Amit Prakash

Pendulum Therapy of Molar Distalization in Mixed Dentition.

ABSTRACT Early and timely pedo-orthodontic treatment is aimed at eliminating the disturbances of skeletal or dentoalveolar development, to harmonize the stomatognathic system before the full eruption of all permanent teeth. The advantages of pendulum appliance are its minimal dependence on patient’s compliance (child cooperation), ease of fabrication, onetime activation and adjustment of the springs if necessary to correct minor transverse and vertical molar positions. This article reports a successful treatment method of class II malocclusion with pendulum appliance in mixed dentition phase. Distalization of maxillary molar was done, followed by guidance of canine impaction orthodontically and other dental correction using 0.022 MBT appliances. Posttreatment results were stable and remarkable. How to cite this article: Patil RU, Prakash A, Agarwal A. Pendulum Therapy of Molar Distalization in Mixed Dentition. Int J Clin Pediatr Dent 2016;9(1):67-73.

The effectiveness of pendulum, K-loop, and distal jet distalization techniques in growing children and its effects on anchor unit: A comparative study

Background: A common strategy to correct Class II malocclusions using a nonextraction protocol in children is to move the maxillary molars distally using molar distalization appliances, which usually derive their anchorage from maxillary premolars, causing mesialization of premolars and protrusion of incisors. Objectives: To evaluate the skeletal, dental and soft tissue changes produced by three different distalizing appliances, namely, pendulum, K-loop, and distal jet appliances. Materials and Methods: Sixty-six children of mean age 14.13 years requiring molar distalization were divided into three groups: Group I (pendulum appliance), Group II (K-loop), and Group III (distal jet). Lateral cephalometric films were taken before and after 5 months of molar distalization and following cephalometric parameters were used to assess the effects of maxillary molar distalization, namely, anteroposterior skeletal (SNA/SNB/ANB), vertical skeletal (face height ratio/Frankfort-mandibular plane [FMA]/angle formed between Maxillary plane & Mandibular plane (MM)), interdental (overjet/overbite), maxillary dentoalveolar, and soft tissue parameters. Results: There was no significant age difference between the three groups. In overall treatment changes among the three groups, the Anteroposterior skeletal changes were not statistically significant, vertically FMA angle increased by 1.79° ± 2.25° and overbite reduced by 2.38 ± 1.83 mm. The maxillary first molars were distalized by an average of 4.70 ± 3.01 mm (Upper 6 [U6] to pterygoid vertical [PTV]). The maxillary central incisor labial tipping increased to an average of 1.61 ± 2.73 mm and cant of upper lip increased by 3.40° ± 5.88° are statistically significant (P < 0.05). Conclusion: All three distalization techniques in growing children produced significant effects on anchor unit. There was an increase in FMA angle, significant bite opening, proclination of the maxillary incisors and increase in the cant of the upper lip.

Comparison of Stresses generated by Different Bracket Debonding Forces using Finite Element Analysis

The purpose of the study is to evaluate the stresses generated at bracket-cement and the tooth continuum by different bracket debonding techniques commonly used in orthodontic clinic. Materials and methods: Peeling, twisting and masticatory force of one Newton was applied on the finite element model of bracket-cement and the tooth assembly and the principle stresses were obtained through the ANSYS software. The validated three-dimensional finite element model of the bracket-cement-tooth system constructed for the study consisted of 40,536 nodes and 49,201 finite elements. Results: The results showed that the debonding stresses generated by masticatory and twisting forces were 4.781 MPa and 4.140 MPa respectively on enamel, whereas peeling force produced 3.480 MPa stress on the enamel.

A new stent for miniscrew implant placement

Abstract In recent years mini implants have added new horizons in clinical orthodontics. However, the success of miniscrew implant is mostly dependent on the placement accuracies in horizontal and vertical direction. To fulfill this goal the article introduces a new innovation – the TNA (Tarulatha, Nitin, Amit) stent. This particular stent with multiple loops in both horizontal and vertical arm will guide the clinician in choosing the right location with the abundant bone for the secure and safe implant placement. Vertical arm is of help in deciding the height of the implant placement in cases such as deep bite where the implant needs to be placed high. Other striking feature is of the occlusal guide arm for deciding the X-ray direction. Multiple use of this stent which can be constructed chair side makes it unique in the crowd of implant guiding stents.

Miniscrews-assisted Lacebacks in Forsus to Minimize Lower Incisor Proclination

Forsus is a Class II corrector appliance used in growing as well as in young adults. Proclination and forward movement of lower incisor is the major drawback reported using this appliance. Forsus results in Class II correction mainly through dentoalveolar effect and minimal skeletal effect. We used a new innovation incorporating miniscrew assisted laceback to minimize lower incisor proclination. Utilization of miniscrew assisted laceback effectively reduces the unfavorable proclination and allows additional skeletal effects. This method applies a distal driving force on the lower anteriors, which minimizes lower incisor proclination. It is proven to be effective method in controlling the lower incisor flaring.

