OBJECTIVE: The study aimed to assess the accuracy and reliability of five cephalometric parameters in diagnosing class III malocclusion in Saudi and Yemeni population. MATERIAL AND METHODS: A cross-sectional, descriptive study in which total 60 lateral cephalograms (30 of Saudi and 30 of Yemeni population) of Class III malocclusion were hand-traced. ANB angle, Wits appraisal, Beta angle, W angle, and Yen angle were measured. The validity, reliability, sensitivity, and positive predictive values (PPVs) of these parameters were calculated. RESULTS: In Saudi population, a strong correlation was found between ANB angle and Wits appraisal (r = 0.892, P < 0.05), ANB and Beta angle showed highest sensitivity (0.933) followed by Wits appraisal (0.900), and ANB angle showed the highest PPV (0.965) followed by Beta angle (0.933) and Wits appraisal (0.931). In Yemeni population, a strong correlation was found between ANB angle and Wits appraisal (r = 0.887, P < 0.05), ANB angle and W angle showed highest sensitivity (0.966) followed by Wits appraisal (0.933), whereas W angle showed the highest PPV (1.00) followed by ANB angle (0.966) and Wits appraisal (0.933). CONCLUSION: In Saudi population, ANB angle and Beta angle, whereas in Yemeni population, ANB angle and W angle are the most valid cephalometric indicators to accurately assess the class III malocclusion. ANB angle in the Saudi population and W angle in the Yemeni population have the highest PPV in correctly diagnosing class III malocclusion.

OBJECTIVE: To evaluate the skeletal, dental and soft tissue cephalometric changes by addition of daytime Class III elastics to the Alternate Rapid Maxillary Expansion-Constriction (AltRAMEC) and Reverse Headgear (RH) protocol in skeletal Class III patients with maxillary retrusion. Material and Methods: 54 patients with maxillary retrusion and CVMI (Cervical vertebral maturity index) <CS3 were randomly allocated to an AltRAMEC/RH group (group 1) and AltRAMEC/RH/Class III elastics group (group 2). Each group underwent 5 weeks of AltRAMEC using bonded RME (Rapid Maxillary Expansion) appliance, followed by reverse headgear therapy with a Petit type facemask for 4-5 months. The protraction so obtained was maintained by the use of daytime Class III elastics in group 2. A total of twenty skeletal, dental and soft tissue parameters were evaluated by a blinded examiner. Results were evaluated statistically. Results: Significant forward movement of the maxilla with counter-clockwise rotation, improved intermaxillary relationships, downward and backward movement of the mandible, and favourable soft tissue changes were observed in both the groups under study. The results were more pronounced in group 2. Increase in vertical dimensions, proclination of maxillary and retroclination of mandibular incisors was also observed. Statistically significant differences were present between the two groups for all of the maxillary and mandibular skeletal, intermaxillary and two of the soft tissue parameters tested; while the differences were not found to be significant for dental parameters. Conclusion: Addition of Class III elastics to the AltRAMEC/RH protocol yielded more pronounced, favourable and statistically significant results.

OBJECTIVE: To compare airway widths among skeletal Class I malocclusion patients with different vertical facial patterns. MATERIAL AND METHODS: A total of 103 lateral cephalograms of skeletal Class I patients (mean age of 20 ± 2.3 years) with no history of orthodontic treatment, trauma, facial syndromes, or nasopharyngeal dysfunction were included. Based on the Frankfort–mandibular plane angle measurements, the sample was divided into three groups: low-angle, high-angle, and normal-angle groups. Upper and lower pharyngeal airway widths were measured as described by McNamara. The analysis of variance test was performed to compare the means of groups. Pairwise comparisons were performed using Tukey's post-hoc test. Differences were considered statistically significant at P < 0.05. RESULTS: ANOVA showed a significant mean difference between the groups for both the upper and lower airway widths withP values of 0.011 and 0.003, respectively. Tukey Pairwise comparisons showed the upper airway width to be significantly narrower in the high-angle group compared to the normal-angle (P = 0.021) and low-angle groups (P = 0.013). Furthermore, the lower airway width in the high angle group was significantly narrower than the normal angle (P = 0.020) and low-angle groups (P = 0.017). There were no statistically significant differences between normal and low angle groups. CONCLUSIONS: The upper and lower pharyngeal widths in the Class I high-angle group were significantly narrower than those in the normal-angle and low-angle groups.

