malocclusion

The demand for orthodontic treatment to correct malocclusion has increased worldwide. A main cause of applying for orthodontics treatment may arise from mental disorders, such as Body Dysmorphic Disorder (BDD). This study aimed to investigate the relationship between BDD, the real need for orthodontic treatment based on the ICON index, and inquiry about orthodontics treatment in women. 

In a case-control study, 414 women from the public outpatient dental clinic of Mashhad University of Medical Sciences, completed a demographic questionnaire, Beck Depression Inventory (BDI II), Beck Anxiety Inventory (BAI), and Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS). A specialist also determined the ICON index for each participant. 

Among 414 subjects, 52 patients (31 in the orthodontics and 21 in the control group) (p=0.182) had a BDD-YBOCS score of 20 or above. The frequency of BDD, based on a definite diagnosis by an interview with a psychiatric specialist, was 6.28% among the orthodontic patients, which was significantly more than that of other dental patients (p<0.05). The mean ICON index score was found to have a significant difference between the orthodontic patients and the controls (p<0.001). No correlation was found between the severity of ICON and BDD-YBOCS scores in all the participants (p=0.804), in the cases (p=0.655), or the controls (p=0.403). 

The current study found no correlation between ICON and BDD score. However, a significantly higher rate of BDD subjects receiving orthodontic procedures suggests using the BDD-YBOCS survey in dental clinics to screen patients suspected of having BDD for further psychological management.

This study compared the opinion of dental clinicians and patients regarding dental appearance and the need for cosmetic dental procedures. This information can serve as a basis for efficient treatment planning.

This cross-sectional study was conducted on 200 dental patients, 5 general dentists, and 5 restorative dentists. A standardized questionnaire with 17 questions was used to collect information regarding the opinion of patients about the appearance of their anterior teeth and the need for cosmetic dental procedures. Tooth shade, overjet, and overbite were also recorded, and three photographs were obtained from their teeth and assessed by dental clinicians. Data were analyzed by the Spearman, independent t, Mann-Whitney, and Bonferroni tests and ANOVA (alpha=0.05). 

Of 100 male and 100 female patients participating in this study, 73% were satisfied with the appearance of their teeth, which was higher than the satisfaction rate reported by general dentists (65%) and restorative dentists (48%). The difference in opinion was not significant between the patients and general dentists (p=0.325). The satisfaction level of the restorative dentists was significantly lower than the patients (p<0.001) and general dentists (p<0.001). The patients were mostly dissatisfied with the color of their teeth (60%), and 88.5% were interested in cosmetic procedures (mostly bleaching). The opinion of the three groups was not significantly different regarding the need for cosmetic procedures (p=0.414). 

Restorative dentists had a significantly lower satisfaction with dental appearance of the patients, compared with general dentists and patients themselves. However, the opinion of the three groups was not significantly different regarding the need for cosmetic procedures.

Oral health is becoming increasingly essential for improving one›s quality of life in India as the population›s life expectancy increases. Many oral and orofacial diseases affect students, notably dental caries, gingivitis, malocclusion, and dental fluorosis. This study aimed to examine the oral health condition of school students in Tiruvannamalai District, Tamil Nadu, India.

A cross-sectional survey was conducted among school students aged 5–17. Two government and two private schools within the Tiruvannamalai district were chosen using the cluster random sampling method, and 5282 students participated in the study. The World Health Organization (WHO) oral health assessment was used to determine the oral health status of school students. The Kruskal-Wallis ANOVA and median tests were used to analyze the data. Post-hoc analysis using the Mann-Whitney U test was also performed for the dmft/DMFT index. The chi-square test was used to compare the proportions of gingivitis, malocclusion, and dental fluorosis. The P value < 0.05 was considered statistically significant.

There was a 3:2 male-to-female ratio among the study participants. Dental caries, gingivitis, malocclusion, and dental fluorosis were found to be 63%, 37.1%, 8.4%, and 3.7%, respectively. The results showed that there was a significant difference in dental caries (P = 0.001), gingivitis (P = 0.001), and malocclusion (P = 0.001). However, they showed no significant difference in dental fluorosis (P = 0.732) of primary, middle, and high school populations attending government and private schools in the Tiruvannamalai district.

