Narendra Sharma

Effects of first premolar extraction on airway dimensions in young adolescents: A retrospective cephalometric appraisal.

Objective: To evaluate the upper airway dimensions in adolescents treated for bimaxillary proclination with first premolar extraction. Materials and Methods: A retrospective cephalometric evaluation was carried out on the available pre and post orthodontic treatment records of 150 patients (12-18 years of age) who had bimaxillary proclination and were treated with fixed orthodontic therapy. Cephalometric landmarks for sagittal airway measurements and hyoid bone were identified; linear and angular measurements were obtained. Descriptive statistics using paired t-test was used to assess changes in pre and post treatment values and Pearsons correlation coefficient was calculated to evaluate the reliability of observations. The method error calculations were performed using the Dahlberg formula. Results: It was observed that the mean values of nasopharyngeal dimension and Total Airway Length (TAL) showed no statistically significant difference in pre and post treatment groups. All other airway and hyoid parameters showed statistically significant difference. Pearsons correlation coefficient showed statistically significant correlations in all the airway and hyoid parameters. Conclusions: In the present study, the nasopharyngeal dimension and TAL were not found to be directly affected by the retraction of anterior teeth, This can be attributed to the fact that nasopharyngeal dimension and TAL are not under direct influence of tongue position. The other findings also indicated direct correlation of tongue position to oropharynx and hypopharynx. Consequently, we emphasize clinically relevant anatomic risk factors that should be given prime importance and serious consideration on the decision whether to extract or not in growing patients.

A Tailored Approach for Growth Modification: An Innovative Approach

Aim: The aim of this study is to evaluate the treatment effects of the clear block appliance during comprehensive correction of class II malocclusion in growing patients. Introduction: Sagittal discrepancy commonly exists in skeletal class II malocclusions. The popular of the class II malocclusions is division 1 type among them. The presence of original skeletal jaw abnormality is the origin of the class II malocclusions. The treatment result of such skeletal malocclusion depends on the age, latent growth, and cooperation of the individual. The class II division 1 malocclusion in a growing individual can be successfully treated with different types of myofunctional appliance. The present article illustrates a new approach (clear block appliance) to correct sagittal discrepancy to make optimal use of the patient’s pubertal growth spurt to achieve best possible results. Based on the results in these patients, the clear block appliance was very effective in correcting class II malocclusions. Although the results are positive, they should be tested on a large sample size. Clinical significance: Clear block appliance proved to be the best alternative to other myofunctional appliances, where side effects in the form of anchorage loss or proclination of lower incisor do not occur with similar results.

Corticotomy assisted treatment of anterior open bite in an adult patient

This case report discusses orthodontic treatment combined with the corticotomy technique to accelerate tooth movement and shorten the treatment time in a 34-year-old female patient with an anterior open bite and flared and spaced upper and lower incisors. Fixed orthodontic appliances (MBT 0.018″ edgewise brackets) were bonded, and 4 months later, buccal and lingual corticotomy with alveolar augmentation procedure in the maxillary arch from canine to canine was performed. Orthodontic therapy proceeded with frequent activation of the appliances to retract the incisors every 2 weeks. The total treatment time was 10 months with an active period of 4 months and no adverse effects were observed at the end of active treatment. The addition of the decortication procedure to the conventional orthodontic therapy decreased the duration of treatment significantly. Successful closure of the anterior open bite with adequate overbite and interdigitation of the teeth was achieved.

Treatment of Class II malocclusion with a flexible fixed functional appliance: A case series

Class II malocclusion is one of the most commonly occurring conditions, and the component mostly involved is mandibular retrognathism. The treatment modalities include both removable and fixed appliances. The advantage of fixed functional appliances is that it is not dependent on patient compliance. Various fixed functional appliances are available such as rigid, flexible, and hybrid. The present case series discusses a flexible type of fixed functional appliance, i.e. Sharmas bite corrector appliance in three cases: A 16-year-old female patient with Class II malocclusion due to mandibular retrognathism, a 14-year-old male patient with Class II malocclusion due to mandibular retrognathism, and a 17-year-old female patient with Class II malocclusion due to mandibular retrognathism. The effects produced by this appliance are similar to the conventional fixed functional appliances such as Forsus, Herbst, and also it has a distinct advantage of quick chairside fabrication, simple design, and inexpensive.

Fraser syndrome without cryptophthalmos: A rare case report

Fraser syndrome is a rare autosomal recessive multisystem disorder characterized by features such as cryptophthalmos, syndactyly, congenital malformations, and abnormal genitalia. We report a case of 13-year-old male, who had multiple congenital anomalies and clinico radiological features consistent with Fraser syndrome without cryptophthalmos.

Management of a growing Skeletal Class II Patient: A Case Report.

