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Background/Aim. Dentists and particularly general dental practitioners (GDPs) should be able to identify problems such as malocclusions and refer patients with such problems to orthodontics. The aim of the study was to evaluate the awareness of orthodontic problems and referral practices among GDPs and non-orthodontic specialists practicing in the Kingdom of Saudi Arabia. Methods. A cross-sectional prospective study included GDP and specialists/consultants of both genders, aged between 22–60 years, practicing general dentistry and specialists other than orthodontics who had worked in their field for two or more years. Non-practicing dentists and nonregistered dentists were excluded. Data was analyzed on SPSS version 21.00. Results. Among the respondents, 55.5% were men, and 44% were GDPs. Out of the total number of respondents, 107 (53.5%) GDPs and 66 (33%) non-orthodontic specialists practiced orthodontic referral in their practices. By using the χ2 test, statistical analysis of different variables depending on the participants’ gender and specialty was performed. It revealed that variables with significant p-value were: orthodontist referral, the recommendation of orthodontic treatment only after the eruption of all permanent teeth, awareness of tooth extraction for alignment of irregular teeth, and awareness regarding worsening of temporomandibular joint problems by orthodontic treatment. Conclusion. The referral practices of dentists practicing in the Kingdom of Saudi Arabia concerning orthodontic patients were satisfactory, although awareness regarding orthodontic problems requires continuous learning and considerate positive progression toward basic orthodontics.

Aim: To assess the degree of conversion (DC) and shear bond strength (SBS) of experimental adhesive (EA) infused with and without 1 % Cerium oxide (CeO₂)-NPs on metallic bracket bonded to enamel conditioned with three different pretreatment regimes PDT-activated (Riboflavin) RF, ECY (Er, Cr: YSGG), and Phosphoric acid (PA). Material and Method: EA and EA modified with 1 % CeO₂-NPs were prepared. Characterization of CeO2NPs was assessed using a scanning electron microscope (SEM). Seventy-two premolars extracted due to periodontal or orthodontic reasons were disinfected. Samples were mounted and allocated into three groups according to enamel surface treatment before bracket bonding. Samples in Group 1 were pretreated with Traditional 37 % PA-gel; Specimens in Group 2 surface treated with RF-activated PDT, and samples in Group 3 were conditioned using ECY. Brackets were placed on conditioned surfaces and samples were aged and underwent SBS testing using UTM. ARI index was used to assess bond failure. DC was evaluated for both adhesives using FTIR. ANOVA and Tukey post hoc test were used to compare the means and standard deviation (SD) of SBS and DC in different experimental groups. Results: Enamel conditioned with PA and RF activated by PDT demonstrated comparable bond values with 1 % CeO2 infused in EA and EA (p > 0.05).ARI analysis shows that enamel conditioned with PA and RF activated by PDT showed the majority of failure types between 1 and 2 irrespective of the type of adhesive. DC value in EA (73.28±8.37) was the highest and comparable to 1 % CeO2 infused in EA (66.48±6.81) Conclusion: RF-activated PDT can be used alternatively to 37 % PA for enamel conditioning when bonding metallic brackets. Infiltration of 1 % CeO2 NPs in EA improves SBS irrespective of the type of enamel conditioning. Infusion of 1 % CeO2 NPs in EA demonstrates no significant difference in DC compared to EA.

Background and Objectives: Evaluation of the levels of cytokine and bone metabolic biomarkers (BMBs) in patients receiving fixed orthodontic therapy (FOT) and Invisalign. Materials and Methods: Sixty participants were enrolled after meeting the predefined inclusion criteria. Patients then underwent either FOT or Invisalign by allocating them randomly to each group (n = 30). The basic periodontal assessment was performed, including the plaque index (PI), gingival index (GI), and bleeding on probing (BoP), at baseline and again after 4 weeks. Gingival crevicular fluid (GCF) samples were taken from each individual at baseline and after 4 weeks. An enzyme-linked immunosorbent assay (ELISA) technique was used to determine the cytokine and BMB levels. An unpaired t-test compared the FOT and Invisalign group’s means and SDs. Paired t-tests examined the difference between T0 baseline and T1. Results: Patients treated with either FOT or Invisalign presented no statistically significant difference in terms of periodontal parameters such as PI, GI, and BoP (p > 0.05). The levels of IL-6 were significantly higher in patients treated with FOT as compared to Invisalign at T1 (p < 0.05) The other tested cytokines, IL-10, 13, 17, and GM-CSF, were not significantly different in either the FOT or Invisalign group at baseline and 4 weeks follow-up (p > 0.05). Regarding BMBs, it was detected that NTx and OC levels in both of the investigated groups were not significantly different at baseline and after 4 weeks (p > 0.05). However, NTx levels rose significantly (p < 0.05) and OC levels fell from T0 to T1. Conclusions: FOT and Invisalign displayed comparable outcomes in terms of cytokine and BMB levels. However, only IL-6 and NTx were significantly different at week 4 from baseline.

