Kuldeep Phukon

Mandibular canine transmigration is a rare occurrence in oral cavity, the etiology of which is not clear. Maximum cases of transmigrate canine goes undetected and if reported, it is during routine radiological investigation. There are literatures published on singular or multiple cases of unilateral or bilateral occurrence of transmigration and their treatment. This paper reports two rare transmigrated mandibular canine cases (Mupparapu type 3 and type 5). Both types are considered as rarest types of transmigrant canine. Keywords: Ectopia, mandibular canine transmigration, transplantation, rare occurrence.

The purpose of this case report is to show that even though a case could seem to be a surgical one but it’s not mandatory to operate it that way, rather shift towards the conservative treatment, as per the requirement of the patient. A 13 years old female patient who had severe dento-skeletal class II malocclusion with ANB 8?indicative of orthognathic surgery. Since the patient was adamant for not undergoing any surgical procedure, we decided to go for fixed functional therapy after functional decompensation with extraction of all first premolars. The result of this case is an example that the surgical cases could be treated using camouflage. The dental as well as the skeletal discrepancies were very well addressed and treated to the ideal relation. Keywords: class II sub division 1, Severe skeletal discrepancy, Deep bite, Fixed functional appliance (FFA), Nonsurgical Treatment and camouflage, Functional decompensation.

Objectives: To evaluate the efficacy of Micro-osteoperforations(MOPs) on the rate of tooth movement, levels of Pain and Discomfort associated with MOPs as well as differences in anchorage loss between tooth movement with and without MOPs. Methods: Ten patients with Bidentoalveolar Protrusions, who were treated with Extraction of Upper First Premolars; divided into control and experimental groups. MOPs were performed on experimental side and control side did not receive MOPs. Canines on both sides were completely retracted till second premolar contact and time taken was recorded. Pain and discomfort were monitored with a numeric rating as well as visual analog scale. Anchor loss, if any was measured using study models and cephalometric method. Results: Micro-osteoperforations significantly increased the rate of tooth movement by 1.64-fold. The patients did not report to have experienced significant pain or discomfort during or after the procedure. No other complication was reported. And anchorage loss was not encountered. Conclusions: Micro-osteoperforations can be used as an effective, comfortable, and safe procedure to accelerate tooth movement without taxing anchorage and with minimal pain or discomfort. Mops tend to reduce the duration of orthodontic treatment. Keywords: Orthodontic tooth movement, Accelerated orthodontics, Micro-osteoperforations, Canine retraction, Anchorage.

Introduction: Introduction: With the emerging concept of accelerated orthodontics, the duration of treatment has become a prime concern for the orthodontists and the patients. Modern technology has perfected a new equipment that has become almost indispensable in modern dentistry, in accordance with the philosophy of minimally invasive therapy i.e the laser [LIGHT AMPLIFICATION BY STIMULATED EMISSION OF RADATION]. The purpose of this study was to clinically evaluate and compare the effects of low-level laser therapy (LLLT) and rate of retraction of teeth in conventional and self-ligating bracket systems. Method: This split mouth study comprised of 20 subjects. The subjects were equally divided into two groups; the first group (Group A) consisted of 10 patients who underwent treatment with low friction self-ligating brackets [Ormco Damon Q] and the second group(Group B) consisted of 10 patients who underwent treatment with conventional straight wire brackets [Koden MBT]. The retraction was carried out in 0.019" × 0.025" SS wires using conventional retraction technique with a constant force of 150 gm. The experimental side was exposed to biostimulation using 810 nm gallium-aluminum-arsenide (GaAlAs) diode laser on days 0,21,42,63,84th of retraction. A total of 10 irradiations for 10 sec per site were given, 5 on the buccal side and 5 on the palatal side of the tooth. A digital vernier caliper with an accuracy of ±0.001 mm was used to measure the distance between the contact points of the maxillary canine and second premolar on 1st and 84th day of retraction. Result: Rate of retraction was significantly higher in the laser assisted retraction side when compared with conventional retraction side in both DAMON Q & MBT groups, Laser DAMON combination accelerated the orthodontic tooth movement by 5.44% than that of laser MBT combination. Conclusion: Combination of Laser and self-ligating brackets is a promising method for accelerating tooth movement. Keywords: Low level laser therapy, biostimulation, accelerated orthodontics, Damon Q Brackets, MBT Brackets, self-ligating.

Objectives: Introduction:-Smartphone & its application has changed our lives completely with the better access they provide to connect with the rest of the world. By making using of these technological advances we have designed a mobile app “ORTHODONT PAIN TRACKER” for better coordination & follow of the patient alongwith that various studies can be conducted. Objective:- To develop a mobile application for assessment of actual pain perception during orthodontic treatment in different sex & various time intervals in a day and in a week. Material & Methods:- 50 patients currently in the process of receiving orthodontic treatment was included in the study in the age group of 17 to 30 years (includes 25 males & 25 females). All the patient has to download the app “ORTHODONTIC PAIN TRACKER” from the link provided by the orthodontist thereafter patient details and his treatment details are to be filled. App includes the pain scale with various colourful attractive emoticons for patient to easily understand & mark his pain score of the day. Results- Statistically significant decrease in orthodontic pain from first to seventh day. Clinically significant increase of pain in different sex & different time interval was found to have a significant co-relation with high pain scores. Conclusion:- In this group of selected patient records, the differences are found in pain perception of both male and female subjects; however, females showed significantly higher pain intensity at all time points and a greater diurnal variability in pain perception as compared to males. Keywords:- Orthodont pain tracker, Pain intensity, Levelling wires, Pain perception, Niti wire.

Objective: To evaluate the tongue pressure exerted on the loop of transpalatal arch in different craniofacial patterns at different heights from the palatal mucosa. Material and Method: 15 subjects were divided into three groups according to Schudy’s facial divergence angle as: Group I (Normodivergent), Group II (Hypodivergent) and Group III (Hyperdivergent). TPA was fabricated and placed at 2mm, 4mm and 6mm heights from the palatal mucosa in each subjects and tongue pressure was measured during swallowing using pressure sensors placed on the loop of TPA. The data obtained were recorded and subjected to statistical analysis. Result: On intergroup comparison, maximum tongue pressure was found in Group III followed by Group I and Group II and the difference was statistically significant (p by 4mm and 2mm in each group and difference was statistically significant (p Conclusion: The maximum tongue pressure was observed in Hyperdivergent and minimum in Hypodivergent craniofacial pattern. It increases as the distance of the TPA from the palatalmucosa increases in all craniofacial patterns. Keyword: Hyperdivergent; Hypodivergent; Normodivergent; Transpalatal Arch, Tongue pressure.

Background: The present study is conducted with an aim to characterize Hydroxyapatite (HA) produced from therapeutically extracted premolar teeth using two different procedures. Hydroxyapatite was produced from premolar teeth using the process of calcination at 8500c and using Smart Dentine Grinder. The process of sample preparation influences its properties, the crystal structure and thermal stability of the produced powder was investigated using X-ray diffraction analysis (XRD) and Fourier transform infrared spectroscopic (FTIR) analysis. The former confirmed the successful production of HA crystals, while the latter confirmed the presence of hydroxyl (OH-) and phosphate (PO4-3) functional groups. Results: The FTIR and XRD analysis graphs obtained for the samples from the two procedures were compared with graphs of Hydroxyapatite samples from previous studies. Conclusion: FTIR and XRD analysis used to characterize the samples obtained from two procedures namely calcinations & using Smart Dentin Grinder confirmed the presence of Hydroxyapatite crystals. The procedure used has an effect on the crystalline properties of the Hydroxyapatite. Keywords: Hydroxyapatite; Fourier transform infrared spectroscopic analysis; X-ray diffraction analysis (XRD); Calcination; Smart Dentine Grinder.

Class II div 2 malocclusions have Labially tipped maxillary lateral incisors and retroclined maxillary central incisors , so placing a straight NiTi wire often aligns these teeth out of the arch. Even though NiTi wires influence the average appointment time and help make life easier for orthodontists, they have a reputation of aligning teeth at the expense of reciprocal forces exerted on adjacent teeth, which are mostly unwanted. A simple method to align these teeth in their correct axial inclinations is explained in the following clinical innovation technique.

A novel corona virus 2019 (2019-nCoV) or the severe acute respiratory syndrome corona virus 2(SARS-CoV-2) was the causative agent of acute respiratory disease that lead to the unprecedented outbreak in Wuhan City, Hubei, China emerged in December 2019. This was termed as COVID -19 by World Health Organisation (WHO). It was declared as pandemic and health emergency of international concern on 30th January 2020 The severe global containment efforts and quarantine efforts were taken worldwide in response to this global outbreak. This article summarises a brief overview and essential knowledge about COVID - 19 and it also provides management protocols for dental professionals and orthodontists in particular to combat the novel epidemic coronavirus. Keywords: Coronavirus, COVID -19, Epidemic, SARS-COV-2.

Surgical-orthodontic treatment of jaw deformities presents challenges in both diagnosis and mechanotherapy. The orthognathic approach has undergone a paradigm shift through the years, from correcting the skeletal component to addressing the soft tissues, thus optimizing aesthetic outcome. This case report presents a patient with a skeletal class II malocclusion with facial asymmetry who has been managed by surgical first orthognathic approach (SFOA). The treatment duration was decreased tremendously because of the Regional Acceleratory Phenomenon (RAP). The treatment outcome resulted in class I skeletal and dental relationships with phenomenal changes in correction of facial asymmetry attaining a pleasing facial profile and divergence. Keywords: Surgery First Orthognathic Approach (SFOA), Facial asymmetry, orthognathic surgery, Skeletal class II, Regional Acceleratory Phenomenon (RAP)

Powerscope is one of the innovations in fixed functional appliances. It is based on the concept of forward displacement of mandible with distal movement of maxilla thus reducing the class II skeletal tendency to class I, hence it is a class II corrector which is used in a treatrment of mandibular retrusion by bringing about increase in mandibular length. It is a very effective appliance to be used in a non compliant patient as it is a one piece fixed appliance attached to the wires thus reducing the chances of bond failures at brackets and tubes. It brings about growth modification in skeletal class II cases by sagittal movement of the mandible. Based on the advantages of powerscope over other fixed functional appliances the following case report exhibits a case which showed significant changes in Class II malocclusion without going for an extraction approach. Keywords: Fixed Functional Appliance, Class II corrector, Patient Compliance, Growth Modification, Mandibular Retrusion

Introduction:This occlusal curvature is a naturally occurring phenomenon in the human dentition, describedin the late 19th century, by Ferdinand Graf von Spee. It is an inveterate parameter in describing ideal occlusion.The phenomenon still needs an immense understanding of its determinants to unravel all the aspects of its existence and the role that it plays in governing the other dental and skeletal variables. Materials and Methods: A total of 107 patient pre-treatment records were selected. The lateral cephalograms and study models of the selected sample were thoroughly evaluated based on various skeletal and dental cephalometric and cast parameters. For the precision in the measurement of the depth of curve of Spee and thereby precise grouping, a computer based photographic method was employed for which a standardized photographic set-up was advocated. Results: Statistically significant correlations were found between the depth of curve of Spee and overjet, lower incisor–NPg mm, lower incisor–NPg0, lower incisor–NB and Md-PABH measurements. Amongst these significant values Md-PABH, L1-NB, L1-MP, L1-NPg (0) and L1-NPg (mm) were negatively correlated and overjet was positively correlated. Conclusions: It was deduced that Curve of Spee is more influenced dentally and to a minor extent by facial morphology. Keywords: Curve of Spee, Photographic Method, Irregularity Index, Cephalometric Parameters, Overbite.  

The word “moral” is defined as relating to the principles of right and wrong in behavior and “ethics” is defined as a system of moral values or the principles of conduct governing an individual or a group and deals with the values relating to human conduct, with respect to the right and wrong of certain actions and to the goodness and badness of the motives and ends of such actions. An orthodontist must follow basic bioethical principles such as benevolence, autonomy, causing no harm, and justice in order to instill the patient-doctor trust and to have healthy clinical practice. It should be emphasized that the use of these principles is of extreme importance in facing the ethical issues common to clinical practice.

Over the years, several methods for correcting tongue thrust have been introduced. However, the correction of the habit of tongue thrust with removable and fixed tongue crib in any clinical situation has always been a matter of concern. This article presents a placement of modified lingual arch with tongue crib for correction of tongue thrust and also the improper positioning of tongue with a class I malocclusion in an adult patient. Keywords: tongue, thrust, crib, lingual, mandibular, modified.

Class II skeletal base with vertical maxillary excess (VME) and skeletal mandibular deficiency presents a combination of several problems about function, psychology, and esthetics. The optimal treatment plan generally includes a harmonized orthodontic-surgical approach through superior repositioning (Vertical maxillary impaction) using Le-Fort I osteotomy, mandibular advancement, and genioplasty. A 23-year-old woman with severe skeletal Class II malocclusion, convex profile, and gummy smile was referred to our department. Skeletally, she presented with vertical maxillary excess, mandibular deficiency along with a hyperdivergent growth pattern. Dentally, Class II molar, and canine relationships increased overjet and overbite with proclined upper (U1-SN: 118o) and lower incisors (L1-MP: 97o). Maxillary impaction was planned to correct the gummy smile, and mandibular advancement to improve the convex profile and correct the mandibular deficiency. In adjunct, genioplasty was also planned to correct the chin deficiency. The decompensation phase involved correction of the proclination and crowding of the upper incisors by extraction of the upper first premolars and decrowding, uprighting, and retracting the lower incisors by using the molar extraction space thus increasing the overjet. Bi-jaw surgery which included a Le-fort I osteotomy for vertical maxillary impaction (4mm), bilateral sagittal split osteotomy (BSSO) for mandibular advancement (5mm), and genioplasty was done to correct the skeletal and dental Class II. This case report describes a multidisciplinary approach in the successful management of a patient with VME and mandibular advancement to achieve superior function, stability, facial esthetics, and an ideal occlusion. Keywords:Orthognathic surgery; Skeletal Class II; Le-Fort I; BSSO; Genioplasty.

Objective: The aim of the invitro study was to analyze the color stability of monocrystalline and polycrystalline ceramic brackets after immersion in artificial saliva and a potentially staining health drink solution. Methods: Twenty monocrystalline and twenty polycrystalline ceramic brackets of American orthodontics were immersed in artificial saliva and health drink solution intermittently for 15 months, respectively. Color changes were measured by a spectrophotometer and visual assessment scale at 0, 3,6,9,12,15 months. Statistical analyses were performed with IBM SPSS version 17. Data were assessed by Multivariate Profile Analysis, Analysis of Variance (ANOVA), and Multiple Comparison Tests of means. Results: The results from the spectrophotometer and visual assessment show that the polycrystalline ceramic brackets showed a greater degree of stain uptake when immersed in a nutritive health drink solution and the monocrystalline ceramic brackets showed less staining at the end of 15 months. Conclusion: Both the monocrystalline and polycrystalline ceramic brackets undergo staining when placed in staining solutions. Comparatively monocrystalline ceramic brackets produced less stain and were better than the polycrystalline ceramic brackets when immersed in a health drink solution by 25%. The combined effect of time, type of bracket, and type of staining solution had influenced the degree of stain uptake. Keywords: Ceramic Brackets, Color Stability, Artificial Saliva, Staining Solution, U-V Spectrophotometer, Visual Assessment.

Introduction:The relationship between physical appearance and perception of an aesthetic deviation forms a basic criterion for people to seek a solution. In Dentistry, Patient’s desire to enhance their facial beauty is one of the most common driving factors to undergo orthodontic treatments. Having a clear understanding of patient's attitudes, need and perceptions towards orthodontic treatment , will help in better treatment planning and delivery. Aim: To evaluate Awareness, attitude, and perception of dental undergraduate students towards orthodontic treatment. Materials and Methods: 316 undergraduate students from four different dental colleges of Tamilnadu participated in a questionnaire survey. The survey was conducted through Google forms. Frequency distribution was generated for all variables.Categorical variables were evaluated using a Chi-square test for statistical difference between the gender. Results: 74.6% of the participants felt that their self-esteem will improve if they have good alignment and 87.6 % of people thought orthodontic treatment will make their smile look better. 71.4% of males agreed for treatment when advised, while only 50% of females agreed for the same.15% of males thought that their teeth affect 100% of facial appearance. Statistically, a significant difference was observed with respect to the preference of metal and ceramic brackets between males and females. Males preferred metal brackets over ceramic brackets while females preferred ceramic over metal brackets. Conclusion: The study showed that dental undergraduates had fair knowledge and a positive attitude towards orthodontic treatment. Gender difference exists in preferences for the type of orthodontic treatment. Keywords: Awareness, attitude, perception, orthodontic treatment, dental students.

