to mandibular incisors. Tanaka and Johnston 9 Space Analysis is a simple and widely used method to predict the sizes of unerupted canines and premolars in mixed dentition for both jaws and for both the genders.a combination of the previous two methods. Correlation coefficient for male and female (Table II) was calculated separately between sum of width of mandibular incisors and mandibular first molar with sum of width of permanent mandibular canine and premolars and between sum of width of mandibular incisors and maxillary first molar with sum of width of permanent maxillary canine and premolars. RESULTS: The correlation values for three groups with sum of width of permanent mandibular and maxillary canine and premolars determine (Table I) and the results showed the positive correlation with all the three groups. i. The actual values and predicted values were compared using paired t – test. The regression equation is: Y = a + bX In which Y (dependent variable. Our aim in this study was to determine the group of teeth which represent the maximum correlation with the width of permanent canines and premolars in the cosmopolitan Indian population and also to formulate the regression correlation equation for the same. Sum of width of maxillary canine and premolars showed higher correlation with sum of mandibular incisors and maxillary molar. The equations were subjected to statistical analysis to check the accuracy.. as recommended by Hixon and Oldfather 11. Staley et al 15 . The regression correlation equation was derived to predict sum of width of permanent mandibular and maxillary canine and premolars for both the jaws for Male and Female. Sum of width of mandibular incisors and mandibular first molar.V‘s K.G. Also found the regression equation to predict the width of unerupted canines and premolars. A Digital Vernier Caliper (0. proximal or occlusal abrasion.radiographic methods. the correlation values were calculated using below mentioned groups with sum of width of maxillary and mandibular permanent canine and premolars 1. 2. They found correlation between the sum of width of mandibular incisors and maxillary permanent first molar with sum of width of mandibular canine and premolars was higher 1. 2. A separate equation to be formulated for male and female for both the jaws. and held occlusally parallel.sum of width of mandibular canine and premolars ) equals the predicted 84 Material and Methods: Pre-treatment plaster models of 100. The measurements included the mesiodistal width of all the twelve maxillary and . Bishara and Staley 13. 16. mandibular teeth from the right first permanent molar to the left first permanent molar. Further regression correlation equation was formulated separately for male and female. The caliper beaks were inserted from the buccal (labial). 50 women and girls) were selected from the records of the Orthodontic Department at M.H Dental College & Hospital.B. Nashik. as the literature shows significant difference in the width of the teeth in males and females18. Sum of width of mandibular incisors. All the casts had all relevant teeth (ones used for comparison) fully erupted and presented with no proximal caries or fillings. 1. Al-Khadra et al in 1993 showed that the Tanaka and Johnston analysis overestimates the sizes of unerupted canines and premolars in the majority of cases 17. the use of prediction tables associated with measurements of erupted and unerupted teeth. Camilo et al found the correlation between sum of width of mandibular canine and premolar with sum of width of permanent mandibular incisors and mandibular first molars with maximum correlation coefficient among non. maxillary and mandibular permanent canine and premolars. or attrition. The data was collected.to 25-yearold patients (50 men and boys.
22 + 0. mandible r = 0.656. and sum of width of mandibular incisors and maxillary first molar with sum of width of permanent maxillary canine and premolars were calculated for each sex separately.63.716. It is simple.44 0. 1. Upper canine and premolar: Y = 11. is higher than using only mandibular incisors to predict the mesiodistal width of canines and premolars.663X Estimated equations for the females. mandible r = 0. the above method provides a good non radiographic prediction method.678X 2 Using the formulae sum of width permanent canine and premolar for mandibular and maxillary arch.6751. Lower canine and premolar: Y = 12.sum of mandibular incisors and mandibular first molars). The literature shows difference between the right and left side were small and not statistically significant.619. and specific for the population from which it is developed. More closer correlation was obtained for each sex ( male. The difference in means of the actual and predicted values showed no statistically significant difference and also the standard error was small (Table III).725X 1 2 maxilla r = 0. The difference between male and female tooth widths is been shown in several studies18. 