Nandakumar Janakiraman

Three-dimensional cone-beam computed tomography-based virtual treatment planning and fabrication of a surgical splint for asymmetric patients: surgery first approach.

Virtual 3-dimensional planning in orthognathic surgery allows for a detailed visualization and analysis of skeletal and dental deformities, especially in patients with asymmetries. This approach also eliminates conventional stone model surgery through computer-aided fabrication of surgical stents. This article presents a new approach with 3-dimensional cone-beam computed tomography-based treatment planning for the surgical correction of facial asymmetry in conjunction with the surgery first approach. Good esthetic and occlusal outcomes were obtained for 2 patients after orthognathic surgery and orthodontic treatment with a short total treatment time.

A prospective comparative study between differential moments and miniscrews in anchorage control

The purpose of this study was to measure the efficacy of anchorage control between differential moments mechanics and temporary anchorage devices in a clinical trial. Forty-six patients requiring extraction of maxillary first premolars were allocated into 2 treatment groups. The differential moments group (G1) received a nickel titanium (NiTi) intrusion arch and a 150g NiTi closing coil spring for separate canine retraction, followed by a continuous mushroom loop archwire for the retraction of the incisors. The TAD group (G2) received one miniscrew placed between maxillary second premolars and first molars with a 150 g NiTi closing coil spring connecting the miniscrew to a hook placed in the archwire between the lateral incisor and canine. Lateral cephalograms were taken before (T1) and after incisor retraction (T2). The ratio of molar protraction to incisor retraction was calculated and intragroup and intergroup changes in upper lip, maxillary incisor and molar position were analyzed by paired and independent t-tests. Twenty-eight patients were analyzed after 18 patients did not receive the intervention, were lost to follow-up, or discontinued treatment. The ratio of molar protraction to incisor retraction in G1 was 0.44 and in G2 was -0.11, which was significantly different. There was a statistically significant change in upper lip from T1 to T2 but no difference between the two groups. Moreover, there was a significant distal molar tipping and lingual incisor tipping in G2. There is a significant difference in the amount of anchorage control using differential moments mechanics compared to TADs. Although statistically significant retraction of upper lip was observed in both groups, there was no significant difference between the two groups.

Corticotomy-assisted molar protraction with the aid of temporary anchorage device.

This case report describes the interdisciplinary management of a 58-year-old woman who was missing lower first molars and supraerupted maxillary first molars. The treatment plan included intrusion of the upper first molars and corticotomy-assisted mandibular second molar protraction with the aid of temporary anchorage devices. Miniscrews were effective in intrusion of the maxillary first molars and protraction of the lower second molars. Although good functional outcome was achieved in 41 months, the corticotomy-assisted procedure did not significantly reduce the treatment time.

Integration of 3-dimensional surgical and orthodontic technologies with orthognathic “surgery-first” approach in the management of unilateral condylar hyperplasia

Recent innovations in technology and techniques in both surgical and orthodontic fields can be integrated, especially when treating subjects with facial asymmetry. In this article, we present a treatment method consisting of 3-dimensional computer-aided surgical and orthodontic planning, which was implemented with the orthognathic surgery-first approach. Virtual surgical planning, fabrication of surgical splints using the computer-aided design/computer-aided manufacturing technique, and prediction of final orthodontic occlusion using virtual planning with robotically assisted customized archwires were integrated for this patient. Excellent esthetic and occlusal outcomes were obtained in a short period of 5.5 months.

Evaluation of rotational control and forces generated during first-order archwire deflections: a comparison of self-ligating and conventional brackets

The purpose of this study was to compare the activation and deactivation forces generated during first-order archwire deflections when different sizes and types of NiTi wires are paired with conventional and self-ligating brackets (SLBs) and to evaluate the rotational control between these same archwire and bracket combinations. Four maxillary premolar SLBs (Damon 3MX, SmartClip, Carriere, and In-Ovation R) and one conventional twin bracket (Victory) were paired with seven archwires [0.014, 0.016, 0.018, 0.016 × 0.022 Ultra Therm (thermal A f 80-90°F), 0.016, 0.018 SPEED Supercable, and 0.017 × 0.025 Turbo]. A cantilever test design was used and 10 trials per bracket/archwire combination were performed. Load/deflection data were captured over 4 mm fi rst-order archwire deflections. Forces generated were compared across all bracket/archwire combinations. Among thermal archwires, for a given deflection, forces increased with increasing archwire size. Supercable archwires displayed less force than their same size thermal counterparts. The Turbo archwire generated force values in between those of 0.016 and 0.018 thermal archwires. Rotational control improved with increasing wire dimensions and for a given archwire size. Rotational control among brackets generally ranked as follows: In-Ovation R > SmartClip > Carriere and Damon 3MX.

