Ali Borzabadi-Farahani

Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children

The aim of this cross-sectional study was to determine the prevalence of malocclusions, occlusal traits, and their gender distribution in urban Iranian school children. Five hundred and two subjects (253 females and 249 males, aged 11-14 years) were examined. Molar relationship, overjet (OJ), overbite, midline deviation, crossbite, and crowding/spacing were recorded. Gender dimorphism was evaluated by the chi-square test. According to the classification of Angle, the prevalence of Class I, Class II division 1, Class II division 2, and Class III malocclusions was 41.8, 24.1, 3.4, and 7.8 per cent, respectively. Symmetric molar relationship was present in 69.5 per cent. An OJ of at least 3.5 mm or more was present in 28.1 per cent; an OJ of more than 6 mm in 3.6 per cent, and 4.2 per cent had a reverse OJ. A normal overbite was observed in 60.4 per cent, while 34.5 per cent had an increased and 2.2 per cent a very deep overbite. An anterior open bite (AOB) was present in 1.6 per cent and a scissor bite or anterior crossbite in 2 and 8.4 per cent, respectively. A posterior crossbite was observed in 12.4 per cent (8.4 per cent unilateral, 2 per cent bilateral, and 2 per cent in association with an anterior crossbite). Midline deviation was present in 23.7 per cent. Severe crowding (>or=5.1 mm) was observed in 16.7 and 10.8 per cent and spacing in 18.9 and 20.7 per cent of the maxillary and mandibular arches, respectively. Significant gender differences were found for overbite (P < 0.001), midline deviation (P < 0.05), and maxillary and mandibular arch crowding/spacing (P < 0.05). The prevalence of Class II malocclusions was comparable with Caucasians; however, the most severe forms of Class II malocclusions were rare in this Iranian population. The relative prevalence of Class III malocclusions in the present study was greater than in Caucasians. Crowding was the most common dental anomaly in both arches.

Labial Bone Thickness in Area of Anterior Maxillary Implants Associated with Crestal Labial Soft Tissue Thickness

Objective:To explore the relationship between implants labial bone thickness (ILBT) and crestal labial soft tissue thickness (CLSTT). Materials and Methods:This retrospective study used records of 32 (22 females and 10 males) patients who had 2 implants placed in their maxillary arch (64 implants; diameter range, 3.3–4.6 mm) between the canines at either maxillary lateral incisor (7 and 10) or central incisor (8 and 9) region. All patients had diagnostic and postoperative cone beam computed tomography scans; the ILBT at the crestal and midimplant levels were recorded. CLSTT was measured approximately 4 months after the placement of implants using a digital caliper at the crestal level. Results:Mean (standard deviation) CLSTT and ILBT at crestal and at midimplant levels were 2.45 (0.88), 1.79 (0.68), and 2.33 (1.01) mm, respectively. Overall, 26 implants had prior bone augmentation. Significant relationships between the CLSTT and ILBT at crestal (Spearmans rho = 0.720) and midimplant levels (Spearmans rho = 0.707) were observed (P < 0.001). The determination coefficients (R2) between CLSTT and ILBT at crestal and midimplant levels were 0.649 and 0.542, respectively. Following regression equations were produced: CLSTT = 1.043 * ILBT (crestal level) + 0.586 and CLSTT = 0.955 * ILBT (midimplant level) + 0.955. Conclusion:Based on this study, CLSTT and ILBT were highly associated in the anterior maxillary region.

Orthodontic Considerations in Restorative Management of Hypodontia Patients With Endosseous Implants

The use of implant-supported restorations in patients with hypodontia remains challenging and requires a multistage treatment that begins in late mixed dentition and continues into late adolescence. The aim of this article is to review the role of orthodontics in endosseous implant rehabilitation of patients with hypodontia. The MEDLINE, Web of Science, Scopus, Cochrane databases, and necessary scientific textbooks were searched for relevant studies and reviews, and as far as possible, they were only included if they had been cited at least once in the literature. Dental implants are susceptible to overloading as the periodontal ligament is absent and the proprioceptive nerve endings are either lacking or very limited. Patients with hypodontia may present with skeletal features such as short and retrognathic maxilla, prognathic mandible, and shorter lower anterior facial height, and they sometimes need orthognathic correction as part of their overall treatment. Dental problems vary and include bimaxillary retroclination of incisors, spacing, centerline discrepancies, microdontia, hypoplastic enamels, ankylosis of the retained primary teeth, overeruptions, and volume deficiencies of alveolar ridges. The challenges mentioned, as well as bone volume deficiencies, compromise the successful placement of implants. Orthodontic strategies and techniques, such as uprighting mechanics, extrusion/intrusion, delayed space opening, and orthodontic implant site-switching, can be used to create, preserve, or augment the implant site. After orthodontic site development, the final planned position of the teeth should be maintained with a rigid bonded retainer; overlooking this stage may compromise the implant site and require orthodontic retreatment.

Association between orthodontic treatment need and caries experience.