2. So. practical. These values were greater than the Tanaka and Johnston values obtained by Sable et al for Indian population (maxilla r = 0. mandible r = 0. Upper canine and premolar: Y = 19.6651). Lower canine and premolar: Y = 16.641. Thus. 2. So. X2 . the correlation coefficient of sum of width of mandibular incisors and mandibular first molar with sum of width of permanent mandibular canine and premolars. mandible r = 0.extraction decision7. X ( independent variable ) equals the sum of the mesiodistal width of the 4 mandibular permanent incisors plus the mesiodistal width of the 4 mandibular permanent incisors plus the mesiodistsal width of permanent maxillary/mandibular first molars (X1 – sum of width of mandibular incisors and maxillary first molars. Overestimating seems to be better to prevent lack of space.65 + 0. The correlation coefficient obtained fora. Estimated equations for males: 1. . b.663)19 and also by the original Tanaka and Johnston study (maxilla r = 0. Overestimation of only 1mm beyond the actual width of the permanent canine and premolar on each side of the arch would not affect the extraction or non. Sum of width of Mandibular incisors and maxillary first molar with sum of width of permanent maxillary canine and premolars. The formulated equation though overestimates the width of canine and premolar but the value predicted is very close to the actual values. but this approach could suggest tooth extraction for some patients. Similarly this method can overestimate or underestimate.sum of the mesiodistal widths in the millimeter of the mandibular/maxillary permanent canines and premolar on both sides.13 + 0. both the sides were considered together for individual arch. Thus. The difference was not found to be statistically significant (Table III). However no method is 100% precise. 20. female 85 CONCLUSION: 1. Sum of width of Mandibular incisors and mandibular first molar with sum of width of permanent mandibular canine and premolars. The values of constant a and b are as follows.maxilla r = 0.553X 1 2. providing an easy and simple way for prediction of width of canine and premolars. Further research for individual ethnic population groups for better predictability needs to be done with increased sample size to increase the accuracy of the equation. 3.65) 9.6821). The calculated or predicted values were compared with actual measured values. The simplified regression equation predicts the sum of width of the permanent canine and premolar very close to the actual measurements. The constant a is the y intercept. mandible r = 0. The ideal prediction method should determine no difference between predicted and actual widths of permanent canine and premolar and the standard deviation of the difference should be as small as possible. and the constant b is the slope of the regression. DISCUSSION: For the Indian population it was found that when the maxillary and mandbular 1st molars were included along with the sum of incisors there was more correlation seen with the respective sum of width of permanent maxillary and mandibular canine and premolars( maxilla r = 0.
J Am Dent Assoc 1984. 11. Huckaba GW. Dent Clin North Am 1964.132:340–5. 2. Dabir P A. Prediction of the size of unerupted canines and premolars in contemporary Arab population. New Regression Equations for Predicting the Size of Unerupted Canines and Premolars in a Contemporary Population. Am J Orthod Dentofacial Orthop. The prediction of the size of unerupted canines and premolars in a contemporary orthodontic population. 19.33:754-9.76:300-9.36:39-47. . Al-Khadra BH. Macko D J.73:68-72. Melgco CA. Am J Orthod 1984. Arch size analysis and tooth size prediction. Comparisons of mesiodistal and buccolingual crown dimensions of the permanent teeth in three populations from Egypt. Prediction of the widths of unerupted canines and premolars. Staley RN.33:177-223. Mixed dentition case analysis. J Dent Res 1957. Estimating size of unerupted permanent teeth. Martin JF. 4.11:431-40. Gesch D. and Carlos de Oliveira AR.107:309-14. Jacob M.155161. 17. 28:236-40. 7. Am J Orthod Dentofacial Orthop 1995. Tanaka MM. J Am Dent Assoc 1974. Am J Orthod 1980. Linear arch dimension and tooth size. Am J Orthod Dentofacial Orthop. Hoag JF. 86 12. Angle Orthod 2002. et al. Staley RN. Bishara SE. Ballard ML. The use of regression constants in estimating tooth size in a Negro population. Paula S.104:369–372. 9. 15. 3. Mexico.1996:27. J Indian Orthod Society. Oldfather RE. 1993. 8.48:62-9. Am J Orthod Dentofacial Orthop. Chicago: Year Book Medical Publishers. Estimation of the sizes of unerupted cuspid and bicuspid teeth. 2007. 1989. Prediction of mesiodistal diameter of unerupted lower canines and premolars using 45° cephalometric radiography. Staley RN. Am J Orthod 1947. 20. Hixon EH. Am J Orthod 1949. Moyers RE.72:216–221. Almeida MAO. 10.88:798-80i. 14. and the United States.96:416-22. 16. I: mixed dentition diagnosis and treatment. Mixed dentition mandibular arch length analysis: A step-by-step approach using the revised Hixon-Oldfather prediction method.B. The limitations of orthodontic treatment. Moorrees CFA. Splieth C. Nance HN. Sonnenberg EM. Ingervall B. Mesiodistal crown diameters of the deciduous and permanent teeth in individuals.78:296-302. Sable R. Nourallah WA. Carey CW. 1988:577. 18. Khordaji MN. Angle Orthod 1958. 13.REFERENCES: 1. Jensen S. Lennartsson B. Am J Orthod 1947. Am J Orthod 1978. Jakobsen JR. Ferguson FS. 6. Bishara SE. Indian norms for the prediction of unerupted permanent canines and premolars segment using statistical prediction techniques. 86:130-5. Prediction of lower canine and premolar widths in the mixed dentition. O’Gorman TW. Garcia AF.35:762-75. Kerber PE. Thomsem SO. Wylie WL. et al. Tirre de Sousa MA. Shelly TH. Mandibular permanent first molar and incisor width as prediction of mandibular canine and premolar width. Lee PCF. Staley RN. et al. Abdallah EM. A revision of the Hixon and Oldfather mixed-dentition prediction method. Am J Orthod 1979. Prediction of breadth of permanent canines and premolars in the mixed dentition. Johnston LE. 5. 4th ed. Angle Orthod 1978. Handbook of orthodontics.108:185-90.
