Mc Wey

Condylar growth and mandibular positioning with stepwise vs maximum advancement

INTRODUCTION The aim of this study was to compare the effects of several Class II malocclusion treatments on condylar growth and positioning of the mandible. METHODS The material comprised series of lateral cephalograms obtained at the start, after about 6 months, and after about 12 months of treatment from 3 groups of consecutively treated patients who used a headgear-activator with stepwise mandibular advancement (HGA-S), a headgear-activator with maximum jumping of the mandible (HGA-M), and a headgear-Herbst appliance with stepwise advancement (HGH-S), respectively. Six-month growth data from matched controls were used to calculate the net treatment effects. RESULTS Mandibular prognathism was enhanced after stepwise advancement but not after maximum jumping, and only during the initial phase of therapy; the effect was significantly greater for the fixed functional appliance than for the removable functional appliance. Lower-facial height was increased by the HGA-S, unchanged by the HGA-M, and restrained by the HGH-S. The low construction bite of the HGH-S meant that the extent of bone apposition on the posterior and superior parts of the condyle was similar, whereas the high construction bite of the HGA-S and the HGA-M meant that the effect on the superior part was greater, but only significantly so after stepwise advancement. CONCLUSIONS The mode of jumping, the vertical opening, and whether the functional appliance is fixed or removable affect the amount and pattern of condylar growth, and the position of the mandible.

The oral health of people with chronic schizophrenia: A neglected public health burden.

Objective: People with chronic schizophrenia have high rates of physical ill-health such as heart disease. However, there has been less attention to the issue of poor oral health including dental caries (tooth decay) and periodontal (gum) disease, although both have consequences for quality of life and systemic physical health. We therefore measured tooth decay and gum disease in Malaysians with schizophrenia. Methods: We recruited long-stay inpatients with schizophrenia from June to October 2014. Four dental specialists assessed oral health using the decayed–missing–filled teeth index, the Community Periodontal Index of Treatment Needs and the Debris Index of the Simplified Oral Hygiene Index. Results were compared with the 2010 Oral Health survey of the general Malaysian population. Results: A total of 543 patients participated (66.7% males, 33.3% females; mean age = 54.8 years [standard deviation = 16.0]) with a mean illness duration of 18.4 years (standard deviation = 17.1). The mean decayed–missing–filled teeth was 20.5 (standard deviation = 9.9), almost double that of the general population (11.7). Higher decayed–missing–filled teeth scores were associated with both older age (p < 0.001) and longer illness duration (p = 0.048). Only 1% (n = 6) had healthy gums. Levels of decay and periodontal disease were greatest in those aged between 45 and 64 years, coinciding with the onset of tooth loss. Conclusion: Dental disease in people with schizophrenia deserves the same attention as other comorbid physical illness. The disparity in oral health is most marked for dental decay. Possible interventions include oral health assessments using standard checklists designed for non-dental personnel, help with oral hygiene, management of iatrogenic dry mouth and early dental referral.

Anthropometric Study of Three-Dimensional Facial Morphology in Malay Adults

Objectives To establish the three-dimensional (3D) facial soft tissue morphology of adult Malaysian subjects of the Malay ethnic group; and to determine the morphological differences between the genders, using a non-invasive stereo-photogrammetry 3D camera. Material and Methods One hundred and nine subjects participated in this research, 54 Malay men and 55 Malay women, aged 20–30 years old with healthy BMI and with no adverse skeletal deviation. Twenty-three facial landmarks were identified on 3D facial images captured using a VECTRA M5-360 Head System (Canfield Scientific Inc, USA). Two angular, 3 ratio and 17 linear measurements were identified using Canfield Mirror imaging software. Intra- and inter-examiner reliability tests were carried out using 10 randomly selected images, analyzed using the intra-class correlation coefficient (ICC). Multivariate analysis of variance (MANOVA) was carried out to investigate morphologic differences between genders. Results ICC scores were generally good for both intra-examiner (range 0.827–0.987) and inter-examiner reliability (range 0.700–0.983) tests. Generally, all facial measurements were larger in men than women, except the facial profile angle which was larger in women. Clinically significant gender dimorphisms existed in biocular width, nose height, nasal bridge length, face height and lower face height values (mean difference > 3mm). Clinical significance was set at 3mm. Conclusion Facial soft tissue morphological values can be gathered efficiently and measured effectively from images captured by a non-invasive stereo-photogrammetry 3D camera. Adult men in Malaysia when compared to women had a wider distance between the eyes, a longer and more prominent nose and a longer face.