By assessing the oral health examination of school students in the Tiruvannamalai district, the risk for dental caries was found to be higher in primary than middle and high school populations, while high school students had a higher prevalence of gingivitis, malocclusion, and dental fluorosis than middle and primary school students.

This study assessed the orthodontic treatment needs of Iranian and Arab university students using the Index of Orthodontic Treatment Need (IOTN). 

This cross-sectional study was conducted on 100 Arab and 100 Iranian patients presenting to Ajman University dental clinic in 2023. The subjects were selected by convenience sampling and were 19‒25 years of age. The dental health component (DHC) and esthetic component (AC) of the IOTN were used to assess their malocclusion and the need for orthodontic treatment. Data were analyzed using the chi-squared test at a significance level of 0.05. 

According to the DHC, 60% of Arab and 64% of Iranian patients had malocclusion with moderate to extreme need for treatment. Of the Iranian population, 12% were Grade I (no need), 24% were Grade 2 (little or mild need), 28% were Grade 3 (moderate need), 20% were Grade 4 (severe need), and 16% were Grade 5 (extreme need). These values were 17%, 23%, 32%, 20%, and 8%, respectively, for the Arab population. According to the AC, 59% of Iranians and 56% of Arabs required little or no treatment, while 27% of Iranians and 31% of Arabs had moderate need, and 14% of Iranians and 13% of Arabs had severe need for treatment. The difference between the two populations was insignificant in the DHC (P=0.431) or AC (P=0.681) grading. 

The two groups with different ethnic backgrounds exhibited no significant difference regarding orthodontic treatment needs.

Cleft lip and palate (CLP) are among children’s most common congenital craniofacial abnormalities. CLP results from the failure of the fusion of facial processes during embryogenesis. The etiology of CLP is complex and thought to involve genetic influences along with variable interactions from environmental factors. The treatment process involves a multidisciplinary approach while focusing on achieving functional and aesthetic well-being for the patient. 

Case Report:

 In this paper, we report using a multidisciplinary approach to treat a complex case of bilateral CLP in a 7-year-old female patient. The treatment significantly changed the patient’s facial profile, in addition to improving her occlusion, aesthetics, and function. 

The treatment of CLP should follow a multidisciplinary approach while considering several factors, such as age, developmental stage, and psychosocial factors. This approach has been shown to improve patients’ well-being and quality of life.

The Donohue syndrome, also known as leprechaunism, is a rare autosomal recessive genetic disorder of insulin resistance. The severe form of insulin resistance seen in this syndrome is due to a mutation in the insulin receptor gene. This syndrome has symptoms such as delayed growth before and after birth, premature growth, lipoatrophy, hypertrichosis, acanthosis nigricans, and dysmorphic face.

This report presents oral manifestations (such as macrodontia, severe crowding, supernumerary tooth, etc.) and management of a 10-year-old patient with the Donohue syndrome.

Considering the extensive oral manifestations of the Donohue syndrome, good oral hygiene and regular dental follow-ups are necessary for such patients.

This study evaluated correlations between Angle’s Class I and Class II malocclusions, lateral cephalometric parameters, and smile characteristics assessed through lateral and oblique smile views.

A sample of 20 patients (≥15 years, with no prior orthodontic treatment) were selected for this study. The selected individuals were grouped according to Angle’s classification of malocclusion. Pretreatment records were taken including lateral cephalogram and extra-oral smile photographs in lateral and oblique views. In the lateral cephalogram, skeletal, dental, and facial parameters and in lateral and oblique smile views, smile index, commissure angle, and incisal display angle were recorded. ANOVA and Pearson correlation test were used for data analysis. P-value<0.05 was considered as significant.

The results of this study showed no significant difference in cephalometric parameters except for UFH/LFH, which was higher in Angle’s Class II malocclusion. The smile index, commissure angle and incisal display angle differed significantly between the two malocclusions in both lateral and oblique smile views except for incisal display angle in the oblique view. 

The lateral and oblique smile index decreased from Class I to Class II. In contrast, the lateral and oblique smile commissure angle and lateral smile incisal display angle increased in Class II compared to Class I. No significant difference was found in skeletal and dental parameters between Angle’s Class I and Class II malocclusions except for UFH/LFH, which was higher for Angle’s Class II malocclusion.

