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Background: Skeletal nongrowing class II patients with retrognathic mandible are often at risk of developing obstructive sleep apnea (OSA). This skeletal discrepancy, when severe enough, is often addressed by surgical mandibular advancement which not only achieves aesthetics, structural balance, and functional efficiency but also improves the airway function. Objective: The aim of the study was to evaluate the effectiveness of surgical mandibular advancement on airway dimensions, in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA. Materials and Methods: The sample consisted of 8 patients with skeletal class II due to retrognathic mandible associated with OSA. Screening was done with functional outcomes of sleep questionnaire (FOSQ) score and confirmed with polysomnography. Pretreatment and posttreatment airway dimensions/volume were assessed and calculated on cone beam computed tomography (CBCT). Three months post surgery, oxygen saturation was recorded. Results: A statistically significant improvement in mean oxygen saturation level was observed from 87.62 ± 7.70 to 97.75 ± 0.46 and mean increase in airway volume was from 48.60 ± 7.17 to 69.48 ± 26.22. The smallest cross section increased from 137 ± 74.37 to 253.75 ± 76.67. Anteroposterior dimensions increased significantly from 6.17 ± 1.78 to 9.33 ± 2.07 and transversed from 24.56 ± 6.41 to 30.14 ± 3.35. FOSQ score improved from 9.37 ± 2.61 to 15.25 ± 0.88. Conclusion: Surgical mandibular advancement is an effective treatment option in improving airway dimensions in nongrowing skeletal class II patients with mandibular retrognathism associated with OSA.

Objectives: The aim of this systematic review was to assess the available literature for the effects of platelet-rich plasma (PRP) in orthodontics. Material and Methods: This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA). The following databases were searched up to May 2020: Medline (through PubMed), Cochrane, and Google Scholar, and reference lists of the included studies were screened. Randomized controlled trials (RCTs) and controlled clinical trials using PRP an adjunct with the standard orthodontic procedures including animal and human subjects as participants were included in the study. The quality of the included human RCTs was assessed per the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0), whereas the risk of bias of the included animal studies was assessed using SYRCLES’s RoB tool. Results: Eight studies, six animal and two human studies, fulfilled the inclusion criteria. Three animal studies and one human RCT reported that PRP increased the rate of tooth movement when used as an adjunct along with orthodontic treatment. Conclusion: According to the currently available literature, PRP is an efficient non-invasive method of tooth acceleration, but as most of the studies carried are on animals and cannot be applied to humans indistinctly.

With the increasing awareness of the ravages of airway disorders especially obstructive sleep apnoea (OSA) as a sleep related breathing disorder and the realization that dentist has the capability of offering possible solutions in this area, it is time to consider new aspect of dentistry as Dental sleep medicine. The concept focuses on practice of clinical dentistry aimed at achieving ideal jaw relationship, establish normal oral function and performance. The principal aspect of function and performance is airway and breathing which, in fact, is one of the most important function for humans. Altered airway and pattern of breathing could change the posture of tongue, jaws and head and lead to malocclusion. Early dental treatment has a beneficial effect not only on the teeth but establish the best possible airway at the earliest possible age. Today, dental profession is crucial and integral part of the interdisciplinary group in the management of SRBDs. This review article will guide a dentist to identify a child or adult suspected or at a risk of SRBD. Also, explain role of dentist and orthodontist in the management and treatment of the SRBDs. Keywords: Sleep-related breathing disorders (SRBDs), Obstructive Sleep apnoea (OSA), Snoring, Mandibular advancing oral appliances.

