The application of virtual reality and augmented reality in dentistry - a literature review

In recent times, dentistry has seen significant technological advancements that have transformed various specialized areas within the field. Developed into applications for mobile devices, augmented reality (AR) seamlessly merges digital components with the physical world, enhancing both realms while maintaining their individual separateness. On the other hand, virtual reality (VR) relies on advanced, tailored software to visualize a digital 3D environment stimulating the operator's senses through computer generated sensations and feedback. The current advances use the application of VR, haptic simulators, the use of an AI algorithm and many more that provides new opportunities for smart learning and enhance the teaching environment. As this technology continues to evolve, it is poised to become even more remarkable, enabling specialists to potentially visualize both soft and hard tissues within the patient's body for effective treatment planning. This literature aims to present the newest advancements and ongoing development of AR and VR in dentistry and medicine. It highlights their diverse applications while identifying areas needing further research for effective integration into clinical practice.

Exploring the knowledge and awareness on applications of virtual reality and augmented reality technology among dental healthcare professionals - a crosssectional survey

OBJECTIVE

To assess the knowledge and awareness of Virtual Reality (VR) and Augmented Reality (AR) technology in dentistry.

METHODS

A questionnaire survey-based study was conducted using Google forms on a sample of 273 dental healthcare professionals (DHCP) from October- November 2023, after obtaining ethical approval. A validated questionnaire, divided into three sections, was used to assess the knowledge and awareness of dental healthcare professionals on virtual and augmented reality. Section A was about demographic statistics, section B assessed knowledge and awareness regarding VR and AR and section C consisted of future acceptability of VR and AR among DHCP. The frequency of each question was reported in percentages. To assess the difference of knowledge and awareness of AR and VR among different specialties of DHCP, one-way ANOVA test was applied and in case of significant results pairwise comparison was performed by post-hoc Tukey test.

RESULTS

There was a statistically significant difference of knowledge (1.40 ± 0.49) among different dental healthcare professionals. On pairwise comparison, a statistically significant difference (p = ˂0.05) of knowledge and awareness of AR and VR was found among dental specialist and other dental health professionals.

CONCLUSIONS

A concerning lack of knowledge and awareness among dental healthcare professionals regarding AR and VR technology in dentistry was found. Interestingly, within the spectrum of specialties, dental specialists demonstrated a comparatively higher awareness than their counterparts in other specialties. Addressing barriers, notably a lack of knowledge, is crucial for successful technology adoption in dental education and practice.

Comparison of mesiodistal root angulation of teeth by conventional panoramic and cone beam computed tomography images - A cross-sectional study

INTRODUCTION

Accurate bracket positioning is required for proper root parallelism and for stable orthodontic treatment outcomes. This study aimed to determine the difference in mesiodistal root angulation of teeth measured on three radiographic images.

MATERIAL AND METHODS

A cross-sectional study was conducted using orthopantomogram (OPG), panoramic images of cone beam computed tomography (Pan-CBCT) and cone beam computed tomography (CBCT). An occlusal plane was constructed in OPG and Pan-CBCT for angular measurements. The axial and sagittal views were used for assessing the mesiodistal root angulation on CBCT. Mesiodistal root angulation differences among three radiographs were assessed using the Kruskal-Wallis test. Mann-Whitney U test was applied for pairwise comparison and multinomial logistic regression was used to determine the association of sexual dimorphism with the direction of root angulation.

RESULTS

On comparing the mesiodistal root angulation in degrees (DE) among all three groups, upper right (UR2) and left lateral incisors (UL2) were found to be statistically significant with P=0.033 and P=0.050 respectively. On pair-wise comparison, we found a statistically significant difference for upper right lateral incisor (UR2) between OPG and Pan-CBCT (P=0.045). Upper left lateral (UL2) (P=0.024) was significant in OPG and Pan-CBCT while upper left first molar (UL6) (P=0.043) in OPG and CBCT group. On comparing the sexual dimorphism in the direction of root angulation, females showed a greater tendency of mesial root angulation (5.62) times for upper right second premolar (UR5) as compared to males.

CONCLUSIONS

There were no significant difference in mesiodistal root angulation between panoramic CBCT and CBCT images. The angulation of the upper lateral incisors was found to be significant between OPG and panoramic CBCT images, whereas the angulation of the upper right lateral incisors and left first molars was significant between OPG and CBCT images. In terms on sexual dimorphism, females showed greater mesial angulation of teeth than males.