OBJECTIVE: To compare dental and skeletal ages among African American (AA), Caucasian (C) and Hispanic (H) subjects (chronological ages 9 to 15-years). MATERIAL AND METHODS: A total of 168 subjects (9 to 15 years old) were equally divided into AA, C, and H groups, with an equal number of males and females. Each group was divided equally into 7 chronological age-groups, ranging from 9 to 15 years. Dental age was determined from panoramic radiographs as primary, early mixed, late mixed, or permanent dentition (scored as 1-4). Skeletal age was calculated from hand-wrist radiographs using Fishman's Skeletal Maturation Index (SMI 1-11). One-way analysis of variance and Tukey's test were used to compare skeletal and dental ages among AA, C and H subjects; and AA, C and H subjects in each chronological age-group. The two-sample t-test was used to compare SMI and dental age among females and males. RESULTS: Skeletal and dental age were not significantly different between AA, C and H subjects. Mean SMI was higher in females than males; and there were no significant gender differences regarding dental age. Mean SMI and dental age were significantly different among AA, C and H subjects in the 12-year-old and 11-year-old age groups, respectively. CONCLUSIONS: Dental and skeletal maturation are fairly similar among AA, C and H subjects (aged 9 to 15 years).

OBJECTIVE: This study aimed to assess the feasibility of reusing nickel–titanium (NiTi) alloy wires after 6 weeks of intraoral use by evaluating the changes in the load-deflection properties and surface characterization of these alloy wires after cold sterilization by immersion in 2% of acidic glutaraldehyde for 10 h. MATERIAL AND METHODS: Twenty wires each in three groups of G1-as-received wires (ARW), G2-unsterilized used wires, and G3-sterilized used wires (SUW) were tested by the three-point bending test and scanning electron microscopy (SEM). The data were subjected to statistics, one-way analysis of variance, and Bonferroni posthoc test for comparison. RESULTS: Recycling of NiTi wires produced statistically insignificant changes in both the loading and unloading properties of the wires. The forces needed to twist the used wires, that is, G2-(UUW) and G3-(SUW) were lower than G1-(ARW), suggesting lowering of the stiffness of the wires. Superelasticity is well-maintained by G2-(UUW) and G3-(SUW) although there is an insignificant lowering of the forces exerted by them during loading and unloading. SEM demonstrated no increase in the pitting of surfaces in both G2-(UUW) and G3-(SUW); multiple areas were seen to be more smoothened over G2-(UUW) and G3-(SUW) NiTi wires surfaces. CONCLUSION: The findings of this study support the reuse of NiTi wires after 6 weeks of use in oral conditions followed by cold sterilization by immersion in 2% acidic glutaraldehyde for 10 h.

The treatment of Angle Class I malocclusion by atypical extraction is rather challenging. The extraction of four first premolars often manages it. However, in cases of compromised and non-restorable teeth, the extraction decision may be altered, making the anchorage and the treatment mechanics more challenging. This article reports the clinical case of a 16-year-old patient from Sudan who presented with a chief complaint “My teeth are crooked and sticking out.” He had Angle Class I malocclusion with a bimaxillary dentoalveolar protrusion. He had severe crowding in both arches and localized marginal gingivitis related to an ectopically erupted upper right canine (UR3) and lower right first premolar (LR4). The patient had a provisional restoration in the lower right first molar (LR6). Extraction of three first premolars and one first molar was the alternative of choice for this treatment, which restored function, providing improved periodontal health, achieved the desired facial esthetics, and allowed finishing with a stable and balanced occlusion. Management of angle class I malocclusion with atypical extraction patterns should be performed with careful mechanics and anchorage planning to obtain good results.