Fig.6751 87 .6247 Sum of width of permanent Maxillary canine and premolars 0.5927 0.6514 0. 1 : Digital Vernier Caliper with modified pointed beaks.6551 0. used to measure the mesiodistal widths of all the teeth Table I : Correlation coefficient values for the three groups of teeth with sune of width of maxillary and manibular canine and premolar Sum of width permanent Mandibular canine and premolars Sum of width of Mandibular incisors Sum width of Mandibular incisors and mandibular first molar Sun of width of Mandibular incisors and maxillary first molar 0.648 0.
5974 mm ± 2.62 1.281 42.Table II : Correlation coefficient for male and female Male Sum of width of Mandibular incisors and mandibular first molar with sum of width of permanent mandibular canine and premolars 0.5478 mm ± 2.946* 0.148* Difference (actual predicted) Standard Significance error (P value) 88 .29 mm -0.8343 mm ± 1.525 -0.665 mm ± 2.417 43. Actual value of canine + premolar (Mean) Predicted value of canine + premolar (Mean) Mean Male 50 Upper Lower Female 50 Upper Lower 42.5432 mm ± 2.1375 mm ± 1.62 1.58 mm -0.12 0.67 1.6417 Table II : Showing mean values of actual and predicted canines and premolars and their significance values.46 1.692 mm ± 1.6821 Female Sum width of Mandibular incisors and maxillary first molar with sum of width of permanent maxillary canine and premolars 0.52 1.55 mm SD 1.49 1.084* 0.24 42.002 41.716 0.656 0.62 1.438* 0.171 42.12 41.1567 mm ± 1.02 mm -0.52 41.
) Ashima Valiathan BDS (Pb).com Abstract : Evidence-based health care depends on application of the best knowledge a discipline can offer about the clinical course of a disease or condition and the effectiveness of alternative treatments. Nidhi Kedia Dr. with the dentist’s clinical expertise and the patient’s treatment needs and preferences. The evidence produced by such Meta-analytic and systematic review procedures can be considered the strongest possible. Director of Post Graduate Studies. Manipal College of Dental Sciences. Manipal College of Dental Sciences. . DDS. Ashima Valiathan (BDS (Pb). Department of Orthodontics and Dentofacial Orthopedics. Manipal Dr. a critical appraisal and a cautious interpretation of the results are essential. relating to the patient’s oral and medical 89 condition and history.” Clinical practice guidelines are defined as “systematically developed statements to assist practitioners and patients in arriving at decisions on appropriate health care for specific clinical circumstances. USA.ORTHODONTIC CONCLUSIONS OF SYSTEMATIC REVIEW AND META ANALYSES Authors: Dr. Manipal Adjunct Professor Case Western Reserve University Cleveland. Manipal College of Dental Sciences. no: 0820-2922184. (Mrs. MS (USA) Professor and Head of Department Director of Post Graduate Studies Department of Orthodontics and Dentofacial Orthopedics. Address for correspondence: Dr. MS (USA) Professor and Head.”To produce well-developed guidelines. India. Ohio. Extrapolation of findings from systematic reviews into clinical practice must consider the methodological quality and external validity of the studies used in such reviews. DDS. Postgraduate Student Department of Orthodontics. determining which information is “best” and summarizing it in a clinically useful manner. Email id: avaliathan@yahoo. Ph. Evidence-based Dentistry is defined by American Dental Association as “an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence. Manipal Manipal: 576104 Karnataka. Systematic reviews and Meta analyses are considered the preferred method for identifying all of the available knowledge. Nidhi Kedia (BDS). Although systematic reviews are the best available source of evidence. INTRODUCTION The principles and philosophy of evidence-based practice rapidly are becoming established in all areas of health care.