The safety zone for mini-implant maxillary anchorage in Mongoloids.

Result: The study revealed 4.84% of the students were free of caries while caries prevalence is 95.16% which is very high and coincide when comparing it to control group from other study in the same area. The mean of DMFT/dmft is low 0.24/0.59 that is may be due to various reasons ranging from biochemical differences in salivary buffering to differences in living environment, dietary and hygiene habits. This study revealed insignificant between neither the mean of DMFT/dmft for both gender Male & Female 0.24/0.57 and 0.24/0.65 nor the mean of plaque index 1.5/1.33 respectively. Also the age group distribution was insignificant. Among Survey 93.7% agree with role of sugar in leading to caries while 3.1% disagree & 3.1% they don’t know. There was 85.9% who do brush their teeth and 14.1% don’t. There was 87.5% agree with that brushing will prevent caries but 9.47% they did not agree. For the method of brushing it was found that 93.2 % use tooth brush 3.4 % use fingers and 3.4% use Meswak .I condylar resorption (ICR) is a progressive disease that affects the temporomandibular joint area with a change in condylar shape and/or mass. Several theories to the development of this type of deformity exists which ultimately leads to condylar shrinkage and/or chronically dislocated non-reducing disc displacement. Predisposing factors such as sex, age, and malocclusion have all been linked to the occurrence of ICR. To properly diagnose a case, certain key elements must be present. Cases with ICR will be presented, with an emphasis on their treatment from both an Orthodontic and surgical perspective.J like there is physiotherapy for the rest of the body there is Myo-functional therapy for the mouth. The mouth is a complex of muscles like any other part of our body which are used to bite, smile, swallow and breathe. For their optimum function, these muscles need to be in complete balance with the teeth. Habits of mouth breathing, open mouth rest posture, abnormal swallowing as well as thumb/finger sucking can displace the balance between these muscles. This results in small jaws with crowded teeth, tongue thrusts while swallowing and/or speech problems etc. Esthetically teeth can be realigned and brought back into the right spot with braces, but functionally if these habits persist, the chances of relapse are greater. It also takes longer and is more difficult to achieve orthodontic results without addressing the reason as to what caused the crooked teeth to happen in the first place. Myo-functional Therapy helps with the elimination of oral habits of mouth breathing and finger/ thumb-sucking, as well as the establishment of correct tongue rest posture. It also helps establish the correct pattern of chewing and swallowing by eliminating thrusts. The presentation will have many before and after photos to help identify issues that can be corrected using this therapy and how patients will benefits from the long term effects of proper posture and function. Ideally it is best to have a closed mouth at rest; thorough out the day and while as sleep at night, with the tongue supporting the palate. It is also important to have the tongue reach the roof of the mouth while we swallow. If the tongue does not reach the roof and has a low/lateral posture, the chances of using accessory muscles of face for swallowing are greater. That puts strain on those muscles and causes people to retain what they call “The Infantile Swallow.” This improper tongue posture also causes the roof of the mouth to be narrow and can result in crowding and an improper bite. Although the way our jaws grow has some genetic component; it is the environment that they grow in that determines their final posture. There will be some great information to share on how oral posture effects growth and how it can be reversed for better airway development.Case: A 12 year old male patient with complaint of drainage of fluid from depression on the lower lip reported in the Department of Oral Medicine and Radiology of King George Medical University Lucknow. The watery discharge was continuous and was aggravated during eating. Past surgical history revealed that the patient had undergone surgical correction of upper cleft lip and cleft palate at the age of 10 months. The family history did not reveal consanguineous marriage of his parents. According to his mother, the patient was born after a normal, full-term pregnancy with no exposure to radiation. The extra oral examination revealed surgical scar of the upper operated bilateral cleft lip and a median transverse pit on the lower lip filled with watery fluid. Intraoral examination of soft tissues showed a surgical scar of cleft palate correction. Dental examination revealed missing maxillary lateral incisors (hypodontia) and malpositioned teeth. An orthopantamograph disclosed bilateral palatal cleft and missing maxillary lateral incisors. On examination the left feet showed complete syndactyly of second and third toe while partial syndactyly of second and third toe was evident in right feet. The ultrasonography (USG) of lower abdomen revealed which was located in inguinal canal. The USG and colour Doppler examination further revealed that both testes were undescended & slightly reduced in volume with normal contour, echotexture and vascularity with no evidence of varicocele on any side. The clinical diagnosis of VWS syndrome was made on the basis of above findings.Various reviews have been distributed with respect to maxillary first molar root canals morphology utilizing different ethnic gatherings, strategies, and methodologies. Every now and again used strategies to study the root canal morphology are utilizing staining solutions, radiographic procedures and all the more as of late presented cone beam compute tomography. CBCT is a technique that uses a particular bean to create three dimensional pictures to uncover anatomic subtle elements precisely. The key points of interest of utilizing CBCT are that it is noninvasive and grants 3-D recreation of the root canals. Root morphology and properties of human tooth tissues vary among different ethnic Populaces. 