Background Different types of retention appliances have been proposed over the years, but their effectiveness in maintaining arch dimensions and alignment after orthodontic treatment is still unclear. Aim To assess the efficacy of vacuum-formed retainers (VFRs) in preserving arch widths, arch length, and anterior alignment in maxillary and mandibular arches, compared to removable Hawley retainers (HRs) or fixed bonded retainers (FBRs). Search methods: unrestricted literature search of five major databases up to March 2024. Selection criteria randomized/non-randomized clinical studies comparing VFRs to removable HRs or FBRs. Data collection and analysis after duplicate study selection, data extraction, and risk of bias assessment, random effects meta-analyses of standardized mean differences and their 95% confidence intervals were performed, followed by meta-regressions, sensitivity analyses, and assessment of the quality of evidence with GRADE. Results Twenty-two prospective studies (4 non-randomized and 18 randomized controlled trials) involving 1797 patients (mean age 17.01 years, 38.3% males) were included. No significant differences were found in the intercanine width, intermolar width, and arch length between VFRs and HRs, in both arches (P  > 0.05). However, VFRs were statistically more effective than HRs in terms of Little's irregularity scores (LII) in the maxilla (eight studies; SMD = −0.42; 95% CI: −1.03 to −0.09; P  = 0.02; I 2 = 73.4%) but not in the mandible (P  = 0.12). No significant differences were reported for all considered outcomes between VFRs and FBRs in in both arches (P  > 0.05), except for lower LII, where VFRs were significantly less efficient (eight studies; SMD = 1.49; 95% CI = 0.26–2.7; P  = 0.02; I 2 = 93%). Follow-up times, risk of bias, and wire type (of FBRs) did not show statistically significant effects on outcome variables. Sensitivity analyses showed robustness of the findings for including non-randomized and postretention studies. The certainty in these estimates was from moderate to low due to the risk of bias and inconsistency. Conclusions Low to moderate quality evidence indicates that VFRs are as effective as HRs in maintaining arch widths, length, and alignment. Low-quality evidence found similar efficacy between VFRs and FBRs, with FBRs being statistically more effective at maintaining lower arch alignment, but the difference was not clinically significant. Registration PROSPERO registration (CRD42024518433). [ABSTRACT FROM AUTHOR]