Objectives- With the replacement of conventional OPG, lateral cephalogram to Digital OPG, digital Cephalogram, CBCT technology, conventional models to digital models and emergence of CAD-CAM technology, we can now hope for instant 3 dimensional manufacturing of digital appliances. A three-dimensional (3-D) printing is a process of making 3-D solid ob8qkjects from a digital file. The digital 3-D model is saved in STL format and then sent to the 3-D printer where the layer by layer design of an entire 3-D object is formed. Each of these layers can be observed as a thin sliced horizontal cross-section of the eventual object. Automated model-making with the 3-D printer dramatically reduces fabrication times and exponentially increases output per technician. Thus by transitioning to a fully digital process, there is no need to store bulky physical models and keep all your cases digitally, for as long as you need. The properties, performance, lifetimes and recycling potential of printed parts must also be considered. In dentistry, mass customization and digital inventory aspects, which are areas where additive manufacturing excels, will almost certainly drive significant further growth. The ability to locally create accurate, working models for individual patients along with predictable low cost and rapid turnaround times are appealing factors that will likely drive mainstream acceptance to this technology in some form within dental practices. Keywords: 3D Printing, CAD-CAM, Additive manufacturing, 3D Printer..

Objectives- Objective: To evaluate and compare the efficacy, displacement and stress distribution patterns of two fixed functional appliances in the mandible. Material and Methods: The construction of the finite element model was done which was read into Mimics software and processed. The results were extracted using ANSYS. Results: The maximum anterior displacement of 0.669 mm was observed in mandible with AdvanSync 2 (Ormco Co, Glendora, Calif) whereas, the maximum anterior displacement of 0.690 mm was observed in mandible with PowerScope 2 (American Orthodontics, Sheboygan, Wis). The maximum von Mises stresses of 32.289 Mpa were observed at medial surface of the head of condyle, lateral border of mandible and lateral border of coronoid process with AdvanSync 2 whereas, the maximum von Mises stresses of 38.855 Mpa were observed at medial surface of head of condyle, lateral border of mandible, angle of mandible and lateral border of coronoid process with PowerScope 2. Conclusion: Greater forward movement of the mandible was observed with PowerScope 2. Amount of von Mises stress and tensile stress generated with PowerScope 2 was greater. The von Mises stress produced by all the appliances was within the physiological limit but it was found to be minimum with AdvanSync 2. Therefore, this study establishes AdvanSync 2 as more biologically acceptable as compared to PowerScope 2. Hence, both Class II correctors can be used in cases that require fixed functional treatment to render fruitful results. Keywords: AdvanSync 2; PowerScope 2; Fixed functional treatment; Class II correctors; Finite element; Mandible

Class II Subdivision refers to the asymmetric molar relationship that can be commonly accounted to dental and occasionally to the skeletal disharmony. Furthermore, the discrepancy may be present in the maxilla or the mandible. To put it differently Class II subdivision is a heterogeneous group of malocclusions and cannot be considered as a discrete entity to be treated with predefined specific strategies. Treatment goals encompass the usual cook-book approach and entail the orthodontists to think-before-act strategy considering all the parameters that may be affected favorably or deleteriously while executing a specific plan. Treatment options may vary from non-extraction to four premolar extractions depending upon the site and severity of the malocclusion. Another consideration would be the indispensable side-effects of the biomechanics involved that may be symmetric or asymmetric, again depending upon the needs of the patient. These not only require thorough diagnosis but also clarity in the treatment goals. This piece of literature would briefly outline the important considerations while treating Class II Subdivision cases with the help of examples of three patients bearing different etiologies treated with contrasting strategies. Keywords: Class-II Subdiv malocclusion, Midface deficiency, Decompensation, Overjet, Crossbite

Introduction: An adult female patient with anterior open bite appears dento- alveolar component with skeletal class III malocclusion , hyperdivergent growth pattern and tongue thrusting habit. Objective: Aim of this case report is to show the effect of habit breaking appliance along with the fixed orthodontic treatment in a non- growing Class III patient with dental open bite with marked improvement in overjet, overbite and profile of the patient. Results: The goal of the treatment has been achieved according to patient’s desire and satisfactory interdigitation. Conclusion: The treatment resulted in an aesthetic, functional, and stable occlusion, along with an improved facial profile. Keywords: Non-extraction orthodontic, open-bite, non-growing, class III malocclusion.

The novel coronavirus or severe acute respiratory coronavirus syndrome 2 was acausative agent of acute respiratory disease that resulted in an unexpected outbreak inChina in December 2019. Protocols for the provision of dental treatment during theCOVID-19 pandemic were created after analysis of the severity of the COVID-19pandemic and were focused on grouping patients by diagnosis and need, andconsidering interventions by risk and benefit. The purpose of this article is to commenton the emergence, epidemiology, threats and to safeguard orthodontists during thispandemic crisis. It is hoped that the recommendations proposed in this work wouldcontinue to manage dental treatment around the world before and after this pandemic. Keywords:Covid-19, Orthodontic virtual management, Dental Practice management.

The purpose of this study was to evaluate the orthodontic status and perceived orthodontic treatment needs of 2016 tribal adolescents screened in the Paderu Revenue Division of Visakhapatnam District. The sample chosen for this epidemiological survey comprised of a total of 2016 higher secondary schools students aged 13 to 19 years (1157 boys and 859 girls) none of whom had undergone any prior orthodontic treatment. The occlusion of the students was assessed and classified into the categories of ideal occlusion and Angle’s Class I, II & III malocclusions. Other parameters noted were overjet, overbite, crowding, spacing and midline diastema. Results revealed that 32% had normal occlusion. Of the 68% with malocclusion 71% had Angle’s Class I malocclusions, 27% had Angle’s Class II malocclusions & 2% had Angle’s Class III malocclusions. Questions were posed during the examination process to assess orthodontic awareness, self -perceived dental esthetics and perceived treatment needs. While 81% were aware of orthodontic treatment only 16% had a perceived need for treatment. The most prevalent malocclusion amongst the tribal adolescents was Angles’s Class I malocclusion with bimaxillary proclination. A chi-square test of independence showed that there was no significant association between gender and the prevalence of malocclusion, X2 (2, N = 2016) = 5.5, p = .13.

Anchorage in orthodontics is one of the most important consideration during extraction treatment planning. Unwanted movement of molars in extraction space is called anchorage loss. Anchorage loss can be assessed by Cephalometrics but superimposition is one of the main disadvantages of this method. Thus, in this article we used a modified “Nance palatal arch" which helps to assess anchorage loss during different stages of treatment. Keywords:  Anchorage, Anchorage loss, Nance palatal arch, Superimposition

Over the years, several methods have evolved for correction of open bite. Open bite correction using elastics in clinical situation have always been a matter of concern for patient as well as clinician. This articles aims to explain an auxillary arch wire for closure of openbite with minimal patient compliance. Keywords: Openbite, Extrusion, Auxillary Archwire

This article demonstrates the effective growth modulation using Maxillary intrusion splint with headgear in treatment of vertical maxillary excess and Bidental proclination as opposed to contemporary skeletal anchorage modalities such as Temporary Anchorage Devices, etc. This case report is about a 14 year old female patient who reported with a chief complaint of forwardly placed upper front teeth with gummy smile. On examinationthe patient had a convex profile with incompetent lips and excessive gingival display. Treatment included Maxillary Intrusion Splint (MIS) along with headgear to bring about restriction of maxillary growth in vertical and sagittal direction. This was followed by extraction of all first premolars and fixed mechanotherapy in order to correct the proclination. Ideal overjet, overbite and intercuspations were achieved and maintained even one year after debonding. Keywords: Gingival display, Maxillary Intrusion Splint, Bidental proclination, Headgear, Vertical Maxillary Excess

A 21 years old male patient, presented with the chief complaint of irregularly placed upper and lower front teeth and difficulty in chewing. Medical history was non-significant. Extraoral examination revealed a mesofacial face with grossly facial symmetry, straight profile, and average to high mandibular plane angle with a toothy smile. Lower lip was thick and everted. Functional examination revealed a normal temporomandibular joint. He was treated with a nonextraction treatment plan that involved bilateral maxillary molar distalization using Hilgers pendulum appliance followed by fixed mechanotherapy. Keywords: Molar distalization, Non-extraction treatment, Pendulum appliance

In this clinical review, prognostic factors related to the spontaneous eruption of palatally displaced canine are discussed based on available literature.There are number of literature has been published from time to time regarding different measures those helps in detection of prognostic variability for the spontaneous eruption of palatally displaced canine. Age at the time of diagnosis, position of canine related to sectors, angulation to different axes, distance of crown to cemento-enamel junction and occlusion plane, and position of root apex are the prime indicators of the prognosis. This review is a compilation of different studies published regarding spontaneous eruption of palatally displaced canine. Keywords: Palatally displaced canine, Sector classification, Angulation, Prognostic factors.

Purpose: To assess the correlation between Down syndrome and delayed eruption of permanent teeth, in relation to the chronological age, in children with Down syndrome. Methods: The study group included 80 children in mixed dentition, of ages between 6 and 12 years: 30 children with Down syndrome and 50 healthy children. Clinical and radiological examinations were done, focusing on the relation between dental age and chronological age of all patients. Results: The presence of Down syndrome in children has a notable influence (p Keywords: Children, Chronological age, Down syndrome, Dental eruption, Mixed dentition.

Introduction: Stainless steel used for fabrication of various components of fixed orthodontic appliances interact to oral environment and releases metal ions including nickel and chromium, absorbed systemically can cause side effects to the body if their concentration exceeds above toxic dose. Aim: To determine and compare the level of nickel and chromium in serum of patients undergoing fixed orthodontic treatment at different time period. Materials and Methods: Serum sample of 13 patients was taken before (Group I) and after one week (Group II), one month (Group III) and three month (Group IV) of appliance placement. Level of nickel and chromium ion was determined using Graphite Furnace Atomic Absorption Spectro-photometry. Data was statistically analyzed using SPSS Statistical Analysis Software (Version15.0). Results: Serum level of nickel and chromium was highest in Group II and lowest in Groups I. On comparison among different groups, statistically significant difference was found between Groups I vs II, III and IV (p ( Conclusion: The serum nickel and chromium level was maximum after one week of appliance placement then gradually declined. This level was well below the toxic dose of these ions. Keywords: Nickel and Chromium serum level; Graphite furnace atomic absorption spectrometry; Transpalatal arch; Fixed orthodontic appliance.

Various methods are available today to evaluate dento-skeletal asymmetry but none seems to be efficient to be efficient to the tune of Customized Transparent Graphed Jig (CTGJ). Furthermore in Class II subdivision cases where molar is in Class II relation on one side and Class I on the other. It becomes real testing point for the clinician to diagnose the faulty molar. Supplementary diagnostic aids in the form of PA cephalogram also fail to categorically define the malocclusion site a part from an extra radiographic exposure to the patient. The need for precise and accurate measurement of the dento-skeletal asymmetry without any hazard of extra radiation led us to the fabrication of a Customized Transparent Graphed Jig (CTGJ) whose results could be calibrated even to the tune of 0.5mm. This article shows a fabrication and method of application of a Customized Transparent Graphed Jig (CTGJ) to measure dentoskeletal asymmetry of maxillary and mandibular arch. Keywords: Class II subdivision, dentoalveolar asymmetry, Customized Transparent Graphed Jig (CTGJ), skeleton-dental asymmetry.

This case report shows the management of a patient with skeletal Class II relationship with increased overjet by combined surgical and orthodontic treatment. When this patient reported to us, his maxillary first premolars were already extracted during unsuccessful orthodontic treatment 2 years back. Pre-surgical orthodontic treatment involving consolidation of spaces and creation of sufficient overjet was done. The bilateral sagittal mandibular advancement osteotomy with reduction genioplasty was performed by oral and maxillofacial surgeon. Skeletal and occlusal relationships reconstruction resulted in a more desirable facial profile and stable occlusion for this patient.

Introduction – This clinical study was undertaken to compare the rate of anterior teeth alignment and discomfort in patients treated with conventional and passive self ligating brackets along with an indigenously designed functional and dummy orthodontic vibration device. Materials and Methods – 36 patients were selected for fixed orthodontic treatment and randomly divided into 6 groups- MBT and SLB with vibration(30 Hz,25g), MBT and SLB(control groups), MBT and SLB with dummy device(placebo groups). Little’s irregularity index for lower anteriors was evaluated at start of treatment (T0), at 6 weeks (T1) and 12 weeks (T2). Pain was scored on a visual analogue scale (VAS) at 1 hour after archwire insertion and 2 hours after insertion within which time patients had used their allotted devices. Results – There was no significant difference in irregularity between groups at T0. Significant alleviation of crowding was seen in the MBT groups subjected to vibration compared to control and placebo MBT groups (p=0.05). However this difference in resolution of irregularity was not statistically significant between the SLB group with vibration and placebo and control groups. The reduction in pain was found to be statistically significant by the use of vibration device at all appointments (p Conclusion - The vibration device was more effective for initial alignment in the MBT group compared to SLB group. Pain was significantly reduced in both MBT and SLB groups by vibration therapy. Keywords: Accelerated tooth movement, vibrations, pain.

Background and objective: With the emerging concept of accelerated orthodontics, the duration of treatment has become a primary concern for the orthodontists and the patients. The emergence of Piezocision has influenced the efficiency, duration, cost and convenience of accelerated orthodontics dramatically. Here, an effort has been made to compare and assess the rate of retraction between piezocision induced and conventional retraction. Methodology: A split mouth study was done on patients requiring first premolar extraction to compare the changes in the rate of retraction where enmasse retraction was done by active tie backs, with piezocision on the experimental side and without piezocision on the control side. A mid-level incision was placed between the roots of the teeth allowed insertion of the piezoelectric knife into cortical and medullary bone to get full effect of regional acceleratory phenomenon (RAP). Measurements were taken at 3 intervals: T0 - Beginning of enmasse retraction, T1 - After completion of enmasse retraction on experimental side and T2 - Bilateral completion of enmasse retraction. Cast measurements were taken at T0 and T1 using digital vernier caliper. Results: (1) The rate of retraction was in a velocity of 1.5275±0.18337 mm/month versus 0.8863±0.09833 mm/month with conventional enmasse retraction. (2) The Piezocision side is 1.725 times faster than conventional retraction side. (28.8571/16.7286). Interpretation and Conclusion: It was concluded from the study that piezocision assisted enmasse retraction was 1.75 times significantly faster than conventional retraction. The difference in the rate of retraction of both was statistically significant. Key words: Piezocision, Piezotome, Accelerated orthodontics, Regional acceleratory phenomenon (RAP)..

INTRODUCTION: The external gonial angle which plays significant role in the diagnosis of craniofacial disorders is routinely measured from lateral cephalogram and orthopantogram. But how far these radiograph methods are reliable for the measurements of external gonial angle is a question which has been of much interest to investigators. AIMS AND OBJECTIVES: To compare and discover any difference between the values of gonial angle obtained from the lateral cephalogram and orthopantogram and also between the values of the male and female.To determine the value of external gonial angle in Assamesse population. MATERIALS AND METHOD: The study was conducted on the lateral cephalogram and orthopantogram of 30 female and 30 male patients having Class-I skeletal malocclusion within the age group of 18-30 years. Each lateral cephalogram and orthopantogram was traced twice and average value of each parameter was taken as the data. RESULTS: In the study, the mean values of external gonial angle was 120.18 degree in panoramic radiograph and 121.75 degree in lateral cephalogram with no significant difference found in gonial angles obtained from lateral cephalogram and orthopantogram between two genders. CONCLUSION: The Gonial angle is an important parameter of the craniofacial complex which gives an indication about the vertical parameters and symmetry of the facial skeleton which can be correctly measured by both lateral cephalogram and orthopantogram (OPG) Keywords: Gonial angle, lateral cephalogram, orthopantogram(OPG), Assamesse population.

Aims and Objectives: To establish the Soft Tissue and Dentoskeletal parameters for the young Indian adults of Gujarat State, according to Arnett and Bergman STCA and to compare the values of Arnett and Bergman STCA of Gujarati population with the original norms (i.e. for the Caucasian white population) of Arnett Bergman STCA and to identify differences if any. Methods In this study, standard cephalometric radiographs of about 100 adults were taken with age ranging from 19 yrs 1 month to 24 yrs 9 months with Class 1 normal occlusion with all permanent teeth present and possessing good facial symmetry with cephalometric parameter readings within normal range and not having undergone any orthodontic or maxillofacial / plastic surgery in the past. Tracings were made manually and the values were measured and analysed statistically. Results:The statistical data was analysed with statistical software S.P.S.S 6.1.4 for Windows. The findings obtained revealed a preponderance of weak chin in Gujarati population. Overall facial length was lower with acute nasolabial angle and thinner lower lip with a decreased inter-labial gap as well as decreased maxillary incisor exposure when compared to the white population. Conclusion: The findings suggest a need for further studies to confirm normal soft tissue cephalometric values not only for the Gujarati population but also for the population of other states because of interstate ethnic group variations. These will directly influence orthodontic and orthognathic diagnosis as well as treatment planning. Keywords: Gingival display, Maxillary Intrusion Splint, Bidental proclination, Headgear, Vertical Maxillary Excess.  

