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   Table of Contents - Current issue
Coverpage
January-March 2019
Volume 53 | Issue 1
Page Nos. 1-94

Online since Tuesday, February 5, 2019

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EDITORIAL  

Helming the winds of change while standing on the shoulders of giants… p. 1
Puneet Batra
DOI:10.4103/0301-5742.251574  
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ORIGINAL ARTICLES Top

Comparison between acetaminophen, ibuprofen, and ketorolac as an efficient single-dose preoperative medication for control of pain associated with initial aligning archwire: A double-blind randomized control trial p. 3
Nimish Arun Wajekar, Murlidhar Radhakrishnan Sastri, Neha Naresh Vazirani, Snehal Satish Pathak
DOI:10.4103/jios.jios_12_18  
Background: Pain regulation is an issue of utmost importance for an orthodontist and a patient that undergoes orthodontic treatment. This is mainly because there is no set standard for controlling pain during orthodontic treatment. Objectives: The aim of the present study is to compare the efficacy of commonly prescribed drugs, acetaminophen, ibuprofen, and ketorolac on relieving orthodontic pain. Materials and Methods: A sample of 80 orthodontic patients scheduled to undergo fixed orthodontic treatment were selected and allocated (block randomized) into four experimental groups of 20 patients each, of which Group 1 was prescribed acetaminophen (500 mg), while Groups 2–4 were prescribed ibuprofen (400 mg), ketorolac (10 mg), and placebo (lactose capsule), respectively. All the prescriptions were given as a single-dose preoperatively. Each patient was thereafter asked to note the degree of pain perceived at specific intervals of time with reference to a questionnaire and a 100-mm visual analog scale. Statistical Analysis: Data comparison was done by applying the analysis of variance test to compare each group for every experimental parameter. To further elucidate the individual comparisons between each time point, the Tukey's test was used as post hoc analysis. Results: There were significant relationships between the four drug groups for each parameter, namely chewing, biting, occluding on anterior teeth together, and occluding on posterior teeth together (P < 0.05). Conclusion: The present study concluded that, when compared with the placebo group, the use of (nonsteroidal anti-inflammatory drugs) ketorolac, ibuprofen, and acetaminophen preoperatively reduced the pain perceived at 2 hours and 6 hours after archwire placement. However, the results were much significant for the ketorolac group as compared with the ibuprofen and acetaminophen groups. Trial Registration: Clinical Trials Registry-India CTRI/2017/03/007995.
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Variations of salivary levels of osteoprotegerin during orthodontic tooth movement p. 10
Upasak Mukherjee, U S Krishna Nayak, U S Arjun Nayak, NK Adarsh, MN Kuttappa, Akhil Shetty
DOI:10.4103/jios.jios_175_18  
Aim: The study aimed to determine the variations of salivary levels of osteoprotegerin (OPG) during the different stages of orthodontic tooth movement. Materials and Methods: A sample of 24 patients was taken up for the study. Salivary samples were collected from each of the patients at the following intervals: T(0) – before start of the appliance therapy, T(1) – 24–48 h following treatment initiation, T(2) – after 2 weeks of appliance insertion, and T(3) – 5 weeks of appliance insertion. At all times, whole unstimulated salivary samples were collected. ELISA-based assay was used to determine the levels of OPG in the salivary samples. The results were statistically analyzed using ANOVA with Bonferroni t-test. The significance value of P< 0.05 was considered as statistically significant. Results: According to the results, there was an insignificant decrease and increase of OPG levels. Salivary levels in the alternate stages of treatment. P value for this particular study was found to be 0.05. Conclusion: The findings indicate that the variations in salivary concentrations of OPG might be linked to various stages of orthodontic tooth movement. The site specificity of OPG collection requires further studies in the long run.
