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Angle's Class II Division 1 malocclusion is illustrated as a prominent maxilla along with protrusive maxillary anteriors, mandibular retrognathism, or both, often leading to functional and aesthetic concerns. Effective management of this condition in growing patients typically involves a combination of functional and orthodontic appliances to correct dental and skeletal discrepancies. Treating this malocclusion in the deceleration stages of growth is often challenging for orthodontists. This case report exemplifies the potency of Forsus appliance in addressing Class II Division 1 malocclusion in growing patients, underscoring its role in achieving favorable orthodontic outcomes.

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Introduction Non-syndromic oral clefts, affecting one in 700 newborns in India, are the most prevalent craniofacial anomalies, with genetic or environmental causes impacting various life aspects. Studies indicate higher dental disturbances, particularly impacted canines, in cleft lip and palate (CLP) patients compared to non-cleft individuals. Impacted canines, trapped by hard tissues, require early diagnosis to prevent orthodontic issues. The widely used Ericson and Kurol method employs orthopantomograms (OPGs) to classify canine impaction in typical children. However, diagnosing canines in CLP patients is challenging due to palate defects and post-grafting complications. This study aims to compare the utility of the Kumar and Daigavane (KD) grading system and the sector classification to determine the best method for diagnosing impacted canine eruption paths. Method This cross-sectional comparative observational study was conducted at Sharad Pawar Dental College's Department of Orthodontics and Dentofacial Orthopaedics. The sample size, calculated using a significance level of 5% and a prevalence of 1%, required a minimum of 16 participants aged 9-11 years with non-syndromic clefts and impacted canines. Patients with systemic diseases or over 12 years of age were excluded. The sectoral and KD classification systems collected and evaluated OPGs from qualifying cleft patients. Sector classification considered the angle between the occlusal plane or canine tip and the adjacent tooth's long axis, while KD's classification considered the Frankfort horizontal plane, occlusal plane, vertical height from the occlusal plane, canine apex root position, and canine exposure to the cleft defect. Results The study found an 81.25% agreement between the KD grading system and the sector classification, with a Cohen's kappa value of 0.586, indicating a moderate agreement. The KD system showed 81.82% sensitivity and 80.00% specificity, with positive and negative predictive values of 90.00% and 66.67%, respectively. The receiver operating characteristic (ROC) curve analysis revealed the KD system's superior performance in identifying impacted and non-impacted canines compared to the sector classification. Conclusion The KD grading system demonstrated higher efficacy than the sector classification for evaluating the impacted canines in children with unilateral cleft lip and palate (UCLP). The KD system's high sensitivity and specificity make it a valuable tool for predicting canine eruption paths and addressing anatomical challenges in cleft conditions. This study highlights the need for accurate diagnostic tools tailored to cleft patients and contributes to advancing orthodontic treatment outcomes through improved classification systems.

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Orthodontics is undergoing a digital revolution, transforming traditional techniques with modern technology. This evolution is driven by the need for precise diagnosis and treatment planning. Digital platforms, including digital radiography and cone beam computed tomography (CBCT), are replacing conventional methods, enhancing documentation, analysis, and appliance production. Three-dimensional imaging enables customized treatment plans and appliance design using computer-aided design and computer-aided manufacture (CAD/CAM). Integration of digital models and software facilitates treatment simulation and patient communication. Digital videography enhances diagnostic capabilities. Embracing digital processes is essential for improved patient care and practice efficiency in orthodontics. This review article on digital orthodontics aims to provide a comprehensive overview and critical analysis of the current advancements, technologies, applications, benefits, and challenges in the field of orthodontics utilizing digital tools and technologies.