Periodontally compromised adult patients present with multiple problems of malocclusion, esthetics, function and psychological stress. Orthodontic treatment of such patients is not contra indicated but needs special considerations, certain precautions, and determination of specific, realistic and achievable treatment objectives. Need of the hour is to have an integrated approach where the periodontal treatment precedes Orthodontic treatment to restore periodontal health. Orthodontic treatment should be performed under strict plaque control and with measures to place the teeth in a structurally balanced and functionally efficient position. Aim of this case series is to demonstrate orthodontic treatment of adult patients with periodontally compromised status. In this case series more emphasis is given on correction of Gingival recession on single tooth by means of torquing alone without any free gingival grafts. Keywords: Interdisciplinary, Orthodontics, Adult, Periodontal.

Proper management of biomedical waste produced in Orthodontic practice is an important component of environmental health protection. Wise handling and disposing of biomedical waste is very critical. In Orthodontic practice, a number of biomedical wastes are produced. This article is designed to explore and review on the issues such as categories related to biomedical waste and procedures of handling and disposal methods of biomedical waste management in Orthodontic practice and formulate a simplified scheme. Keywords: Biomedical waste; management; Orthodontics; practice; schedule; segregation

Introduction – This prospective clinical study was undertaken to analyze the three-dimensional facial soft tissue changes in bimaxillary protrusion extraction treatment cases using 3D structured light based scanner and facial photographs and to compare the two modalities. Materials and Methods– 25 Indian adult patients of 18 - 23 years of age with dentoalveolar bimaxillary protrusion malocclusion and all four premolar extraction with maximum anchorage as treatment plan were taken. A pre-operative and post- operative extra oral 3D scan and 2D photographs were obtained for each subject. A prospective comparative evaluation of 12 lateral and 10 frontal soft tissue parameters was done. Results – Significant changes were seen in distance of Sn, Pog, Ls, and Li from TVL, Ls and Li from E line and S line, Inf sulcus to H line, Naso- labial angle, H angle, and Merrifield Z angle (p Conclusion–Significant soft tissue profile changes are obtained from pre-treatment to post- treatment in all first four premolar extraction bimaxillary protrusion cases mainly in antero-posterior direction. The changes observed through evaluation of scans were similar to the ones obtained through photographs. Keywords: Soft tissue profile changes, Extraction treatment, structured light based Scanner, Photographs, 3D versus 2D.

 Class III malocclusion is highly prevalent among Asian population, especially in the form of a midface deficiency. This case report describes three such cases that have been treated using growth modification and orthodontic decompensation with orthognathic surgery. Case report 1 is of a 12 years old female patient having Angle’s class III malocclusion based on skeletal class III jaw bases with 12 mm of reverse overjet, 0 mm of overbite, proclined maxillary anteriors, retroclined and crowded mandibular anteriors and rotated 13 and 23. Case report 2 describes a 12 years old male patient diagnosed with Angle’s class III malocclusion based on skeletal class III jaw bases with 2 mm of reverse overjet and 5mm of overbite and anterior crossbite i.r.t. 11,12-31, 41. Case report 3 demonstrates a 22 years old male patient with Angle’s class III malocclusion based on skeletal class III jaw bases with 3 mm of reverse overjet and -2 mm of overbite with proclined maxillary anteriors and retroclined mandibular anteriors; spacing in the upper anteriors and crowding in lower anteriors, with anterior crossbite.Treatment in all the cases achieved good functional stability. Keywords: III malocclusion, Midface deficiency, Decompensation, Overjet, Crossbite.

Accurate bracket placement is of utmost significance in Orthodontics. The indirect bonding technique allows orthodontists to achieve maximum efficiency during bracket placement , helps in accurate bracket positioning. Indirect bonding offers benefits to shorten the chairside bonding procedure. Several methods and techniques have evolved over the years in indirect bonding. These methods have differed either in adhesive used to fix brackets to casts or in the material used to fabricate transfer tray. A simple, efficient and cost-effective method is employed in our department with application of Modelling clay as adhesive and glue gun as transfer tray material for precise indirect bonding technique. Modelling clay used in this technique is soft, non-toxic, does not crumble or dry and enables the orthodontist to easily place the bracket and reposition it accurately on the cast and also aided in maintaining bracket’s stability during the fabrication of transfer tray. Keywords: Indirect bonding, Modelling clay, Glue gun material, transfer tray, Simple, Cost-effective.

Objectives- To assess the precision and reliability of Tweed's Triangle and effective mandibular length, corpus size on 2 dimensional conventional lateral cephalogram and 3D CBCT scan. Methods - 30 male adults are selected for (group A) - manual tracing, (group B) - on screen digitized tracing by software for lateral 2D cephalogram, & (group C)- digital tracing by software for 3D CBCT scan for angular measurements of Tweed's Triangle (FMA, IMPA, FMIA) and linear measurements of effective mandibular length ( Co-Gn ) and corpus size(Go-Gn). Results- Statistical analysis by ANOVA and post HOC-LSD test reveals significant difference for FMA (p Conclusions -3D CBCT scan for Tweed's triangle, effective mandibular length and corpus size can be more precise and reliable for diagnosis and treatment planning. Keywords- Lateral cephalogram, Tweed’s triangle, Effective mandibular length, Mandibular corpus size, 3D CBCT scan.

Purpose: The present study aims to assess the environmental effects that tongue posture, upper airway and maxillary dentoalveolar morphology have with respect to their association in skeletal Class II malocclusion cases. Materials and methods: Pre treatment lateral cephalograms and study models of 32 adult skeletal Class II malocclusion orthodontic patients were selected randomly. Tongue posture measured as tongue to palate distance along 7 different lines and 3 linear upper airway parameters were determined cephalometrically. For maxillary dentoalveolar morphology, Inter canine width (ICW) and Intermolar width (IMW) was determined on study models. Pre treatment lateral cephalogram and study models of equal number of age matched skeletally Class I malocclusion patients were included as controls in this study. Results: The mean measurement for tongue posture along 5 of the 7 reference lines are significantly higher in controls compared to the cases (P-value0.05 for both). Conclusion: A definitive pre treatment, mid treatment and post treatment assessment of tongue posture and upper airway on a lateral cephaogram and dentoalveolar morphology on study models is important in management of adult skeletal Class II malocclusion cases. Keywords: Tongue posture, upper airway, dentoalveolar morphology, skeletal class II malocclusion.

Abstract: Class III malocclusion is always challenging for the orthodontist. There aredifferent methods to address the Class III malocclusion in growing patients, adolescents and adults. When the malocclusion is very severe and beyond the scope of orthodontics alone, ortho-surgical approach is considered to correct the underlying skeletal deformity. This article is a description of two cases treated with bi-jaw surgery to achieve the desired treatment outcome. Keywords: Orthognathic surgery, Skeletal Class III malocclusion, Bi-jaw surgery Adult orthodontics, Inter-disciplinary orthodontics.

Introduction: The aim of this study was to evaluate the vertical, sagittal and transverse effects of semi rapid maxillary expansion (SRME) in patients with transverse maxillary discrepancies using a modified removable expansion appliance assessed by lateral cephalograms and dental models. Materials and Methods: The lateral cephalograms and dental models of 50 treated patients group were compared with those of 29 untreated control group at 3 different times: pretreatment (T0), after expansion (T1) and after fixed appliance therapy (T2). The mean age for treated group was 13.8yrs (32 females; 18 males) and control group was 13.2yrs (15 males; 14 females). A total of 18 measurements (8 angular; 10 linear) were measured in vertical, sagittal and transverse planes at T0, T1 and T2 stages. The T0-T1, T1-T2 and T0-T2 changes were compared statistically in treated group with respect to the corresponding untreated control group. The intra-group and inter-group comparisons were statistically analyzed using Wilcoxon signed rank test. Results: In comparison to controlled group the following parameters in treated group showed a statistically significant change from T0 to T2. In vertical plane increase in ANS–Me and in sagittal plane decrease in angle ANB and OJ; increase in SNB and U1-SN was seen. In the transverse plane ICW, IPW, IMW, PMW showed net gain of 3.27, 5.06, 3.7 and 2.82mm respectively. Conclusion: The results of present study suggest that the design and protocol followed in using SRME is effective for the correction of maxillary transverse discrepancies with acceptable vertical and sagittal control. Keywords: Semi Rapid Maxillary Expansion, Transverse Maxillary Deficiency, Sagittal and Vertical Effect, Lateral Cephalogram, Model study.

Aim-Purpose of this study is to compare the validity of different cephalometric angles like Beta, Yen, Pi and W angle for evaluating sagittal jaw dysplasia in Skeletal Class I and Class II malocclusion among Bhopal population and to obtain most reliable parameter for orthodontic diagnosis. Material and Method-120 pretreatment lateral cephalograms were selected on the basis of inclusion criteria and were divided into 2 groups (n= 60) i.e. Skeletal Class I and II on the basis of ANB Angle and Wits Appraisal between ages of 16-35 years which further subdivided into Male and Female (n=30). Landmarks were located, traced and analyzed. Results- There was statistically highly significant difference found for cephalometric parameters in Skeletal Class I and Class II Malocclusion. (p=0.001) Mean value of ANB angle was 1.917±1.37 and 6.292±1.27, Wits was -0.742±3.02 and 3.442±2, Beta angle was 31.692±4.41 and 24.125±5.60, Yen angle was 123.28±3.47 and 117.16±4.47, Pi angle was -0.658±3.37 and 4.817±3.14 and W angle was 55.792±2.61 and 52.017±3.34 among Skeletal Class I and II groups respectively. Yen angle (91.67 % & 76.67 % ) and Pi angle (90.00 % & 71.67 % ) had high sensitivity and specificity to discriminate between Class I & II. Cut off value was ? 3for Pi and >119 for Yen angle. Conclusion- Yen Angle is the most accurate and reliable parameter to differentiate between Skeletal Class I and Class II Groups with highest sensitivity and specificity followed by Pi Angle. Keywords: Sagittal dysplasia, Beta Angle, Yen Angle, Pi Angle, W Angle.

Aim and Objective: The purpose of this study was to investigate magnitude and direction of forces generated in the maxillary anterior region with engagement of arch wires into slots of conventional and self-ligating brackets during initial leveling and alignment stage of orthodontic treatment. Materials and Method: Three-dimensional models of Damon Q (Ormco, Glendora, California) and Mini 2000 (Ormco, Glendora, USA) brackets (upper 3 to 3) were modeled using micro computed tomography. A 3D orthodontic model was designed to replicate moderate crowding in the dental arch with all supporting structures. The simulated malocclusion represented a maxillary central incisor displaced 3.8 mm lingually and 3.16 mm gingivally. 0.014” Copper-Nickel-titanium (CuNiTi) wire was engaged in Damon Q and Mini 2000 brackets for alignment on the same model and force magnitude and stresses generated were measured with ANSYS Mechanical R19.0 software. Results: Damon Q brackets delivered light continuous forces when compared to Mini 2000 brackets. Stresses generated on teeth and periodontal ligament (PDL) are lesser with Damon Q as compared to Mini 2000 brackets. Tooth deformation was more with Damon Q brackets as compared to Mini 2000 brackets. Conclusion: Adult orthodontic cases, especially with compromised periodontal health, can be treated more efficiently with minimum patient discomfort and complications such as root resorption with Damon Q brackets and 0.014” CuNiTi wires. Keywords: Self-ligation, MBT brackets, Damon Q, Finite element analysis, Copper-Nickel-titanium.

To When one is at the Cross roads of managing a missing maxillary lateral incisor ,there are two options to finish with a good occlusion The two options are a) Reshaping the maxillary canine into a lateral incisor (Canine Substitution) and the maxillary premolar into a lateral incisor1 and b) Open space and replace the missing lateral incisor with a prosthesis. Which among the two options would be the right choice is the topic of discussion in this article. This article reviews a case of a missing maxillary right lateral incisor and how it was managed successfully taking into account both the esthetic and functional aspects. Factors that contribute to achieving functional occlusion and criteria to reshape teeth for substitution will be discussed. Keywords: - Missing maxillary lateral incisor, Functional Occlusion, Canine Substitution, Ridge Development, Reshaping of teeth.

Morphometrics is used to describe the size, shape and form of any object as well as organisms or a part of organism. Geometric morphometrics is the quantitative representation and analysis of morphological shape using geometric coordinates instead of measurements. The use of geometric morphometrics in clinical orthodontics is to accurately locate the landmark matrices of each of the individuals into morphometric space created around the consensus .The relative location in this space, defined by the two main components explaining biggest shape variation within a given population , represents , the skeletodental diagnosis . Thus, the morphometrics distance of each case will be indicative of the clinical severity of case. Therefore, each diagnostic case would have a precise location into morphometrics space in relation to its expression of skeletal malocclusion as well as its expression of skeletal vertical pattern. Thus this article aims to review the application of geometric morphometrics: clinical and research; in an effort to provide a better understanding of the subject for an interpretation that will stimulate researches in this field of study. Keywords: Geometric Morphometrics, Maxillofacial Anatomy, Growth, Anomalies.

Background: Malocclusions with gummy smile and vertical maxillary excess mainly occurs by overgrowth of the maxillary anterior dentoalveolar heights, but it is difficult to intrude anterior segment with conventional orthodontic mechanics. Surgical treatment i.e. anterior maxillary osteotomy is the treatment of choice in such cases. However, if the patients are not willing to undergo surgical intervention, an alternative method must be considered to treat the gummy smile. Aim: To describe the non-surgical treatment of skeletal malocclusion with vertical maxillary excess and gummy smile. Method: In this case series, we treated malocclusions with severe gummy smile and vertical maxillary excess using mini-plates instead of mini-implant, so that:- 1) Simultaneous molar distalization, premolar retraction & anterior retraction with intrusion could be achieved with segmental mechanics. 2) Variable force vectors depending on amount of intrusion and retraction required in cases could be applied by varying line of action of force. 3) Mini-plates are more stable at higher forces. Results: In all the cases the treatment resulted in marked improvement in the facial profile and correction of gummy smile. Ideal overjet and overbite was achieved. The cases were finished with Class I Molar and canine relation. Upper incisors were intruded & retracted remarkably avoiding orthognathic surgical intervention to correct gummy smile. Conclusion: Mini-plate is a viable treatment option for correcting dentoalveolar malocclusion with vertical maxillary excess and severe gummy smile. Keywords: Mini-plates, Anterior Maxillary Osteotomy, Gummy smile, Vertical Maxillary Excess

An 18 year male patient presented with mandibular asymmetry with asymmetric mandibular and maxillary arches with midline shift and unilateral anterior crossbite. There were dental compensations in association with skewed mandibular arch. The patient was treated nonsurgically without any extractions and asymmetric orthodontic mechanics. Pretreatment and post treatment records are shown and the treatment strategy was discussed. Keywords: Asymmetry, Condylar hyperplasia, Crossbite.

Cleft Lip and Palate is the most common congenital abnormalities of the orofacial region. Management of these patients requires a multispeciality approach. A 13-year-oldpost-pubertal female patient presented with cleft lip and palate, collapsed upper arch, oroantral fistula, missing upper left lateral incisor, deviated nasal septum (DNS) and hypernasality of voice. The orthodontic treatment objectives were to align and expand the arches to correct the crossbite and provide sufficient space for bone grafting to close the oro-antral fistula and replacement of lateral incisor to achieve acceptable facial aesthetics. The patient was treated using a preadjusted edgewise appliance. Arch expansion was carried out using quad helix; subsequently alveolar bone grafting was performed to close oroantral fistula, Maryland bridge was placed to replace missing upper left lateral incisor. Adjunctively, septoplasty was done to address DNS and speech therapy for hypernasality. At the end of treatment Class I canine and molar relationship were achieved bilaterally, the crossbite was corrected and the missing maxillary lateral incisor was replaced with a Maryland’s bridge as an interim prosthesis till future implant placement. Posttreatment records showed excellent results with good occlusion, facial balance and esthetic harmony Keywords: Twin Block, MRI, Skeletal Class II malocclusion.

To have stable orthodontic corrections, many malocclusions require the so-called permanent or fixed retention. Bonding of lingual retainer needs stabilization for accuracy and survival of retainer. The present article describes a simple, cost-effective, and quick method using R clip for stabilisation and placement of bonded lingual retainer. Keywords: Retainers, Bonded lingual retainer

AIM: To assess the enamel loss after debonding of ceramic, composite plastic and stainless steel brackets and to compare them. MATERIALS AND METHODS: The sample used was 90 maxillary first premolars that were extracted for orthodontic purpose. The teeth were segregated as three equal groups of 30 teeth each. Group I samples were bonded using ceramic brackets (Virage) and Group II with composite plastic brackets (Silkon Plus) and Group III with stainless steel (Mini master series) brackets. Debonding of all samples were done according to manufacturers’ instructions. After debonding, the tooth surfaces were evaluated by ARI index and examined by scanning electron microscope for enamel cracks. All the bracket bases were examined under a stereomicroscopeand scored according to the Modified Adhesive Remnant Index (m ARI) followed by energy dispersive spectroscopic (EDS) analysis to detect calcium (Ca++) on the adhesive composite material on bracket base after debonding. RESULTS: On SEM examination, the enamel surfaces of Group I sample showed more enamel cracks. EDS analysis proved that the loss of elemental calcium is more evident in tooth surface bonded with ceramic bracket. CONCLUSION: The results indicate that after debonding procedure of ceramic bracket enamel loss is more, when compared to that of composite plastic and metal brackets.This implies that debonding of ceramic bracket needs meticulous attention.

