OBJECTIVES: This study aimed to evaluate the extent to which online communication can enhance patients' knowledge of orthodontic topics, as well as compare the effectiveness of images, video, and text messages as tools for delivering orthodontic information. MATERIALS AND METHODS: Two WhatsApp groups were created comprising 30 males and 33 females. The Google form template was used to formulate a 25-item questionnaire containing information related to orthodontic topics. At the beginning of the first stage, a link to the questionnaire was sent to the groups and their answers were given scores, which were referred to as (T1). During the second stage, a piece of daily information relevant to the field of orthodontics was sent to the groups over a 14-day period. On Day 15, the link to the previous questionnaire was sent again and the participants were asked to complete it for a second time. These answers were corrected, given scores, and labeled as (T2). Scores from the first and second stages were compared. RESULTS: There was a significant increase in the average total score from the first questionnaire (T1 = 15.3) to the second questionnaire (T2 = 17.9). All types of media formats were greatly effective in improving the patients' knowledge. Images proved to be the best tool for delivering information and were considerably more effective than video and text messages. CONCLUSION: This study indicates that WhatsApp as an online communication tool could be used to effectively enhance the knowledge of orthodontic patients. Images are the best method for delivering information to orthodontic patients.

OBJECTIVES: This study aimed to assess the perception of orthodontic staff members around clinical learning outcomes (LOs) of the undergraduate orthodontic curriculum with a focus on dental schools in Saudi Arabia. MATERIALS AND METHODS: Twenty-three LOs were formulated, all of which were associated with skills required in the undergraduate orthodontics course. Orthodontic staff members were invited to provide their opinion regarding the curriculum using a Likert scale, whereby participants could answer each question on a scale from “Strongly Agree” to “Strongly Disagree.” RESULTS: Sixty-one teaching staff members agreed to partake in this study. The highest level of agreement among the participants pertained to conducting systematic orthodontic intraoral and extraoral examinations (100%), followed by explaining causes for space loss (98.3%). The lowest level of agreement was regarding executing a treatment plan for non-skeletal cases (62.2%) followed by skills of fabrication and activation of removable appliances (77%). Around 67.1% of the academics refused to allow dental students to select and bond orthodontic brackets. CONCLUSION: It is time to amalgamate the objectives and create a unified national list of LOs for all orthodontic curriculums across the country without any distinction of knowledge or skills required at the undergraduate level.

OBJECTIVE: This study aims to facilitate a surgeon's preoperative assessment by detecting the prevalence, location, and course of the mandibular incisive canal (MIC) in our population. METHODOLOGY: A retrospective study was conducted at King Saud University, Riyadh, Saudi Arabia. A total of 93 cone-beam computed tomography (CBCT) scans of patients aged 18–50 years were taken. The images were reformatted from the sagittal sections to para-sagittal sections at premolars, canines, lateral incisors, and central incisors measured to the distance of MIC to the tooth apex, to the inferior border of the mandible, to the buccal cortex, and to the lingual cortex. RESULTS: MIC among the patients was found to be present in 96.8% of the total subjects. Prevalence between genders showed that it was present in 97.9% of the male patients and 95.5% of the female patients. The average distance from the buccal cortex is 4.88, the lingual cortex is 5.54, inferior border is 9.94, and root apices is 7.67. The age-wise and gender-wise comparison of a mean distance of MIC to the different surfaces in the different cross-sections showed that there is no correlation, and there is a significant correlation, respectively. CONCLUSION: The detection of the MIC presence and location using CBCT should be earnestly considered for surgical procedures that are intended to be done in the interforaminal region.

OBJECTIVES: This study aimed to evaluate the visual facial perception in response to scars associated with repaired cleft lip (CL) on a male adolescent model, as assessed by eye-tracking technology. MATERIAL AND METHODS: Unilateral and bilateral facial images of repaired CL on the upper lip and nasal asymmetry were added to an image of a male adolescent model, using Photoshop CS5 software. 40 laypeople eye movements were tracked by an infrared sensor of the Eye Tribe hardware in conjunction with OGAMA software. An analysis of variance was used to identify differences in total fixation time for the added areas of interest. A visual analog scale of attractiveness with a questionnaire were also incorporated into the study. Statistical analysis was performed using a significance level of P < 0.05. RESULTS: Significant differences were noted between the image with no scar and the image featuring a unilateral scar for total fixation time associated with the right eye (p = 0.002) and right nose area (p = 0.003), in addition to the numbers of fixations for the right eye (p = 0.005) and right nose area (p = 0.007). Comparing the image with no scar with the image featuring a bilateral scar showed a significant difference only for the number of fixations on the right eye (p = 0.005). The heatmaps and fixation point maps for both the unilateral and bilateral scar images indicated increased fixation for the scar areas. For the image with no scar, increased fixation was captured for the right eye area. Pearson's correlation coefficient test showed a moderate positive (p = 0.692) relationship when comparing to unilateral and bilateral cleft scars. CONCLUSIONS: The participating laypeople perceived the cleft-repaired faces and did not perceive any difference in attractiveness between the images featuring the unilateral and bilateral postsurgical clefts and lip scarring.

OBJECTIVE: The purpose of this study was to describe the dentofacial morphology of Yemeni adults. MATERIALS AND METHODS: The lateral cephalograms of 100 Yemeni adults (50 males, 50 females) were included in the study. All subjects were born to Yemeni parents and grandparents. They all had Class I occlusions with minor or no crowding, well-aligned upper and lower dental arches, good facial harmony, all teeth present except third molars, and no history of orthodontic therapy or maxillofacial surgery. Five angular and eighteen linear measurements were analyzed to determine the soft tissue, skeletal, and dental features. The differences for each measurement between Yemeni males and females were calculated using unpaired t–tests. RESULTS: Significant sexual and racial differences were found for three linear parameters in the skeletal analysis, one angle, and four linear dental measurements, and for all soft tissue linear parameters. Yemeni adults showed a tendency to a facial pattern of Class II, convex profile, reduced prominence of chin, increased lower facial height, and a clockwise rotation of the mandibular plane angle. CONCLUSION: Yemeni adults have different dentofacial parameters when compared to other racial standards, and these differences could aid in diagnosis and treatment planning.

OBJECTIVE: Esthetic enhancement plays an important role in orthodontic treatment. This study was conducted on females as most girls have their growth spurt at a younger age than boys do, so their demand to facial esthetics, especially those who have residual growth of mandible producing class III effect, requires full understanding to smile features helping in diagnosis and treatment planning for maximum patient satisfaction. MATERIALS AND METHODS: This study was conducted on 30 skeletal Class III and Class I female adults (18–30 years old) who were divided equally into two groups comprising 15 each. Two frontal digital photographs were taken for each subject, one at rest and the other in the posed smile position. Photographs were taken for each subject in the natural head position by a Canon EOS 1200 D camera set on a tripod at a distance of 1.5 m. The incisogingival height of the right maxillary central incisor was clinically measured using a vernier caliper to the nearest 0.1 mm. Photographs were uploaded on Photoshop software for standardization and then uploaded on the Digital Smile Design software (DSD) where the actual incisogingival height of the central incisor was used for automatic calibration. Esthetic components at rest and on smiling were measured for both groups; all linear variables were measured to the nearest 0.1 mm. RESULTS: Class III females tended to have wider smile widths, less gingival display, longer chin heights, shorter lower vertical dimensions, and a higher percentage of nonconsonant and flat smile arcs than Class I subjects. CONCLUSIONS: The components of the smile should be considered as a guide to help in planning and designing the mechanics during comprehensive orthodontic treatment.

AIMS: This study searched the effects of fluoridated toothpaste on the enamel surface of deciduous molars eroded by different pediatric liquid medicaments which were encircled by orthodontic bands by gravimetric analysis method. MATERIALS AND METHODS: A suitable orthodontic band was used to band each of the 110 non-carious exfoliated deciduous molars, and stored in artificial saliva. These teeth were divided randomly into fluoridated and non-fluoridated groups (50 teeth each), and 10 teeth were used as negative controls. The enamel surface of the fluoridated group was swabbed with fluoridated toothpaste for 5 minutes twice daily. Each group was subdivided into five clusters of 10 teeth each according to the type of medication used which included paracetamol, Adol, amoxicillin, Medazole (ME), and Viton (VI) according to a specific immersion cycle. The erosion induced in the enamel for all the teeth was evaluated by gravimetric analysis for different intervals. RESULTS: The results showed that the weight loss increased with increasing exposure to liquid medication for all groups, but this increase was smaller in the fluoridated group. The highest mean weight loss after 28 days was in VI, and the lowest was in ME (0.145 [0.005] mg; 0.08 [0.008] mg), respectively. CONCLUSION: The fluoridated toothpaste significantly reduced medically eroded enamel by oral medical syrups. The gravimetric method is valid for the detection of erosion on banded deciduous molars.

OBJECTIVES: The purpose of this study was to evaluate the accuracy and reliability of Mobile Application-Based Software for chair side cephalometric analysis. MATERIALS AND METHOD: Pretreatment lateral cephalograms of 20 patients (10 males and 10 females) were selected randomly and were traced manually and also using Application-based software (One Ceph). 20 angular and three linear parameters were measured both manually and with the software in all the patients. Inter and intra-operator reliability of one ceph was evaluated and the measured parameters were statistically compared with the manual method (Gold Standard). RESULT: The accuracy of angular and linear values was compared for all 23 parameters and our results showed no significant difference in the two methods used for most of the measurements. Three of the measurements [Angle of convexity (N-A; A-Pog); ANB angle; Upper Incisor to NA (Angular)] did show a statistically significant difference though these were clinically irrelevant. CONCLUSION: Application-based cephalometric analysis can be an effective clinical diagnostic tool for chair-side cephalometric evaluation of orthodontic patient.

OBJECTIVE: To comparatively evaluate the ability of three different customized lingual appliance systems in achieving predicted results with respect to the mesiodistal crown tip, labiolingual crown inclination, in–out position of Maxillary permanent anterior teeth, and Maxillary arch form. METHODS: Three commercial houses: Incognito, iLingual 3D, and Lingual matrix were analysed in this study. The final sample size consisted of 42 cases. Fourteen digital prediction and posttreatment models of the maxillary arch were provided by three orthodontic offices each using a different system. Discrepancies between the prediction and posttreatment model in mesiodistal tip, labiolingual inclination, in–out position of anterior teeth, and arch form were analyzed. RESULTS: Incognito displayed the highest accuracy in all parameters except for in–out positioning. Lingual Matrix showed greater precision in achieving planned mesiodistal positions than labiolingual inclination while it was just the opposite for iLingual 3D. All three systems proved to be clinically reliable in achieving the predicted in–out positions of permanent Maxillary anterior teeth. CONCLUSION: These systems were considerably accurate in achieving planned treatment goals with minute deviations from the predicted value.

OBJECTIVE: Stainless steel and nickel-titanium wires are commonly used in fixed orthodontic appliances. Orthodontists often prescribe fluoride gel to avoid demineralization of teeth. This study investigated the effect of acidulated phosphate fluoride gel on the tensile properties, surface morphology and surface chemical composition of stainless steel and nickel-titanium wires. METHODS: Forty samples of stainless steel and nickel-titanium wires were examined, twenty for each type. Each wire type was divided into four subgroups. The first subgroup was not immersed in fluoride gel and considered as control, while the other three subgroups were immersed in 10 mL of fluoride gel for different periods of time. Then, the wires were removed from the gel, rinsed in a distilled water and left to dry. The ultimate tensile force of each wire was measured using a tensile testing machine. Scanning electron microscope (SEM) and energy-dispersive X-ray spectroscopy (EDX) were used to examine the control and 24 h immersed subgroups. RESULTS: One-way analysis of variance ANOVA showed that there were no significant differences in the ultimate tensile forces between control and fluoride-treated subgroups (P = 0.172 for SS wires and P = 0.672 for NiTi wires). However, changes in the surface morphology and elemental composition of wires were shown by the SEM and EDX. CONCLUSIONS: Although immersion of stainless steel and nickel-titanium wires in the fluoride gel did not affect their tensile properties, however, surface deterioration was evident. So, further investigations are recommended to study the effect of these changes on the oral health of patients.

OBJECTIVES: The aim of the study was to clinically evaluate and compare 0.016-inch superelastic nickel–titanium (NiTi) and 0.016-inch heat-activated nickel–titanium (NiTi) archwires in terms of alignment efficiency, root resorption, and pain intensity. METHOD: A total of 20 patients requiring fixed orthodontic treatment, having Little's irregularity index of 5–8, and requiring first premolar extractions were recruited. They were randomly allocated to receive two different archwires (0.016-inch superelastic NiTi or 0.016-inch thermoelastic NiTi). Good-quality impressions were taken of the lower arch before archwire placement (T0) and at every month after that till the alignment was complete. The rate of tooth alignment was measured on casts by determining Little's irregularity index. The pain experienced by the patient was assessed 24 hours and 1 week after the placement of the archwire on a visual analogue scale. Cone beam computed tomographic radiographs of lower anterior teeth were taken before and after alignment to assess root resorption. Data obtained were subjected to statistical analysis using the SPSS software (version 20.0). The level of significance was kept at 5%. RESULTS: The repeated measures ANOVA indicated that there was no significant difference in the aligning efficiency of superelastic and heat-activated NiTi wires. (p = 0.45). The Mann Whitney U test showed that superelastic NiTi wires had statistically significant higher VAS scores than heat-activated NiTi at 24 hours and 1-week interval (p < 0.05). Student's t-test indicated greater root resorption with superelastic NiTi but the difference was not statistically significant. CONCLUSION: Both the wires showed similar aligning efficiency and resulting root resorption. Superelastic NiTi was observed to produce more pain compared to heat-activated NiTi in the aligning phase.

Aim: To evaluate and compare the efficacy of Ozonated Olive Oil Gel, Chlorhexidine gel, and Amflor (Fluoridated) mouthwash on reducing the count of Streptococcus mutans and Lactobacillus in patients undergoing fixed orthodontic therapy evaluated at different time intervals. Methods: Sixty patients undergoing orthodontic treatment were randomly divided into three groups (n = 20) based on antimicrobial agents used (Group 1: Ozonated olive oil gel; Group 2: Chlorhexidine gel; Group 3: Fluoridated mouthwash). Elastomeric modules from brackets were collected at T₀ (Fresh samples) and T₁ (2^nd week) and T₂ (4^th week) for assessment of the microbial growth. These collected modules were cultured and evaluated for the presence of Streptococcus Mutans and Lactobacilli and numbers of colonies were counted at each interval. Data obtained was subjected to statistical analysis using SPSS software (Version 20.0). Level of significance was kept at 5%. Intra-group and inter-group comparison between pretreatment, 2^nd week and 4^th week was done for each group using Wilcoxon signed rank test and Mann–Whitney U test. Results: There was presence of Streptococcus Mutans and Lactobacilli during orthodontic treatment which progressively increased from T_o to T₁ and then declined from T₁ to T_2. The colony counts were maximum for Fluoridated mouthwash and least for Chlorhexidine and the results were statistically significant (P < 0.05). Conclusion: All three antimicrobial agents used were effective against Streptococcus mutans and Lactobacillus. Chlorhexidine proved to be more efficacious whereas Fluoridated mouthwash proved to be least effective against both Streptococcus mutans and Lactobacillus bacteria.

BACKGROUNDS: Bleaching procedure can be companied before, during, or after orthodontic treatments. However, the risk of compromised bond strength of brackets to bleached enamels is in debate. This study tried to evaluate the shear bond strength (SBS) of bonded metal brackets to the previously bleached enamels. MATERIALS AND METHODS: In this in vitro study, 60 extracted, sound, human premolars were mounted vertically in cylindrical molds. The samples were randomly divided into four groups (n = 15): Control (C); at-home bleached by 20% carbamide peroxide (HB); in-office bleached by 45% carbamide peroxide (OB); and in-office bleached by 40% hydrogen peroxide activated with diode laser (L-OB). Sixty stainless steel brackets were bonded by no-primer adhesive resin (OrthoCem). Then SBS of bonded brackets was measured after 5000 thermal cycles at 5°C and 55°C. Finally, the collected data were analyzed by one-way ANOVA, and Tukey HSD tests by using SPPS software at a significant level of 0.05 (α = 0.05). RESULTS: Group C showed significantly higher SBS values (all P < 0.001); however, there were no significant differences in SBS compared to other tests' groups with each other (all P > 0.05). CONCLUSION: The SBS of bonded orthodontic brackets were compromised after bleaching with 20% and 40% of carbamide peroxide. Diode laser activation may not eliminate the negative effect of bleaching agents on SBS of bonded orthodontic brackets, neither.

AIM: To evaluate the stress changes in the maxilla during fixed functional appliance use using three-dimensional finite element method (FEM) stress analysis. SETTINGS AND SAMPLE POPULATION: A three-dimensional finite element model of the maxilla was constructed using the images generated from the cone-beam computed tomography of a patient treated for Class II malocclusion with a fixed functional orthodontic appliance. The FEM was used to study the stress changes seen in the maxilla, which were evaluated in the form of highest von Mises stress and maximum principal stress before and after the application of fixed functional appliance. RESULTS: Higher areas of stress were seen in the model of the maxilla with the fixed functional appliance (140 MPa) compared to that in the resting stage (58.99 MPa). CONCLUSIONS: An increase in the maximum principal stress and von Mises stress in the posterior regions of the maxilla and maxillary teeth was seen. The stresses seen were double than that without the appliance. A high distalization force on the maxilla was seen with the fixed functional appliance.

OBJECTIVE: The purpose of this split-mouth single-centered, parallel-group, randomized clinical trial was to evaluate the efficiency of corticotomy-facilitated orthodontics in rapid canine retraction. METHODS: The sample consisted of 10 patients (15–25 years old) requiring extraction of the maxillary first premolars with subsequent canine retraction. The patients' right sides were randomly assigned to either the corticotomy (experimental) or control groups. Corticotomy cuts and perforations were performed and canine retraction was initiated bilaterally with closed-coil nickel-titanium springs that applied 150 g of force. The following variables were examined till the end of canine retraction on both sides: Rate of canine retraction, canine root resorption, and patient perception of the procedure. The rate of canine retraction was assessed every month using study models while root resorption was evaluated using CBCT. Patient's perception was evaluated using a 100 mm VAS. RESULT: Mean time taken for full completion of canine retraction: 5.7 months (test) and 7.1 months (control). Mean root resorption: 0.53 ± 0.10 (control) and 0.24 mm ± 0.10 (test). Mean VAS scores: 16 ± 3.94 (24 hours) and 2 ± 2.58 (1 week) at control side and 46.50 ± 6.69 (24 hours) and 2 ± 2.58 (1 week) at test. CONCLUSION: There was an overall reduction in the time taken for canine retraction with corticotomy; however, an increase in the rate of canine retraction in the corticotomy-facilitated method was evident only for the first four months, compared to the conventional method. Less root resorption was observed in corticotomy-facilitated method than conventional method. Pain perception was more for corticotomy-facilitated method than conventional method at 24 hours, but similar after one week.

OBJECTIVES: The present study aimed to assess the level of mothers' knowledge toward cleft lip and palate and their experience concerning presurgical orthopedic management. MATERIALS AND METHODS: This was a cross-sectional study where the mothers were invited to complete a self-administered validated and reliable questionnaire. The questionnaire included questions that aimed to assess mother's knowledge related to the most prevalent aspects of cleft lip and palate anomaly itself and additionally, questions associated with presurgical orthopedic treatment as an adjunct therapy. Descriptive statistics were used to define the characteristics of the study variables. Chi-square test was utilized to assess relationships between categorical variables. RESULTS: Totally, 145 mothers completed the survey (response rate was 73%). Forty-six (46%) of the mothers provided an incomplete or improper definition of the anomaly and 35 (24%) claimed that they know the cause of the anomaly. The majority of mothers did not identify family history as a risk factor; consanguinity was identified in 29% (n = 42). Of the total, 58 mothers (40%) agreed that dental management of CLP requires teamwork and the majority (n = 126, 87%) recognized the plastic surgeon as the most important specialist. Mothers aged 20-30 years old (n = 42, 53%), and those who are university graduates (n = 38, 48%), as well as employed mothers (n = 52, 66%) have in general a higher degree of knowledge regarding cleft lip and palate (P < 0.001). More than half of the mothers (n = 70, 57%) reported that presurgical orthopedic treatment was useful and needed for their infants. CONCLUSIONS: Most of the mothers reported a high level of knowledge about cleft lip and palate and they experienced the usefulness of the orthopedic appliances for their infants. However, there was uncertainty in some parts such as definition, diagnosis, causes, and risk factors for cleft lip and palate. Therefore, understanding the causes of cleft lip and palate, as well as comprehensive education concerning the essential role of the orthopedic appliances to improve cleft lip and palate are crucial for mothers to improve their infants' quality of life.

OBJECTIVES: The aim of the present study was to investigate the trends in the use of fixed appliance and accelerated orthodontics to decrease the treatment duration. Further, this study aimed to assess the effect of demographic factors on the participant's choice of treatment modality. METHODS: This was a cross-sectional study in the form of questionnaire-based online survey especially designed and distributed to 265 orthodontists via email. The questions aimed to collect basic information about the participants and respondents' choices for decreasing the treatment duration. The data were analyzed according to gender, level of academic education and years of clinical experience using Chi-square test. RESULTS: A response rate of 85.2% was reported. Most of the orthodontists aimed to reduce the treatment duration by the biomechanical (66.8%) and surgical approaches (27.4%). The use of sliding mechanics (69.4%) and one-step retraction was more common (66.3%). MBT bracket prescription was more prevalent (51.7%), followed by Roth (41.1%). Conventional brackets were used more than self-ligating brackets, and aesthetic brackets were avoided by one third of the respondents. NiTi wires were the most commonly used wires during the alignment stage (44.2%). However, the effect of gender, years of clinical experience and specialty level of education showed some effects on the use of certain techniques and clinical practice of the respondents. CONCLUSIONS: Most of the orthodontists aimed to decrease orthodontic treatment duration by using biomechanical and surgical approaches. Gender and clinical experience to a certain extent affected the participants' choice during orthodontic treatment.

OBJECTIVES: This study was aimed at assessing the knowledge and awareness of orthodontists and orthodontic residents in Nigeria about the COVID-19 pandemic and the appropriate infection control measures required to mitigate its spread in orthodontic practice. MATERIALS AND METHODS: It was a cross-sectional descriptive study of orthodontists and orthodontic residents. Ethical approval for the study was obtained from the Institutional Review Board. Data collection was via an online questionnaire designed using Google forms and these were sent to the phone numbers of study participants. Data analysis was done using Statistical Package for Social Sciences version 20. RESULTS : A total of 73 respondents with a mean age of 43.41 ± 9.21 years participated in the study. About 90% of the respondents had a very good knowledge of COVID-19, including its etiology, modes of transmission, signs, and symptoms. However, very few respondents were aware of the less common symptoms such as skin rash (16.4%) and red eyes (26%). Over 80% of the respondents knew the appropriate measures to take to prevent the spread of the virus in the dental clinic, in addition to the appropriate personal protective equipment (PPE) to use. CONCLUSION: The respondents had a very good knowledge of the basic epidemiology of COVID-19 and the means of prevention of its transmission in the dental clinic. However, there was limited knowledge of the less common symptoms of the infection. In addition, majority of the respondents had a very good idea of the appropriate PPE to be used.

OBJECTIVE: To provide a cost-saving innovative audience response system (ARS) that permits typing texts and compare its efficiency to the paper-based method in case-based learning (CBL). MATERIALS AND METHODS: Orthodontic clinical cases were presented to 149 undergraduate dental students for discussion among teammates. Responses were collected using ARS-based and paper-based. ARS was constructed from an online survey platform (Google forms) then QR code was created for easy and fast access. Students used their cellphones to scan code, view questions, discuss, type, and submit answers within 10 minutes. Feedbacks were collected using a feedback survey. Outcome measures included the number of words, spelling mistakes, time required by the instructor to read submissions, and activity time compliance. RESULTS: The average number of words submitted by females in ARS-based 47 ± 8 was significantly higher than 35 ± 16 paper-based, and male ARS-based 36 ± 18 (P < 0.05). ARS-based submissions required significantly less time to read compared to paper-based among whole group, females, males (P < 0.001, P < 0.05, P < 0.001), respectively. Spelling mistakes were lower 1 ± 1 in ARS-based compared to paper-based 2 ± 2. The ARS-based first submission was (-4.28) minutes before the deadline, while paper-based last submission was (+2.19) minutes after (P < 0.05). ARS-based submissions were 12.5 seconds faster to read than paper-based (P < 0.001). Out of 56.4% of respondents, 63.1% preferred using ARS-based and 80% agreed that it provided immediate feedback, with high overall satisfaction. CONCLUSIONS: This innovated ARS was found to facilitate CBL. It is superior in time and cost-saving to paper-based and other ARSs. It could be useful in distance learning especially during the COVID-19 pandemic.

OBJECTIVE: This study aimed to test the intra and inter-rater reliability, reproducibility, and validity of a new guide called the “Cone Beam Computed Tomography-Maxillary Canine Impaction (CBCT-MCI),” designed to assess the position, severity, and predictability of the maxillary canine impaction (MCI) treatment intervention using Cone Beam Computed Tomography (CBCT). MATERIALS AND METHODS: This study is a retrospective radiographic review of 44 patients with unilateral or bilateral MCI. A total of 56 maxillary impacted canines' CBCT radiographs were analyzed using the new CBCT-MCI guide, with each of its 10 items scored. The total scores of the 10 items were then compared to a scale to predict the best treatment intervention of MCI: normal spontaneous eruption, surgical-orthodontic traction, or surgical extraction. Radiologists and orthodontists have developed, tested, and retested the CBCT-MCI guide on the same 56 maxillary impacted canines using CBCT radiographs to check its reliability and reproducibility using the Kappa coefficient. Furthermore, the validity of this guide was tested by comparing the predicted best treatment intervention with the actual treatment administered to the assessed impacted maxillary canine using the Kappa coefficient and percentage of agreement using cross-tabulation. RESULTS: The result of this study showed significantly strong Kappa values of intra-rater agreement (k = 0.91, (P < 0.0001) and inter-rater agreement (k = 0.84, P < 0.0001). Furthermore, testing the relationship between the two MCI treatment interventions using cross-tabulation, the agreement percentages between the predicated and actual treatment plans of the assessed MCI ranged between 70% and 95.5% with a significantly strong Kappa value (k = 0.82, P < 0.0001). CONCLUSIONS: This study suggests that the CBCT-MCI guide is capable of producing accurate, reliable, and reproducible results in assessing and predicting the type of orthodontic treatment intervention of MCI in a simple, quick, and efficient way.

OBJECTIVE: To evaluate the surface topography and roughness of orthodontic arch wire materials, including low-friction titanium molybdenum alloy (TMA), conventional TMA, and stainless-steel arch wires. MATERIALS AND METHODS: The surface topography was evaluated using atomic force microscopy (AFM). A total of 24 wire specimens were used for the AFM scans {8 low-friction TMA (TMA-Low), 8 conventional TMA (TMA-C), and 8 stainless steel (SS)} (Ormco, Orange, CA, USA), measuring 0.016 × 0.022 inches. The conventional and low-friction TMA arch wires served as the test groups, while the stainless-steel arch wire served as the control group. RESULTS: Surface roughness evaluation using AFM revealed that the highest mean of all three roughness parameters was found in the TMA-C group followed by the TMA-Low and SS arch wires in descending order. Pairwise comparison of the mean values showed that the mean value of the SS arch wire material is statistically significantly lower than the mean values of the other two arch wire materials (TMA-C and TMA-Low). However, there was no statistically significant difference in the mean values of TMA-C and TMA-Low arch wires. CONCLUSION: The SS arch wire showed the smoothest surface topography among the alloys and had statistically significantly lower roughness values than the TMA-C and TMA-Low groups. Low-friction TMA arch wire is still considered to be inferior to stainless steel arch wire.

OBJECTIVE: To search the effects of Curve of Spee (COS) flatting on the stresses and displacement on the different mandible landmarks and lower teeth during posterior teeth loading using three-dimensional (3D) finite element analysis. MATERIALS AND METHODS: Three-dimensional hemi mandibular model was created from real selected mandible. The lower teeth was aligned originally in a curved form with 2.4 mm depth at the cusp tip of the second premolar. Another replica with flat aligned teeth was formed to confirm the analysis by up righting premolars and molars. A load was applied at mesio-buccal cusp of the lower first molar on both models, and the resultant stresses and displacements on the mandibular landmarks and the lower teeth were tested. RESULTS: Von mises over the mandible was higher in flat than in curve model. The highest stress levels were detected at the Mesio-buccal cusp tip of first molar for flat and curved simulation (5053, 3304) Mpa respectively. Mesio-distally, the teeth displacement was higher in curve model than in flat one. The maximum distal displacement, in flat model, was seen in central and lateral incisors. While, in curve model, the maximum distal displacement was grasped within first and second premolars. CONCLUSIONS: Flatting the COS magnify the stresses over whole mandible and reduce lower teeth displacement mesio-distally. We speculated that the readjustment of the COS after orthodontic treatment could reduce the stress and displacements on the lower anterior teeth and decrease the lower anterior teeth crowding relapse.

OBJECTIVES: To develop and test the validity and reliability of an Arabic version of the psychosocial impact of dental aesthetics questionnaire (PIDAQ). MATERIALS AND METHODS: The original English version was translated into Arabic, back-translated, pre-tested, and cross-culturally adapted before being administered to 205 individuals aged between 18–30 years from Medina, Saudi Arabia. Cronbach's alpha coefficient was used to test internal consistency, and the intraclass correlation coefficient (ICC) was used to assess test–retest reliability. Construct validity was assessed using factor analysis, and convergent validity was tested by comparing PIDAQ scores to the aesthetic components of the Dental Aesthetic Index (DAI) and Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC), while discriminant validity was assessed by comparing PIDAQ scores to participants' self-evaluation of orthodontic treatment need. Gender and age differences in the PIDAQ score were assessed. RESULTS: Cronbach's alpha coefficient was 0.940, corrected item-total correlation coefficients were between 0.509 and 0.719, and the ICC was 0.937. Principal component factor analysis extracted three domains, and factor loading ranged from 0.563 to 0.843. Total PIDAQ score and subscale scores had significant correlations with the DAI and IOTN-AC. The questionnaire discriminated well between participants who had a perceived need for orthodontic treatment and those with no perceived need. There were no significant age or gender differences in participants' PIDAQ scores. CONCLUSIONS: The Arabic version of the PIDAQ had excellent psychometric properties with sufficient reliability and validity to be used for the assessment of the orthodontic-related quality of life in young Arab adults.

