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Abstract Background One of the most undesirable side effects of comprehensive orthodontic treatment is white spot lesions (WSLs). Despite many attempts at prevention of WSLs, its prevalence remains very high on debonding. There are many agents like fluoride toothpastes, fluoride varnishes, and fluoride mouth rinses, and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) is frequently used for the remineralization of WSLs. However, there is no consensus in the literature with respect to the success rates of these agents. Thus, the present study was designed to evaluate the efficacy of fluoride toothpaste alone and in combination with fluoride varnish and CPP-ACP plus crème in the remineralization of post-orthodontic WSLs. Methods Forty-five subjects in the age range of 16–25 years having at least one post-orthodontic WSL were included in the study. All the subjects were randomly divided into three groups (toothpaste group, varnish group, and CPP-ACP group). The efficacy of various remineralizing agents on the remineralization of WSLs was evaluated clinically and by DIAGNOdent immediately after debonding and subsequently after 1, 3, and 6 months of their use. Results Twice daily use of fluoride toothpaste alone had no significant effect on remineralization of WSLs at various intervals of observations (P = 0.078). Application of fluoride varnish along with twice daily use of fluoride toothpaste for 6 months significantly decreased the severity of WSLs (P 0.05). Conclusions The use of fluoride varnish and CPP-ACP plus crème in addition to twice daily use of fluoride toothpaste had no additional benefit in the remineralization of post-orthodontic WSLs.

Objective: To test the hypothesis that there are no differences in various risk factors of dental caries among children with cleft lip and palate when compared to non-cleft high caries risk and non-cleft caries free children. Design: Seventy-three children in the age range of 4-9 years comprised three groups; Group-I (n = 23, children with cleft lip and palate), Group-II (n = 25, non-cleft high caries risk children) and Group-III (n = 25, non-cleft caries free children). Various risk factors for dental caries like type of oral hygiene practice, sugar exposures/day, developmental defects of enamel, caries activity, salivary streptococci mutans levels and lactobacilli levels were evaluated and compared among the three groups of children. Results: The mean deft score among Group-II children was significantly more (P < 0.01) as compared to the Group-I children. The mean deft + DMFT score among Group-I and Group-II children was comparable (P = 0.149). Developmental enamel defects were more among Group-I children as compared to Group-II and Group-III children (P < 0.01). Hypoplasia of the maxillary anterior teeth was more common among Group-I children as compared to Group-II (P < 0.05) and Group-III children (P < 0.001). The association between hypoplastic teeth and dental caries was significant (P < 0.05). The salivary acidogenic potential as evaluated by Snyder test was comparable among Group-I and Group-II children. The salivary streptococcus mutans levels in Group-I and Group-II children were higher when compared to lactobacillus counts. Conclusion: The risk factors of dental caries among children with cleft lip and palate were more as compared to non-cleft high caries risk and non-cleft caries free children.

Objective: The objective of this study is to establish the cephalometric hard tissue norm for orthognathic surgery for North Indian subjects. Materials and Methods: A total of 100 young adults which consists of 46 males and 54 females with the age range of 14-24 years with balanced facial profile and minimum arch length discrepancies were chosen for the study. Lateral cephalograms with teeth in occlusion were recorded and analyzed manually to establish the norm. The mean values of various cephalometric hard tissue variables for North Indian males and females were compared with those Caucasians. P < 0.05 was considered to be statistically significant. Results: All the cephalometric parameters for orthognathic surgery except mandibular length and lower incisor inclination were comparable among North Indian males and females. The mandibular length was significantly more among North Indian males than females (P < 0.05) and the inclination of lower incisors was significantly more among North Indian females than males (P < 0.05). However, many of the cephalometric parameters for orthognathic surgery were significantly different among North Indian and Caucasian males and females. Conclusion: The cephalometric norms for orthognathic surgery were established for North Indians and many measurements were different from those for Caucasians.