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This case report presents an orthodontic treatment approach involving retained deciduous teeth. The patient presented with a Class I malocclusion and buccal crossbite. Despite the presence of retained deciduous teeth, a non-extraction treatment plan was devised to address the malocclusion and achieve optimal dental alignment. The treatment protocol included the use of fixed appliances and quad helix to facilitate the alignment of permanent dentition. The progress of treatment was closely monitored through regular follow-up appointments and adjustments to the treatment plan as necessary. Upon completion of treatment, the patient achieved a harmonious occlusion, improved dental alignment, and a pleasing aesthetic outcome. This case report highlights the successful management of a challenging orthodontic case through a non-extraction approach with retained deciduous teeth, emphasizing the importance of individualized treatment planning and careful consideration of each patient's unique dental anatomy.

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Orthodontic space closure is a critical aspect of treatment aimed at the correct positioning of teeth and is linked to tooth movement and optimal biomechanics. Therefore, the goal of this case study is to elucidate the process, describing the challenges encountered and the solutions adopted, with a focus on the frictionless technique and the use of devices like the Opus Loop to close spaces. Sliding mechanics, known for high friction, and segmental mechanics, characterized by low friction and continuous adjustment, are two significant technologies used. In this specific case, the frictionless methods applied to a 23-year-old female patient with protruding superior labial incisors included: extraction of the first premolars in all four quadrants, followed by consecutive wiring. Retraction was performed using an Opus Loop, significantly improving the patient's facial profile and dental arch over the next year and a half. As a result, the study demonstrates that the Opus Loop greatly reduces friction forces and offers an effective mechanism to influence tooth movement in orthodontic treatment regimens.

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Proclination of anteriors is significantly found in developing malocclusions and affecting both aesthetics and function. In patients with protrusions or crowding, extraction therapy is often necessary. Orthodontic treatment is initiated with the extraction of maxillary first premolars to address the protrusions or crowding and achieve a harmonious occlusion. There are two ways to retract anteriors during extraction space closure: friction or frictionless. The present case report explains the innovative treatment approach for the correction of anterior protrusion using multiple variability (MV) loops. Even with the good efficiency of the MV loop, meticulous wire bending is one of the disadvantages of the loop, and it requires clinician skills. Smaller loop fabrication will be the future scope of the appliance to increase patient compliance toward the treatment using MV loop as it will cause less hindrance in the vestibular region.

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Cleft lip and palate (CLP) represent a common congenital defect, which needs a multidisciplinary team approach for satisfactory aesthetic and functional correction. Transverse discrepancies are among the major problems in CLP cases, and maxillary expansion has been used to correct skeletal and dental transverse discrepancies between the mandible and maxilla. During the long period, many types of expansion protocols have been cited in the literature. This report presents the treatment of a nine-year-old patient with unilateral CLP and emphasizes the combination of orthodontic and surgical interventions. The maxillary expansion was achieved by Coffin spring, and then oronasal fistula closure surgery was done for both function and aesthetic purposes.

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BACKGROUND: Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment. METHOD: The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site. DISCUSSION: We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe. TRIAL REGISTRATION: ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC).

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Background Upper airway obstruction (UAO) is a significant clinical concern due to its potential to lead to serious health issues, including obstructive sleep apnea (OSA) and cardiovascular diseases. Traditional diagnostic methods, such as spirometry, are often invasive and complex. This study aims to validate a portable ventilatory airway screening (PVAS) device as a non-invasive, cost-effective alternative for measuring upper airway breathing pressure and respiratory flow. Objectives To validate the accuracy of the PVAS device in measuring upper airway breathing pressure and respiratory flow by comparing its readings with those obtained from standard spirometry tests. Methods This cross-sectional analytical study involved 40 growing individuals aged 10-14 years, divided into two groups based on cephalometric analysis: Skeletal Class I (20 patients) and Skeletal Class II with retrognathic mandible (20 patients). Breathing pressure, volume, and velocity measurements were recorded using both the PVAS device and spirometry, and their accuracy was compared. Results The PVAS device showed high concordance with spirometry results, demonstrating significant accuracy in measuring breathing pressure, volume, and velocity. Skeletal Class II individuals exhibited significantly higher breathing pressure and reduced respiratory flow compared to Class I individuals, as measured by the PVAS device. Conclusion The PVAS device is a valid and accurate tool for non-invasive measurement of upper airway breathing pressure and respiratory flow. Its ease of use and reliability make it a valuable tool for clinical practice, particularly in the early diagnosis and management of airway obstructions.

