Cleidocranial Dysplasia (CCD) is a syndrome that causes skeletal growth disturbances. The impaction of many permanent teeth and several supernumerary teeth are among the dental problems of patients with this syndrome. This patient was a 14 y/o girl with CCD syndrome. She was skeletal Cl III with reverse overjet; many impacted teeth, and several supernumerary teeth. Orthodontic treatment was done in two stages. In the first stage, supernumerary anterior teeth were extracted, and the impacted teeth were exposed for traction. In the second stage, posterior supernumerary teeth were removed, and upper canines and posterior impacted teeth were exposed for forced eruption. For traction of the mandibular anterior teeth in the first stage, a new appliance was designed, which included a fixed lower lingual arch, a TMA labial wire, and high-pull headgear with J-hooks. Traction of upper canines and posterior teeth was done with the conventional method using an archwire and other teeth as anchorage. At age 21, orthognathic surgery was performed to correct Class III skeletal relationships. All of the anterior mandibular teeth erupted in a short time with the new appliance. Two premolars and upper canines could erupt into the arch. The patient had no root resorption, no periodontal bone loss, good facial esthetics with Class I skeletal relationship, and normal overjet and overbite. Orthodontics and orthognathic surgery can provide aesthetic and function to CCD patients. The new appliance can be used as an effective device for the traction of multiple impacted teeth in the mandibular anterior area.

Introduction: Transverse occlusal plane (TOP) should be parallel to the true horizontal lines of the face (ie, the interpupillary line [IP] and commissural line [CL]). This study aimed to investigate the opinions of laypersons, orthodontists, and oral and maxillofacial surgeons about the impact of imbalanced IP and CL on facial attractiveness. Methods: We used a symmetrical face image as the reference. Then, using Photoshop software, we constructed the following 6 photographs: TOP roll relative to CL and IP (3 & DEG; and 6 & DEG;) with parallelism of CL and IP, CL roll relative to TOP and IP (3 & DEG; and 6 & DEG;) with parallelism of TOP and IP, TOP and CL roll relative to IP (3 & DEG; and 6 & DEG;). Consequently, the participants rated the photographs on the basis of their attractiveness. Kruskal-Wallis and Mann-Whitney U tests were used to compare the ratings. Results: One hundred thirtyone laypersons, 22 orthodontists, and 20 surgeons participated in this study. It was found that 51.1% of laypersons, 86.4% of orthodontists, and 70% of surgeons selected the reference photograph as the most beautiful, followed by the photograph with a 3 & DEG; roll of CL relative to TOP, with parallelism of TOP and IP (29% of laypersons, 31.8% of orthodontists, and 35% of surgeons). Conclusions: Most participants selected the reference photograph as the most beautiful and realized a roll in the horizontal planes up to 3 & DEG;. The parallelism of the esthetic line of dentition relative to interpupillary is preferred over its parallelism relative to CL. (Am J Orthod Dentofacial Orthop 2023;164:386-94)

Purpose Fluoride varnish can decrease shear bond strength (SBS) of orthodontic brackets to enamel. Recently, laser has been used as a method of enamel preparation for bracket bonding. The present study aimed to compare SBS of orthodontic brackets on fluoridated and non-fluoridated teeth prepared by acid and laser etching. Materials and methods In this in-vitro study, 84 human extracted maxillary first premolars were divided into 4 groups: (1) fluoride varnish + acid-etching (AF); (2) fluoride varnish + laser-preparation (LF); (3) acid-etching (A); (4) laser-preparation (L). AF and LF groups were exposed to fluoride varnish and after 6 hours were washed. Samples in AF and A groups were prepared with 37% phosphoric acids and LF and L groups were etched by Er,Cr:YSGG laser. Afterwards, brackets were bonded. The samples were assessed by universal testing machine for SBS. Adhesive remnant index (ARI) was assessed under magnification in stereomicroscope. Statistical analysis was done by ANOVA analysis. P-value was considered to be 0.05. Results Maximum and minimum SBS were observed in A (SBS = 18.77) and AF (SBS = 2.78) groups, respectively. SBS of fluoridated laser-etched teeth (LF) was more than fluoridated acid-etched teeth (A). SBS was less than acceptable clinical bond strength in AF group. ARI was similar between groups (P-value < 0.097). Conclusion Fluoride varnish decreased SBS of brackets to enamel. Laser caused more SBS in fluoridated teeth than acid etched teeth. Thus, enamel preparation by laser may be considered a successful method in fluoridated teeth. Randomized controlled trials are recommended for this issue.