Effect of bonded and removable retainers on occlusal settling after orthodontic treatment: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to summarize the effectiveness of bonded and removable retainers (the Hawley and Essix retainers) in terms of improving occlusal settling (occlusal contact points/areas) after orthodontic treatment. We searched the Cochrane Library, PubMed, CINAHL Plus, and Dental & Oral Sciences Source (DOSS), as well as SIGLE, Google Scholar and ClinicalTrials.gov for eligible studies. We included randomized and non-randomized controlled trials along with cohort studies. Studies that reported occlusal contacts/areas during retention with fixed bonded and removable retainers were included. To assess the quality of the randomized controlled trials (RCTs), the Cochrane Collaboration risk-of-bias (RoB) tool was utilized, whereas the Newcastle-Ottawa Scale (NOS) was used to assess the quality of cohort studies.We included 6 articles in our systematic review after scrutinizing 219 articles and eliminating the illegible ones based on duplication, titles, abstracts, and objectives. Bonded retainers (BRs) allowed faster and better posterior occlusal settling as compared to the Hawley retainer (HR). However, HR showed good occlusal settling in the anterior dental arch. The Essix retainer (ER) showed a decrease in occlusal contact during the retention phase. Meta-analysis showed no statistically significant difference between BRs and removable retainers. In conclusion, HR allowed better overall occlusal settling as compared to other retainers. However, BRs allowed faster settling in the posterior tooth region. The Essix retainer showed poor settling of occlusion. Overall, there is an insufficient number of high-quality RCTs to provide additional evidence, and further high-quality RCTs are needed.

Diagnostic and prognostic role of cancer stem cell biomarkers in oral squamous cell carcinoma; A Systematic Review

Objectives

To evaluate the role of cancer stem cell biomarkers in diagnosis and prognosis of OSCC patients.

METHODS

The search strategy was entered into PubMed NLM, EBSCO CINAHL, EBSCO Dentistry & Oral Sciences Source, Wiley Cochrane Library, and Scopus. The full text eligible studies (n=7) were assessed for their quality using the JBI Critical Appraisal Checklist to evaluates the methodological quality of the studies based on possibility of bias in its design, conduct, and analysis. Selected studies were further analysed based on different parameters such as publication year, sample size, and outcomes.

RESULTS

A total of 432 studies were identified through the search strategy. A total of 306 records were removed before screening either because of duplication or marked ineligible by the automation tools. The screened records were 126 out of which 104 were removed as they were not conducted on OSCC. Twenty-two reports were sought for retrieval, however, we could not find the full text of 3 studies and12 studies were excluded because the biomarkers were not associated with cancer stem cells. The most common cancer stem cell biomarkers associated with OSCC were MCT1,VEGF-A, GD15, HIF1 α, Ki67, Hsp 70, Cyclin D1, and CD44.

CONCLUSIONS

Various stem cell biomarkers have been found to have diagnostic and prognostic role in oral squamous cell carcinoma such as Cyclin D1, VEGF-A, GD15, and CD44. They can be used to predict the overall survival rate, local progression-free survival rate, and distant metastasis-free survival rate in Head and Neck cancer patients.

Knowledge and awareness of dental stem cells among dental healthcare professionals - a cross-sectional study

Objectives

To assess knowledge and awareness of dental healthcare professionals on dental stem cells.

METHODS

A questionnaire survey-based study was conducted using Google forms on a sample of 69 dental healthcare professionals (DHCP) from September - October 2022, after obtaining ethical approval. A validated questionnaire was used to assess the knowledge and awareness of dental healthcare professionals on stem cells, which was then divided into three sections. The section A was about demographic statistics, section B assessed knowledge and awareness regarding dental stem cells and section C consisted of 5 score VAS scale to assess the acceptability of future research and increase implication of dental stem cells (DSC) among DHCP. The frequency of each question was reported in percentages. To assess the difference of knowledge and awareness of DSC among different specialties of DHCP, one-way ANOVA test was applied and incase of significant results pairwise comparison was performed by post-hoc Tukey test.

RESULTS

Mean scores of knowledge and awareness of DSC among female DHCP were 54.26 ± 11.73 and males were 53.50 ±8.19. There was a statistically significant difference of knowledge (p= 0.02) among different dental healthcare professionals. On pairwise comparison by post-hoc Tukey HSD we found statistically significant difference (p = 0.03) of knowledge and awareness of dental stem cells among general dentists and operative dentistry specialists.