Introduction: The treatment for patients with mild skeletal maxillary excess can be camouflaged by distalisation of the entire maxillary arch. This study compares the efficacy of aligners and passive self-ligation appliance to achieve en masse maxillary arch distalisation using infrazygomatic crest miniscrews. Materials and methods: 12 patients indicated for distalisation with infrazygomatic crest miniscrews were selected. Group 1 (n=6) was bonded with passive self-ligation appliance. Group 2 (n=6) used clear aligners for treatment. Cephalometric software was used to compare the pre and post distalisation readings in the individual appliances for quantifying the amount of distalisation. Results: Aligners demonstrated more retraction of the upper incisors. . Conclusion: Both the appliances are effective in en masse maxillary distalisation. Dental parameters demonstrated aligners having better control in distalisation. Keywords: Infra zygomatic crest screws, TAD, Self-ligation appliance, aligners.

Background & Objectives: Glenoid Fossa position plays an important role in the establishment of different craniofacial patterns. The purpose of this study was to verify the position of the glenoid fossa in subjects with different sagittal patterns, to assess the correlation between the position of Glenoid Fossa and different sagittal skeletal patterns and to assess the correlation between the position of the glenoid fossa and the functional occlusal plane. Methods: A lateral cephalometric study was carried out on 200 subjects aged 18-45 years who were classified according to skeletal sagittal relationships using ANB angle into four groups (Cl. ? =50, Cl. ?? Div.1 =50, Cl. II Div.2 = 50, Cl. ??? =50 subjects). Cephalometric analysis comprised both sagittal and vertical measurements for the assessment of the position of the glenoid fossa in relation to surrounding skeletal structures. Results: The results revealed that in sagittal skeletal relation, the glenoid fossa position was more posterior in skeletal Class II Div.2 when compared with skeletal Class II Div.1, Class I and Class III; while in the vertical plane, the position of the glenoid fossa was more cranial in skeletal Class III when compared with skeletal Class I, Class II Div.1 and Class II Div.2. On the other hand, there was no correlation between the position of the glenoid fossa and the functional occlusal plane. Interpretation & Conclusion: In conclusion, subjects with skeletal Class II Div.2 show a more posterior position of the Glenoid Fossa in relation to cranial base when compared to subjects with skeletal Class II Div.1, Class I and Class III regarding the sagittal plane and there is no valuable diagnostic information from the functional occlusal plane in relation to the position of the glenoid fossa. Keywords: Glenoid fossa; Class I malocclusion; Class II Div.1 malocclusion; Class II

Objectives: To evaluate the dimensional accuracy of slot base width and slot top width of ten commercially available bracket systems and to investigate the slot profile. Materials and Methods: 0.022-inch upper right central incisor stainless steel brackets of ten different bracket systems (Gemini (3M Unitek), Victory series (3M Unitek), Master Brackets (American Orthodontics), Microline (Tomy), Equilibrium (Dentaurum), Micro- LPTM (Modern Orthodontics), SapphireTM (Modern Orthodontics), Mini 2000 (Orrmco), Mini Diagonali (Leone) and Midi Diagonali (Leone)) were measured using a stereomicroscope to determine the slot base widths, slot top widths and slot profile. Results and discussion: The slot widths of all bracket systems significantly differed from each other (p bracket systems studied. Conclusion: The bracket slot dimensions could be inaccurate due to improper machining and this adversely affects the three-dimensional tooth movement. Keywords: Slot dimensions, slot profile, machining inaccuracy.

Introduction: This study was conducted to correlate vertical facial patterns with ABO blood groups and also to evaluate the differences in distribution of ABO blood groups among males and females with different vertical facial patterns. Materials and Methods: 162 subjects (66 males and 96 females) were randomly selected from the OPD of a tertiary care hospital (age-12-30 years). Standard pretreatment records for each individual were taken. The individuals were divided into 03 vertical skeletal facial patterns using Frankfurt Mandibular Plane Angle (FMA) as Group 1- Hypodivergent FMA individuals), Group 3- Hyperdivergent FMA >27 degrees (45 individuals). Results: The mean ± SD of age in Group 1, Group 2 and Group 3 was 17.89 ± 2.33 years, 17.25 ± 3.57 years and 17.53 ± 3.60 years respectively (P-value>0.05). The blood group distribution of cases studied did not differ significantly between group of male and female cases studied (P-value>0.05). The blood group distribution of cases studied differed significantly between group 1 and 2 (P-value0.05). A+ blood group was more prevalent in horizontal growth pattern and B+ in vertical and average growth patterns (P-value Keywords: Slot dimensions, slot profile, machining inaccuracy.

Aim: The aim of the present study was to find the association between head posture and type of malocclusion using Digimizer software. Material and Method: Pre-treatment lateral cephalograms of 90 patients were divided into 3 malocclusion groups, Class I (n=40), Class II (n=40) and Class III (n=10) malocclusion groups on the basis of ANB angle and WITS appraisal. Amongst these three malocclusion groups, relationship between the head posture and malocclusion was evaluated by measuring 9 postural angles and 8 malocclusion traits. Results: Cranio-horizontal angles were maximum in Class I malocclusion followed by Class II then Class III malocclusion. Amongst Cranio-cervical angles, SN-C2, SN-C4 angles were maximum in Class III malocclusion followed by Class II then Class I whereas Pal-C2,Pal-C4 angles were maximum in Class II followed by Class I then Class III. Cervical curvature angle was maximum in Class II followed by Class I then Class III. None of these angles determining head posture showed significant difference between the subjects with different malocclusion. Correlation coefficient observed were in range of 0.3 to 0.4 and had less predictive value. Conclusion: Development of malocclusion has multifactorial etiology, of which headposture is one of the factors resulting in malocclusion. This could be the reason thatvariabilities in postural angles determining head posture was seen in differentmalocclusion groups but difference was not significantand correlation coefficient had lesspredictable value. Keywords: Head posture, Malocclusion, Lateral cephalograms, Cranio-vertical angle,Cranio-cervical angle, Cervical curvature.

Bimaxillary proclination is a common clinical occurrence requiring careful treatmentplanning and an equally careful execution1.To maintain or achieve an ideal Class I molar relation with an ideal incisor relationship anchorage preservation plays a crucial role indiagnosis and treatment planning. A plethora of mechanics using conventional intraoral and extra oral appliances have been used in past decades, but all have some or other advantages and disadvantages over one another. So to overcome their disadvantages orthodontic implants came into existence, as it’s not a new concept, but yes its popularization took long time lapse, taking over the market over a small span of time, as one of the best means of anchorage control and space closure, but the biomechanical principals for anchorage (dental) control still holds its good in a different and unique sense for each and every case. This case report discusses one of such clinical situation where two different anchorage systems (skeletal anchorage and dental anchorage) have been used based on their advantages and disadvantages. Keywords: Temporary anchorage devices (TADs), Class I malocclusion, Extraction, Skeletal Anchorage, Dental Anchorage, MBT metal brackets, Cortical and Cancellous bone..

Rapid canine retraction by means of dentoalveolar distraction serves the purpose to reduce treatment duration without any unfavourable effect on periodontium. A case of 21 yr old female with class I bimaxillary protrusion was planned for 1st premolars extraction. A custom made distractor was fabricated modifying hyrax screw for retraction of maxillary canine. Extraction of 1st premolar was done along with lengthening the apical area of premolar socket modifying it according to the roots of canine. Distal to canine microosteoperforation was done for accelerating the tooth movement. A planned and sequential activation of the appliance led to the bodily retraction of canine in the extraction space within 10 days. Upper Incisors were then retracted through 3 piece intrusion arch. Lower anteriors were retracted en-masse through K-Sir appliance. Total treatment time was reduced from 20-24 months to 14 months only. Keywords: Rapid canine retraction; Distractor; custom made distractor; microosteoperforation; Hyrax screw.

Rehabilitation of edentulous space with prosthesis is often complicated with overeruption of antagonistic tooth and usually requires pre prosthodontic intervention. Therefore,= orthodontic intrusion of the overerupted tooth to facilitate prosthodontic rehabilitation is required. Without orthodontic molar intrusion restoring the posterior occlusion often entails the need for significant reduction of maxillary molar crown height, with the potential need for costly iatrogenic root canal therapy and restoration. Conventional orthodontic techniques do not intrude posterior teeth effectively, and almost all methods result in anterior extrusion rather than posterior intrusion. This case report describes the treatment of a patient with supra-erupted maxillary first molar which was intruded with RA Molar intrusion appliance .The results showed that the biological responses of the teeth and the surrounding bony structures to the intrusion appeared normal and acceptable. Keywords: Maxillary intrusion, Molar intrusion appliance, overerupted molars.

Aim and Objective: To evaluate buccolingual inclinations of first molars among untreated individuals with different facial pattern using Cone Beam Computer Tomography (CBCT). Material and Method: This cross-sectional study was conducted using pre-treatment CBCT records of 45 patients selected from the institutional archives, 15 each were grouped as Group 1, Group 2 and Group 3 categories (normodivergent, hypodivergent and hyperdivergent facial pattern). CBCT images were standardised by rotating the sagittal slice, so that the FH plane was oriented parallel to the true horizontal. The long axis of each first molar was determined, and the inclination of each molar was measured using the long axis and the floor of maxillary sinus. Statistical analysis was done for tooth inclination measurements to determine whether there were significant differences. Results: The maxillary molars exhibited buccal inclination of 5.55 ± 2.52 deg, 6.54 ± 3.52 deg and 8.09 ± 2.69 deg respectively in Group 1, Group 2 and Group 3 on right side, 7.83 ± 2.44 deg, 8.31 ± 4.00 deg and 9.45 ± 2.50 deg respectively on left side. The mandibular molars exhibited lingual inclination of 8.27 ± 4.24 deg, 8.57 ± 4.04 deg and 8.91 ± 2.85 deg on right side, 7.83 ± 2.44 deg, 8.31 ± 4.00 deg and 9.45 ± 2.50 deg on left side. Statistically significant differences were found between groups 1 and 3, but not between groups 2 and 3. Conclusion: From this study, variations in mean molar inclination values are observed between Normodivergent, Hypodivergent and Hyperdivergent groups. The conclusion drawn from the study is that there is buccal inclination in maxillary molars and lingual inclination in mandibular molars. Hyperdivergent subjects have relatively more buccal inclination in maxillary molars and lingual inclination in mandibular molars when compared to Hypodivergent subjects and Normodivergent subjects. Keywords: Buccolingual inclination, untreated adults, facial pattern.

Introduction: Fixed functional appliance (FFA) is most commonly used for Class II correction which requires minimal patient compliance. PowerScope provides one of the best non extraction treatment options for non-compliant patients. This appliance addresses the critical needs of an orthodontist, including patient comfort and acceptance, extensive range of motion, and simple installation. Objectives of study: This study was conducted to evaluate the clinical efficiency of PowerScope appliance by assessing skeletal, dentoalveolar, and soft?tissue changes and condyle?glenoid fossa relationship after using the appliance. Methodology: Twenty patients of mean age of 16years with post pubertal growth period, who reported to the Department of Orthodontics and Dentofacial Orthopedics, have been treated for Class II malocclusion (extraction and nonextraction) and treated with Powerscope appliance were selected for the study. Selected patients pretreatment and post treatment lateral cephalogram were taken. Results: The study revealed statistically significant changes in dentoalveolar and soft?tissue parameters after using PowerScope appliance and also significant changes in condyle-glenoid fossa relationship after using PowerScope appliance. Conclusion: PowerScope was clinically efficient in the correction of Class II malocclusion in noncompliant patients. Hence, based on this study, we can conclude that PowerScope partly corrects by skeletal movement and mostly by dentoalveolar movement with a significant improvement in facial profile. Key words: Class II correction, PowerScope appliance.

Background: The long treatment duration of fixed orthodontic therapy is one of the major concerns associated with orthodontic treatment and hence various methods to reduce treatment time are being researched nowadays. Of the various methods employed for accelerating the tooth movement, the surgical methods which work on RAP (regional acceleratory phenomenon) show the most promising result. However, the invasiveness of these procedures limits their clinical acceptability. Micro-osteoperforations is surgical method of accelerating tooth movement which is gaining popularity due to its promising results and reduced invasiveness. Aim: To show micro-osteoperforations facilitated rapid alignment in crowding cases. Method: In this case series, we treated dental crowding malocclusion (Little’s irregularity index between 4-6mm) with mini-implant facilitated micro-osteoperforations. Six MOPs were performed using mini-implant, two MOPs each mesial to the canines on both sides and between central incisors in the midline on labial aspect of mandible. The outcome measures were to -Reduced overall treatment time needed to complete alignment of mandibular anterior teeth. -Improved patient reported outcome measures i.e. subject’s perception of pain, comfort and satisfaction. Results: In all cases, the treatment time for complete alignment of mandibular incisors was reduced remarkably along with patient satisfaction. Conclusion: MI-facilitated MOPs accelerated tooth movement without any significant pain and discomfort. Keywords: Accelerated orthodontics, regional acceleratory phenomenon (RAP), micro-osteoperforations, dental crowding.

The success of the class II treatment depends on the proper diagnosis and treatment planning for that the major role is played by the clinician and the facial growth pattern also plays an important role. The unfavorable growth patterns make it difficult to correct the skeletal malocclusion or to improve the facial profile. The successful use of functional appliances in treatment of skeletal Class II malocclusion is based upon age of patient, compliance of the patient and facial growth pattern. This case report aims to show how the effect of twin block on a growing patient with permanent dentition phase and hyperdivergent growth pattern helps in utilizing the remaining growth and thus minimizing the severity of skeletal malocclusion later followed by extraction of all 1st premolars and helps in achieving the pleasant profile and smile. Keywords: Hyperdivergent growth pattern, vertical growth, twin block, class II malocclusion.

Class III malocclusion is one of the most difficult problems to treat in the mixed dentition. It has a multifactorial etiology involving both genetic and environmental causes. The dental and skeletal effects of maxillary protraction with a facemask therapy are well documented in several studies. Although treatment in the late mixed or early permanent dentition can be successful, results are generally better in the deciduous or early mixed dentition. The following case shows early treatment of a young patient with maxillary deficiency using a facemask. Keywords: Class III malocclusion, facemask therapy, maxillary deficiency.

Accelerated orthodontics is one of the desired concepts to reduce the treatment duration. It is based on the fact that when bone is surgically stressed, a series of events is initiated causing increased osteoclastogenesis, hence acceleratory phenomenon or periodontically accelerated osteogenic orthodontics. Corticotomy is the procedure of creating perforations or cuts in the cortical bone and extending minimally into the medullary bone. Surgical injury causes transient osteopenia in alveolar bone. This reduces the biomechanical resistance to tooth movement and enables faster tooth movement through trabecular bone. Periodontally accelerated osteogenic orthodontics (PAOO) technique is a combination of a selective decortication-facilitated orthodontic technique and alveolar augmentation. Based on the concept, following case report showed the application of PAOO in anterior space closure. Keywords: Regional acceleratory phenomena (RAP), Corticotomy, Wilkodontics, Bone remodelling, Transient osteopenia.

Early treatment response is desired by both patient and orthodontist and achieving the same with new modification in the routine procedures is the requirement of modern orthodontic practice in order to shorten the treatment time. Nance palatal button (NPB) commonly used as anchorage appliance for maximum or critical anchorage cases and also as a space maintainer. This passive device was modified to achieve active tooth movement in the present case and to accomplish the correction of bilateral premolar rotations as well as anchorage requirement at the same time to reach the goal of alignment and levelling as early as possible.

Loss of permanent teeth due to caries has become prevalent in dental patients. Hence, in orthodontic treatment planning these spaces are either closed or maintained for prosthesis. Presented in this article is an innovative, modified lingual arch which offers space maintenance for prosthetic rehabilitation of missing mandibular first molars. It is not only easy but quick to fabricate too. Keywords – Space maintenance, Modified lingual arch

Purpose: Maxillary central incisor teeth present morphological variations in different malocclusions. The collum angles of maxillary central incisors in Class II, division 2 and Class III malocclusions are significantly higher than the other groups of malocclusions. The higher prevalence of root resorption seen in central incisors with increased column angle after orthodontic treatment, warranted the need to study the stress patterns over these teeth during intrusion. In this study, FEM has been used to evaluate and compare the effect of normal bracket and inverted bracket positioning on stress distribution in PDL and root displacement of maxillary central incisors with 11° collum angles during application of intrusion force. Methods: FEM models of maxillary central incisor with normal collum angle (6°) and a high collum angle (11°)–representing the class II division 2 teeth were modeled. MBT prescription brackets were used to study the effect of positive or negative (invertion of bracket) torque on maxillary central incisors with high column angle. Each of the samples was loaded with intrusive force (0.5 N) perpendicular to the ideal position of bracket. The results were compared with the maxillary central incisor with normal column angle bonded with positive torque (+17°) MBT bracket. Results: The calculated stress in the inverted bracket model was lesser and extended over a smaller area, as compared to normally positioned bracket in the teeth with increased collum angle. Also, better intrusion was achieved as compared to the conventional bracket placement which exerts positive torque resulting in root impingement frequently seen with such teeth. Conclusion: The results of this study warn against the use of high positive torque prescription brackets , for Angle Class II division 2 subjects with increased collum angle. The orthodontic treatment must be tailored with respect to the biologic variations presented by the individual patient. Keywords: Class II Div 2 Malocclusion, Root Resorption, FEM,Torque.