Zirconium dioxide silver‐doped nanoparticles (ZrO2AgDNPs) impacts the adhesive material in terms of its physical characteristics, antimicrobial properties, degree of conversion (DC), and micro‐tensile bond strength (μTBS) of orthodontic brackets to the enamel surface. A comprehensive methodological analysis utilizing a range of analytical techniques, including scanning electron microscopy coupled with energy‐dispersive x‐ray spectroscopy (EDX), Fourier‐transform infrared (FTIR) spectroscopy, DC analysis, and μTBS testing. A light‐curable orthodontic adhesive, specifically Transbond XT, was combined with ZrO2AgDNPs at 2.5% and 5%. As a control, an adhesive with no incorporation of ZrO2AgDNPs was also prepared. The tooth samples were divided into three groups based on the weightage of NPs: group 1: 0% ZrO2AgDNPs (control), group 2: 2.5 wt% ZrO2AgDNPs, and group 3: 5 wt% ZrO2AgDNPs. EDX graph demonstrated silver (Ag), Zirconium (Zr), and Oxygen (O2), The antibacterial efficacy of adhesives with different concentrations of NPs (0%, 2.5%, and 5%) was assessed using the pour plate method. The FTIR spectra were analyzed to identify peaks at 1607 cm−1 corresponding to aromatic CC bonds and the peaks at 1638 cm−1 indicating the presence of aliphatic CC bonds. The μTBS was assessed using universal testing machine (UTM) and bond failure of orthodontic brackets was seen using adhesive remanent index (ARI) analysis. Kruskal–Wallis test assessed the disparities in survival rates of Streptococcus mutans. Analysis of variance (ANOVA) and post hoc Tukey multiple comparisons test calculated μTBS values. The lowest μTBS was observed in group 1 adhesive loaded with 0% ZrO2AgDNPs (21.25 ± 1.22 MPa). Whereas, the highest μTBS was found in group 3 (26.19 ± 1.07 MPa) adhesive loaded with 5% ZrO2AgDNPs. ZrO2AgDNPs in orthodontic adhesive improved μTBS and has acceptable antibacterial activity against S mutans. ZrO2AgDNPs at 5% by weight can be used in orthodontic adhesive alternative to the conventional method of orthodontic adhesive for bracket bonding. Research Highlights: The highest μTBS was found in orthodontic adhesive loaded with 5% ZrO2AgDNPs.ARI analysis indicates that the majority of the failures fell between 0 and 1 among all investigated groups.The colony‐forming unit count of S. mutans was significantly less in orthodontic adhesive loaded with nanoparticles compared with control.The 0% ZrO2AgDNPs adhesive showed the highest DC. [ABSTRACT FROM AUTHOR]

Objective: To assess orthodontist's knowledge about maintenance of oral hygiene in the course of active management in the sub-population performed in Saudi Arabia. Methods: The cross-sectional plan, performed in multiple dental treatment facilities including governmental hospitals and private dental clinics in Abha City, KSA, between November 10, 2019 and December 29, 2019. A total of 500 individuals were selected according to the following inclusion criteria which was male and female during orthodontic treatment patients wearing fixed orthodontic appliances for at least 6 months which aged between 10-30 years. Sample size was calculated through Rao soft software. Data was collected through non probability purposive sampling. The exclusion criteria were uncooperative and unresponsive patients. A structured questionnaire assessed demographic characteristics of patients (age, gender) and orthodontists' knowledge about maintenance of oral hygiene of patients in the course of active management. They evaluated frequency of tooth brushing, tooth paste selection, usage of several fluoride supplements etc. For categorical data, mean and standard deviation were used, descriptive statistics was described as frequency and percentage. For the evaluation of association among categorical variables, a Chi-square test was used. Statistically significant p

Orthodontics is the branch of dentistry which deals with malalignment of teeth and facial skeleton. The mechanics of fixed appliance therapy completely relies on retention of orthodontic appliance. Retention is the phase of Orthodontic treatment that attempts to keep teeth in corrected position after treatment with orthodontic braces. Without the phase of retention, there is a tendency for teeth to return to their initial position. Hence it is very necessary to prevent relapse. It depends on many factors. Every orthodontic patient should wear retention appliances to prevent relapse. This review article in detail discusses the protocol of retention and various factors affecting it.

Abstract Congenital missing lateral incisor of maxilla is a common tooth anomaly. Its replacement can have many options. The choice ought to be understandable for patients or guardians hence effectively address the patient's issues. Regardless of canine replacement, solitary inserts, tooth-supported prosthesis are techniques for patients with missing maxillary missing lateral incisors, although numerous confront are engaged with acquiring and holding ideal outcomes. In this case, report a case of 16 year old boy was discussed which has the diagnosis of Class II division 1 with missing upper laterals and anterior open bite. Plan was to perform space closure by canine lateralization and retraction of upper anterior to reduce the overjet followed by extraction of lower 5s to alleviate anterior crowding, correct molar relationship, maintain lower anterior teeth position, finishing, and alignment followed by retention.

