Assessment of the Knowledge of General Dentists Practicing in Tehran about Timing of Orthodontic Treatment

Objective: The ideal time to commence orthodontic treatment is very important. In Iran, due to the widely distributed population and low number and uneven distribution of orthodontists, general dental practitioners (GDPs) play an important role in proper treatment of occlusal and functional disorders and referring orthodontic patients to orthodontists. The purpose of this study was to assess the knowledge of GDPs about the proper timing of orthodontic treatment in comparison with orthodontists practicing in Tehran.Methods: This cross-sectional analytical study was conducted on GDPs and orthodontists practicing in Tehran, who were selected by random sampling. The questionnaire used in this survey asked for demographic information including age, sex, academic degree, work place and work experience and contained questions concerning the knowledge of clinicians regarding the proper time to commence treatment for the most common types of occlusal disorders, functional disorders, temporomandibular joint (TMJ) disorders and other orthodontic problems. The answers of both groups of participants were assessed based on the American Board of Orthodontics objective grading system (ABO OGS). Results: The results of ANOVA showed that the two groups were significantly different in terms of age (p<0.05), sex, academic degree (p<0.001), and place of work (private office, private clinic, governmental clinic) (p<0.05). The results of comparison of GDPs and orthodontists for the proper time of initiation of orthodontic treatment for occlusal, functional and TMJ disorders showed that the GDPs had significantly less knowledge in this regard.Conclusion: Because of low level of knowledge of GDPs about the ideal time to commence orthodontic treatment, further training regarding diagnosis of malocclusion in primary and mixed dentition periods, etiology of malocclusion, recognition of normal occlusion and normal dental relationships as well as the proper time to start orthodontic treatment for each type of disorder seems necessar

Comparison of the Accuracy of Hexagon Imaging Software versus Digital and Hand Tracings of Lateral Cephalograms

Objectives The aim of this study was to evaluate the validity and reliability of a newly designed cephalometric analysis program (Hexagon software) in comparison with manual and digital (Dolphin software) tracings. Methods Pre-treatment lateral cephalometric radiographs of 32 adult patients between 18 to 41 years (10 males and 22 females, mean age of 22.78 ± 5.17 years) were randomly chosen. For each radiograph, 10 angular and 6 linear measurements were calculated using three different methods (manual and digital using two different software programs). The cephalograms were manually traced using acetate paper, x-ray light box, 0.3 mm HB pencil, ruler, and protractor. For digital tracing, cephalograms were traced with Dolphin vertion-10 (USA) and Hexagon (Iran) software programs. All the analyses were performed by one operator 2 times with at least a four-week interval between the two tracings. The intra-class correlation coefficient (ICC) was used to evaluate the intra-examiner agreement, while the differences between the methods were analyzed using paired t-test, and ANOVA. Results The intra-examiner repeatability of all measurements in all three tracing methods showed high agreement. Differences in measurements between the two software programs and hand tracing were not statistically significant for any of the cephalometric parameters (P>0.05). Conclusion The results demonstrated that the accuracy of cephalometric tracing by the Hexagon software was similar to the Dolphin software, and the manual tracing technique

Hemifacial Microsomia: A Mini-Review and Case Report

Objectives Hemifacial microsomia (HFM) is an asymmetric craniofacial malformation, which results from hypoplasia of the first and second branchial arch components and is characterized by a wide spectrum of phenotypic expressions, varying from the underdevelopment of the temporomandibular joint, mandible, facial and trigeminal nerves, masticatory muscles, ears, and hypoplastic maxillary, temporal, orbital, and zygomatic bones to conductive hearing loss due to external and middle ear deformities. Management of this developmental defect is multidisciplinary and associated with various phenotypic spectra and severities. A wide range of treatment protocols, such as surgical interventions, have been proposed, especially for mandibular hypoplasia, including rib or fibular bone grafting, distraction osteogenesis (DO), orthognathic surgery, and a combination of these procedures. Case In this study, the treatment course and 17-year follow-up of a patient with HFM were described. The treatment included autogenous costochondral grafting, followed by full-time application of an asymmetric hybrid functional appliance, fixed orthodontic therapy, orthognathic surgery, and contour modification surgery to achieve optimal facial aesthetics. Conclusion Patients can benefit from functional jaw orthopedics psychosocially and the consequent enhanced facial symmetry during childhood and adolescence is really advantageous   &nbsp