CONCLUSIONS

We found poor knowledge and awareness of dental healthcare professionals regarding dental stem cells. However, operative and endodontic specialty had more awareness on dental stem cells as compared to any other specialty. There was positive approach for further future researches on stem cells.

Can smile influence the lower anterior vertical facial height on frontal view in an adult Asian female subject? A cross-sectional study

Objectives:

Smile is a universal phenomenon, the effect of which is not discovered on the lower anterior facial height (LAFH). The objective of this study was to determine the influence of smile on different LAFH in frontal view as assessed by different panels of raters using visual analog scale (VAS) in a female subject.

Material and Methods:

The frontal photographs (at rest and on smile) were taken at natural head position of a female subject aged 28 years old after taking informed consent. LAFH of the photographs was modified using a Photoshop software (Adobe Systems, San Jose, Calif.). Sixty raters equally divided into orthodontic residents, general dentists, and laypersons were given a VAS to make subjective assessments of facial attractiveness of the modified photographs. Comparison of raters’ scores was done using Kruskal–Wallis and Mann–Whitney U-tests. Wilcoxon Signed-Rank test was used to compare the esthetic scores of the subject at rest and with smile.

Results:

The mean age of the all raters was comparable (early adulthood). All raters preferred normal or slightly shorter LAFH in both postures, that is, at smile and rest. Similarly, all raters disliked long face modifications. On comparing smile and rest photographs at various LAFH, we found less VAS scores for smile. Gender of raters played no role in difference of VAS scores.

Conclusion:

All the panels of rater found normal LAFH to be the most attractive; however, the panels disliked long face modifications on both smile and at rest. Smile had no positive influence on the VAS scores as assumed so the effect of “Smiloflage” must be investigated further to understand it properly.

Compliance to donning and doffing of personal protective equipment among dental healthcare practitioners during the coronavirus pandemic: a quality improvement plan, do, study and act (PDSA) Initiative

Introduction

With the emergence of SARS-Cov-2, the Centers for Disease Control and Prevention (CDC) defined mandatory guidelines for donning and doffing personal protective equipment (PPE) among dental healthcare professionals. The study’s objective was to improve the compliance of the donning and doffing protocols for PPE among dental practitioners by the Plan, Do, Study, and Act (PDSA) cycle.

Materials and methods

A quasi-experimental study was conducted on a sample of dental healthcare professionals using the non-probability purposive technique. In the first planning stage, compliance with CDC-approved donning and doffing was assessed on the clinical premises. In the second stage, an educational session was arranged with all the healthcare professionals to explain stepwise guidelines of donning and doffing to improve the quality of donning and doffing compliance. In the third stage, improvement in the quality outcome was then assessed after the session. Data were normally distributed. Qualitative variables for all the steps of donning and doffing are reported as frequency and percentages. Pareto charts were made to assess the non-compliance rate for donning and doffing protocols among dental healthcare professionals.

Results

There was an improvement of 44.55% in the hand hygiene practices before wearing the PPE after the second step of the PDSA cycle. A percentage improvement of 7.4% was recorded for removing jewellery, wearing the gown and wearing a surgical cap. No improvement was seen in securing the mask/ respirator ties, washing hands after wearing the respirator, placing the goggles or face shield practices.

Conclusions

PDSA cycle improved the overall compliance to PPE donning and doffing practices. Most of the protocols were followed by the dental healthcare professionals; however, some of them remained the same or worsened due to ease in SARS-CoV 2 restrictions.

Acceptance of SARS-CoV-2 vaccination and the associated factors among dental health care professionals: A cross-sectional survey

BACKGROUND

One of the greatest inventions of the 21st century is the development of vaccines against the life-threatening pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Whenever a new medication or treatment modality is introduced globally, it is accompanied by anxiety in the general public and among health care professionals.

OBJECTIVES

The aim of the study was to explore factors that may influence the acceptance of COVID-19 vaccination among dental health care professionals, as they are the first subgroup in the population to receive the vaccine.

MATERIAL AND METHODS

A survey-based cross-sectional study was conducted on 164 health care professionals (general dentists, dental specialists with 2 years of experience after graduation and dental assistants). Data was collected by sending a URL link to the hardand soft-copy questionnaire on Google Forms through all social media platforms. The questionnaire had 2 sections - the 1st part concerned the demographic details and the 2nd part was designed to assess the acceptance of SARS-CoV-2 vaccination among dental health care professionals and the related factors. The normality of the data was assessed with the Shapiro-Wilk test. The Cox regression algorithm was applied to evaluate the factors associated with the acceptance of SARS-CoV-2 vaccination.