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Deep learning has emerged as a revolutionary technical advancement in modern orthodontics, offering novel methods for diagnosis, treatment planning, and outcome prediction. Over the past 25 years, the field of dentistry has widely adopted information technology (IT), resulting in several benefits, including decreased expenses, increased efficiency, decreased need for human expertise, and reduced errors. The transition from preset rules to learning from real-world examples, particularly machine learning (ML) and artificial intelligence (AI), has greatly benefited the organization, analysis, and storage of medical data. Deep learning, a type of AI, enables robots to mimic human neural networks, allowing them to learn and make decisions independently without the need for explicit programming. Its ability to automate cephalometric analysis and enhance diagnosis through 3D imaging has revolutionized orthodontic operations. Deep learning models have the potential to significantly improve treatment outcomes and reduce human errors by accurately identifying anatomical characteristics on radiographs, thereby expediting analytical processes. Additionally, the use of 3D imaging technologies such as cone-beam computed tomography (CBCT) can facilitate precise treatment planning, allowing for comprehensive examinations of craniofacial architecture, tooth movements, and airway dimensions. In today's era of personalized medicine, deep learning's ability to customize treatments for individual patients has propelled the field of orthodontics forward tremendously. However, it is essential to address issues related to data privacy, model interpretability, and ethical considerations before orthodontic practices can use deep learning in an ethical and responsible manner. Modern orthodontics is evolving, thanks to the ability of deep learning to deliver more accurate, effective, and personalized orthodontic treatments, improving patient care as technology develops.

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This case presents the effective non-extraction orthodontic treatment of a 13-year-old boy with crowding in both upper and lower arches and deep bite. The patient's chief complaint was irregularly placed maxillary anterior teeth. The active treatment duration lasted for 10 months, which resulted in the successful alleviation of arch crowding and correction of the deep bite without the extraction of any sound erupted tooth. Posttreatment, all of the patient's chief complaints were relieved. Essix retainers were fitted post-debonding, with instructions for the patient to wear them for the subsequent year to maintain the achieved results. This case highlights the efficacy of non-extraction orthodontic strategies in addressing crowding and deep bite issues, drawing the importance of individualized treatment plans to achieve optimal outcomes.

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Background In the contemporary era, where science and technology know no boundaries, this in vivo study explores the impact of growth modulation therapy using Twin Block, Forsus Fatigue Resistant, and Clear Block appliances on alkaline phosphatase (ALP) levels in gingival crevicular fluid (GCF). Bone physiology involves modeling and remodeling, with orthodontics applying forces to teeth, influencing tissue reactivity and bone modeling. ALP, a marker of osteoblast function, plays a crucial role in bone growth. GCF reflects immunological and inflammatory responses during orthodontic force application, making it a valuable medium for studying ongoing metabolic processes related to bone turnover. Aim The study aims to comparatively analyze ALP levels in GCF during growth modulation therapy, assessing the efficacy of Twin Block, Forsus Fatigue Resistant, and Clear Block appliances. The research involves 30 experimental samples divided into three study groups and a control group. The samples are collected at various time intervals, and ALP levels are analyzed using a spectrophotometer. Statistical analysis includes paired and unpaired t-tests, one-way analysis of variance (ANOVA), and multiple comparisons. Results Results demonstrate a significant increase in ALP levels during the growth modulation therapy, indicating a positive correlation with bone remodeling. Twin Block appears to be the most effective appliance, exhibiting higher ALP activity compared to Clear Block and Forsus groups. Conclusion In conclusion, this study provides valuable insights into the biochemical responses during growth modulation therapy, emphasizing the potential of GCF analysis in understanding orthodontic treatment effects.