The principles and philosophy of evidence-based practice rapidly are becoming established in all areas of health care. On the other hand. It is difficult for clinicians to read and assimilate into their practice the information from the many articles published each year. It is difficult for clinicians to read and assimilate into their practice the information from the many articles published each year. These problems may explain in part why there are relatively few systematic reviews of topics relevant to orthodontics—namely. Their tremendous value lies in the rigorous methods that are used to minimize bias and in their ability to combine smaller studies and thus increase statistical power to detect a treatment effect. a comprehensive search strategy. systematic reviews often do not produce final. one should use the methods of the evidence-based process to assemble. degree of association between a risk factor and a disease or accuracy of a diagnostic test. Meta Analysis is defined as “a review that uses quantitative methods to combine the statistical measures from two or more studies and generates a weighted average of the effect of an intervention.” The primary advantage of the systematic reviews and Meta-analyses are that it not only tells us what we do know. they often show where high-quality primary studies are lacking and help to define future agendas. During the 1990s. The product of this process of reviewing the knowledge base related to a specific clinical question is known as a systematic review of the evidence. Meta-analysis has been used to give helpful insight into: • • allow a more objective evaluation of the evidence. the effect of different types of therapy). systematic reviews and Meta analyses are considered the preferred method for identifying all of the available knowledge. assessment of the methodological quality of the included studies. organize and synthesize the best available evidence from clinical research and integrate this with clinical expertise in the formation of clinical recommendations. the relative impact of independent variables (e. During the 1990s.. Evidence-based Dentistry is defined by American Dental Association as “an approach to oral health care that requires the judicious integration of systematic assessments of clinically relevant scientific evidence. Systematic review (SR) has been defined as “a review that has been prepared using a systematic approach to minimizing biases and random errors which is documented in a materials and methods section” (Egger et al 2003). and the strength of relationship between variables and Might explain the heterogeneity between studies. The strengths of systematic reviews and Meta-analyses include a clearly defined question.g.one should use the methods of the evidence-based process to assemble. These questions address only a small proportion of the clinical decisions. 90 instead. explicit inclusion criteria. the design of these studies and their power often are inadequate. that the number of studies addressing a given clinical question. Today. psychotherapy. • • • There are few systematic reviews that address a small number of questions. synthesis of the data and a summary of the results. but also what we do not. outdoor education).g. . expert panels of clinical research methodologists and other specialists developed protocols to reduce bias in collecting and synthesizing findings from clinical scientific studies. organize and synthesize the best available evidence from clinical research and integrate this with clinical expertise in the formation of clinical recommendations. with the dentist’s clinical expertise and the patient’s treatment needs and preferences. thus increasing the statistical power of the analysis and the precision to assess the treatment effects.” Clinical practice guidelines are defined as “systematically developed statements to assist practitioners and patients in arriving at decisions on appropriate health care for specific clinical circumstances. present a more precise estimate of treatment effects & the overall effectiveness of interventions (e. definitive answers for health care. Evidence-based health care depends on application of the best knowledge a discipline can offer about the clinical course of a disease or condition and the effectiveness of alternative treatments.. determining which information is “best” and summarizing it in a clinically useful manner. relating to the patient’s oral and medical condition and history.”To produce well-developed guidelines. expert panels of clinical research methodologists and other specialists developed protocols to reduce bias in collecting and synthesizing findings from clinical scientific studies. Evidence-based health care depends on application of the best knowledge a discipline can offer about the clinical course of a disease or condition and the effectiveness of alternative treatments. They increase the overall sample size by combining data from individual studies.