OBJECTIVE: To assess the practice of using orthodontic brackets as tooth decorations among dental offices and patients in Jeddah, Saudi Arabia. MATERIALS AND METHODS: The study was a cross-sectional survey using 2 questionnaires. The first included 14 doctor questions where 300 dental offices in Jeddah, Saudi Arabia were contacted by phone. The second questionnaire included 22 patient questions where 50 patients who currently have or have had decorative braces answered the questions online. RESULTS: Out of 250 dental offices that responded, 91 offices (36.4%) answered “yes” to offering decorative braces. Most dentists use metal brackets (96.3%) on both the upper and lower arches (98.8%) and ligate a wire (83.8%) using colored elastomeric ligatures. Out of 50 patients who answered the patient questions, 28 patients (56%) were females and the mean age was 19.84 years (±2.32). 37 (74%) patients reported that their decorative braces were not placed by dentists and mostly by over the counter glue. Finally, 62% reported they were not satisfied, and 84% said they would not recommend getting decorative braces to their family and friends. CONCLUSION: Our results indicate that the use of decorative braces is prevalent, and most are not being placed by dentist. As healthcare providers, we are obliged to educate the public of potential harm that can result when decorative braces are used, to hopefully limit the spread of this unfortunate practice.

OBJECTIVE: To evaluate the orthodontic treatment outcome among patients with non-syndromic unilateral cleft lip and palate using the Peer Assessment Rating (PAR) index. MATERIALS AND METHODS: The retrospective study comprised a sample of 80 patients with unilateral cleft lip and palate (39 males and 41 females) with complete pretreatment and posttreatment orthodontic records. The patients were divided into two groups according to the treatment modalities. Group 1 (n = 55), nonsurgical (consisted of patients treated with comprehensive orthodontics) and Group 2 (n = 25), surgical (with presurgical orthodontics followed by maxillary advancement orthognathic surgery). PAR score was evaluated on pretreatment and posttreatment study models for both groups. RESULTS: The mean percentage change for the weighted PAR score of Group 1 and Group 2 was 76.79 ± 20.27% and 82.37 ± 11.38%, respectively. Out of the total sample of 80 cases; 62 (77.5%) cases were “greatly improved,” 16 (20%) cases were “improved,” and 2 (2.5%) showed “worse/no improvement.” Nearly 72.5% of cases in Group 1 and 88% in Group 2 were greatly improved. CONCLUSIONS: The reduction in PAR score in both groups was satisfactory as more than 70% of the patients were in the greatly improved category. The results of the PAR index revealed a high occlusal outcome of orthodontic treatment rendered by the department for patients with unilateral cleft lip and palate.

OBJECTIVE: To compare demineralization around orthodontic brackets cured by conventional method and transillumination method. MATERIALS AND METHOD: Sixty freshly extracted human premolar teeth were divided into four groups. Group 1: Brackets bonded with conventional method of bonding by curing labially for 40 sec. Group 2: Brackets bonded with transillumination method of bonding for 50 sec. Group 3: Brackets bonded with conventional method of bonding by curing labially for 20 sec followed by 30 sec of transillumination. Group 4: Brackets bonded with transillumination method of bonding for 30 sec followed by labial curing for 20 sec. Ground sections were prepared of each tooth and microleakage was evaluated using a binocular microscope at 40× magnification (Olympus BX53) and an image was taken using a digital camera (Olympus EPL3) connected to the microscope. The images were analyzed using Magnus Pro Image software. Scores were assigned to different degrees of microleakage at the demineralization zone around enamel-adhesive-bracket complex at the occlusal, middle, and gingival margins using linear measurement tool. Data obtained was subjected to statistical analysis using SPSS software (Version 20.0). Level of significance was kept at 5%. Intragroup comparison was done using Kruskal-Wallis test followed by Mann-Whitney U-tests for pairwise comparison. RESULTS: Group 4 showed least mean demineralization in occlusal, middle, and cervical areas as compared to other groups and the results were statistically significant (P < 0.05). CONCLUSION: Transillumination can be employed as a method synergistically with conventional curing to achieve minimum amount of demineralization during fixed orthodontic treatment.

OBJECTIVE: To determine the frequency of congenitally missing maxillary lateral incisors (LIs) and to find out its variability in relation to gender. MATERIALS AND METHODS: A retrospective study was carried out between January 2017 and December 2017. Orthopantomographs (OPGs) and lateral cephalographs record search of all orthodontic adolescent patients aged 12 to 18 years were taken from the archival records of the department. Orthopantomographs helped to diagnose the presence of unilateral/bilateral maxillary lateral incisors while the ANB angle was calculated from the lateral cephalographs to divide the subjects into various skeletal malocclusions. STATISTICAL ANALYSIS USED: The statistical analysis was done using the Statistical Package for Social Sciences (SPSS version 17.0). The frequencies were compared with the help of the Chi-square test. P<0.05 was considered statistically significant. RESULTS: The frequency of missing upper laterals among the male patients was 0.9%, however, 2.8% of the female patients were having missing maxillary lateral incisors. Based on gender, 62.16% had a bilateral expression of missing upper laterals, 16.21% had left unilateral expression, and 21.62% had right unilateral expression. Furthermore, skeletal class I malocclusion had a prevalence of 54.16% of bilateral missing lateral incisors in upper arch as compared to 40% of left unilateral expression and 37.5% of right unilateral expression whereas in skeletal class II malocclusion, the prevalence of right unilateral expression was 37.5% as compared to bilateral expression which was 33.33%. The left unilateral expression in skeletal class II malocclusion was found to be only 20%. The highest prevalence of missing laterals in skeletal class III malocclusion was left unilateral expression which was around 40%. The prevalence of right unilateral expression was 25% whereas the bilateral absence of upper laterals in skeletal class III malocclusion was 12.5%. CONCLUSION: The prevalence rate for congenitally missing upper lateral incisors in the orthodontic adolescent population aged 12 to 18 years was found to be 3.77% in the present study while females were found to have a greater percentage of agenesis of the upper lateral incisors (2.8%) as compared to the males (0.9%).

OBJECTIVE: The study aimed to assess the accuracy and reliability of five cephalometric parameters in diagnosing class III malocclusion in Saudi and Yemeni population. MATERIAL AND METHODS: A cross-sectional, descriptive study in which total 60 lateral cephalograms (30 of Saudi and 30 of Yemeni population) of Class III malocclusion were hand-traced. ANB angle, Wits appraisal, Beta angle, W angle, and Yen angle were measured. The validity, reliability, sensitivity, and positive predictive values (PPVs) of these parameters were calculated. RESULTS: In Saudi population, a strong correlation was found between ANB angle and Wits appraisal (r = 0.892, P < 0.05), ANB and Beta angle showed highest sensitivity (0.933) followed by Wits appraisal (0.900), and ANB angle showed the highest PPV (0.965) followed by Beta angle (0.933) and Wits appraisal (0.931). In Yemeni population, a strong correlation was found between ANB angle and Wits appraisal (r = 0.887, P < 0.05), ANB angle and W angle showed highest sensitivity (0.966) followed by Wits appraisal (0.933), whereas W angle showed the highest PPV (1.00) followed by ANB angle (0.966) and Wits appraisal (0.933). CONCLUSION: In Saudi population, ANB angle and Beta angle, whereas in Yemeni population, ANB angle and W angle are the most valid cephalometric indicators to accurately assess the class III malocclusion. ANB angle in the Saudi population and W angle in the Yemeni population have the highest PPV in correctly diagnosing class III malocclusion.

OBJECTIVE: To evaluate the skeletal, dental and soft tissue cephalometric changes by addition of daytime Class III elastics to the Alternate Rapid Maxillary Expansion-Constriction (AltRAMEC) and Reverse Headgear (RH) protocol in skeletal Class III patients with maxillary retrusion. Material and Methods: 54 patients with maxillary retrusion and CVMI (Cervical vertebral maturity index) <CS3 were randomly allocated to an AltRAMEC/RH group (group 1) and AltRAMEC/RH/Class III elastics group (group 2). Each group underwent 5 weeks of AltRAMEC using bonded RME (Rapid Maxillary Expansion) appliance, followed by reverse headgear therapy with a Petit type facemask for 4-5 months. The protraction so obtained was maintained by the use of daytime Class III elastics in group 2. A total of twenty skeletal, dental and soft tissue parameters were evaluated by a blinded examiner. Results were evaluated statistically. Results: Significant forward movement of the maxilla with counter-clockwise rotation, improved intermaxillary relationships, downward and backward movement of the mandible, and favourable soft tissue changes were observed in both the groups under study. The results were more pronounced in group 2. Increase in vertical dimensions, proclination of maxillary and retroclination of mandibular incisors was also observed. Statistically significant differences were present between the two groups for all of the maxillary and mandibular skeletal, intermaxillary and two of the soft tissue parameters tested; while the differences were not found to be significant for dental parameters. Conclusion: Addition of Class III elastics to the AltRAMEC/RH protocol yielded more pronounced, favourable and statistically significant results.

OBJECTIVE: To compare airway widths among skeletal Class I malocclusion patients with different vertical facial patterns. MATERIAL AND METHODS: A total of 103 lateral cephalograms of skeletal Class I patients (mean age of 20 ± 2.3 years) with no history of orthodontic treatment, trauma, facial syndromes, or nasopharyngeal dysfunction were included. Based on the Frankfort–mandibular plane angle measurements, the sample was divided into three groups: low-angle, high-angle, and normal-angle groups. Upper and lower pharyngeal airway widths were measured as described by McNamara. The analysis of variance test was performed to compare the means of groups. Pairwise comparisons were performed using Tukey's post-hoc test. Differences were considered statistically significant at P < 0.05. RESULTS: ANOVA showed a significant mean difference between the groups for both the upper and lower airway widths withP values of 0.011 and 0.003, respectively. Tukey Pairwise comparisons showed the upper airway width to be significantly narrower in the high-angle group compared to the normal-angle (P = 0.021) and low-angle groups (P = 0.013). Furthermore, the lower airway width in the high angle group was significantly narrower than the normal angle (P = 0.020) and low-angle groups (P = 0.017). There were no statistically significant differences between normal and low angle groups. CONCLUSIONS: The upper and lower pharyngeal widths in the Class I high-angle group were significantly narrower than those in the normal-angle and low-angle groups.

OBJECTIVE: To compare dental and skeletal ages among African American (AA), Caucasian (C) and Hispanic (H) subjects (chronological ages 9 to 15-years). MATERIAL AND METHODS: A total of 168 subjects (9 to 15 years old) were equally divided into AA, C, and H groups, with an equal number of males and females. Each group was divided equally into 7 chronological age-groups, ranging from 9 to 15 years. Dental age was determined from panoramic radiographs as primary, early mixed, late mixed, or permanent dentition (scored as 1-4). Skeletal age was calculated from hand-wrist radiographs using Fishman's Skeletal Maturation Index (SMI 1-11). One-way analysis of variance and Tukey's test were used to compare skeletal and dental ages among AA, C and H subjects; and AA, C and H subjects in each chronological age-group. The two-sample t-test was used to compare SMI and dental age among females and males. RESULTS: Skeletal and dental age were not significantly different between AA, C and H subjects. Mean SMI was higher in females than males; and there were no significant gender differences regarding dental age. Mean SMI and dental age were significantly different among AA, C and H subjects in the 12-year-old and 11-year-old age groups, respectively. CONCLUSIONS: Dental and skeletal maturation are fairly similar among AA, C and H subjects (aged 9 to 15 years).

OBJECTIVE: This study aimed to assess the feasibility of reusing nickel–titanium (NiTi) alloy wires after 6 weeks of intraoral use by evaluating the changes in the load-deflection properties and surface characterization of these alloy wires after cold sterilization by immersion in 2% of acidic glutaraldehyde for 10 h. MATERIAL AND METHODS: Twenty wires each in three groups of G1-as-received wires (ARW), G2-unsterilized used wires, and G3-sterilized used wires (SUW) were tested by the three-point bending test and scanning electron microscopy (SEM). The data were subjected to statistics, one-way analysis of variance, and Bonferroni posthoc test for comparison. RESULTS: Recycling of NiTi wires produced statistically insignificant changes in both the loading and unloading properties of the wires. The forces needed to twist the used wires, that is, G2-(UUW) and G3-(SUW) were lower than G1-(ARW), suggesting lowering of the stiffness of the wires. Superelasticity is well-maintained by G2-(UUW) and G3-(SUW) although there is an insignificant lowering of the forces exerted by them during loading and unloading. SEM demonstrated no increase in the pitting of surfaces in both G2-(UUW) and G3-(SUW); multiple areas were seen to be more smoothened over G2-(UUW) and G3-(SUW) NiTi wires surfaces. CONCLUSION: The findings of this study support the reuse of NiTi wires after 6 weeks of use in oral conditions followed by cold sterilization by immersion in 2% acidic glutaraldehyde for 10 h.

OBJECTIVES: To analyze the craniofacial morphology in child patients and adolescents by evaluating the skeletal cephalometric profile of the HIV infected patients in this age group and comparing them with the HIV-negative controls. MATERIALS AND METHODS: The present study was a planned case-control study which included 25 HIV-positive adolescent patients aged between 10 and 18 years (the study group) who were compared with 25 age- and sex-matched HIV-negative adolescent controls (the control group). All the patients had been HIV infected via a vertical transmission with positive serology confirmed in two different tests and had been kept on HAART since they were born. The diagnostic aids used for orthodontic documentation included facial photographs, digital orthopantomographs, lateral teleradiographs, and study models. RESULTS: With reference to the methodologies used for taking the cephalometric values, all the methods used were in strong agreement with each other for almost all the variables studied and had high intra-class correlation coefficient values except Co-A, SN.ANSPNS, and SNB which, too, had a good agreement of 60%. Nevertheless, the agreement was positive for these variables, too, since the P values obtained were found to be statistically significant (P < 0.05). CONCLUSION: Most of the measurements in the HIV-infected adolescents were found to be similar to the ones obtained for the HIV-negative controls, although, the study results highlighted the significance of further studies to be conducted in this regard, especially, the longitudinal study designs wherein the said variables can be studied on a follow-up basis in longitudinal studies to have an idea of the exact changes observed and their pattern in the included groups.

OBJECTIVES: To evaluate the perception of esthetics and the attractiveness of the smile, in frontal view, with mandibular asymmetry, through the eye-tracking. MATERIALS AND METHODS: OGAMA software and The Eye Tribe Tracker hardware were used to obtain eye tracking in certain areas of interest on the face. To simulate asymmetry, Photoshop® image editing software was used to create a vertical reference line to the midline of the face and make it symmetrical with control of the angulation relative to another horizontal reference line passing through the vertices. Then, the lower third of the face added asymmetries or deviations, starting from zero, with increments of 2 by 2 degrees up to 6 degrees. The study included 60 laypeople, 30 males and 30 females, without any knowledge about the study, showing good vision, and not having used drugs with the possibility of influencing cognitive or motor skills. RESULTS: From the heat map in cases of mandibular asymmetry, it is possible to visualize that for both sexes the evaluators evaluated with a certain degree of similarity mainly when the deviations presented with 6 degrees. The trajectory of the male and female gaze in cases with asymmetry shows that in cases with a magnitude of 6 degrees, the raters traced mainly in the region of the mouth with little transition in the eye region and mainly in the areas of interest considered as “other.” In the images presented with a magnitude of up to 4 degrees, they were traced in the general image. CONCLUSIONS: The perception of laypeople from mandibular asymmetry to the right in females presented a higher perception when compared to males with mandible asymmetry to the left.

OBJECTIVES: To assess the effect of malocclusion on the self-esteem of adolescents. MATERIALS AND METHODS: This cross-sectional study evaluated 496 student aged between 12 and 14 tears old living in Shiraz city. The level of self-esteem was determined using the Rosenberg self-esteem scale (RSES). To assess the degree of malocclusion, Index of Orthodontic Treatment Need- Dental Health Component (IOTN-DHC) was used. The Spearman's correlation coefficient was calculated to assess the correlation of malocclusion and self-esteem. The mean of IOTN-DHC and total score of RSES in different age groups were analyzed using the Kruskal–Wallis test. The mean IOTN-DHC and total score of RSES were compared between the two municipal districts and males and females using the Wilcoxon test and independent t-test, respectively. RESULTS: A significant but weak correlation was noted between IOTN-DHC and self-esteem (r = 115/0, P = 04/0), while IOTN-DHC subscale: space shortage, dental missing, overjet, overbite, and crossbite had nonsignificant correlation with self-esteem. The socioeconomic status of adolescents significantly affected their self-esteem (P < 0.001). CONCLUSIONS: Weakly significant correlation between mild malocclusion and dental self-esteem.

OBJECTIVES: To assess the knowledge level and attitude of the Saudi population about the use of a dental implant as a treatment option for replacing the missing teeth. MATERIALS AND METHODS: This cross-sectional study adopted a quantitative approach and used an online questionnaire to collect data. Nine hundred and five participants were recruited as per the inclusion criteria (above 18 years of age, know how to read and write, and technology literate). The collected data were analyzed statistically using IBM Statistical Package for Social Sciences (SPSS) software. RESULTS: A low level of knowledge about teeth replacement methods (56%) was recorded among the participant, while 44.4% of them had heard about implant, bridges, and dentures. The oral hygiene of the participants was considered good (59.3%). The main source of information, reported by the participants, was the dentist (53.4%). The knowledge about dental implants was found to be significantly the highest (P = 0.02) among the highly educated participant who had completed postgraduate studies. CONCLUSION: There is a need for introducing comprehensive orientation programs, conducted by dentists, to communicate knowledge about dental implants. The social campaigns and official information programs should be instigated for improving the knowledge of the patients. Structured programs should be also introduced at an academic level, for enhancing the knowledge related to replacing missing teeth and dental implants.

OBJECTIVE: To assess the gingival parameters in the clear aligner treatment versus the three other types of brackets, i.e., conventional metal, conventional ceramic, and metal self-ligating. MATERIALS AND METHODS: Eighty patients coming for regular appointments undergoing orthodontic treatment were included. They were further divided into four groups with 20 patients in each: Group one underwent conventional brackets (CB) treatment; Group two had conventional ceramic brackets (CCB); Group three was treated with self-ligating (SL) brackets; Group four underwent with clear aligner (CA) treatment. Inclusion criteria were any patient with a minimum age of 18 years having Class II, Class III skeletal relationship, undergoing orthodontic treatment for at least 6 months with fixed orthodontic appliances (FOA) on both arches. While smokers, pregnant, diabetics, or those taking medication affecting gingival health or having cardiovascular diseases were excluded. Also excluded were patients who used antiseptic solutions or mouthwash during the past 6 months, underwent any periodontal treatments in the past 6 months, or who had fixed bridges and crowns or extensive restorations close to the gingival margins. Seven indices, namely plaque index, gingival index, gingival bleeding index, sulcus bleeding index, papillary bleeding index, basic periodontal examination index, and bleeding on probing index, were recorded for all groups. RESULTS: Mean age for Group 1 with CB was 26.65 ± 5.15 years, whereas it was 27.65 ± 8.15 years for Group 2 with CCB, and 26.85 ± 5.19 for Group 3 with SB. Group-4 with CA treatment had a mean age of 26.85 ± 4.83 years. Multivariate analysis and a Bonferroni correction was performed (P = 0.008). CA treatment has better periodontal parameter values compared with the CB and the CCB groups, and no significance difference with the SL brackets group. CONCLUSION: CA treatment has better periodontal indices levels compared to other types of orthodontic treatments such as CB and the CCB groups; no significant difference with the SL brackets group. Importance should be given to oral hygiene instructions before, during, and after the treatment.

OBJECTIVE: To assess the prevalence of malocclusion and orthodontic treatment needs in a Saudi sample of Jeddah city. MATERIALS AND METHODS: A cross-sectional (descriptive) study was performed in 2017 among 3016 subjects (1507 females and 1509 males) selected according to stratified random sampling design. The inclusion criteria were Saudi students aged between 14-18 years with no craniofacial deformities or syndromes and no orthodontic treatment carried out. Malocclusion was assessed using the modified Bjork et al. system, and Angle's classification and orthodontic treatment need to be evaluated by using the IOTN (DHC). Descriptive, associations and gender differences were assessed by one-way ANOVA, Chi-square, and Fisher exact tests. Data was analyzed using STATA version 13.0 (StataCorp, College Station, Texas, USA). Statistical significance was set at P < 0.05. RESULTS: Approximately 12% of the participants had normal occlusion, 57% had Class I malocclusion, 17% had Class II malocclusion, and 14% had Class III malocclusion. The highest prevalence of malocclusion traits was for displacement, followed by a crossbite. The IOTN results revealed slight need for orthodontic treatment in (n = 795-26%) moderate/borderline in (n = 1166-39%), and great need in (n = 1055-35%). Class II and III malocclusion, OJ, reverse overjet, scissor bite, open bite, midline discrepancies, and crowding were significantly higher in males than females (P < 0.05). CONCLUSION: Overall, there was a high prevalence of malocclusion and high orthodontic treatment need. The most common malocclusion was Class I. The most common orthodontic treatment need was moderate to borderline.

OBJECTIVE: To evaluate the effects of different adhesion promoters, namely, Enhance LC, Ortho Solo, Assure Universal Bonding Resin and deproteinizing agents such as 5.25% NaOCl, 10% papain gel on the shear bond strength of orthodontic brackets. MATERIALS AND METHOD: The present study was approved by the Ethics Committee of Teerthanker Mahaveer Dental College and Research Centre, affiliated to Teerthanker Mahaveer University, Moradabad, India. Around 150 extracted sound human upper bicuspids were taken and divided into six groups. Group 1 control (37% H₃PO₄), Group 2 (37% H₃PO₄+ Ortho Solo), Group 3 (37% H₃PO₄+ Assure Universal Bonding Resin), Group 4 (37% H₃PO₄+ Enhance LC), Group 5 (5.25% NaOCl + 37% H₃PO₄), and Group 6 (10% papain gel + 37% H₃PO₄). In all the groups (n = 150) orthodontic metal brackets were bonded with Transbond^TM XT and all the samples were subjected for evaluation of shear bond strength using Instron universal testing machine at a cross speed of 0.5 mm/min. The bracket failure mode was examined using Adhesive Remnant Index (ARI). The Kruskal-Wallis test and the Mann-Whitney test were used to compare the shear bond strength. The Chi-square test was used to determine significant differences in the ARI scores among the groups. The significance for all statistical tests was P < 0.05. RESULTS: Mean values of shear bond strength showed statistically significant differences between the evaluated groups (P < 0.005). The lowest and highest shear bond strength was attributed to Group 1 (control) and Group 2 (Ortho Solo), respectively. No statistically significant difference was noted for the mean ARI scores between control, adhesion promoters, and deproteinized group (P < 0.05). CONCLUSION: It was concluded that adhesion promoters and deproteinizing agents can be used to enhance the shear bond strength of orthodontic brackets. Among all the groups Ortho Solo showed the highest bond strength when used with Transbond^TM XT.

OBJECTIVE: To evaluate the antimicrobial property of cetylpyridinium chloride (CPC) when polymerized with cold cure acrylic and to assess the duration of its release from modified acrylic. MATERIALS AND METHODS: CPC was added in different concentrations (0%, 2.5%, 5%, and 10%) to cold cure acrylic resin and 180 acrylic discs were prepared. These were divided into four groups of 45 each depending on the concentration of CPC. The antimicrobial property of the modified acrylic for Streptococcus mutans was tested using disc diffusion assay in agar. The duration of release of CPC from self-cure acrylic was tested with optical density reading of solutions by ultraviolet spectrophotometer. The effect of addition of CPC on diametral tensile strength (DTS) of acrylic was tested using UTM (Instron) and the effect of water aging on modified acrylic was compared with unaged specimens. RESULTS AND CONCLUSION: The normality of the data was checked by Shapiro–Wilktest, and as the data failed to show normal distribution, inferential statistics were performed using nonparametric tests of significance. Antimicrobial activity of modified acrylic increased with increase in CPC concentration. Greatest CPC release was observed on the seventh day with a decrease in release from 7 to 180 days. There was a decrease in the diametral strength of the modified resin and water aging had a significant effect on the DTS of the modified resin.

OBJECTIVES: To investigate the effectiveness of mini-implant (MI)-facilitated micro-osteoperforations (MOPs) in accelerating mandibular anterior teeth alignment. MATERIALS AND METHODS: Thirty teenage patients with mandibular crowding (Little's irregularity index between 4 and 6 mm) were randomly allocated to either “experimental” group (micro-osteoperforation assisted alignment) or “control” group (conventional orthodontics). Blinding was done at the data analysis stages. Six MOPs were performed using MI on the labial aspect in the mandibular anterior region. The primary outcome was the overall treatment time needed to complete alignment of mandibular anterior teeth. The secondary outcomes were to compare the marginal bone height loss and volumetric root resorption around mandibular incisors along with subject's perception of pain, comfort and satisfaction. RESULTS: There was statistically significant difference in the total treatment duration for complete alignment of mandibular incisors. The completion of cases in experimental group was 43.93% times faster than the control group. There were no statistically significant differences in volumetric root resorption and marginal alveolar bone height loss around mandibular incisors as well as pain perception between the two groups. CONCLUSIONS: MI-facilitated MOPs accelerated tooth movement significantly upto nine weeks without any significant pain and discomfort, with no increase in root resorption and marginal alveolar bone height loss.

OBJECTIVES: To compare the accuracy of the linear measurements made on pre- and posttreatment three-dimensional (3D) scanned digital models with conventional plaster study models. MATERIALS AND METHODS: The study was conducted on pre- and posttreatment study models of 132 patients. A 3D model scanner was used to scan the plaster models to form 3D digital models. The measurements were made on the plaster models using digital Vernier calipers, and the 3D digital models were assessed for similar measurement using a software of the model scanner. The intraclass correlation for intraoperator error showed good correlations between the measurements made on conventional plaster models and digital models. RESULTS: Although the comparison of the linear measurements made by conventional and digital methods on both pre- and posttreatment study models using intraclass coefficient showed a good correlation, analysis of variance showed significant mean differences in the measurements of multiple variables in both the groups. The number of variables showing significant differences was more in the pretreatment group. The measurements obtained by Vernier calipers were generally higher than those of scanned pre- and posttreatment study models. CONCLUSION: The linear measurements made by conventional and digital methods showed statistically significant mean differences. The accuracy of recording can be affected by the severity of pretreatment malocclusion, but the deviations were not large enough to contradict the use of the digital models for orthodontic records.

OBJECTIVES: To evaluate and compare the effect of different enamel deproteinizing agents on topographic features of enamel and shear bond strength before acid etching. MATERIALS AND METHOD: In total, 120 sound human maxillary premolars were taken and divided into three groups: Group 1 control (37% phosphoric acid (H₃PO₄), Group 2, (5.25% Sodium Hypochlorite (NaOCl)+ 37% H₃PO_4, and Group 3, (10% Papain gel + 37% H₃PO₄). These groups were further divided into A and B subgroups. In subgroups 1A, 2A, and 3A (n30) topographic features were evaluated using Scanning electron microscope (SEM) at different magnifications. Insub-groups 1B, 2B, and 3B (n90) metal brackets were bonded with Transbond™ XT, and all the samples were subjected for Shear Bond Strength (SBS) evaluation using universal testing machineat a cross speed of 0.5 mm²/min. The failure mode was analyzed using adhesive remnant index (ARI).Statistical analysis was done using one-way ANOVA for the shear bond strength, and Kruskal-Wallis test followed by Mann-Whitneywas performed for ARI scores. RESULTS: SEM showed predominance of type 3 etching pattern in control Group (1A) and type 1 and type 2 in deproteinizedGroups (2A and 3A).Mean values of shear bond strength showed statistically significant differences between evaluated groups (P < 0.005).The lowest and highest shear bond strength was attributed to Group 1B (Control) and 3B (10% papain gel), respectively. Statisticallysignificant differences were noted for the mean ARI scores between control and deproteinized group (P < 0.05). CONCLUSION: 10% papain geland 5.25% NaOCl can be used as deproteinizing agents on enamel surface before acid etchingto enhance the shear bond strength of orthodontic brackets.

OBJECTIVES: To investigate pain intensity, interleukin-1β and prostaglandin E₂ values in saliva during initial orthodontic treatment among varying age groups and their correlation between these mediators. MATERIALS AND METHODS: Twenty healthy patients distributed equally in age and gender groups were chosen. Unstimulated saliva was collected before the placement of orthodontic fixed appliance (T₀), 1 hour after the placement of the appliance with 0.014” nickel titanium archwire (T₁), 1 month after the first visit (T₂), and 1 hour after the placement of 0.016” nickel titanium archwire (T₃). The saliva samples were then analyzed for prostaglandin E₂ and interleukin-1β using enzyme-linked immunosorbent assay. Pain intensity was measured using a numerical rating scale. RESULTS: Prostaglandin E₂ and interleukin-1β levels had increased at T₁ followed by a drop at T₂ and a subsequent increase at T₃. The prostaglandin E₂ and interleukin-1β levels were higher in adults than children. There was an insignificant correlation between the interleukin-1β and prostaglandin E₂ changes in all the patients. No significant differences were seen in pain scores between adults and children. Insignificant correlation was seen between pain scores and prostaglandin E₂ and interleukin-1β. CONCLUSION: Prostaglandin E₂ and interleukin-1β can be detected in saliva and are increased in during the initial orthodontic treatment but are higher in adults than children. Pain intensity was not significantly different between adults and children.