To assess the reliability of different salivary biomarkers as skeletal maturity indicators when compared with other methods of skeletal maturity assessment.A comprehensive search was conducted on three electronic databases: PUBMED, Google scholar and Cochrane library for the articles published from 2000 to July 2021. Assessment of skeletal age on the basis of levels of different salivary biomarkers at different pubertal stages was considered as the primary outcome. Electronic search, data collection and risk of bias assessment were performed by two authors with conflict resolution by the third author.Total 158 articles were retrieved after screening of titles, abstracts and full texts of all articles, of which 15 articles were selected for qualitative synthesis. All these studies were cross-sectional in design. These studies compared the levels of different salivary biomarkers as Alkaline Phosphatase (ALP), Insulin-like Growth Factor - I (IGF-I), Insulin-like Growth Factor Binding Protein-3 (IGFBP-3), Cortisol, Indian Hedgehog (IHH) protein and Dehydroepiandrosterone sulphate (DHEAS) with other methods of skeletal age estimation. Out of these six biomarkers salivary IGF-1 is a reliable indicator for skeletal maturity assessment.The current evidence suggests that salivary biomarkers can be used as an adjunct for growth prediction during orthodontic treatment planning along with other methods of skeletal maturation assessment. Still there is need for further research with longitudinal studies in this field.

The aim of this study was to investigate the association between objective wear time and treatment efficacy of a twin block (TB) appliance.A TB appliance incorporating a compliance indicator was delivered to 44 children in the age group of 11-14 years (25 boys and 19 girls). Participants were instructed to wear the appliance full time and were recalled at 3-4- week intervals. Cephalograms and study models were taken at baseline and after 6 months of appliance therapy.Data from 41 of the 44 participants were analyzed. A wide variation in daily wear time among participants was observed. Based on wear time, they were divided into full time (FT17 h/d) and part time (PT12 h/d) wear groups. Mean wear durations were 20.86 hours in the FT-wear group and 9.55 hours in the PT-wear group. In skeletal changes, the ANB (A point, nasion, B point) angle was reduced by 2.69° in the FT-wear group, and 1.33° in the PT-wear group, and statistically significant increases were seen for the mandibular base measurement (Pg/OLp) in the FT-wear group (2.22mm), compared with those in the PT-wear group (0.44mm). . In dental changes, overjet were reduced by 3.91 mm and 2.0 mm in the FT-wear and PT-wear group, respectively. This difference was statistically significant.Skeletal effects were pronounced in the FT-wear group, and dentoalveolar changes were comparable in the 2 wear groups. The maximum skeletal treatment effect of a TB appliance was found to occur with FT wear over a 6-month treatment period.

To evaluate and compare the skeletal changes during the retention period after expansion with "Transforce Transverse lingual or palatal Appliance®" (TTA) and "NiTi Palatal Expander®" (NPE) in growing subjects with class II division 1 malocclusion and to compare these changes with a matched historical control.A unicentric two arm, parallel randomized clinical trial with additional historical control group was conducted over a period of six years. The subjects in the age group of 9-13 years were screened and recruited as they reported. The inclusion criteria were: late mixed/early permanent dentition, class II or end on molar relationship, posterior transverse inter-arch discrepancy 4-8mm, overjet≥5mm, cephalometrically ANB4° and CVMI stage CS2-CS3. Subjects were randomly allocated to two study groups (SG), TTA and NPE using block randomization. Appliances in both SG were managed and followed by a single clinician with equal standards of care. The lateral cephalograms in digital form were obtained at the beginning of the treatment (T1), post-expansion (T2) and after ten months retention period (T3). Linear positional change1mm and angular change0.75° were considered as a clinically significant change. Due to the ethical reasons a historical control of ten patients (CG) comparable to the SG for age and inclusion criteria was used to rule out the growth changes on serial lateral cephalograms. All Cephalometric measurements were done by a single operator blinded for the group allocation. Operator's measurement error was estimated. The study was single-blinded in regard to statistical analysis. Inter-group comparisons between SG were made by using an unpaired Student's t-test. ANOVA with post-hoc analysis was used for comparison among the study and control groups.A total of 36 subjects were recruited, 18 in each SG. Average time required to achieve the desired expansion in the TTA and NPE group was 13.6 weeks and 9.8 weeks respectively. The TTA group showed significant increase in SNB (1.54±0.33°) when compared with the control group (0.53±0.37°) and with the NPE group (0.74±0.29°) (P0.0001). Significant differences were observed when post-retention changes in SNB, ANB, Wits appraisal, and N perpendicular to Pogonion, were compared among the three groups (ANOVA, P0.0001). Tukey's multiple comparison showed that these mandibular sagittal changes were significantly greater in the TTA group than in NPE and the control group (P=0.007, Bonferroni corrected value).Cephalometrically significant sagittal advancement of mandible took place after expansion with TTA and NPE compared to untreated control. TTA appears to be more efficient for the sagittal positional changes than the NPE. Additional studies with larger samples are warranted to elucidate individual variations in skeletal response to the expansion protocol with these appliances.

