Facial convexity in macedonian subjects

Objective: The assessment of the patient’s soft tissue profile is a critical step in orthodontic diagnosis and treatment planning. Achieving a pleasing esthetic profile is an important goal of orthodontic therapy, and can influence the treatment plan and mechanotherapy. The aim of the present study was to evaluate the convexity angles in Macedonian participants with different sagittal irregularities. The examination was performed on 90 profile cephalograms on Macedonian subjects with permanent dentition, aged 16-21 years, divided in Class I, II/1 and III malocclusions, with symmetrical gender distribution and no previous orthodontic treatment. Examined parameters were angle of facial convexity (N’– Sn’-Pg’) and angle of total facial convexity (N’-Pr’-Pg’). Results: The analysis of the size of the angle of facial convexity and angle of total facial convexity showed that the highest average value was in the subjects of class III, followed by class I and the lowest average values were in the subjects with II/1. For p <0.05, the analysis of variance indicated a significant difference between the three groups of malocclusion, in both sexes. There is a significant linear positive weak correlation between age and the parameter N’– Sn’-Pg ‘(with increasing age the value of this parameter also increased ). Conclusion: Our study has shown that the biological range of facial soft tissue values needs to be determined according to age, sex, and orthodontic anomalies for each ethnic group. Keywords: esthetic profile, orthodontic therapy, cephalogram

Ортодонтски третман и влијанието на букалните коридори врз атрактивноста на насмевката

Естетските вредности денес се разликуваат од оние што биле стандард до пред неколку децении. Лицевата естетика еволуира од едноставна микроестетика на забите постигната со ортодонтски третман до макро естетика на лицето како и начинот на кој забите влијаат на лицевите пропорции. Овие пропорции се оценуваат како перцепции за лицева убавина. Естетската перцепција е променлив фактор и зависи од поединецот и е под големо влијание од неговото лично искуство и социјалното опкружување, тоа е една од причините зошто професионалното мислење за евалуација на лицевата естетика не може секогаш да се совпаѓа со перцепцијата и очекување на пациенти или општата популација. Естетска и атрактивна насмевка е една од најважните компоненти коja влијаe на целокупната лицева естетика. При ортодонтски третман покрај основните карактеристики на насмевка, големината, обликот и бојата на забите, фактори кои придонесуваат за добивање на една атрактивна насмевка се однесуваат на карактеристиките на гингивата (боја, контура, текстура, гингивална видливост), присуство на smile arc, видливост на забите како и просторот на букалните коридори. Маргарет Волф Хангерфорд славно изјавила „Убавината е во окото на гледачот“, естетската перцепција е субјективна. Целта на овој труд е да се образложат букалните коридори како една од осумте главни компоненти на насмевката и да се елаборира нивното влијание врз ортодонтската дијагноза и планирање на третман. Во литературата постојат многу обиди за проучување на влијанието на ортодонтскиот третман врз лицевата естетика особено естетиката на насмевката. Постојат различни начини според кој информациите се собираат, анализираат и објавуваат. Пребарувањето за селекција на трудови е направено во базата на податоци на PubMed, преку предтходно дефинирана стратегија и се опфатени трудови од 1958 до 2022 година. Користени се помошни алатки односно селекција на трудови во последните 5 години, кои го опишуваат влијанието на ортодонтскиот третман врз лицевата естетика и атрактивноста на насмевката како и перцепција на насмевката од различен панел (ортодонти, стоматолози, општа популација). Минималниот простор на букалните коридори може да се смета како една од преферираните естетски карактеристики, оние лица со големи букални коридори може да се сметаат како субјекти за ортодонтски третман од естетски аспект. Клучни зборови: атрактивност, букални коридори, насмевка, ортодонтски третман, перцепција..