OBJECTIVES: Previous reports have shown that high-frequency vibration can increase bone remodeling and accelerate tooth movement. The aim of this study was to evaluate the effects of high-frequency vibration on treatment phase tooth movement, and post-treatment bone density at initiation of retention, with cone-beam computed tomography (CBCT). MATERIALS AND METHODS: Thirty patients with initial Class I skeletal relationships, initial minimum-moderate crowding (3–5 mm), treated to completion with clear aligners and adjunctive high-frequency vibration, (HFV group) or no vibration, (Control group) were evaluated. The patients were instructed to change aligners as soon as they become loose. Changes in bone density associated with orthodontic treatment were evaluated using i-CAT cone-beam computed tomography (CBCT) and InVivo Anatomage^® software to quantify density using Hounsfield units (HU) between treated teeth in 10 different regions. HU values were averaged and compared against baseline (T1) and between the groups at initiation of retention (T2). RESULTS: The average time for aligner change was 5.2 days in the HFV group, and 8.7 days in the control group (P = 0.0001). There was significant T1 to T2 increase of HU values in the upper arch (P = 0.0001) and the lower arch (P = 0.008) in the HFV group. There was no significant change in average HU values in the upper (P = 0.83) or lower arches (P = 0.33) in the control group. The intergroup comparison revealed a significant difference in the upper, (P = 0.0001) and lower arches (P = 0.007). CONCLUSION: High-frequency vibration adjunctive to clear aligners, allowed early aligner changes that led to shorter treatment time in minimum-moderate crowded cases. At initiation of retention, the HFV group demonstrated statistically significant increase as compared with pre-treatment bone density, whereas control subjects showed no significant change from pre-treatment bone density.

OBJECTIVES: This study aimed to evaluate how dental practitioners and laypersons differ in their perception of altered smile aesthetics based on viewing images of a digitally manipulated smile. MATERIALS AND METHODS: A photograph with close to ideal smile characteristics was selected and digitally manipulated to create changes in buccal corridor space (BCS), midline diastema, gingival display, and midline shift. These altered images were rated by two groups: dental practitioners and lay persons using a visual analogue scale. The mean ± standard deviation (SD) of both groups were calculated and the Student's t-test was used to identify any statistically significant differences between the groups. Data analysis was done using the Statistical Package for Social Science (version 23.0; SPSS Inc., Chicago, Illinois, USA). RESULTS: The dentists were more sensitive to changes in the midline shift than laypeople and provided lower scores. There were no significant differences between the two groups when the gingival display alteration was ≤3 mm. However, for gingival display of 4 mm and 5 mm, there was significant difference between the two groups, with dentist rating them poorer as compared with the laypeople (P < 0.001). Dentists were more sensitive than the laypeople for midline diastema of 2 mm and 3 mm (P < 0.001 and P = 0.005 respectively). Changes in the BCS had minimal impact on the overall esthetic score for both the groups. CONCLUSIONS: Perception of smile esthetics differed between dentists and laypersons.

BACKGROUND: This study was undertaken to evaluate the enzyme activity profiles in human saliva and gingival crevicular fluid (GCF) in accelerated tooth movement when compared with normal orthodontic tooth movement (OTM) in extraction cases. MATERIALS AND METHODS: Twenty patients who required premolar extractions were treated with MBT mechanotherapy. They were divided into two equal groups: conventional (Group I) and corticotomy (Group II) which was performed on both the jaw sides before initiating retraction. GCF was collected from mesial and distal aspects of canine before initiation of retraction and at 7^th, 14^th, 21^st, and 28^th days, and then at fifth and sixth weeks and third and sixth months after retraction. A total of 5 mL of unstimulated saliva was collected from the subjects after 90 min of nonoral activity (subjects were refrained from eating and drinking). RESULTS: The results showed that in Group I, the peak of aspartate aminotransferase (AST) and alkaline phosphatase (ALP) enzyme activity occurred on the 14^th day of force application. In Group II, the enzyme activity progressively increased from day 0 to 6 weeks, peaking at the sixth week, and then a decline in enzyme activity was observed on third and sixth months. When ALP and AST activities in GCF and saliva were compared between Groups I and II, no statistically significant difference was observed on days 0, 7, and 14. CONCLUSION: Corticotomy-accelerated tooth movement is a promising technique that has many applications in orthodontic treatment of adults as it helps overcome many of the current limitations of this treatment. The enzymatic activity signifies osteoclastic and osteoblastic activities, so ALP and AST from the saliva and GCF may potentially be used as biomarkers for monitoring corticotomy-assisted OTM.

INTRODUCTION: Motivation for orthodontic treatment among adolescents has been linked with patients' response during treatment. Parents have also been seen to be influencing factors in patient motivation. This study investigates the motivation for orthodontic treatment among patients and their parents/guardians. MATERIALS AND METHODS: Data were obtained from 100 orthodontic children (41 boys, 59 girls), with a mean age of 11.9 years, in the age range of 7–17 years, and with parents/guardians from three public hospitals. Recruitment focused on patients and their parents at their initial screening appointment and those scheduled for regular orthodontic treatment. Data were collected by the use of survey forms for both patients and parents. Data were analyzed using Epi info^TM version 3.5.1. RESULTS: Children were more motivated to have orthodontic treatment than their parents before treatment, however parents showed greater motivation for their children to have orthodontic treatment than did the children during treatment. Children on treatment were less motivated than those who have not started treatment. Using braces was more important to children than their parents. Parents of children on treatment were more motivated for their children to have orthodontic treatment than parents of children who were not yet on treatment. Children undergoing orthodontic treatment were not willing to have extractions as part of their treatment, while parents did not have much objections (P = 0.001). Parents were willing to comply with dietary instructions imposed on their children. (P = 0.45). Pretreatment, children were more willing to brush after meals than the ones undergoing treatment (0.010). CONCLUSION: Parents of children on treatment were more motivated for their children to have orthodontic treatment than parents of children who were not yet on treatment. Children on treatment were less motivated during treatment.

OBJECTIVE: To evaluate the incidence of malocclusion and requirement for orthodontic treatment in the Saudi region of Hail city. MATERIALS AND METHODS: 520 Saudi participants between 7 and 12 years from Hail city were used in the research, all of whom were selected using a simple randomization method. For every participant, various malocclusion variables such as molar, canine, and incisor relationship, overjet, overbite, open bite, cross bite, scissor cross bite, and the score for the orthodontic treatment need [Index of Orthodontic Treatment Need (IOTN)] were recorded. A light source was used for examination, in addition to mouth mirrors, a calibrated ruler, and a portable dental chair. RESULTS: The prevalence of class I molar relationship was 70.4%, with class II being 21.3% and class III being 8.3%. As for the incisor relationships, class I was found at a prevalence of 72.5%, class II at 19.8%, and class III at 7.7%. Additionally, the following malocclusion characteristics were also found: deep overbite (>4 mm) (16.2%), increased overjet (>4 mm) (14.4%), posterior cross bite (13.3%), anterior open bite (7.7%), anterior cross bite (5.2%), scissor bite (4%), and posterior open bite (0.6%). A total of 4.4% were identified as requiring orthodontic treatment. Grades 1 and 2 were 25.5% and 58.5%, respectively. There was a significant relationship found between grades 3 and 4, and the anterior open bite, cross bite, and scissor bite. CONCLUSION: This research showed that class I malocclusion was most dominant, followed by classes II and III, respectively. When the Hail city school pupils in the study were assessed for IOTN index, grades 3 and 4 were found to be highly related to anterior open bite, cross bite, and scissor bite.

OBJECTIVE: The aim of this study was to compare the efficiency of canine retraction using modified Marcotte and T-loop retraction springs. MATERIALS AND METHODS: Twenty-four subjects with a treatment plan involving bilateral extractions of upper first premolars were included in the study. A split-mouth design was used to randomly allocate opposite quadrants to either modified Marcotte spring (MS) or T-loop spring (TLS) for canine retraction. Cephalometric radiographs and models were used to measure the rate of canine retraction (primary outcome) and compare the angular/rotational changes in the canines and anchorage loss in molars (secondary outcomes) following retraction. Subjective assessment of pain and discomfort was compared using visual analog scale (VAS). Paired and independent t-tests were used to evaluate changes. RESULTS: The mean amount and rate of retraction of the canine were found to be significantly higher for MS (3.56 ± 0.696 mm and 1.188 ± 0.232 mm, respectively) when compared with TLS (2.125 ± 0.472 mm and 0.71 ± 0.157 mm, respectively). Distopalatal rotation of the canine was also significantly lesser for MS (2.42°±1.868°) than TLS (5.65° ±2.84°, P < 0.001). However, the amount of anchorage loss and canine tipping were significantly higher for MS. Statistically significant higher values in the VAS score for TLS indicated greater discomfort. CONCLUSION: MS exhibited increased rate of retraction and rotation control when compared with TLS during sectional canine retraction. Patient comfort was better for MS as evidenced by the VAS scores. However, the amount of tipping and anchorage loss obtained with MS were significantly higher than TLS.

OBJECTIVE: The aim of this study was to investigate the effect of intraoral conditions and fluoride mouthwashes on mechanical properties and surface characteristics of different types of titanium molybdenum alloy (TMA) wires. MATERIALS AND METHODS: Three types of TMA wires of dimension 0.017” × 0.025” [1. Standard TMA (TMA), 2. ion-implanted, low-friction TMA (LF) and 3. Colored, Honey Dew TMA (HD)] were tested in three conditions as three groups; A) Control (as received), B) No fluoride (following intraoral use without fluoride) and C) Fluoride (following intraoral use with fluoride rinses). Surface roughness was evaluated using 3D Optical Profilometer. Three point bending tests were done to evaluate load deflection characteristics (LDR), ultimate tensile strength (UTS), and Young's modulus (E). Statistical evaluation was done using one-way analysis of variance (ANOVA), Bonferroni multiple comparison, and paired t-tests. RESULTS: Control group TMA exhibited significantly higher surface roughness, peak height, and LDR as well as lower UTS and E when compared to LF and HD (P < 0.001). In nonfluoride group, the surface roughness and LDR increased significantly for all three types of wires (P < 0.001). The UTS and E showed a significant decrease (P < 0.001). Additional use of fluoride mouthwashes (fluoride group) further increased surface roughness and LDR and decreased the UTS and E (P < 0.001). CONCLUSION: The ion-implanted LF/HD varieties had better surface smoothness, lower LDR, higher UTS, and higher E than standard TMA in the control group, pointing towards a better efficiency of these wires. Intraoral conditions significantly increased surface roughness and deteriorated mechanical properties of all types of TMA wires. With the use of daily fluoride mouthwashes, the deterioration was much worse.

OBJECTIVES: To systematically investigate and critically appraise the quality of the currently available literature regarding the morphological, postural, and functional changes observed in individuals following glossectomy. MATERIALS AND METHODS: A search without restrictions in eight databases (including grey literature) and hand searching from inception until March 2018 was performed. Data on morphological, postural, and functional changes after glossectomy were reviewed. Methodological quality was evaluated using the risk of bias in nonrandomized studies of intervention tool. RESULTS: Out of 835 initially identified unique records, only three articles following patients for 1 year after glossectomy fulfilled the selection criteria. Overall, no significant morphological, postural, and functional changes were observed. Only the distance between the dorsum and the nasal line increased and the freeway space decreased significantly. CONCLUSIONS: Overall, no significant differences were noted in the medium term, in terms of dentofacial structures adaptation and tongue function following glossectomy. Further research is warranted in order to elucidate the consequences of the altered oral environment.

OBJECTIVES: Leptin, a polypeptide which is related to body fat regulation, is also found to have a role in the inflammatory reaction. The aim of this study is to assess the concentration of leptin in Gingival Crevicular Fluid (GCF) during orthodontic force application and to correlate its concentration to rate of tooth movement. METHODS: Twenty orthodontic patients (10 males and 10 females) were selected for the study. Leptin concentration was measured at T0, before force application; T1, one hour after force application; T2, one day after force application; T3, one week after force application; T4, one month after force application. GCF was collected using filter paper strips from the distal aspect of gingival sulcus of the right maxillary canine distalized by an active lace-backs of tooth movement was measured on dental casts, before and one month after force application. One-way ANOVA with Bonferroni correction and Pearson's correlation test were used to analyze the data. RESULTS: The mean GCF leptin concentration increased from T0 to T1, rose to a peak at T2, then declined to a minimum value at T3 and then increased to a value at T4, closer to the base line value (T0), and it was statistically significant (P < 0.05). There was positive correlation of the overall mean leptin concentration to rate of tooth movement (correlation coefficient = 0.634). CONCLUSION: There was a biphasic change in GCF leptin concentration during one cycle of orthodontic force application. There was a positive correlation between the GCF leptin concentration and rate of tooth movement.

OBJECTIVES: This study aimed at evaluating the effect of using a 45S5 bioglass paste and a topical fluoride as protective agents against acidic erosion (resembling acidic beverage softdrinks intake) for enamel surrounding orthodontic brackets. MATERIALS AND METHODS: Sample of 21 freshly extracted sound incisor and premolar teeth was randomly divided into three equal groups: a bioglass group (Bioglass) (NovaMin, 5-mm average particle, NovaMin Technology), a Fluoride group (Fluoride) (Gelato APF Gel, Keystone Industries), and a control group (Control). Orthodontic brackets were bonded to the utilized teeth usingMIP (Moisture Insensitive Primer) and Transbond PLUS color change adhesive. All specimens were challenged by 1% citric acid for 18 min. The top enamel surfaces next to the orthodontic brackets were examined by SEM-EDS. Wilcoxon Signed-Rank test was used to compare the area covered by the 45S5 bioglass paste before/after erosion P < 0.05. RESULTS: 45S5 bioglass paste application resulted in the formation of an interaction layer that significantly resisted erosion challenge P < 0.05. The fluoride and control specimens showed signs of erosion of the enamel next to the orthodontic brackets (P < 0.05). CONCLUSION: 45S5 bioglass paste can efficiently protect the enamel surfaces next to orthodontic brackets for acidic erosion challenges.

OBJECTIVES: To determine whether the modification of dental occlusion, without molar extraction, affected the gustatory papillae located in the tongue of growing rats. MATERIALS AND METHODS: Five-week-old male Wistar rats were randomly divided into an anterior bite plate (ABP) group and a control group. Under general anesthesia, ABPs were placed on the occlusal surfaces of the maxillary incisors, while metal caps covered the mandibular incisal edges of the rats in the ABP group. The control group rats underwent a sham operation. The rats in both groups were euthanized 14 days after the procedure. The circumvallate papillae and taste buds were analyzed by immunohistochemical methods, and the fungiform papillae were observed and counted after immersion of the tongue in 1% methylene blue. RESULTS: Two weeks after ABP insertion and mandibular incisal cap placement, the gustatory papillae exhibited morphological and structural changes. The rats in the ABP group had exhibited significantly fewer fungiform papillae, and narrower circumvallate papillae, with greater trench depths, larger trench profile areas, smaller taste bud profile areas, lower ratios of the taste bud profile area to the trench profile area, and more taste buds than those in the control group. CONCLUSIONS: Our findings support the association between occlusal and taste functions and provide a basis for further studies on the gustatory function. In conclusion, loss of molar occlusion, resulting from the ABP and metal cap insertion, altered the peripheral gustatory receptors in the growing rats.

OBJECTIVE: To evaluate the maxillary canine retraction rate and anchorage loss with active and passive self-ligating brackets (SLBs). MATERIALS AND METHODS: The study was conducted on 10 patients whose age ranged from 14–20 years. The patients had minimal to no crowding with a dental protrusion of maxillary incisor that required the extraction of maxillary first premolars and retraction of canines. The maxillary canines had to be in a good alignment and level before treatment to ensure that canine retraction had started from the same point bilaterally. A cone beam computed tomography (CBCT) had been taken for each patient's maxilla before treatment initiation and after complete canine retraction. Using nickel titanium, close-coil spring canine retraction on both sides and the rate of canine movement was measured. RESULTS: The patients were checked every 2 weeks to measure the retraction rate and ensure that a constant force (150 g) was being delivered to both canines. The pre- and post-canine retractions CBCT were superimposed to evaluate the pattern and rate of canine movement and anchorage loss. The result of this study showed no statistically significant difference between the two groups. CONCLUSION: The type of SLB, either active or passive, does not affect the rate or type of canine movement during its retraction in the orthodontic extraction cases, and the anchorage loss of the upper molars was nearly the same in both type.

OBJECTIVE: To evaluate the status of occlusion among school children in city of Abha, Saudi Arabia. MATERIALS AND METHODS: The current study was based on the clinical examination of 1998 Saudis (mean age 14.13 ± 0.99 years) who were randomly selected by a multi-stage random sampling technique from the city of Abha. The occlusal parameters recorded in this study were molar and canine relationships, overbite, overjet, crowding, spacing, anterior open bite, anterior crossbite, posterior crossbite, and scissors bite using gloves, light source, mouth mirror, and ruler. RESULTS: Class I molar relationship was observed in 1219 (61%) of the total sample, while Class II and III molar relationships were observed in 326 (16.3%) and 154 (7.7%), respectively. Class I–III canine relationships were seen in 1255 (62.8%), 231 (11.6%), and 112 (5.6%) of the sample, respectively. Normal overbite was found in 1490 (74.6%) of cases, while 1515 (75.8%) had normal overjet. The most prevalent malocclusion trait was crowding (26.6%), followed by spacing (20.6%), increased overjet (19.5%), increased overbite (19.4%), posterior crossbite (8.5%), and anterior open bite (6.1%). CONCLUSIONS: Crowding was the highest occlusal trait in frequency followed by spacing, increased overjet, and increased overbite. Class I molar and canine relationships, normal overjet, and normal overbite were frequent findings among Saudi adolescents in Abha city.

AIMS: To determine the association and level of agreement between young adults' perception of orthodontic treatment need (subjective need) and the orthodontists' assessment of treatment need (normative objective need). METHODOLOGY: For this study, 670 students [280 males and 390 females; mean age (standard deviation) of 15.32 (1.81) years] were selected from public and private schools from different demographic areas of Jeddah city, Saudi Arabia, and divided into two age groups (12–15 years) and (16–19 years). All the participants were examined, and the Index of Orthodontic Treatment Need (IOTN) components [dental health component (DHC) and aesthetic component (AC)] were recorded. RESULTS: Kappa statistics showed a statistically significant but fair agreement between clinician AC (CAC) and student AC (SAC) assessments in both age groups (k = 0.343 and 0.334, respectively; P < 0.001), whereas Spearman's correlation coefficient showed a statistically significant but moderate association (r = 0.487 and 0.517, respectively; P < 0.001). The degrees of agreement were 76.4% and 76.7% at the no-need and mild-need levels of treatment, respectively. There was a statistically significant but weak association between the subjective and normative needs (SAC and IOTN-DHC) in both age groups (r = 0.336 and 0.360, respectively; P < 0.001). However, the degrees of agreement were 58.9% and 61.5% at the no-need and mild-need levels of treatment, respectively. CONCLUSION: Significant but weak positive association was found between the normative and subjective orthodontic treatment needs, indicating a lack of understanding of the nature of malocclusion and its consequences. Thus, promoting further knowledge and awareness of malocclusion are indicated.

OBJECTIVE: To evaluate the effect of different surface treatments and bonding modalities on the shear bond strength (SBS) between metallic orthodontic brackets and zirconia crowns. MATERIALS AND METHODS: Sixty zirconia specimens were computer-aided design/computer-aided manufacturing milled, sintered, glazed, and embedded in acrylic resin. The specimens were divided into three groups according to the surface treatment applied: C: no surface treatment (control), S: sandblasted with 50 μm Al₂O₃, and D: Sof-Lex disc roughening. Each group was further subdivided into two subgroups according to the resin cement used: P: Clearfil Ceramic Primer + Panavia F2.0 (Kuraray) and R: RelyX U200 (3M/ESPE). Metallic orthodontic brackets were bonded to the labial surface of the specimens. All specimens underwent thermocycling. SBS test was applied using a universal test machine at a cross head speed of 1 mm/min. Data were analyzed using Mann–Whitney test (α = 0.05). RESULTS: Subgroup SP showed the highest SBS (20.8 ± 4.8 MPa), followed by subgroups SR (16.7 ± 4.6 MPa), DP (12.3 ± 2.8 MPa), and DR (11.6 ± 3 MPa). However, all specimens in the control group underwent debonding during thermocycling. The different surface treatment groups showed highly significant differences (P < 0.05), whereas the resin cement subgroups showed no significant differences (P > 0.05). CONCLUSION: SBS between glazed zirconia crowns and metallic brackets strongly depended on the surface treatment applied. Sandblasting achieved the highest SBS. Roughening with Sof-Lex disc proved to be a reliable surface treatment modality for glazed zirconia. Bonding to untreated glazed zirconia surfaces led to bond failure. Both resin cements yielded strong SBS results.

OBJECTIVE: Using the cast-radiograph evaluation (CRE) score of the American Board of Orthodontics (ABO), the purpose of this study was 1) to find the post-treatment discrepancies that contributed to low-quality outcomes and 2) to identify if there might be any correlation between cephalometric changes and post-treatment discrepancies. MATERIALS AND METHODS: About 200 records submitted for the Thai Board of Orthodontics examination were analyzed. Overall, 23 parameters of the CRE scores and 12 cephalometric changes were collected. Based on the total CRE score, the cases were classified into three categories: pass (score <20), undetermined (score 20–30), and fail (score >30). Kruskall–Wallis was used to analyze the differences of mean CRE scores among these three categories. In addition, the cases were further classified into fixed appliance, two-phase and orthognathic surgery groups. Correlation tests were carried out to determine if there might be any association between cephalometric changes and CRE parameters. RESULTS: Significant differences of mean CRE scores were found for all CRE components except interproximal contacts. Significant correlation coefficients with the total CRE scores were found for all parameters except interproximal contacts. Significant moderate association was found between lower incisor changes and CRE scores in the two-phase and orthognathic surgery group. CONCLUSIONS: In order to improve treatment outcome quality, the top four parameters that orthodontists should pay attention to are occlusal contacts, occlusal relationship, marginal ridges, and alignment and rotations. Cephalometric changes were not suitable as weighting factors for total CRE scores.

OBJECTIVE: To determine the prevalence of malocclusion and orthodontic treatment need in a sample of Omani adolescents aged 11–16 years. MATERIALS AND METHODS: The total sample included 854 adolescents with 387 boys and 467 girls between the age of 11 and 16 years with no previous orthodontic treatment history. The study design was cross-sectional. The parameters studied were skeletal relationship, lip competency, teeth impactions, missing teeth, contact point displacement, crowding, spacing, incisors and molars classification, overjet, overbite, crossbite, oral hygiene and caries. The Index of Orthodontic Treatment Need (IOTN) was used to study the need for orthodontic treatment for the total sample. RESULTS: There was a high prevalence of Class I jaw relationship (86.2%). About 81.6% of the sample studied had Class I molar relationship and 73.8% had Class I incisors relationship. About 61.4% of the sample had no contact displacement, while 5.2% had contact displacement >4 mm. Severe crowding in the maxilla was found in 2.3% while spacing was found in 24.2%. Around 11% of the sample studied had Class II div 1 incisors relationship, 13.5% Class III and only 1.8% had Class II div 2 incisors relationship. Only 8.6% of the sample studied had an overjet >6 mm while 16.3% had a deep bite and 0.2% had anterior open bite of >4 mm. Teeth impaction was found in 11.7% while permanent missing teeth was present in 1.8%. The results showed that 13.9% had a very great need for treatment while 43.2% of the sample did not need any treatment. CONCLUSION: Among the Omani adolescents, there was a high prevalence of Class I jaw relations and Class I molar relationship. The prevalence of malocclusion and treatment need in Omanis shows some variation when compared to other ethnicities.

OBJECTIVES: To evaluate the possible change in teeth lengths as an indicator of orthodontically induced tooth root resorption (OITRR) after high-frequency mechanical vibration (HFV) treatment concurrent with Invisalign Smart Track® aligners as evaluated by cone beam computed tomography (CBCT). MATERIALS AND METHODS: The sample, composed of 30 patients with an average age of 26 ± 11 years and Class I malocclusion with an initial anterior crowding ranging from 3 to 5 mm, was divided equally into two groups; Group I received adjunctive high-frequency mechanical vibration (HFV); Group II, the control, did not receive adjunctive mechanical treatment. The maxillary incisor's teeth lengths were measured using Mimics software before (T1) and after (T2) treatment. All data were analyzed using Student's t-test. Reliability testing was completed by randomly selecting 10 patients' CBCTs, and their teeth lengths were measured twice by the same investigator over a 15-day interval and compared confirming intra-operator accuracy. RESULTS: The control group showed a statistically significant decrease in tooth lengths compared to the HFV group which showed nonstatistically significant change of tooth lengths. CONCLUSION: Patients treated with HFV showed minimum tooth length changes after treatment, which may indicate that HFV can reduce OITRR with treatment using clear aligners.

OBJECTIVE: To our knowledge, no study has compared the facial and dental morphology of adult Latin and Japanese populations. The purpose of this study was to assess differences in the facial and dental morphology between adult Spanish and Japanese women with Class I malocclusion using lateral cephalograms. MATERIALS AND METHODS: The lateral cephalograms of 33 adult Spanish and 33 adult Japanese women were traced and digitized by a single investigator. All patients satisfied the following criteria: female sex; age 18–35 years; skeletal Class I malocclusion (ANB angle, 2°–5°; angle Class I malocclusion; arch length discrepancy, −10 to + 10 mm; overjet, 1–5 mm; overbite, 1–5 mm); absence of congenital anomalies, significant facial asymmetry, or congenitally missing teeth, with the exception of the third molars; significant temporomandibular joint problems; severe crowding; and no history of orthodontic treatment. RESULTS: Eleven and six angular measurements for the skeletal and dental hard tissues, respectively, were computed in accordance with previous studies. The results showed that Japanese women had significant maxillary and mandibular protrusion, clockwise mandibular rotation, greater labial tipping of incisors, and a smaller interincisal angle compared with Spanish women. CONCLUSION: At the time of orthodontic treatment planning, it is important to consider the facial and dental morphological characteristics of individual ethnic groups to achieve satisfactory outcomes and retention. The findings of this study provide valuable information that will aid in orthodontic treatment planning for adult Spanish and Japanese women.

OBJECTIVE: To determine the mean soft tissue facial profile for Circassian adults as determined by Legan–Burstone cephalometric analysis. MATERIALS AND METHODS: 71 lateral cephalometric radiographs for nongrowing Circassian adults with normal occlusion were traced and accurately measured. RESULTS: With regard to facial form analysis, Circassian adults showed higher facial convexity angle, retruded mandible, and obtuse lower face–throat angle. When compared with lip form norms, Circassians showed increased nasolabial angle, deeper mentolabial sulcus, and increased maxillary incisor exposure. Comparison between men and women showed that mentolabial sulcus depth was significantly increased in Circassian men compared with Circassian women. CONCLUSION: The results of this study showed that soft tissue facial profiles for Circassians and Caucasians are different in certain values. Such differences should be taken into account when formulating a treatment plan for Circassian patients seeking orthodontic treatment and orthognathic surgery.

CONTEXT: The purpose of this study was to evaluate the accuracy and reliability of tooth length measurements using conventional and cone-beam computed tomography (CBCT) imaging techniques. AIM: The aim of this study was to assess the accuracy and reliability of various tooth length measurements made on CBCT scans and conventional imaging techniques [intraoral periapical radiograph (IOPA) and orthopantomogram (OPG)]. SETTINGS AND DESIGN: This is an in-vitro comparative study. SUBJECTS AND METHODS: In total, 50 extracted single-rooted premolar teeth were mounted on the dry human mandible. For each extracted tooth, measurements for tooth length, crown length, and root lengths were taken with a Vernier caliper and using three imaging modalities: CBCT, OPG, and IOPA radiographs. The measurements were compared with the gold standard (Vernier caliper). STATISTICAL ANALYSIS USED: One-way analysis of variance was used to compare mean values between the groups that are Vernier caliper, CBCT, IOPA, and OPG. The multiple comparisons of means of tooth length, root length, and crown length were done by Bonferroni test. RESULTS: A significant difference in the tooth length measurements was seen between the measurements taken by CBCT and IOPA and between IOPA and OPG. But, no significant difference was seen between any other groups. The highly significant difference was seen between the root length measurements taken by IOPA and OPG and by CBCT and OPG. However, no significant difference was seen between any other groups. No significant difference was seen in between the crown length measurements taken by Vernier caliper and CBCT and between IOPA and OPG. However, a significant difference was seen between all the groups. CONCLUSIONS: Among the radiographic techniques, CBCT was found to be the most accurate in measuring the tooth, root, and crown lengths.

OBJECTIVE: This study was carried to study the prevalence of dental anomalies and treatment modalities/planning among the orthodontic patients. MATERIALS AND METHODS: A total of 370 orthodontic records including their pre-treatment orthopantomographs (OPG) and study models of orthodontic patients in permanent dentition who attended dental clinic were assessed for impaction, hypodontia, supernumerary, supraocclusion, infraocclusion, and any other anomalies excluding the third molars. The association of anomalies with gender status and racial status was analyzed using Pearson's Chi-square test. A P value of <0.05 is considered as significant. The confidence interval at 95% (CI) was set. RESULTS: Among the 370 subjects, 105 (28.4%) presented with at least one anomaly. Eighty-five (23%) demonstrated a single anomaly and 20 (5.4%) with more than one anomaly. The most prevalent anomaly was impaction (14.32%), followed by hypodontia (7.03%). The less common anomalies were microdontia (1.08%), dilacerations (0.27%), and generalised enamel hypoplasia (0.27%). Maxillary right lateral incisors and canines were the most common affected teeth and these are located on the maxillary right quadrant. It was evident that dental anomalies were statistically dependant on race (P = 0.025), but independent of gender. The most common treatment planned for these patients was fixed appliance. CONCLUSIONS: Impaction was predominant among 28.4% subjects observed with anomaly and most patients with anomaly are treated with fixed appliances (49%). CLINICAL RELEVANCE: These anomalies play a great role in occlusion and alignment in treatment planning and relapse for orthodontic treatment.