Aim: To determine efficacy of single mini implant placed below anterior nasal spine in achieving true incisor intrusion in deep bite adult patients. Methods: Sample of this prospective study comprised of ten adult patients (10 female) undergoing treatment at the Department of Orthodonics, SDM college of Dental Sciences; Dharwad, India. Patients with in the age range of 20–24 years (mean 21.2 years; SD ± 8.32 years) with deep overbite of at least 4 mm were treated using mini implant as a source of anchorage. An intrusion force (60 g) was delivered by zing string which was attached to a stop crimped in the middle of the passive 018” SS utility archwire after initial alignment. Lateral cephalograms and other records were taken at the beginning of intrusion at T1 and after intrusion at T2. Results: The amount of intrusion achieved using mini implants as a source of anchorage for intrusion was statistically and clinically significant with a mean value of 2.8 mm, when measured from centroid of maxillary incisor and palatal plane in a time interval of 3.3 months. Conclusion: Single mini implant placed below anterior nasal spine is an efficient source of anchorage to achieve true incisor intrusion. Keywords: Intrusion, Mini implant, Deep bite.

Objective: To compare the position of condyle in Skeletal Class II Division 2 patients between pre- and post-alignment and leveling phase and to formulate a list of variables which may help in predicting the favorable prognosis in treatment planning of this malocclusion. Materials and Methods: Serial Lateral cephalograms of 25 subjects of Skeletal class II, Division 2 malocclusion were taken in natural head position. Software Nemoceph Nx-2009 was used to make all the tracings and measurements. All subjects were treated by non-extraction orthodontic therapy, were analyzed at two point of times i.e., pre-treatment and post-leveling and alignment. Fifteen landmarks were identified, angular and linear measurements were analyzed (17 skeletal and 5 dental) in both vertical and horizontal plane. Results: Glenoid Fossa/Condyle, showed a statistically significant forward movement from the vertical plane, a statistically significant difference was seen, in all the four linear variables, i.e., overbite, ANS-Me, S-Go and Co-Go. In the angular measurements, statistically significant difference was observed in interincisal angle, I-Pal Plane and LI-M and Plane. In 36% of the subjects, post-alignment and leveling phase mandible was found to be more anteriorly repositioned in the glenoid fossa. Conclusions: 1) There was a definite unlocking of the mandible in 36% of the subjects. 2) There was a statistically significant increase in the horizontal anterior reposition of the mandible in the glenoid fossa. Keywords: Class II div 2 Malocclusion

This article reports the successful use of two palatally placed mini-screws in the maxilla for correction of class II malocclusion by distalisation of complete maxillary arch in an adult patient who had a skeletal Class II malocclusion, vertical growth pattern with proclined anterior teeth, bilateral class II molar relationship, convex soft tissue profile, acute nasolabial angle and potentially competent lips. Temporary anchorage devices (TADs) in the posterior region between maxillary second premolar and maxillary first molar teeth on palatal side were used as anchorage for the retraction of whole maxillary arch. This technique requires minimal compliance and is particularly useful for correcting Class II malocclusion with protrusive maxillary front teeth without extraction. Keywords: Class II malocclusion, Distalisation, Temporary anchorage devices.

In contemporary orthodontics, the complex and multifactorial etiology of class II malocclusion has always presented a clinical challenge to the orthodontists. Management of class II malocclusion requires a thorough evaluation as the treatment options available vary widely from growth modification using dentofacial orthopedics with functional appliances, dental camouflage using extraction or non-extraction approaches or even orthognathic surgery. Selection of treatment modality for class II patient is based on the age, growth potential, location of skeletal component, the severity of malocclusion and the compliance of the patient. Correction of skeletal class II malocclusion due to retrognathic mandible can be done with non-compliance appliances such as fixed functional appliances. Fixed functional appliances are emerging as viable and successful treatment option for class II patients owing to the refinement in their designs and mechanics to advance the retrognathic mandible. A wide variety of non-compliance fixed functional appliances are available that can be used with comprehensive fixed mechanotherapy. Forsus fatigue resistant device and Powerscope are two such fixed functional appliances used for class II correction. These appliances can be assembled chair-side and installed easily intraorally. This case report substantiates the efficacy of these appliances in the two types of Class II malocclusion growing patients presenting with a chief complaint of forwardly placed upper jaw and a mean age of 14 years (age range of 13–15 years). Keywords: Class II malocclusion, Fixed functional appliance, Growth modification.

Concrescence is an abnormal union of adjacent teeth involving only the cemental tissues of the affected teeth. It has been previously reported in the region of maxillary molars, posing a hazard to their extraction. However there is no mention of it being seen in the region of maxillary anterior teeth of patients requiring orthodontic treatment. As a clinical diagnosis of concrescence is not possible, special radiographic techniques have to be employed. The following is an unusual case report of a patient in whom orthodontic treatment progress was delayed owing to the inability to detect the concrescent roots of maxillary right central and lateral incisors. CBCT helped in confirming the diagnosis and site of concrescence. Surgical separation of the roots allowed the orthodontic treatment to progress but resulted in severe root resorption in the concerned teeth. Since proper alignment of anterior teeth is essential to produce an esthetic outcome, concrescence, if present, can pose a grave potential hazard to orthodontic treatment. Keywords: Concrescent roots, Incisors, Orthodontic treatment, Root resorption

Recently, there is increase in number of adult patients seeking orthodontic treatment. Anchorage control is major issue in adult orthodontic patients. Introduction of mini implants in orthodontics for anchorage control has helped us to treat many complex malocclusions. However, the stability and placement depends on accurate position mini implant. This article highlights the fabrication of a stent which is simple in design, cost effective and provides an accurate placement of a mini-implant in sagittal and vertical planes. Keywords: Orthodontic treatment, Anchorage, Mini-implants, Stent.

Orofacial clefts are the most common craniofacial birth defects with the necessity of orthodontic treatment so as to improve aesthetics, function and growth. This case report presents the successful orthodontic management of an adult female with operated unilateral cleft lip and palate with severely canted smile and vertical growth pattern categorized as Goslon 4. The main feature of the case is correction of canted smile without orthognathic surgery. Keywords: UCLP, Canted smile, Nonsurgical, Scissors bite, cleft

Distalization of upper molars aided by second molar extraction is a method of gaining space for alignment of teeth in patients with class II malocclusion who have a pleasant profile. It is a viable treatment alternative when conventional extraction of bicuspids is contraindicated. This case report presents a therapeutic protocol for the management of class II malocclusion by second molar extraction to accelerate molar distalization using a modified pendulum appliance and correction of severe deep bite with anterior crowding and enhance facial esthetics. Keywords: Second molar extraction, molar distalization, modified pendulum appliance, deep bite correction.

Functional jaw orthopedic appliances have a common effect, forward positioning of the lower jaw. This case report demonstrates treatment of skeletal class II malocclusions in growing individuals using growth modulation appliances. The goal was to match the skeletal bases and achieve pleasing profile with ideal over jet and overbite and correct the class II molar relation. The cases were successfully managed by modulating the growth. Orthopedic appliance, combination pull headgear with activator was used in the first case and in the second case myofunctional appliance, twin block was used. Skeletal corrections were attained at the end of the growth modulation therapy Keywords: Twin block, combi pull headgear, class II malocclusion.

Supraeruption of the maxillary molars because of loss of the opposing teeth creates occlusal interference, functional disturbances and increased complexity of restoring edentulous space. The purpose of this case report is to demonstrate the use of orthodontic microimplants for intrusion of maxillary 1st molars. A 24-year-old girl with an supraerupted maxillary right 2nd premolar and 1st molar encroaching on the opposing mandibular edentulous space were successfully intruded using two well placed microimplants and partial fixed appliance. Two orthodontic microimplants on either side provides a simple, balanced and predictable force system for true intrusion of the molars. Keywords: Molar intrusion, Microimplants, Supraerupted molars.

This case report demonstrates the efficacy of fixed functional Class II corrector Powerscope ™ in the correction of Class II division 2 malocclusion. A patient having Class II division 2 malocclusion with retruded mandible was treated using Preadjusted-Edgewise MBT 0.022” prescription and fixed functional class II corrector appliance Powerscope™. Pre, mid, post- treatment and one year post-treatment follow up photographs, orthopantomograms and lateral cephalograms were taken. Cephalometric analysis was done. 8 months of fixed functional Class II corrector appliance PowerscopeTM wear obtained stable and successful results with improvement in facial profile, skeletal jaw relationship, and mild increase in IMPA. One year follow up record shows stable results achieved by fixed functional Class II corrector appliance PowerscopeTM. Keywords: PowerscopeTM, Class II division 2 malocclusion, Fixed functional, Class II corrector appliance.

Extraoral examination in orthodontics plays a vital role in diagnosis and treatment planning. Extraoral examination includes various factors such as shape of head and facial form. Craniometry is the study of the shape and form of human head or skull. It is used to measure maximum cranial width and length. To determine the bizygomatic width and facial height ‘vernier calliper’ or ‘Gap calliper high precision digital step face height gauge’ is used. However, these devices are expensive and not readily available in the clinics. Elementary diagnostic craniometer has been devised with simplicity in nature and comparatively accuracy in the results.

Introduction: Tongue thrust is stated as the forward movement of tongue tip between the teeth to meet the lower lip during deglutition and during speech, so that the tongue lies interdental. TAD’s supported tongue crib involves minimal compliance, they are simple and relatively less expensive. The palatal area allows a convenient access and lowers the risk of damaging surrounding anatomical structures. Procedure: Conventional tongue crib (0.023? SS Wire) soldered to ‘U’ shaped framework (0.036? SS Wire) with two loops at its end for engaging the miniscrews. Framework is adapted so as to place the miniscrews in the paramedian area around the first premolars. Materials and equipment: Stainless steel wire (0.023?, 0.036?), Silver solder, flux, universal plier, Spot welder, Hydrosolder unit and miniscrews. Clinical application: The TAD’s supported tongue crib can be used for various reasons like in patients with tongue-thrust in adjunct to the following; in mixed dentition phase with a number of mobile/erupting teeth; non-compliant patients who fail to comply full time wear of removable appliances. It can also be efficiently put to use in patients with agenesis and in cases where long-term use is necessary. Conclusion: The TAD’s supported tongue crib can be used as a successful modality with fixed as well as removable appliances and can be useful during or after course of orthodontic treatment. It is easy to fabricate in the office requiring less time.

Aim and objective: The aim of study was to assess the reliability of frontal sinus with different variables in predicting different skeletal jaw relations. Material and method: 120 orthodontic patients of age group 18 years to 30 years and above who came for orthodontic treatment were assessed by using pre-treatment records. After taking radiographs, frontal sinus, maxillary sinus and cephalometric landmarks were traced and further divided into three groups depending of ANB angles. Statistical analysis using ANOVA and independent sample t-test was used to analyze the results. Pearson’s coefficient correlation was used to find reliability between frontal sinuses and various variables in different skeletal patterns. Result: A statically significant correlation was found between frontal sinus with skeletal malocclusion P < 0> Conclusion: As frontal sinus area was larger in class III and significantly correlating with mandibular length, symphysial width, it is more reliable as compared to maxillary sinus in predicting skeletal relations. Keywords: Maxillary sinus, Frontal sinus, Malocclusion, Prediction, Cephalometrics

Introduction: Study was carried out to compare the accuracy in producing digital formats of analog lateral cephalograms by taking a digital photograph and by scanning with a flatbed scanner. Aim: To investigate whether taking a digital photograph of an analog lateral cephalometric radiograph is as accurate as using a flatbed scanner to scan the same radiograph for digitization. Methods: Twenty lateral cephalograms were randomly selected from the records at a Dental College and Hospital in Belgaum. They were photographed with a digital camera and scanned with a flatbed scanner. Both images were then digitized with imaging software (Facad digital imaging program version 3.5). Set of predetermined measurements were transferred on all analog cephalograms. They were then measured on the imaging software. Student t test was used to test for statistically significant differences between the measurements. Statistical analysis used: Student paired t test. Results: Angular measurements were deviating less from the original values after digitizing with both methods, but linear measurements were significantly changed. Conclusion: It is acceptable to take photographs of analog cephalograms if only angular measurements are to be considered. However, these images cannot be accepted when considering linear measurements. Keywords: Cephalograms, Comparison, Digital, Digitization.

Introduction: Dentofacial disfigurement and its relation to facial morphology, with specific attention to self-image, personality, social acceptance, and behavior. The ability to predict the magnitude and direction of a patient’s facial growth early in life would enable the clinician to identify those who require interceptive growth modification and to ensure that the appropriate treatment can be rendered while growth is possible. Materials and method: 58 (30 female and 28 male) Subjects for the present study has been selected randomly from patient treated in Department of Orthodontics and Dentofacial Orthopedics, Hazaribag College of Dental Sciences and Hospital, Hazaribag, Jharkhand. Results: Among the 58 subjects hyperdivergent pattern group found to be smallest (10.3%) with the neutral and hypodivergent patterns are 17.2% and 72.4 % show the distribution of malocclusion among morphological patterns. Conclusion: This study found mean values of all linear measurements in males are larger than female. Relatively strong correlations are found between lower gonial angle, gonial angle, mandibular plane angle, palatal /mandibular plane angle, Frankfurt/ mandibular plane angle SNB, Y Axis , sum of saddle + articular + gonial angles and posterior facial height. Keywords: Facial morphology, Hypodivergent, Hyperdivergent, Malocclusion.

Background: The most commonly observed skeletal discrepancy in the orthodontic population is class II. It has been observed that there are conflicting results in order to characterize the dental arch form of patients with Class II malocclusion. Therefore, this study was done to compare the effect of all four first premolar extractions on the mandibular intercanine archwidth of orthodontically treated samples with Angle’s Class I and Class II division 1 malocclusion using occlusograms. Materials and method: Occlusograms of pre and post treatment mandibular study models of patients with Class I (n = 30) and Class II division 1 (n = 30) treated with extractions were included in the study. The data was analyzed by ANOVA followed by Tukey’s multi comparison test. Results: There was no statistically significant difference in the pre and post treatment mandibular intercanine arch width between the two groups. However in both groups a significant increase in mandibular intercanine arch width was observed post treatment which was 1.35 ± 0.76 mm in Group I and 1.44 ± 0.84 mm in Group II. Interestingly mean change in mandibular intercanine arch width of both the did not differ significantly (p = 0.667) though it was 6.2% higher in Group II as compared to Group I. Conclusion: Since the change in mandibular intercanine arch width is significant in both Class 1 and Class II division 1 malocclusions, the tendency for relapse in such cases is high. Hence greater emphasis must be given upon planning the retention phase so as to prevent the increased tendency to relapse. The retention protocol has to be followed strictly in cases treated with extraction of premolars. Keywords: Mandibular intercanine width; Occlusogram; Extraction therapy, Class I malocclusion; Class II division 1 malocclusion.

Introduction: In today’s scenario, it is very common for an orthodontist to see a Skeletal Class II Malocclusion due to retrognathic mandible in growing patients. Although various approaches for the treatment have been devised, twin block remains the most acceptable and popular among the functional appliances. Amongst the various approaches made towards the evaluation and assessment of the changes occurring in the temporomandibular joint caused by the functional appliance, MRI has been the choice of approach for the same  owing to its diversified advantages. Aim and objectives: To evaluate and compare hard and soft tissue changes in the Temporomandibular Joint caused by Clarks Twin Block appliance before and after the correction of class II molar relation by using MRI. Result: The results of the study suggested that the forward position of condyle within the glenoid fossa and retrusion of articular disc in relation to condylar head was statistically significant after twin block therapy. At stage 1 (Pre-treatment), 8 of the 10 cases had anterior condylar position, and 2 patients had a posterior condylar position. Whereas, stage II (Post treatment) revealed 9 of the 10 patients showing anterior condylar position and 1 showed concentric condylar position. Conclusion: The position of condyle in glenoid fossa and articular disc retrusion in relation to condylar head was statistically significant after twin block therapy. Forward relocation of the C-GF complex seems to be one of the mechanisms of action of functional appliances. Key message: MRI study on functional appliance therapy supports and provides evidence for anterior remodelling of the condyle-glenoid fossa complex at the end of 6 months treatment with Twin block appliance. Key words: Twin Block, MRI, Skeletal

Objectives: To evaluate the initial displacement of maxillary anterior teeth under different forces of en masse retraction. To find out the ideal force system for en masse retraction using initial displacement. Material and Methods: ADENTASCAN was converted into three dimensional Finite Element Model (FEM) of maxilla using HyperMesh software. Two models were constructed having different implant angulations i.e., 45 and 60 degrees. Each model was applied 150, 200, 250 and 300 gm of load. The results were analyzed using ANSYS software. Results: The maximum initial displacement of 0.095 mm was observed in lateral incisor under 300 gm of load with 45 degrees of implant placement, followed by central incisor and the least displacement was observed in canine. Conclusion: The amount of initial tooth displacement can predict the favorable force system required for en masse retraction of anterior teeth which according to our study is 300 gm of retraction force at 60 degrees of implant placement. Key words: FEM, Ideal force system, Initial displacement, Orthodontic tooth movement.