2,3T course focuses on a number of systemic factors that have an impact on the indications, contraindications and success rates of endosseous implants. The results of this modern treatment approach – implants are different when applied to a health-compromised patient or, more accurately defined, “medically complex patient.” It is of utmost importance that the treating dentist considers the interaction between “local” and “systemic” factors. The number of medically complex patients, together with the aging population, is constantly growing. Dentists should be aware of this change in the population profile, which assures an increase or at least prevents a decrease in their patient pool. Increased attention to the patient’s general health becomes mandatory. The patient’s medical history plays a central role in dental treatment planning, and monitoring devices for blood pressure, pulse, oxygen saturation and temperature have become imperative in every dental office that provides implant-supported oral rehabilitation. Since implant dentistry is a medical dental discipline required for the general population but mainly for medically complex patients, a basic knowledge in internal medicine is becoming a sine qua non subject in the education program of every dentist. Statistical data accentuate the need for this approach. By the year 2020, 17.7% of the population in the United States will be over 65 years old, and 85% of this population will have at least one chronic disease and will be taking between two and eight medications. Cooperation with the patient’s physician and the provision of full information relating to the physiological implications of implant treatments are basic requirements for patient selection, treatment planning and follow-up. However, it is the dentist’s responsibility to make the final decisions and to intelligently apply them. Nonetheless, several studies relating to the risk factors associated with dental implants for medically complex patients are encouraging. The perioperative morbidity and the rate of implant failure are not higher for the medically complex patients in terms of age, diabetes or the use of steroids. Local anesthesia, anxiolytic and analgesic medications do not appear to increase the rate of complications. Unfortunately, there are few evidence-based data on dental implant treatment for medically complex patients; guidelines are inadequate and perioperative recommendations are sparse, resulting in unclear protocols. This course presents current knowledge that will help to facilitate this multifaceted decision-making process, thereby improving both treatment outcome and patient satisfaction. The topics to be covered include the following: dental implant therapy for the diabetic patient, the hypertensive patient, the patient with an increased bleeding tendency and the patient treated with bisphosphonates, the use of adrenalin in local anesthesia, and the implications of radioand chemotherapy.Methods: The government of Pakistan is committed to achieving the millennium development goals by 2015 in partnership with the World Health Organization and the World Bank. To facilitate the challenges of globalization and achieving a prosperous Pakistan in the 21st century partnership stakeholders secretariat practicing collaboration of the Gadap Town eight health subsystems together a private medical university hospital to raise the health status of society. The operational policies and the practices of collaboration in the utility of primary health care services in the municipality of Gadap Town, Karachi, from 2006 to 2013 was analyzed by using documents, interviews with key informants and participant observation. Universality, redistribution, integration and plurality, quality etc in health services were judge as the analytical categories took by the office of administration in 2001, to conform the national health policy continue until the present date.Materials & Methods: 32 Zirconia copings were divided into 0.5 mm and 1 mm thickness. Half of the 0.5 mm and 1 mm copings were veneered with an overall thickness of 3 mm and 4 mm. Half of all zirconia copings were veneered using build up (BU) and the remaining half using hot press (PR) method. Four metal ceramic crowns (MCC) with C/V ratio of 0.5/2.5mm and an overall thickness of 3 mm were used as controls. All specimens were cemented to titanium implant abutments and tested using micro indenter. Crack length, hardness and surface roughness for all specimens was evaluated which was then utilized to calculate fracture toughness. ANOVA was utilized to analyze the results.Results: Oral hygiene practice was found to be lower among cases (57.0%) as compared to their controls (83.2%), and the differences were statistically significant after adjusting for other variables (OR=3.40, 95% CI, 2.30, 5.02), but there was no differences among cases andcontrols in using toothpaste, tattooing the gum and mouse rinsing practices. In this study, year of employment, grow riftvalley area, consumption of sweet food items, Khat chewing habit and presence of calculus, gingivitis and plaque in the oral cavity was significantly associated with dental caries. There was no significant difference between cases of dental caries and their controls in their knowledge towards oral health, age, rank, educational status, marital status, religion, ethnicity, diet, alcohol drinking, and cigarette smoking habitsO Sleep Apnea, otherwise called Sleep Disordered Breathing, is a well documented sleep breathing disorder with an extremely wide spectrum