BACKGROUND: The association between maxillary development and vector relationships is used in the field of plastic surgery, but the validity of this principle has not been tested yet. AIM: The aim of this study is to determine whether visual classification of anterior malar projection using vector relationships is supported by cephalometric analysis. MATERIALS AND METHODS: Normal, healthy 40 subjects aged 10–15 years with no history of orthodontic treatment, craniofacial syndromes, or trauma formed the study group. These subjects based on the visual assessment of vector relationship (positive and negative) were divided into 2 groups (Group A and Group B), consisting of 20 subjects each. Vectors were drawn on the profile photographs. Sella–Nasion–Orbitale (SNO) angle were traced using the Nemoceph software. The relationship of anterior malar projection obtained from profile photograph and lateral cephalogram were compared. The data obtained were subjected to statistical analysis. RESULTS: Skeletal differences between the positive and negative vector groups based on SNO angles were statistically significant (P < 0.001). SNO angulations in the negative vector group were smaller than the positive vector group by an average of 5.9°. CONCLUSIONS: Visual assessment of vector relationship can be effectively used to classify anterior malar projection. This also helps in diagnosing maxillary hypoplasia and executes different treatment modalities.

AIM: The value of gonial angle indicates the range of steepness as well as the direction of mandibular growth. Exact measurement of right (R) and left (L) gonial angles from a lateral cephalometric radiograph is challenging due to the superimposition of both sides. Thus, the aim of the present study was to assess the potential of determining accurate measurement of R and L gonial angles by employing orthopantomographs (OPGs) and to compare the findings with the measurements obtained from lateral cephalometric radiographs. MATERIALS AND METHODS: A total of 125 standardized panoramic as well as lateral cephalometric radiographs of Libyan subjects were obtained from the orthodontic clinical records (36 males and 89 females). Mandibular inclination was computed by averaging the R and L gonial angles produced by drawing tangents to the inferior border of the mandible and to the distal aspect of the ascending ramus and the condylon on each OPG. Moreover, similar steps were followed to extract the gonial angle from the cephalometric radiographs. RESULTS: Student's paired t-tests revealed no significant discrepancies between the R and L gonial angle values extracted from the OPG (123.88° ± 6.53° and 123.27° ± 6.55°) at P = 0.0.070. The mean values of the gonial angle (average of the R and L mean values) extracted from the OPG (123.58° ± 6.38°) and cephalometric radiographs (125.14° ± 6.23°) were not significantly different (P = 0.084). Furthermore, Pearson's correlation coefficient revealed strong correlation between the value of the gonial angle measured in the cephalometric radiograph and the mean value extracted from the OPG (r = 0.897 at P < 0.001). CONCLUSION: OPGs are as useful as lateral cephalometric radiographs in the assessment of mandibular inclination and steepness in Libyan subjects. They have the added advantage of reducing patient exposure to radiation by cutting the number of radiographs required during diagnosis.

OBJECTIVES: This study was designed to explore whether force magnitude would influence incisor torque control and the overall outcome in patients with bimaxillary protrusion who need mass incisor retraction. MATERIALS AND METHODS: Forty-one female patients (aged > 15 years) with bimaxillary protrusion requiring mass incisor retraction were selected. Two sliding mechanics were utilized, with the elastic group receiving a light force of ~100 g by wearing elastics and the power chain group receiving a moderate force of ~250 g by power chain. Lateral cephalograms obtained before and after treatment were traced and measured. RESULTS: Patients in both groups displayed maxillary protrusion with a similar skeletal class II tendency. A longer treatment time was found in the elastic group. No difference in the distance of incisor tip movement was observed between the two groups; however, a larger inclination of upper incisors was found in the elastic group, indicating less loss of torque. In addition, larger reduction in Sella-Nasion-A and A-Nasion-B angle was observed in the elastic group, which was accompanied by a larger ratio of upper lip retraction to upper incisor retraction as well as more upper lip retraction. CONCLUSIONS: Sliding mechanics with elastics to generate light forces can achieve better torque control with more reduction in skeletal and soft tissue protrusion.

OBJECTIVES: The objective of this study was to compare the shear bond strength (SBS) of new and rebounded orthodontic brackets bonded to the buccal sound and cleaned enamel surfaces using two orthodontic adhesives: resin-modified glass-ionomer (RMGI) and resin-composite. MATERIALS AND METHODS: Forty premolars were randomly allocated into four groups, 10 teeth/group. New and rebonded brackets were bonded to sound and cleaned enamel surface, and then were subjected to thermocycling. The bond strength was determined using a universal testing machine at a crosshead speed of 1 mm/min. Remaining adhesives on enamel after bracket debonding was scored independently by two investigators who were not aware of the four different groups, using adhesive remnant index (ARI). RESULTS: There was a statistical significant difference in SBS of the four groups (P = 0.005). SBS values were significantly higher with cleaned enamel surfaces after adhesive removal compared to sound enamel. SBS was significantly higher for rebonded brackets, when compared with the new brackets. No significant difference was found between the two adhesives types. The level of agreement between the two raters was higher toward the classification of higher categories of ARI (scores 5 and 6) with agreement percentage 91.7% and 100%, respectively. There was more adhesive remained among resin-composite groups. CONCLUSIONS: The bond strength of debonded sandblasted stainless-steel brackets was higher than new brackets. Resin-composite and RMGI orthodontic adhesives used in this study exhibited sufficient SBS values for bonding brackets to sound and cleaned enamel and comparable to each other.

OBJECTIVES: The purpose of this pilot study was to evaluate the root lengths of upper incisors as an indication of the degree of orthodontically-induced apical root resorption following treatment with Smart Track® aligners and compare it with two different fixed orthodontic appliances – regular and Damon brackets – using cone-beam computerized tomography (CBCT). MATERIALS AND METHODS: The sample comprised 33 patients with class I malocclusion and 4–6 mm crowding divided in 3 groups; Group I: 11 patients treated with Smart Track® aligners, group II: 11 patients treated with Damon brackets, and group III: 11 patients with regular brackets. Maxillary incisors teeth lengths were assessed using Dolphin imaging software before and after treatment. All data were analyzed using analysis of variance and t-test. RESULTS: All groups showed statistically significant root resorption, 0–1.4 mm for clear aligners, 0.1–2.3 mm for Damon, and 0–2.5 mm for regular brackets group. However, cases treated with fixed appliance in general showed significantly higher resorption than those treated with Smart Track® aligners (P < 0.05). CONCLUSION: Orthodontically-induced root resorption, as evaluated by root length, is an inevitable drawback with different orthodontic techniques. However, the use of Smart Track® aligners showed less root resorption relative to regular fixed appliances.

OBJECTIVE: To assess and compare the changes in pharyngeal airway space dimensions following orthodontic treatment of skeletal class II and class III facial deformities with premolar extraction. MATERIALS AND METHODS: Sixty pre and posttreatment lateral cephalometric radiographs of patients who underwent fixed orthodontic treatment with premolar extraction were collected. The sample was divided into two groups – 32 patients with skeletal class II and 28 patients with skeletal class III malocclusion. Both groups were subdivided into growing patients (<16 years old) and adults (>16 years old). Nasopharyngeal, palatopharyngeal, and glossopharyngeal airway space dimensions were measured in the pretreatment (T0) and posttreatment (T1) cephalometric radiographs using Dolphin Imaging 11.7 software. Two-way, repeated-measures analysis of variance was used to assess the in-treatment changes. RESULTS: Nasopharyngeal airway dimension showed similar significant increase in class II (P = 0.042) and class III (P = 0.049) patients from T0 to T1, whereas palatopharyngeal and glossopharyngeal dimensions were insignificantly decreased in both groups. However, both malocclusions followed the same pattern of changes in relation to airway dimensions. In addition, no significant statistical difference was found in the airway spaces between growing and adult patients. CONCLUSIONS: Extraction of premolars did not affect the pharyngeal dimensions except those of the nasopharynx, which showed a significant increase after extraction in both groups.

OBJECTIVE: To assess the knowledge of, demand for, and need for the orthodontic specialty in comparison to other dental fields in a sample of Saudi males. MATERIALS AND METHODS: A multiple choice questionnaire was designed to assess participants' knowledge interest, demand, and need for treatment in the following dental specialties: orthodontics, periodontics, prosthodontics, endodontics, and restorative dentistry. Subjects desiring clinical examination underwent further assessment to document their actual needs. In addition to the subjects' age, the frequencies of tooth brushing, dental pain, treatment seeking, and routine checkup were collected. Descriptive statistics and Pearson's Chi-square test were applied to compare the percentages of the knowledge of, demand for, and need for each dental discipline. The significance level was set at P < 0.05. RESULTS: A total of 1566 Saudi males completed the initial survey of dental knowledge, and 1406 subjects then completed the needs checklist. For the assessment of treatment needed, a total of 177 Saudi males were examined. The average age was 31.25 years (±13.44) and 30.61 years (±10.21) for the surveyed and examined groups, respectively. Subjects' interest in orthodontic knowledge (25%) and demand (27.6%) were not significantly different (P = 0.113), unlike the highly significant difference in the need counterpart (62.5%, P < 0.001). Highly significant differences (P < 0.001) were detected between the three outcome frequencies (knowledge interest, demand, and need) within all dental disciplines, except for the endodontic group where there was no significant difference detected (P = 0.625). Further analysis for the differences between each possible pairing of the three outcomes is highlighted. CONCLUSIONS: Subjects' knowledge of orthodontics approximated their treatment demand. However, orthodontic need was significantly much higher. Different patterns of distinction for other dental specialties were detected and described.

INTRODUCTION: The purpose of this study is to evaluate the validity of a free-access software package (ITK-SNAP) in segmenting and measuring the volume of upper airway spaces secondary to rapid maxillary expansion (RME). MATERIALS AND METHODS: Sixteen participants who required RME were recruited for this study. Preoperative (T1) and 6-month postoperative (T2) cone-beam computed tomographic scans of all participants were analyzed. OnDemand3D software packages was used for superimposition and orientation of the images, while ITK-SNAP software was used to measure the volume of airway spaces. At week one (W1), all volumetric measurements were carried out by one examiner and repeated after 1 week (W2). Paired t-test, the interclass correlation coefficient, and Dahlberg coefficients of reliability were used to assess the reproducibility. RESULTS: Student's t-test showed no significant difference between the W1 and W2 set of measurements (P > 0.05). Coefficients of reliability were above 95% and intraclass correlation coefficient ranged from 0.99 to 1.000, which altogether confirmed the satisfactory reproducibility of the measurements. CONCLUSIONS: ITK-SNAP software package is a reliable and cost-effective method to segment and measure upper airway changes subsequent to RME.

INTRODUCTION: It has been reported that Class II, division 2 maxillary central incisors frequently demonstrate increased collum angles, which indicates an excessive palatal “bend” of the crown. However, evidence supporting such observation is mostly derived from radiographic studies. OBJECTIVE: The objective of this study was to evaluate and compare the collum angle of maxillary central incisors in Class I, Class II, division 1, and Class II, division 2 cases using cone-beam computed tomography. MATERIALS AND METHODS: Forty-eight consecutive orthodontic cases (16 Class I, 16 Class II, division 1, and 16 Class II, division 2 malocclusion) with cone-beam computed tomography as part of their initial diagnostic records were evaluated. Cross-sections including maxillary right and left central incisors were used to calculate the angulation between the crown and root long axes (collum angle). Comparisons between groups were performed using analysis of variance for multiple and post-hoc Tukey for paired analyses. RESULTS: Mean collum angle observed in Class II, division 2 cases was significantly larger (5.2 ± 1.3°) than the ones obtained for Class I (1.1 ± 4.2°) (P = 0.034) or Class II, division 1 cases (0.1 ± 0.7°) (P = 0.014). CONCLUSIONS: Our findings suggest that Class II, division 2 individuals demonstrate accentuated lingual inclination of the maxillary central incisor crown compared to the other types of malocclusion studied here. Such morphological feature indicates the need for better tooth movement planning, especially in regard to root palatal torqueing of the maxillary central incisors.

OBJECTIVE: The aim of this systematic review and meta-analysis is to quantitatively compare previous studies that evaluated skeletal and dentoalveolar effects of the Forsus^TM Fatigue Resistance Device (FRD) in the treatment of Class II malocclusion with a matched untreated control group. MATERIALS AND METHODS: Four electronic searches PubMed, Web of Science, Cochrane Library, and Science Direct that were limited to articles on human studies comparing the effect of Forsus appliance with a matched control group in the treatment of Class II malocclusion from the year (2000–2017). An additional manual search was carried out by examining the references of the included articles, SEARCH terms included; Forsus and Class II malocclusion. The quality of the included studies was assessed using the modified methodological score for clinical trials. The data were analyzed using Michael Borenstein's Comprehensive Meta-Analysis Software (V3.3.070, Biostat, Inc., US). RESULTS: Seven studies were included comprising 273 participants (Forsus group = 142; control group = 131). The results indicated a statistical significant skeletal effect of the Forsus appliance on increasing the occlusal plane only (P < 0.001). The results also indicated a statistical significant (P < 0.001) dentoalveolar effects of the Forsus appliance on the following outcomes; protruding, proclining, and intruding lower incisors; retroclining upper incisors, distalizing and intruding upper molars, as well as reducing overjet and overbite. CONCLUSIONS: The Forsus^TM showed positive effects on the maxillary incisors and first molars as well as overjet and overbite. However, multiple negative effects were reported on the occlusal plane and lower incisors that need to be considered when using such appliance in treating Class II malocclusion.

AIM OF THE STUDY: The main objective of the present study was to investigate the level of job satisfaction among professional orthodontists in relation to some significant intrinsic and extrinsic factors that generally affect their performance. MATERIALS AND METHODS: A cross-sectional study was conducted among orthodontists working in the Kingdom of Saudi Arabia using an online survey questionnaire through Survey Monkey. A total of 161 responses were received; among those, 57.8% of the respondents were Saudi and 42.2% were non-Saudi. RESULTS: On an overall satisfaction basis, a majority of orthodontists (80.7%) were satisfied with orthodontics as their profession irrespective of their gender. Only 4.4% showed dissatisfaction, whereas the remaining 14.9% were moderately satisfied with orthodontics as a profession. In-depth analysis revealed that a majority of the respondents (56.2%) showed reservations over having ample time for their family life. 52.8% of the respondents strongly agreed that they are assigned significant paperwork. Likewise, 66.5% of the orthodontists showed moderate to dissatisfaction over time adherence by the patients. CONCLUSION: The findings of the present investigations depicted a higher level of passion and commitment among the male and female respondents for the profession in spite of the fact that they do not have adequate time for their personal life. The working efficiency of orthodontists may be significantly enhanced by sparing them from too much paperwork and ensuring that their patients appear on time.

OBJECTIVES: The aim of the study was to assess the association and correlation between the overjet and muscle activity (the masseter and temporalis muscles) in patient with Class II malocclusion in different genders using surface electromyography (sEMG). MATERIALS AND METHODS: The overjet (measured clinically) and electromyographical activity (rest, chew, post chew rest, clench and post clench rest) of the masseter and temporalis muscle of class II malocclusion patient were assessed in 18 patients (3 males and 15 females) from the School of Dental Science, Hospital University Sains Malaysia. RESULTS: The results were compared by simple linear regression test to evaluate the association between overjet and muscle activity in different genders. Class II malocclusion patients with increased overjet group showed significant association with masseter muscle activity on chewing stage (P = 0.005, F = 6.081 and adj-R² = 0.473). Left temporalis muscle in class II malocclusion showed a significant linear association (P = 0.014, F = 0.812 and adj-R²= −0.034) with gender during clench. CONCLUSION: In conclusion, class II malocclusion patient with increased overjet can affect masticatory muscle function and as well as clench force may differ in gender.

OBJECTIVES: A skeletal anterior open-bite is a challenging malocclusion for the orthodontist due to the difficulty and instability of correction. Treatment options for the adult patient include extractions, anterior extrusion with intermaxillary elastics, posterior intrusion using skeletal anchorage, occlusal adjustment, and orthognathic surgery. Patient compliance plays a key role in posttreatment stability. The present case report demonstrates the orthodontic treatment of an adult patient who presented with a complex open-bite malocclusion. MATERIALS AND METHODS: Treatment involved the placement of four miniscrews to assist intrusion of maxillary molars by applying posterior vertical maxillary elastics and extrusion of the anterior segments using anterior vertical interarch elastics. RESULTS: Ideal intercuspation was successfully achieved and good stability was maintained during 3 years following treatment. CONCLUSION: The intrusion of the maxillary molars with miniscrews is an interesting option in selected cases of skeletal anterior open bite. The retention protocol should be specific in these cases.

OBJECTIVES: The objective of this study was to evaluate the use of survival analysis in cyclic fatigue testing in orthodontic bracket bonding. MATERIALS AND METHODS: We used 100 extracted bovine lower incisors (50 orthodontic brackets and 50 eyelet brackets). Each set of brackets was further divided by etching technique (25 total-etch and 25 self-etch). Cyclic fatigue testing was performed at a crosshead speed of 2 mm/min using an up-and-down method. Kaplan–Meier survival data analyses and Cox regression analyses were performed. RESULTS: Survival analysis proved to be a simple methodology and revealed that the etching technique was not a statistically significant predictor for survival of orthodontic bracket bonding with either tensile or shear cyclic forces at P > 0.05. In tensile cyclic loading, high mechanical loading after controlling for the etching technique is a statistically significant predictor for lower survival of the orthodontic bracket bond at P < 0.001. CONCLUSIONS: Both etching techniques (total-etch and self-etch) are equally efficient in bonding orthodontic brackets. High mechanical loading is an important predictor of bond failure when applying tensile cyclic forces. Finally, survival analysis is a simpler alternative method to analyze orthodontic bracket bonding subjected to cyclic tensile and shear forces and gives similar results to other complicated methods.

Objectives: This retrospective study aimed to evaluate the dentoalveolar, skeletal, and soft tissue effects obtained with bone-anchored pendulum appliance in patients with Class II malocclusion. Materials And Methods: A total of 18 patients (4 male, 14 female) at a mean pretreatment age of 14.0 years (+1.08) were enrolled in this study. All patients were treated with the bone-anchored pendulum appliance for an average duration of 4.8 months. Only the active distalization period was evaluated with predistalization and postdistalization lateral cephalograms. Skeletal, dentoalveolar, and soft tissue variables were obtained. Based on these variables, the treatment effects were evaluated with dependent t-test. Results: Correction of Class II molar relationship resulted from distal movement of 3.45 mm and tipping of 11.24° of the first maxillary molars. The premolars were distalized accompanying the molars. Conclusions: The bone-anchored pendulum appliance proved to be an effective method for distalization of maxillary molars in cases that require maximum anchorage, avoiding reciprocal mesial movement of premolars and incisors.

Objectives: To compare orthodontic elastics with different force extension characteristics, thereby aiming to reduce the orthodontist's inventory for elastics. Materials And Methods: Thirty nonextraction class I models were used to determine extension distances. Light, medium, and heavy forced Latex elastics of size 1/4 and 3/16 (from three manufacturers) were used. Thirty elastics from each pack were selected, for a total sample size of 540 elastics. Elastic force was measured at three extensions: three times the lumen (A), first molar to opposing canine (B), and second molar to opposing canine distance (C). Force values were compared with the analysis of variance followed by the post hoc Scheffe test. Results: Mean distance for extensions B and C were 22.3 and 38.7 mm, respectively. There was a continuous but significant increase in the force of 1/4 elastics when stretched from A to extension C. A significant increase in the force level of 3/16 elastics was only noted when stretched from A to B. Overall, 1/4 elastics had a wider range of force coverage in the extensions used, compared to 3/16 elastics. Conclusions: The use of 1/4 elastics is sufficient to cover the range of forces in orthodontic treatment.

Objective: Testing of methods to enhance the shear bond strength (SBS) between orthodontic metal brackets and amalgam by sandblasting and different primers. Materials And Methods: Three hundred samples of amalgam restorations (KerrAlloy^®) were prepared in self-cured acrylic blocks, polished, and divided into two groups: nonsandblasted and sandblasted. Each group was divided into five subgroups with different primers used in surface treatment methods, with a control group of bonded brackets on human mandibular incisors. Following the surface treatments, mandibular incisor brackets (Unitek^®) were bonded on the amalgam with adhesive resin (Transbond XT^®). The SBS of the samples was tested. The adhesive remnant index (ARI) and failure modes were then determined under a stereo-microscope. Two-way analysis of variance, Chi-square, and Kruskal–Wallis tests were performed to calculate the correlations between and among the SBS and ARI values, the failure modes, and surface roughness results. Results: There were statistically significant differences of SBS among the different adhesive primers and sandblasting methods (P < 0.05). The sandblasted amalgam with Assure Plus^® showed the highest SBS (P < 0.001). Samples mainly showed an ARI score = 1 and mix-mode failure. There was a statistically significant difference of surface roughness between nonsandblasted amalgam and sandblasted amalgam (P < 0.05), but no significant differences among priming agents (P > 0.05). Conclusions: Using adhesive primers with sandblasting together effectively enhances the SBS between orthodontic metal brackets and amalgam. The two primers with the ingredient methacryloxydecyl dihydrogen phosphate (MDP) monomer, Alloy Primer^® and Assure Plus^®, were the most effective. Including sandblasting in the treatment is essential to achieve the bonding strength required.

Introduction: Esthetics plays an essential role in orthodontic treatment. The psychological effects of malocclusion are an inspiration to improve one's esthetics and seek treatment. Objectives: This study aimed to assess relationships between self-esteem and malocclusion severity and type in adolescents using a self-esteem measurement scale and the index of treatment need (IOTN) and to investigate the influence of age, sex, and school type in these relationships. Materials And Methods: Adolescent students aged 12–19 years randomly selected from four private and two governmental schools were enrolled for this study. After completing the self-esteem questionnaire, participants were examined by researchers to evaluate malocclusion severity and type using the IOTN. Results: The sample consisted of 886 participants: 558 females (62.9%) and 328 males (37.1%) with a mean age of 16 years. Chi-square analysis showed that 17.1% of males and 31% of females showed low levels of self-esteem, with a statistically significant difference (P < 0.001). Cases with multiple malocclusions showed significantly lower self-esteem (P = 0.018) compared with single-category malocclusion. Anterior teeth spacing, crowding, and overjet malocclusion showed the highest percentages of low self-esteem. Conclusions: The present study supports that malocclusion has negative effects on self-esteem; multiple malocclusions with spacing, crowding, and overjet had the greatest effects.

OBJECTIVE: The aim of this study was to evaluate the histological responses of cementum, root dentin, and pulp following intentional root injuries caused via self-tapping and self-drilling miniscrews. MATERIALS AND METHODS: Fourteen patients (with a mean age of 15.7 years and age range of 14–18 years) who were scheduled for the extraction of all four first premolars as part of their orthodontic treatment plan participated in this study. The roots of the right and the left quadrants' first premolars were designedly injured using self-tapping miniscrews and self-drilling miniscrews, respectively. Teeth were extracted eight weeks after the injury. Cementum repair was assessed through histological examinations. RESULTS: In this study, 40 teeth (75.4%) showed reparative cementum formation and 13 teeth (24.5%) showed no repair. There was no significant difference between the two groups regarding the formation of reparative cementum (P = 0.3). In all examined teeth, the inflammatory response of the pulp to the cold test was within the normal range. CONCLUSION: This study showed that in most cases, the healing of cementum was observed eight weeks after the injury and the two methods of miniscrew insertion showed no significant difference when it comes to the healing process.

OBJECTIVE: To investigate the effect of different intracoronal bleaching methods on the shear bond strength and site of failure of ceramic brackets. MATERIALS AND METHODS: Sixty freshly extracted human maxillary incisors were randomly divided into four groups (n = 15). Endodontic access cavity was prepared and root canals were filled, root fillings were removed 2mm apical to the cementoenamel junction, and a 2-mmthick layer of glass ionomer cement base was applied. Group 1 served as the control. Intracoronal bleaching was performed with 35% carbamide peroxide in group 2, sodium perborate in group 3, and 37.5% hydrogen peroxide in group 4. The teeth were immersed in artificial saliva for 4 weeks before bracket bonding. Ceramic brackets were bonded with composite resin and cured with LED light. After bonding, the shear bond strength of the brackets was tested with a universal testing machine. The site of bond failure was determined by modified ARI (Adhesive Remnant Index). RESULTS: The highest value of shear bond strength was measured in control group (18.67 ± 1.59 MPa), which was statistically significant from groups 2,3, and 4. There was no significant difference between groups 2 and 4. The lowest shear bond strength was measured in group 3. ARI scores were not significant from each other. CONCLUSIONS: Intracoronal bleaching significantly affected the shear bond strength of ceramic brackets even after 4 weeks of bleaching. Bleaching with sodium perborate affects shear bond strength more adversely than does bleaching with other agents like hydrogen peroxide and carbamide peroxide.

Objectives: The present study was conducted to evaluate the effect of nanosized aluminum trioxide (Al₂O₃) particles when added to the Nano-Bond adhesive system and its effect on the microshear bond strength of nanocomposite resin to dentin. Materials And Methods: A newly developed adhesive (Nano-Bond) and one type of light-cured resin restorative material (nanocomposite resin) were used in this study. The occlusal surfaces of extracted human molar teeth were ground perpendicular to the long axis of each tooth to expose a flat dentin surface. The adhesives were applied to the dentin surfaces according to manufacturers' instructions. The nanocomposite resin was then placed and light cured for 40 s. After immersion in water at 37°C for 24 h, the specimens were subjected to thermocycling before testing, and a microshear bond test was carried out. The recorded bond strengths (MPa) were collected, tabulated, and statistically analyzed. A one-way analysis of variance and Tukey's tests were used to test for significance between the means of the groups; statistical significance was assumed when the P ≤ 0.05. Results: The mean microshear bond strength of the Nano-Bond adhesive system containing nanosized Al₂O₃at a concentration of 2% was 23.15 MPa (Group B), which was significantly greater than that of the Nano-Bond adhesive system without additives (15.03 MPa, Group A). Conclusions: These results indicate that nanosized Al₂O₃added to the Nano-Bond adhesive system at a concentration of 2% increases the microshear bond strength.

Objective: To study the impact of orthodontic treatment on the quality of life in two patient groups, one treated with the twin block appliance and the other with fixed appliances. Materials and Methods: Ninety-eight patients, aged between 10 and 16 years, were recruited in the fixed (20 males and 29 females) or functional (29 males and 20 females) treatment groups. The oral health-related quality of life (OHRQoL) was measured before treatment and followed up at the end of the treatment. The instrument used to measure OHRQoL was a modified self-administered short version of the English Oral Health Impact profile (OHIP-16[E]) questionnaire. Results: OHRQoL worsened at the initial stages of the treatment. The overall score of OHRQoL reduced significantly at the end of the treatment in both groups. Both groups showed comparable improvements in OHRQoL as the treatment progressed (analysis of variance test P = 0.05). Conclusions: The OHRQoL patterns, during the treatment with fixed and twin block appliances, were very similar. This suggests that the functional appliance's impact on the QoL may be overestimates by clinicians. OHRQoL improved significantly with both fixed and functional appliances by the end of the treatment. The OHRQoL trends observed during the study can be communicated to patients and used to increase patients' compliance since they are made aware of the whole treatment process.

Objectives: The aim of the present systematic review was to assess the effect of functional appliances on the airway dimensions in patients with skeletal Class II malocclusion. Materials And Methods: Articles were identified through a literature survey carried out through the following databases: (1) PUBMED, (2) Google Scholar, (3) The Cochrane Library, (4) Embase, (5) Lilac, and (6) Web of Scholars. The systematic review analyzed 12 articles comprising removable functional appliances, 3 articles with fixed functional appliances, and 2 articles having both fixed and removable functional appliances. Results: Qualitative assessment was done for all the 17 studies. The effect of functional appliances in the dimensions of three airway spaces – nasopharynx, oropharynx, and hypopharynx were analyzed. Conclusions: Significant increase in the dimensions of nasopharynx and oropharynx was observed with Activator. Significant increase in the nasopharynx and hypopharynx (male patients) was observed with Bionator. Insignificant increase in the oropharynx was observed with the same. Significant increase in the oropharynx and hypopharynx was observed with Twin Block. Insignificant increase in the nasopharynx was observed with the same. Significant increase was observed only in the hypopharynx for Frankel II. Decreased or insignificant change was observed with FMA, MPA IV, and Herbst appliances.

Objective: This study was aimed to evaluate the dental age in Saudi children from panoramic radiographs using the Demirjian method to estimate their chronological age. Materials And Methods: This retrospective cross-sectional study consisted of 1902 panoramic radiographs of 955 boys and 947 girls between the ages of 3–17 years. All children were placed in the age group closest to their chronological age. The dental age was scored on all seven left mandibular teeth by calibrated examiners. Bivariate analyses using the t-test and Pearson correlation were performed. Results: There was significant difference in both boys and girls in all the age groups between their chronological age and dental age. Even though there was a slight overestimation in boys in some age groups and slight underestimation in girls in some groups, correlation analysis showed that there was a highly significant correlation between the chronological age and dental age for both boys (r² = 0.96, P < 0.001) and girls (r² = 0.98, P < 0.001). Moreover, correlation analyses for each age group showed a significant correlation between the chronological age and the dental age, using the Demirjian method, in most age groups (P < 0.01). When comparing the maturation score between boys and girls, the Student's t-test showed that there were no statistical differences between boys and girls in most age groups. Conclusion: Saudi boys and girls living in the western region of Saudi Arabia exhibited similar pattern of dental development when compared to the Demirjian method. Hence, the Demirjian method could be used as reference in children from the western region of Saudi Arabia.