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Does malocclusion affect Adolescents' social acceptance? p. 14
Fadia M Al-Hummayani, Salwa M Taibah
DOI:10.4103/jios.jios_29_18  
Objectives: The aim of this study was to evaluate the social impact and self-perception of malocclusion among adolescents and to investigate whether types and severity of malocclusion have any effect on adolescents' social acceptance. Methodology: The sample size was 886 males and females living in Jeddah city, Saudi Arabia, chosen from middle and high schools' students, with ages ranging from 12 to 19 years. After completion of the questionnaire to assess social impact, all participants were examined using Index of Orthodontic Treatment Need (IOTN), Dental Health Component, and Aesthetic Component. Results: The results showed that there was a highly significant difference between the means of both social impact and self-perceived need scores according to gender and according to the severity of treatment need as assessed by the examiner using IOTN. Malocclusion has a negative effect on social acceptance. Anterior spacing, anterior open bite, increased overjet, and crowding–in this order–have the most negative impacts on adolescents' social acceptance. Conclusions: Social acceptance is negatively affected by the severity of malocclusion. Spacing, open bite, increased overjet, and crowding have the most negative impacts on adolescents' social acceptance.
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Immediate Complete Anterior Guidance Development (ICAGD) applied to post-orthodontic patients with Temporomandibular Disorders: A single interventional study of 50 cases p. 21
Prafulla Thumati, John C Radke, Roshan Prafulla Thumati
DOI:10.4103/jios.jios_70_18  
Objective: The objective was to test the efficacy of immediate complete anterior guidance development (ICAGD) treatment applied to a select group of postorthodontic temporo-mandibular disorder (TMD) patients with specified myalgic symptoms. Materials and Methods: The symptoms of a carefully selected group of fifty postorthodontic myalgic TMD patients without serious temporomandibular joint disturbances were documented with a 0–10 Visual Analogue Scale, pre and post ICAGD treatment. Bilateral masseter and temporalis muscle activity and relative bite force were measured multiple times before and after treatment. The Mann–Whitney U-test was used to analyze the anamnestic data, and Student's paired t-test was used to analyze all the measured data. Results: Disclusion times were significantly reduced (P = 0.000) as were the posttreatment subjective symptoms (P = 0.0003). The relative force levels clenching in maximum intercuspal position became more equally distributed between the left and right sides after treatment (P < 0.0002), although the total electromyography (EMG) activity during the clenching did not change (P > 0.4940). The left and right lateral excursive EMG activity was significantly reduced after treatment (P < 0.05). Conclusions: The application of ICAGD reduced: (a) the lateral excursive disclusion times, (b) the myalgic reported symptoms, (c) the left–right imbalance of forces during clenching, and (d) the amount of muscular effort during lateral excursions for this group of postorthodontic myalgic TMD patients.
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Evaluation of tooth surface characteristics after application of intrusive orthodontic forces using scanning electron microscope: An In vivo study p. 27
Gauravdeep Kaur, Maninder Singh Sidhu, Seema Grover, Ashish Dabas, Namrata Dogra
DOI:10.4103/jios.jios_55_18  
Introduction: Orthodontic forces when applied to tooth structure leads to some amount of resorption depending upon force duration and magnitude applied. Study aimed to evaluate tooth surface changes after application of intrusive orthodontic forces using scanning electron microscope. Materials and Methods: 20 patients were selected requiring first premolar extraction for treatment of malocclusion with fixed mechanotherapy and were divided into four groups. Group I and III consisted application of 50 gm of light force on right side and left side respectively for 4 weeks intervals. Group II and IV consisted application of 150 gm of heavy force on right side and left side respectively for 8 weeks intervals. A cantilever spring was attached from buccal tube of molar band to bracket bonded on first premolar. After 4 and 8 weeks respectively; first premolars were extracted and surface chareacteristics were evaluated using SEM. Each tooth sample was divided into middle and apical third and further into buccal, lingual, mesial and distal surfaces on each tooth. Results: Statistical significant (P < 0.001) changes were observed in middle third area using both light and heavy forces. Conclusions: Heavy forces during intrusion should be used cautiously in orthodontic biomechanics, if such procedures are to be carried out over a long period of time.