The strengths of systematic reviews and Meta-analyses include a clearly defined question. On the other hand. They increase the overall sample size by combining data from individual studies. they often show where high-quality primary studies are lacking and help to define future agendas. explicit inclusion criteria. Generally unilateral occurrence of dental agenesis is more common than bilateral occurrence. systematic reviews and Meta analyses are considered the preferred method for identifying all of the available knowledge. assessment of the methodological quality of the included studies.. However bilateral agenesis of maxillary lateral incisors is more common than unilateral.. the design of these studies and their power often are inadequate. Meta-analysis has been used to give helpful insight into: • • allow a more objective evaluation of the evidence. followed by the maxillary lateral incisor and the maxillary second premolar. with/ without the addition of an upper removable expansion plate may be effective in preventing a posterior crossbite from being perpetuated to the mixed and permanent dentitions(Petren S et al 2003) Moyer’s method of mixed dentition analysis can show population variations. These problems may explain in part why there are relatively few systematic reviews of topics relevant to orthodontics—namely. SUMMARY OF VARIOUS SYSTEMATIC REVIEWS AND META ANALYSES: 1. systematic reviews often do not produce final. The two most consistent. In addition.” The primary advantage of the systematic reviews and Meta-analyses are that it not only tells us what we do know. strong effect sizes with the highest • • • • • • • There are few systematic reviews that address a small number of questions. psychotherapy. outdoor education).The product of this process of reviewing the knowledge base related to a specific clinical question is known as a systematic review of the evidence. Systematic review (SR) has been defined as “a review that has been prepared using a systematic approach to minimizing biases and random errors which is documented in a materials and methods section” (Egger et al 2003). and development of prediction tables for specific populations is needed (Buwembo et al 2003). but also what we do not. Evidence for a direct causal relationship between craniofacial structure and obstructive sleep apnoea (OSAS) is unsupported by the literature. Their tremendous value lies in the rigorous methods that are used to minimize bias and in their ability to combine smaller studies and thus increase statistical power to detect a treatment effect. a comprehensive search strategy. The mandibular second premolar is the most affected tooth (Mattheeuws et al 2004). being higher in Europe and Australia than for North American Caucasians. Diagnosis and treatment planning: Skeletal maturity determined by hand-wrist radiographic analysis correlates with overall facial growth velocity. However. Meta Analysis is defined as “a review that uses quantitative methods to combine the statistical measures from two or more studies and generates a weighted average of the effect of an intervention. that the number of studies addressing a given clinical question. Lateral cephalograms have acceptable reliability for evaluation of adenoid size. definitive answers for health care. with the overall prevalence of agenesis in the maxilla being similar to that in the mandible (Polder et al 2004).37 times higher than in males. the prevalence of dental agenesis in females is 1. and the strength of relationship between variables and Might explain the heterogeneity between studies. the effect of different types of therapy).g. degree of association between a risk factor and a disease or accuracy of a diagnostic test. small proportion of the clinical decisions. although the association of maxillary and mandibular growth velocities to skeletal maturity is less clear-cut. both qualitatively and quantitatively. thus increasing the statistical power of the analysis and the precision to assess the treatment effects. Today. present a more precise estimate of treatment effects & the overall effectiveness of interventions (e. (Carlos Flores-Mir et al 2004) • Prevalence of hypodontia differs by continent and gender.g. instead. the relative impact of independent variables (e. synthesis of the data and a summary of the results. determining which information is “best” and summarizing it in a clinically useful manner. These questions address only a 91 . Occlusal grinding in the primary dentition. cephalograms are less reliable for evaluation of the size of the posterior nasopharyngeal airway (Major et al 2006).
The long-term difference in stability between a maxillary or mandibular correction was not large. (Lagravere et al 2006) Maxillary protraction has a significant treatment effect. True maxillary molar intrusion (with high-pull headgear is achievable) of 0. and it is significantly unrelated to dental anomalies. although maxillary surgery may increase stability slightly and have a greater esthetic impact. with an ANB increase of 1. There might be an association with over-retained deciduous teeth (Papadopoulos et al 2009). No statistically significant mandibular expansion with the exception of the intercondyle width was identified (Lagravere et al2005). with maxillary prevalence and no sex preference. The magnitude of reported change suggests molar intrusion in isolation (with high-pull headgear) is unlikely to address significant anterior open-bite malocclusions (Ng et al 2006). Orthodontic patients without cutaneous piercing had no statically significant difference in Ni hypersensitivity prevalence.8 mm). or impacted teeth. Children with overjets larger than 3 mm are approximately twice as much at risk of traumatic dental injuries on anterior teeth than children with overjets less than 3 mm. unless patients have a history of previous cutaneous piercing exposure to Ni (Kolokitha et al 2008). this was also true for patients who had orthodontic treatment before piercing. Long-term dental arch changes after rapid maxillary expansion (RME): Similar maxillary molar and cuspid expansion could be found in adolescents