Abstract Objective. To investigate the association between orthodontic treatment need (OTN) and caries experience (CE). Subjects and methods. Using a stratified sampling method, 748 subjects (355 females, 393 males; mean ± standard deviation age 15.11 ± 2.23 years) were examined. The Dental Aesthetic Index (DAI), DMFT, simple (DMFT > 0) and severe CE (DMFT > 8) were recorded. Socio-economic status (SES) was assessed by recording parental education, mothers employment status, and household size. Results. Higher (but not statistically significant) CE was observed in subjects with OTN (DAI > 30). The association between DAI and DMFT scores was not significant (rho = 0.05). Mean DMFT score did not vary significantly between the SES and OTN subgroups. In children with a household size >6 persons (n = 85), OTN was associated with higher CE and a higher prevalence of severe CE compared with those without OTN. In this group, when DAI treatment need grade increased, severe CE prevalence also increased from 10.8% to 50%. Similarly, in those with OTN and household size >6 persons, the odds of observing subjects with severe CE was 4.6 times higher (95% confidence interval 1.45–14.55) compared to those without OTN. Conclusions. Associations were observed between OTN and CE and also between the prevalence of severe CE and the severity of malocclusion in children with a household size >6 persons. The current findings suggest that the relationship between caries experience and malocclusion should be assessed in a wider context of SES and background factors.

An insight into four orthodontic treatment need indices.

Occlusal indices have been introduced and used to rank or categorize the occlusion. According to Dr. William Shaw and colleagues (1995), there are five types of occlusal indices, diagnostic, epidemiologic, orthodontic treatment need, orthodontic treatment outcome, and treatment complexity indices. Orthodontic treatment need indices are used to rank the malocclusion. They were devised to minimize the subjectivity associated with the diagnosis, referral and complexity assessment of malocclusion. Some are also multifunctional and used to assess the outcome of orthodontic treatment. The overall aim of the present article is to provide an overview on four commonly used American and European orthodontic treatment need indices, review their modifications, advantages, and limitations. These indices are the Index of Orthodontic Treatment Need (IOTN), the Dental Aesthetic Index (DAI), the Handicapping Labio-Lingual Deviation index (HLD), and the Index of Complexity, Outcome and Need (ICON).

A review of the oral health-related evidence that supports the orthodontic treatment need indices

BACKGROUND AND OBJECTIVES To date, there is no evidence-based method of quantification for malocclusion. Consequently, how deviant occlusal traits should be scored and weighted relative to one another is a matter of serious debate. Orthodontic Treatment Need Indices (OTNI) use the subjective opinion of the experts, as their foundation, to define the pathological boundaries (cut-offs) of occlusal traits. This paper reviews the evidence relating malocclusions or deviated occlusal traits to oral health problems, and investigates if this evidence supports the cut-off points and the rationale used for OTNI. MATERIALS AND METHODS The relevant cited studies and reviews from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar. RESULTS So far, the evidence for harmful effects of deviated occlusal traits on oral health is either lacking or exists as cross-sectional (mostly) and longitudinal (a few and primarily short-term) studies. When an association was reported between a deviated occlusal trait and an oral health problem, either the strength of that association was weak, or due to methodological issues, findings were not conclusive. Consequently, establishing a cause and effect relationship is difficult. Further, commonly used OTNI do not record a full spectrum of occlusal traits, and relating their ranking or scoring systems to the available evidence is difficult. Therefore, there is little evidence to suggest that individuals with a high need (high score), as measured by OTNI, will necessarily put at risk their oral health if they turn down orthodontic therapy. CONCLUSION OTNI have a role in the epidemiology and can be used for resource planning, but their predictive value to detect the future objective functional deficits or oral health problems is questionable. OTNI will need revalidation over time with emerging research findings.

A review of the evidence supporting the aesthetic orthodontic treatment need indices

OBJECTIVES Aesthetic improvement and psychological enhancement have been cited as justifications for orthodontic treatment. This paper reviews the evidence that relates malocclusion to psychological health and quality of life and explores whether this evidence supports the most commonly used aesthetic Orthodontic Treatment Need Indices (OTNI). MATERIALS AND METHODS The relevant cited material from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar. RESULTS The subjective nature of aesthetic indices and the variable perception of attractiveness between clinicians and patients, and among various cultures or countries are a few limitations of aesthetic OTNI. The available evidence of mainly cross-sectional studies on the link between malocclusion and either psychosocial well-being or quality of life is not conclusive, and sometimes contradictory, to suggest these characteristics are affected by malocclusions. Further, the long-term longitudinal studies did not suggest that people with malocclusion are disadvantaged psychologically, or their quality of life would be worse off, which challenges using aesthetic OTNI to assess the social and psychological implications of malocclusion. CONCLUSION The subjective nature of aesthetic OTNI and the minor contributory role of malocclusion in psychosocial health or quality of life undermine using aesthetic indices to assess the likely social and psychological implications of malocclusion. Consequently, using aesthetic OTNI, as a method to quantify malocclusion remains open to debate. Various soft and hard-tissue analyses are used before formulating a treatment plan (i.e., assessment of sagittal and vertical skeletal relationships). The addition of a shortened version of these analyses to the aesthetic OTNI can be a good substitute for the aesthetic components of OTNI, if an assessment of the aesthetic aspects of malocclusion is intended. This reduces subjectivity and improves the validity of the OTNI that incorporate an aesthetic component.