Enigma of Fixed Retainers

Fixed retainers are a reliable form of retention for avoiding relapse and maintaining dental arch shape. They function regardless of patient cooperation, and they fulfill high esthetic expectations. Teeth have tendency to return to their former position, as time required for retaining the treatment result. The most appropriate mode of retention for the post-treatment situation should be used, based on a careful evaluation of the patient’s pretreatment diagnostic records, habits, cooperation, growth pattern, and age. Retention after orthodontic intervention is as important part of the therapy as the active treatment. Age and maturity of the patients, result of the orthodontic intervention, origin and character of the anomaly, type of the retainer, compliance of the patients; all can influence the chance of relapse. The retention period should be twice longer than the active orthodontic treatment. This article covers various aspect of fixed retention in detail

Evaluation of skeletal maturation in Indian adolescents using calcification stages of permanent mandibular second molar

Aim: The aim of this study was to investigate the relationships between the stages of calcification of teeth (permanent mandibular second molar) and cervical vertebrae maturation (CVM). Materials and Methods: This study was conducted on 200 Indian children (98 boys and 102 girls), whose panoramic radiographs (orthopantomogram) for mandibular second molar tooth calcification stages and visual appraisals of the lateral cephalograms for CVM stages, were recorded using Demirjian Index (DI) and CVM indicator (CVMI). Results: Each stage appeared earlier in female participants than males. A highly significant association was found between DI and CVMI. Stage F and G of DI, which corresponds to Stage 3 of CVMI indicated the start of the peak in mandibular growth, which would be appropriate time to plan for growth modification appliance placement. Stage G of DI also corresponds to Stage 4 of CVMI, i.e., deceleration of adolescent growth spurt. Stage H of DI corresponding to CVMI Stages 5 and 6 indicates that the peak of mandibular growth has already occurred and is not appropriate for functional appliances. Conclusion: Mandibular second molar calcification stages are reliable skeletal maturity indicators for the evaluation of growth phases in children.

Efficacy of probiotic lozenges to reduce Streptococcus mutans in plaque around orthodontic brackets

Background: Probiotics were defined as live microorganisms which when administered in adequate amounts confer a health benefit on the host. The aim was to evaluate the effect of the application of probiotic lozenge on the Streptococcus mutans levels in the plaque of orthodontic patients. Materials and Methods: A sample of 30 randomly selected patients (14 females and 16 males) having orthodontic treatment were selected for the study. They were divided into two groups of 15 each. One group of patients (Group 2) was given the probiotic (Lactobacillus brevis CD2) lozenges, and the other group (Group 1) was given the placebo lozenges. The lozenges were administered to the patients from day 1 after the first plaque sample had been assessed and continued until day 30. Plaque samples were again taken and evaluated at the end of day 30. The samples were placed into individual microcentrifuge tubes with anonymous coding and sealed for transport for real-time polymerase chain reaction to the 3B Blackbio Biotech India Ltd., Bhopal, India. Results: After the use of the probiotic lozenges, 14 of 15 subjects in Group 2 showed reduction in the S. mutans levels; in two subjects, there was no detectable S. mutans after 30 days. In Group 1 after use of placebo, 3 out of 15 patients showed a decrease in S. mutans levels. Conclusion: This indicates that daily short-term ingestion of a Lactobacilli brevis derived probiotic through a lozenge tablet could reduce the levels of S. mutans in plaque around orthodontic brackets.

Cone Beam Computed Tomography – Applications in Orthodontics

As the beam covers the entire region of interest, x ray source makes one pass or less around the patient’s head, when acquiring images. The beam is captured on a two dimensional planar detector. The beam diameter ranges from 4 cm to 30 cm. The sensor captures from 159 to 600 basis images. These images then compute a spherical or cylindrical volume of the area. In this volume, the densities at all locations (voxels) are calculated from the basis images. Voxels are cuboids and can generate images in the axial, saggital and coronal planes. The processed volumetric data are exported from the CBCT manufacturer’s software as a Digital Imaging and Communications in Medicine (DICOM) files. From this data set operator can extract thick or thin, planar or curved reconstructions in any orientation. 1

Evaluation of dental age and associated developmental anomalies in subjects with impacted mandibular canines

OBJECTIVES To assess the null hypothesis that there is no difference in the rate of dental development and the occurrence of selected developmental anomalies related to shape, number, structure, and position of teeth between subjects with impacted mandibular canines and those with normally erupted canines. MATERIALS AND METHODS Pretreatment records of 42 subjects diagnosed with mandibular canines impaction (impaction group: IG) were compared with those of 84 subjects serving as a control reference sample (control group: CG). Independent t-tests were used to compare mean dental ages between the groups. Intergroup differences in distribution of subjects based on the rate of dental development and occurrence of selected dental anomalies were assessed using χ(2) tests. Odds of late, normal, and early developers and various categories of developmental anomalies between the IG and the CG were evaluated in terms of odds ratios. RESULTS Mean dental age for the IG was lower than that for the CG in general. Specifically, this was true for girls (P < .05). Differences in the distribution of the subjects based on the rate of dental development and occurrence of positional anomalies also reached statistical significance (P < .05). The IG showed a higher frequency of late developers and positional anomalies compared with controls (odds ratios 3.00 and 2.82, respectively; P < .05). CONCLUSIONS The null hypothesis was rejected. We identified close association of female subjects in the IG with retarded dental development compared with the female orthodontic patients. Increased frequency of positional developmental anomalies was also remarkable in the IG.