Orthodontic anomalies in mixed dentition

Aim: To estimate the frequency of orthodontic anomalies in the period of mixed dentition in children, and to highlight the importance of prompt treatment in order to prevent more serious disorders of the child oral health. Materials and methods: For accomplishing the goal we’ve conducted systematic and control check-ups on children at the age of 9; 95 children from urban areas, and 68 from rural areas. Results: Of 95 analyzed children from urban areas with ethnic Macedonian population, 81 have an orthodontic anomaly. Nearly half of them i.e. 39 have mobile appliances. The most common anomaly are protrusion of teeth standing at 28.3%, a deep bite with 21% and crowding with 17.2%. Of 68 analyzed children from rural areas of ethnic Albanians, 54 have an orthodontic anomaly, while only 3 children wear mobile appliances. The most common anomalies are both crowding and maxillary protrusion of teeth with an equal 27.7%. If we compare the results: the occurrence of orthodontic anomalies is slightly higher in the Macedonian population. Conclusion: Orthodontic anomalies are diagnosed during regular systematic dental check-ups for children aged 7-13. The period of mixed dentition, which is characterized by an intense growth of the jaws, is ideal for orthodontic treatment. The parents have opportunities to inform themselves of the orthodontic anomaly of their children and promptly visit an orthodontist. With properly conducted activities on behalf of the preventive teams, we can severely decrease the percentage of children with orthodontic irregularities. DOI: http://dx.doi.org/10.5281/zenodo.122730

Влијанието на ортодонтските аномалии врз појавата на гингивална инфламација

Apart from dental plaque microbes, which are the main factors in the etiology of gingival inflammation, a local risk factor that has a major impact on clinical expression of inflammation are orthodontic anomalies because they create conditions for greater accumulation of dental plaque. The aim of this study was to evaluate the influence of orthodontic malocclusion crowding and open bite, as a local risk factor in relation to the accumulation of dental plaque, which is the primary etiological factor in the etiopathogenesis of gingival inflammation, and to determine the pathological influence of the dental plaque on the gingival tissue, by recording the index of gingival inflammation (IGI) and the index of gingival bleeding (IGB). For this purpose, 60 patients with orthodontic anomalies were observed; 30 of them with crowding and 30 with open bite. As a control group, 30 examinees were included. In all examined groups index of dental plaque (IDP), index of gingival inflammation (IGI) and index of gingival bleeding (IGB) were evaluated. The results showed a statistically significant difference in IDP, IGI and IGB values  between patients with crowding and open bite compared to examinees without orthodontic anomalies. All these obtained results point to the fact that orthodontic anomalies are a risk factor for gingival inflammation which is the introduction to periodontal disease. Education, motivation and use of appropriate mechanical and chemical means for maintenance of oral hygiene are necessary in patients with orthodontic anomalies in order to protect the already affected periodontal complexОсвен микроорганизмите од денталниот плак,  кои се основни чинители во етиологијата на гингивалната инфламација, локален ризик-фактор кој има големо влијание врз клиничката експресија на инфламацијата се ортодонтските аномалии, бидејќи создаваат услови за поголема акумулација на денталниот плак. Целта на нашиот труд беше да се утврди влијанието на ортодонтските аномалии - збиеност и отворен загриз, како локални ризик-фактори во однос на акумулацијата на денталниот плак кој е примарен етиолошки фактор во етиопатогенезата на гингивалната инфламација  и да се утврди патолошкото влијание на денталниот плак врз гингивалното ткиво, преку евидентирање на индексот на гингивална инфламација (ИГИ) и индексот на гингивално крвавење (ИГК). За таа цел беа опсервирани 60 пациенти со ортодонтски аномалии, од кои 30 со збиеност и  30 со отворен загриз. Како контролна група беа вклучени 30 испитаници без ортодонтски аномалии. Кај сите испитувани групи беше проследен индексот на дентален плак (ИДП), индексот на гингивална инфламација (ИГИ) и индексот на гингивално крвавење (ИГК). Резултатите покажаа дека постои статистички значајна разлика во вредностите на ИДП, ИГИ и ИГК помеѓу испитаниците со ортодонтски аномалии и испитаниците без ортодонтски аномалии. Добиените резултати укажуваат на фактот дека ортодонтските аномалии се ризик фактор за појавата на гингивална инфламација која е вовед во пародонталната болест. Кај пациентите со ортодонтски аномалии, неопходна е едукација, мотивација и користење на соодветни механички и хемиски средства за одржување на добра орална хигиена, со цел да се заштити веќе афектираниот пародонтален комплекс

Orthodontic Treatment of a Periodontally - Affected Adult Patient (Case Report)