Advances in Management of Class II Malocclusions

Although mandibular advancement by bilateral sagittal split osteotomy seems to be a good mandibular treatment option to treat skeletal class II malocclusion, it is less stable than setback; relapse depends on a wide range of patient‐centered and surgeon‐centered factors relating to the skill and experience of the surgeon, proper seating of the condyles, the exact amount of mandibular advancement, the tension of the muscles and soft tissues, the mandibular plane angle, and the patient\u27s age. In fact, patients with low and high mandibular plane angles have increased vertical and horizontal relapses, respectively. Nonsurgical management of class II malocclusion may be an option by which to effectively manage such cases. The present chapter discusses different treatment modalities for clinical management of class II malocclusion in growing and non‐growing patients

Dental Management of a Patient with Amelogenesis Skeletal Class III Multidisciplinary Malocclusion & Anterior Open bite; A Case Report

Objectives Amelogenesis imperfecta (AI) comprises a clinically and genetically heterogeneous group of conditions that affects the dental enamel, occasionally in conjunction with other dental, oral, and extra oral tissues. The purpose of this case report was to describe the necessity of the multidisciplinary approaches taken to treat a young patient diagnosed with hypocalcified-type of amelogenesis imperfecta along with skeletal class III jaws relationship and anterior open bite.Case A 19 year-old female was presented to the department of orthodontics, School of Dentistry at Shahid Beheshti University of Medical Sciences (Tehran, IRAN) with the chief complaints of dental sensitivity to hot and cold, teeth discoloration leading to esthetic concerns. On examination the patient was confirmed as skeletal CL III with a long face syndrome and severe anterior open bite. The patient reported difficulty with mastication and poor self-image due to teeth appearance .Interdisciplinary team approach was proposed in a three phase treatment plan: pre-surgical treatment, surgical treatment, postsurgical treatment. This approach enabled the team to successfully improve the patient’s facial profile, resolve malocclusion, and normalize the aesthetic.Conclusion This case management revealed the importance of having a coordinated team approach consist of orthodontist, oral surgeon, and prosthodontist as a necessary key to a successful treatment. This approach is essential for successful management of structural, aesthetic, and functional issues as well as an achievement of high patient’s satisfaction

Management of Costochondral Graft Overgrowth Following Treatment of Condylar Ankylosis: A Case Report

Costochondral graft (CCG) is a common treatment modality for temporomandibular joint (TMJ) ankylosis. One of disadvantages of CCG is unpredictability of growth pattern and risk of overgrowth. This report illustrates management of a patient with CCG overgrowth. The patient was a girl, aged 7 years with severe facial asymmetry and TMJ ankylosis. The treatment comprised releasing of ankylotic mass and use of CCG for TMJ reconstruction. Four years later, the patient underwent overgrowth of the grafted side. Following clinical examination and scintigraphy, the grafted side was shaved to prevent more growth and the patient left to pass adolescent growth spurt. Ultimately, remnant deviation may be compensated by mild genioplasty and fat injectio

The Effect of Methylphenidate on Cervical Vertebral Maturation and Dental Age in Patients with Attention Deficit Hyperactivity Disorder

Statement of the Problem: It is postulated that attention deficit/hyperactivity disorder (ADHD) with or without medication has an inhibitory effect on the children’s growth and development. Purpose: This study aimed to assess the dental age and cervical vertebral maturation (CVM) stage in ADHD patients with or without medication. Materials and Method: This cross-sectional study evaluated the pretreatment panoramic and lateral cephalograms of 129 patients (70 males, 59 females aged 8-14 years). Demirjian index and Baccetti’s CVM index were used to determine the dental age and CVM stage, respectively. The subjects were evaluated in two groups of ADHD (case, n=59) and healthy individuals (control, n=70). The ADHD patients were divided into two groups of AWT (ADHD with Treatment, n=43) and AW (ADHD without treatment, n=16) based on the use of methylphenidate. Paired t-test was used to compare the mean dental age between the groups. Linear and ordered logistic regression models were used to detect differences between the groups. The association between dental and chronological age was assessed by using Pearson correlation coefficient (p< 0.05). Results: After age and sex adjustment, the skeletal maturity stage was found to be similar to the control group based on the presence of the disorder or use of medication (p= 0.711 and p= 0.436, respectively). Similarly, the patients’ dental age was similar to the controls in AW and AWT groups (p= 0.180 and p= 0.421, respectively). The correlation between dental age and chronological age was 0.79 in AWT, 0.88 in AW, and 0.88 in control group (p< 0.001 for all the three). Conclusion: After age and sex adjustment, the dental and skeletal age of ADHD patients with or without Methylphenidate treatment do no manifest a significan