RESULTS

Out of 164 participants, 85.37% showed a positive attitude toward vaccination and only 7.32% of dental health care professionals were not willing to get vaccinated; out of them, 5 were males and 7 were females. Those who refused to get vaccinated included 3.6% of general dentists, 21.1% of dental specialists and 11.7% of dental assistants. The complications of major concern were fever, myalgia and the lethargic condition immediately after vaccination.

CONCLUSIONS

A small percentage of health care professionals declined to get vaccinated against COVID-19 and the main reason was uncertainty about the associated side effects. The respondents were mostly concerned about such side effects as fever, myalgia and the lethargic condition immediately after vaccination.

Influence of incisor inclination and anterior vertical facial height on facial attractiveness in an adult Asian male

INTRODUCTION

Balanced facial proportions and hard tissue relationships are important factors in facial attractiveness. The objective of this study was to determine the most pleasing maxillary incisal inclination (MII) on the lateral profile and the impact of various lower anterior facial height (LAFH) ratios (at rest and with a smile) on facial attractiveness.

METHODS

This cross-sectional study was performed with 66 raters equally divided into 3 panels: general dentists (GD), orthodontic residents (OR), and laypersons (LP). Lateral profile view photographs of an Asian man were modified using Photoshop software (Adobe Systems, San Jose, Calif) to show altered MII and LAFH ratios at rest and when smiling. Subjective evaluations of facial attractiveness were performed by raters using a visual analog scale. Kruskal-Wallis test was used to compare esthetic scores among raters, and the Mann-Whitney U test was applied to compare ES between groups.

RESULTS

Kruskal-Wallis test showed significant differences in esthetic scores among raters for -10° (P = 0.028) and -15° MII (P = 0.030). Similarly, significant differences were found in ES for 8% LAFH ratio (P = 0.022), and 4% LAFH ratio (P = 0.035) at rest. Mann-Whitney U test showed significant differences between raters for -10° and -15° MII and between 8% and 4% LAFH ratio at rest.

CONCLUSIONS

All groups rated -5° inclinations to be most attractive. General dentists and orthodontic residents found normal LAFH to be the most attractive, whereas long facial height was less attractive with smile. In addition, smile had a camouflaging effect on LAFH.

Knowledge and awareness of dental specialists, general dentists and dental assistants regarding SARS‑CoV‑2

BACKGROUND

Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) has had drastic effects among healthcare professionals.

OBJECTIVES

This study aimed to assess knowledge and awareness among dental specialists, general dentists and dental assistants regarding standard patient care guidelines for minimizing the spread of the infection.

MATERIAL AND METHODS

A survey-based cross-sectional study was conducted on a sample of 84 participants. The participants were divided into groups of dental specialists, general dentists and dental assistants. A modified version of a validated questionnaire was used to evaluate knowledge and awareness regarding SARS‑CoV‑2 as per the Centers for Disease Control and Prevention (CDC) guidelines. Data was analyzed using the one-way analysis of variance (ANOVA) and post-hoc Tukey's tests to assess differences in knowledge regarding the SARS‑CoV‑2 guidelines across the 3 groups. The simple linear regression analysis was used to examine factors influencing the knowledge scores.

RESULTS

Among all dental specialists, 13 orthodontists, 9 operative dentists, 8 maxillofacial surgeons, 4 prosthodontists, and 1 periodontist responded to the survey. The mean knowledge scores of dental specialists, general dentists and dental assistants were 10.05 ±2.10, 9.95 ±2.30 and 8.53 ±2.10, respectively. Overall, we found a significant difference (p = 0.02) in the knowledge scores between the groups, and pairwise comparisons showed that there was a significant difference (p = 0.03) in the knowledge scores between dental specialists and dental assistants.

CONCLUSIONS

These findings suggest that hospitals should conduct mandatory workshops, training sessions and seminars to raise the awareness of the novel coronavirus pandemic and disinfection protocols, not only for specialists, but for all staff members.

Cephalometric predictors for optimal soft tissue profile outcome in adult Asian class I subjects treated via extraction and non-extraction. A retrospective study

OBJECTIVE

The aim of this retrospective study was to identify cephalometric predictors associated with favourable soft tissue profile outcomes after premolars extraction and non-extraction in class I malocclusion subjects.