Class II malocclusion is a common orthodontic discrepancy affecting one-third of the world’s population. Thus, functional appliances that cause forward posturing of the mandible can induce mandibular growth, and are therefore a popular approach for treatment of Class II malocclusion during the growth spurt period. This study aimed to compare the dental, skeletal, and soft tissue effects of the Twin Block (TB) and Guilan Functional Appliance (GFA) on Class II patients with mandibular deficiency.

This retrospective study compared 30 patients treated with TB and 30 patients treated with GFA. All patients had ANB > 5 degrees, SNB < 77 degrees, and overjet > 5 mm. Preoperative lateral cephalograms of patients were compared with their lateral cephalograms obtained after completion of phase II of treatment. Comparisons were made by paired t-test (alpha=0.05).

In the GFA group, SNA significantly decreased from 84.66 to 82.16 degrees (P<0.05) while SNB experienced an insignificant reduction from 75.83 to 74.63 degrees, and ANB experienced a significant reduction from 6.26 to 4.86 degrees (P=0.005). In the TB group, SNA significantly decreased from 82.26 to 81.96 (P<0.05) while SNB increased from 75.43 to 76.69 degrees (P=0.599), and ANB decreased from 6.3 to 5.67 degrees (P=0.049). both the TB and GFA decreased the Wits. This reduction was greater in the GFA group; however, the difference between the two groups did not reach statistical significance(P=0.931).

Despite different designs, both functional appliances were successful in treatment of patients with mandibular deficiency.

 This study assessed the correlation of tongue posture with dental arch characteristics in sagittal and vertical skeletal patterns using cone-beam computed tomography (CBCT).

 This cross-sectional study evaluated 225 CBCT scans of sagittal Class I, II, and III patients. Class I and II groups were subdivided into high-angle, normal, and low-angle vertical subgroups. Palatal length, width, and height, maxillary width (Wmax), mandibular width (Wman), tongue posture according to the Graber’s analysis, tongue length (TGL), and tongue height (TGH) were three-dimensionally measured. Statistical analyses were conducted using one-way and two-way ANOVA, and Pearson and Spearman tests (alpha=0.05).

 All dental arch parameters were significantly greater in Class III, compared with Class I and II groups (P<0.05), except for) Wman, palatal length, and palatal height( . Palatal height was significantly greater in Class II and III, than Class I group (P<0.05). Wmax was lower in high-angle than low-angle, and palatal length was lower in high-angle than low-angle and normal groups (P<0.05). In Class I normal-angle patients, Wmax had a positive correlation with TGL. In Class I low-angle patients, Wmax had a moderate positive correlation with TGH.

 Significant differences were found in Wmax and palatal length among the vertical groups. In different skeletal patterns Wmax, Wman had a low to moderate positive correlations with D4, D5, D5ʹ, TGL and TGH. Wmax in Class I was significantly lower than that in Class III; this variable in Class II was significantly lower than that in Class III

This review aims to collate and analyze the existing evidence on the comparison of external apical root resorption (EARR) in subjects treated with clear aligners (CAs) and fixed appliances (FA). An electronic search was conducted in six databases for articles published in all languages until July 2023. Studies that evaluated EARR in subjects treated with CAs and FAs were included. The RoB 2 tool for RCTs and the ROBINS-I tool for non-randomized studies were used to analyze the risk of bias (ROB). A random effects meta-analysis was performed to assess EARR extent in maxillary and mandibular anterior teeth for subjects treated with CAs and FAs. Ten studies (eight retrospective, one RCT, and one CCT) were included in this review, out of which six studies reported a moderate ROB, one reported a serious ROB, and three reported a low ROB on qualitative analysis. The quantitative analysis of six studies revealed a significant intergroup difference (P<0.05) in the mean EARR for maxillary central (SMD=-0.62, P<0.00001) and lateral incisors (SMD=-0.47, P=0.01) with a moderate heterogeneity (I2=56%), as well as the mandibular central incisors (SMD=-0.27, P=0.04) with high heterogeneity (I2=79%). EARR was lower in subjects treated with CAs than FAs. A moderate quality of the available evidence suggests that EARR was less evident in subjects treated with CAs when compared with FAs.