BACKGROUND: The advanced periodontal disease is characterised by a strongly pronounced loss of attachment and reduction of the alveolar bone support, which leads to luxation, migration of the teeth, functional discomfort and poor facial aesthetics. CASE PRESENTATION: The aim of this paper is to present the case of a 26-year-old female patient, registered at the Clinic of Periodontology with highly expressed gingivitis, unsatisfactory periodontal status, presence of diastemas between the frontal teeth and attachment loss of 5-6 millimetres in different areas. We conducted a thorough classic periodontal treatment, as well as training for proper maintenance of oral hygiene, with frequent professional oral-prophylactic sessions, complemented with orthodontic treatment. Fixed orthodontic appliances were installed, and mild forces were applied for gradual levelling of the teeth, with constant control of the periodontal status. After 20 months of treatment, the patient was in retention. CONCLUSION: Orthodontic therapy of periodontally-affected teeth can begin only after exhaustive administration of a periodontal treatment. Orthodontic treatment as an addition to the periodontal restoration must be gradual with mild forces for an optimal dental response, thus helping to improve function, facial aesthetics and psychological confidence of adult patients

Is there any difference in arch dimension measurements at digital vs. plaster models?

Digital models are a reliable alternative to conventional plaster models that are accurate, efficient, easy to use, and allow visualization of the planned treatment results. The Aim: To make a comparison of arch dimensions measurements(width, length, and height) made on digital and plaster models. Material-Methods: Orthodontic plaster models of 60 patients with dental crowding, aged 13-18 years were observed. Linear measurements of arch dimensions were performed first manually with a digital caliper and then digitally with 3Shape’s OrthoAnalyzer TM software program on the scanned plaster models with 3Shape D800 TM scanner. Dental arch width, length and height by Harper were performed. Arch width was measured as intercanine, inter-premolar (IPM4, IPM5) and intermolar (IM6) distance. Arch length was measured as measured as the distance between the distal surface of the first permanent molar and the point of contact between the central incisors. Arch height was measured as the distance between the distal surfaces of the first permanent molars and the septal margin of the central incisors, following the linea mediana. Results: There is no statistically significant difference in the width of the dental arches between plaster and digital models. There is a statistically significant difference, in the length and height of both dental arches in favor of smaller length dimensions in digital models, and in addition to larger height dimensions in digital models. Conclusions: Measurements on digital models are suited for reliable diagnostic measurements, which compare well to those obtained from plaster casts, the current gold standard. Keywords: conventional plaster models, digital models, gnathometric analysis

Impact of Covid-19 pandemic оn orthodontic treatment

Purpose: The purpose of the study is to determine the relationship between the COVID-19 pandemic and the attitudes, behaviors and beliefs related to orthodontic treatment. Methodological approach: The research represents a retrospective cross sectional study conducted on a sample of 192 orthodontic patients from public and private facilities. Results: A strong majority of respondents stated that the pandemic had an impact on their orthodontic treatment, lifestyle and financial situation. Only 19.8% of respondents would cancel scheduled orthodontic check-ups due to fear of infection with COVID-19, yet more than half of patients reported having anxiety related to COVID-19. More than half of the patients said they followed the orthodontist's instructions during the pandemic. Conclusion: The results generate useful information to help meenage the expectations and needs of patients and orthodontic practices during a pandemic, contributing to the continuous improvement of community dental health services. COVID-19-related anxiety is a factor in the success of orthodontic treatment as well as adequate communication between orthodontist and patient. Keywords: orthodontics, Covid-19, pandemi