OBJECTIVES: To analyze the craniofacial morphology in child patients and adolescents by evaluating the skeletal cephalometric profile of the HIV infected patients in this age group and comparing them with the HIV-negative controls. MATERIALS AND METHODS: The present study was a planned case-control study which included 25 HIV-positive adolescent patients aged between 10 and 18 years (the study group) who were compared with 25 age- and sex-matched HIV-negative adolescent controls (the control group). All the patients had been HIV infected via a vertical transmission with positive serology confirmed in two different tests and had been kept on HAART since they were born. The diagnostic aids used for orthodontic documentation included facial photographs, digital orthopantomographs, lateral teleradiographs, and study models. RESULTS: With reference to the methodologies used for taking the cephalometric values, all the methods used were in strong agreement with each other for almost all the variables studied and had high intra-class correlation coefficient values except Co-A, SN.ANSPNS, and SNB which, too, had a good agreement of 60%. Nevertheless, the agreement was positive for these variables, too, since the P values obtained were found to be statistically significant (P < 0.05). CONCLUSION: Most of the measurements in the HIV-infected adolescents were found to be similar to the ones obtained for the HIV-negative controls, although, the study results highlighted the significance of further studies to be conducted in this regard, especially, the longitudinal study designs wherein the said variables can be studied on a follow-up basis in longitudinal studies to have an idea of the exact changes observed and their pattern in the included groups.

OBJECTIVES: To evaluate the perception of esthetics and the attractiveness of the smile, in frontal view, with mandibular asymmetry, through the eye-tracking. MATERIALS AND METHODS: OGAMA software and The Eye Tribe Tracker hardware were used to obtain eye tracking in certain areas of interest on the face. To simulate asymmetry, Photoshop® image editing software was used to create a vertical reference line to the midline of the face and make it symmetrical with control of the angulation relative to another horizontal reference line passing through the vertices. Then, the lower third of the face added asymmetries or deviations, starting from zero, with increments of 2 by 2 degrees up to 6 degrees. The study included 60 laypeople, 30 males and 30 females, without any knowledge about the study, showing good vision, and not having used drugs with the possibility of influencing cognitive or motor skills. RESULTS: From the heat map in cases of mandibular asymmetry, it is possible to visualize that for both sexes the evaluators evaluated with a certain degree of similarity mainly when the deviations presented with 6 degrees. The trajectory of the male and female gaze in cases with asymmetry shows that in cases with a magnitude of 6 degrees, the raters traced mainly in the region of the mouth with little transition in the eye region and mainly in the areas of interest considered as “other.” In the images presented with a magnitude of up to 4 degrees, they were traced in the general image. CONCLUSIONS: The perception of laypeople from mandibular asymmetry to the right in females presented a higher perception when compared to males with mandible asymmetry to the left.

OBJECTIVES: To assess the effect of malocclusion on the self-esteem of adolescents. MATERIALS AND METHODS: This cross-sectional study evaluated 496 student aged between 12 and 14 tears old living in Shiraz city. The level of self-esteem was determined using the Rosenberg self-esteem scale (RSES). To assess the degree of malocclusion, Index of Orthodontic Treatment Need- Dental Health Component (IOTN-DHC) was used. The Spearman's correlation coefficient was calculated to assess the correlation of malocclusion and self-esteem. The mean of IOTN-DHC and total score of RSES in different age groups were analyzed using the Kruskal–Wallis test. The mean IOTN-DHC and total score of RSES were compared between the two municipal districts and males and females using the Wilcoxon test and independent t-test, respectively. RESULTS: A significant but weak correlation was noted between IOTN-DHC and self-esteem (r = 115/0, P = 04/0), while IOTN-DHC subscale: space shortage, dental missing, overjet, overbite, and crossbite had nonsignificant correlation with self-esteem. The socioeconomic status of adolescents significantly affected their self-esteem (P < 0.001). CONCLUSIONS: Weakly significant correlation between mild malocclusion and dental self-esteem.

OBJECTIVES: To assess the knowledge level and attitude of the Saudi population about the use of a dental implant as a treatment option for replacing the missing teeth. MATERIALS AND METHODS: This cross-sectional study adopted a quantitative approach and used an online questionnaire to collect data. Nine hundred and five participants were recruited as per the inclusion criteria (above 18 years of age, know how to read and write, and technology literate). The collected data were analyzed statistically using IBM Statistical Package for Social Sciences (SPSS) software. RESULTS: A low level of knowledge about teeth replacement methods (56%) was recorded among the participant, while 44.4% of them had heard about implant, bridges, and dentures. The oral hygiene of the participants was considered good (59.3%). The main source of information, reported by the participants, was the dentist (53.4%). The knowledge about dental implants was found to be significantly the highest (P = 0.02) among the highly educated participant who had completed postgraduate studies. CONCLUSION: There is a need for introducing comprehensive orientation programs, conducted by dentists, to communicate knowledge about dental implants. The social campaigns and official information programs should be instigated for improving the knowledge of the patients. Structured programs should be also introduced at an academic level, for enhancing the knowledge related to replacing missing teeth and dental implants.

