Vijay Prakash Sharma

A correlative study of dental age and skeletal maturation

INTRODUCTION Skeletal age had been assessed by comparison between maturation of hand-wrist with stages of cervical vertebrae or canine calcification stages in past and this had been closely related to craniofacial growth. The importance of pubertal growth spurt in various types of orthodontic therapies is already established. AIMS AND OBJECTIVES Hence, this study was aimed to evaluate the relationship of skeletal maturity by hand-wrist with cervical vertebral maturation indicators and canine calcification stages. MATERIALS AND METHODS The study consisted of randomly selected 90 children from Lucknow population with 45 males (age range 10-13 years) and 45 females (age range 9-12 years). Lateral Cephalogram, hand-wrist x-ray, and periapical x-rays of maxillary and mandibular right canines were taken. STATISTICAL ANALYSIS Mean, standard deviation was calculated of different groups. Correlation was made among cervical vertebral maturation, hand wrist maturation, and canine calcification stages at various age groups. RESULTS There was strong correlation between skeletal maturation indicator and cervical vertebral maturation indicator for both male (0.849) and female (0.932), whereas correlation between skeletal maturation indicator and canine calcification was good for both male and female (0.635, 0.891). CONCLUSION It was concluded that cervical vertebral maturation indicator and canine calcification stages can also be used for assessing skeletal maturity.

Brodie bite with an extracted mandibular first molar in a young adult: A case report

Total buccal crossbites are rare, but, when they occur, they can be extremely difficult to correct, even with surgery and orthodontics. In most patients with in-locking crossbites, the maxillary teeth erupt past their mandibular antagonists, creating severe occlusal difficulties. This article presents an adult patient with scissors-bite or partial telescoping bite bilaterally in the posterior region and an extracted mandibular first molar on the right side. She was treated with expansion of the mandibular arch, and the subsequent open bite was closed with the help of masticatory muscle exercises and high-pull headgear. The second and third molars were uprighted and moved mesially to close the extraction spaces.

Comparison of esthetic outcome after extraction or non-extraction orthodontic treatment in class II division 1 malocclusion patients

Introduction: The extraction of premolars as a practical form of orthodontic therapy has been accepted for many years, but there remains a controversy regarding the effect of premolar extraction to improve esthetics as well as dentoskeletal relationship. The esthetic impact of the soft-tissue profile might play a major role in deciding on premolar extraction or non-extraction treatment, particularly in borderline patients. This cephalometric study was undertaken to compare the post-treatment soft-tissue profiles of successfully managed Class II, Division 1 malocclusions treated with either all first premolar extractions or treatment with a non-extraction therapy. Materials and Methods: The sample consisted of 100 post-pubertal female patients of Class II Division I malocclusion. Group 1, treated with four first premolar extractions, consisted of 50 female patients with a mean age of 14 years 1 month. Group 2, treated without extractions, consisted of 50 patients with a mean age of 13 years 5 months. Pre-treatment and post-treatment lateral cephalometric radiographs were evaluated. The pre-treatment to post-treatment stage comparison and the intergroup comparison of the treatment changes were conducted between extraction and non-extraction groups of Class II malocclusion samples with t-tests. Results: The soft-tissue facial profiles of the extraction and non-extraction samples were the same following active treatment except for a more retruded lower lip and a more pronounced lower labial sulcus in those patients subjected to extraction. Conclusions: The extraction or non-extraction decision, if based on sound diagnostic criteria, seems to have no systematic detrimental effects on the facial profile.

An ultrasonographic evaluation of masseter muscle thickness in different dentofacial patterns.

OBJECTIVES The aim of this study is to compare the masseter muscle thickness in different vertical dentofacial patterns and identify the possible sexual dimorphism and also to correlate masseter muscle thickness with craniofacial morphology using cephalometric parameters. MATERIALS AND METHODS The masseter muscle thickness was measured using ultrasonography in 60 subjects (30 females and 30 males). Standardized lateral and posteroanterior cephalograms were taken to determine the facial morphology. The subjects were divided into three vertical pattern groups (I, II, and III) according to their Jarabak ratio: hypodivergent ( n = 20), normodivergent (n = 20), and hyperdivergent (n = 20). The sample was further subdivided into males and female subgroups. RESULTS Masseter muscle thickness relaxed (MMTR) in hypodivergent group was 13.94 ± 1.51. Mean value of MMTR in normodivergent group was 12.53 ± 1.21 and the MMTR in hyperdivergent group was 11.13 ± 1.18. The mean value of masseter muscle thickness contracted (MMTC) in hypodivergent group was 15.46 ± 1.33. Mean value of MMTC in normodivergent group was 13.81 ± 1.38 and the mean value of MMTC in hyperdivergent group was 12.27 ± 1.26. MMTC showed a significant, negative correlation with mandibular plane angle and gonial angle. Posterior facial height, symphysis width, intermolar width of maxillary first molars, maxillary width, and facial width (bizygomatic width) showed significant ( P < 0.05 or P < 0.01) positive correlation. CONCLUSION The masseter muscle thickness varied among the three vertical dentofacial patterns and sexual dimorphism also existed except in the hyperdivergent group. Masseter muscle thickness was found to be negatively correlated to vertical facial pattern and positively associated with transverse craniofacial morphology.