A long face with increase in the lower anterior facial height (LAFH)has its own share of complexities with regard to its diagnosis and management. The point of importance is to carefully diagnose and differentiate if the cause of the long face is due to the increase in the upper 1/3rd or the lower 2/3rd of the Lower anterior facial height. Although there are well established protocols in the management caused due to the increase in the upper 1/3rd such as orthognathic surgery, mini implants and intrusion arches, management caused due to the increase in the lower 2/3rd has rather limited option. This article describes the management of a patient with a long face caused due to an increase in only the lower 2/3rd of the LAFH with a vertical reduction genioplasty and also focusses on the diagnostic criteria required to differentiate the various causes for a long face. Keywords: Long face, Diagnosis, Management

The treatment of skeletal open bite has challenged the general dentist, oral surgeon, and orthodontist for a long time. This deformity produces social and psychological distress as well as functional problems in patients. The establishment of a correct diagnosis and aetiology is very important and may indeed dictate the method and choice of treatment. The present case report demonstrates the orthodontic and surgical treatment of an adult patient with high angle growth pattern and skeletal open bite malocclusion. Keywords: Skeletal open bite, orthognathic surgery, vertical dysplasia.

Class II malocclusions are challenging to treat especially when associated with a skeletal component of either maxillary protrusion, mandibular retrusion or combinations. Use of fixed with a retrusive mandible during the growth phase. The AdvanSync2 Class II corrector is the latest in a long series of fixed functional appliances introduced over the years. Literature relating to its efficacy is scarce, especially in the Indian context due to its recent introduction. Four case reports of patients treated with the AdvanSync2 Class II corrector and the findings observed in the sagittal and vertical dimensions are presented. The findings are similar to most fixed functional appliances except treatment duration which is reduced in all cases. Keywords: AdvanSync2, Class II corrector, cephalometrics, modified Herbst.

Dental anterior open bite associated with decreased incisor dentoalveolar height. The occlusal planes in the dental anterior open bite usually diverge from the mesial to the first premolar forward. The outcome of this case report describe a notabletreatment of dental anterior open bite. Here a male patient aged 22 years presented 4.2 mm anterior open bite along with increased lower anteriorfacial height. Other features are as follows - competent lip, deficient incisor display during rest and smile, fractured enamel of both upper central incisors. Treatment was carried outby extrusion of both upper and lower incisors with camouflage non-extraction therapy followed by composite buildup of fractured upper central incisors. There was no recurrence of anterior open bite, and balanced occlusion was maintained during the follow up of next 2 years after treatment completion which suggest a long term stability of occlusion. Keywords: Dental anterior open bite, Camouflage non-extraction, Fixed orthodontic appliances

For correction of Class II malocclusion many Class II corrector appliances are available in the market. Fixed functional appliances like Powerscope and Advanced sync have requirement of shims for further activation of these appliances. Sometime all available shims (provided with appliance) are used or some shims are lost but still activation is required. In this scenario we have to order new shims, which are costly and time consuming. Fabricated UECS surpasses these difficulties and can be used for further activation of these fixed functional appliances. Keywords: Class II corrector, Fixed functional appliance, Universal Economic Crimpable Shims, Powerscope.

Canines are the second most common teeth subjected to impaction next to 3rd molars. Unlike 3rd molars where extraction will be the chief treatment approach, canines being considered as cornerstone teeth in the dental arch and plays an main role in esthetics and function, so different treatment techniques should be selected to preserve and align then in the arch with smile enhancement. Furthermore, treatment selection for impacted canines depends on several factors such as patient compliance, age and canine position. Therefore, the present paper discusses the management of impacted canines in a 14 year old girl by orthodontic therapy and a brief literature review regarding impacted canines. Keywords: Canine Impaction, non-extraction, bilateral canine impaction, Maxillary canine impaction

This case report presents the management of impacted right central incisor in 11 year old girl by surgically exposing the crown of impacted tooth and applying light force orthodontic traction technique. An Interdisciplinary approach is essential to successfully move an impacted incisor into proper position. The Surgical- orthodontic treatment plan included surgical removal of odontoma and orthodontic traction in this patient. However, long-term monitoring of the stability and periodontal health is critical after orthodontic traction. The outcome was excellent esthetically and functionally. Keywords: Impacted incisor, orthodontic traction, surgical exposure.

An Impacted tooth can be defined as a tooth which fails to erupt partially or completely to its correct position in the dental arch and its eruption potential has been lost. Incidence of mandibular canine impaction is less compared to maxillary canine impaction . Orthodontic management of impacted canine is a very common procedure and a variety of techniques had been introduced in the field of orthodontics for disimpaction of canine. It is always better to do orthodontic disimpaction without engaging the attachment from impacted canine directly to arch wire to prevent arch wire disintegration and unwanted effects on the adjacent tooth. Through this case report we are introducing a specially designed mini implant supported disimpaction spring to manage mesioimpacted buccally placed mandibular canine. The spring can be made with 0.017*0.025 SS or TMA wire. It delivers a slow continuous force and it can be reactivated in each appointment if necessary. Force delivery has to be maintained throughout at 100 gm of force. It gives vertical as well as uprighting force on the impacted canine.The action of this spring is completely independent of arch wire. This Spring will take its support from 2 mini implants placed in the mesial and distal interdental area of same side mandibular molar. This spring can also be used in maxillary arch by changing the angulations of the spring depending on the position of impacted canine. Keywords: orthodontic management, mandibular impacted canine, mini implant supported spring

The participation of a multidisciplinary team to accomplish the appropriate treatment of impacted tooth with odontoma is extremely relevant because of the esthetic and functional ramifications of a missing tooth as well as the psychological well-being of the individual. Odontomas are the most common type of odontogenic tumors and generally they are asymptomatic. Two types of odontomas are described: compound and complex based on either the appearance of well-organized tooth-like structures (compound odontomas) or on a mass of disorganized odontogenic tissues (complex odontomas). Odontomas frequently interfere with eruption of teeth leading to their impaction. This is a case report of a 16- year-old boy with unerupted maxillary left first bicuspid due to a complex composite odontoma .Surgical excision of the odontomas and orthodontic treatment to get the impacted maxillary left first bicuspid into alignment is discussed. Key words: impacted maxillary left first bicuspid, complex odontoma, orthodontic management.

Restoration of function and esthetics simultaneously is a great challenge for the orthodontist. Oral rehabilitation with prosthetic implants requires a good quality and quantiy of bone. The anterior region, being the most aesthetic region of the face, requires special consideration in terms of position of the implant, color, shape and size of the prosthesis. For the successful regeneration of the bone to hold the implant, the technique of alveolar distraction osteogenesis is used with great success nowadays. Alveolar distraction follows the principle of distraction osteogenesis which was proposed as an alternative method for the reconstruction of the defects of the jaws as proposed by Ilzrov in 1989. It seems to be a promising method for reconstructing segmental bone defects in the jaws.

Background: The role of periodontal mechanoreceptors (PMRs) in the reflex control of the jaw muscles has been mainly derived from animal studies and few human studies. This study investigated the response of the PMRs in the activity of the masseter muscles in humans to controlled orthogonal stimulation of the upper left central incisor, both before and during orthodontic treatment. Materials and methods: Surface EMG of sixteen neurologically normal male subjects (mean age 13.2) were recorded following a rapid stimuli of 3Newtons. 8 class II patients with retrognathic mandible were treated with twin block and 8 class I patients were treated with pre adjusted fixed appliance. Pre-treatment and during treatment EMG of masseter with stimulus in rest position without splint and with both stimulus and splint. Results: The class I subjects showed a statistically significant (p Conclusions: This study has shown that periodontal mechanoreceptors supply information regarding position and forces applied to the tooth. Large scale studies are needed to validate these findings. Keywords: Periodontal mechanoreceptors, Masseteric reflex and tooth movement.

Introduction: In recent time there is surge in application of various methods to accelerate orthodontic movement. The associated potential side effects of biological and surgical stimulus led to the popularization of noninvasive method in which vibratory stimulation had been reported to be effective in accelerating orthodontic tooth movement. Commercially available vibratory devices have shown contradictory results regarding their effect on increasing the rate of orthodontic tooth. Vibratory toothbrushes, as an alternative to provide vibratory stimulus has also showed positive results in increasing the rate of tooth movement. Aim and objectives: To validate the efficacy of mechanical vibration through powered toothbrushes in accelerating the rate of orthodontic tooth movement.. Material and methods: This was a prospective controlled clinical trial; sample consisted of 25 patients within the age range of 15-25 years, undergoing fixed orthodontic treatment. Maxillary first premolars were extracted at least four month prior to canine retraction. A force of 150 gm. was delivered from active module tie for retraction of canine. Subjects were instructed to apply vibratory stimulus through powered toothbrush (60 Hz frequency) only on experimental site for 5 min at 8 hour interval every day, for three months and in fourth month no vibratory stimulus was given. Study models were made and distance of maxillary canine distal movement (mm) was measured with vernier caliper after every 4 weeks (each month) from beginning of the canine retraction. Results: There was no significant difference in rate of orthodontic tooth movement after first, second and third month consecutively on comparison between control and experimental site. While fourth month showed less tooth movement of experimental side as compared to control side. Conclusion: Our findings suggest that vibratory stimulation from powered toothbrushes had no effect on accelerating the rate of orthodontic tooth movement. Key words: Vibratory stimulation, Powered toothbrushes, Rate of orthodontic tooth movement.

Aim : of this article is to evaluate explicit and potential uses of CBCT in orthodontics, discuss some of the caveats, & summarize published evidence on CBCT in orthodontics. Background: CBCT is well established diagnostic aid in the field of orthodontics, but there is lack of consensus on the clinical use of CBCT in orthodontics. With the increasing popularity of CBCT, evidence for various uses has to be documented for common consensus Methods: Search for key words ‘CBCT’ ‘CBCT Review’ was done in PubMed Ref and top ranking orthodontic journals based on SCIMago journal Ranking index Rference. Results: Literature search did not yield evidence to justify the routine use of CBCT as essential diagnostic aid to be used for each and every patient of orthodontics. Conclusion: There is lack of consensus at present on use of CBCT as routine procedure in orthodontics. This may change in future with more evidence on benefits v/s risks of CBCT accumulates

Aim: To compare rate of canine retraction by using periodontally accelerated osteogenic orthodontics and conventional mechanotherapy using CBCT. Material & Methods : The present study was conducted on patients who reported for routine orthodontic treatment. A sample of 10 patients who required bilateral maxillary 1st premolar extraction and canine retraction as a part of their orthodontic treatment were included for this study. A split mouth randomised technique was used to assess the retraction of upper canines. In this split-mouth design technique, upper canine of one side (right) was retracted with Periodontally Accelerated Osteogenic Orthodontics (PAOO) and on contralateral side it was done with conventional mechanotherapy. Results: The rate of canine retraction on right side was 1.94 mm/month whereas on left side it was 1.15 mm/ month. Canines were retracted faster with the PAOO procedure and the difference was of 0.78 mm/month which was highly statistically significant with the p-value Conclusions: The rate of canine retraction was more on right side (PAOO) than on left (Conventional) side. Periodontally Accelerated Osteogenic Orthodontics (PAOO) helped canine move faster into the extraction space than the conventional mechanothery.Periodontally Accelerated Osteogenic Orthodontics (PAOO) helped to maintain the bone density level during the orthodontic tooth movement which decreased in the conventional orthodontic tooth movement. Keywords: Accelerated orthodontics, Regional Acceleratory Phenomenon (RAP), PAOO, Decortication, Rate of Canine Retraction.

Introduction: The prevalence of lingual orthodontics has been increasing among the youth who prefer to undergo treatment with invisible appliances. The HIRO system is the most popular and widely accepted technique for lingual appliance bonding as it is economical. However, the great precision required for this system renders it highly technique sensitive. The final finish of the case depends, to a great extent, upon the accuracy and precision of each step involved in the HIRO system. Methods: The present technique describes a novel procedure for lingual indirect bonding using HIRO system. The conventional HIRO system has been modified by integrating 3D scanning and rapid prototyping with treatment planning and virtual diagnostic set-up. Result: This procedure makes the set-up more accurate for a better finish and saves a lot of laboratory time. Conclusion: The hybrid HIRO is a cost effective method for patients who cannot afford a fully customized lingual appliance. It also opens a range of possibilities for the incorporation of 3D technology in routine clinical practice. Keywords: 3D Scanning, Resin prototyping, Virtual model, HIRO system.

Aim: To present simple photogrammetric techniques that can objectively evaluate standardized digital extraoral and intra-oral photographs for diagnostic and therapeutic purposes. Materials and methods: 11 measurements (9 linear and 2 angular) from standardized lateral photographs were compared with analogous measurements from standardized lateral cephalograms. The study was conducted on 60 subjects (n=60, 41 females, 19 males) aged 18-25 years.8 photogrammetric techniques on standardized photographs, linear and angular photogrammetric analysis on lateral photographs, linear photogrammetric analysis on frontal and frontal smile photographs, photogrammetric analysis of occlusal cant, photogrammetric smile analysis and tooth and intra-arch measurements on occlusal photographs are described. Results: All 11 parameters that were analyzed showed strong correlation. The intraclass correlation coefficients (ICC) and corresponding 95% confidence intervals (CI) of all parameters showed that the reliability of the photographic technique was excellent. Conclusions: Photogrammetry on standardized photographs used in daily orthodontic practice offers a simple, cost effective solution without the hazard of radiation exposure. The 8 photogrammetric techniques described here show that photogrammetry has multiple applications. However, there is a need to standardize photogrammetric techniques, develop multiple photogrammetric analyses for different needs and obtain mean values for parameters from different populations. Keywords: Occlusal, photogrammetry, smile analysis, reliability

Proper classification and diagnosis are prerequisites for determining the nature of an orthodontic problem. The diagnostic methods have shifted from a two dimensional to three dimensional approach. Despite advances in orthodontic diagnostic aids, the setup technique provides the foundation on which the modern day three dimensional diagnosis of malocclusion is based. Kesling, after developing a tooth positioner as an aid in finishing orthodontic treatments, suggested that cutting and repositioning the teeth in duplicate study models of the malocclusions would allow simulation of the results before starting orthodontic treatment. The aim of this article is to present a simplified method of doing diagnostic setup with the objective of encouraging its use in day to day clinical practice. Keywords: Diagnostic aids, Setup, Tooth positioner, Malocclusion, Simulation.

Aims and Objectives: The present study was done with an aim of taking facial photographs in a standardized manner to eliminate the intra observer errors and also to observe the reliability and repeatability of the same in successive visits. Methods: A single individual of 23 years old was selected; photographed in NHP with mirror method and in FH-plane by orienting the head with the help of a specially designed device and a laser source (Bosch GLL 2X professional) by using a Cannon EOS 1300D DSLR camera for 25 times. Standard analyze the results using SPSS software version 22.0 Results: Standard deviation values are lower for laser group compared to NHP group in both profile and frontal photographs suggesting the laser technique for head positioning in FH-plane is better in reliability and repeatability than the NHP. Chi-square test suggesting that frontal photographs for both NHP, FH-plane is statistically significant while the profile groups are not statistically significant. Conclusion: This method allowed us to take facial photographs of patients with head positioned such that the FH plane is parallel to the floor, which helps in standardization of photographs and superimposition with lateral cephalograms.