OBJECTIVE: To assess the gingival parameters in the clear aligner treatment versus the three other types of brackets, i.e., conventional metal, conventional ceramic, and metal self-ligating. MATERIALS AND METHODS: Eighty patients coming for regular appointments undergoing orthodontic treatment were included. They were further divided into four groups with 20 patients in each: Group one underwent conventional brackets (CB) treatment; Group two had conventional ceramic brackets (CCB); Group three was treated with self-ligating (SL) brackets; Group four underwent with clear aligner (CA) treatment. Inclusion criteria were any patient with a minimum age of 18 years having Class II, Class III skeletal relationship, undergoing orthodontic treatment for at least 6 months with fixed orthodontic appliances (FOA) on both arches. While smokers, pregnant, diabetics, or those taking medication affecting gingival health or having cardiovascular diseases were excluded. Also excluded were patients who used antiseptic solutions or mouthwash during the past 6 months, underwent any periodontal treatments in the past 6 months, or who had fixed bridges and crowns or extensive restorations close to the gingival margins. Seven indices, namely plaque index, gingival index, gingival bleeding index, sulcus bleeding index, papillary bleeding index, basic periodontal examination index, and bleeding on probing index, were recorded for all groups. RESULTS: Mean age for Group 1 with CB was 26.65 ± 5.15 years, whereas it was 27.65 ± 8.15 years for Group 2 with CCB, and 26.85 ± 5.19 for Group 3 with SB. Group-4 with CA treatment had a mean age of 26.85 ± 4.83 years. Multivariate analysis and a Bonferroni correction was performed (P = 0.008). CA treatment has better periodontal parameter values compared with the CB and the CCB groups, and no significance difference with the SL brackets group. CONCLUSION: CA treatment has better periodontal indices levels compared to other types of orthodontic treatments such as CB and the CCB groups; no significant difference with the SL brackets group. Importance should be given to oral hygiene instructions before, during, and after the treatment.

OBJECTIVE: To assess the prevalence of malocclusion and orthodontic treatment needs in a Saudi sample of Jeddah city. MATERIALS AND METHODS: A cross-sectional (descriptive) study was performed in 2017 among 3016 subjects (1507 females and 1509 males) selected according to stratified random sampling design. The inclusion criteria were Saudi students aged between 14-18 years with no craniofacial deformities or syndromes and no orthodontic treatment carried out. Malocclusion was assessed using the modified Bjork et al. system, and Angle's classification and orthodontic treatment need to be evaluated by using the IOTN (DHC). Descriptive, associations and gender differences were assessed by one-way ANOVA, Chi-square, and Fisher exact tests. Data was analyzed using STATA version 13.0 (StataCorp, College Station, Texas, USA). Statistical significance was set at P < 0.05. RESULTS: Approximately 12% of the participants had normal occlusion, 57% had Class I malocclusion, 17% had Class II malocclusion, and 14% had Class III malocclusion. The highest prevalence of malocclusion traits was for displacement, followed by a crossbite. The IOTN results revealed slight need for orthodontic treatment in (n = 795-26%) moderate/borderline in (n = 1166-39%), and great need in (n = 1055-35%). Class II and III malocclusion, OJ, reverse overjet, scissor bite, open bite, midline discrepancies, and crowding were significantly higher in males than females (P < 0.05). CONCLUSION: Overall, there was a high prevalence of malocclusion and high orthodontic treatment need. The most common malocclusion was Class I. The most common orthodontic treatment need was moderate to borderline.