MATERIALS AND METHODS

A total of 80 subjects, treated with non-extraction and premolars extraction (40 subjects each), were equally divided into favourable (FG) and unfavourable (UFG) groups using subjective and objective soft tissue profile outcome assessment methods. An independent t-test was utilized for the comparison of cephalometric measurements between the non-extraction (NE) and premolars extraction (PME) treatment modalities. Cox proportional hazard algorithm regression analysis was performed to identify cephalometric factors associated with favourable soft tissue outcomes.

RESULTS

The pre-treatment mean age of the NE group was 20.2±2.3 and PME group was 20.2±2.5 years. After dividing the sample of the NE and PME groups according to subjective and objective soft-tissue outcome assessment criteria, FG and UFG consisted of 20 subjects each. Cox proportional hazard algorithm regression analysis found upper incisor to NA angle (95% CI: 1.033, 1.196) to be associated with FG in NE and upper incisor to SN (95% CI: 1.018, 1.206) and ANB angle (95% CI:1.165, 3.608) in PME. There was a statistically significant strong correlation between subjective and objective evaluation methods (P≤0.001).

CONCLUSIONS

Cephalometric analysis is a valuable tool to predict soft-tissue outcomes after NE and PME. Increased upper incisors inclinations at the start of NE treatment result in favourable soft tissue profile outcomes. Slightly convex profile and proclined maxillary incisors are the predictors of favourable soft tissue profile outcome after PME. There was a statistically significant association between subjective and objective evaluation criteria of soft tissue outcomes.

Stress and anxiety among dental practitioners during the COVID-19 pandemic: A cross-sectional survey

BACKGROUND

Dental professionals are at great risk of contracting coronavirus disease 2019 (COVID-19).

OBJECTIVES

The objectives of this study were to determine the levels of stress and anxiety among dental professionals, and to determine which dental procedures cause the greatest amount of stress and anxiety during the COVID-19 pandemic.

MATERIAL AND METHODS

This cross-sectional survey was conducted by requesting voluntary participation of dental healthcare workers through the authors' own e-form, which consisted of our self-developed questionnaire, the Perceived Stress Scale (PSS) and the Generalized Anxiety Disorder-7 scale (GAD-7). The simple and multiple linear regression analyses were used to assess the effect of dental procedures and other factors associated with stress and anxiety among the participants. A p-value ≤0.05 was considered statistically significant.

RESULTS

This survey included 85 participants (32 males, 53 females) with a mean age of 31.6 ±6.0 years. Significant associations were found between severe stress for scaling (p < 0.001; p < 0.001), complex fillings (p < 0.001; p < 0.001), root canal treatment (RCT) (p = 0.001; p = 0.007), crown and bridge work (p < 0.001; p < 0.001), denture work (p = 0.034; p = 0.001), third molar extractions (p < 0.001; p < 0.001), surgical procedures (p < 0.001; p = 0.001), and implant placement (p = 0.001; p = 0.022) and the PSS and GAD-7 scores, respectively.

CONCLUSIONS

Dental healthcare workers exhibit severe stress and anxiety associated with elective dental procedures. Dental emergencies should take precedence and elective dental treatment should be carried out with utmost caution, ensuring all protective measures. Psychological support for dental healthcare professionals should be made accessible.

The influence of incisor inclination and anterior vertical facial height on facial attractiveness in an Asian woman

INTRODUCTION

Orthodontic treatment can help improve facial attractiveness through the modification of factors affecting the soft tissue profile. The objectives of this study were to determine the impact of different maxillary incisal inclinations and lower anterior facial heights (at rest and with a smile) on the facial attractiveness of an Asian woman, as perceived by different panels of raters using visual analog scale (VAS) scores.

METHODS

A cross-sectional study was performed with 66 raters equally divided into 3 panels that consisted of general dentists, orthodontic residents, and laypersons. Raters assessed modified photographs of a subject with various incisor inclinations and lower anterior facial height/total anterior facial height (LAFH/TAFH) on lateral profile view. Modifications were made using Photoshop software (Adobe, San Jose, Calif). Subjective evaluations of facial attractiveness were performed by raters using VAS. Kruskal-Wallis test was used to compare VAS scores among raters. Mann-Whitney U test was applied to compare VAS scores between groups.

RESULTS

Significant differences in VAS scores were found among raters for -10° (P = 0.004) and -15° (P = 0.021) incisal inclinations. Significant differences were found in VAS scores for -8% LAFH/TAFH (P = 0.044) and 4% LAFH/TAFH with smile (P = 0.002).