Background : Mandibular corpus distraction osteogenesis( DO) is emerging as the standard of care in the management of mandibular deficiencies exceeding 8 mm. Mandibular retrognathia has been regarded as a risk factor for airway deficiency and sleep disordered breathing. In view of the above this retrospective cephalometric study was conducted with the aim to evaluate upper airway dimensional changes and hyoid position variations in adult patients with mandibular deficiency treated by mandibular DOand to establish the ratio of mandibular advancement to increase in airway dimensions. Materials and Method: Pre and post treatment lateral cephalograms of 12 adults (7 females and 5 males) with severe mandibular deficiency treated by combined orthodontics and mandibular DO were evaluated for changes in posterior airway space (PAS), Superior airway space (SAS), minimum airway space (MAS), hyoid bone position (MP-H), effective mandibular length (Co-Gn), mandibular corpus length (Go-Pg) and pogonion position (N perpendicular- Pg). The cephalograms were manually traced by a single operator and the data was analyzed using MINITAB 13.2 version software. Results: There was statistically highly significant (p d” 0.0001) increase in PAS, SAS, MP-H, Co-Gn and Go- Pg. The mean ratio of mandibular advancement to increase PAS, SAS, and MAS was 1:0.49, 1:0.37 and 1:0.45 respectively. Hyoid bone moved superiorly and anterior direction by 3.6+1.8 mm and was found to be statistically highly significant (p d” 0.0001). Conclusion: The study showed an overall improvement in airway dimensions and in hyoid position after mandibular lengthening suggesting that the procedure is a viable treatment option in correction of upper airway deficiencies and sleep disordered breathing.

Background and Objective: To evaluate the motivation and satisfaction of combined orthodontic-orthognathic treatment and to assess the outcome of the same objectively(cephalometrics)of post-treatment soft-tissue profile and subjectively through profile photographic aesthetic evaluation by laypersons and clinicians. Correlation with satisfaction of the patients and the degree of post-treatment soft-tissue correction Materials and Methods: The sample comprised of 30 patients (Kerala origin) who had completed combined orthodontic-orthognathic treatment. Motivation and satisfaction with treatment results were evaluated using a pre-validated questionnaire. Post-treatment cephalograms were assessed using the Burstone and Legan’s Soft tissue analysis along with comparison to regional norms of the Kerala population. Standardized pre and post- treatment profile photograph aesthetics were assessed by six laypersons and six clinicians using a 7- point scale. Results:The most common reasons for seeking orthognathic treatment were dissatisfaction with facial appearance (76.7 percent)- majority (14/23) being women and problems in biting and chewing (23.6 percent). All patients were satisfied with treatment results. Some degree of numbness in the lips and/or jaw beyond 1 month post-operatively was experienced by 66 percent. The most satisfied patients were the ones who were dissatisfied initially with their facial appearance. Complete cephalometric normalization of the parameters was not achieved with orthognathic surgery, showing significant differences when compared to the aesthetic norms. There were significant differences in the aesthetic scores between laypersons and clinicians. Interpretations and Conclusion:Although satisfied with the results, majority of the patients found the surgical experience as the most unpleasant part of the whole treatment process. The professionals should make efforts to understand the patient’s motivations for and expectations of treatment. Maxillary prognathism and vertical height ratio were the only cephalometric parameters that significantly influenced clinicians’ assessment of profile aesthetics. Patient satisfaction was not related to cephalometric change observed. Keywords: Motivation; Satisfaction; Orthodontics; Orthognathic Surgery; Aesthetics; Psychological; Kerala Population; Cephalometrics

Cleidocranial dysostosis is a generalized skeletal dysplastic condition and primarily affects the development of the bones and teeth. The genetic etiology lies on chromosome number 6p21, core binding factor (CBFA1). This paper explains the treatment procedure carried out for a sixteen year old female patient diagnosed with cleidocranial dysostosis. Therapy includes surgical removal or exposure of impacted teeth, extraction of supernumerary teeth along with orthodontic treatment. Key words: Cledio-cranial dysplasia, supernumerary teeth, diagnosis

Diagnosis and management of skeletal and dental asymmetries associated with malocclusions of varying severity are in most instances a challenging prospect for an orthodontist. A detailed history followed by proper diagnosis and an efficient treatment plan is always necessary in management of such cases. Diagnosis and management of Class II malocclusion with skeletal and dental components compounded with mandibular deformity is presented. Keywords: Diagnosis, asymmetry, coronoidectomy, orthomorphic

Presurgical naso alveolar molding (PNAM) is a non-surgical method of reshaping the gums, lips and nostrils previous to CLP surgery, thus lessening the severity of the cleft. The purpose of this case series is to describe a novel and ingenuous device, the MU Hook used in lieu of the conventional PNAM technique.Five cases which used the MU Hook have been described.This device offers multiple benefits over the conventional PNAM as it obviates the need of a plate,so it can be used in CVS infants,or patients with neonatal teeth.Appointments are reduced thus ensuring better compliance,comfort and wellbeing of the parents and the patient.

“Laugh and the world laughs with you, snore and you sleep alone.” Putting a social spin to this innocuous condition highlights prevalence of sleep disordered breathing amongst the population. Obstructive Sleep Apnea Syndrome (OSAS) is defined as interrupted airflow despite persistent respiratory effort. OSAS is associated with medical comorbidities such as hypertension, ischemic heart disease, pulmonary hypertension etc. The well-known signs, symptoms and craniofacial risk factors of OSAS are posterior tongue posture, hypoplastic mandible, increased hyoid distance and neck circumference. Although the gold standard for diagnosis of OSAS is overnight polysomnography, the lateral cephalogram provides crucial information about the airway dimensions. With an increase in adult population seeking treatment and a knowledge of craniofacial growth and development, the orthodontist is at a unique vantage point wherein he/she can identify susceptible individuals. Management involves a team approach between orthodontist and pulmonologist. Orthodontic management involves oral appliances and maxillo-mandibular ortho-surgical procedures. Oral appliances are an effective and efficacious treatment modality which can provide cogent improvement. In a developing country where it might not be possible for all patients to afford expensive medical therapy, oral appliances provide a viable alternative and help reduce the economic and disease burden.  This paper will describe two cases of OSAS which were managed conservatively with Oral Appliance therapy showing two different modalities of treatment. There was amelioration in the symptoms of OSAS, improvement in general health as well as a significant improvement in the quality of life. Keywords: Mandibular advancement device, sleep apnea, snoring.

This case report represents a 19-year-old male who complained of reverse occlusion with problems in mastication and unpleasant facial aesthetics. The lateral view showed a concave profile with a prominent chin and malar deficiency. The patient was diagnosed as having a skeletal and dental Class III malocclusion with a negative overjet of – 6 mm. The cephalometric readings showed a prognathic mandible and a small maxilla with an ANB angle of -13 degrees. The treatment plan included a phase of presurgical orthodontics with extraction of one lower incisor, alignment of both the arches individually and decompensation of incisors followed by a double jaw surgery. The sagittal split ramus osteotomy and Leforte I osteotomy were performed after sixteen months of presurgical orthodontics. Postoperative orthodontic treatment period was eight months. Total active treatment period was two years and at the end of which good interdigitation leading to better masticatory ability. The esthetics improved remarkably leading to a greater self confidence. Keywords: Orthognathic surgery, Class III malocclusion, lower incisor extraction, bi jaw surgery

This case report describes the nonsurgical, nonextraction therapy of a 18-year-old girl with a skeletal Class III malocclusion, and a reverse overjet and impacted mandibular premolars. The Class III malocclusion was corrected with alignment of impacted premolar and retraction of lower anteriors with fixed appliances, combined with short Class III and vertical elastics in the anterior area. The Class I molar and canine relationships were achieved, and the facial profile improved substantially. Keywords: Class III malocclusion, Impaction,reverse overjet

This is a case report of 21 year old male who turned up to the department of orthodontics with chief complaint of protruded maxilla. He had class II skeletal malocclusion with excessivevertical growth of maxilla and reverse smile arc . Excessive visibility of gum tissues leading to gummy smile. A combined orthodontic and surgical treatment resulted in harmonious occlusion ,esthetics and function. Keywords: Maxillary excess, incompetent lips, open bite,vertical growth pattern, superior repositioning of maxilla.

This article presents two cases of adolescent male patients of skeletal class II malocclusion treated by Twin block appliance followed by fixed appliance therapy. Twin block is a myofunctional appliance which was used for growth modification in both the patients for promoting mandibular growth. Fixed appliance therapy was followed then after to in both the cases showed good skeletal, dental and soft tissue relationships. The patients  had improved esthetics and self confidence. Keywords: Myofunctional appliances, Profile, Growth pattern.

Orthodontic treatment comprises different phases with unique characteristics and challenges. Tooth size discrepancies are considered an important variable especially in the anterior segment. Orthodontic treatment of patient with peg shaped lateral incisor becomes difficult due to problem encounter during bonding of orthodontic bracket on malformed tooth. Maintaining midline and space for final restoration on peg shaped lateral incisor during orthodontic treatment is mostly done using coil spring which is less efficient, tedious and uncomfortable to patient. This article presents a new method of management of Bolton discrepancy due to peg shaped lateral in conjunction with temporary prosthetic pontic by orthodontic method. Keywords: Bolton discrepancy, peg shaped lateral incisor, pontic.

Miniscrew implants (MSIs) have appeared to be the boon to orthodontists with wide range of applications in management of complex malocclusions. However, MSI failures remains the most common problem affecting their successful utilization. Researches are oriented towards improving the stability and minimizing their failure rate. This article presents the brief review of MSI development, their use in anchorage management and update on development of protocol and current status of research at AIIMS, New Delhi. This knowledge will be helpful in exploring possible research approaches in bone and soft tissue adaptation to MSIs and possible modification of current design of MSI for improving its success rate.

Aim: This prospective clinical study was undertaken to evaluate micro-implant stability during the various phases of orthodontic treatment following micro-implant insertion. Methods and Material: This study included twenty micro-implants which were inserted in subjects whose treatment plan comprised of a micro-implant placement in the maxillary posterior region between the roots of first molar and premolar. Microimplant stability was evaluated using resonance frequency analysis (RFA) method and Implant stability quotient(ISQ) values was recorded after insertion (T0), during loading (T1), 2 weeks later (T2), 4 weeks later (T3), 6 weeks later (T4) and just before removal of micro-implant (T5) in two directions perpendicular to each other. All ISQ values were tested for statistically significant differences between the different time intervals. Statistical analysis used: Kolmogorov-Smirnov test, Wilcoxon matched pairs test, Mann-Whitney U test. Results: From T0 to T5, the overall stability decreased significantly (P < .001) by 5.08 ± 4.02 ISQ values. Highest RFA changes were seen from T1 to T2, were the stability decreased highly significantly (P < .001) by 2.66 ± 2.42 ISQ values. Conclusions: Longitudinal measurement of micro-implant stability using RFA demonstrated overall significant decrease in stability during the various phases of orthodontic treatment following micro-implant insertion. During 2nd week a significant decrease of the stability was observed compared to other time intervals. Stability of micro-implant was found to be maximum at 1st week after insertion, hence early loading of micro-implant will be appropriate. Key-words: Resonance Frequency Analysis, Implant Stability Quotient, Micro-Implants, Stability.

The effectiveness of a single non-osseointegratedmidpalatal mini-implant to provide sagittal and vertical anchorage hasn’t been compared with buccal mini-implants and conventional dental anchorage. Aims: This study aims to compare the effectiveness of a single midpalatal implant in conjunction with a transpalatal arch (TPA), with the anchorage control of buccal inter-radicular mini-implants and the conventional dental anchorage.A prospective clinical study was designed to compare the anchorage control in the sagittal and vertical dimensions, their retraction rate and total treatment durations. Method and Materials: Thirty patients were treated, ten each with conventional dental anchorage, buccal mini-implant anchorage, and midpalatal mini-implant anchorage with TPA. Each patient had four lateral cephalograms taken at pretreatment T0, post leveling and aligning T1, post space closureT2, and post-treatment Tp, which were used for evaluation of results. Treatment changes were measured on these cephalograms for mesial and vertical changes in molar position, sagittal and vertical changes in incisor positions, retraction rate and total treatment duration. Statistical analyses used: Arithmetic mean, standard deviation, ‘Paired t-test’ and One-way Anova were used. All the data were analyzed with SPSS version 11. Post-hoc Tukey’s test was used for groupwise comparison. Results: In the sagittal dimension, themidpalatal mini-implant showed better anchorage control than buccal miniimplants, which in turn fare better than conventional dental anchorage. In the vertical dimension, the buccal mini-implants maintained anchorage better than the midpalatal mini-implant,which in turn did better than conventional dental anchorage. There is no significant difference in the rate of retraction and total treatment time amongst the three anchorage systems. Conclusions: A singlemidpalatalnon-osseointegratingmini-implant, secured to the transpalatal arch, should be preferred for absolute anchorage for enmasse retraction in maxilla, in view of its better sagittal anchorage, predictability of anatomic location and relative ease of placement, over bilateral buccal mini-implants (except in high mandibular plane angle cases where the bilateral buccal mini-implants may be preferred for their better vertical anchorage control). Key-words: mini-implants, TADs, anchorage, buccal, palatal

Materials and methods: 3D finite element model of maxillary bone (both cortical and cancellous) and mini-screws were generated on a computer to evaluate stress values at bone and mini-screw interface with varying the angle of insertion, length and diameter. Miniscrews having diameter of 1.6 mm and 2 mm were used. The length of miniscrews was fixed at 8 mm, 10 mm and 12 mm. These were inserted at 4 different insertion angles of 450, 600, 750 and 900. Results: Comparison of the maximum von Mises stress in the cortical and cancellous bone showed that stress/strain field that develops at the mini-screw and bone interface decreased with increase in diameter, length and insertion angle of the mini-screw. Conclusion: Wider bi-cortical mini-screws should be preferred over mono-cortical mini-screws and should be placed as perpendicular to the bone as possible for better and enhanced stability. Keywords: Mini-screw, Finite Element Analysis, Mono-cortical, Bi-cortical

Introduction: an in vitro evaluation of thread outline variation of orthodontic mini-implant for axial pullout test on the strength of the orthodontic mini-screws. Materials and Method: This study was done on 35 Titanium mini-screws. The mini-screws were divided into five test groups. Each group consisted of 7 mini-screws. The mini-screws in Group A containing buttress reverse thread shape, acted as a control group for their respective experimental group containing other thread shaped mini-screws. The 35 blocks were made with synthetic bone support Rigid Polyurethane foam. Then the mini-implants were inserted at these point with implant driver perpendicular to the surface of sample block. The load was smeared to the head of mini-implant at the speed of 10 mm/min of cross head. The highest load at which the mini-implant dislodge was recorded in the universal testing machine. Results: The results of comparison shows that Group A shows highest pullout resistance value (212.787 N) then group D (204.43N), Group E (195.681N), Group C (182.234N) and group B (174.160N). The above pullout resistance value are in decreasing order. Reverse buttress thread shape had highest resistance to pullout force in axial direction and buttress thread shape had least resistance to pullout force test. While comparing the groups with control group, it was found that comparison between group A and B, and comparison between group A and C shows the statistically significant values as p value < 0> Conclusion: The Buttress Reverse thread design may be more useful as it shows highest pullout resistance value than other thread shape form i.e. Rounded thread shape, Trapezoidal thread shape, 75 degree joint profile thread shape and Buttress thread shape in decreasing order respectively. Key Words: Mini-screws, thread shape, axial pull-out test

Introduction of mini implants to the field of orthodontics has allowed the orthodontist to treat a wide range of malocclusion than those could be treated by conventional anchorage system. As the force could directly be applied from the anchor unit for the required tooth movement, the chances of anchor loss could be minimized. Therefore, mini-screws not only enable the orthodontists to have good control over tooth movement in all three dimensions but also help them to provide the best of the treatment result . This review will illustrate the versatility of biomechanics provided by orthodontic mini-implants for the correction of the malocclusion along with the advantages, disadvantages and the complications due to the use of the mini implants. Keyword: Mini-implant, Anchorage, Orthodontics

The term ‘iatrogenic’ is defined as that which is ‘results from the activity of a health care provider, institution or health professional. Iatrogenic malocclusions are malocclusion resulting from previous dental and/or orthodontic treatment. This series of two case reports highlights the use of micro-implants in the treatment of such iatrogenic malocclusions. In the first case report a patient KB reported with forwardly placed upper front teeth. His previous dental treatment included root canal treatment of all the four incisors followed by coronal coverage to solve his chief complaint. The treatment plan included replacement of coronal coverage, extraction of all bicuspids and retraction and intrusion using micro-implants, followed by permanent coronal coverage. In the second case report the patient GC complained of poor esthetics due to forwardly placed upper front teeth. In her previous orthodontic treatment, all the first bicuspids were extracted but her extraction space was not opened and her esthetics was not improved. Her treatment plan included extraction of upper first molars, use of micro-implants to intrude and retract the upper arch and cause autorotation of the lower jaw, mesialization of upper second and third molars and reduction in the gummy smile. Keywords: iatrogenic malocclusion, micro implants, re-treatment.

Gummy smile along with a hyperdivergent profile is one of the most complex malocclusions in clinical orthodontics. It is often characterized by excessive maxillary posterior dentoalveolar height along with excessive anterior dentoalveolar height. Such situation in an adult patient often demands surgical therapy. However, patient reluctance towards surgery and alternative method using miniscrews is now frequently used in such cases. In case report, orthodontic treatment of a 25year old male patient with skeletal class II malocclusion, gummy smile and hyperdivergent profile has been described. For the correction of gummy smile and facial profile, we decided for full maxillary arch intrusion using a single palatal miniscrew implant along with a modified transpalatal arch. The active treatment phase lasted 24 months. Keywords: Gummy smile; Miniscrew; Facial profile; Adult patient

First permanent molars are not usually extracted for orthodontic purposes, but their compromised status may necessitate such a step in certain cases. This article reviews the literature, the rationale and technical considerations of orthodontic treatment with extractions of first permanent molars.