Aim : To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Materials and Methods: Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months) after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. Results: Maxillary distraction resulted in significant advancement of maxilla (P

Attachment of force elements from the gingival hook of maxillary molar tubes during the retraction of the anterior teeth is very common in orthodontic practice. As the line of force passes below the center of resistance (CR) of molar, it results its mesial tipping and also anchorage loss. To overcome this problem, the line of force should pass along the CR of molar. This article highlights a method to overcome this problem by attaching a removable power arm to the headgear tube of molar tube during the retraction of the anterior teeth.

Purpose: To test the hypothesis that there is no immediate and long-term effects of maxillary distraction osteogenesis (DO) on nasal index among adult subjects with cleft lip and palate deformities. Materials and Methods: Twelve adult subjects in the age range of 17-20 years with complete unilateral cleft lip and palate underwent advancement of maxilla by DO. The immediate and long-term effects of maxillary DO on nasal index were evaluated from extra-oral full face frontal photographs recorded prior to DO (T), at the end of active DO (T) and at least 2-years after the DO (T). The ANOVA, Post Hoc test (Bonferroni) and Pearson correlation coefficients were used. The probability value ( P value) 0.05 was considered as statistically significant. Results: SNM angle and Ptm-M distance increased significantly by DO ( P < 0.001). The nasal index increased significantly ( P < 0.01) by 13.85 % from T value of 85.15 ± 4.49 to 99.02 ± 11.16 % at the end of active distraction (T) and by 12.69 to 97.84 ± 9.14 % at the end of long-term follow-up (T). The correlation between sagittal maxillary advancement and nasal index was statistically significant ( P < 0.001). For each millimeter of maxillary advancement, the nasal index increased by 1.38 % and 1.8 % at the end of active distraction and long-term follow-up respectively. Conclusion: The advancement of maxilla by distraction osteogenesis among subjects with cleft lip and palate deformities increased nasal index significantly. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the efficacy of resin-modified glass ionomer cement varnish in the prevention of white spot lesions (WSLs) during early orthodontic treatment with fixed appliances. Materials and methods: A total of 480 maxillary and mandibular anterior teeth were studied. The varnish was applied to either the right or left side of the maxillary or mandibular anterior teeth on a random basis. For each experimental quadrant in each patient, the varnish was applied to the labial surfaces of incisors and canines, from the gingival surface of the bracket to the free gingival margin. White spot lesions were recorded on a standard pro forma before (T0) and approximately 6 months following varnish application (T1) by DIAGNOdent and direct visual inspection. Results: The DIAGNOdent score at T1 was increased significantly in the control maxillary lateral and mandibular central (P < 0·05), and lateral incisors (P < 0·01). The visual scores in experimental maxillary lateral incisors and mandibular canines were decreased significantly at T1 (P < 0·05). The sidewise post-treatment (T1) comparisons of control and experimental teeth for visual scores revealed significant decreases for maxillary lateral incisors, maxillary canines and mandibular canines (P < 0·05). Conclusion: Application of resin-modified glass ionomer cement varnish had a favourable effect in the prevention of WSLs during comprehensive orthodontic treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to evaluate whether there is any remodeling of bone at infraorbital rim following maxillary distraction osteogenesis (DO) at Le Fort-I level. Materials and methods: Twelve adult subjects in the age range of 17-21 years with complete unilateral cleft lip and palate underwent advancement of the maxilla by DO. The effect of maxillary DO on the infraorbital rim remodeling was evaluated from lateral cephalograms recorded prior to the DO (T), at the end of DO (T), and at least 2-years after the DO (T) by Walker's analysis. The ANOVA and two-tailed t test were used and probability value ( P value) 0.05 was considered as statistically significant level. Results: There was anterior movement of maxilla by 9.22 ± 3.27 mm and 7.67 ± 3.99 mm at the end of immediate (T) and long-term (T) follow-up of maxillary DO, respectively. The Walker's analysis showed 1.49 ± 1.22 mm and 2.31 ± 1.81 mm anterior movement of the infraorbital margin (Orbitale point) at the end of T and T, respectively ( P < 0.01). This apposition of bone at the infraorbital rim region further improved the facial profile of these patients. Conclusion: The advancement of maxilla by distraction osteogenesis at Le Fort-I level induced significant bone apposition at infraorbital rim. Clinical relevance: Patients with mild midface hypoplasia who would otherwise may be candidates for osteotomy at Le Fort-II or Le Fort-III level may benefit from maxillary distraction at Le Fort-I level. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study is to establish the cephalometric hard tissue norm for orthognathic surgery for North Indian subjects. Materials and Methods: A total of 100 young adults which consists of 46 males and 54 females with the age range of 14-24 years with balanced facial profile and minimum arch length discrepancies were chosen for the study. Lateral cephalograms with teeth in occlusion were recorded and analyzed manually to establish the norm. The mean values of various cephalometric hard tissue variables for North Indian males and females were compared with those Caucasians. P < 0.05 was considered to be statistically significant. Results: All the cephalometric parameters for orthognathic surgery except mandibular length and lower incisor inclination were comparable among North Indian males and females. The mandibular length was significantly more among North Indian males than females (P < 0.05) and the inclination of lower incisors was significantly more among North Indian females than males (P < 0.05). However, many of the cephalometric parameters for orthognathic surgery were significantly different among North Indian and Caucasian males and females. Conclusion: The cephalometric norms for orthognathic surgery were established for North Indians and many measurements were different from those for Caucasians. [ABSTRACT FROM AUTHOR]