ABSTRACT Sagittal and transverse discrepancies often coexist in skeletal class II malocclusions. Orthopedic growth modification can work well in such cases, provided that the remaining pubertal growth is adequate and that the clinician can provide timely treatment to coincide with the peak growth period. The transverse discrepancy is generally corrected first, establishing a proper base for the sagittal correction to follow. For example, in a skeletal class II case with a narrow maxillary arch and retrusive mandible, maxillary expansion is performed initially to facilitate functional mandibular advancement. The present article illustrates an exception to this rule, in a case where sagittal correction was undertaken before transverse correction to make optimal use of the patients pubertal growth spurt in first phase followed by a second phase of fixed appliance therapy during adolescence to achieve optimal results. How to cite this article: Sharma NS. Management of a growing Skeletal Class II Patient: A Case Report. Int J Clin Pediatr Dent 2013;6(1):48-54.

Riding Pontic: A Tool to Keep Patients Smiling

ABSTRACT All patients expect a beautiful smile at the completion of orthodontic treatment, but some patients show concern regarding their appearance while undergoing treatment. The appearance of a gap from a missing tooth can be a concern, especially if it is in the display zone of a patients smile. If the treatment plan includes prosthetic replacement of the missing tooth rather then space closure, then space maintenance is also an issue. In an appearance conscious patient use of riding pontic as space maintainers is a good option during treatment. How to cite this article: Sharma NS. Riding Pontic: A Tool to Keep Patients Smiling. Int J Clin Pediatr Dent 2013;6(2): 127-131.

An Inexpensive Universal Mouth Props, Saliva Ejector and Tongue Retractor

Throughout the field of dentistry, chairside procedures must be managed to simultaneously achieve a number of objectives. Dentists, orthodontists, prosthodontists, endodontists and the like must provide patient comfort while at the same time accomplishing complex therapeutic treatment procedures within the confines of the oral cavity. The clinician must also manage a number of peripheral factors while he or she focuses on achieving worthwhile, long-lasting treatment results. The clinician must strive to minimize such factors as the amount of chairside time required to accomplish various treatment goals, the amount of auxiliary staff assistance required as well as overall practice overhead to ensure that such professional services remain economically practical for all involved. All of these factors drive dental professionals to embrace improved chairside systems, armamentarium, techniques and procedures that save time, improve results and reduce costs. One aspect of such dental practice economics addressed by the present invention involves procedures such as scaling, root planning, crown and bridge procedures, restorative dentistry and direct bonding must be accomplished. Such procedures typically demand that a dry field be achieved and maintained from the beginning to the end of procedures. In such cases, side access, visibility and maintaining dry conditions within the oral environment are essential for the successful treatment results.

Mastering interproximal stripping: with innovations in slenderization.

ABSTRACT Crowding and irregularity remain a consistent problem for children. Management of space problems continues to play an important role in a dental practice. It also represents an area of major interaction between the primary provider and the specialists. Proximal stripping is routinely carried out to avoid extraction in borderline cases where space discrepancy is less and in cases where there is a discrepancy between the mesio- distal width of maxillary and mandibular teeth to satisfy Bolton ratio. Proximal stripping is carried out using of metallic abrasive strip, safe sided carborundum disk, or with long thin tapered fissure burs with air rotor. The use of rotary cutting instrument can harm the pulp by exposure of mechanical vibration and heat generation (in some cases). Whereas, the large diameter of the disk obstructs vision of the working area. Also fracturing away a portion is a common problem with disk. Tapered fissure burs cut the tooth structure as the width of bur or overcutting may occur of the tooth structure due to high speed. The use of metallic abrasive strip is the safest procedure amongst the above. The strip can be placed in the anterior region without any difficulty but using it in the posterior region is difficult as, it is difficult to hold it with fingers while stripping the posterior teeth. To avoid this inconvenience here with a simple and economical way of fabricating strip holder from routine lab material is presented. Clinical implications: Proper management of space in the primary and mixed dentitions can prevent unnecessary loss in arch length. Diagnosing and treating space problems requires an understanding of the etiology of crowding and the development of the dentition to render treatment for the mild, moderate and severe crowding cases. Most crowding problems with less than 4.5 mm can be resolved through preservation of the leeway space, regaining space or limited expansion in the late mixed dentition. In cases with 5 to 9 mm of crowding, some can be approached with expansion after thorough diagnosis and treatment planning. Most of these cases will require extraction of permanent teeth to preserve facial esthetics and the integrity of the supporting soft tissue. Sequential proximal stripping is routinely carried out to avoid extraction in borderline cases where space discrepancy is less and reserved for treatment of mild tooth-size/arch-size discrepancies. How to cite this article: Sharma NS, Shrivastav SS, Hazarey PV. Mastering Interproximal Stripping: With Innovations in Slenderization. Int J Clin Pediatr Dent 2012;5(2):163-166.

A New 2D Bracket-Positioning Gauge

Orthodontists have used a variety of hand-held dental instruments to position the brackets for direct bonding. A number of instruments, including the Boone and Dougherty gauges, have been used for accurate positioning of brackets in direct bonding. Although position adjustments can be made with such an instrument, the bracket can easily slip when the instrument is removed. Indirect bonding may be a solution, but it is time-consuming and does not provide for precise repositioning of brackets that fall off. We have developed a gauge that allows accurate, reproducible bracket placement at 3 to 6 mm from the instrument base.