Aim: The aim of this study was to evaluate sexual dimorphism in nasal proportions of Class I and Class II skeletal malocclusions in adults. Materials And Methods: The sample comprised 120 patients (females 18 years and above and males 21 years and above), with no history of previous orthodontic treatment or functional jaw orthopedic treatment. They were divided into different groups based on point A-Nasion-point B (ANB) angle and gender. Groups I and II included 30 males and 30 females with skeletal class I malocclusion (ANB 0–4 degrees). Groups III and IV included 30 males and 30 females with skeletal class II malocclusion, respectively (ANB above 4 degrees). Results: In regards to the comparison between males and females (Class I + Class II), nasal length (P < 0.001), nasal depth 1 (P < 0.001), nasal depth 2 (P < 0.001), nasobasal angle (P < 0.001), soft tissue convexity angle (P < 0.001), and nasal bone length (P < 0.008) were found to be statistically significant. Nasobasal angle was found to be significantly higher in females than in males (Class I) (P < 0.001). Nasolabial angle was prominent in class I males than in class I females (P < 0.001). Soft tissue convexity angle of Class I participants was significantly lower than that of Class II participants (P < 0.001), whereas nasobasal angle and nasomental angle of Class I participants were found to be significantly higher than that of Class II participants (P < 0.001). Conclusion: Sexual dimorphism was found in various nasal parameters. Significant amount of differences was found in the nasal proportions of Class I and Class II (male and female) participants.

Objectives: To investigate the effect of using osteogenic induced gingival fibroblasts (OIGFs) and low intensity pulsed ultrasound (LIPUS) on root resorption lacunae volume and cementum thickness in beagle dogs that received orthodontic tooth movement. Materials and Methods: Seven beagle dogs were used, from which gingival cells (GCs) were obtained and were induced osteogenically to produce OIGFs. Each third and fourth premolar was randomly assigned to one of the five groups, namely, LIPUS, OIGFs, bone morphogenetic protein-2 (BMP-2), OIGFs + LIPUS, and control. All groups received 4 weeks of bodily tooth movement, then LIPUS-treated groups received LIPUS for 20 min/day for 4 weeks, and OIGFs groups received an injection of OIGFs near the root apex. Microcomputed tomography analysis was used to calculate root resorption lacunae volume and histomorphometric analysis was performed to measure the cementum thickness of each root at 3 root levels on compression and tension sides. Results: There was no significant difference in resorption volume between the treatment groups. OIGFs + LIPUS increased cementum thickness (P > 0.05) in third premolars near the apex, and LIPUS increased cementum thickness (P > 0.05) in fourth premolars near the apex. Furthermore, BMP2 increased cementum thickness at the coronal third at the compression side. Conclusion: OIGFs, LIPUS, and BMP-2 can be potential treatments for orthodontically induced root resorption, however, improvements in experimental design and treatment parameters are required to further investigate these repair modalities.

Objectives: To establish the overall and anterior Bolton ratio among a sample of Qatari population and to investigate whether there is a difference between males and females, as well as to compare the result obtained by Bolton. Materials and Methods: The current study consisted of 100 orthodontic study participants (50 males and 50 females) with different malocclusions and age ranging between 15 and 20 years. An electronic digital caliper was used to measure the mesiodistal tooth width of all maxillary and mandibular permanent teeth except second and third molars. The Student's t-test was used to compare tooth-size ratios between males and females and between the results of the present study and Bolton's result. Results: The anterior and overall ratio in Qatari individuals were 78.6 ± 3.4 and 91.8 ± 3.1, respectively. The tooth size ratios were slightly greater in males than that in females, however, the differences were not statistically significant (P > 0.05). There were no significant differences in the overall ratio between Qatari individuals and Bolton's results (P > 0.05), whereas statistical significant differences were observed in anterior ratio (P = 0.007). Conclusions: Within the limitation of the limitations of the present study, definite conclusion was difficult to establish. Thus, a further study with a large sample in each malocclusion group is required.

Objectives: To evaluate comparatively the effect of quercetin on postbleaching shear bond strength (SBS) and adhesive remnant index (ARI). Materials and Methods: Intact maxillary premolars were divided randomly into 12 groups of 10 each: (1) bonding the bracket immediately after bleaching, (2) bonding 1 week after bleaching, (3-8) application of three experimental concentrations of quercetin (0.1%, 0.5%, and 1%) at two time durations (5 and 10 min), (9-10) application of the solvent of quercetin at two time periods (5 and 10 min), (11) application of 10% sodium ascorbate for 10 min, and (12) bonding the brackets on nonbleached teeth. Bleaching was performed using 15% carbamide peroxide gel for 5 days (6 h daily). After incubation and thermocycling, the SBS of brackets was measured. The ARI too was recorded at ×20. The data were analyzed statistically (α =0.05). Results : Bleaching reduced the SBS below 10 Megapascal (MPa) level (P < 0.05) while all the postbleaching treatments (except the application of the solvent of quercetin) recovered the SBS back to values greater than 10 MPa (P < 0.05) and also back to nonbleached SBS levels (P > 0.01). All eight postbleaching treatments had rather similar efficacies (P = 0.1396). The concentration of quercetin (beta = 0.259, P = 0.042) but not its duration (beta = 0.213, P = 0.093) significantly improved its efficacy. Conclusion: Bleaching can weaken the bond strength of orthodontic brackets below acceptable levels. The application of quercetin or Vitamin C or delaying the bracket bonding improved the postbleaching SBS.

Objectives: To assess the best temporal association between the application of a fluoride varnish on enamel and bonding procedures. Materials and Methods: Eighty mandibular bovine incisors were used. Teeth were divided into 4 groups (20 per group); Groups 1-3 were treated with fluoride varnish (Fluor Protector, Ivoclar Vivadent, Schaan, Liechtenstein), and Group 4 served as control with no pretreatment. Tooth were stored in deionized water (37°C) and subjected to thermal cycling for 400 (Group 1), 800 (Group 2), and 2500 (Group 3) cycles corresponding, respectively, to 15, 30, and 90 days in order to simulate the three different timing of bracket bonding. Shear bond strength (SBS) was measured using an Instron Universal Testing machine. Tooth surfaces were examined under a stereomicroscope at 10× magnification to assess the amount of adhesive remnant index (ARI). One-way analysis of variance (ANOVA) and Tukey's honestly significant difference post-hoc test were used for the comparison of SBS values between groups (P < 0.05). The Chi-square test was used to examine differences among ARI scores. (P < 0.05). Results: One-way ANOVA and Tukey post-hoc test showed that the SBS of different groups were significantly different and was impacted by different timing of bonding (P < 0.05). The main differences were between the control group (17.02 ± 6.38 MPa) and Group 1 (6.93 ± 4.3 MPa). The ARI scores showed that there were no significant differences between the four tested groups. Conclusions: The SBS of the brackets bonded 15 days after the application of the fluoride was set back to an optimal value.

Objective: To test the null hypothesis that there is no effect of esthetic perception of smiling profile in three different facial types by a change in the maxillary incisor inclination and position. Materials and Methods: A smiling profile photograph with Class I skeletal and dental pattern, normal profile were taken in each of the three facial types dolichofacial, mesofacial, and brachyfacial. Based on the original digital image, 15 smiling profiles in each of the facial types were created using the FACAD software by altering the labiolingual inclination and anteroposterior position of the maxillary incisors. These photographs were rated on a visual analog scale by three panels of examiners consisting of orthodontists, dentists, and nonprofessionals with twenty members in each group. The responses were assessed by analysis of variance (ANOVA) test followed by post hoc Scheffe. Results: Significant differences (P < 0.001) were detected when ratings of each photograph in each of the individual facial type was compared. In dolichofacial and mesofacial pattern, the position of the maxillary incisor must be limited to 2 mm from the goal anterior limit line. In brachyfacial pattern, any movement of facial axis point of maxillary incisors away from GALL is worsens the facial esthetics. The result of the ANOVA showed differences among the three groups for certain facial profiles. Conclusion: The hypothesis was rejected. The esthetic perception of labiolingual inclination and anteroposterior of maxillary incisors differ in different facial types, and this may effect in formulating treatment plans for different facial types.

Objective: To investigate the age- and gender-related changes in upper and lower incisors' position and inclination in different vertical craniofacial relationships. Materials and Methods: A retrospective study on patients' records of age 8-48 years. The sample was divided based on Frankfort mandibular plane angle into three groups; normal, high, and low angle groups. It was then subdivided according to age. Upper and lower incisors' inclinations and positions were assessed from lateral cephalometric radiographs. Gender and age associations and effects size were calculated using two-way ANOVA tests. Significance level was set at P < 0.05. Results: Four hundred and twenty records (F = 272, M = 148) were included; 115 had normal, 81 low, and 250 had high vertical relationships with no significant age and gender distribution differences (P > 0.05). All significant associations and effects were found in the low angle group only. A significant association was found between gender and upper incisor inclination (P < 0.05) with medium effect size (0.13 ≤ ηp ² < 0.26). An association is also found between age × gender interaction and upper incisor inclination and lower incisor position (P < 0.05) with large effect size (0.26 ≤ ηp ² ). Conclusion: Age- and gender-related upper and lower incisor changes were found to be significant in subjects with decreased vertical skeletal pattern only. The upper incisor inclination and the lower incisor position were the most affected variables with age and gender.

Objective: To investigate the influence of silver (Ag), zinc oxide (ZnO), and titanium dioxide (TiO ₂ ) nanoparticles on shear bond strength (SBS). Materials and Methods: One hundred and twenty extracted premolars divided into four groups with thirty specimens in each group. Group 1 (control): brackets (American Orthodontics) were bonded with Transbond XT primer. Groups 2, 3, and 4: brackets (American Orthodontics) were bonded with adhesives incorporated with Ag, ZnO, and TiO ₂ nanoparticles in the concentration of 1.0% nanoparticles of Ag, 1.0% TiO ₂ , and 1.0% ZnO weight/weight, respectively. An "Instron" universal testing machine AGS-10k NG (SHIMADZU) was used to measure the SBS. The data were analyzed by SPSS software and then, the normal distribution of the data was confirmed by Kolmogorov-Smirnov test. One-way ANOVA test and Tukey's multiple post hoc procedures were used to compare between groups. In all statistical tests, the significance level was set at 5% (P < 0.05). Results: A significant difference was observed between control (mean [standard deviation (SD)] 9.43 [3.03], confidence interval [CI]: 8.30-10.56), Ag (mean [SD]: 7.55 [1.29], CI: 7.07-8.03), ZnO (mean [SD]: 6.50 [1.15], CI: 6.07-6.93), and TiO ₂ (mean [SD]: 6.33 [1.51], CI: 5.77-0.89) with SBS (F = 16.8453, P < 0.05) at 5% level of significance. Conclusion: Incorporation of various nanoparticles into adhesive materials in minimal amounts may decrease SBS and may lead to the failure of bracket or adhesive. The limitation of this study is that it is an in vitro research and these results may not be comparable to what the expected bond strengths observed in vivo. Further clinical studies are needed to evaluate biological effects of adding such amounts of nanoparticles and approve such adhesives as clinically sustainable.

Objectives: The aim of this study was to investigate the effects exerted by the acidulated fluoride gel on stainless steel and nickel-titanium (Ni-Ti) orthodontic wires. Materials and Methods: Sixty stainless steel and Ni-Ti orthodontic archwires were distributed into forty archwires used for in vitro study and twenty for in situ study. Fluoride was applied for 1 h in the in vitro experiment while it was applied for 5 min in the in situ experiment. The friction resistance of all wires with ceramic brackets before/after topical fluoride application was measured using a universal testing machine at 1 min intervals of moving wire. Moreover, surface properties of the tested wires before/after fluoride application and before/after friction test were examined by a scanning electron microscope (SEM). Dunnett's t-test was used to compare frictional resistance of as-received stainless steel wires and Ni-Ti wires to the wires treated by fluoride in vitro and in situ (P < 0.05). Two-way ANOVA was used to compare the effect of fluoride application and type of wire on friction resistance in vitro and in situ (P < 0.05). Results: Ni-Ti wires recorded significantly high friction resistance after fluoride application when compared to stainless steel wires in vitro, P < 0.05. Fluoride application did not significantly affect the friction resistance of the tested wires in situ, P < 0.05. SEM observation revealed deterioration of the surface texture of the Ni-Ti wires after fluoride application in vitro and in situ. Conclusions: The in vitro fluoride application caused an increase in friction resistance of Ni-Ti wires when compared to stainless steel wires. In vitro and in situ fluoride application caused deterioration in surface properties of Ni-Ti wires.

Aims: This study is conducted to determine the amount of distortion of digital panoramic radiographs. Materials and Methods: Panoramic radiographs of all patients who received dental implants in the years 2012 and 2013 were selected from the records at the faculty of dentistry, King Abdulaziz University. Radiographs were analyzed using the R4 Kodak Software for linear measurements of implants length and width. The measurements were compared to the actual size of the implant, and the amount of distortion was calculated. Results: A total of 169 implants were analyzed. Horizontally, there was a statistically significant increase of 0.4 mm in width in the radiographic measurement compared to the actual size in the incisor region. Vertically, the sample overall exhibited a decrease by 0.4 mm compared to the actual size. Incisors had the highest difference with a decrease of 1.7 mm in the radiographic measurements compared to actual size. The highest distortion was found in the incisor region for both diameter and length (1.1 and 0.86), respectively. Conclusion: Digital panoramic radiographs show minimal to no distortion. The highest distortion is found in the anterior area.

Introduction: Archwires act as gears to move teeth with light, continuous forces. However, the intraoral use of orthodontic archwires is liable to surface deposits which alter the mechanical properties of archwires, causing an increase in the friction coefficient. Objectives: To evaluate the surface changes of the stainless steel archwires after 6 weeks of intraoral use and its influence on frictional resistance during sliding mechanics. Materials and Methods: As-received rectangular 0.019" × 0.025" stainless steel orthodontic archwires (control) were compared with the archwires retrieved after the final phase of leveling and alignment stage of orthodontic treatment collected after 6 weeks of intraoral exposure (test samples) from 10 patients undergoing treatment. The control and test samples were used to evaluate surface debris using Scanning Electron Microscopy, surface roughness was assessed using Atomic Force Microscope and frictional forces were measured using Instron Universal Testing Machine in the buccal inter-bracket region that slides through the molar tube for space closure. Unpaired t-test and Pearson correlation tests were used for statistical analysis (P < 0.05 level of significance). Results: Significant increase was observed in the level of debris (P = 0.0001), surface roughness (P = 0.0001), and friction resistance (P = 0.001) of orthodontic archwires after their intraoral exposure. Significant positive correlations (P < 0.05) were also observed between these three variables. Conclusion: Stainless steel test archwires showed a significant increase in the degree of debris and surface roughness, increasing the frictional forces between the archwire-bracket interfaces which would considerably reduce the normal orthodontic forces. Thus, continuing the same archwire after levelling and alignment for space closure is not recommended.

Objective: To cephalometrically evaluate and compare the skeletal, dentoalveolar, and soft tissue changes after maxillary protraction with skeletally anchored and conventional facemask. Methods: The data for the study were collected from the pre- and post-treatment records of patients of maxillary retrusion treated with skeletally anchored and conventional facemask therapy. Twenty subjects were included in the study and were categorized into two groups, namely skeletal anchored maxillary protraction (SAMP) group with the mean age of 10.10 ± 1.1 years and conventional facemask maxillary protraction (CFMP) group with the mean age of 9.90 ± 1.1 years. Pre and post-treatment lateral cephalograms were assessed. Results: The data were analyzed by Mann-Whitney test and Wilcoxon signed-rank test. The mean duration of treatment in SAMP group and CFMP group was 5.8 months and 10 months, respectively. The mean forward displacement of the maxilla (vertical point A) was 3.40 ± 1.07 mm in SAMP group and 2.80 ± 0.79 mm in CFMP group. The mandible showed downward and backward rotation in both the groups with more rotation in CFMP group. A significant increase in maxillary incisor inclination was seen in CFMP group as compared to SAMP group. A significant decrease was found in mandibular incisor inclination in both the treatment groups. The soft tissue changes corresponded to underlying skeletal tissue. C onclusions: SAMP is proven to be a better treatment modality as compared to CFMP for achieving true skeletal changes and minimal dental changes in cases with developing skeletal Class III with maxillary retrusion.

Introduction: The objectives of the present study were to elucidate the effects of fluorosis in orthodontic bonding and to evaluate the efficiency of an adhesion promoter (Assure Universal Bonding Resin) in bonding to fluorosed teeth. Materials and Methods: Extracted premolars were divided into two groups on the basis of Thylstrup and Fejerskov Index. Ten samples from each group were etched and evaluated for etching patterns using scanning electron microscope (SEM). The remaining samples were subdivided into four groups of 20 each on the basis of adhesives used: IA, IIA - Transbond XT and IB, IIB - Transbond XT plus Assure Universal Bonding Resin. Shear bond strength (SBS) was measured after 24 h using the universal testing machine. Adhesive remnant index (ARI) scores were recorded using SEM. Statistical analysis was conducted using a two-way analysis of variance, and Tukey's post hoc test was performed on SBS and ARI scores. Results: Similar etching patterns were observed in both fluorosed and nonfluorosed teeth. No significant differences were found in the SBS values observed in both groups (8.66 ± 3.19 vs. 8.53 ± 3.44, P = 1.000). Increase in SBS was observed when Assure Universal Bonding Resin was used. Higher ARI scores were observed when adhesion promoter was used for bonding. Conclusions: Mild-moderately fluorosed teeth etch in a manner similar to the nonfluorosed teeth. Similar bond strengths were achieved in fluorosed and nonfluorosed teeth when conventional composite was used. Use of adhesion promoter increases the bond strengths in both groups of teeth.

Introduction: The aims of this study were to establish the prevalence of dental features that indicate a need for early intervention and to ascertain the prevalence of different methods of early treatment among a population of Nigerian children in mixed dentition. Methods: Occlusal relationships were evaluated in 101 children in mixed dentition between the ages of 6 and 12 years who presented at the Orthodontic Unit, Department of Child Dental Health, Lagos University Teaching Hospital over a 2 years period. The need for different modes of early orthodontic treatment was also recorded. Results: Anterior tooth rotations (61.4%) and increased overjet (44.6%) were the most prevalent occlusal anomalies. Others included deep bite (31.7%), reverse overjet (13.9%), and anterior open bite (14.8%). Severe maxillary spacing and crowding were exhibited in 12.0% and 5.0%, respectively. About a third (35.7%) of the subjects presented with crossbite while lip incompetence was observed in 43.6% of the subjects. About 44% of the subjects also presented with various oral habits with digit (15.8%) and lip sucking (9.9%) being the most prevalent. Subjects were recommended for treatment with 2 by 4 fixed orthodontic appliances (22.3%), habit breakers (20.7%), removable orthodontic appliances (16.5%), and extractions (15.7%). Conclusions: Increased overjet and anterior tooth rotation were the majority of occlusal anomalies seen, which are not only esthetically displeasing but may also cause an increased susceptibility to trauma to these teeth. Treatment options varied from extractions only to the use of appliance therapy.

Objective: To compare the stain resistance of three types of clear elastomeric modules exposed to several common dietary substances through the assessment of the perception of a group of dentists to discoloration using visual analog scale (VAS). Materials and Methods: Elastomeric modules from Unitek (AU), Ormco (OR), and dentaurum (DE) were immersed in the following food substances: Coffee, black tea, chocolate, energy drink, ketchup, and Coca-Cola for 72 h. VAS was used to reflect the module staining severity. Results: Significant difference was found among the three types of modules examined in this study. OR modules showed the least mean staining ratings by the examiners. There was no statistical difference in the staining properties between AU and DE modules. Coffee and tea showed higher staining potential as compared to all staining media. Furthermore, there was no difference in the staining characteristics of coffee and black tea. Conclusions: Coffee and tea are strong staining media that should be avoided by patients who opted to have esthetic appliances for their orthodontic treatment. Elastomeric modules manufactured by AU showed higher staining optical properties as compared to the other two companies, which could be related to the manufacturing processing of these modules.

Objectives: To evaluate the effect of moments and the combination of forces and moments on the mechanical properties of a bracket type miniscrew, resembling engagement of a rectangular wire by three-dimensional (3D) finite element study. Materials and Methods: By solid work software (Dassaunlt systems solid works, concord, Mass), a 3D miniscrew model of 6, 8, 10 mm lengths was designed and inserted in the osseous block, consisted of the cortical, and cancellous bones. The stress distributions, maximum stresses, and deflections of the miniscrew were evaluated for all parts using ANSYS (Work Bench, 2014). Results: As the magnitudes of the load increased from 100 to 200, 400 and 800 grf-mm, the peak of stresses in the 6 mm long miniscrew were increased from 7.7 to 61.5 Mpa. The maximum values of Von Mises in the cancellous bone were tremendously lower in comparison to the cortical bone by one hundredth. As the length of the miniscrew in contact with the bone was increased, the amounts and patterns of stress distribution in the cortical bone and the miniscrew did not change significantly. Conclusions: As the moment magnitude increased, the pick stresses increased linearly. The existence of cancellous bone was not significantly responsible for the stress distribution. The pattern of stress distribution did not change by the length of the miniscrew.

Objectives: Facial Aesthetics, a major consideration in orthodontic diagnosis and treatment planning, may not be judged correctly and completely by simply analyzing dental occlusion or osseous structures. Despite this importance, there is no index to guarantee availability of treatment or prioritize patients based on their soft tissue treatment needs. Individuals having well-aligned teeth but unaesthetic convex profiles do not get included for treatment as per current malocclusion indices. The aim of this investigation is to develop an aesthetic index based on facial profiles which could be used as an additional tool with malocclusion indices. Materials and Methods: A chart showing typical facial profile changes due to underlying malocclusions was generated by soft tissue manipulations of standardized profile photographs of a well-balanced male and female face. A panel of 62 orthodontists judged the profile photographs of 100 patients with different soft tissue patterns for assessing profile variations and treatment need. The index was later tested in a cross-section of school population. Statistical analysis was done using "irr" package of R environment version 2.15.1. Results: The index exhibited very good reliability in determining profile variations (Fleiss kappa 0.866, P < 0.001), excellent reproducibility (kappa 0.9078), high sensitivity, and specificity (95.7%). Testing in population yielded excellent agreement among orthodontists (kappa 0.9286). Conclusions: A new Facial Aesthetic index, based on patient's soft tissue profile requirements is proposed, which can complement existing indices to ensure treatment to those in need.

Objectives: To compare the levels of pentraxin 3 (PTX-3) in gingival crevicular fluid (GCF) in patients undergoing orthodontic canine retraction with active tieback and nickel titanium (NiTi) coil spring. Materials and Methods: Fifteen patients of the age group 15-25 years with first premolar extraction undergoing canine retraction were selected. One month after placement of 0.019" × 0.025" stainless steel wire, canine retraction was started with active tieback (150 g force) on upper right quadrant and NiTi coil spring (150 g force) on upper left quadrant. GCF samples were collected 1 h before commencement of canine retraction and thereafter at intervals of 1 h, 1 day, 1 week, and 2 weeks after application of force. The collected GCF was eluted from the microcapillary pipette in 100 μl phosphate-buffered saline (pH 5-7.2). The samples were analyzed for PTX-3 levels by the ELISA technique. Results: The mean levels of PTX-3 at 1 h before canine retraction (baseline) was 1.30 ± 0.22 ng/ml and at 1 h 1.66 ± 0.33 ng/ml, 1 day 2.65 ± 0.09 ng/ml, 1 week 1.96 ± 0.15 ng/ml, and 2 weeks 1.37 ± 0.18 ng/ml in active tieback group. The mean levels of PTX-3 at 1 h before canine retraction was 1.32 ± 0.30 ng/ml, and at 1 h 1.71 ± 0.39 ng/ml, 1 day 2.78 ± 0.12 ng/ml, 1 week 2.52 ± 0.18 ng/ml, and 2 weeks 2.12 ± 0.17 ng/ml in NiTi coil spring group. A significant difference of P < 0.001 was found in PTX-3 levels in GCF during canine retraction between active tieback and NiTi coil spring at 1 day, 1 week, and 2 weeks. Conclusion: The results showed that PTX-3 levels increased from 1 h after application of orthodontic force and reached peak at 1 day, followed by a gradual decrease at 1 week and 2 weeks in both active tie back and NiTi coil spring groups.

Objective: To evaluate esthetics perception and satisfaction of the facial profile among Iranian male adolescents and adults. Materials and Methods: In this cross-sectional study, male subjects referred to Orthodontic Department of Mashhad Dental School were enrolled (n = 84) and were divided into two groups: Adolescents (n = 39), and adults (n = 45). They were also assigned to straight, convex, or concave profile groups based on the facial profile angle (G-Sn-Pog'). An ideal silhouette of the lower facial profile was designed in Adobe® Photoshop® CS2 software (Kansas, USA). Then, eight other silhouettes representing different relations of the maxilla and mandible were constructed. Patients were asked to use numbers 1-10 to rank the facial profiles in the order of the attractiveness, and choose a silhouette that best closely resembled their own profile. Moreover, using a questionnaire patients were asked to rank their satisfaction with their profile, and asked to assign a number (1-5) to each question as follows; one represented the least satisfaction, while five reflected the highest satisfaction. Results: Adult and adolescent subjects with straight (adults: 12.0 ± 1.9, adolescents: 12.8 ± 1.05) and concave (adults: 10.0 ± 2.14, adolescents: 10.0 ± 2.08) profile showed the highest and the least satisfaction with their own profile, respectively. Both adult and adolescent group selected "retrognathic maxilla, prognathic mandible" as the least attractive profile. Overall, "straight" and "bimaxillary dentoalveolar retrusion" were chosen as the most attractive silhouettes in adolescent and adults, respectively. In comparison to a professional opinion (clinician ranking), 42.9% of adolescents and 22% of adults were able to correctly diagnose their own profiles type. Conclusion: Most of the male adolescents and especially adults diagnosis of their own profile differed with a professional assessment.

Objectives: To assess in vitro the quantitative and qualitative debonding behavior of the AEZ debonding plier, compared to shear debonding force, in debonding orthodontic metal brackets. Materials and Methods: Thirty-two extracted premolars bonded with metal brackets were randomly divided into two equal groups according to the type of simulated debonding method; compressive bond strength (CBS) group using AEZ debonding plier (Ormco Corporation, USA) attached to the Instron machine, and shear bond strength (SBS) group using regular Instron attachments. All teeth were subjected to debonding forces, and debonding strength was assessed. The buccal surfaces were then examined, under a stereomicroscope, and adhesive remnants were scored using adhesive remnant index (ARI). Debonding strengths comparison was performed using the independent sample t-test. ARI score comparison was performed using the Mann-Whitney U-test. Correlation between debonding strength and ARI scores was performed using the Spearman correlation. Results: There was no significant difference in mean debonding strength between the SBS (M = 6.17 ± 0.77 MPa) and CBS (M = 6.68 ± 1.67 MPa) groups (P > 0.05). The CBS group showed significantly less adhesive remnants than the SBS group (P < 0.05); 62.5% of CBS group had ARI score 1, whereas 68.8% of SBS group had ARI score 3. No significant correlation between ARI and debonding strength was found (P < 0.05). Conclusion: SBS was found to produce similar debonding strength to the AEZ debonding plier in vitro. However, the AEZ debonding plier resulted in less adhesive remnant which is of great advantage for reducing chair-time during cleanup after debonding brackets.

Background: Bonding brackets to dental surfaces restored with composites are increasing. No studies to date have assessed the efficacy of laser irradiation in roughening of composite and the resulted shear bond strength (SBS) of the bonded bracket. We assessed, for the 1 ^st time, the efficacy of two laser beams compared with conventional methods. Materials and Methods: Sixty-five discs of light-cured composite resin were stored in deionized distilled water for 7 days. They were divided into five groups of 12 plus a group of five for scanning electron microscopy (SEM): Bur-abrasion followed by phosphoric acid etching (bur-PA), hydrofluoric acid conditioning (HF), sandblasting, 3 W and 2 W erbium-doped yttrium aluminum garnet laser irradiation for 12 s. After bracket bonding, specimens were water-stored (24 h) and thermocycled (500 cycles), respectively. SBS was tested at 0.5 mm/min crosshead speed. The adhesive remnant index (ARI) was scored under ×10 magnification. SEM was carried out as well. Data were analyzed using analysis of variance (ANOVA), Kruskal-Wallis, Tukey, Dunn, one-sample t-test/Wilcoxon tests, and Weibull analysis (α =0.05). Results: The SBS values (megapascal) were bur-PA (11.07 ± 1.95), HF (19.70 ± 1.91), sandblasting (7.75 ± 1.10), laser 2 W (15.38 ± 1.38), and laser 3 W (20.74 ± 1.73) (compared to SBS = 6, all P = 0.000). These differed significantly (ANOVA P = 0.000) except HF versus 3 W laser (Tukey P > 0.05). ARI scores differed significantly (Kruskal-Wallis P = 0.000), with sandblasting and 2 W lasers having scores inclined to the higher end (safest debonding). Weibull analysis implied successful clinical outcome for all groups, except for sandblasting with borderline results. Conclusion: Considering its high efficacy and the lack of adverse effects bound with other methods, the 3 W laser irradiation is recommended for clinical usage.