Background:Fixed orthodontic treatment may cause discomfort four to six weeks after the initiation of the treatment as it may change the type and amount of food consumed by children. This temporary change may have a long-term effect on the growth status of such children. This study aimed to detect the longitudinal relationship between fixed orthodontic treatment and developmental indicators in children and adolescents.Methods:The study population encompassed adolescents undergoing fixed orthodontic treatment as the exposure group (n = 30) and adolescents with no orthodontic treatment as the control group (n = 90). The patients' dental age, weight, height, body mass index (BMI), and wrist circumference were assessed at the baseline, as well as 1, 3, and 6 months after the orthodontic treatment. The significance level was set to be p = 0.05.Results:One-hundred twenty participants were included in this study. In the two groups, all growth parameters revealed an increasing trend. In the exposure group, weight-related indices (i.e., weight, BMI, and wrist circumference) decreased in the first month and then increased during the next five months. All indices in the control group and height in the exposure group exhibited a continuous increase.Conclusion:Fixed orthodontic treatment affects childhood growth indices. However, these effects are probably short-term, and the catchup growth mechanism can offset these effects and modify the changes in growth indices. A longer follow-up period is recommended to be considered by future researchers.

Purpose: This study aimed to compare the effect of benzocaine and menthol patches on pain alleviation following elastomeric separator placement.Patients and Methods: This triple-blind split-mouth trial was conducted on healthy 14-25 years old patients of orthodontic department. Eligibility criteria included presence of second premolar, first and second molars in both sides of the mandible, no chronic pain in oral cavity, or chronic consumption of analgesic drugs. Elastomeric separators were placed mesial and distal of first mandibular molars and patients were randomized into two groups: 1) menthol/ placebo patches, 2) benzocaine/ placebo patches. The mucosal patches were placed randomly on the buccal area of mandibular first molars on both sides. Main outcome was pain level reported by patients on the Visual Analogue Scale (VAS) in seven-time intervals in three following days. Data were analyzed by linear mixed model. P-value was set to be 0.05. Results: Sixty-four patients were randomized in a 1:1 ratio with no loss to follow-up. Both benzocaine and menthol patches significantly reduced mean pain level compared to placebo patch (P< 0.001). Benzocaine patch had more analgesic effect; however, the difference was not statistically significant (P=0.115). Time interval had a significant effect on recorded pain except the first time interval. Age and gender had no significant effect on pain. No adverse event was reported in patients. Conclusions: Both benzocaine and menthol patches were effective in alleviating pain. Therefore, they can be recommended to be used for reducing pain following orthodontic elastomeric separator placement.

Background: Simulation and prediction can facilitate the decision between an extraction versus nonextraction treatment plan. This study aimed to assess the accuracy of Dolphin Imaging software in predicting profile changes in class I borderline cases. Methods: In this retrospective study, class I borderline patients (i.e., both extraction and nonextraction treatment plans were possible for them) aged 15-35 years were enrolled. All of the cephalometric analyses were done by Dolphin Imaging software, version 11.8 Premium. The initial cephalograms were superimposed on initial photographs. The final values for the 7 angular and linear landmarks of the upper and lower incisors were extracted from post-treatment cephalograms and inserted in the "Goals" tab of the Dolphin Imaging software. Post-treatment images of patients were simulated. Final post-treatment photographs were superimposed on the simulated pictures. The differences between the real and simulated pictures were calculated in relation to the reference lines. The P value was set at 0.05. Results: A total of 70 patients (36 with tooth extraction, and 34 without tooth extraction) were included. In the extraction group, the horizontal position of both lips was predicted to be significantly more protruded than it actually was, whereas in the nonextraction group, the only difference between the simulated and actual results was that the vertical position of the lower lip, which was simulated as being more inferior than it actually was. Conclusions: Despite the statistically significant differences between the real and simulated pictures, the differences were small and clinically insignificant. Prediction via Dolphin Imaging software can be an appropriate guide in extraction-nonextraction borderline cases. (C) 2021 World Federation of Orthodontists. Published by Elsevier Inc. All rights reserved.