and young adults. There is actually little autonomous improvement in overbite from age 8 up to age 50. Although mandibular body length (Go-Gn) appears to be an associated factor. There is an average 76% mean stability for anterior open bite correction in adolescents.The effect of overjet on the risk of dental injury is less in boys than in girls of the same overjet group and the risk of anterior tooth injuries tends to increase with increasing overjet size (Nguyen et al 1999). More transverse dental arch changes 92 • • . RME appears not to produce clinically significant anteroposterior or vertical skeletal changes(Lagravere et al 2005) Subjects who had undergone Slow Maxillary Expansion had less relapse compared with subjects who had undergone RME(Lagravère et al 2005) Based on a secondary level of evidence. There is an 84% level of stability for surgical open bite correction in adults. • • • • • • • • • 2. although dental changes predominate in transverse dental dimension. • Long-term transverse skeletal maxillary increase with rapid maxillary expansion (RME) is approximately 25% of the total dental expansion achieved in prepubertal adolescents. Significantly less indirect mandibular molar and cuspid expansion was attained in young adults compared with adolescents. Nasal patency is improved by the procedure. No anteroposterior or vertical dental changes were associated with RME. the segmented arch technique can produce 1.96mm during orthodontic treatment has been shown to occur. Scientific evidence suggests that orthodontic treatment is not associated with an increase of Ni hypersensitivity. although clinical evidence with appropriate quantification is deficient.73° (Jager et al2001). Rigid fixation is found to be better than non-rigid fixation for stability in the mandible. In non-growing patients. peg-shaped or hypoplastic teeth. • Tooth transposition seems to occur more often unilaterally than bilaterally. this does not support causality (Miles et al 1996). surgically assisted rapid palatal expansion (SARPE) produces greatest expansion at the molars diminishing progressively to the anterior part of the dental arch.5mm of incisor intrusion in the maxillary arch and 1.diagnostic accuracies had variables related to mandibular structures (Sn/MPA. Limited true incisor intrusion is achievable in both arches. No evidence about the relationships between temporomandibular disorders (TMDs) and orthodontic treatment exists (Kim et al 2002).9mm in the mandibular arch (Julia Ng et al 2005). Go-Gn). were found after puberty compared with before puberty. The difference may not be clinically significant (0. Treatment Mechanics: • Immediate changes resulting from rapid maxillary expansion (RME) are both dental and skeletal in nature. with more favourable long-term outcomes expected in less skeletally mature patients. Patients who had cutaneous piercing before orthodontic treatment had a statistically significant increase in the prevalence of Ni hypersensitivity. with minimal sagittal and vertical skeletal changes arising. such as congenitally missing teeth.
There were also increases in arch width and intercanine and deciduous intermolar or premolar distances (Hashish et al 2009) Most studies that reported a reduction in temporomandibular dysfunction ( TMD) signs and symptoms after orthognathic treatment reported this association in skeletal Class II patients. distalization.019 x 0. and distal tipping of the molars. Clinically effective torque can be achieved in a 0. and is variable and larger than published theoretical values. The amount of supplementary mandibular growth achieved with functional appliances appears to be significantly larger if the functional treatment is performed at the pubertal peak in skeletal maturation. • Protraction face mask therapy is effective in Class III patients who are growing. demonstrating a large effect • • • • • . mainly in a vertical direction but there is no change in the position of the glenoid fossa (Mills et al 1991). as well as on bracket slot dimension. Surgical correction of skeletal Class III malocclusion after combined maxillary and mandibular procedures appears to be stable for maxillary advancements up to 5 mm and for the correction of presurgical sagittal intermaxillary discrepancies smaller than 7 mm (Mucedero et al 2008). combined orthodontic – surgical treatment duration is variable and appears to be operator sensitive. especially after surgery. however. In contrast. The Herbst appliance shows greatest efficiency. Data derived from medium/high quality research described over 75% of success of orthopedic treatment of Class III malocclusion (RME and facial mask therapy) at a follow-up observation 5 years after the end of orthopedic treatment. Protraction in combination with an initial period of expansion may provide more significant skeletal effects (Kim et al 1999) Functional appliances in Class II treatment • No appreciable restraining effect on the forward growth of the maxilla in either group (Andresen and Frankel appliances) is seen.• Effect of lip bumpers on mandibular arch dimensions: An increase in arch length was attributed to incisor proclination. This. continues to improve. Most patients experience restriction in mouth opening and lateral excursions after surgery. aggressive overcorrection at a skeletal level appears to be advisable and essential to the stability of the treatment outcome (De Toffol et al 2008). with an additional mandibular growth increment of 0. there is evidence that the earlier the orthodontic treatment begins the longer its duration. such as the technique employed. when Class II division 1 93 • malocclusions are considered. the participants’ skeletal deformity could have had a direct impact on TMD. age does not seem to play a role provided the patients are in the permanent dentition. but to a lesser degree in patients who are older than 10 years of age.28mm per month followed by the Twin-block with 0. The engagement angle depends on archwire dimension and edge shape. In contrast. the compliance of the patients. and most patients regain the full range of movement 2 years after surgery (Riyami et al 