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Analysis of plaque microflora in patients pretreatment and during treatment with fixed orthodontic appliances: An In vivo Study p. 38
Atteeque Ahmed, Ashwith Hegde, Rajaganesh Gautam, Ajit Kalia, Salil Nene, Shymal Vairagi
DOI:10.4103/jios.jios_104_18  
Aim: The study analyzed plaque microflora to compare the growth of periodontopathogens-Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Prevotella nigrescens and Campylobacter rectus in patients undergoing fixed orthodontic treatment. Materials and Methods: Samples of plaque microflora from gingival crevices from incisors, and molars were collected by sterile periodontal probe at four different time periods-first was taken before placement of fixed appliances (T0) considered to be control group, then at 1 week (T1), 1 month (T2), and 5 months of starting fixed treatment (T3).The samples were transported to the laboratory and processed within 24 hr using the polymerase chain reaction technique. Results: The statistical significance of intragroup comparisons was done using test RMNOVA. The colony-forming units at different follow-up intervals showed a significant increase in all tested periodontopathogens except A. actinomycetemcomitans which showed no significant increase. Conclusion: Fixed orthodontic treatment can interfere in normal oral hygiene which can initiate plaque accumulation further leading to inflammation due to increase in periodontopathogens. Therefore, oral hygiene should be constantly monitored for plaque control.
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A Comparative assessment of the effect of professional oral hygiene measures on the periodontal health of patients undergoing fixed orthodontic appliance therapy p. 43
PG Francis, Prathapan Parayaruthottam, Vincy Antony, Fajar Ummar, K M Muhamed Shaloob, K Jubin Hassan
DOI:10.4103/jios.jios_21_18  
Objective: Maintaining good oral hygiene during fixed orthodontic treatment will help keep good periodontal health, which will reflect in the final outcome of orthodontic treatment. Hence, we undertook this study to find out whether doing professional prophylaxis midway during fixed orthodontic treatment will reduce adverse changes on the gingival and periodontal apparatus due to poor oral hygiene maintenance when compared to homecare measures only. Materials and Methods: This prospective study involved twenty patients who underwent fixed orthodontic therapy, in the Orthodontics Department of a teaching institution. The effect of regular home care measures only as compared to professional prophylaxis midway during orthodontic treatment in addition to regular home care on the periodontal health was evaluated on two separate visits over a 9-month period. Results: The clinical parameters indicating periodontal conditions during fixed orthodontic treatment, such as plaque, gingival, bonded bracket plaque indices and probing depth, were evaluated. The results revealed that an oral prophylaxis done in the 5th month during a 9-month study drastically improved the gingival and periodontal health of patients. Conclusions: The present study was done to understand the importance of professional prophylaxis and proper instructions in oral hygiene maintenance during orthodontic treatment in our target population. Results showed a significant improvement of gingival and periodontal health in the present study, with an improvement in plaque control with professional prophylaxis which was in accordance with most of the previous studies. Hence, it can be concluded that plaque control with professional prophylaxis in orthodontic patients is a very important adjunct in the maintenance of proper periodontal health and prevention of periodontal disease.