OBJECTIVE:Chlorhexidine gluconate is currently the most effective oral antimicrobial agent against microorganisms, but discoloration of the teeth prevents its long-term use and can reduce patient cooperation. In this study, the effect of chlorhexidine and a diluted chlorhexidine-based, fluoride, cetylpyridinium and vitamin added mouth rinse (Orthokin) on stain index in fixed orthodontic patients was compared.MATERIALS AND METHODS:This study was performed as a double blind randomized controlled trial on 50 patients undergoing fixed orthodontic treatment in the age group of 14-30 years. The patients were categorized as two groups of chlorhexidine and Orthokin mouth rinses and were asked to use mouthwash for eight weeks. Groups were matched according to colouring food consumption. Extrinsic staining index was assessed by modified Loben technique. Data was analysed by SPSS software. P value was set to be 0.05.RESULTS:In the chlorhexidine group, the stain extent index and overall stain index were increased significantly at 8 weeks (P<0.001 and P=0.002, respectively). However, the increase in stain intensity index was insignificant (P=0.07). In Orthokin group, the changes in stain extent, stain intensity and overall stain were insignificant (P=0.66, P=1.000, P=0.47, respectively).CONCLUSION:According to the results of the present study, chlorhexidine mouthwash causes more staining of teeth compared to Orthokin mouthwash. It seems that lower concentrations of chlorhexidine can be prescribed to orthodontic patients. Although these compounds are effective in sense of oral hygiene, they do not cause significant discoloration.

COVID-19 is now a worldwide concern, causing an unprecedented pandemic. The infected cases show different symptoms based on the severity of the disease. In asymptomatic and non-severe symptomatic cases, the host immune system can successfully eliminate the virus and its effects. In severe cases, however, immune system impairment causes cytokine release syndrome which eventually leads to acute respiratory distress syndrome (ARDS). In recent years, photobiomodulation (PBM) has shown promising results in reducing acute pulmonary inflammation. Considering the high potential impact of PBM on immune responses, we hypothesized that using PBM could be an effective treatment modality for ARDS management in COVID-19 patients.

BACKGROUND:The decision regarding the selection of extraction or non-extraction orthodontic treatment is a common challenge in orthodontic treatment planning. OBJECTIVES:The objective of this study was to compare the effects of extraction and non-extraction orthodontic treatment on the soft tissue profile of borderline class I patients. MATERIAL AND METHODS:In this retrospective study, 70 patients were selected from among those referred to the Department of Orthodontics of the Faculty of Dentistry at Hamadan University of Medical Sciences in Iran. The inclusion criteria were skeletal class I, 4-10 mm of space deficiency, and the possibility of applying both extraction and non-extraction orthodontic treatment. All patients underwent fixed orthodontic treatment with the use of 0.022-inch-slot edgewise brackets. The patients were divided into 2 groups (n = 35) according to the 4-premolar extraction or non-extraction treatment plan. The 2 groups were compared by means of the cephalometric analysis. RESULTS:There were 11 males and 24 females at a mean age of 17.46 years in the non-extraction group, and 9 males and 26 females at a mean age of 18.46 years in the extraction group. The upper and lower incisors as well as the lower lip moved forward in the non-extraction group (lower lip to E‑plane = 0.87 ±1.39 mm, U1-SN = 2.83 ±8.03°, IMPA = 4.64 ±5.47°). The incisors and the lips moved backward in the extraction group (upper lip to E‑plane = -1.42 ±2.08 mm, lower lip to E‑plane = -1.56 ±1.97 mm, U1-SN = -7.63 ±9.02°, IMPA = -7.05 ±6.79°). The differences were statistically significant (p < 0.05). Mentolabial sulcus became more pronounced in the non-extraction group (1.92 ±2.73 mm; p < 0.001) and shallower in the extraction group (-1.90 ±4.2 mm; p = 0.000). CONCLUSIONS:Orthodontic treatment can change the soft tissue appearance of the lower third of the face. The lips and the incisors moved forward in the non-extraction group and backward in the extraction group.