The Bolton analysis is commonly used by orthodontists. The Bolton ratios of different populations are significantly different from the standard values of Bolton. This study sought to examine the Bolton's anterior and overall ratios in various malocclusion types in Mashhad, Iran, in contrast to the Bolton’s standards.

This descriptive-analytical study was conducted on 240 study models of patients (121 males and 119 females) in four groups (n= 60 cases) of normal occlusion, Class I, Class II, and Class III. The mesiodistal dimensions of the teeth were measured twice using a digital caliper. The anterior and overall ratios of Bolton were calculated. Statistical analysis was conducted utilizing SPSS 18.0.

The mesiodistal width of the maxillary lateral incisors in normal occlusion cases was greater than that in Class I, Class II, and Class III malocclusions (P<0.05). Conversely, the mesiodistal width of the maxillary first and second premolars was the greatest in Class II and the smallest in Class III malocclusion (P<0.05). Correlation was not observed between dental ratios (anterior and overall) and gender or malocclusion groups (P>0.05). Furthermore, the anterior ratio was significantly higher than the Bolton's standard in Class I and III malocclusion groups (P<0.05). The normal occlusion group's overall ratio was significantly lower than the Bolton's original ratio (P<0.05).

Implementing the Bolton analysis in the population of Mashhad, Iran should be approached with caution.

Anterior crossbite is the most commonly observed developing malocclusion during the mixed dentition period. Dental crossbite occurs due to over-retained deciduous teeth or their delayed exfoliation, impacted or supernumerary teeth, pathologies present around the affected teeth, or dental trauma during the primary dentition period. Various removable and fixed appliances have been used in the literature for correction of crossbite depending on the patient's age, and space availability in dental arch.

This paper presents a case series of anterior crossbite cases corrected using a simple posterior bite plane appliance. This appliance is simple, easy to fabricate, and takes less time to correct the crossbite.

A posterior bite plane with a palatal plate could be an efficient solution for correction of anterior dental crossbite in the mixed dentition period. This chair-side fabricated appliance achieves correction quickly without harming the periodontal tissue. Developing malocclusions should be immediately identified by dentists to prevent complex treatment options in the future.

The aim was to determine the effect of first premolars extraction with maximum incisor retraction on airway magnitude and hyoid bone position in cases with bimaxillary dentoalveolar protrusion.

Lateral cephalograms of patients with Class I skeletal and dental relationships were retrospectively recruited. Inclusion criteria were 15-30 years old patients having bimaxillary proclination who had undergone all first premolar extractions with maximum incisor retraction.  Patients with dentofacial anomalies, chronic mouth breathing and those who had undergone tonsillectomy or adenoidectomy were excluded. Pre-and post-treatment lateral cephalograms were digitally analyzed for airway measurements and hyoid bone position. Paired samples T-test was used for statistical analysis. P-value<0.05 was considered statistically significant.

A total of 33 patients, comprising 22 females and 11 males, with a mean age of 24.39 ± 6.92 years were included. Statistically significant differences were found in airway dimensions from pre-treatment to post-treatment; upper airway size between soft palate and posterior pharyngeal wall (SPP-SPPW) was reduced by 1.91mm (12.78%), at uvula & middle posterior wall (U-MPW) by 2.51mm (20.60%), at tongue base to posterior-inferior point on middle pharyngeal wall (TB-TPPW) by 3.39mm (24.26%) and vallecular to lower pharyngeal wall by 1.51mm (9.94%). The vertical position of hyoid bone also significantly reduced as indicated by inferior movement of hyoidale (H) by 4mm (3.8%). There was no significant changes in the horizontal position of the hyoid bone.

Premolar extraction with maximum retraction in bimaxillary protrusion cases can decrease the airway dimension and increase vertical position of hyoid bone.

 We aimed to assess the effect of finger-sucking, nail-biting, and salivary levels of growth hormone on the type of malocclusion among primary school students. 

This study was conducted among 10–11-year-old (4th and 5th class of the elementary schools) students in the center of Karbala city from February to June 2021 using a multistage cluster random sampling technique. Data related to oral habits were obtained using questionnaires, which were distributed among the students and collected the next day after being answered and signed by the parents. Unstimulated saliva samples were collected, and salivary levels of growth hormone were assessed using the enzyme-linked immunosorbent assay (ELISA) method. Data were analyzed via multinomial logistic regression using R software. 