OBJECTIVE: To evaluate the effects of different adhesion promoters, namely, Enhance LC, Ortho Solo, Assure Universal Bonding Resin and deproteinizing agents such as 5.25% NaOCl, 10% papain gel on the shear bond strength of orthodontic brackets. MATERIALS AND METHOD: The present study was approved by the Ethics Committee of Teerthanker Mahaveer Dental College and Research Centre, affiliated to Teerthanker Mahaveer University, Moradabad, India. Around 150 extracted sound human upper bicuspids were taken and divided into six groups. Group 1 control (37% H₃PO₄), Group 2 (37% H₃PO₄+ Ortho Solo), Group 3 (37% H₃PO₄+ Assure Universal Bonding Resin), Group 4 (37% H₃PO₄+ Enhance LC), Group 5 (5.25% NaOCl + 37% H₃PO₄), and Group 6 (10% papain gel + 37% H₃PO₄). In all the groups (n = 150) orthodontic metal brackets were bonded with Transbond^TM XT and all the samples were subjected for evaluation of shear bond strength using Instron universal testing machine at a cross speed of 0.5 mm/min. The bracket failure mode was examined using Adhesive Remnant Index (ARI). The Kruskal-Wallis test and the Mann-Whitney test were used to compare the shear bond strength. The Chi-square test was used to determine significant differences in the ARI scores among the groups. The significance for all statistical tests was P < 0.05. RESULTS: Mean values of shear bond strength showed statistically significant differences between the evaluated groups (P < 0.005). The lowest and highest shear bond strength was attributed to Group 1 (control) and Group 2 (Ortho Solo), respectively. No statistically significant difference was noted for the mean ARI scores between control, adhesion promoters, and deproteinized group (P < 0.05). CONCLUSION: It was concluded that adhesion promoters and deproteinizing agents can be used to enhance the shear bond strength of orthodontic brackets. Among all the groups Ortho Solo showed the highest bond strength when used with Transbond^TM XT.

OBJECTIVE: To evaluate the antimicrobial property of cetylpyridinium chloride (CPC) when polymerized with cold cure acrylic and to assess the duration of its release from modified acrylic. MATERIALS AND METHODS: CPC was added in different concentrations (0%, 2.5%, 5%, and 10%) to cold cure acrylic resin and 180 acrylic discs were prepared. These were divided into four groups of 45 each depending on the concentration of CPC. The antimicrobial property of the modified acrylic for Streptococcus mutans was tested using disc diffusion assay in agar. The duration of release of CPC from self-cure acrylic was tested with optical density reading of solutions by ultraviolet spectrophotometer. The effect of addition of CPC on diametral tensile strength (DTS) of acrylic was tested using UTM (Instron) and the effect of water aging on modified acrylic was compared with unaged specimens. RESULTS AND CONCLUSION: The normality of the data was checked by Shapiro–Wilktest, and as the data failed to show normal distribution, inferential statistics were performed using nonparametric tests of significance. Antimicrobial activity of modified acrylic increased with increase in CPC concentration. Greatest CPC release was observed on the seventh day with a decrease in release from 7 to 180 days. There was a decrease in the diametral strength of the modified resin and water aging had a significant effect on the DTS of the modified resin.

OBJECTIVES: To investigate the effectiveness of mini-implant (MI)-facilitated micro-osteoperforations (MOPs) in accelerating mandibular anterior teeth alignment. MATERIALS AND METHODS: Thirty teenage patients with mandibular crowding (Little's irregularity index between 4 and 6 mm) were randomly allocated to either “experimental” group (micro-osteoperforation assisted alignment) or “control” group (conventional orthodontics). Blinding was done at the data analysis stages. Six MOPs were performed using MI on the labial aspect in the mandibular anterior region. The primary outcome was the overall treatment time needed to complete alignment of mandibular anterior teeth. The secondary outcomes were to compare the marginal bone height loss and volumetric root resorption around mandibular incisors along with subject's perception of pain, comfort and satisfaction. RESULTS: There was statistically significant difference in the total treatment duration for complete alignment of mandibular incisors. The completion of cases in experimental group was 43.93% times faster than the control group. There were no statistically significant differences in volumetric root resorption and marginal alveolar bone height loss around mandibular incisors as well as pain perception between the two groups. CONCLUSIONS: MI-facilitated MOPs accelerated tooth movement significantly upto nine weeks without any significant pain and discomfort, with no increase in root resorption and marginal alveolar bone height loss.

