Serial extraction is a sequential plan of premature removal of one or more deciduous teeth in order to improve the alignment of permanent teeth and then removal of permanent teeth to maintain the proper ratio between tooth size and arch size. The aim of this case report was to present a case treated successfully with a modified serial extraction protocol in the lower arch because the patient had congenitally missing lower second premolars with severe crowding. The treatment consisted of selective removal of the deciduous mandibular teeth only (C, D, and E) and no permanent premolar removal. However, the space of the missing second premolars was utilized to resolve the anterior crowding along with the spontaneous closure of the extra spaces by physiologic movement of the permanent mandibular teeth. Whereas in the upper arch conventional serial extraction was performed.

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.

Uprighting springs, an integral part of the Begg ligsht wire differential force technique is gaining more and more popularity, as a useful adjunct in contemporary preadjusted edgewise appliance systems as well. It can be used with brackets containing vertical slots for mesiodistal crown uprighting, or as braking auxiliaries providing additional anchorage while protracting posteriors. Here, we present a simple and quick chair side method of fabricating and customizing uprighting springs according to the required crown/root movement for correction. This communication would serve as a ready reckoner during fabrication of the springs, thus dispelling the confusion that usually arises regarding direction and position of the coil and active arm.

Oligodontia, or agenesis of six or more teeth, excluding third molars, which involves canine agenesis is rare, and restorative management can be challenging. Bilateral agenesis of a permanent canine in the general population often indicates a several missing adult teeth. The most common sign of it is the primary canine retention beyond its exfoliation age. The multistage restorative management includes the early diagnosis, excluding associated medical problems as well as assessment of patient's malocclusion and facial skeletal pattern, life span of deciduous teeth, possibility of premolar substitution, minimum required number of prosthetic units, patient's preferences, and the cost of treatment. A 10-year-old boy with bilateral agenesis of maxillary permanent canines is described. Some thoughts on the multidisciplinary restorative management of this case are discussed.

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.

The disadvantages of having orthodontic interventions both before and after orthognathic surgery include a long treatment time of 7-47 months and temporary worsening of facial appearance. Nowadays, the concept of surgery-first, followed by orthodontic treatment is applied to orthognathic surgery cases in different orthodontic centers in the world. This concept and technique is called "surgery-first-orthognathic-approach" or "surgery-first approach" (SFA) rigid fixation (skeletal anchorage system) of the bony segments and regional acceleratory phenomenon were keys to broad implementation of the SFA. This article is intended to provide an overview of SFA including indications, general and specific guidelines, different protocol variations, success rate and potential problems.

Canine retraction is a very important step in treatment of patients with crowding, or first premolar extraction cases. In severe crowding cases until, the canines have been distilized to relive the crowding, space to correctly align the incisors will not be available. Correct positioning of the canines after retraction is of great importance for the function, stability, and esthetics. The aim of this systematic review was to examine, in an evidence-based way, which kinds of canine retraction methods/techniques are most effective and which have the least side effects. A literature survey was performed by applying the Medline Database (Entrez PubMed) and Science Direct database covering the period from 1985 to 2014, to find out efficient ways to accomplish canine retraction. Randomized controlled trials (RCTs), prospective and retrospective controlled studies, and clinical trials were included. Two reviewers selected and extracted the data independently and assessed the quality of the retrieved studies. The search strategy resulted in 324 articles, of which 22 met the inclusion criteria. Due to the vast heterogeneity in study methods, the scientific evidence was too weak to evaluate retraction efficiency during space closure. The data so far reviewed proved that elastomeric power chains, elastic threads, magnets, NiTi coil springs, corticotomies, distraction osteogenesis, and laser therapy, all are able to provide optimum rate of tooth movements. All the methods were nearly similar to each other for retraction of canines Most of the techniques lead to anchorage loss in various amounts depending on the methods used. Most of the studies had serious problems with small sample size, confounding factors, lack of method error analysis, and no blinding in measurements. To obtain reliable scientific evidence, controlled RCT's with sufficient sample sizes are needed to determine which method/technique is the most effective in the respective retraction situation. Further studies should also consider patient acceptance and cost analysis as well as implants and minor surgeries for canine retraction.