Introduction: Considering the little evidence regarding peri-orbital infections, this study was aimed to obtain information about the epidemiology, etiology, and management of orbital infections. Material and Methods: In this retrospective investigation, all patients with peri-orbital infection who were hospitalized in a tertiary ophthalmologic center in AL-Zahra hospital, Isfahan, Iran from 2008 up to 2018 were identified. Documented data and radiographic images were extracted. The data regarding epidemiology, etiology and disease course was analyzed. Results: Sixty nine patients (35 males, 34 females) with the age range between 3 months to 85 years were included. Preseptal cellulitis was recorded in 53 cases (76.8%) and orbital cellulitis was seen in 16 cases (23.2%), and the proportion of preseptal to orbital was 3.3 to 1. The mean duration of hospitalization in patients with preseptal cellulitis was 6.38 ±, 4.59 days and in patients with orbital cellulitis was 12.44 ±, 9.63 days. Most patients with preseptal cellulitis were treated by medication therapy (71.7%), while the orbital cellulitis were often treated by surgical procedures (56.2%). Sinusitis was the main cause of both preseptal and orbital cellulitis in all age groups, except infants under 1 year, which dacryocystitis was identified as primary factor. Conclusions: The prevalence of peri-orbital infection was higher in children. The prevalence ratio of preseptal to orbital cellulitis was 3.3:1. The main etiologic factor was sinusitis. There is no agreement for the treatment modalities of peri-orbital infections and the timing of surgical intervention. Continuous evaluation of treatment course, both clinically and radiographically is important. Reassessment is recommended when improvement is not seen after 6-7 days of treatment.

PURPOSE:The orbital cavity can be affected in zygomaticomaxillary complex (ZMC) fractures. The aim of this study was to assess the relation between orbital volume changes and enophthalmos in patients with ZMC fractures. MATERIALS AND METHODS:A descriptive study of consecutive adult patients with recent isolated unilateral ZMC fractures who were otherwise healthy was performed from 2016 through 2017. Multislice computed tomographic (CT) scans were taken of all patients and enophthalmos was measured clinically using a Hertel exophthalmometer. In the axial plane, enophthalmos was measured on CT scan using Mimics software. Three-dimensional reconstruction and volume measurement of the orbital cavity also were performed using Mimics software. The correlation between clinical and radiographic amounts of enophthalmos was measured by Pearson correlation coefficient analysis. The association among radiographic enophthalmos, clinical enophthalmos, and volume changes of the orbital cavity was assessed by linear regression. The P value was set at .01. RESULTS:Ninety-six patients (77 men, 19 women; mean age, 28.48 ± 8.29 yr) were assessed. Mean volumes of control and fractured bony orbits measured on CT scan were 29.02 ± 1.71 and 32.05 ± 2.22 cm3, respectively (P < .001). There was a strong positive correlation between clinically and radiographically measured amounts of enophthalmos (correlation coefficient = 0.97; P < .001). Based on the linear regression model, for each 1-cm3 orbital volume change, clinical and radiographic enophthalmos amounts changed by 0.68 and 0.71 mm, respectively (P < .0001). CONCLUSION:ZMC fractures commonly increase orbital volume and the degree of change is strongly correlated with enophthalmos.