The finger sucking was a significant predictor for class 2 malocclusion (p < 0.001). Night-time finger sucking was a significant predictor for class 3 malocclusion (p = 0.031). Salivary levels of growth hormone and nail-biting were not significant predictors for malocclusion (p ˃ 0.05). Also, finger sucking was a marginally nonsignificant predicator for class 3 malocclusion (p = 0.057). 

 Cross-sectional studies capture data at a single point in time, and they cannot establish a cause-and-effect relationship. More cohort studies are required to reach a conclusion about the effect of non-nutritive sucking habits such as finger sucking, nail-biting and salivary level of growth hormone on type of malocclusion.

Objectives :

This study aimed to assess the relationship of skeletal class of malocclusion with some radiomorphometric indices of the mandible in short-face patients.

Methods :

This cross-sectional study was conducted on 179 short-face patients between 17 to 30 years who sought orthodontic treatment during 2013 to 2020. The gonial and antegonial angles, and type and depth of antegonial notch were assessed bilaterally on traced panoramic radiographs. The correlation between radiomorphometric indices and class of malocclusion was analyzed using One-way ANOVA and Independent T-test by SPSS version 25 (alpha=0.05).

Results:

 The mean size of gonial angle was significantly different among the three classes of malocclusion (P<0.001), and the largest gonial angle was recorded in class III, and the smallest in class I patients. The mean size of antegonial angle and antegonial depth were not significantly different among the three classes of malocclusion (P=0.487). The difference in the mean size of gonial and antegonial angles was not significant between males and females (P=0.119, and P=0.176, respectively). However, the mean antegonial depth in males was significantly greater than that in females (P<0.001). Type I antegonial notch was more common in females than males at both sides. Age had no significant correlation with gonial angle, antegonial angle, or antegonial notch depth (P=0.422, P=0.737, P=0.392, respectively).

Conclusion:

 Facial growth pattern in short-face patients can be predicted with antegonial angle. Also there is significant correlation between skeletal class of malocclusion and the size of gonial angle.

The term Ponticulus Posticus (PP) refers to a complete or partial bony bridge on the vertebral artery that passes through the superior-lateral surface of the posterior arch of the atlas. This study was conducted with the aim of investigating the prevalence of ponticulus posticus in orthodontic patients referred to Mashhad Dental School.   

In this cross-sectional study, one thousand cephalograms were selected from the patients referred to the orthodontics department of Mashhad Dental School between 2017 and 2021. In lateral cephalogram images with appropriate quality, the type of malocclusion was determined using the AudaxCeph software (Audax d.o.o., Ljubljana, Slovenia). Then, the images were evaluated for the presence or absence of PP. For the statistical analysis, chi-square and t-test were used.   

In this study, 861 lateral digital cephalograms were analyzed. The overall prevalence of PP in the studied population was 17.5%. The prevalence of PP was higher in males than in females (P < 0.001).  The variables “presence of PP” (P = 0.056) and “type of PP” (P = 0.522) were found to be independent of age groups. Although class II subjects showed a higher prevalence of PP, skeletal malocclusion classes were not found to be correlated with the presence of PP (P = 0.104) nor with its types (P = 0.958).   

The current study is considered the primary study that provides data concerning the prevalence of PP in the East of Iran. Our study showed that PP was not rare in this region. More studies with 3D radiological examination are needed to increase the accuracy of diagnosing PP and its prevalence in Iran.

This study aimed to investigate the effect of growth modification treatments on oral health-related quality of life in adolescents aged 11 to 14 years with Class II malocclusion.

Eighty people participated in this case-control study. The case group (n=43) included adolescents with a history of Class II malocclusion treated with growth modification. The control group consisted of 37 adolescents with Class II malocclusion who were not treated. Both groups were given a translation of the Child Perception Questionnaire (CPQ), measuring the quality of life in four domains: oral symptoms, functional limitations, psychological health, and social well-being. Data were statistically analyzed by SPSS software and a significance level of 0.05 was considered.

The oral health-related quality of life of the case group was better than the control group in all areas although this difference was not statistically significant (P=0.204).

The oral health-related quality of life between two groups was not different; however, the difference in mental health components between the two groups was clinically negligible.