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The tongue-thrusting habit significantly contributes to the development of the anterior open bite (AOB), particularly when an infantile swallowing pattern persists into the later stages of childhood and adolescence. This habit results in the protrusion of the anterior teeth. Treatment typically involves addressing the underlying causes, incorporating retraining exercises, and utilizing mechanical appliances to control tongue positioning. However, commonly used devices such as palatal cribs or spurs may present challenges, including speech impediments, chewing difficulties, and the potential for unintended injuries. This paper presents a case report detailing the treatment of a patient with an AOB, dental protrusion, and spacing. The treatment approach included the application of a fixed tongue trainer, in the form of a modified bluegrass appliance. Subsequent fixed orthodontic therapy was employed to rectify proclined teeth within the dental arch.

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Introduction In orthodontics, having a beautiful smile is very important. It is frequently the main driving force behind people's efforts to enhance their oral health and professional opportunities. Orthodontic and dental treatment planning might benefit greatly when evaluating the aesthetic components of a patient's smile in individuals with varying skeletal growth patterns. In order to help orthodontists achieve the best possible functional and aesthetic results for their patients, the eight elements of a balanced smile are essential to orthodontic therapy. This study aims to evaluate, in comparison to Skeletal Class I Average instances, eight balanced smile components in patients with Skeletal Class II Vertical and Horizontal growth patterns. Methodology A total of 45 patients aged 14-30 were selected from the Orthodontics and Dentofacial Orthopedics Out-Patient Department (OPD). They were divided into three groups: Skeletal Class I Average, Skeletal Class II Vertical, and Skeletal Class II Horizontal cases based on their malocclusion type. Patients were made to smile in response to a joke or social conversation and their photos were analyzed using Photopea software (Photopea Inc., Prague, Czech Republic) to determine the eight components of a balanced smile. Result Three skeletal classes' worth of smile components were examined in this study. Lip line measurements varied greatly; the highest mean measurement was found in the Skeletal Class II Vertical group (p-value < 0.01). There were no noteworthy correlations found between smile arc and upper lip curvature. Measurements of lateral negative space did not show any significant group differences. On the other hand, a significant correlation was seen in smile symmetry, where asymmetrical smiles were more prevalent in Skeletal Classes I and II Vertical groups (p-value is 0.00072). While arch symmetry suggested a potential relationship between the groups, dental midline alignment revealed possible associations. Conclusion Assessing the aesthetic components of smiles in patients with varying skeletal growth patterns, i.e., contrasting Class II Vertical and Horizontal growth patterns with Class I Average cases, provides valuable information about the connection between smile aesthetics and facial skeletal structure. The results suggest that when compared to Class I typical instances, Skeletal Class II Vertical and Horizontal growth patterns may show clear variations in certain aspects of an attractive smile. Comprehending these variations is essential for devising treatment strategies for patients, and additional investigation is needed. In order to obtain optimal aesthetic outcomes, treatment strategies should strive to optimize smile aesthetics while addressing personalized treatment plans that take into account the patient's unique facial features, smiling preferences, and functional requirements.

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This is a rare clinical case report of a 19-year-old male patient reported in the Department of Orthodontics and Dentofacial Orthodontics, Sharad Pawar Dental College, Sawangi (Meghe), Wardha, Maharashtra, with chief complaint of asymmetry present on the lower left side of the face and forwardly placed upper front teeth. The asymmetry was due to the congenital complete absence of the left condyle and skeletal cant in the maxilla and functional occlusal plane. The true agenesis of the condyle is an extremely rare condition that requires proper diagnosis and interdisciplinary management. In this case, there was left-sided condylar agenesis with no other skeletal anomaly present, which was treated by pre-surgical orthodontics for decompensation and surgical correction of skeletal cant followed by Ramal distraction osteogenesis and advancement genioplasty. A condylar stock metal implant was placed on the left side for functional rehabilitation. The patient expressed satisfaction with the aesthetic and functional improvements, highlighting the effectiveness of the integrated orthodontic-surgical approach.