Background: There are certain reported cases of unusual displacements of teeth involved in a maxillofacial trauma to the maxillary sinus, nasal cavity, gastrointestinal tract or the airway, if worst. All these usually lead to complication the worst being death. So enquiring about them is a very essential part of surveying a maxillofacial trauma patient involving dentition. Case: This patient was referred to our department for a dental consultation for his ill-defined firm, mildly tender, non-suppurative, submental swelling unresponsive to medication. He had undergone a polytrauma involving his face two months back. An orthopantomogram was ordered which showed a lower central incisor from the fracture site had slipped through the fracture gap into the submental space possibly missed by the CT scan. There was also a lower border splaying at the fracture site. A layer-wise dissection was done extra-orally to retrieve the tooth. Conclusion: This case envisages the importance of an OPG as an adjuvant to the basic radiographic study, in the emergency room, for a patient with oral and maxillofacial trauma. It also establishes the importance of a meticulous secondary survey, including counting the number of teeth and establishing a correct occlusion to avoid a complication and re-operation. Besides, a medical negligence lawsuit can also arise as some teeth may slip to lungs even.

Background and Objectives: Evaluation of the levels of cytokine and bone metabolic biomarkers (BMBs) in patients receiving fixed orthodontic therapy (FOT) and Invisalign. Materials and Methods: Sixty participants were enrolled after meeting the predefined inclusion criteria. Patients then underwent either FOT or Invisalign by allocating them randomly to each group (n = 30). The basic periodontal assessment was performed, including the plaque index (PI), gingival index (GI), and bleeding on probing (BoP), at baseline and again after 4 weeks. Gingival crevicular fluid (GCF) samples were taken from each individual at baseline and after 4 weeks. An enzyme-linked immunosorbent assay (ELISA) technique was used to determine the cytokine and BMB levels. An unpaired t-test compared the FOT and Invisalign group's means and SDs. Paired t-tests examined the difference between T0 baseline and T1. Results: Patients treated with either FOT or Invisalign presented no statistically significant difference in terms of periodontal parameters such as PI, GI, and BoP (p > 0.05). The levels of IL-6 were significantly higher in patients treated with FOT as compared to Invisalign at T1 (p < 0.05) The other tested cytokines, IL-10, 13, 17, and GM-CSF, were not significantly different in either the FOT or Invisalign group at baseline and 4 weeks follow-up (p > 0.05). Regarding BMBs, it was detected that NTx and OC levels in both of the investigated groups were not significantly different at baseline and after 4 weeks (p > 0.05). However, NTx levels rose significantly (p < 0.05) and OC levels fell from T0 to T1. Conclusions: FOT and Invisalign displayed comparable outcomes in terms of cytokine and BMB levels. However, only IL-6 and NTx were significantly different at week 4 from baseline. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study aimed to investigate the effect of obesity prospectively on tooth movement via an orthodontic device and changes in inflammatory cytokines, periodontal tissues, and orofacial pain. SUBJECTS AND METHODS: Prospective design in which data was gathered at baseline T0, 1 hour, 24 hours, and 1 week after the application of fixed orthodontic appliances. The total sample size was 60 participants aged between 12 to 18 years and divided into 2 groups based on the inclusion and exclusion criteria. Anthropometrical estimation was made using a bioimpedance meter. A clinical assessment was performed before the application of fixed appliance bonding (T0) one hour after bonding (T1), after 24 hours (T2), and finally after one week (T3). At T0 little irregularity index was assessed, gingival crevicular fluid (GCF) was collected and periodontal examination including probing depth (PD), gingival bleeding (GB), and the presence or absence of calculus were measured. Orofacial pain was assessed at three levels: 1 hours, 24 hours, and 1 week after application of fixed orthodontics using a visual analog scale. For inter-group comparison, Mann-Whitney and t-tests were used and for interphase, comparison cluster analysis was performed. The level of significance was p<0.05. RESULTS: The participants in obese groups were significantly higher in terms of weight, BMI, WHR, FM, and BF