2009). the skill and number of operators involved. evidence of enhanced mandibular growth related to functional appliance treatment is limited and only seen when Articulare is used as a reference point for calculation of mandibular unit length (Chen et al 2002). Thus. A slight mean increase in mandibular growth could be observed.022 inch bracket slot with archwire torsion of 15 to 31 degrees for active self-ligating brackets and of 23 to 35 degrees for passive self-ligating brackets with a 0. and the severity of the initial malocclusion and impacted maxillary canines prolong treatment(Athanasiou et al 2008). There are indications that extraction treatment lasts longer than the non-extraction therapy.23mm per month (Cozza et al 2006). Clicking is more likely to improve than deteriorate after surgery. A decrease in the prevalence of signs and symptoms by more than 50% postsurgery compared with the presurgery state was reported in some studies whereas fewer subjects with skeletal Class III or a o high mandibular plane angle (>32 ) seemed to benefit from surgery. Functional appliances/ orthopedic appliances: Orthopedic appliances in Class III treatment. Bimaxillary surgical therapy could be considered an effective procedure in skeletal Class III malocclusion correction. various factors.025 inch stainless steel wire (Archambault et al 2010). 3. Thus. Patients having orthognathic treatment for correcting dentofacial deformities and also suffering from TMD are more likely to see improvements in their signs and symptoms than deterioration. crepitus does not seem to be affected by surgery. Extra oral appliances improve the sagittal intermaxillary relationship.
oral appliance therapy may have adverse effects on the craniomandibular and craniofacial complex (Hoekema et al 2004). Functional appliances and combination appliances reveal a large decrease in overjet. Oral appliances may be recommended for treatment of mild symptomatic OSA. Crown / Banded Herbst appliance did not produce statistically significant changes in the sagittal length or position of the skeletal maxilla. However increased maternal age is not associated with the development of isolated oral clefts. Fixed functional appliances. Removable Twin-block appliances also produce little change in the soft tissue profile. While Continuous Positive Airway Pressure (CPAP) is more effective than oral appliances. • Distraction osteogenesis is preferred to conventional osteotomy for younger CLP patients with more severe deformities. Patients undergoing both soft and hard palate closure before 3 yrs have significantly poorer occlusal outcomes. Fluoride-releasing bonding materials have a cariesinhibitory effect of 20% of total caries experience likely to develop during orthodontic treatment with fixed appliances. although the optimal 94 • • • .• on the maxillary skeleton. Dental changes have more impact than skeletal changes in the correction of Class II division 1 malocclusions (Barnett et al 2008). with both alternatives delivering marked improvements in facial aesthetics (Cheung et al 2006). Twin block appliances also show a significant effect on the maxilla. the difference in symptomatic response between these two treatments is not significant. However. Combination appliances (with both functional and extra oral appliance components) seem to affect the sagittal intermaxillary relationship by acting mainly on the mandibular skeleton as well as having a dentoalveolar effect on overjet. and those patients who are unwilling or unable to tolerate CPAP therapy (Lim 2006). impact and management • CL/P and CP occurrence is correlated with increasing birth order (Vieira et al 2002) and maternal smoking (Zeiger et al 2005). with concurrent mandibular osteotomy less frequently required. Functional appliances (activators and twin block) improve mainly by their effect on the mandible and show an important dental effect by overjet reduction. Delayed palatal closure generally results in better dental arch relationships. • 6. No significant change in the maxilla was seen. Valiathan A et al (1999)reported higher incidence of root resorption with Begg treatment in a review paper. 5. Distraction osteogenesis can correct moderate to large discrepancies by either complete or incomplete Le Fort I osteotomy. These appliances show very little clinical improvement in overjet. Activators and Bionators produce statistically significant but clinically insignificant changes in soft tissue profile (Flores Mir et al 2006).Iatrogenic effects and preventive measures • The treatment-related causes of root resorption include the total distance the apex moves and the time such movement takes (Segal et al 2004). The parental craniofacial complex in orofacial clefting is distinctive in comparison to the non-cleft and isolated cleft palate population.05% sodium fluoride mouth rinses may reduce the severity of enamel demineralization during fixed appliance therapy. However. They appear to achieve this growth modification by means of a sutural response. Daily use of 0. velopharyngeal function and speech between the two approaches. The use of topical fluorides in addition to fluoride toothpaste during fixed appliance therapy reduces the incidence of decalcification in populations with both fluoridated 4. which is not the case in the singular use of extraoral traction (Antonarakis et al 2007). Oral appliances in obstructive sleep apnoea (OSA) • Oral appliances improve subjective sleepiness and obstructive sleep apnoea (OSA) compared with a control. Use of Glass Ionomer cement for bracket bonding reduces the prevalence and severity of white spots compared with composite resins (Benson et al 2005). Cleft lip and palate (CLP): aetiology. There is no conclusive data on differences in surgical relapse. these differences are subtle and their characterization difficult (Weinberg et al 2006). measured with the GOSLON yardstick. with no change in the anteroposterior position of the lower lip and the soft tissue menton or improvement of the facial convexity being found (Flores Mir et al 2006). timing for palatal closure requires further investigation (Nollet et al 2005).