CONCLUSIONS

Professionals preferred normal incisal inclinations to be the most attractive. General dentists found reduced facial height to be unattractive. Orthodontic residents and laypersons considered increased LAFH/TAFH to be most unattractive. Smile had a negative impact on VAS scores at extreme anterior facial height modifications.

Effectiveness of metronidazole gel and mobile telephone short-message service reminders on gingivitis in orthodontic patients

OBJECTIVES

To compare the effectiveness of metronidazole gel and mobile telephone short-message service (SMS) reminders on gingivitis in patients undergoing fixed orthodontic treatment.

MATERIALS AND METHODS

The trial was double blinded (patient and investigator), and only the clinical trial unit pharmacist was unblinded. Data were collected from patients undergoing fixed orthodontic treatment for at least 6 months. A total of 66 patients were randomly assigned to either 0.8% metronidazole gel (n = 22), SMS reminder and placebo gel (n = 22), or placebo (control) group only (n = 22). Gingival index (GI), bleeding index (BI), and orthodontic plaque index (OPI) were evaluated on several teeth at baseline (T0) and after 4 weeks (T1). Paired-sample t-tests were used to compare mean differences of indexes at T0 and T1 in the groups, and independent-sample t-tests were used to determine the effects of interventions compared with the controls.

RESULTS

Data from 64 patients were analyzed; there were 2 dropouts. There were statistically significant (P < .05) reductions in GI, BI, and OPI scores from T0 to T1 for each intervention. However, there were no significant differences between each intervention and the control group. There were no adverse effects.

CONCLUSIONS

The null hypothesis could not be rejected. There is no difference between interventions (application of 0.8% metronidazole gel and SMS reminder for reinforcing oral hygiene) in reducing gingival inflammation in orthodontic patients.

Assessment of cooperation and compliance in adult patients at three stages of orthodontic treatment at a tertiary care hospital: A cross-sectional study

OBJECTIVE

The study was conducted to assess cooperation and compliance in adult orthodontic patients during the leveling and alignment, space closure/molar correction and finishing stages of orthodontic treatment.

MATERIALS AND METHODS

This cross-sectional study was conducted on adult patients undergoing fixed orthodontic mechanotherapy in a tertiary care hospital. Patient cooperation was assessed during orthodontic treatment stages using Orthodontic Patient Cooperation Scale (OPCS) and compliance by Clinical Compliance Evaluation (CCE) form. A sample size of 38 subjects was included for each stage of treatment; therefore, a total of 114 subjects were recruited for the study. Shapiro-Wilk test identified that the data were normally distributed. One way ANOVA was used to evaluate the percentage cooperation and compliance among three stages. Pair-wise comparisons among the three stages were performed using Post hoc Tukey test. Simple and multiple linear regression analysis were carried out to see the factors associated with cooperation and compliance.

RESULTS

A statistically significant difference was seen for scores of patient cooperation and compliance using CCE (P=0.01); however, the results of the OPCS were non-significant among the three stages of treatment (P=0.16). There was a significant difference in patient cooperation and compliance between space closure/molar correction and finishing stage (P=0.01). A highly significant decline in oral hygiene was found with the progression of orthodontic treatment, from space closure/molar correction to the finishing stage of treatment (P<0.001).

CONCLUSIONS

Improvement in the cooperation and compliance levels for adult orthodontic patients was observed during the space closure/molar correction stage, which then showed a decline as the treatment progressed. Maintenance of oral hygiene was gradually reduced with the progression of orthodontic treatment.

Effect of class II extractions and functional appliance treatment on smile esthetics

BACKGROUND

Class II malocclusion is routinely observed in orthodontics. Its treatment usually revolves around the growth modification or the extractions of the teeth. Identifying treatment that leads to the greatest improvement can aid clinicians in providing the desired smile esthetics.

OBJECTIVES

The aim of the study was to compare smile esthetics between treatment groups by measuring various smile variables and the esthetic perceptions of 3 panels of raters.

MATERIAL AND METHODS

A cross-sectional study was performed on 66 patients equally divided into the functional appliance (FA) and upper first premolar extraction (UPE) groups. Eight smile variables were measured on post-treatment photographs using the Adobe Photoshop® software. Ten orthodontic residents, general dentists and laypersons performed the subjective evaluations of smiles using the visual analog scale (VAS). The Mann-Whitney U-test was applied to compare smile variables between the groups. The Kruskal-Wallis test was used to compare esthetic scores (ES) among the raters. The simple linear regression analysis, followed by the multiple linear regression analysis was applied to determine the smile variables associated with the ES values.