OBJECTIVES: To compare the accuracy of the linear measurements made on pre- and posttreatment three-dimensional (3D) scanned digital models with conventional plaster study models. MATERIALS AND METHODS: The study was conducted on pre- and posttreatment study models of 132 patients. A 3D model scanner was used to scan the plaster models to form 3D digital models. The measurements were made on the plaster models using digital Vernier calipers, and the 3D digital models were assessed for similar measurement using a software of the model scanner. The intraclass correlation for intraoperator error showed good correlations between the measurements made on conventional plaster models and digital models. RESULTS: Although the comparison of the linear measurements made by conventional and digital methods on both pre- and posttreatment study models using intraclass coefficient showed a good correlation, analysis of variance showed significant mean differences in the measurements of multiple variables in both the groups. The number of variables showing significant differences was more in the pretreatment group. The measurements obtained by Vernier calipers were generally higher than those of scanned pre- and posttreatment study models. CONCLUSION: The linear measurements made by conventional and digital methods showed statistically significant mean differences. The accuracy of recording can be affected by the severity of pretreatment malocclusion, but the deviations were not large enough to contradict the use of the digital models for orthodontic records.

OBJECTIVES: To evaluate and compare the effect of different enamel deproteinizing agents on topographic features of enamel and shear bond strength before acid etching. MATERIALS AND METHOD: In total, 120 sound human maxillary premolars were taken and divided into three groups: Group 1 control (37% phosphoric acid (H₃PO₄), Group 2, (5.25% Sodium Hypochlorite (NaOCl)+ 37% H₃PO_4, and Group 3, (10% Papain gel + 37% H₃PO₄). These groups were further divided into A and B subgroups. In subgroups 1A, 2A, and 3A (n30) topographic features were evaluated using Scanning electron microscope (SEM) at different magnifications. Insub-groups 1B, 2B, and 3B (n90) metal brackets were bonded with Transbond™ XT, and all the samples were subjected for Shear Bond Strength (SBS) evaluation using universal testing machineat a cross speed of 0.5 mm²/min. The failure mode was analyzed using adhesive remnant index (ARI).Statistical analysis was done using one-way ANOVA for the shear bond strength, and Kruskal-Wallis test followed by Mann-Whitneywas performed for ARI scores. RESULTS: SEM showed predominance of type 3 etching pattern in control Group (1A) and type 1 and type 2 in deproteinizedGroups (2A and 3A).Mean values of shear bond strength showed statistically significant differences between evaluated groups (P < 0.005).The lowest and highest shear bond strength was attributed to Group 1B (Control) and 3B (10% papain gel), respectively. Statisticallysignificant differences were noted for the mean ARI scores between control and deproteinized group (P < 0.05). CONCLUSION: 10% papain geland 5.25% NaOCl can be used as deproteinizing agents on enamel surface before acid etchingto enhance the shear bond strength of orthodontic brackets.

OBJECTIVES: To investigate pain intensity, interleukin-1β and prostaglandin E₂ values in saliva during initial orthodontic treatment among varying age groups and their correlation between these mediators. MATERIALS AND METHODS: Twenty healthy patients distributed equally in age and gender groups were chosen. Unstimulated saliva was collected before the placement of orthodontic fixed appliance (T₀), 1 hour after the placement of the appliance with 0.014” nickel titanium archwire (T₁), 1 month after the first visit (T₂), and 1 hour after the placement of 0.016” nickel titanium archwire (T₃). The saliva samples were then analyzed for prostaglandin E₂ and interleukin-1β using enzyme-linked immunosorbent assay. Pain intensity was measured using a numerical rating scale. RESULTS: Prostaglandin E₂ and interleukin-1β levels had increased at T₁ followed by a drop at T₂ and a subsequent increase at T₃. The prostaglandin E₂ and interleukin-1β levels were higher in adults than children. There was an insignificant correlation between the interleukin-1β and prostaglandin E₂ changes in all the patients. No significant differences were seen in pain scores between adults and children. Insignificant correlation was seen between pain scores and prostaglandin E₂ and interleukin-1β. CONCLUSION: Prostaglandin E₂ and interleukin-1β can be detected in saliva and are increased in during the initial orthodontic treatment but are higher in adults than children. Pain intensity was not significantly different between adults and children.