Background: Marking pencils which are frequently used in orthodontics may cause microbial contamination. The purpose of this study was to evaluate and compare the effectiveness of three disinfection and sterilization methods (autoclave, glutaraldehyde solution, and Deconex spray) on orthodontic markers. Materials and Methods: One hundred and twenty orthodontic markers were divided into four groups each 30 pencils: One control group and three groups for three different disinfection/sterilization methods. To evaluate the effectiveness of these methods, pencils were initially contaminated by common pathogen by immersing the pencils in a suspension containing 1.5 × 10 ⁸ CFU/ml organisms. Then, the pencils were subjected to corresponding disinfection/sterilization methods, and the number of remaining microorganisms was calculated and compared with control group. Results: In the control group, the mean number of Escherichia coli was significantly higher than the other two microorganisms (P = 0.01, P = 0.031). However, the mean numbers of Staphylococcus aureus and Candida albicans were not significantly different (P = 0.1). After sterilization with autoclave and glutaraldehyde, no microbial growth was observed, whereas after disinfection with Deconx spray some colonies of microorganisms still could be observed. Conclusion: Autoclaving and glutaraldehyde solution are the best methods for disinfecting orthodontic markers.

Aim: To assess the effects of adding nano-titanium dioxide (nano-TiO ₂ ) and nano-silicon dioxide (nano-SiO ₂ ) and their mixture to poly (methyl methacrylate) (PMMA) to induce antimicrobial activity in acrylic resins. Materials and Methods: Acrylic specimens in size of 20 mm × 20 mm × 1 mm of 0.5% and 1% of nano-TiO ₂ (21 nm) and nano-SiO ₂ (20 nm) and their mixture (TiO ₂ /SiO ₂ nanoparticles) (1:1 w/w) were prepared from the mixture of acrylic liquid containing nanoparticles and acrylic powder. To obtain 0.5% and 1% concentration, 0.02 g and 0.04 g of the nanoparticles was added to each milliliter of the acrylic monomer, respectively. Antimicrobial properties of six specimens of these preparations, as prepared, were assessed against planktonic Lactobacillus acidophilus and Streptococcus mutans at 0, 15, 30, 45, 60, 75, and 90 min follow-up by broth dilution assay. The specimens of each group were divided into three subgroups: Dark, daylight, or ultraviolet A (UVA). The percent of bacterial reduction is found out from the counts taken at each time point. Statistical Analysis: Data were analyzed using one-way analysis of variance and Tukey's post hoc analysis. Results: Exposure to PMMA containing the nanoparticles reduced the bacterial count by 3.2-99%, depending on the nanoparticles, bacterial types, and light conditions. Planktonic cultures of S. mutans and L. acidophilus exposed to PMMA containing 1% of TiO ₂ /SiO ₂ nanoparticles showed a significant decrease (P < 0.001) (98% and 99%, respectively) in a time-dependent manner under UVA. The S. mutans and L. acidophilus counts did not significantly decrease in PMMA containing 0.5% nano-TiO ₂ and PMMA containing 0.5% nano-SiO ₂ in the dark. No statistically significant reduction (P > 0.05) was observed in the counts of S. mutans and L. acidophilus in PMMA without the nanoparticles exposed to UVA. Conclusions: PMMA resins incorporated with TiO ₂ /SiO ₂ nanoparticles showed strong antimicrobial activity against the cariogenic bacteria.

Objective: The aims of this study were to determine the prevalence of hypodontia in the permanent dentition in a sample of Qatari patients attending a dental center and to compare the results with the reported findings of other populations. Materials and Methods: Orthodontic files including orthopantomographs of 1000 patients (655 females and 345 males, 11-36-year-old) were examined and inspected for evidence of hypodontia. Results: The prevalence of hypodontia in the present Qatari sample was 7.8%; 6.9% was in males and 8.2% in females. Hypodontia was found more frequently in the maxilla than in the mandible. The distribution of missing teeth was noticed in the left side more than the right side. The most frequently missing teeth were the maxillary lateral incisors followed by the mandibular second premolars, maxillary second premolars, and mandibular left lateral incisor. The majority of patients with hypodontia had one or two teeth missing, but rarely more than four teeth were missing in the same patient. Bilateral missing teeth in the current study was commonly seen in the maxillary lateral incisor (14.1%) followed by mandibular second premolar (12.8%) and maxillary second premolar (6.4%). Conclusions: The prevalence of hypodontia in a sample of Qatari individuals was within the range reported in the literature for other populations. The incidence of hypodontia in the anterior segment requires multidisciplinary team approach (orthodontic and prosthodontic) to restore the esthetic and function and improve patient self-esteem.

Objectives: To conduct an epidemiological survey of the orthodontic debonding techniques in Italy, and describe the most commonly used methods to remove the brackets and adhesive from the tooth surfaces. Materials and Methods: A survey consisting of 6 questions about bracket debonding methods and instruments used was emailed to 1000 orthodontists, who were members of the Italian Orthodontics Society (SIDO. Clinicians were characterized by different sex, age, origin, and professional experience. Results: Overall, 267 surveys were returned, representing a response rate of 26.7% of the participants interviewed. The 0.2% of the orthodontists responded, via email, confirming that they were not interested, while 3% of the questionnaires were sent back not completed. The 70.1% of the clinicians interviewed did not return any response. Overall, 64% of SIDO members (orthodontists) did not detect any enamel damage after debonding. The brackets used most frequently (89.14%) in clinical practice were the metal ones. The most commonly used pliers for bracket removal were cutters (37.08%) and bracket removal pliers (34.83%). For adhesive removal, low speed tungsten carbide burs under irrigation were the most widely utilized method for adhesive removal (40.08%), followed by high speed carbide burs (14.19%), and diamond burs (14.19%). The most frequently used instruments for polishing after debonding were rubber cups (36.70%) and abrasive discs (21.35%). The 31.21% of the orthodontists found esthetic enamel changes before bonding versus after debonding. Conclusions: This survey showed the high variability of different methods for bracket debonding, adhesive removal, and tooth polishing. The collected answers indicate that most orthodontists have developed their own armamentarium of debonding and polishing, basing their method on trials and errors.

Objective: To investigate the intensity of pain adolescent orthodontic patients experience following the insertion of separators. Materials and Methods: Elastomeric separators were placed mesially and distally to the first molars in 62 adolescents (20 male, 42 female, age 12–15 years), and the participants were given self-administrated questionnaires to document perceived pain, pain upon chewing, and the severity of pain's affecting daily life, using a visual analog scale for seven days. Results: The mean perceived pain scores out of 100 on the first 3 days were 54.6 ± 32.7, 51.7 ± 29.9, and 32.3 ± 28.4, respectively; chewing pain scores were: 61.9 ± 35.3, 52.6 ± 30.4, and 39.5 ± 32.1, respectively; the pain's affecting daily life scores were 24.9 ± 35.5, 21.1 ± 30.9, and 11.9 ± 23.7, respectively. A Kruskal–Wallis test showed a statistically significant difference in the reported pain between the three studied parameters. A Mann–Whitney U-test showed an insignificant difference between male and female adolescents. Conclusion: Pain perception varies among adolescent patients, but it decreases significantly after the first 2 days, with no gender differences.

Aims: A new Resin Modified Glass Ionomer Cement known as nanoionomer containing nanofillers of fluoroaluminosilicate glass and nanofiller 'clusters' has been introduced. An in-vitro study aimed at evaluating shear bond strength (SBS) and adhesive remnant index (ARI) of nanoionomer under etching/unetched condition for use as an orthodontic bonding agent. Material and Methods: A total of 75 extracted premolars were used, which were divided into three equal groups of 25 each: 1-Conventional adhesive (Enlight Light Cure, SDS, Ormco, CA, USA) was used after and etching with 37% phosphoric acid for 30 s, followed by Ortho Solo application 2-nanoionomer (Ketac^™ N100, 3M, ESPE, St. Paul, MN, USA) was used after etching with 37% phosphoric acid for 30 s 3-nanoionomer was used without etching. The SBS testing was performed using a digital universal testing machine (UTM-G-410B, Shanta Engineering). Evaluation of ARI was done using scanning electron microscopy. The SBS were compared using ANOVA with post-hoc Tukey test for intergroup comparisons and ARI scores were compared with Chi-square test. Results: ANOVA (SBS, F = 104.75) and Chi-square (ARI, Chi-square = 30.71) tests revealed significant differences between groups (P < 0.01). The mean (SD) SBS achieved with conventional light cure adhesive was significantly higher (P < 0.05) (10.59 ± 2.03 Mpa, 95% CI, 9.74-11.41) than the nanoionomer groups (unetched 4.13 ± 0.88 Mpa, 95% CI, 3.79-4.47 and etched 9.32 ± 1.87 Mpa, 95% CI, 8.58-10.06). However, nanoionomer with etching, registered SBS in the clinically acceptable range of 5.9–7.8 MPa, as suggested by Reynolds (1975). The nanoionomer groups gave significantly lower ARI values than the conventional adhesive group. Conclusion: Based on this in-vitro study, nanoionomer with etching can be successfully used as an orthodontic bonding agent leaving less adhesive remnant on enamel surface, making cleaning easier. However, in-vivo studies are needed to confirm the validity of present findings.

Objectives: The objectives of this study were to determine the prevalence of snoring in an adult male university population, and to test the null hypothesis that there is no difference in facial profile shape, malocclusion type, or palatal morphology among snorer and nonsnorer. Materials and Methods: Berlin questionnaire was given to 840 students and employees aged 18–45 years (24 ± 40). Both snorers and nonsnorers were assessed for the facial profile type, malocclusion type, and palatal morphology. Chi-square and Student's t-test were used to compare the difference between the two groups. Results: The prevalence of snoring was 16.28%. The most frequent findings among snorer were straight profiles (52.0%), Class I malocclusion (74.7%), and V palatal shape (16.0%), respectively. The Chi-square test revealed a significant difference in terms of V-shaped palatal morphology (P < 0.05); higher neck circumference (NC) (P < 0.007); upper arch length was significantly shorter (P < 0.038); and the inter- first upper premolar distance was significantly narrower (P < 0.013). Conclusion: The null hypothesis is rejected. Snoring in our university population is associated with V-shape palatal morphology, increased NC and decrease in the upper arch length, and inter- first upper premolar distance.

Objectives: The objectives were to evaluate the shear bond strength (SBS) of fiber-reinforced composite (FRC) retainers when bonding them to teeth with and without covering the FRC bars using two different adhesive systems. Materials and Methods: Hundred and twenty extracted human maxillary premolars were randomly divided into eight groups (n = 15). FRC bars (4 mm length, Everstick Ortho^®, Stick Tech, Oy, Turku, Finland) were bonded to the proximal (distal) surfaces of the teeth using two different adhesives (Tetric Flow [TF, Ivoclar Vivadent, Switzerland] and resin-modified glass ionomer cement [RMGIC, ODP, Vista, CA, USA]) with and without covering with the same adhesive. Specimens were exposed to thermocycling (625 cycles per day [5–55°C, intervals: 30 s] for 8 days). The SBS test was then performed using the universal testing machine (Zwick, GMBH, Ulm, Germany). After debonding, the remaining adhesive on the teeth was recorded by the adhesive remnant index (0–3). Results: The lowest mean SBS (standard deviation) was found in the TF group without covering with adhesive (12.6 [2.11] MPa), and the highest bond strength was in the TF group with covering with adhesive (16.01 [1.09] MPa). Overall, the uncovered RMGIC (15.65 [3.57] MPa) provided a higher SBS compared to the uncovered TF. Covering of FRC with TF led to a significant increase in SBS (P = 0.001), but this was not true for RMGIC (P = 0.807). Thermal cycling did not significantly change the SBS values (P = 0.537). Overall, eight groups were statistically different (ANOVA test, F = 3.32, P = 0.034), but no significant differences in bond failure locations were found between the groups (Fisher's exact tests, P = 0.92). Conclusions: The present findings showed no significant differences between SBS of FRC bars with and without covering by RMGIC. However, when using TF, there was a significant difference in SBS measurements between covering and noncovering groups. Therefore, the use of RMGIC without covering FRC bars can be suggested, which can be validated with in vivo studies.

Background and Aim: The purpose of this study was to investigate whether different camera lenses and dental specialties can affect the perception of smile esthetics. Methods: In the first phase of this study, 40 female smile photographs (taken from dental students) were evaluated by six orthodontists, three specialists in restorative dentistry, and three prosthodontists to select the most beautiful smiles. The 20 students with the best smile ranks were again photographed in standard conditions, but this time with two different lenses: Regular and then macro lenses. Each referee evaluated the beauty of the smiles on a visual analog scale. The referees were blinded of the type of lenses, and the images were all coded. The data were analyzed using two-way analysis of variance (ANOVA), Kruskal–Wallis and Mann–Whitney U-tests (alpha = 0.05, alpha = 0.0167). Results: The lenses led to similar scores of beauty perception (Mann–Whitney P = 0.8). There was no difference between subjective beauty perception of specialties (Kruskal–Wallis P = 0.6). Two-way ANOVA indicated no significant role for lenses (P = 0.1750), specialties (P = 0.7677), or their interaction (P = 0.7852). Conclusion: The photographs taken by a regular lens and then digitally magnified can be as appealing as close-up photographs taken by a macro lens. Experts in different specialties (orthodontics, prosthodontics, and restorative dentistry) showed similar subjective judgments of smile beauty.

Objectives: The objective was to compare dentofacial characteristics of Class I malocclusion in Saudi and Japanese adult females. Materials and Methods: Lateral cephalograms of 50 Saudi adult female and 50 Japanese adult female (18-35-year-old) were obtained. All patients were skeletal Class I, angle Class I malocclusion, arch length discrepancy (−10-10 mm), overjet (1-5 mm), overbite (1-5 mm), absence of congenital anomalies, or significant facial asymmetries or congenitally missing tooth other than the 3 ^rd molar and absence of temporomandibular joint problems. Patient cephalograms were traced and digitized. 16 angular measurements and 13 linear measurements of facial form were used. Results: A comparison of the vertical dimension showed that the Saudi females had a significantly larger gonial angle, a significantly larger facial angle and longer lower face height compared to the Japanese females. Dentally, Saudi females had more protruded incisors with increased distances of the posterior teeth to the palatal plane. For the soft tissue dimension, the Saudi subjects had a significantly more prominent nose, retruded lip and a more protruded chin compared with Japanese. Conclusions: There were significant differences in dentofacial morphology between Saudi and Japanese adult females. Both Asian countries have distinct cephalometric features, which should be considered as a reference in treating patients of varying ethnic backgrounds to optimize the final results.

Objective: The objective was to evaluate the Bolton ratio in a North Indian population in Lucknow with different malocclusion. Materials and Methods: Totally, 110 study cast [Age: Female (14.2 ± 1.5 years, Male (13.9 ± 2.3 years)] were taken from the patients undergoing orthodontic treatment and Subjects were divided into three groups: Group I (Angle's Class I, n = 40), Group II (Angle's Class II, n = 50) and Group III (Angle's Class III, n = 20) according Angle's classification of malocclusion. The mesiodistal widths of all maxillary and mandibular teeth from right first molar to left first molar were measured with a digital caliper to calculate the Bolton ratio. The readings were then used to compute the anterior and total Bolton ratios. ANOVA and Tukey's test were used for the statistical analysis. Results: A mean total Bolton ratio of 91.36 ± 2.13 and a mean anterior Bolton ratio of 78.14 ± 4.09 were found for the sample, Significantly higher mean anterior tooth ratios were found for Group II (Angle's Class II) patients (P < 0.01). All other ratios were within close range of Bolton's norms. Conclusions: Angle's Class II patients showed a tendency toward wider mesiodistal widths of teeth in the mandibular anterior region or smaller tooth sizes in the maxillary anterior region.

Background: The study of the mesiodistal size, the morphology of teeth and dental arch may play an important role in clinical dentistry, as well as other sciences such as Forensic Dentistry and Anthropology. Aims: The aims of the present study were to establish tooth-size ratio in Sudanese sample with Class I normal occlusion, to compare the tooth-size ratio between the present study and Bolton's study and between genders. Materials and Methods : The sample consisted of dental casts of 60 subjects (30 males and 30 females). Bolton formula was used to compute the overall and anterior ratio. The correlation coefficient between the anterior ratio and overall ratio was tested, and Student's t-test was used to compare tooth-size ratios between males and females, and between the present study and Bolton's result. Result s: The results of the overall and anterior ratio was relatively similar to the mean values reported by Bolton, and there were no statistically significant differences between the mean values of the anterior ratio and the overall ratio between males and females. The correlation coefficient was (r = 0.79). Conclusions : The result obtained was similar to the Caucasian race. However, the reality indicates that the Sudanese population consisted of different racial groups; therefore, the firm conclusion is difficult to draw. Since this sample is not representative for the Sudanese population, hence, a further study with a large sample collected from the different parts of the Sudan is required.

Objectives: The objective was to assess the shear bond strength (SBS) of composite resins on stainless steel brackets immediately bonded to previously bleached teeth with 35% hydrogen peroxide and to compare the neutralization effect of various antioxidant agents on the bond strength after bleaching. Materials and Methods: One hundred sound human maxillary premolars were used for the study. Teeth were divided into 5 groups (n = 20); Group 1 (control), Group 2 (bleach treatment), Group 3 (sodium ascorbate treatment), Group 4 (tocopherol acetate treatment), and Group 5 (retinol acetate treatment). Teeth in Group 3, 4, and 5 were treated as in Group 2, but after that and before bleaching received treatment with sodium ascorbate, tocopherol acetate, and retinol acetate, respectively. Subsequently, teeth were bonded with stainless steel brackets (Ormco) using 3M Transbond XT. After 24 h, each specimen was loaded into a universal testing machine to determine the SBS at debonding. The data were exposed to the analysis of variance, Bonferroni, and Weibull Analysis. Result: There significant SBS difference (P = 0.000, F = 32.125) between various groups. Group 1 had the highest SBS (12.182 ± 1.41 MPa) and Group 2 the least SBS (6.182 ± 1.49 MPa). Significant SBS differences observed between Group 1 and 2; Group 2 and 3; Group 2 and 4; and Group 2 and 5 (P = 0.000). There was no significant SBS difference between Group 1 and 3; Group 1 and 4; and Group 3 and 4 (P = 1.000). Bonferroni results also indicated that there was a significant difference between Group 1 and 5 (P = 0.002); Group 3 and 5 (P = 0.144); and between Group 4 and 5 (P = 0.008). Weibull analysis indicated that bond strength for a 90% probability of failure, which was highest for Group 1 (13.99 MPa) and lowest for Group 2 (8.49 MPa). Conclusion: The in-vitro study showed that bleaching with 35% hydrogen peroxide reduced the SBS significantly and this could be effectively reversed by the application of 10% sodium ascorbate, 10% tocopherol acetate, or 10% retinol acetate. Thus, treatment of bleached teeth with antioxidants can be a good clinical option for bonding immediately after bleaching.

Background: Rapid palatal expansion is one of the most important orthopedic treatments that correct the dental and palatal constriction. Stability of the changes partly depend on the rapidity of new bone formation in affected sutures after expansion. The purpose of this study was to investigate the effect of laser irradiation on the healing of midpalatal suture concurrent to the expansion of midpalatal suture in rats. Materials and Methods: A total of 78 male Sprague rats in seven groups were evaluated: A control group of six rats without any treatments and three experimental groups of 24 which underwent palatal expansion for different time periods (7, 14, and 30 days), and each divided into two groups of with and without laser irradiation. Laser therapy was done by gallium-aluminum-arsenide diode laser with 810 nm wavelength and 4 J/cm ² irradiation in days 0, 2, 4, 6, 8, 10, 12, 14 in 4 points (1 labial and 3 palatal points). After sacrificing, the sections were evaluated by histomorphometric and quantitative analysis and results were statistically investigated by independent samples t-test. Results: The results in 7 days, 14 days, and 30 days show that laser therapy can increase the rate of osteogenesis in palatal suture during rapid palatal expansion but the differences in 7 days groups were not significant (P = 0.117) while in 14 days groups (P = 0.032) and 30 days groups were significant (P = 0.001). Most of effectiveness of low-power laser was seen between 14 and 30 days while the laser therapy was stopped. Conclusion: These findings suggest that low-level laser irradiation can increase and accelerate bone regeneration in the midpalatal suture after rapid palatal expansion, hence, reduce retention time.

Objective: The aim of this cross-sectional study was to compare craniofacial growth among operated and unoperated unilateral cleft lip and palate non-syndromic subjects. Materials and Methods: A sample of 180 subjects of Indian origin was selected. Of them, 90 were operated, and 90 were unoperated complete unilateral cleft lip and palate individuals. The subjects were divided into three age groups of 3-5, 8-10, and 20-25 years comprised of 30 patients in each group. The following measurements were evaluated: Angle and length of the cranial base; maxillary spatial positioning and length; mandibular spatial positioning; morphology and length; maxillomandibular relationship. Comparative analysis of the means between the groups was performed with Student's t-test at the significance levels of 5%. The ANOVA test has been performed to test the effect of time. Results: No significant differences were observed between the measurements that represented the angle and length of the cranial base of unoperated and the operated patients (P>0.05). There was statistically significant decrease ( P˂0.05) in the maxillary length (Co-A; 69.00 mm in 3-5 years, 68.33 mm in 8-10 years, and 67.17 mm in 20-25 years age group), and SNA angle (74.83Ί in 3-5 years, 74.17 Ί in 8-10 years and 73.17 Ί in 20-25 years age group) in operated group. No significant difference noticed on cephalometric values of the mandible, except Ar-Go-Me angle ( P˂0.05), which showed vertical growth pattern in unoperated patients (132.50 Ί in 3-5 years, 132.00 Ί I 8-10 years and 138.33 Ί in 20-25 years age group). Conclusion: Lip and palate repair has a significant influence on the maxilla and resulting in retarded growth of maxilla, which causes midface deficiency beyond acceptable sagittal limits. The Gonial angle showed vertical growth pattern in unoperated patients, but the cranial base angle and length of unoperated and the operated patients were similar.

Objectives: The aim was to evaluate the in vitro effects of fluoride solutions with different acidities on load-deflection characteristics of nickel-titanium (NiTi) orthodontic wires. Materials and Methods: In this study, which lasted 30 days, 36 (3 cm long, 0.016 × 0.022 inches, SENT 1622, G & H wire Company, Greenwood, Indiana, USA) NiTi wires, were divided into three experimental groups of 12 each. Two groups were subjected to 0.05 topical fluoride mouthwash with different acidities (G1, pH 4; G2, pH 6.6) for 90 s, twice a day, and kept in normal saline after that. The third group (G3, the control group) was kept in normal saline only. Load and unload forces were measured with three bracket bending test in a universal testing machine (Testometric Co, Rochdale, UK). Loading and unloading plateaus and hysteresis were also recorded. Data were then analyzed using analysis of variance and honestly significant difference Tukey at P < 0.05. Results: During the loading phase, there was a significant difference between deflections (P < 0.001); but there was no interaction effect (P = 0.191) and no significant difference among three groups (P = 0.268). In the unloading phase, there was a significant difference between deflections (P < 0.001) and an interaction effect was also observed (P = 0.008). Further, significant differences noted among three groups (P = 0.037). Only in the unloading phase, at deflections of 2.2 through 0.2 mm, significant differences between the mean force values of the G1 and G3 groups were observed (P = 0.037). Conclusion: Based on this in-vitro study, compared to neutral fluoride solution, daily mouthwash with a fluoride solution with more acidic pH of 4 affected the NiTi wires load-deflection characteristics during the unloading phase. This finding may have clinical implications and can be further validated by in-vivo studies.

Objectives: The aim was to assess and compare the prevalence of orthodontic treatment need among various special health care needs (SHCN) schoolchildren and adolescents in Dharwad, India. Materials and Methods: This cross-sectional study was carried out among 492 subjects in age group of 12-19 years (mean age 14.02 ± 1.84 standard deviation [SD]) who were examined for occlusal anomalies using dental aesthetic index (DAI). They were classified into five groups as: Visual impairment, speech and hearing disability (SH), physical disability, mentally subnormal and multiple disabilities (MD). Chi-square test was used to compare the orthodontic treatment need among various SHCN groups. One-way ANOVA and ANCOVA were performed to test any significant differences in mean DAI scores among the SHCN groups. Results: None of the children were undergoing or had undergone orthodontic treatment for malocclusion. Mean DAI score was 28.81 ± 11.64 (SD). Orthodontic treatment was indicated in 50.2% of study population who had DAI scores of 26 and above. Mandatory orthodontic treatment (DAI >=36) was required in as high as 29% of MD individuals when compared to only 10% of SH individuals. Significant differences in DAI scores were found between the SHCN groups. Conclusions: The need for orthodontic treatment among SHCN individuals was found to be high. Yet, absence of any orthodontic treatment for any child points out to the fact that the dental services are highly needed in these individuals.

Purpose: The aim of this study was to compare frictional forces between monocrystalline alumina (MA), polycrystalline alumina (PA), and stainless steel (SS) brackets with two SS wires: Rectangular and round. Materials and Methods: In this in vitro study, 60 0.022" brackets [20 PA (0° torque, Forestadent, Germany) and 20 MA (0° torque, Ormco, California, USA)] brackets plus 20 SS brackets (0° torque, Foretadent, Germany) and 60 SS archwires (30 rectangular 0.019" ×0.025" archwires and 30 round 0.018" archwires, Ortho Technology, USA) were used in subgroups of 10 from the combination of all brackets and all archwires. A universal testing machine (Instron, Model STM 250, Germany) was used to investigate the static frictional resistance. The angulation between the bracket and wire was 0°, and the wires were pulled through the slots at a crosshead speed of 10 mm/min. Two-way and one-way analyses of variance (ANOVA) and Tukey tests were used to analyze the data. Results: Mean (SD) static frictional force for each group was as follows: MA + round: 3.47 (0.38); MA + rectangular: 4.05 (0.47); PA + round: 4.14 (0.37); PA + rectangular: 4.45 (0.65); SS + round: 3.28 (0.22); and SS + rectangular: 4.22 (0.61). Significant effects of bracket types (P = 0.001) and archwire types (P = 0.000) on the friction force were detected using ANOVA. Tukey test indicated significant differences between PA brackets with both SS and MA brackets (P < 0.05), but not between SS and MA brackets. The two archwires as well had significantly different effects (Tukey P = 0.000). Conclusions: Based on the present in-vitro study, the PA brackets might create higher frictional forces compared to both SS and MA brackets. The rectangular 0.019" ×0.025" archwire might create greater forces than round 0.018" archwire.

Objectives: This in-vitro study aimed at evaluating the effect of three debonding sequences on the shear bond strength (SBS) of new stainless steel (SS) brackets. Materials and Methods: Stainless steel twin brackets (0.022-inch, American Orthodontics, Sheboygan, WI, USA) were bonded with light cure adhesive (Transbond XT, 3M Unitek, St. Paul, MN, USA) to 80 newly extracted human premolars after acid etching with 37% phosphoric acid (30 s). Brackets were debonded with a universal testing machine, and new brackets were bonded to teeth using the same adhesive and same manner. This process was repeated twice, and brackets were debonded within 24 h after bonding. The longitudinal changes of average SBS were assessed with the repeated measures ANOVA. Post-hoc tests using the Bonferroni correction were also used to compare the average SBS at three debonding sequences. Result: The mean SBS decreased significantly after each debonding sequence (P < 0.01). The corresponding mean values (standard deviation, 95% CI) after the first, second, and third debonding sequences were 22.88 MPa (4.08, 21.97-22.79), 19.36 MPa (4.54, 18.62-20.64), and 16.67 MPa (4.27, 15.72-17.62), respectively. There was no significant difference among the adhesive remnant index (ARI) scores of three debonding sequences (χ² = 5.067, df = 6, P = 0.53). Conclusion: Average SBS after three debonding sequences was significantly decreased, but was above the recommended 5.9-7.8 MPa. In-vivo studies are required to validate the finding of this study.

Aim: To determine the static frictional resistance of different lingual brackets at different second order angulations when coupled with stainless steel (SS) archwire in dry and wet conditions. Materials and Methods: Using a modified jig, frictional resistance was evaluated under different conditions for a total of 270 upper premolar lingual brackets (0.018″ × 0.025″ - conventional - 7 ^th generation and STb, self-ligating - evolution) with no in-built tip or torque together with 0.016″ × 0.022″ straight length SS archwires. For conventional brackets, the archwire was secured with 0.008″ preformed SS short ligature ties. Statistical Analysis: One way analysis of variance with Tukey HSD as post-hoc test was applied for degree wise and bracket wise comparison within dry condition and wet condition. For pair wise comparison Student's t-test was used. Results: Under both conditions the static frictional resistance is significantly higher for self-ligating brackets at 0°, while at 5° and 10° it is higher for 7 ^th generation brackets. Statistically, significant difference does not exist at 0° between conventional brackets and the same was found at 5° and 10° between STb and self-ligating brackets. With an increase in second order angulations, all the evaluated samples exhibited an increased frictional value. Wet condition samples obtained a higher value than their corresponding dry condition. Conclusion: The self-ligating bracket evaluated in this in vitro study is not beneficial in reducing friction during en-mass retraction due to its interactive clip type.

Objectives: The aim of this study was to evaluate the cytotoxic effects of fiber reinforced composite bonded retainers in comparison with flexible spiral wires (FSWs) under high and low cariogenic-simulated environments using human oral fibroblasts. Materials and Methods: Four types of bonded retainers were evaluated: (1) reinforced with glass fibers: Interlig (Angelus), (2) reinforced with polyethylene fibers: Connect (Kerr), (3) reinforced with quartz fibers: Quartz Splint UD (RTD), and (4) FSW. Twenty specimens of each sample group were prepared with the same surface area and halved. Next, half of them were placed in a high cariogenic environment 60 min in 10% lactic acid 3 times a day and remained in Fusayama Meyer artificial saliva for the rest of the day) and the other half were placed in a low cariogenic environment 20 min in 10% lactic acid 3 times a day and remained in Fusayama Meyer artificial saliva for the rest of the day) for 1, 7 and 30 days. Cell viability was assessed by MTT assay. Data were analyzed using SPSS software (α =0.05). Results: During the 1 ^st month, cytotoxicity reduced gradually. In the low cariogenic-simulated environment, the cytotoxicity of all of the groups were reported to be mild at day 30 and the difference between them was significant (P = 0.016). In the same period in the high cariogenic-simulated environment, the cytotoxicity of Connect and Quartz Splint was mild, and they had lower cytotoxicity than the other groups. Meanwhile, Interlig had moderate (52%) and FSW had severe cytotoxicity (22%) and the difference between the groups was also significant (P = 0.000). Conclusions: FSW retainers are not recommended in those at high-risk for dental caries. However, in those at low-risk, there is no difference from the standpoint of cytotoxicity.