Orthognathic surgery can affect patients' quality of life. The aim of the present study was to assess changes in quality of life during combined orthodontics-surgery treatment and effect of orthodontist-surgeon teamwork on final patient's satisfaction. Twenty-six orthognathic patients who were referred to oral and maxillofacial department of 3 hospitals in Tehran were included in the study. Orthognathic quality of life questionnaire (OQLQ) was given to patients 1 week before, 4 weeks and 4 months after surgery. Two self-designed forms were used for evaluating mood and comfort of patients 1 week before surgery and 4 days after surgery. Self-designed forms were given to the orthodontists and the maxillofacial surgeons to assess quality of teamwork and difficulty of the procedure. Twenty-four patients (15 females and 9 males) with the mean age of 22.62 +/- 3.57 completed the study. Quality of life increased from 1 week before surgery to 4 months after surgery (P<0.013) and the difference was statistically significant between OQLQ score at 1 week before surgery and that of 4 months postoperative. Esthetic and social domain showed significant changes during the studied period. Orthognathic quality of life questionnaire at 4 months postoperative was correlated with surgery difficulty and duration. It can be concluded that orthognathic surgery can improve quality of life, especially in esthetic and social aspects.

Purpose: Secondary grafting of alveolar defects with iliac crest bone is a common treatment method in cleft patients. The aim of this study was to evaluate the effectiveness of the combination of symphysis bone, allograft, and platelet-rich fibrin in regeneration of alveolar defects compared with iliac bone graft.Materials and Methods: In this randomized clinical trial, patients with unilateral alveolar defects were divided randomly into two categories. Group A comprised patients in whom the combination of chin symphysis bone plus allogeneic bone material plus leukocyte-and platelet-rich fibrin was considered for treatment. Group B comprised patients in whom iliac bone graft was considered. Cone beam computed tomography before treatment and 1 year postoperatively was used for measurement of bone formation (bone volume in cubic centimeters). The data were analyzed by paired t and x(2) tests via SPSS software (version 23; IBM, Armonk, NY). P <.05 was considered significant.Results: Each group included 10 patients (with 6 male patients in group A and 5 male patients in group B). The mean age of patients in groups A and B was 9.5 +/- 1.5 years and 9.9 +/- 1.9 years, respectively. The mean volume of alveolar defectswas 0.89 +/- 0.29 cm(3) in group A and 0.95 +/- 0.27 cm(3) in group B. The percentage of bone regeneration in groups A and B was 69.5% and 73.8%, respectively.Conclusions: It seems that chin symphysis bone plus allogeneic bone material plus platelet-rich fibrin is a proper combination for bone regeneration in alveolar defects with a small to moderate volume range. (C) 2016 American Association of Oral and Maxillofacial Surgeons

Nowadays bilateral sagittal split osteotomy (BSSO) is the most common technique for treatment of mandibular skeletal deformities. One of the most sensitive stages in BSSO is recognition of inferior alveolar nerve entrance. This technical note presents a noble and safe approach for medial osteotomy in BSSO which is based on anatomy of mandible during the surgery. In this approach osteotomy initiates at the junction of buccal and lingual cortices of ramus and will continue parallel to buccal cortex and in the same direction with sagittal cut. Compared to conventional BSSO technique, less neurosensory complications, risk of condylar sagging and bad splitting are expected in suggested modification. The operation time, healing and recovery periods are shorter, which cause more convenience for both surgeon and patient.

Purpose: Considering the little evidence around acellular dermal graft application in secondary lip reshaping, this study is aimed to quantitatively examine the effect of acellular dermal graft in combination with Z-plasty technique in secondary defects of cleft lip. Methods: In this clinical investigation, patients with secondary unilateral cleft lip deformity were selected. Standard photographs were prepared for each patient. Subsequent to scar revision, submucosal tunneling and Z-plasty, implantable human acellular dermal graft was placed and fixed in submucosal pocket. Quantitative parameters included angle of symmetry , dimension of symmetry (DS), defect height (DH), parallel lines, and lip thickness were measured presurgically and 1 year after treatment. Pre and post-operative pictures were compared and the changes were documented according to the criteria. P value less than 0.05 were considered as significant. Results: Eighteen patients were included in this study. The difference of “DS” between normal side and cleft side was 3.1 ± 1.5 mm presurgically and 1.1 ± 1.8 mm postsurgically. The change was significant (P value < 0.05). The difference between pretreatment and posttreatment measures of “DS”, “DH”, and “Lip Thickness” were 2.75 ± 4.55, 3.43 ± 4.82, and 2.66 ± 3.04 mm, respectively. The results were significant (P value<0.05). Conclusions: Based on the results, acellular dermal graft in combination with Z-plasty was able to improve lip deformity in patients with secondary defects of cleft lip. Further studies are recommended regarding the application of this technique in patients with bilateral cleft lip and severe “DH.”