Objective: To test the hypothesis that twin-block and Mandibular Protraction Appliance-IV (MPA-IV) are not effective in improving the pharyngeal airway passage (PAP) dimensions among Class II malocclusion subjects with a retrognathic mandible. Materials and Methods: Eighty-three subjects ranging in age from 8 to 14 years were divided into four groups. Group I included 30 Class I malocclusion subjects (healthy controls); group II consisted of 16 Class II malocclusion subjects (Class II controls); group III had 16 subjects in whom Class II malocclusion was treated by MPA-IV; and the remaining 21 subjects formed group IV, whose Class II malocclusions were corrected by twin-block appliance. Lateral cephalograms recorded at the beginning of orthodontic treatment in group I subjects and at the beginning and end of follow-up/treatment with functional appliance in group II, Ill, and IV subjects were analyzed to determine the PAP dimensions. Paired f-test, one-way analysis of variance, and Tukey tests were applied for statistical analysis, and a P-value .05 was considered statistically significant. Results: Soft palate length was decreased significantly in group III (P < .05) and group IV (P < .001) subjects. Soft palate thickness in group IV subjects was increased significantly as compared to group 11 (P< .05) and group III (P< .01) subjects. The improvement in soft palate inclination in group III and group IV subjects was significant (P < .01). The oropharynx depth was increased significantly in group III (P< .05) and group IV (P< .001) subjects. The depth of the hypopharynx was increased significantly (P < .01) in group IV subjects. Conclusions: The twin-block appliance was more efficient than the MPA-IV in the improvement of PAP dimensions among Class II malocclusion subjects with retrognathic mandible. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the treatment outcome and long-term stability of skeletal changes following maxillary advancement with distraction osteogenesis in adult subjects of cleft lip and palate. Materials and Methods: Total 12 North Indian adult patients in the age range of 17-34 years with cleft lip and palate underwent advancement of maxilla by distraction osteogenesis. Lateral cephalograms recorded prior to distraction, at the end of distraction, 6 months after distraction, and at least 24 months (mean 25.5 ± 1.94 months) after distraction osteogenesis were used for the evaluation of treatment outcome and long-term stability of the skeletal changes. Descriptive analysis, ANOVA, and post-hoc test were used, and P-value 0.05 was considered as a statistically significant level. Results: Maxillary distraction resulted in significant advancement of maxilla (P<0.001). Counterclockwise rotation of the palatal plane took place after maxillary distraction. The position of the mandible and facial heights were stable during distraction. During the first 6 months of the post-distraction period, the maxilla showed relapse of approximately 30%. However, after 6 months post distraction, the relapse was very negligible. Conclusions: Successful advancement of maxilla was achieved by distraction osteogenesis in adult subjects with cleft lip and palate. Most of the relapse occurred during the first 6 months of post-distraction period, and after that the outcomes were stable. [ABSTRACT FROM AUTHOR]