Background: Previous studies have reported on mechanical properties of different orthodontic wires. However, there is a paucity of information that comparing the mechanical properties of Blue Elgiloy (BE) when compared to stainless steel and TMA, as finishing wires as received by different companies. Aims: The aim of this study was to evaluate the mechanical properties of BE wires compared to stainless steel (SS) and titanium Molybdenum alloy (TMA) also known as β titanium as provided by two companies. Materials and Methods: Six 0.016" x 0.022"-14mm-samples of each wire were fixed individually to Instron machine and were tested in loading and unloading for three times. The initial load was set for 500 Kg at a speed of 1mm/min and displacement was adjusted for (0.5, 1mm in loading and 0.5 mm unloading at 25°C). Statistics Analysis: Variables were compared between groups by ANOVA test using SPSS statistical software. Results: BE shows comparable forces to SS when loaded 0.5 and showed decreased forces in 1mm loading compared to SS, and higher than TMA. BE also showed no forces at unloading and high deformation. Conclusion: BE from the two companies showed comparable mechanical properties while SS and TMA were different. The deformation of BE and its decreased forces in unloading may limit its clinical use.

Objectives: To compare the mean shear bond strength (SBS) of moisture insensitive primer (MIP) used for orthodontic bonding in the presence and absence of saliva. Materials and Methods: A total of 60 human noncarious maxillary premolars with sound buccal surfaces, recently extracted were collected in two groups of each 30. Maxillary premolar brackets were bonded to the teeth using light cure (Transbond XT, 3M Unitek, Monrovia, CA, USA) and MIP (Transbond MIP 3M Unitek, Monrovia, CA, USA,) in the presence and absence of saliva. Operators' saliva was used during the bonding under moist condition. After debonding, all the specimens were examined under a stereomicroscope (×40 magnification) for adhesive remnant using adhesive remnant index (ARI). The SBS tests were done using Instron universal testing machine at cross-head speed of 1 mm/min, force passing parallel to the buccal surface using custom rod and registered in Newtons later converted into Megapascals. Results: Light cure and MIP (Transbond MIP and Transbond XT, 3M Unitek, Monrovia, CA, USA) in the absence of saliva showed higher mean SBS than the presence of saliva. Group I (light cure and MIP) in the absence of saliva showed mean SBS of 9.65 ± 0.90 Mpa. Group II (light cure and MIP) with the presence of saliva showed mean SBS of 9.03 ± 1.14 Mpa. The difference between both the groups was statistically significant, as confirmed by paired t-test (P < 0.05). In-Group I, ARI scores showed that more than half of the adhesive was left over the tooth surface, and Group II showed that there was no or insignificant amount of adhesive left over the tooth surface. Chi-square test revealed significant difference in debonding characteristics among the test groups of ARI (P < 0.05). Failure occurred mainly in resin- bracket base and resin - adhesive interfaces (χ² = 10.04, df = 3, P = 0.031). Conclusion: Moisture insensitive primer is effective in the presence/absence of moisture and has shown SBS value of more than 7.8 Mpa as stated by Reynolds, hence material is suitable for clinical use.

Aim: The aim of the present study was to compare the undisturbed plaque formation on teeth bonded with Preadjusted (Captain Ortho, Libral Traders, Mumbai, India) and Begg Brackets (Captain Ortho, Libral Traders, Mumbai, India) with nonbonded control sites via a de novo plaque growth over a period of 7 days. Materials and Methods: A clinical trial with the split-mouth design was set up enrolling 10 dental students. Within each subject sites with (Preadjusted) (P-site), Begg brackets (B-site) and control sites were followed. Plaque index and gingival index were recorded on days 3 and 7. Supra-gingival and sub-gingival plaque samples were taken from the brackets and the teeth on days 3 and 7, and were sent for aerobic and anaerobic culturing. The total number of bacterial colony forming units (CFU) was assessed for each sample using a colony counter. Tukeys and Dunnett test then statistically analyzed data. Results: The mean plaque index and gingival index increased on P-site and B-site on the third and 7 ^th day. The shift from aerobic to anaerobic species was observed earlier in P-sites than in B-sites. The CFU were significantly higher for all sites on day 7 when compared with day 3. The aerobe/anaerobe CFU ratio was significantly lower in P-sites than in B-sites and then control showing an increase in the number of anaerobic species on the 3 ^rd and 7 ^th day (P < 0.05). Based on observed means, the mean difference was significant (P < 0.05). Conclusion: The present data suggest that Preadjusted brackets accumulated more plaque than Begg brackets. Bracket design can have a significant impact on bacterial load and on periodontal parameters.

Objectives: This study aimed to outline orthodontists' perspectives at what stage they would initiate orthodontic treatment and also sought to assess the relationship between orthodontists' views and their genders, types of practice, and experience levels. Materials and Methods: A questionnaire was sent electronically to 165 practicing orthodontists at different regions in Saudi Arabia. The orthodontists were asked to consider at what stage they would initiate orthodontic treatment for a child with one of 29 different types of occlusal deviations, functional problems, and temporomandibular disorders (TMDs) listed in the questionnaire as their main orthodontic problem. Frequency distributions of all the variables were derived, and comparisons were made using the Chi-square tests. Results: Fifty-two electronically completed questionnaires were returned (31.5% response rate). The majority of the respondents were males (63.5%). The majority of respondents (90%) reported that they would treat most of the occlusal deviations in the mixed dentition stage. Anterior cross-bite was the most frequent indication for treatment during the early mixed dentition stage (73.7%). Conditions rated as best treated during the late mixed, or the permanent dentition stages were; overjet > 6 mm with interdental spacing, maxillary midline diastema >2 mm and deep bite >5 mm without palatal impingement. The majority of respondents (86.6%) preferred to treat most of the functional problems in the deciduous or early mixed dentition stage. Orthodontists with more than 15 years of experience preferred to treat patients with TMDs, whereas those with <15 years of experience opted to refer such patients to TMD specialists. Conclusions: The findings of the present study suggest that orthodontists should consider many factors, such as the risks, benefits, duration, and costs of early and late intervention, when deciding the best timing to begin orthodontic treatment.

Background: Three-dimensional cephalometric analyses are getting more attraction in orthodontics. The aim of this study was to compare two softwares to evaluate three-dimensional cephalometric analyses of orthodontic treatment outcomes. Materials and Methods: Twenty cone beam computed tomography images were obtained using i-CAT ^® imaging system from patient's records as part of their regular orthodontic records. The images were analyzed using InVivoDental5.0 (Anatomage Inc.) and 3DCeph™ (University of Illinois at Chicago, Chicago, IL, USA) software. Before and after orthodontic treatments data were analyzed using t-test. Results: Reliability test using interclass correlation coefficient was stronger for InVivoDental5.0 (0.83-0.98) compared with 3DCeph™ (0.51-0.90). Paired t-test comparison of the two softwares shows no statistical significant difference in the measurements made in the two softwares. Conclusions: InVivoDental5.0 measurements are more reproducible and user friendly when compared to 3DCeph™. No statistical difference between the two softwares in linear or angular measurements. 3DCeph™ is more time-consuming in performing three-dimensional analysis compared with InVivoDental5.0. Clinical Implications: InVivoDental5.0 utilizes less time in performing three-dimensional cephalometric measurements compared to 3DCeph™ system.

Objective: The aim of this study was to compare the amount of root resorption after orthodontic treatment between the bidimensional and the Roth straight-wire techniques. Another objective was to compare the amount of root resorption in the whole sample studied and record the prevalence of root resorption. Materials and Methods: The sample consisted of 40 patients (age ranged between 11 and 18 years) with Angle Class II division 1 malocclusions, treated nonextraction. Twenty patients were treated with bidimensional technique and 20 with a 0.018-inch Roth straight-wire technique. Root lengths of the maxillary incisors were measured on pre- and post-treatment periapical radiographs. Results: The results demonstrated that the bidimensional and Roth straight-wire groups showed significant root resorption after treatment, 1.11 (0.17) and 0.86 (0.05), respectively, P < 0.001. When comparing the amount of root shortening between the bidimensional and Roth straight-wire groups, there was no significant difference between the mean change from pre- to post-treatment between bidimensional group (mean = 1.00 ± 1.34) and Roth straight-wire group (mean = 0.88 ± 0.86), P = 0.63. Considering the whole sample, there was no root resoprtion in 32.5% of the analysed teeth. There was only mild resorption in 56.2%, moderate in 8.8% and severe in only 2.5% of the teeth. Conclusions: Treatment with the bidimensional technique did not produce an increase in the amount of root resorption. The prevalence and amount of root resorption was similar between bidimensional and Roth straight-wire techniques.

Context: The detrimental effect of moisture on orthodontic bonding has long been known. Hydrophilic bonding materials have been introduced suggesting the possibility of obtaining successful orthodontic bonding to a moisture contaminated enamel surface. Aims: This study has been performed with an aim to compare the in vitro shear bond strength (SBS) and debonding characteristic of moisture-insensitive primer (MIP) (Transbond MIP) (3M Unitek, South Peck Road, Monrovia, California, USA) and self-etching primer (SEP) (Transbond Plus SEP) (3M Unitek, South Peck Road, Monrovia, California, USA) in combination with a color changing adhesive system (Transbond Plus Color Change) (3M Unitek, South Peck Road, Monrovia, California, USA) under both dry and contaminated condition. Settings and Design: Randomized controlled clinical study. Subjects and Methods: One hundred and twenty freshly extracted teeth for the purpose of orthodontic treatment were collected. Teeth were randomly assigned into four groups, each consisting of 30 specimen and stainless steel brackets were bonded using each primer-adhesive combination under different enamel conditions, that is, dry and enamel contaminated with natural saliva. SBS and adhesive remnant index were calculated for each group. Results: Analysis of variance of SBS for both MIP and SEP under dry and contaminated condition showed no statistical significance (P = 0.5). Chi-square test showed significant difference in debonding characteristics among the test groups (P < 0.001). All the groups showed typical debonding characteristics of separation either at the bracket-adhesive interface or within the adhesive itself. Conclusions: Moisture contamination did not affect the SBS and adhesive remaining on tooth for both MIP and SEP.

Aim: The aim of this study was to evaluate angulation and inclination of teeth from the study models of individuals with normal occlusion and evaluation of actual expression of torque expressed by three different bracket systems. Materials and Methods: In this study, the inclination and angulation were measured on 30 study models of North Indian individuals. A self-developed instrument (torque angle gauge) was used for the measurement. Fifteen study models were duplicated for the evaluation of torque expression in the bracket of three different manufacturers with different shape and size of bases. Results: The results give the mean, minimum and maximum, standard deviation of the normative data individually for each tooth. A significant correlation was noted in the angulation of maxillary canine and first premolar, and between premolars; and between mandibular central incisor with lateral incisor and canine, and between premolars. Conclusions: There was a highly significant correlation of teeth angulation and inclination in the maxillary and mandibular arch. Though the error in expression of torque was not significant, but it showed a large range, indicating the need to vary the position of brackets in different bracket systems for achieving optimum torque.

Objective : To investigate the role played by the cranial base flexure in influencing the sagittal and vertical position of the jaws in Indian population. Materials and Methods : Lateral cephalograms of 108 subjects were divided into three categories (Group A: NSAr > 125°, Group B: NSAr-120°-125°, Group C: NSAr < 120°) according to value of NSAr. Measurement of eight angular (SNA, SNB, NPg-FH, ANB, NAPg, SN-GoGn, Y-Axis, ArGo-SN) and seven linear (N-S, S-Ar, Ar-N, Ar-Pt A, Ar-Gn, Wits appraisal, N- Pt A) variables were taken. Results : Pearson correlation coefficient test was used to individually correlate angular and linear variables with NSAr for the whole sample as well as in individual group. Unpaired t-test was used to analyze the difference in the means of all the variables between the three groups. Significance was determined only when the confidence level was P < 0.05. Several parameters (SNB, NAPg, ANB, Y-Axis, GoGn-SN) showed significant positive correlation while others showed negative correlation (SNA, NPg-FH, N-S) with NSAr. Conclusions : This study show cranial base angle has a determinant role in influencing the mandibular position and it also affects both the mandibular plane angle and y-axis. Flattening of the cranial base angle caused a clockwise rotation of the mandible. The jaw relation tends to change from class III to class II, with progressive flattening of the cranial base and vice-versa.

Objective: The aim was to formulate a prediction regression equation for Yemeni and to compare it with Moyer's method for the prediction of the size of the un-erupted permanent canines and premolars. Subjects and Methods: Measurements of mesio-distal width of four permanent mandibular incisors, as well as canines and premolars in both arches were obtained from a sample of 400 school children aged 12-14 years old (13.80 ± 0.42 standard deviation) using electronic digital calliper. The data were subjected to statistical and linear regression analysis and then compared with Moyer's prediction tables. Results: The result showed that the mean mesio-distal tooth widths of the canines and premolars in the maxillary arch were significantly larger in boys than girls (P < 0.001), while, in the mandibular arch, only lateral incisors and canines were also significantly larger in boys than in girls (P < 0.001). Regression equations for the maxillary arch (boys, Y = 13.55 + 0.29X; girls, Y = 14.04 + 0.25X) and the mandibular arch (boys, Y = 9.97 + 0.40X; girls, Y = 9.56 + 0.41X) were formulated and used to develop new probability tables following the Moyer's method. Significant differences (P < 0.05) were found between the present study predicted widths and the Moyer's tables in almost all percentile levels, including the recommended 50% and 75% levels. Conclusions: The Moyer's probability tables significantly overestimate the mesio-distal widths of the un-erupted permanent canine and premolars of Yemeni in almost all percentile levels, including the commonly used 50% and 75% levels. Therefore, it was suggested with caution that the proposed prediction regression equations and tables developed in the present study could be considered as an alternative and more precise method for mixed dentition space analysis in Yemeni.

Objective: The aims of this study were to determine the prevalence of hypodontia in the permanent dentition in a sample of Sudanese patients who sought orthodontic treatment and to compare the results with the reported findings of other populations. Materials and Methods: Orthodontic files including orthopantomographs of 1069 patients (760 females and 309 males - more than 8 years old) were examined and inspected for evidence of hypodontia. Results: The prevalence of hypodontia of the present sample was 5.1%. Hypodontia was found considerably more frequently in the mandible than in the maxilla. The distribution of missing teeth was noticed in the left side more than in the right side. The most frequently missing teeth were the maxillary lateral incisors, followed by the mandibular second premolars, maxillary second premolars and mandibular left lateral incisor. The majority of patients had two or three teeth missing, but rarely more than 5 teeth missing. Conclusions: The prevalence of hypodontia of this study was within the range of that reported in the literature. The incidence of hypodontia in the anterior segment requires great need for orthodontic and prosthodontic treatment. With early detection of hypodontia, alternative treatment modalities can be planned and performed with a multidisciplinary team approach restoring the esthetic and function.

Objectives: The objective of this study is to assess the differences in facial profile preference among different layers of people in the United Arab Emirates. Facial profile self-awareness among the different groups was also evaluated. Materials and Methods: A total sample of 222 participants (mean [standard deviation] age = 25.71 [8.3] years, almost 80% of the participants were of Arab origin and 55% were males); consisting of 60 laypersons, 60 dental students, 60 general practitioners, 16 oral surgeons, and 26 orthodontists. Facial profile photographs of a male and female adult with straight profiles and a Class I skeletal relationship were used as a baseline template. Computerized photographic image modification was carried out on the templates to obtain seven different facial profile silhouettes for each gender. To assess differences in facial profile perception, participants were asked to rank the profiles of each gender on a scale from most to least attractive (1 [highest score] and 7 [least score]). Awareness and satisfaction with the facial appearance on a profile view was assessed using questionnaires completed by the non-expert groups. Results: The straight facial profile was perceived to be highly attractive by all five groups. The least attractive profiles were the bimaxillary protrusion and the mandibular retrusion for the male and the female profiles, respectively. Lip protrusion was more esthetically acceptable in females. Significant differences in perception existed among groups. The female profile esthetic perception was highly correlated between the expert groups (P > 0.05). Overall agreement between the non-expert group's perceptions of their own profiles and evaluation by the expert orthodontist was 51% (κ = 0.089). Candidates who perceived themselves as having a Class III facial profile were the least satisfied with their profile. Conclusions: Dental professionals, dental students, and laypersons had a similar perception trends in female and male aesthetic preference. Laypersons were more tolerant to profiles with bi-maxillary retrusion. The expert group's esthetic perception was highly correlated only for the female profiles. Most of the non-experts were unable to correctly identify their facial profile.

Aims: The present study was conducted to investigate the relevance of cortical plate proximity of maxillary central incisor root, maxillary alveolar bone width, and the apical root resorption in extraction and non-extraction orthodontically treated cases. Further, the correlation between the apical root resorption and the various parameters was investigated. Materials and Methods: A total of 80 lateral head cephalographs, 40 pre-treatment and 40 post-treatment, of orthodontic subjects with a mean age of 15 years treated with fixed standard edgewise appliance were obtained. All subjects were divided into two groups as extraction and non-extraction cases. Twelve linear and three angular parameters were measured and evaluated. The paired " t"- test, Pearson's correlation coefficient, and the stepwise regression analysis were done to test the relationship between the apical root resorption and the various parameters. Results and Conclusions: The study revealed slightly greater amount of apical root resorption in extraction subjects as compared to non-extraction subjects. However, no statistically significant difference was found between the two treatment modalities. In extraction subjects, the apical root resorption was directly proportional to the pre-treatment length of maxillary central incisor and inversely proportional to the root width in apical one-third region, though there was a weak correlation. In non-extraction subjects, the pre-treatment anteroposterior position of the root apex of maxillary central incisor in the alveolar bone, in combination with its root width in the apical one-third region formed the predictive factors for the variance in the amount of the apical root resorption, though there was a weak correlation. Furthermore, the changes in the alveolar widths at the root apex and mid-root region were considered as predictive factors for the amount of apical root resorption during extraction and non-extraction treatment, respectively.

Objective: The aim of this study was to estimate the orthodontic treatment need in a sample of 12-year-old Yemeni school children using the dental aesthetic index (DAI). Materials and Methods: The sample comprised 3003, 12-year-old children attending school in six of the governorates of Yemen. For each subject, the standard demographic information such as gender and age was collected, after which an intraoral examination for occlusal status using the DAI was performed. Results: The mean (SD) of DAI score was 24.86 (8.44) points (95% CI, 24.07-25.65). Overall, 36.6% of the sample found to have a dental appearance that requires orthodontic treatment, ranging from 'selective' to 'mandatory'. Of whom, 19.0% presented with severe and handicapping malocclusion, requiring 'definite' and "mandatory' treatment according to the DAI (DAI ≥ 31). Although there was no gender difference in the mean DAI score (P > 0.05), the sex distribution of the DAI treatment categories was significantly different (Chi-square = 13.258, df = 3, P = 0.004). The results of the individual DAI components showed that about 8% of the sample had more than one missing permanent teeth. Anterior maxillary and mandibular irregularity occurred in more than 33% of the sample. More than 30% of the children examined showed signs of crowding. Spacing in the incisal segments occurred in almost 25% of the sample. Almost 30% of the sample had an antero-posterior molar relation discrepancy. Conclusion: According to the findings of this study, almost one in five of the evaluated Yemeni school children had a DAI score above or equal to 31 points, suggesting highly desirable or mandatory orthodontic treatment need.

Aim: To investigate the added-value of using CBCT in the orthodontic treatment method of maxillary impacted canines and treatment outcome. Materials and Methods: The sample consisted of 118 treated patients. The CBCT group (n = 58) (39 females/19 males with the mean age of 14.3 years) included those with conventional treatment records consisting of panoramic and cephalometric radiographs, intra-and extra-oral photographs, and dental casts and complemented with a CBCT scan for additional diagnostic information. The conventional group (n = 60) (31 females/29 males with mean age 13.1 years) included those with similar conventional treatment records but without CBCT imaging. Results: There were significant differences in the canine-related variables between both groups. The CBCT group had the higher level of difficulty and more severely displaced canines when compared with the conventional group. However, no significant difference was found between groups either in the number of treatment methods used or in the use of interceptive methods combined with other treatment modalities or choice of extraction versus non-extraction. In terms of treatment success and interval duration, no significant differences were found. However, treatment duration was significantly (4 months) shorter in the CBCT group compared with the conventional group (P = 0.023). Conclusion: CBCT has been used in cases with more severe symptoms of maxillary canine impaction. The use of CBCT improved the diagnostic capabilities and improved the chances of success in the more difficult cases to a level similar to that of simpler cases treated on the basis of 2D information.

Objectives: The objective of this study is to compare the shear bond strength (SBS) of stainless steel (SS) orthodontic brackets bonded with four different orthodontic adhesives. Materials and Methods: Eighty newly extracted premolars 0 were bonded to 0.022 SS brackets (Ormco, Scafati, Italy) and equally divided into four groups based on adhesive used: (1) Rely-a-Bond (self-cure adhesive, Reliance Orthodontic Product, Inc., Illinois, USA), (2) Transbond XT (light-cure adhesive, 3M Unitek, CA, USA), (3) Transbond Plus (sixth generation self-etch primer, 3M Unitek, CA, USA) with Transbond XT (4) Xeno V (seventh generation self-etch primer, Dentsply, Konstanz, Germany) with Xeno Ortho (light-cure adhesive, Dentsply, Konstanz, Germany) adhesive. Brackets were debonded with a universal testing machine (Model No. 3382 Instron Corp., Canton, Mass, USA). The adhesive remnant index (ARI) was recordedIn addition, the conditioned enamel surfaces were observed under a scanning electron microscope (SEM). Results: Transbond XT (15.49 MPa) attained the highest bond strength. Self-etching adhesives (Xeno V, 13.51 MPa; Transbond Plus, 11.57 MPa) showed clinically acceptable SBS values and almost clean enamel surface after debonding. The analysis of variance (F = 11.85, P < 0.0001) and Chi-square (χ² = 18.16, P < 0.05) tests revealed significant differences among groups. The ARI score of 3 (i.e., All adhesives left on the tooth) to be the most prevalent in Transbond XT (40%), followed by Rely-a-Bond (30%), Transbond Plus with Transbond XT (15%), and Xeno V with Xeno Ortho (10%). Under SEM, enamel surfaces after debonding of the brackets appeared porous when an acid-etching process was performed on the surfaces of Rely-a-Bond and Transbond XT, whereas with self-etching primers enamel presented smooth and almost clean surfaces (Transbond Plus and Xeno V group). Conclusion: All adhesives yielded SBS values higher than the recommended bond strength (5.9-7.8 MPa), Seventh generation self-etching primer Xeno V with Xeno Ortho showed clinically acceptable SBS and the least amount of residual adhesive left on the enamel surface after debonding.

Background: An important stage at the very beginning of orthodontic therapy is the separation of teeth where space is created for banding of the molars. A dislodged separator may create problems if ingested or it may get wedged between the adjacent teeth causing acute localized periodontitis. In order to overcome these shortcomings of conventional separators, the Kansal Separator was conceptualized. This separator has been designed as a single device that acts simultaneously on both mesial and distal aspects of tooth, causing adequate separation. In addition to separator's independent 2 in 1 action, the self-locking connecting bar prevents the premature dislodgement of the separator. Aim: To determine the force vectors produced by Kansal separator. Materials and Methods: A prototype model was created to study the forces produced. Results: The separator's unique design is based on sound biomechanical principles that explicate the proof of concept and allows the separator to be distinctly effective and effi cient in variable clinical situations, thus amplifying its uniqueness. Discussion: The Kansal Separator, a 2 in 1 orthodontic tooth separator, has a unique design enabling the device to simultaneously separate the teeth on the mesial and distal aspect of the tooth to be banded. Conclusion: Kansal Separator's unique design is based on sound biomechanical principles that explicate the proof of concept and allows the separator to be distinctly effective and efficient in variable clinical situations, thus amplifying its uniqueness.

Background: To compare changes in the amount and distribution of dental plaque associated with placement of elastomeric modules over a self-ligating bracket during orthodontic treatment and to relate these changes to the periodontal inflammation. Materials and Methods: A cross-arch randomization trial was carried out at Bristol Dental School, United Kingdom. Clinical measurements of periodontal inflammation and plaque accumulation and microbiological test were done on 24 patients aged 11-14 years [Mean (SD) age = 12.6 (1.01) years] wearing fixed appliances (Damon 2 brackets, Ormco, Orange, CA, USA) at the start and 3 months into fixed orthodontic treatment. Results: In the first 3 months of treatment there was no statistically significant difference in bleeding on probing between incisors with and without elastomeric modules (P = 0.125 and 0.508, respectively). The difference in plaque accumulation was not statistically significant (P = 0.78). The difference in probing depths between the incisors was not statistically significant (P = 0.84). The microbiological analysis showed no difference. Conclusions: Based on this preliminary 3 months study, elastomeric modules were not significantly associated with any increased risk during treatment when compared to self-ligating brackets. The longer term studies are needed to further confirm the findings of the present study.

Objective: The objective of this study was to establish a new regression equation for North Indian and to compare and correlate the predicted width of unerupted canine and premolars obtained from the proposed regression equation of the present study in the North Indian population sample, Moyer's prediction table and also from Melgaco regression equation with the actual width; in order to check the applicability of various methods of mixed dentition analysis for the North Indian population. Materials and Methods: The sample consisted of 200 dental casts obtained from the North Indian patients and students which consists of 100 males and 100 females with the average age of 20.12 ± 4.70 years for males and 19.54 ± 3.16 years for females. Mesiodistal tooth widths of mandibular arch from permanent right first molar to left first molar were measured with an electronic digital caliper. Student t-test was used for comparison and Pearson's correlation coefficient was used to correlate the actual sum and the predicted width of the permanent mandibular canines and premolars obtained from various methods. Results: The difference between the actual and predicted width was statistically insignificant using the regression equation obtained for the North Indian sample population (correlation r = 0.78) in contrast to the significant difference with predicted width obtained from Melgaco equation (r = 0.61) and Moyer's prediction table (r = 0.42). Conclusions: A new proposed regression equation for the North Indian population was established. Amongst the three regression equations devised, the proposed regression equation formulated in the present study; gave the most accurate results confirming racial variation in tooth size. This method is considered as an easy and practical way to predict the size of unerupted canines and premolars.

Objective: To assess the relationship between mandibular arch length and widths in a sample of Yemeni subjects aged (18-25) years. Materials and Methods: The investigation involved clinical examination of (765) adults; only 214 (101 females, 113 males) out of the total sample were selected to fulfill the criteria for the study sample (normal dento-skeletal relationship). Study models were constructed and evaluated to measure mandibular arch dimensions. The Spearman's correlation coefficient (r) was calculated between the measurements of arch widths and lengths. Results: Overall, the male group demonstrated greater transverse and sagittal mandibular dimensions; However, this was only statistically significant for measurements of inter-first and second molar distances and anterior arch length (P < 0.05). Relatively stronger linear relationships were observed between the inter-canine distance and mandibular arch lengths (P < 0.05, Spearman's r ranged between 0.17 to 0.50). Conclusion: Among studied mandibular dimensions in subjects with normal dento-skeletal relationship, only the inter-canine distance demonstrated a week to moderate linear relationship with the mandibular arch lengths.

Objectives: The primary aim of the present study was to assess the applicability of Tanaka and Johnston and Moyers' methods of prediction in Libyan subjects and secondary aim was to develop a new prediction method for the examined population if required. Materials and Methods: The study sample comprised 343 Libyan schoolchildren with age ranged from 12 to 17 years; 169 males age matched with 174 females, all with no craniofacial abnormalities and orthodontically untreated. The mesiodistal (MD) tooth widths were measured and compared with the estimated values derived from Tanaka and Johnston equations and from Moyers' probability tables at 35%, 50% and 75% respectively using Paired t-tests. The constants a and b in the linear regression equation (y = a + bx), the correlation coefficient, the coefficient of determination and the standard errors of estimate were computed. Results: Significant sexual dimorphism in lower incisors mesiodistal width was observed. There were significant discrepancies between the current measurements and those estimated from Tanaka and Johnston's equation and Moyers' tables. New linear regression equations were derived for both sexes to allow precise prediction for Libyan subjects. The correlation coefficients between the total MD width of the mandibular permanent incisors and that of the maxillary and mandibular canines and premolars were found to be 0.66 and 0.68 for males and 0.57 and 0.58 in females, respectively. Conclusions: It appears that there is a limitation in the application of Tanaka and Johnston's equation and Moyers' methods to Libyan subjects. The developed prediction equation is more accurate for predicting the MD widths of unerupted canine and premolars of Libyan population.

Aims: To determine whether alteration of the maxillary central and lateral incisors' length and width, respectively, would affect perceived smile esthetics and to validate the most esthetic length and width, respectively, for the central and lateral incisors. Materials and Methods: Photographic manipulation was undertaken to produce two sets of photographs, each set of four photographs showing the altered width of the lateral incisor and length of the central length. The eight produced photographs were assessed by laypeople, dentists and orthodontists. Results: Alteration in the incisors' proportion affected the relative smile attractiveness for laypeople (n=124), dentists (n=115) and orthodontists (n=68); dentists and orthodontists did not accept lateral width reduction of more than 0.5 mm (P<0.01), which suggests that the lateral to central incisor width ratio ranges from 54% to 62%. However, laypeople did not accept lateral width reduction of more than 1 mm (P<0.01), widening the range to be from 48% to 62%. All groups had zero tolerance for changes in central crown length (P<0.01). Conclusion: All participants recognized that the central incisors' length changes. For lateral incisors, laypeople were more tolerant than dentists and orthodontists. This suggests that changing incisors' proportions affects the relative smile attractiveness.

