Evaluation of pain perception associated with maxillary first molars distalization in the presence of maxillary third molars versus extracted third molars using infra-zygomatic mini-screws: A randomized clinical trial

Aim: The purpose of this randomized clinical trial was to compare the pain associated with distalizing maxillary first molars with the presence versus extraction of unerupted third molars using infra-zygomaic mini -screws in a group of adolescent female patients. Study design: This randomized clinical trial (parallel group design) was approved by the Research Ethics Committee of the Faculty of Dentistry, Future University in Egypt Materials and methods: 30 patients requiring bilateral maxillary molar distalization using infra-zygomatic mini-implant were randomly allocated to third molar extraction (TME) or third Molar presence (TMP) groups All patients were asked to assess their pain levels on the day of the mini-implant insertion procedure and after 24 hours, 72 hours, and 1 week using a numeric pain rating scale. Additionally, Each patient completed a numeric pain rating scale form on the day of mini-screw loading, 3 days, 1 week, and 2 weeks following appliance fixation. Every patient received three copies, and the first, third, and sixth appliance activations required the same pain response. Results: At the mini-implant site, the mean pain scores in the TMP and TME on the same day for screw insertion were 5.27±2.08 and 4.89±1.99, respectively. And faded away gradually in both groups. Throughout the distalization phase, the average pain severity at the maxillary molar site on the day of mini-implant loading was 4.2±1.46 in the TMP group and 4.13±2.2 in the TME group. That subsides gradually to mild pain after one week of each appliance activation. comparable results found between both groups Conclusion: Pain experienced by the patient during maxillary molar distalization is comparable regardless of the presence or absence of the third molar. The insertion of infra-zygomatic screws caused moderate to modest discomfort in both groups. The distalization procedure was associated with mild to moderate discomfort, which progressively subsided after the loading day

Role of anatomical sites and correlated risk factors on the survival of orthodontic miniscrew implants:a systematic review and meta-analysis

Abstract Objectives The aim of this review was to systematically evaluate the failure rates of miniscrews related to their specific insertion site and explore the insertion site dependent risk factors contributing to their failure. Search methods An electronic search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Knowledge, Scopus, MEDLINE and PubMed up to October 2017. A comprehensive manual search was also performed. Eligibility criteria Randomised clinical trials and prospective non-randomised studies, reporting a minimum of 20 inserted miniscrews in a specific insertion site and reporting the miniscrews’ failure rate in that insertion site, were included. Data collection and analysis Study selection, data extraction and quality assessment were performed independently by two reviewers. Studies were sub-grouped according to the insertion site, and the failure rates for every individual insertion site were analysed using a random-effects model with corresponding 95% confidence interval. Sensitivity analyses were performed in order to test the robustness of the reported results. Results Overall, 61 studies were included in the quantitative synthesis. Palatal sites had failure rates of 1.3% (95% CI 0.3–6), 4.8% (95% CI 1.6–13.4) and 5.5% (95% CI 2.8–10.7) for the midpalatal, paramedian and parapalatal insertion sites, respectively. The failure rates for the maxillary buccal sites were 9.2% (95% CI 7.4–11.4), 9.7% (95% CI 5.1–17.6) and 16.4% (95% CI 4.9–42.5) for the interradicular miniscrews inserted between maxillary first molars and second premolars and between maxillary canines and lateral incisors, and those inserted in the zygomatic buttress respectively. The failure rates for the mandibular buccal insertion sites were 13.5% (95% CI 7.3–23.6) and 9.9% (95% CI 4.9–19.1) for the interradicular miniscrews inserted between mandibular first molars and second premolars and between mandibular canines and first premolars, respectively. The risk of failure increased when the miniscrews contacted the roots, with a risk ratio of 8.7 (95% CI 5.1–14.7). Conclusions Orthodontic miniscrew implants provide acceptable success rates that vary among the explored insertion sites. Very low to low quality of evidence suggests that miniscrews inserted in midpalatal locations have a failure rate of 1.3% and those inserted in the zygomatic buttress have a failure rate of 16.4%. Moderate quality of evidence indicates that root contact significantly contributes to the failure of interradicular miniscrews placed between the first molars and second premolars. Results should be interpreted with caution due to methodological drawbacks in some of the included studies

Evaluation of the physical properties of a novel twin block appliance in treatment of skeletal class II growing females with mandibular deficiency

Objective: This study was performed to reveal the physical changes of polymers used after gamma irradiation of a modified twin block appliance versus conventional twin block appliance in the treatment of growing females with skeletal Class II malocclusion having mandibular deficiency. Materials and methods:  The total sample consisted of 12 specimens 6 from every polymer, modified twin block group which was composed of polyethylene polymer and conventional twin block group which was formed of poly methyl-methacrylate polymer used in this study, exposed to different gamma irradiation doses (25 KGray and 30 KGray) in order to test their physical properties. Assessment was done using UV-visible spectroscopy and scanning electron microscope. Results: This study revealed that concerning the gamma radiation effect on the polymers used, Poly methyl methacrylate showed yellowish color change    and increased number of pores on its surface after irradiation while polyethylene vacuum sheets didn’t show any color change but the scratches and pores appeared on its surface using scanning electron microscope. Conclusion: From the previous results it can be concluded that the modified twin block appliance can be used as an alternative orthopedic appliance in treatment of skeletal class II malocclusion growing subjects with mandibular retrusion.&nbsp

A survey of the practice of regional anesthesia in Saudi Arabia

Objective: This survey aimed to assess both the extent of practice and need for training in regional anesthesia among anesthesiologists in Saudi Arabia in 2012. Methods: We distributed an electronic survey among 382 anesthesiologists attending the bi-annual meetings of the Saudi Anesthetic Association, enquiring about their practice in regional anesthesia. Questions concerned the practice of regional anesthesia, use of ultrasound guidance, and the need for training workshops. Results: The response rate of anesthetists was 55.2% with most of them were males and had mean age of 25-50 years. Most anesthesiologists (88.2%) were practicing regional anesthesia frequently in the operating rooms (75.3%) rather than designated block room. From the respondents, only 14.2% did fellowship in regional anesthesia, 21.8% and 18.5% were using ultrasound and nerve stimulation guidance, respectively, 11.4% received formal training, and 86.3% were willing to attend training workshops on regional anesthesia. There was a significant negative correlation between the ultrasound users and their institutional positions ( r=−0.191) ( P=0.026). Conclusions: We believe that more could be done to improve the practice of regional anesthesia in the Kingdom of Saudi Arabia, including the implementation of formal training and conduction of more frequent specialized courses/workshops in the field of regional anesthesia with special reference to ultrasound regional anesthesia blockade techniques