RESULTS

Statistically significant differences were found between the FA and UPE groups for the buccal corridor ratio (BCR) (p = 0.046), the visible dentition width ratio (VDWR) (p = 0.019) and the arch form index (AFI) (p < 0.001). The Kruskal-Wallis test showed significant differences in ES among the raters for the FA (p < 0.001) and UPE (p = 0.004) groups. The simple linear regression analysis showed significant associations between ES and the patient's age (p = 0.002), BCR (p = 0.020) and VDWR (p = 0.006). The multiple linear regression analysis showed that age (p = 0.008) and VDWR (p = 0.021) were significantly associated with the ES values.

CONCLUSIONS

The FA group had narrower buccal corridor spaces, a greater visible dentition width and a wider arch form in their smiles. The UPE group showed an increase in the buccal corridor width. Each panel rated the FA appliance group as superior.

Factors affecting changes in soft tissue profile after various treatment modalities for skeletal Class II malocclusion: A cross-sectional study

INTRODUCTION

Various treatment modalities are used to treat skeletal Class II malocclusion with different effects on the soft tissue. This study was aimed to determine factors affecting changes in soft tissue profile after various treatment modalities for skeletal Class II malocclusion.

MATERIALS AND METHODS

A cross-sectional study was conducted using pre-treatment and post-treatment lateral cephalograms of 141 subjects. The sample consisted of 47 patients treated with Clark's Twin Block, 47 with first premolar extractions, and 47 with Class II elastics. The post-treatment cephalograms were superimposed on pre-treatment radiographs using stable landmarks: anterior wall of sella turcica and anterior cranial base. The changes in profile were evaluated by paired t-test using X-Y co-ordinate system. Changes in profile were predicted by using multi-variable linear regression analysis. Level of significance was kept at P≤0.05.

RESULTS

The changes in soft tissue profile were statistically significant for all the landmarks (P<0.001) of nose, upper and lower lip, and chin in horizontal and vertical direction, except subnasale and labrale superius in the horizontal direction. The soft tissue profile changes can be predicted for all landmarks with various prediction powers except pronasale, subnasale, and inferior labial sulcus in the vertical direction.

CONCLUSIONS

Almost all the soft tissue landmarks of nose and lower third of the face exhibit downward and forward movement. The changes in the upper lip in both horizontal and vertical directions were found to be more predictable than those occurring in the lower lip.

Predicting the bracket bond failure rate in orthodontic patients: A retrospective cohort study

The aim of this study was to determine the risk factors associated with orthodontic bracket bond failure and to develop a prediction equation for orthodontic bracket bond failure rate using the risk factors. This was a retrospective cohort study conducted on a sample of 690 brackets in orthodontic patients aged 10 to 28 years old (mean age 17.97±5.11 years old) visiting a dental hospital. The effect of various parameters of orthodontic bond strength was assessed on bracket failure rate using survival analysis. Parametric (exponential) regression analysis was used to determine the risk factors associated with bracket failure and a prediction equation was formulated to predict the bracket failure rate. The overall mean survival time for the brackets was 3.04 (2.9-3.17) years. The univariate analysis showed a statistically significant (P<0.05) association of bracket material, site, overjet, overbite, incisor and molar classification and age. The multivariate analysis showed a significant interaction between site and side along with bracket material, jaw, overjet and overbite in the model. The risk of bracket failure on the right posterior region is 7.7 times that in the right anterior region when adjusted for all other variables in the model (HR: 7.7; 95% CI: 4.3-13.6). The model including bracket material, jaw, overjet, overbite and interaction between site and side can be used as a predictor of hazard rate for orthodontic bracket failure. Care should be taken in bonding brackets in the posterior region, as their debonding rate is higher as compared to anterior region.

Does periodontally accelerated osteogenic orthodontics improve orthodontic treatment outcome? A systematic review and meta-analysis

BACKGROUND

Periodontally accelerated osteogenic orthodontics (PAOO) can be used to improve periodontal conditions and accelerate tooth movement.

OBJECTIVE

The aim of this systematic review and meta-analysis was to compare periodontal outcome and treatment duration of patients undergoing PAOO to accelerate orthodontic treatment.