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Awareness and practice of ethics and guidelines with cone-beam computed tomography prescription in orthodontics p. 49
Shahista Parveen, Uma Kulkarni, Rohan Mascarenhas, Roopali Shetty
DOI:10.4103/jios.jios_134_18  
Aims and Objectives: Cone-beam computed tomography (CBCT) is now being widely used in orthodontic practice. On the one hand, there is an increasing need of CBCT for diagnosis and research, and on the other hand, there is a broad concern for the exposure to radiation. Prescribing CBCT scan requires judicious clinical judgment to maximize the benefits and minimize the harm. The best way to reduce unnecessary ionizing radiation from CBCT is to follow recommended guidelines and ethical principles. This study was undertaken to determine if ethical principles are followed when prescribing CBCT scans. This study also analyzed the awareness of guidelines for the use of CBCT in orthodontics. Materials and Methods: Web-based questionnaire study was carried out to assess awareness and practice of ethics and guidelines for CBCT prescription after approval from the University Ethics Committee. Voluntariness, privacy, and confidentiality were ensured through informed consent. 101 orthodontists and 103 orthodontic residents participated in the survey. Responses were anonymous and were subjected to statistical analysis. Results: The mean scores were as follows (1) principle of autonomy (0.585 ± 0.25), (2) principle of beneficence and nonmaleficence (0.405 ± 0.17), and (3) principle of justice (0.36 ± 0.22). There is no statistical difference for the scores of ethical principles among orthodontists and orthodontic residents (P > 0.05) except for the principle of beneficence and nonmaleficence (P < 0.05). Only 100 respondents (49 orthodontists and 51 Orthodontic residents) were aware of guidelines for the use of CBCT in orthodontics. Conclusion: This study gives an insight into the practice of ethics and guidelines whenever CBCT scan is indicated in orthodontics.
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CASE REPORTS Top

Begg's Revisited: Report of a Case p. 57
SM Laxmikanth, Sougenia G Murthy, Sushruth Shetty, Amrita Mishra Kar
DOI:10.4103/jios.jios_71_18  
Begg's technique is based on a unique approach to treat the orthodontic cases by using light forces with the objective of moving the teeth with optimal forces. The foremost etiology of skeletal Class III malocclusion being a genetic inheritance, here we report a case of a female patient, 12 years and 6 months of age who visited to our department with a chief complaint of the highly placed upper right front tooth. The preliminary analysis was performed and diagnosed with Angle's Class I malocclusion with a skeletal Class III. Begg's appliance (TP) was opted for proclination of teeth and followed by placing of 0.013 copper-nickel-titanium archwires in upper and lower arch. 0.016 AJ Wilcock reverse curve of Spee were placed in upper and lower arches subsequently. Proclination of the upper anterior teeth due to uncontrolled tipping significantly improved the facial profile, improvement in upper anterior crossbite with adequate overjet and overbite were obtained.
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Treatment of skeletal class II malocclusion using miniplate anchorage with fixed functional appliance p. 62
Suresh Gorantla, Madhurima Thokala, Darsana Maru, Prabhakar Veginadu, Sudha Sravani Konathala
DOI:10.4103/jios.jios_46_18  
The aim of the present case report was to present the treatment of a growing patient with skeletal class II malocclusion with by mandibular retrusion using PowerscopeTM anchored to mini plates. After initial leveling and alignment of the upper arch using fixed appliance (MBT prescription; 0.022-inch slot), 0.021 X 0.025-inch SS arch wire was inserted. One week after the placement of miniplates bilaterally at the symphysis of mandible, powerscope was installed on to the miniplates and the upper 0.021 X 0.025 inch archwire anterior to the molars. After eight months, powerscope was removed and lower arch strap up was done. Favorable skeletal and dental changes were observed at the end of active treatment with powerscope and finishing and detailing with fixed appliance.
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Treatment of a severe tooth size-arch length discrepancy using rapid maxillary expansion and mandibular incisor extraction: An unconventional combination approach p. 69
Harpreet Singh, Pranav Kapoor, Poonam Sharma, Raj Kumar Maurya, Tanmay Mittal, Deepak Kumar Bhagat
DOI:10.4103/jios.jios_90_18  
Rapid maxillary expansion (RME) has proven to be a viable treatment option for space gaining in maxilla. Similarly, mandibular incisor extraction when used in aptly selected cases has been reported to be a valuable adjunctive therapy to relieve tooth size-arch length discrepancy in mandibular arch. However, cases reporting the concomitant use of both these modalities are few. The objective of the present article is to report the successful orthodontic treatment of severe tooth size-arch length discrepancy in an adolescent patient using a combination of nonextraction treatment including RME, proclination of anterior teeth and reproximation in the maxillary arch, and single incisor extraction in the mandibular arch. Through a meticulously planned individualized treatment approach, esthetically and functionally stable results with good occlusion were achieved, which were well-maintained at 3-year follow-up. The favorable treatment outcome and long-term stability achieved substantiates the feasibility of this unconventional treatment option in selected cases.