Objective: This study was done to evaluate the effect of mini implant anchorage to control lower incisor inclination in treatment of Class II malocclusion with fixed functional appliance. Materials and Method: 20 patients (12 males and 8 females) with Class II div 1 malocclusion with a mean age of 19.23+ 2.42 years were selected and randomly divided in two groups. All patients were treated using 0.022"(MBT) with Forsus fatigue resistant device (3M Unitek). Group I consisted of 10 patients treated with Forsus fatigue resistant device (FRD) and Group II consisted of 10 patients treated with Forsus fatigue resistant device and miniscrew implant for anchorage (FMI). Lower incisor inclinations were measured on the lateral cephalograms and the data was statistically analyzed. Results: The mean degree of lower incisor inclination at pre functional (T0) for FRD group was ; L1 to NB : 28.80o ± 3.79oand IMPA 97.10o ± 5.32o. At post functional stage (T1) L1 to NB was 36.00o ± 4.13oand IMPA 107.8o ± 6.51o.The mean degree of lower incisor inclination at pre functional (T0) for FMI group was ; L1 to NB : 25.20o ± 4.39oand IMPA 97.60o ± 6.14o .At post functional stage (T1) L1 to NB was 28.20o ± 2.39oand IMPA 102.0o ± 7.68o.The results showed that there was statistically highly significant increase in the inclination of the lower incisors in the FRD group compared to the FMI group (p=0.001). Conclusion: Miniscrew implant anchorage is effective in minimizing the lower incisor proclination associated with fixed functional appliance treatment in Class II malocclusion.

With an increasing number of patients demanding quality dental health care, the interdisciplinary interactions between clinicians of different specialties of dentistry has increased considerably. Prosthetic replacement of missing teeth plays a major role in improving the overall quality of life. Comprehensive prosthetic rehabilitation often requires the services of an Orthodontist to move certain teeth before final restorations can be fabricated. Acceptance of adjunct orthodontic tooth movement in the adult population has increased the frequency with which it is being employed for pre prosthetic planning. We present a case report of adjunct orthodontic tooth movement involving intrusion of a supra erupted maxillary molar in a long standing edentulous space in the mandibular arch followed by rehabilitation using an osseointegrated Implant. Keywords: Adjunct, intrusion, osseointegrated

The dental rehabilitation treatment of cleft lip and palate patients requires a multi-pronged interdisciplinary involvement of orthodontics, restorative dentistry, prosthodontics and oral surgery to provide them with optimal esthetics, function, and stability. These teams provide a multi-faceted evaluation which includes input from a variety of professional disciplines making it possible for coordinated care and reduces the fragmentation of several independent specialists. Teams also have a special opportunity to address the complex social and psychological issues prevalent in treating persons with birth defects This clinical case series describes an interdisciplinary (oral surgery, orthodontics, restorative and prosthodontics) approach for the coordinated treatment of cleft lip and palate patients. Keywords: Cleft lip and palate

Skeletal Class III malocclusion may occur due to maxillary retrognathism, mandibular prognathism or a combination of both and is often associated with skeletal and dental dysplasia in all planes of space. Orthognathic surgery involving maxillary advancement, mandibular setback or a bijaw surgery is usually indicated in adult patients with no residual skeletal growth depending on the severity of skeletal dysplasia. A careful diagnosis, treatment planning and multidisciplinary approach are the cornerstones in successful management of such cases. The effects of ortho-surgical treatment on pharyngeal airway and possibility of subsequent breathing disorders like Obstructive Sleep Apnea should be assessed pre-surgically and due consideration should be given in treatment planning. This case report describes successful interdisciplinary management of a case of skeletal Class III malocclusion with Bijaw orthognathic surgery involving maxillary advancement and mandibular setback. The effect of treatment on pharyngeal airway was assessed using Acoustic Pharyngometry. Keywords: Ortho-surgical management of skeletal Class III, Bijaw orthognathic surgery, Acoustic Pharyngometry

Objective: To use an indigenously designed photographic soft tissue profile analysis to derive soft tissue norms for the age groups of 9-11 and 12-15 years for the local population ; to establish the normal anteroposterior relationship of mandible to the cranial base and the face ; and to examine the reliability of the four reference planes namely the SnV , GV , NV, PV. Materials and methodology: Standardised right lateral photographs of the subjects were taken in NHP. All these images were transferred to the computer and were resized to real size images. Four lines i.e. Nasion Vertical (NV), Pupil Vertical (PV), Subnasale Vertical ( SV), and Glabella Vertical (GV) were used as reference lines and perpendicular distances of various points were measured from each of the four reference lines. Mean and SD was calculated. Results: Soft tissue photographic norms were generated for children with age group of 9 - 1 1 a n d 12- 15 years for class I. Important findings were B’ lies on NV for both sexes and Pog’ lies on GV for both sexes in the age group of 9-11 years which can be practically implied in routine practice. In the age group of 12- 15 years , Pog’ lies on NV in girls and is 2 mm behind it , in boys. The Nasion vertical was found to be a reliable reference plane in both the age groups. Conclusion: The photographic analysis that was devised in this study was found to be a reliable and useful tool in recognising antero-posterior skeletal deviations related to the mandible in the two age groups studied. Keywords: Photographic ; Glabella ; Nasion ; Analysis ;Vertical

Objective: Evaluation of distribution of stresses in human mandible generated during clenching in various malocclusion groups like class I, II, III malocclusion for better diagnosis and treatment and rearrangement of teeth to distribute forces. Materials and methods: 3D anatomical models were generated using DICOM images from CBCT scans. These jaw models were exported using STL format. Such models were developed from class I, II, III malocclusion Cone Beam Computed Tomography (CBCT) data. Complete model was saved as .stl file which were imported in HyperMesh software to generate volume mesh from surface volume by refining the mesh volume of each part of all cases. Result: In CLASS I MALOCCLUSION the stress trajectories were observed from beneath the teeth in the alveolar process, lower border of mandible. The stress was homogeneously distributed throughout the mandibular body, symphysis region, ramus, gonial angle. In CLASS II MALOCCLUSION, the high concentration of stress is seen on symphysis region and beneath the posterior crest of alveolar bone. In case of CLASS III malocclusion, the force is not homogeneously distributed throughout entire mandibular body and was observed more in the ramus of the mandible and posterior part even the coronoid process.The low amount of stress was observed in anterior part of mandible and on condylar head. Conclusion: Various Von Mises stress distributions trajectories and stress patterns were observed in different classes of malocclusion i.e. in class I, II, III malocclusion in cases with normal maxilla and skeletal class I, II, III malocclusion Keywords: CBCT, DICOM, Finite element analysis,Regional thresholding,Von Mises stress,Trajectories.

Special needs individuals are those individuals who are prevented by a physical or mental condition from full participation in the normal range of activities of their age groups. They usually exhibit high prevalence of impacted teeth. Case presentation: 15- year old visually impaired patient presented with an impacted upper left canine and upper left second premolar with multiple deciduous teeth. The canine was brought into occlusion using a boot loop. Conclusion:Treatment of impacted teeth requires thorough analysis of patients’ records, correct diagnosis, and a treatment plan with a special focus on behaviour management in handicapped children. Key words: impacted teeth, handicapped, boot loop.

Introduction: White spot lesions and gingivitis are most common sequlae of fixed orthodontic appliance therapy. Studies have revealed that silver nanoparticles have antimicrobial property against bacteria, fungi and protozoa. Aim: To assess antibacterial property of silver coated stainless steel orthodontic brackets against S. mutans, L. acidophilus, P. gingivalis. Material and Method: This experimental study was carried out in 120 stainless steel orthodontic brackets, out of which 60 brackets were silver coated, 60 brackets were uncoated. These brackets were tested for its antimicrobial property against S. mutans, L. acidophilus and P. gingivalis. Antibacterial property of silver coated stainless steel brackets measured by bounting colony forming unit (CFU). Antibacterial property of silver coated brackets against P.gingivalis demonstrated by reduction in optical density. Results and Conclusion: These data were statistically analyzed and it was concluded that Silver coated stainless steel orthodontic brackets shows more antibacterial activity against S. mutans, L. acidophilus and P. gingivalis compared to the control group. Silver coating of stainless steel orthodontic brackets can be used to prevent development of dental plaque, there by controlling the dental caries and periodontal disease. Keywords: White spot lesions, Nanoparticles, Antimicrobial.

Background: Cleft Lip and palate (CLP) are instantly recognizable disruptions of normal facial structure.. Genetic and Environmental factors have a role in aetiology of orofacial clefts. FGFs (Fibroblast Growth Factors) and their receptors (FGFRs) plays an important role in development of craniofacial structures. So this study is done to evaluate the single nucleotide polymorphisms of FGF2 and FGF18 with Non-syndromic cleft lip and palate in local population. Methodology: 25 subjects with nonsyndromic cleft lip and palate and 25 unrelated controls, collected from the department and the extracted DNA samples were subjected to Polymerase chain reaction and later they were subjected to DNA sequencing. Results were documented in the form of electropherograms. Results: The results show strong association between the presence of FGF2 gene variant rs1476214 and FGF18 gene variant rs4043716 with the Nonsyndromic cleft lip and palate. This study also suggests that chances of Non syndromic cleft lip and palate is highest in subjects having GG (p < 0> Conclusion: This study concludes that that FGF2 gene variant rs1476214 and FGF18 gene variant rs4043716 can be considered as one of the genetic marker of Non syndromic cleft lip and palate for our population. Key words: Non-syndromic Cleft Lip and Palate, FGF2 gene variant rs1476214 and FGF18 gene variant rs4043716.

This method is a modification to the original active laceback to distalize canine. Keywords: Laceback, Open coil spring.

Objective: Objective of the study was to compare the developmental stages of mandibular second and third molars for assessing the level of skeletal maturation. Study design: A retrospective and cross-sectional study was conducted. Pre-treatment lateral cephalograms and panoramic radiographs (OPG) of 130 males and 161 females aged 9–18 years were evaluated. Demirjian Index (DI) for mandibular second and third molars developmental stages and the cervical vertebrae maturation indicators (CVMI) suggested by Hassel and Farman for skeletal maturation were used. Results: Significant association was observed between mandibular molars maturation levels and the cervical vertebrae maturation (Pearson’s contingency coefficient = 0.735 in females and 0.757 in males for third molars; and 0.726 in females, and 0.672 in males for second molars). Correlations were higher for third molars. CVMI stage 2 (acceleration phase of pubertal growth spurt (PGS) corresponded to third molar DI stage B in females and stage C in males, while in second molar DI stage E in females and stage F in males was associated with CVMI-2. On the other hand, the third molar DI stages C and D corresponded to CVMI stages 3 and 4 in both genders. The second molar DI stage F in females and stage G in males corresponded to CVMI stage 3 (active PGS). Conclusion: Mandibular third molars development showed stronger association with skeletal maturity assessment as compared to second molars. Mandibular second and third molars can be reliably used for skeletal maturity assessment. Second molar DI stages E and F in females; and F and G in males indicate the active growth period. Third molar DI stage B in females and C in males can indicate the acceleration phase of PGS. Completion of the crown of third molar indicates deceleration of PGS. Keywords: Cervical vertebrae maturation, Growth maturity, Demirjian Index, Mandibular molar

Class II malocclusion is one of the common deformities which one comes across in the clinical scenario. Clinical and radiographic assessment helps us in diagnosing the skeletal and dental components of class II as correct diagnosis and age of patient are the keys to successful management of such cases. Among the various treatment modalities available for managing the skeletal and dental Class II, fixed functional appliances are the recently introduced non-compliance dependent alternatives for management of such cases. These appliances work best during post pubertal stages and allow for the correction of skeletal and dental class II I varying proportions. The present case report describes a case of Class II malocclusion with horizontal growth pattern treated with Powerscope appliance. This hybrid fixed functional appliance allowed for the successful achievement of the treatment objectives. Keywords: Fixed functional appliance.

Appliance (Forsus Fatigue Resistant Device) 1. Change in mandibular incisors inclination during course of fixed functional treatment anchored to mini implants. 2. Pretreatment and post-treatment fixed functional airway changes. Materials and methods: Fifteen Class II malocclusion subjects with mandibular retrusion were selected. Mandibular retrusion was corrected by fixed functional appliance therapy (Forsus Fatigue Resistant Device) and unfavorable labial tipping of mandibular incisors was minimized with usage of mini implants (1.3 × 10 mm Denticon) inserted between mandibular canine and first premolar root area bilaterally. Lateral cephalograms were taken before Forsus placement at mean age of (T1) is 14.25+/-1.65 years of age and after Forsus at T2 is 14.74+/-1.75 years of age. Student Paired t test was used for statistical analysis. Results: Class I molar relationship and overjet correction achieved in an average period of 5.32+/-1.27 months. Increase in mandibular incisor inclination is minimal i.e. 1.07+/- 0.8 degrees with p value-0.061, also increase in upper pharyngeal airway width by 0.93+/- 1.01 mm with p value-0.05 and highly significant increase in lower pharyngeal airway width by 2.7+/- 1.21 mm with p value Conclusion: Association of TADs with fixed functional appliance can reduce undesirable proclination of lower incisors and enhance skeletal response. Upper and lower pharyngeal airway dimensions exhibit changes, withlower airway showing highly significant changes. Keywords: Forsus; Mini-implant; Fixed functional appliance; Class II correction.

Introduction: There has been a long discussion in orthodontics about the sliding and loop mechanics as the preferred method of retraction of anterior teeth in maxillary first premolar extraction cases. But no study has compared sliding and loop mechanics with indirect anchorage for enmasse retraction.this study aims to compare sliding and loop mechanics with indirect anchorage while doing enmasse retraction of anterior six maxillary teeth. Materials and Methods: 11 patients were treated with sliding and loop mechanics each and enmasse retraction was done after maxillary first premolar extraction and using indirect anchorage with the help of miniscrews. Results: Sliding mechanics is found to be better than loop mechanics in anterior retraction and reducing proclination with faster space closure. Loop mechanics was found to be better in torque control and preventing bite deepening during retraction. Conclusion: Both mechanics have their own advantages and disadvantages and hence should be used as per the requirement of individual cases. Keywords: - Sliding, loop, friction, frictionless, indirect anchorage, retraction.

The treatment of Class II malocclusions in adult patients can be either through orthodontic camouflage or through surgery. As far as camouflage is concerned, upper arch extractions or advancement of the mandibular dentition are done to reduce the overjet. When such malocclusions are combined with problems in other planes of space such as open bite, midline shifts etc, accurate diagnosis and treatment planning are paramount to ensure a stable treatment result. This case report is of a 20 year old male patient who presented with a Class II div 1 malocclusion coupled with an anterior open bite. He had an orthognathic maxilla, retrognathic mandible, recessive chin, mm overjet, mm open bite extending from 15 to 23, missing 31. Open bite correction was done by intrusion of the maxillary posteriors using miniscrews, followed by space creation for prosthetic replacement of 31, and using a fixed functional appliance to achieve a Class I occlusion. Keywords: Class II malocclusion, posterior intrusion, mini screws, forsus FRD.

Class II div 1 malocclusion is one of the most common problem for which patients seek orthodontic treatment. With the advent of skeletal anchorage newer and better ways to treat it have been shown by many authors. Here we report a case with full cusp Class II div 1 malocclusion complicated due to congenital absence of lower central incisors, short upper lip and a very large overjet of 20mm, which was treated successfully with the help of tads. Keywords: Class II, Large Overjet, 20mm, Tads, Skeletal anchorage, Non-Surgical.

Introduction- The purpose of this prospective study was to compare the aligning efficiency of two modalities- clear aligner therapy and fixed appliance using nickel titanium wires, in the lower anterior region. Method- The sample included 20 patients who had mild to moderate crowding were selected, and randomly divided into two groups-Aligner group & NiTi group. Records were taken at 4 week intervals till 12 weeks in both the groups. The crowding was measured at all stages using the Little’s irregularity index using a caliper and then summed up to give the total irregularity score Result- The result of this study showed that over a fixed time the Mean for Little’s Irregularity Index scores was compared using Repeated measures of Anova and this difference was found to be statistically significant for both the groups. The maximum change in the score was observed between zero to four weeks of treatment for both modalities. Conclusion- The results of this study indicate that both clear aligners and conventional fixed therapy are effective in the resolution of lower anterior crowding. However, when the two groups are compared, the differences found were not statistically significant. This indicates that clear aligner therapy is an effective treatment modality for mild to moderate malocclusions. Keywords: Clear aligners, Niti Archwires, Efficiency, Crowding, Comparison.