of correlated medical and dental consequences. The dental community as health providers can play an important role in referral as well as management for the disease itself. Meta-analysis of Oral Appliance Therapy as a standalone therapy for mild to moderate and some severe cases shows not only efficacy but as a viable alternative to conventional CPAP therapy when patients are intolerant. Evidence will be presented on Oral Appliance Therapy and its uses, as well as novel connection with bruxism and TMD. I am part of a multicenter observational study with over 1200 subjects showing strong correlation between internal derangement of the TM joints and OSA. The ability of the dental practitioner to aid in diagnosis as well as to treat carefully a serious medical condition will be discussed, the need for more dentists adequately aiding their medical colleagues in the field sleep dentistry cannot be overstated.AIM This study aimed to establish a safety zone for the placement of mini-implants in the buccal surface between the second maxillary premolar (PM2) and first maxillary molar (M1) of Mongoloids. METHODS Thirty-two digital orthopantomograms of Mongoloids were selected and the interdental distance between the second premolar and first molar at 2, 5, 8 and 11 mm from the cemento-enamel junction (CEJ) was measured. The distance between the PM2 and M1 root apices and from the apices to the maxillary sinus was also determined. RESULTS The average width (mm) at 2 mm was 2.58 +/- 0.53; 5 mm was 3.47 +/- 0.61; 8 mm was 4.00 +/- 0.74, 11 mm was 4.36 +/- 0.71 and the distance between the apices was 7.49 +/- 0.79. Only half of the samples were measured at 11 mm, as many of the root apices were superimposed over the maxillary sinus. The measurement (mm) from PM2 root apex to the sinus was -0.18 +/- 1.56, from the mesiobuccal root apex of M1 (MB1) to the sinus was -1.94 +/- 1.70 and from the midpoint between their apices to the sinus was -2.96 +/- 2.06 (superimposed on the sinus). CONCLUSION The safest area to place mini-implants between the second premolar and the first molar in the maxilla of Mongoloids is between 5 to 8 mm above the CEJ.Results: The results reveal that there are highly complex and multifactorial opportunities and barriers in access to oral healthcare. Both Australia and South Africa experience opportunities and barriers in accessing oral healthcare that has various local influences. This leads to unequal access for the disadvantaged members of society, and results in them receiving minimal access to the required oral healthcare.Methods: Case 1An 11 year old boy reported with a chief complain of missing upper front tooth. His medical history was not contributory. Clinical examination revealed a full complement of teeth except for 11. Radiographic examination showed unerupted 11 in the bony socket.The case was managed by a combination of surgical exposure and removable orthodontic appliance. Case 2A 12 year old boy presented with a chief complain of missing lower back tooth. His medical history was not contributory. Clinical examination revealed missing 45 confirmed through radiographs. Tooth was surgically exposed and moved with the help of fixed orthodontic traction.According to the glossary of prosthodontic terms centric occlusion is defined as the occlusion of opposing teeth when the mandible is in centric relation , this may or may not coincide with the maximal intercuspal position [5]. While, centric relation is independent of tooth contact and clinically discernible when the mandible is directed superior and anteriorly [5]. Dynamic or functional occlusion includes lateral excursive and protrusive contact, and refers to the occlusal contacts of the maxillary and mandibular teeth during function, i.e. during speech, mastication, and swallowing [2-4].E patient suspected with infectious endocarditis (I.E.) is first asked: “When was your last visit at a dental clinic?” Does this still hold? During the last 50 years the prophylaxis protocols changed, limiting the amount and the length of time dental patients were treated with wide spectrum drugs. The indications for prophylaxis became more specific and focused, eliminating some. The super “intelligent” microorganisms adapted to the classical available antibiotics via genetic changes. Clinical and laboratory researches revealed uncertainties relating to our accepted protocols. Resistance, efficiencies, follow-ups, costs and side effects are gaining accent and raise crucial questions. Protocols recommended by the AHA and ADA are not any more accepted worldwide. The European NICE went one step farther and claimed that the accepted protocols should be radically modified: in fact prophylaxis being not necessary for the majority of patient undergoing “invasive dental procedures”. In spite of the fact that the decrease in antibiotic prescriptions led to an increase in I.E. cases, the changes merit serious consideration. Incidence of I.E. increased significantly in England since the introduction of NICE guidelines in 2008. In November 2014 it was decided to review them!! Placebo controlled, multicenter randomized double blind studies have not been done. There are contradictory results relating to bacteriemia following administration of Erythromycin, Penicillin V and Clindamycin. 6 reports of fatalities due to anaphylactic reactions to single dose penicillin are known to the AHA!! The “adverse outcome” from I.E. is replacing the “predisposition for I.E.”. The costs of treatment went sky-rocketing saving one year of life reached 800.000 USD. So, the NICE recommendations caused both dismay and confusion among dentists and patients. “Prophylaxis” is the Greek for “take precaution”. If the precautions for the patients did not reach a consensus, did we take the appropriate precautions vis-a-vis the physicians, the legal instances and mainly our patients?