SEARCH METHOD

An electronic search was performed in four electronic databases including Pubmed, EBSCO Cochrane library, CINAHL Complete for randomized clinical trials till November 2017. A hand search was performed on clinicaltrials.gov and Google scholar.

SELECTION CRITERIA

Randomized controlled trials reporting periodontal outcomes and treatment duration of PAOO in adult patients by evaluating treatment duration, root resorption, bone density and pocket depths were included.

DATA COLLECTION AND ANALYSIS

Two authors conducted searches, data extraction and bias assessment with conflict resolution with a third author. Cochrane's tool for risk of bias assessment was used for evaluation. A manual search was conducted for additional studies. A quantitative synthesis of the pooled results was conducted.

RESULTS

Five studies were included in the qualitative synthesis and two in the quantitative synthesis. A total of 56 patients underwent the PAOO technique; the effects of this therapy were compared with 21 patients who underwent corticotomy, 9 underwent non-extraction comprehensive orthodontic treatment and 15 underwent fixed mechanotherapy with extractions of first premolars. A random effect model was used for pocket depths and showed a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, -0.03; 95% CI, -0.16, 0.09). Bone density elucidated a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, 27.69; 95% CI, -2.29, 57.67). Fixed effect model was used for root length which revealed a non-significant difference between bioactive glass augmented corticotomy and corticotomy alone (weighted mean difference, 0.01; 95% CI, -0.00, 0.02).

CONCLUSIONS

Studies showed significant improvements in periodontal health. Treatment duration was reduced in patients who underwent PAOO. Root resorption was not sufficiently evaluated by current literature.

Correlation between radiographic parameters for the prediction of palatally impacted maxillary canines

Objective:

This study aimed to identify radiographic parameters on routine orthopantomograms to aid in early diagnosis of palatally impacted canines.

Design:

Split-mouth case-control study.

Setting:

Single-centre university dental hospital.

Methods:

Thirty-three individuals with palatally impacted canines and non-impacted contra-lateral teeth were recruited. Radiographic variables angle A, angle B, angle C, distance D, sector class and depth of vertical impaction were measured for both groups. Mann–Whitney U test and Spearman’s correlation coefficient were used to analyse significant differences and association between variables with sector class and depth of vertical impaction, respectively. Logistic regression analysis determined radiographic parameters as predictors of palatal impaction.

Results:

Significant differences were seen between sector class, depth of vertical impaction and the radiographic parameters between cases and controls ( P ⩽ 0.001). For cases, strong correlation was found for angle C between the impacted canine and occlusal plane (r = −0.28, P = 0.022) and perpendicular distance D of impacted canine to the occlusal plane (r = 0.81, P ⩽ 0.001) with the depth of vertical impaction. Logistic regression analysis showed the odds of canine impaction increase with an increase in angle B and angle C.

Conclusions:

Our study showed that greater depth of vertical impaction, sector class, increased perpendicular distance and reduced angulation from occlusal plane resulted in palatal impaction of permanent maxillary canines. The odds of palatal canine impaction increase nearly twofold with every 10 increase in angle B and angle C.

Chin Position: to treat or not to treat

This study was conducted to compare the mean preference scores for orthodontic treatment need, considering the chin position, amongst orthodontists, orthodontic patients and their parents. Male and female profile silhouettes were prepared by changing their chin prominence using Adobe Photoshop 7 with zero degree meridian as line of reference. Rating of these silhouettes was done by the three groups of raters (orthodontists, orthodontic patients and their parents) on a scale of four with one being no need of treatment and four being severe need of treatment. There was a statistically significant difference seen amongst orthodontists and the orthodontic patients and also amongst the orthodontist and the orthodontic patient's parents for the 2mm and 4mm chin position with orthodontists scoring a higher need of treatment as compared to the patients and parents.

Nasolabial angle: a perception of treatment needs

The nasolabial angle holds a very important position in the treatment planning process for an orthodontic case, especially in today's soft tissue paradigm. This study was therefore conducted to compare the mean preference scores for orthodontic treatment need considering the nasolabial angle among orthodontists, orthodontic patients and their parents.

Esthetic preferences for facial soft tissue profiles

Our aim was to determine any significant difference in esthetic preferences for facial soft tissue profiles among orthodontists, orthodontic patients and their parents. As orthodontic treatment influences facial profiles, the patients' preference for their profile should be sought before treatment, instead of assuming what the orthodontist feels is ideal.