Интердисциплинарен пристап и план на терапија кај пациенти со олигодонција

Oligodontia is a rare developmental dental anomaly in humans characterized by the absence of six or more teeth. In European populations the estimated prevalence of both syndromic and non- syndromic oligodontia is 0.14%. Clinical  features of oligodontia include six or more missing teeth, lack of development of maxillary and mandibular alveolar bone height and reduced lower facial height. Variation in tooth morphology, anomalies of the enamel, reduced size and aberrant form, delayed eruption have also been observed. Oligodontia is also associated with reduced salivary secretion rates.  These bring a functional  and esthetic  limitations and impact on emotional well-being. The aim of this study was to present a case of a 12-year-old girl with oligodontia and therapeutic procedures for orthodontic-prosthetic rehabilitation and normal orofacial function. A multidisciplinary approach that includes orthodontic and prosthetic therapy is often necessary for dental management in young patients with oligodontia. Oral rehabilitation and maintenance care in individuals with many missing permanent teeth is a long-standing commitment that requires involvement of different specialists. Methods used are age-dependent, and early diagnosis is crucial. Orthodontic treatment,  autotransplantation,  dental implants, avoiding tooth preparations, and partial prosthetic dentures are treatment choices.Олигодонцијата е ретка дентална аномалија кај хуманата популација, која се карактеризира со недостаток на шест или повеќе заби. Во Европа, преваленцијата на синдромската и несиндромската олигодонција е 0,14%. Клиничките манифестации вклучуваат недостаток на шест или повеќе заби, недоволен развој на максиларниот и мандибуларниот алвеоларен гребен и редуцирана долна третина од лицето. Варијациите во денталната морфологија, редуцираната големина и аберантна форма, аномалиите во емајлот, како и  доцната ерупција, додатно ја влошуваат клиничката слика. Олигодонцијата е асоцирана и со редуцирана саливарна секреција. Сето ова генерира функционални и естетски проблеми, со импакт на емоционалното здравје. Целта на студијата е да се прикаже случај на 12-годишно девојче со олигодонција, и преземените тераписки процедури за ортодонтско-протетска рехабилитација и воспоставување на нормална орофацијална функција. Може да се заклучи дека оралната рехабилитација кај индивидуите со олигодонција  е долготраен процес во кој се вклучени различни специјалисти. Третманот зависи од возраста, а раната дијагноза е круцијална. Превенцијата на кариес, ортодонтскиот третман, автотрансплантацијата, денталните импланти, избегнувањето на препарации на забите и парцијалните протетски надоместоци се препорачани методи

Maxillary ridge preservation prior to immediate implant insertion

There is a growing tendency to place single tooth implants immediately after extracting a failing tooth in the posterior region. The aim of this article is to present the treatment and the one-year clinical follow-up of a patient. This case presentation illustrates a solution of rehabilitation option after maxillary bicuspid loss, including the diagnosis, treatment planning and the procedure of implantation. After the atraumatic extraction of the both maxillary premolars, we did a procedure for alveolar ridge preservation using a mixture of cortico-cancellous allograft and xenograft, and resorbable membrane (Maxgraft® and Mucoderm® by Botiss biomateratials GmbH, Germany) to enlarge the ridge and correct facial and socket defects, as well as thickening the peri-implant tissue. We used endosseous titanium self-tapping dental implants with conical shape, immediately placed after the act of extraction. The platform-switching helps preventing crestal bone loss, increases the volume of soft tissue around the implant platform and improves the esthetic end result. Bone and soft tissue defects were healed over time by wearing a long-term temporary crowns, titanium custom made abutments and final BruxZir® solid zirconia crowns. Conclusion: The paper highlights this combined approach in the placement of implants in fresh extraction sockets with good and stable esthetic and functional results. Keywords: Immediate implant placement, posterior region, extraction sites, ridge preservatio

Diagnostic dilemmas in the most common oral lesions and diseases

Objectives: The diagnosis and treatment of lesions of the oral cavity are an integral part of oral health care, hence the early detection and treatment of these lesions will greatly improve the quality of life of patients and the survival rate in cases of oral cancers. Aim: To present the most common oral changes and lesions, their clinical characteristics and differential diagnostic possibilities, to avoid mistakes and ensure an accurate diagnosis. Methods: research was done exploring specialized databases PubMed, MEDLINE, EBSCO, Science Direct, and Scopus for the period 2010-2023, by use of MeSH terms: pigmented oral lesions, diffuse and bilateral pigmented lesions, focal pigmented lesions, differential diagnosis. Results: The most common oral manifestations were categorized in groups as follows: localized (intravascular, extravasated blood, melanocytic, tattoo) and generalized (hereditary, with systemic diseases, physiologic and medications associated). Conclusions: To minimize wrong diagnoses and achieve more accurate ones, it is necessary to consider the main complaints of patients, medical and dental history, and clinical manifestation, not excluding paraclinical examinations. Laboratory tests, and in many cases histopathological examination, which is known as the gold standard in the diagnosis of oral pathology, are used to confirm the clinical diagnosis. Keywords: oral cavity lesions, pigmented lesions, differential diagnosis