Nanoparticles in orthodontics, a review of antimicrobial and anti-caries applications

Abstract Nanoparticles (NPs) are insoluble particles smaller than 100 nm in size. In order to prevent microbial adhesion or enamel demineralization in orthodontic therapy, two broad strategies have been used. These are incorporating certain NPs into orthodontic adhesives/cements or acrylic resins (nanofillers, silver, TiO2, SiO2, hydroxyapatite, fluorapatite, fluorohydroxyapatite) and coating surfaces of orthodontic appliances with NPs (i.e. coating bracket surfaces with a thin film of nitrogen-doped TiO2). Although the use of NPs in orthodontics can offer new possibilities, previous studies investigated the antimicrobial or physical characteristic over a short time span, i.e. 24 hours to a few weeks, and the limitations of in vitro studies should be recognized. Information on the long-term performance of orthodontic material using nanotechnology is lacking and necessitates further investigation and so do possible safety issues (toxicity), which can be related to the NP sizes.

Agreement between the index of complexity, outcome, and need and the dental and aesthetic components of the index of orthodontic treatment need

INTRODUCTION This was a cross-sectional study to investigate the agreement between assessments of orthodontic treatment need of the index of complexity, outcome, and need (ICON) and the index of orthodontic treatment need (IOTN). METHODS Five hundred two subjects (253 girls, 249 boys; ages, 11-14 years) participated in this study, including a few who were wearing an orthodontic appliance (1 girl, 5 boys). ICON scores and the aesthetic (AC) and dental health components (DHC) of the IOTN were recorded in those not undergoing treatment. The percentages of subjects needing treatment (ICON score >43) and the different complexity components of ICON were compared between the sexes. Observed percentages of agreement and kappa statistics were used to analyze the agreement between the AC and DHC of the IOTN and also the ICON, and the DHC and AC of the IOTN dichotomized into a yes or no categories of orthodontic treatment need. RESULTS No sex differences were found between male and female subjects for treatment need (ICON score >43; P >0.05) and treatment complexity (P >0.05). The kappa statistic for diagnostic agreement between the DHC and AC of the IOTN was 0.55 (95% CI, 0.48-0.63). The kappa statistics for diagnostic agreement between the ICON and the AC and the DHC of the IOTN were 0.40 (95% CI, 0.33-0.46) and 0.78 (95% CI, 0.73-0.83), respectively. The observed agreement between the DHC and the AC of the IOTN was 81.8%. The observed agreement between the ICON and AC and DHC of the IOTN were 71.3% and 89.5%, respectively. CONCLUSIONS In terms of orthodontic treatment need, there was moderate agreement between the ICON and the AC (IOTN), and between the DHC and the AC. There was good agreement between the ICON and the DHC of the IOTN. The ICON is a good substitute for the DHC of the IOTN.

An investigation into the association between facial profile and maxillary incisor trauma, a clinical non-radiographic study.

OBJECTIVES To explore the association between maxillary incisor trauma (MIT) and facial skeletal forms (sagittal and vertical), overjet (OJ), lip coverage, and gender. SUBJECTS AND METHODS Five hundred and two subjects (253 females and 249 males, aged 11-14 years) were examined. Sagittal (Class I, II or III) and vertical skeletal pattern (average, increased or decreased Frankfort-Mandibular Plane Angle (FMPA)) were recorded. Samples were categorized into four groups according to OJ severity: OJ ≤ 3.5 mm, 3.5 mm < OJ ≤ 6.0 mm with competent lips, 3.5 mm < OJ ≤ 6.0 mm with incompetent lips and OJ > 6 mm. Samples were also subdivided into two groups: OJ ≤ 3.5 mm and OJ > 3.5 mm. Chi-square test was performed to determine any gender differences in trauma experience. Logistic regression was performed to test for any differences in risk of MIT in different groups, and to estimate the predictive value of facial skeletal pattern (sagittal), FMPA, gender, OJ, and lip competence for MIT. RESULTS Nine percent had incisor trauma (8.4% MIT). Boys had greater odds of receiving MIT than girls (OR = 2.16; 95% CI, 1.11-4.21). Subjects with Class II skeletal patterns had greater odds of MIT than those with Class I skeletal patterns (OR = 3.98; 95% CI, 1.98-8.00). Subjects with decreased FMPA had greater odds of MIT than subjects with average FMPA (OR = 4.55; 95% CI, 2.28-9.06). Lip competence was not associated with MIT (P > 0.05). Subjects with OJ > 3.5 mm had greater odds of MIT than subjects with OJ ≤ 3.5 mm (OR = 2.83; 95% CI, 1.49-5.37). CONCLUSION Compared with children with normal OJ (≤3.5 mm), Class I skeletal pattern (Straight profile) and average FMPA, the odds of MIT increased significantly in children with OJ > 3.5 mm (OR = 2.83), Class II skeletal pattern (OR = 3.98) and decreased FMPA (short face profile) (OR = 4.55), respectively.