Aim: In this study, we aimed to evaluate the stress distribution on maxilla, mandible, and glenoid fossa after application of Class III intermaxillary anteroposterior orthopedic forces of 150, 250, and 400 gas applied to a three-dimensional (3D) model of the young human dry skull. Methods: A 3D finite element model was developed from the computed tomography images of a growing boy (age, 13 years). ANSYS (version 16.0) software used to simulate Class III force of progressively increasing intensity over maxilla, mandible, and glenoid fossa to quantify the biomechanical reaction with two components, direction and stress. Results: We quantified detailed changes in the maxillofacial sutures, dentition, mandible, and glenoid fossa with bone-anchored maxillary protraction (BAMP) to analyze their effects. Conclusions: As the force increases from 150, 250 to 400 g, stresses are increased on all structures associated except maxillary central incisor which show a decrease in the stresses. Although forces were for maxillary protraction, stress generated at the circummaxillary sutures was minimal. As with any other Class III force, stresses were distributed on whole of condyle, capsular ligament, and minimal at glenoid fossa. This suggests that BAMP has more of mandibular restraining effect.

Objective: Skeletal class II malocclusion is commonly seen in the Indian clinical scenario among the growing population. In the background of newer functional appliances in recent times, Twin block and Bionator still remain widely used in clinical practice. Thus, a prospective clinical trial was designed to study various skeletal and dental effects of these appliances, as well as changes that occur in the control population. Materials and Methods: A sample size of 30 growing individuals with an age range of 9–14 years, showing class II division 1 malocclusion were selected. They were divided into three groups of 10 patients each, of which 10 were controls and 10 patients each for twin block and bionator groups. The average treatment duration was 6 months. Lateral cephalograms were taken before and after the treatment with functional appliances, and selected parameters were compared. Results: There were considerable skeletal and dental changes brought about by both the appliances when compared with controls, however, there were no significant differences in changes brought about by both the appliances when compared with each other. Conclusion: Both Twin block and Bionator appliances can be effectively used for the correction of skeletal class II malocclusion in growing individuals.

Rotation of incisors without any other problem is a common occurrence. Present article describes a simple semifixed appliance for correction of such minor anterior rotations with no need of complete arch fixed mechanotherapy.

Compliance for removable Twin-block appliance wear is one of the most common problems for successful functional correction. This article describes a simple but versatile semi-fixed Twin-block design that ensures full-time wear of the appliance with provision of possible modifications in different clinical situations.

Background The objective of the present study was to evaluate and compare temporomandibular joint changes especially disk-condyle-fossa relationship following functional treatment of skeletal class II division 1 malocclusion using Twin Block and Bionator appliances. Methods The total sample consisted of 30 subjects (13 males and 17 females) with class II division 1 malocclusion having mandibular retrognathism, in the age group of 9 to 14 years. Two treatment groups, i.e., Twin Block and Bionator groups, were formed which comprised ten subjects each, while a group of ten subjects served as the control group. The treatment effects were evaluated using magnetic resonance imaging (MRI). For the treatment groups, pretreatment MRI with wax construction bite was taken. For all subjects, MRI images with corrected sagittal T1 images were recorded in a maximal intercuspation position at pretreatment (R1) and in an unstrained retruded position at the end of a 6-month observation period (R2). Results At the end of 6 months of treatment, the condyles occupied a more anterior position in the fossa to its pretreatment position, while the disk moved more posteriorly in relation to the condyle. The control group showed no changes in the condyle and disk position over a period of 6 months. Conclusions Although the treatment group showed consistent forward positioning of the condyle and backward movement of the disk, long-term MRI findings in these groups will further clarify the adaptations between the condyle fossa and articular disk.