The effect of central incisor's root proximity to the cortical plate and apical root resorption in extraction and non-extraction treatment.

Aims: The present study was conducted to investigate the relevance of cortical plate proximity of maxillary central incisor root, maxillary alveolar bone width, and the apical root resorption in extraction and non-extraction orthodontically treated cases. Further, the correlation between the apical root resorption and the various parameters was investigated. Materials and Methods: A total of 80 lateral head cephalographs, 40 pre-treatment and 40 post-treatment, of orthodontic subjects with a mean age of 15 years treated with fixed standard edgewise appliance were obtained. All subjects were divided into two groups as extraction and non-extraction cases. Twelve linear and three angular parameters were measured and evaluated. The paired “t”-test, Pearsons correlation coefficient, and the stepwise regression analysis were done to test the relationship between the apical root resorption and the various parameters. Results and Conclusions: The study revealed slightly greater amount of apical root resorption in extraction subjects as compared to non-extraction subjects. However, no statistically significant difference was found between the two treatment modalities. In extraction subjects, the apical root resorption was directly proportional to the pre-treatment length of maxillary central incisor and inversely proportional to the root width in apical one-third region, though there was a weak correlation. In non-extraction subjects, the pre-treatment anteroposterior position of the root apex of maxillary central incisor in the alveolar bone, in combination with its root width in the apical one-third region formed the predictive factors for the variance in the amount of the apical root resorption, though there was a weak correlation. Furthermore, the changes in the alveolar widths at the root apex and mid-root region were considered as predictive factors for the amount of apical root resorption during extraction and non-extraction treatment, respectively.

Soft-tissue characteristics of Class-II Division-1 malocclusion in North Indian adult population: A cephalometric study

Background: Facial harmony in orthodontics is determined by the morphologic relationships and proportions of the nose, lips and chin. For the correction of all malocclusions, the facial outlines should be regarded as an important guide in developing a proper treatment plan. Aims and Objectives: (1) The primary aim is to evaluate and compare the soft tissue pattern associated with Angle′s Class I normal occlusion and Angle′s Class-II Division-1 malocclusion in North Indian adult population. (2) The secondary is to access sexual dimorphism for the soft-tissue characteristics. Materials and Methods: Lateral cephalograms of 80 orthodontically untreated adult subjects, 40 were having normal occlusion with good facial profile (Group-A: 20 males-mean age 22.89 years and 20 females-mean age 21.27 years) and 40 subjects with Angle′s Class-II Division-1 malocclusion (Group-B: 20 males-mean age 20.25 years and 20 females-mean age 19.67 years) were analyzed. Methodology: Lateral cephalograms of the subjects were taken in natural head position and were traced manually. 16 linear and 6 angular soft-tissue parameters were measured which were derived from the Steiner, Ricketts, Burstone and Holdaway soft-tissue analyses. All the values were compared using Student′s t-test with a level of significance at P < 0.05. Results: Group-B males had decreased lower lip length, lower face height, nasomental angle (P < 0.001) and lip length ratio (P < 0.01) whereas increased interlabial gap, upper lip to Sn-Pg′, total facial contour angle, maxillomandibular contour angle (P < 0.001), lower lip to Sn-Pg′ angle (P < 0.01) when compared to Group-A males. There was an apparent sexual dimorphism was found in soft-tissue pattern of both the groups. Conclusions: Class-II Division-1 malocclusion have more convex soft-tissue profile, reduced nose length, Shorter procumbent lips and flatter chins when compared to Angle′s Class I malocclusion.