Interdisciplinary approach for increasing the vertical dimension of occlusion in an adult patient with several missing teeth

This case report describes the interdisciplinary treatment of a 39-year-old man with several missing teeth (including both maxillary lateral incisors), Class II malocclusion, deep overbite, and significant mandibular midline deviation. The treatment plan included placement of endosseous dental implants early in the orthodontic treatment to increase the vertical dimension of the occlusion for deepbite correction, canine substitution for the missing lateral incisors, and distalization of the mandibular right buccal segment with the aid of a temporary anchorage device.

Response of the maxillary dentition to a statically determinate one-couple system with tip-back mechanics: A prospective clinical trial.

OBJECTIVE To quantify the effects of tip-back mechanics on the maxillary first molars and incisors. MATERIALS AND METHODS Sixteen subjects with Class II end-on malocclusion were treated with an intrusion arch to achieve distalization of the maxillary molar through tip-back mechanics. Lateral cephalograms were taken prior to molar tip-back (T1), after molar tip-back (T2), and after molar root uprighting (T3). Data were analyzed using the Friedmans and Wilcoxon signed rank tests to evaluate differences in time points (P ≤ .016). RESULTS The maxillary first molar distalized 1.53 mm (P = .001) with 6.65° (P = .001) of distal tipping and 0.86 mm (P = .001) of extrusion at T2. Minor relapse of the first molar (mesial direction) was seen at T3. The maxillary incisors flared labially 0.4 mm, and the incisor root apex moved palatally 1.19 mm (P = .005) at T2. At T3, the incisor root apex moved palatally 1.5 mm (P = .003) from T1. An angular change from T1 of 3.31° (P = .008) and 3.53° (P = .014) was seen at T2 and T3, respectively, as a result of palatal root movement of the maxillary incisors. CONCLUSIONS A significant amount of distalization of maxillary molars was attained at the crown level with tip-back mechanics. Palatal root angulation change was significant in the incisors with minimal anteroposterior movement of the incisal edge.

Bidimensional dentoalveolar distraction osteogenesis for treatment efficiency

This case report describes the treatment of a 16-year-old girl with a unilateral posterior buccal crossbite, a unilateral Class II molar relationship, and a maxillary right canine high in the labial sulcus. The treatment plan included surgically assisted unilateral maxillary expansion for the correction of the buccal crossbite, with simultaneous dentoalveolar distraction of the maxillary right canine into the extraction space of the first premolar aided by skeletal anchorage. Reduced orthodontic treatment time was facilitated by these 2 surgical procedures. A pleasing esthetic result and a good functional occlusion were achieved in 13 months.

Autotransplantation: A biological treatment alternative for a patient after traumatic dental injury

Traumatic dental injury is considered a public dental health problem because of a high childhood incidence, high treatment costs, and prolonged treatment time. Although management guidelines for traumatized teeth have been outlined, tooth loss following trauma is occasionally unavoidable. Here, we describe the successful interdisciplinary management of a traumatized central incisor in an 11-year old boy that was extracted because of a poor prognosis and restored by the autotransplantation of an immature donor tooth into the site. The patient underwent orthodontic treatment in order to close the donor site space and bring the autotransplanted tooth to an ideal position. Postorthodontic treatment radiographs and photographs revealed an esthetic and functional natural tooth replacing the lost tooth. The findings from this case suggest that autotransplantation offers unique advantages as a treatment modality for the restoration of missing teeth, particularly in growing children.

Miniplate-Aided Mandibular Dentition Distalization as a Camouflage Treatment of a Class III Malocclusion in an Adult

This case report describes orthodontic camouflage treatment for a 32-year-old African American male patient with Class III malocclusion. The treatment included nonextraction, nonsurgical orthodontic camouflage by en masse distalization of the mandibular teeth using skeletal anchorage devices. The total treatment time was 23 months. Normal overjet and overbite with Class I occlusion were obtained despite the compensated dentition to the skeletal malocclusion. His smile esthetics was significantly improved at the completion of his treatment.