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CLINICAL INNOVATIONS Top

Bondable hyrax with split tongue crib appliance p. 77
Lijo John
DOI:10.4103/jios.jios_256_17  
The main objective of this innovation was to combine and utilize the benefits of both hyrax appliance for rapid maxillary expansion and tongue crib for habit breaking. It is a very simple, easy to fabricate appliance which can be used for correction of posterior crossbite and tongue thrusting habit in a growing child.
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Composite veneered orthodontic bands: Easy solution to multiple problems p. 79
Poonam K Jayaprakash, Mukesh Kumar, Parag Bohara
DOI:10.4103/jios.jios_156_17  
Orthodontic banding still finds its place in day today clinical practice of orthodontics. Well-prepared orthodontic bands provide adequate mechanical retention, which is further enhanced when cemented with glass-ionomer luting cements. Banded molars withstand the occlusal forces better than their bonded counterparts. Composite veneering of these orthodontic bands can mask the objectionable metallic appearance of the orthodontic bands for better esthetics and acceptance
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Modification in transpalatal arch used in conjunction with a fixed twin block p. 81
Sharath Kumar Shetty, A Roginth Vigneshwaran, Y Mahesh Kumar
DOI:10.4103/jios.jios_214_17  
A simple and innovative method of merging the free end of transpalatal arch into the acrylic used as bite blocks in fixed twin block appliance is presented. Inadequate retention of any orthodontic appliances could lead to aspiration of the foreign body posing medical emergency. The proposed method helps in additional retention as well as prevents the possibility of accidental ingestion of the fixed twin block appliance.
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D-Arch: An interdisciplinary approach to absolute anchorage p. 84
HS Dharmesh, SV Bharathi, H Kiran
DOI:10.4103/jios.jios_229_17  
Anchorage is the most important consideration in any orthodontic treatment planning. The main aim of the D-Arch is to produce absolute anchorage in all three dimensions which cannot be obtained in the conventional transpalatal arch. D-Arch is a rigid, noninvasive appliance to avoid unwanted tooth movement.
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A simplified method for fabricating customized arch form p. 87
Chandra Sekhar Gandikota, Nemani Shivaram, Syed Amaan Husain
DOI:10.4103/jios.jios_266_17  
Customized and prefabricated arch forms are the two basic types of arch forms which determine the outcome of orthodontic treatment. With the introduction of preadjusted edgewise appliance, customized arch forms were rapidly replaced by prefabricated archwires. Although the former was more suitable for a particular patient, they were time-consuming in making and required a lot of chair-side time. The present paper describes a single jig which makes the fabrication of one such arch form (Bonwill Hawley) for any number of patients with different arch dimensions easy and less cumbersome.
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TECHNIQUE TIP Top

Correction of relapsed midline diastema p. 90
Abhishek Kshetrapal
DOI:10.4103/jios.jios_225_17  
Relapse of the midline diastema is one of the most common postorthodontic complaints. Although numerous methods have been cited in literature, we propose an easy, time-saving, cost-effective, and reliable method for its correction using an elastomeric ring separator.
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PG FORUM/CRITICAL APPRAISAL Top

Correlation between panoramic radiography and cone-beam computed tomography in assessing maxillary impacted canines p. 92
Ananta Singh, Anirban Sarkar, Shweta Pandey
DOI:10.4103/0301-5742.251543  
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A multicentric randomized controlled trial to compare a self-ligating bracket with a conventional bracket in a UK population p. 93
Gaurav Pratap Singh, Abhishek Singla, Ashutosh Bhardwaj
DOI:10.4103/0301-5742.251557  
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