Purpose:Considering the little evidence around acellular dermal graft application in secondary lip reshaping, this study is aimed to quantitatively examine the effect of acellular dermal graft in combination with Z-plasty technique in secondary defects of cleft lip. Methods:In this clinical investigation, patients with secondary unilateral cleft lip deformity were selected. Standard photographs were prepared for each patient. Subsequent to scar revision, submucosal tunneling and Z-plasty, implantable human acellular dermal graft was placed and fixed in submucosal pocket. Quantitative parameters included angle of symmetry , dimension of symmetry (DS), defect height (DH), parallel lines, and lip thickness were measured presurgically and 1 year after treatment. Pre and post-operative pictures were compared and the changes were documented according to the criteria. P value less than 0.05 were considered as significant. Results:Eighteen patients were included in this study. The difference of “DS” between normal side and cleft side was 3.1 ± 1.5 mm presurgically and 1.1 ± 1.8 mm postsurgically. The change was significant (P value < 0.05). The difference between pretreatment and posttreatment measures of “DS”, “DH”, and “Lip Thickness” were 2.75 ± 4.55, 3.43 ± 4.82, and 2.66 ± 3.04 mm, respectively. The results were significant (P value<0.05). Conclusions:Based on the results, acellular dermal graft in combination with Z-plasty was able to improve lip deformity in patients with secondary defects of cleft lip. Further studies are recommended regarding the application of this technique in patients with bilateral cleft lip and severe “DH.”

Aim: This study is aimed to investigate the success rate and clinical outcome of placed implants in reconstructed alveolar ridges using iliac cortico-cancellus bone graft compared to normal nonaugmented alveolar ridge. Materials and Methods: In this clinical trial study, 30 patients who were selected and assigned in case and control groups. The case group included patients with severe alveolar bone loss, who needed bone grafting. The control group included patients with sufficient alveolar ridge and no Original Research Article Attar et al.; BJMMR, 9(2): 1-7, 2015; Article no.BJMMR.18216 2 need for bone grafting. The prosthesis was placed on implants after 3 to 8 months. Plaque index, bleeding, pocket depth, mobility, pain, pus secretion and bone loss were evaluated after 24 month. Data were analyzed by SPSS 13. P-value less than 0.05 was considered as significant. Results: Out of 30 patients, two were excluded due to their requirements. Totally 97 implants were placed in patients, which included 52 implants in control group and 45 implants in case group. All of the implants were successfully osseointegrated and loaded. There was no significant difference between the success of inserted implants between both groups (P=0.05). The mesial and distal bone losses were significantly more in patients without iliac bone graft (P=0.05). There was no statistically significant difference between measured outcomes including plaque, bleeding, pocket depth, mobility, pain, and pus secretion (P=0.05). Conclusion: Inserted implant in free non-vascularized iliac bone graft has high rate of success comapred to non-augmented alveolar ridges and has shown to be a reliable method for reconstruction of severe atrophic jaws.

Keratocystic odontogenic tumor (KOT) is one of the major components of nevoid basal cell carcinoma syndrome (NBCCS), which usually occurs in young ages and includes significant structures of jaws. According to high recurrence rate of KOT, there are many controversies in treatment of the lesion, especially in syndromic cases with younger ages. In current report, authors suggest a conservative protocol in the treatment of KOT in a patient with NBCCS.