Aims: Objective of this retrospective study was to evaluate the treatment effects of the MGBM-System (G.B Maino, A. Giannelly, R. Bernard, P. Mura), a new intraoral device to treat Class II malocclusions with no patient cooperation by unilateral or bilateral molar distalization. Materials and Methods: A retrospective study was conducted to compare the pre-distalization and post-distalization cephalograms and dental model casts of 30 patients (15 male, 15 female) with Class II malocclusion treated with MGBM-System. Mean age at the beginning of treatment was 13.3 years (standard deviation 3.3). Angular, horizontal and vertical measurements were recorded to monitor skeletal and dental-alveolar changes. Molar movements in horizontal plane were monitored by making dental measurements on dental model casts. Results: The MGBM-System produced a rapid molar distalization and Class II relationship was corrected in 8 months ΁ 2.05, on average. The maxillary first molars were distalized of 4.14 (PTV-6 cemento-enamel junction), associated with a significant distal axis incline of 10. 5° referred to SN and a significant intrusion of 1.3 mm (PP). As for anchorage loss, the first premolar exhibited a significant mesial movement of 0.86 mm, associated with a significant mesial axis incline of 2.46°. No significative changes in either sagittal or vertical skeletal relationship were observed. Conclusion: The results suggest that the MGBM-System is an efficient and reliable device for distalizing the maxillary permanent first and second molars.

Objective: To assess the mesio-distal tooth width in normal, crowded, or spaced dentitions. Materials and Methods: A sample of 192 maxillary and mandibular dental casts of Libyan subjects was selected from a larger cohort. These subjects did not present with craniofacial anomaly, hypodontia, significant attrition, caries, restorations, or history of permanent tooth extraction or orthodontic treatment. The sample was divided into normal, crowded, and spaced groups according to tooth size/arch length discrepancy. Each group included 32 upper and lower dental casts with equal numbers of males (mean (SD) age = 14.7 (1.9) years) and females (mean (SD) age = 15.7 (2.5) years). The mesiodistal (MD) tooth width, sum of the MD tooth widths mesial to the first molars (TTM), sum of the MD width of the four incisors (I), and the sum of the MD width of canine and first and second premolars (CPP) were calculated for each group. The independent Student t-test was applied sequentially to detect significant differences between paired groups. The ANOVA test was undertaken to explore significant differences between the three groups. Pearson coefficient of correlation was used to evaluate the correlation between I and the corresponding CPP in maxillary and mandibular arches. Results: MD tooth width, TTM, I, and CPP were significantly wider in the crowded compared to normal and spaced dentitions (P<0.001), except for the width of the upper left lateral incisors in both normal and crowded groups. Although there was a trend for smaller tooth widths in spaced dentitions compared to normal ones, this was only significant in the maxillary left central incisor, maxillary right and left lateral incisors, maxillary right first premolar, mandibular right lateral incisor, and mandibular right canine (P<0.05). However, the maxillary TTM, I, and CPP in the normal group were significantly greater than in the spaced group (P<0.05). Significant positive correlations existed between the mean values of I and CPP in both the maxillary and mandibular dentitions of all groups (P<0.01). Conclusions: It appears that in the studied Libyan population, the MD tooth width is a significant component of crowding/spacing.

Aim: To determine the efficiency of erbium: Yttrium aluminum garnet (Er:YAG) laser with Environmental Scanning Electron Microscope (ESEM) and shear bond strength analysis as a method of recycling stainless steel orthodontic brackets and compare with other methods of recycling. Materials and Methods: Eighty samples of extracted premolar teeth bonded to SS brackets were tested for rebonded shear bond strength after recycling by four methods and compared with a control group of 20 samples. These 80 samples were randomized into four groups which were recycled by four methods, namely, sandblasting, thermal method, adhesive grinding by tungsten carbide bur, and Er: YAG laser method. After recycling, ESEM and shear bond strength analysis were used to analyze the efficiency of the recycling methods Results: Er: YAG laser group was found to be having the greatest bond strength among the recycled brackets (8.33±2.51 followed by the sandblasting at 6.12±1.12 MPa, thermal and electropolishing at 4.44±0.95 MPa, and lastly the adhesive grinding method at 3.08±1.07 MPa. The shear bond strength of Er: YAG laser group was found to be having no statistically significant difference with that of the control group (P>0.05 and had statistical signifance with sandblasting, thermal and electropolishing and adhesive grinding groups at P>0.001. ESEM analysis showed complete removal of adhesive from the brackets recycled with Er: YAG laser which mimicked that of the control group. Conclusion: Er: YAG laser (2940 nm) was found to be the most efficient method for recycling, followed by the sandblasting, thermal, and the tungsten carbide methods, which had the least shear bond strength value and is not fit for clinical usage.

Aims: This study aims to explore the criteria used by graduate students while selecting a career as orthodontists and their future aspirations. Materials and Methods: A list of Saudi Board of Orthodontics (SB-Ortho) residents was obtained from the Central and Western regions of the Kingdom and all orthodontic residents (excluding the 1 ^st year residents) were invited to participate in this survey. Permission to contact the orthodontic residents was obtained from the respective program directors. The final study sample composed of 36 orthodontic residents. Results: About 39% of residents chose orthodontic specialty after graduation, nearly 33% selected the career during the undergraduate education while the rest chose the specialty at other stages. Approximately, 67% of the residents chose orthodontic specialty because it is intellectual challenging. Around 25% of residents choose orthodontic to improve their earning and 39% join orthodontic for job prestige. Around 50% of orthodontic Saudi residents planned to use self-ligating brackets; 63.9% planned to use invisalign; 86.1% plan to use temporary anchorage devices. About 72% of residents plan to use a cone-beam computerized tomography; 89% plan to use a digital imaging program; 39% plan to use indirect bonding; and 28% plan to use lingual orthodontics. More than half of the residents showed interest to participate in the research and about a quarter of them were willing to work in small cities. Conclusions: Most of the orthodontic residents in Saudi Arabia take up this specialty as they felt that it was intellectually challenging. The SB-Ortho program adequately prepares the residents in all the modern aspects of the specialty.

Objectives: Frictional resistance is an important counterforce to orthodontic tooth movement during sliding mechanics. This study was carried out to evaluate the effect of different bracket-archwire-ligation combinations on "resistance to sliding" during simulated canine retraction on typodont model. Materials and Methods: the frictional resistance was tested between three modern orthodontic brackets-stainless steel, ceramic, and ceramic with metal slot (0.022-inch), and seven different archwires (0.019 × 0.025-inch)-stainless steel, nickel-titanium, Teflon coated stainless steel, stainless steel with the reverse curve of spee (RCS), Teflon coated stainless steel with RCS, Teflon coated nickel-titanium and nickel-titanium with RCS ligated with stainless steel ligature wire and regular clear elastomeric modules. All tests were carried out in a dry state on an Instron universal testing machine (crosshead speed: 0.5 mm/min). 10 measurements were made from each bracket-archwire-ligature combinations. Results: The highest mean frictional resistance was found in ceramic brackets with nickel-titanium RCS archwire ligated with elastomeric modules while minimum frictional resistance was found in stainless steel brackets with Teflon coated stainless steel archwire ligated with stainless steel ligature. Metal slot ceramic brackets generated significantly lower frictional forces than ceramic brackets, but higher values than stainless steel brackets. Teflon coated archwires shows highly significant reduction of the frictional resistance than their corresponding uncoated archwires. Archwires with RCS had the higher frictional resistance than normal counterpart archwires. Conclusion: Ceramic brackets with metal slot and Teflon coated SS archwires seem to be a good alternative to conventional stainless steel brackets and archwires in space closure with sliding mechanics in patients with esthetic demands.

Aims: To assess the sex discrimination potential of permanent maxillary molar crown widths and cusp diameters. Materials and Methods: Measurements were made on plaster casts of 200 individuals of known sex (100 males, 100 females, aged 12-21 years). Eight parameters were measured on the first and second maxillary molars with a digital caliper [buccolingual, mesiodistal, mesiobuccal-distolingual and distobuccal-mesiolingual crown widths and cusp diameters (hypocone, protocone, paracone, and metacone)]. The percentage of sexual dimorphism for each parameter was calculated. Discriminant function analysis was used to determine the accuracy of sex determination for each molar separately and both the molars taken together. Results: The highest sexual dimorphism was shown by protocone in the first molar and hypocone in the second molar. Furthermore, the sex determination accuracy was highest when the first molar was taken alone than when the second molar or the first and second molars were taken together. Conclusion: Based on this study, odontometric measurements of maxillary molars provide low to moderate sex determination accuracy.

Objectives: This cross-sectional observational study aimed at quantifying primary dentition parameters and exploring differences in those parameters between included age groups. Materials and Methods: The examined sample comprised 800 preschool children, 3- to 5-year-old in Benghazi city, of which 500 fulfilled the inclusion criteria. Primary canine relationship, spacing/crowding, overjet (OJ) and overbite (OB), occlusal relationship was carried out using Federation Dentaire Internationale (1973), modified to the primary dentition. Results: The prevalence of bilateral Class I, Class II, and Class III canine relationship was 69.6%, 22.4%, and 4.4%, respectively. The prevalence of asymmetric canine relationship was 3.6% with no significant difference between gender and age groups. Spacing, closed dentition, and crowding were observed in: 81.6%, 13,4% and 5% respectively in the upper arch, and 58.5%, 24.8%, and 16.7% correspondently in the lower arch. OJ and OB ranging between 1 and 3 mm were found in 82.6% and 56.5%, respectively. An OJ and OB of >3 mm was observed in 11.4% and 35%, respectively, and of edge to edge incisal relationship anteroposteriorly and vertically in 4.6% and 6% in this order. Anterior crossbite and anterior openbite were noted in 1.4% and 2.6%, respectively. There was no significant correlation between OJ and OB and age (P≥0.241). Additionally, there was no significant sex difference in the value of OJ (P=0.561). But, the mean OB value in boys was significantly greater than in girls. Conclusions: The current findings provide an insight into the prevalence of occlusal traits in urban Libyan preschool children and highlight the significance of early detection of malocclusion to assist in achieving effective and individualized long-term treatment planning.

Aim: The purpose of this study was to evaluate the Bolton overall ratio in a north Indian population reporting for orthodontic treatment and to determine the effect of extractions on the Bolton ratios. Another aim of the study was to check the effects of different extraction patterns on the final Bolton ratio. Materials and Methods: One hundred and twenty pre-treatment dental casts (60 males and 60 females) of orthodontic patients were selected randomly. Mesio-distal dimensions of the mandibular and maxillary teeth were measured before treatment, and subjected to Bolton analysis. Hypothetical tooth extraction by the following combinations: All the first premolars, all the second premolars, upper first and lower second premolars and upper second and lower first premolars were performed for each patient. The measurement results were again subjected to Bolton analysis to see whether any tooth-size discrepancy had been created. Results and Conclusion: The tooth material ratio of the studied north Indian population shows a mild maxillary tooth material excess. Extraction of premolars in any combination causes the maxillary tooth material to further increase. There is no significant sex difference in the tooth material ratios with or without extractions. In patients requiring extraction; all first premolar extraction or maxillary first and mandibular second premolar extraction should be preferred. For deciding a treatment plan involving extraction of teeth, we need to consider that the maxillary tooth mass may increase after extraction. Furthermore, the normal or the clinically significant tooth size discrepancies may change following extraction of teeth.

Background: Commonly used parameters for anteroposterior assessment of the jaw relationship includes several analyses such as ANB, NA-Pog, AB-NPog, Wits appraisal, Harvold's unit length difference, Beta angle. Considering the fact that there are several parameters (with different range and values) which account for sagittal relation, and still the published literature for comparisons and correlation of these measurements is scarce. Therefore, the objective of this study was to correlate these values in subjects of Indian origin. Materials and Methods : The sample consisted of fifty adult individuals (age group 18-26 years) with equal number of males and females. The selection criteria included subjects with no previous history of orthodontic and/or orthognathic surgical treatment; orthognathic facial profile; Angle's Class I molar relation; clinical Frankfort Mandibular plane angle FMA of 30±5° and no gross facial asymmetry. The cephalograms were taken in natural head position (NHP). Seven sagittal skeletal parameters were measured in the cephalograms and subjected to statistical evaluation with Wits reading on the true horizontal as reference. A correlation coefficient analysis was done to assess the significance of association between these variables. Results: ANB angle showed statistically significant correlation for the total sample, though the values were insignificant for the individual groups and therefore may not be very accurate. Wits appraisal was seen to have a significant correlation only in the female sample group. Conclusions: If cephalograms cannot be recorded in a NHP, then the best indicator for recording A-P skeletal dimension would be angle AB-NPog, followed by Harvold's unit length difference. However, considering biologic variability, more than one reading should necessarily be used to verify the same.

Aims: To determine the cephalometric norm among Bangladeshi adults and to investigate the differences in craniofacial morphology compared with Japanese and Caucasian normative data. Materials and Methods: Cephalometric radiographs were obtained from 46 Bangladeshi males (mean age 23.8 years) and 52 Bangladeshi females (mean age 24.6 years). Inclusion criteria were the following: Both parents from the same ethnic group, class-I occlusion with an arch length discrepancy less than 2 mm, overbite and overjet from 2 to 4 mm, balanced face, all teeth present except third molar, no previous orthodontic treatment, and no prosthetic replacement of teeth. Nine angular and five linear measurements were constructed for skeletal hard tissue analysis, four angular and six linear measurements for dental hard tissue analysis, and two angular and seven linear measurements for soft tissue analysis. Mean and standard deviations of measurements were determined for each gender. Polygonal chart and profilogram were made. Independent t-test was used to determine differences. Results: The present Bangladeshi population has a smaller lower face height ( P<0.01) and the antero-posterior position of the maxilla and mandible was found to be significantly ( P<0.01) more protruded compared with the Japanese and the Caucasian norms. Significantly ( P<0.01) more protruded upper incisor, less steep occlusal plane, and thinner soft tissue chin were the characteristics in Bangladeshi adults. Conclusions: Relative to the cranial base (SN), the maxillo-mandibular complex was more anteriorly placed compared with the Japanese and Caucasian adults. Further, the effective length of the maxilla and mandible was shorter compared with the Japanese and Caucasian adults. These findings should be considered carefully during orthodontic treatment planning of Bangladeshi adults.

Objective: This study aimed to explore the prevalence of malocclusion and its distribution among 12-17 year old Urban Libyan schoolchildren. Materials and Methods: A total of 900 subjects were examined, of which 343 fulfilled the inclusion criteria; 169 males and 174 females. Molar relationship, overjet (OJ), overbite (OB), midline deviation, crossbite, and crowding/spacing were recorded. Sexual dimorphism was explored using descriptive statistics and the Chi-square tests. Results: The prevalence of malocclusion was 95.6%. Class I, Class II division 1, Class II division 2 and Class III malocclusions comprised 66.5%, 21.9%, 3.5%, and 3.7% respectively of the total sample. The OJ percentage of 51% (zero-3.5 mm), 48.4% (>3.5 mm), 0.6% (≤−3.5 mm to >zero) was recorded, with no significant sex differences ( P=0.225). A normal overbite, increased and open bites were observed in 39.9%, 55.1%, and 2.3% of the group respectively with no sexual dimorphism ( P=0.970). Crossbite was present in 13.1% of the group, with no significant sex difference ( P=0.469). Crowding in the maxillary and mandibular arches were observed in13.9%, and 12.2% respectively. Spacing occurred in 9.4% and 7.9% of the examined maxillary and mandibular arches respectively, with no significant sex difference regarding the presence of spacing/crowding in the maxillary arch ( P>0.05). Males, however, had significantly more spacing and less crowding in the mandibular arch ( P<0.05). Conclusions: The prevalence of malocclusion in Libyan schoolchildren is among the highest reported in the literature. Crowding is among the least reported manifestations of malocclusion.

Objectives: The objective of this study was to assess changes in the oral health-related quality of life (OHRQoL) among patients wearing fixed orthodontic appliances 24 h after insertion. Materials and Methods: Sixty patients aged between 14 and 24 years (29 males and 31 females; mean age, 17.8 years; SD 3.1 years) were recruited from the Postgraduate Clinic, Department of Children's Dentistry and Orthodontics, Faculty of Dentistry, University of Malaya. The oral health-related quality of life (OHRQoL) was measured before treatment and 24 h after insertion of the orthodontic appliance. The instrument used to measure OHRQoL was a modified self-administered short version of Malaysian Oral Health Impact Profile (OHIP-16[M]) questionnaire. The higher the score, the poorer is the OHRQoL. Results: Overall score of OHRQoL increased significantly 24 h after insertion (mean 43.5±10.9) as compared to before insertion (mean 34.1±9.2) ( P<0.001). Significant changes were found for the following items: Difficulties in chewing, bad breath, difficulties in pronunciation, discomfort in eating, ulcer, pain, avoidances of eating certain foods, difficulties in cleaning, embarrassment, avoid smiling, disturbed sleep, concentration affected, difficulty carrying out daily activities, and lack of self-confidence ( P<0.05). Significant changes were also found in the mean difference of OHRQoL for gender ( P<0.001). Conclusion: OHRQoL was found to deteriorate 24 h after insertion of fixed orthodontic appliances in almost all domains, with significant changes in gender. This information can be used as "informed consent," which might increase patient's compliance as they are aware of what to expect from initial orthodontic treatment.

Background: Soft tissues play the primary role of physical appearance and facial esthetics. This study aimed to establish soft-tissue cephalometric standards in North Indian adults, which can be used in diagnosis, treatment planning, and stability of orthodontic outcome and orthognathic patients. Materials and Methods: A group of 60 individuals (30 males and 30 females) with normal occlusion and proportional facial profile were chosen. For the entire chosen sample, lateral cephalograms were obtained. Standard values of 11 soft-tissue measurements were determined. Results: Soft-tissue measurements showed that men had greater soft-tissue facial angle (92.10°) than women (89.92°). Also, they had more nose prominence (18.10 mm) than women (16.44 mm). Skeletal profile convexity (A to N-pog) of men (0.40 mm) was less than women (1.76 mm). Basic upper lip thickness was higher in men (16.60 mm) compared to women (14.24 mm), while H-angle was higher in women (16.68°) as compared to men (14.30°). In the lower face area, inferior sulcus to the H line distance was more in men (7.30 mm) than women (4.80 mm). Men had greater soft-tissue chin thickness (14.10 mm) than women (12.84 mm). Conclusion: The differences in soft-tissue cephalometric norms between men and women of North Indian faces were established, so the orthodontist or surgeon must individualize treatment planning, using local norms as the reference.

Objectives: The Wits values for various ethnic groups are different and the applicability of the norms described in these analyses to different populations is difficult. The objectives of this study were to establish the normal values of Wits appraisal in a sample from the western region of Saudi Arabia and to evaluate the existence of gender dimorphism. Also, to compare the results with previously published Wits values. Materials and Methods: A total of 66 lateral cephalometric digital radiographs of Saudi patients from the western region (25 males and 41 females, mean age 19.32±8.16 years and 20.88±8.77 years, respectively). All subjects had angle class-I occlusion, well-balanced faces, all premolars had erupted and in occlusion, and no history of orthodontic treatment. Tracing was performed using the VistadentOC^® software. Results: Wits mean values were greater in males (−0.73±2.48) than females (1.79±2.06), with significant gender difference ( P<0.001). Comparisons with previously published showed that there is a significant differences between ethnic groups, especially in females' data. Conclusion: Wits appraisal appears to be gender-specific and ethnicity-specific for female values.

Objective: To evaluate the position of hyoid bone in the subjects treated with Twin block appliance. Materials and Methods: The sample consisted of 40 Angle's Class II division 1 subjects treated with Twin block appliance. Lateral radiographs were taken before and after treatment. According to Schudy's facial divergence angle (SN-MP), the subjects were classified in to three groups: group I (hypodivergent, SN-MP: <31° (27°-30°), n=15), group II (normodivergent, SN-MP: 31°-34°, n=15), and group III (hyperdivergent, SN-MP: >34° (35°-38°), n=10). Lateral cephalograms were traced and analyzed manually. After measurements of variables, Student's t-test and one-way analysis of variance (ANOVA) were performed. Results: Post treatment with Twin block therapy, hyoid bone shifted significantly (P<0.01) forward in horizontal dimension in all three groups, although it was highest in group III. However, there was no significant difference amongst the groups. In vertical dimension, hyoid bone shifted in upward direction in all three groups; however, the shift was significant (P<0.01) only in group I and there was a significant difference between group I and rest of the two groups. Width of upper airway significantly (P<0.01) increased and ANB angle significantly (P<0.001) decreased in all three groups with forward movement of mandible. Conclusions: After treatment with Twin block appliance, significant changes occurred in horizontal dimension (anterior displacement), which resulted in significant increase in width of upper pharynx in all three groups.

Objectives: To assess the effects of bimaxillary surgery on Class III subjects with mandibular asymmetry, and to compare the effects of the type of surgery performed in the mandible on the facial profile especially in the presence of facial asymmetry. Materials and Methods: Thirty-six patients in whom imbalance between the maxilla and the mandible were corrected by Le Fort I osteotomy combined with bilateral intraoral vertical ramus osteotomy (BIVRO group, n=9), bilateral sagittal split ramus osteotomy (BSSRO group, n=14), or a combination of intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO) (IVRO + SSRO group, n=13). Cephalograms were taken before surgery (T1), and 1 year after surgery (T2). Hard and soft-tissue changes were compared. Results: The postsurgical findings showed that greater mandibular backward displacement and greater upper lip forward movement were more pronounced among BIVRO group when compared with BSSRO group. Upper lip relation to E-line showed greater improvement in BIVRO group than BSSRO and IVRO + SSRO groups. The ratios of corresponding mandibular soft to hard tissue movements were higher than that of maxillary movements and were more pronounced in IVRO + SSRO and BSSRO groups when compared with BIVRO group. Conclusion: IVRO surgical technique appears to be more effective in positioning the mandible more posteriorly and improving upper and lower lips position and competence.

Aim: To evaluate the effect of the application of either fluoride varnish (FV) or amorphous calcium phosphate (ACP) as preventive method on shear bond strength (SBS) at the same time of their bonding in vitro using self-etching primer (SEP) as an agent for enamel pre-treatment FV. Materials and Methods: Sixty human bicuspids were randomly divided into five groups: G1 was rubbed by SEP for 5 s, G2 for 5 s by SEP and ACP, G3 for 10 s by SEP and ACP, G4 for 5 s by SEP and FV, and G5 for 10 s by SEP and FV. Stainless steel metal brackets were bonded. A Zwick/Roell Z020 Universal Testing Machine (Zwick GmbH and Co, Germany) with a 500 N load cell was used to test SBS. SBS values were analyzed using one-way analysis of variance (ANOVA) and Tukey's post hoc tests (P≤0.05). Differences in adhesive remnant index (ARI) values between groups were calculated. Results: The mean SBS values were 10.00±4.48 MPa, 5.71±4.3 MPa, 7.47±4.44 MPa, 4.4±2.39 MPa, and 3.98±0.83 MPa for groups 1-5, respectively. Significant differences in SBS values between all groups were found. The mean SBS values of groups 2, 4, and 5 were significantly lower than that of the G1. No significant difference was found between G3 and G1. Significant difference in ARI between the groups was found (P<0.001) and G1 had a significantly higher ARI. Conclusion: The results suggested that the application of ACP at the same time of using SEP for 10 s has no effect on SBS.

Background: There is limited data about current utilization of miniscrews in orthodontic practices in India. The purpose of this survey was to obtain information on clinical utilization of miniscrews among orthodontists in India. Materials and Methods: A survey questionnaire was prepared and mailed to 2100 qualified and registered orthodontists in India. Results: A total of 1691 orthodontists responded to the survey, with a response rate of 80.52%. Among them, 952 (56.3%) had never used miniscrews in their clinical practice. Seven hundred and thirty-nine (739) (43.7%) had utilized miniscrews in their treatment, at some point of time. Among the orthodontists who used miniscrews, 463 (62.65%) used a surgical guide for positioning the miniscrews and 276 (37.35%) placed miniscrews without a surgical guide. Six hundred and thirty-four (634) (85.79%) orthodontists placed the miniscrews personally while 105 (14.21%) utilized the help of other specialists for placing the miniscrews. Among the orthodontists who used miniscrews, 76 (10.28%) utilized the help of oral surgeon to place the miniscrews while 29 (3.93%) utilized the help of periodontists to do the procedure. Conclusion: Miniscrews are a useful addition to the orthodontic armamentarium. The major indication for miniscrew was indirect anchorage in critical anchorage cases. The most important factors in determining the clinical utilization of miniscrews as a part of the treatment modality depends upon operator training and skill; fear of complications, patient refusal to accept miniscrews and the clinician's preference for conventional methods without unnecessary invasive procedure.

Objectives: The aims of this study were to determine the mean mesiodistal tooth size width and Bolton's anterior and overall ratios, find any possible sex differences, and study the frequency of tooth size discrepancies among Yemeni population and if there is a difference in tooth size between the right and left sides. Materials and Methods: 176 subjects aged 13-25 years (94 females and 82 males) with different types of malocclusions (94 Angle Class I, 37 Class II division 1, 36 Class II division 2, and 9 Class III) were included in the present study. The mean mesiodistal tooth size width and Bolton's ratios were determined. Results: The results showed that males had significantly larger teeth than females. The prevalence rates of clinically significant discrepancy greater than 2 SD were 29.53% and 14.20% in the anterior and overall tooth size ratios, respectively. Further, the results revealed that there were no significant differences in the tooth size width between right and left sides. Conclusion: The findings of the present study indicate that there was no significant difference between Bolton's ratio and that of Yemeni population.

Background: One of the common types of oro-dental morphopathologic relationship is the Class II Division 1 malocclusion. Therefore, the study of tongue position in Class II Division 1 may reveal a role of the tongue in the etiology or diagnosis of malocclusion. Aims: Present study was done with the aim to evaluate the tongue position radiographically in centric occlusion and rest position in the subjects with Angle's Class 1 normal occlusion and subjects with Angle's Class II Division 1 malocclusion and to find out any differences in tongue position between Angle's Class 1 normal occlusion and Angle's Class II Division 1 malocclusion group. Materials and Methods: The present study was conducted on lateral cephalogram of 40 subjects between the age ranges of 16 to 22 years. The samples were divided into the Angle's Class 1 normal occlusion group (Group I) and the Angle's Class II Division 1 malocclusion group (Group II) with the 20 in each groups. The study involved the evaluation of tongue position at rest position and centric occlusion on the lateral head cephalogram. Results: This study for the evaluation of the tongue position from the rest position to the centric occlusion showed no statistically significant changes in both groups. However, there were greater changes in various parameters (From the rest position to the centric occlusion) in the subjects with Angle's Class II Division 1 malocclusion as compared to the subjects with the Angle's Class I normal occlusion group. Conclusion: From the present study following conclusion can be drawn: with the closure of mandible from the rest position to centric occlusion the tongue moved antero-superiorly in the tip region, superiorly in the dorsum region, and antero-superiorly in the posterior region in normal occlusion and postero-superiorly in Class II Division 1 malocclusion.

Objectives: To investigate the reliability of mechanical and adhesive methods of fixing rectangular wires in the cross-slot of a mini-implant. Materials and Methods: A twin-hooked wire element was placed and fixed in the slot of a mini-implant via a NiTi spring under tension, or by means of an adhesive. For the purpose of mechanical anchorage, the wire was crimped with a special crimping tool to increase its thickness and prevent it from slipping through the slot. Before applying the adhesive, there were four possible methods of preparation: Untreated Wire (Adh. 1); ROCATEC-Pre (Adh. 2); ROCATEC-PRE + Espe Sil (Adh. 3); ROCATEC-PRE + ROCATEC-PLUS + Espe Sil (Adh. 4). The mechanical fixing and two adhesive fixings were aged by means of temperature change (500 cycles). A Zwick universal testing machine was used to measure the maximum strength of the coupling. Results: In all tests, the untreated wire + adhesive withstood the lowest maximum load (Ø 3 N and 10.8 N respectively) and failed the aging test after a maximum of eight cycles. The wires in test group Adh. 4 withstood the highest maximum load (Ø 43.3 N; 41.5 N; 45.9 N after aging) in all tests. The average load withstood by the crimped ligature was 38.7 N. Conclusion: The adhesive method of fixation performs best when the rectangular wire is sand blasted and silanized before application. The mechanical coupling using the crimped ligature is reliable.

Background: A review of literature indicates the Arab cephalometric pattern compared to the Caucasian cephalometric pattern is skeletally bimaxillary retrusive, dentally bimaxillary protrusive, and more divergent palatal and mandibular planes. Objective: The aim of this study was to clarify the cephalometric features of Emirates adults with Class I malocclusion and pleasing soft tissue profile and to evaluate for gender differences. The null hypothesis tested was no differences in lateral cephalometric measurements as a function of gender. Materials and Methods: The lateral cephalometric radiographs of adult Emirati nationals with Class I malocclusion were analyzed in order to characterize an indigenous Class I malocclusion population in the United Arab Emirates. Lateral cephalometric radiographs of 30 males with average age of 24.52±6.09 years and 31 females averaging 23.57±5.52 years were analyzed using Dolphin Imaging software. Twenty-two hard and soft tissue measurements comprised the cephalometric analysis. Results: Only one gender difference was demonstrated out of the 22 cephalometric analysis measurements used in the study; SN-PP mean for females (10.74±3.44 degrees) subjects averaged a 2.3 degree higher mean value than the males (8.43±3.95 degrees, P=0.018). The cephalometric study results were compared to published norms from Steiner and Eastman. Conclusions: Based upon the conditions of the present study, it may be concluded that adult Emirati males and females seeking orthodontic treatment with Class I malocclusion present similar cephalometric profiles with the exception that measurement SN-PP may be steeper in females than males. Moreover, Emiratis are likely to present greater incisor proclination and protrusion than Caucasians and may be generally considered as more bimaxillary protrusive.