Mandibular arch orthodontic treatment stability using passive self-ligating and conventional systems in adults: A randomized controlled trial

Objective This randomized controlled trial aimed to compare the stability of mandibular arch orthodontic treatment outcomes between passive self-ligating and conventional systems during 6 months of retention. Methods Fortyseven orthodontic patients with mild to moderate crowding malocclusions not requiring extraction were recruited based on inclusion criteria. Patients (mean age 21.58 ± 2.94 years) were randomized into two groups to receive either passive self-ligating (Damon® 3MX, n = 23) or conventional system (Gemini MBT, n = 24) orthodontic treatment. Direct measurements of the final sample comprising 20 study models per group were performed using a digital caliper at the debonding stage, and 1 month, 3 months, and 6 months after debonding. Paired t-test, independent t-test, and non-parametric test were used for statistical analysis. Results A significant increase (p < 0.01) in incisor irregularity was observed in both self-ligating and conventional system groups. A significant reduction (p < 0.01) in second interpremolar width was observed in both groups. Mandibular arch length decreased significantly (p = 0.001) in the conventional system group but not in the self-ligating system group. A similar pattern of stability was observed for intercanine width, first interpremolar width, intermolar width, and arch depth throughout the 6-month retention period after debonding. Comparison of incisor irregularity and arch dimension changes between self-ligating system and conventional system groups during the 6 months were non-significant. Conclusions The stability of treatment outcomes for mild to moderate crowding malocclusions was similar between the self-ligating system and conventional system during the first 6 months of retention.