set of studies being too diverse and/or too weak. Bisphosphonates had a strong inhibitory effect (Bartzela et al 2009). gingival recession and increased pocket depth. have not accounted for confounders that may preclude appropriate interpretations. The controlled evidence suggests that orthodontic therapy is associated with small amounts of alveolar bone loss. Although systematic reviews are the best available source of evidence. No statistical test can overcome and rectify the methodological shortcomings of poorly designed primary studies. • Valiathan. there is the possibility that the data used in meta-analyses are not homogeneous. Non-steroidal antiinflammatory drugs (NSAIDs) decreased tooth movement. such as paracetamol (acetaminophen). because systematic review and Meta Analyses investigating orthodontic subjects are few. mandibular intercanine width tends to increase during treatment by about 1 to 2 mm. The net change in mandibular intercanine width of approx. it was not considered clinically important. postretention between 0. More occlusal settling arises with a Hawley retainer than with a clear overlay retainer after a retention phase of three months. Altman believed that the meta-analyses and systematic reviews of prognostic studies are difficult. It was found that all the four bonding agents were efficacious in caries inhibition and showed initial “burst effect” but the Time line and Ultra bond were not suitable as orthodontic adhesive due to poor shear bond strength.6 mm. Ultra bond and Orthodontic cement VP 862. hence only a few orthodontic questions have been answered with well-supported evidence so far. • LIMITATIONS OF META ANALYSIS AND SYSTEMATIC REVIEWS: • First. Regardless whether treatment was extraction or nonextraction.and non-fluoridated water supplies (Chadwick et al2005).” The challenge facing orthodontists in the 21st century is the need to integrate the accrued scientific evidence into clinical orthodontic practice. parathyroid hormone. or the research studies they are based upon. Vitamin D3 stimulates tooth movement.4 mm of the residual expansion remained.Ever Oba. the original dimension. Part of the problem is that some systematic reviews. had no effect.5 and –0. this was no greater than what is documented as normal growth. Corticosteroid hormones. 4. to decrease at postretention to approx.9% to 84% of tooth surfaces. • . Of the 6-mm average. Stability/retention • There is weak evidence of enhanced stability in both the mandibular and maxillary labial segments associated with circumferential supracrestal fibrotomy combined with Hawley retainers.9 mm during the short-term postretention period. In the long-term postretention period. A et al (1997) reported a prevalence of white spot lesions to vary from 4. There is no doubt that the Meta analysis and systematic reviews has its place in the evidencebased dentistry paradigm: however the validity of its findings is greatly dependent on the quality of the individual studies incorporated into the analysis. • The mean expansion was 6 mm (±1. • 5. at least as confirmed by Meta Analyses. Time line. This suggests a small mean worsening of periodontal status after orthodontic therapy. Estrogens probably reduce tooth movement. only 2. There was inadequate evidence that the expansion achieved beyond what is expected from normal development of the maxilla could be retained (Schiffman et al 2001). zero supports the concept of maintenance of the initial inter-canine width in orthodontic treatment (Burke et al 1998). Although statistically significant differences were noted. Claims that orthodontic therapy result in overall improved periodontal health cannot be supported with the existing controlled evidence(Anne-Marie Bollen et al 2008): Therapeutic administration of eicosanoids resulted in increased tooth movement. and thyroxin have all been shown to increase tooth movement. although no direct evidence is available. which subsequently was reduced to 3. a critical appraisal and a cautious interpretation of the results are essential. and dietary calcium seemed to reduce it. whereas their blocking led to a decrease. and to show a net change after 95 CONCLUSION Ackerman20 appropriately stated. versus Hawley retainers in isolation. A et al (1992) reviewed the efficacy of four fluoride releasing bonding agents Flour. but non-NSAID analgesics.9 mm was retained while wearing retainers. (Littlewoods et al 2006).3 mm). Homogeneity 19 is an important requisite of meta-analyses. Valiathan.
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