Reliability of Nolla's dental age assessment method for Lucknow population

Tooth formation is widely used to assess dental maturity and predict the age of growing children. Skeletal age assessment by hand-wrist radiographs has been found to correlate significantly with the growth status of an individual, but has a known drawback in the form of extra radiograph and high dose of radiation exposure in comparison to periapical X-rays used commonly in dentistry. The purpose of this study was to assess the reliability of dental age and to find its comparison with chronological age. Dental maturity was studied from the intraoral periapical radiographs of 90 children aged 9-13 years in Lucknow population with 45 males (age range 10-13 years) and 45 females (age range 9-12 years), and the reliability of dental age estimation using Nollas method was investigated. The children were radiographed for intraoral periapical X-ray of right permanent maxillary and mandibular canines. Chronological age was obtained from the date of birth of the children. Correlation between the dental age and chronological age was analyzed using the paired t-test. Slightly higher mean was recorded in the estimated age (dental age) compared to actual age (chronological age). Females were more advanced in dental maturation than males. Chronological age showed inconsistent correlation with dental age. It was concluded that canine calcification stages can also be used for assessing skeletal maturity.

Relationship between Dental Arch Dimensions and Vertical Facial Morphology in Class I Subjects

Introduction: A well-balanced face has its good proportions in all three dimensions of space, i.e. transverse, sagittal and vertical. The vertical proportions of the face are important in determining the esthetics and harmony of the face. The objectives of this study were to evaluate the relationship between dental arch dimensions and the vertical facial pattern determined by the Jarabak ratio, and to examine the differences in dental arch dimensions between male and female untreated adults. Materials and methods: Lateral cephalograms and study models were obtained from 90 untreated subjects (45 males, 45 females) between 17 and 24 years of age with no crossbite, no/minimal crowding and spacing. The Jarabak ratio (posterior facial height/anterior facial height) was measured on cephalograms of each patient. Study models were used to obtain comprehensive dental measurements, including maxillary and mandibular cumulative mesiodistal width, intercanine, first interpremolar and first intermolar widths as well as arch perimeter, arch length, overbite, palatal height and curve of Spee. Results: The results showed that, for both males and females, there was a trend that as vertical facial height increased, arch width, arch perimeter and overbite decreased but palatal height and curve of Spee increased and males have significantly larger arch dimensions than those of females. Conclusion: It was concluded that dental arch dimensions were associated with facial vertical morphology and gender. Thus, using individualized archwires according to each patient’s pretreatment arch form and width is suggested during orthodontic treatment.

Curve of Spee and Its Relationship with Dentoskeletal Morphology

Objective: The influence of craniofacial morphology on the variation of the depth of curve of Spee includes multiple factors. This plays an important role in the leveling of the curve which is required for retention of achieved results. The study evaluates relationship between the varying depths of curve of Spee and dentoskeletal features. Materials and methods: 120 diagnostic casts and lateral head cephalograms of selected subjects on the basis of depths of curve of Spee as measured on the mandibular casts were selected. The subjects were divided into three Groups (Group-I0-2 mm, Group -II >2-4 mm and Group-III >4 mm of curve of Spee), and further into subgroups according to sex. Cephalometric and study cast variables were measured and subjected to statistical analysis with curve of Spee as the dependent variable and others as independent variables. Results: SNB, APDI, OM, Md5 MP (mm), OJ and mandibular arch length were negatively correlated and ANB, Md6 to MP, ODI, overbite and overjet were positively correlated with depth of curve of Spee in both males and females. Conclusion: The curve of Spee is related to various dentoskeletal variables. Thus, the determination of this relationship is useful to assess the feasibility of leveling the curve of Spee by orthodontic treatment.

To establish the validity of dental age assessment using Nolla's method on comparing with skeletal age assessed by hand-wrist radiographs

Background: Skeletal age assessment by hand-wrist radiographs has been found to correlate significantly with the growth status of an individual, but has a known drawback in the form of extra-radiograph and high dose of radiation exposure in comparison to periapical X-rays used commonly in dentistry. Aims and Objectives: The purpose of the study was to assess skeletal age using hand-wrist radiographs and to find the correlation amongst the skeletal, dental, and chronological ages. Materials and Methods : Ninety Indian healthy children in the age group 9-13 years, comprising equal number of males and females, were included in the study. The children were radiographed for hand-wrist of the right hand and intraoral periapical X-ray for right permanent maxillary and mandibular canine. Results: There was high correlation between skeletal maturation indicator and canine calcification stages for both male and female children (0.635, 0.891). Conclusion: Females were more advanced in skeletal maturation than males. Chronological age showed inconsistent correlation with dental and skeletal ages. It was concluded that canine calcification stages can also be used for assessing skeletal maturity.