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Cleft lip and palate (CLP) is a prevalent congenital craniofacial deformity that can be unilateral or bilateral. This case report highlights the interdisciplinary approach to managing a 24-year-old male with unilateral CLP (UCLP), emphasizing the complexity of associated dental and skeletal challenges. The patient had undergone multiple surgeries, including lip closure at three months, palate repair at seven years, and alveolar bone grafting at 12 years. Clinical assessments revealed a retruded maxilla, an absence of lateral incisors, and scars from previous surgeries. Radiographic evaluations indicated a Class III skeletal pattern and confirmed the presence of a cleft on the left side. Orthodontic treatment commenced with maxillary arch alignment, followed by Le Fort I surgery to address maxillary retrusion, correct skeletal malocclusion, and close the alveolar cleft space. The post-surgical phase involved orthodontic adjustments, crossbite correction, and alignment of the mandibular arch. Despite the discontinuation of treatment due to the patient's relocation, the interdisciplinary collaboration achieved significant improvements, including a corrected facial profile, maxillary advancement, closure of the cleft space, and enhanced dental alignment. The patient's confidence and functionality were positively impacted. This case underscores the importance of a coordinated interdisciplinary approach to addressing the multifaceted challenges associated with UCLP, aiming to optimize both aesthetic and functional outcomes for improved patient well-being.

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The transverse dimension, often overlooked in orthodontics, plays a crucial role in malocclusions, affecting not only occlusion in that dimension but also sagittal and vertical dimensions. Posterior crossbites, indicative of transverse maxillary issues, are commonly addressed through palatal expansion. This case report explores the clinical insights into addressing a constricted maxillary arch in Angle's Class II malocclusion using a nickel-titanium (NiTi) expander. The NiTi expander provides constant and optimal expansion forces by incorporating a temperature-activated NiTi alloy. A 16-year-old male with irregularly placed teeth, high palatal vault, and posterior crossbite underwent treatment involving NiTi expander usage for maxillary expansion. The case presentation details the patient's journey, starting with upper arch bonding and expansion, then lower arch bonding, and concluding with complete leveling and alignment without extractions. The presented case demonstrates successful correction of a constricted maxillary arch, specifically in the canine and molar regions, utilizing the NiTi expander. The observed increase in intermolar width aligns with previous studies, showcasing the effectiveness of slow maxillary expansion. This article contributes valuable clinical insights into addressing transverse maxillary issues, emphasizing the importance of careful consideration in choosing the appropriate expansion method for optimal results.

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The condition of bimaxillary protrusion is commonly seen by orthodontic practitioners in the course of our daily clinical work. It is characterized by both jaws being forwardly placed and increased prominence of the teeth along with lips. When there is a severe bimaxillary protrusion, it can be challenging to correct it effectively with maximum anchorage. In patients with protrusions or crowding, extraction therapy is often necessary. There are two ways to retract anteriors during extraction space closure: friction or frictionless. The present case report explains the frictionless mechanic protocol for the correction of bimaxillary protrusion using a reverse closing loop.

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Twin Block, a functional orthodontic appliance, has a major impact on the dentoalveolar structures with limited skeletal effects. In specific clinical scenarios, particularly in growing patients such as class II division 1 where the mandible is retropositioned, these appliances can effectively address the malocclusions. Patient compliance plays a crucial role in the success of these appliances, which also streamline subsequent phases of fixed appliance treatment. In the current case report, a Twin Block appliance followed by a Quad Block was given to a 12-year-old boy to refine the occlusion. The design and treatment outcomes of the appliance are discussed in this case study.

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Permanent maxillary central incisor impaction is generally a rare phenomenon. Because the anterior teeth have a huge impact on a patient's facial aesthetics, missing anterior teeth are of major concern to patients who seek orthodontic treatment. However, correcting this type of malocclusion poses a challenge to the orthodontist. This case report of a 16-year-old male patient with an impacted maxillary right central incisor takes us through a series of events that are necessary to treat this type of malocclusion. The presenting case also had an impacted supernumerary tooth which was the primary cause for permanent tooth impaction. A combined treatment approach is usually needed to manage this type of case involving both the orthodontist and the surgeon.