than in the non-obese group (p<0.05). Obese participants had significantly more PD 4-5 mm (0.64±0.23 mm) and significantly higher BoP compared to non-obese participants (0.13±0.10 mm). Little's irregularity index at T0 and T3 showed no significant difference among obese and non-obese participants. The inflammatory cytokines level of IL-ß was higher in the obese group compared to nonobese groups. CONCLUSIONS: The intensity of orofacial pain was higher in obese participants after 24 hours along with high levels of IL-ß pro-inflam inflammatory cytokines before and during orthodontic treatment. No difference was noted in tooth movement in both obese and non-obese during orthodontic treatment in the first week. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the bond efficacy and failure rates of rebonded metallic brackets after enamel reconditioning with chemical 37% phosphoric acid (PA) and natural and synthetic photosensitizers activated by PDT. MATERIALS AND METHODS: A total of 50 non-cavitated, and cautiously extracted human premolars were congregated after sample size calculation. The enamel exterior was etched, washed, dried for adhesive application, and cured. Metallic brackets were then oriented and adapted to enamel surface using composite. Later, brackets were debonded from the surface via a Weingart plier. Enamel was finished for ensuing surface reconditioning. Ultimately, specimens were randomly distributed into five groups (n=10). Enamel surface before rebonding was reconditioned with curcumin photosensitizer (CP), riboflavin photosensitizer (RP), rose bengal photosensitizer (RBP), methylene blue photosensitizer (MBP), and 37% PA (control) respectively. After following reconditioning protocol, brackets were rebonded to the enamel exterior employing a composite adhesive system. Then, specimens were subjected to the universal testing machine for analyzing shear bond strength (SBS), and bond failures were predicted using an ARI index. One-way ANOVA and Tukey multiple comparison tests were used for statistical analysis at a variance value of p < 0.05. RESULTS: Enamel reconditioned with 37% PA demonstrated the highest SBS for bracket rebonding, and the lowest SBS was presented by CP actuated by PDT. Enamel reconditioned with RP and RBP corroborated the analogous SBS outcome to 37% PA. Likewise, enamel surface treatment with MBP revealed a statistically significant result to CP for metallic bracket rebonding. The most prevalent failure scores anticipated among groups were 0 and 1 indicating an adhesive failure with the exemption of group 5 (control) that encountered more score 2 cohesive failure on debonding metallic brackets from enamel exterior. CONCLUSIONS: Rose bengal and riboflavin photosensitizers activated by photodynamic therapy with low ARI scores have the potential to be used as viable enamel reconditioning alternatives to 37% phosphoric acid for rebonding metallic brackets. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the feasibility of chlorhexidine (CHX)‐loaded poly‐L‐glycolic acid (PLGA) nanoparticles as a modifier of a commercial orthodontic adhesive via the assessment of physicochemical, biological, and mechanical properties at tooth‐bracket interface. CHX‐loaded PLGA nanoparticles were synthesized using double emulsion‐solvent evaporation method and characterized using transmission electron microscopy and Raman analysis. CHX‐loaded PLGA nanoparticles in Transbond XT orthodontic adhesive were prepared using two different concentrations of the CHX (25 and 50%) and characterized for degree of conversion (DC), antimicrobial, and cytotoxicity testing. Bonded specimens were tested for shear bond strength (SBS) and adhesive remnant index (ARI) at tooth‐bracket interface. The synthesized PLGA nanoparticles averaged between 60 and 80 nm in size. After loading CHX inside PLGA nanoparticles, the morphology of the PLGA nanoparticles was considerably changed. Orthodontic bracket bonded with 25% CHX‐loaded PLGA‐modified adhesive demonstrated DC scores similar to control group. Both 25 and 50% CHX‐loaded PLGA‐modified adhesive specimens showed higher antibacterial activity against S. mutans compared to control group. The least mean SBS values were exhibited by 50% CHX‐loaded PLGA‐modified adhesive samples, while a statistically significant difference was observed in the mean ARI values among all study groups at all‐time points (p =.018). This study indicates that the addition of CHX‐loaded PLGA nanoparticles in Transbond XT achieved stable bonds with enhanced antimicrobial and mechanical properties. [ABSTRACT FROM AUTHOR]

Objective: To assess orthodontist's knowledge about maintenance of oral hygiene in the course of active management in the sub-population performed in Saudi Arabia. Methods: The cross-sectional plan, performed in multiple dental treatment facilities including governmental hospitals and private dental clinics in Abha City, KSA, between November 10, 2019 and December 29, 2019. A total of 500 individuals were selected according to the following inclusion criteria which was male and female during orthodontic treatment patients wearing fixed orthodontic appliances for at least 6 months which aged between 10-30 years. Sample size was calculated through Rao soft software. Data was collected through non probability purposive sampling. The exclusion criteria were uncooperative and unresponsive patients. A structured questionnaire assessed demographic characteristics of patients (age, gender) and orthodontists' knowledge about maintenance of oral hygiene of patients in the course of active management. They evaluated frequency of tooth brushing, tooth paste selection, usage of several fluoride supplements etc. For categorical data, mean and standard deviation were used, descriptive statistics was described as frequency and percentage. For the evaluation of association among categorical variables, a Chi-square test was used. Statistically significant p <0.05 was considered significant. Results: About 500 patients participated in this study, 50% females and 50% males. 130 (26%) participants were treated in governmental facilities, while 370 (74%) were treated in private clinics. The association between orthodontists' awareness and orthodontist's age was found statistically significant "p=0.004". Statistically significant correlation among orthodontists' awareness and place of receiving orthodontic treatment "p=0.001" was also found. Conclusion: The orthodontists' knowledge about maintenance of oral hygiene in the course of active management in subpopulation of Saudi Arabia is insufficient in patient's opinion and there is significant association between orthodontist's age and place of treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: To investigate the antiplaque properties of two plant-based mouthwashes, Morinda citrifolia (MC) and Ocimum sanctum (OS), and their effect on TNF-α, IL-α, IL-β, IL-2, and IL-6 in gingival crevicular fluid (GCF) of patients undergoing fixed orthodontic treatment. Materials and Methods: Seventy-five individuals were recruited according to defined inclusion and exclusion criteria. This study was structured into two distinct phases. Phase I was a combination of toothbrushing using toothpaste containing fluoride (Protocol A), while Phase II toothbrushing included fluoride toothpaste and use of a mouthwash (Protocol B). For Phase II, individuals participating in this study were allocated into different groups through a randomization process: Group 1—0.12% CHX, Group 2—5% MC, and Group 3—4% OS. Each individual’s Phase I and Phase II scores were assessed. GCF was measured in three phases to determine the level of inflammatory biomarkers. The paired t-test evaluated the disparities between the pre- and post-plaque index. Categorical data were subjected to crosstab analysis to assess qualitative variables. The mean values of cytokine levels were presented. An unpaired t-test was employed to assess the levels of cytokines between individuals in Phase I and Phase II. Results: Toothbrushing, fluoride toothpaste, and the supplementary use of mouthwash (Phase II) resulted in mean plaque scores significantly lower than group A (p < 0.001). Cytokines TNF-α, IL-α, and IL-β demonstrated a significant downward trend in herbal mouthwash users. Conclusions: In conjunction with fluoridated toothpaste and brushing, OS and MC can serve as a viable alternative to conventional synthetic mouthwash CHX. This combination demonstrates reducing mean plaque scores and diminishing the levels of cytokines TNF-α, IL-α, and IL-β.

Aim: To evaluate the effect of simulated intraoral hydraulic, thermal, and mechanical stresses on the debonding characteristics of orthodontic brackets under different adhesive regimes. Materials and methods: Groups of pre-coated (G1) and non-coated (G2) orthodontic metal brackets were bonded onto the buccal surfaces of 96 premolars using etch-and-rinse (SG1, n = 24) and self-etch (SG2, n = 24) primers. Twelve specimens (C1) from each subgroup were subjected to early debonding resistance tests, while the other twelve (C2) were used to test delayed debonding resistance after exposure to conditions simulating intraoral hydraulic, thermal, and mechanical stresses. The debonding resistance of the brackets was evaluated using a universal testing machine and the debonding patterns were micro-visualized to determine the adhesive remnant indexes of subgroups of specimens. Results: Within each group, the etch-and-rinse primer (SG1) resulted in higher debonding resistance than self-etch primers (SG2) ( p < 0.05), while there was no difference between non-stressed and stressed specimens ( p > 0.05). Within each category of test specimens, there was no difference between pre-coated (G1) and non-coated (G2) brackets ( p > 0.05). The tested specimens in all categories showed comparable adhesive remnant indexes. However, higher percentages of favorable scores (0 and 1) were obtained for all stressed specimens. Conclusions: Short-term cumulative intraoral stresses have no adverse effect on the debonding values of either pre-coated or non-coated brackets when either etch-and-rinse or self-etch primer is used for bonding. Exposure of the bonded brackets to different types of stress reflects favorable debonding patterns.