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Khalid H Zawawi Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia Objective: To study patients’ acceptance of corticotomy-assisted orthodontics as a treatment option.Methods: Adult patients seeking orthodontic treatment were asked to complete two sets of questionnaires; the first set included questions about age, sex, and level of education and general questions about orthodontic treatment; and the second set was related to the corticotomy-assisted orthodontics. Before answering the corticotomy questions, a brief description of the clinical procedure was explained and photographs of an actual procedure were shown.Results: A total of 150 subjects were approached and 129 (86%) agreed to answer the questionnaires (72 male and 57 female patients). Of these, only 3.1% did hear about corticotomy and 7.8% selected corticotomy instead of extraction. Fear from the surgery (53.2%) was the most frequent reason for not selecting corticotomy followed by fear from pain (36.9%). The acceptance of corticotomy between males and females was similar. No relationship was found between the level of education and prior knowledge of the procedure, P=0.857. Prior knowledge about corticotomy was not a factor in selecting it as a treatment option (P=0.556) to reduce the treatment time (P=0.427).Conclusion: The acceptance of corticotomy-assisted orthodontics as a treatment option was low. Fear from the surgery was the main reason for not selecting it. The acceptance of corticotomy-assisted orthodontics was not related to patient’s level of education or sex. Keywords: orthodontic treatment, corticotomy-assisted orthodontics, patient acceptance, cross sectional survey, alveolar decortication

Khalid H Zawawi,1 Ahmed R Afify,1 Mohammed K Yousef,2 Hisham I Othman,3 Ayman A Al-Dharrab4 1Department of Orthodontics, 2Department of Operative Dentistry, 3Department of Oral Diagnostic Sciences, 4Department of Oral and Maxillofacial Prosthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia Objectives: This longitudinal study was aimed to investigate the association between didactic grades and practical skills for dental students and whether didactic grades can reliability predict the dental students’ practical performance. Materials and methods: Didactic and practical grades for graduates from the Faculty of Dentistry, King Abdulaziz University, between the years 2009 and 2011 were collected. Four courses were selected: Dental Anatomy, Operative Dentistry, Prosthodontics, and Orthodontics. Pearson product-moment correlation analyses between didactic and practical scores were conducted. Results: There was only a significant correlation between didactic and practical scores for the Dental Anatomy course (P

Khalid H Zawawi Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia Objective: To study the patient’s acceptance, expectation, and experience of pain with ­orthodontic temporary miniscrews. Methods: Questionnaires were distributed to 165 potential temporary orthodontic miniscrew recipients or their parents. Using the numeric rating scale, patients who received miniscrews as part of their orthodontic treatment were also asked to rate the pain or discomfort experience after miniscrew placement.Results: A total of 165 subjects completed the first set of questions. There was a significant relationship between level of education and prior knowledge about orthodontic miniscrews (P=0.029). Even though only 12.7% had heard about miniscrews, 82.4% agreed to have miniscrews placed to facilitate orthodontic tooth movement. Eighty-three subjects who needed miniscrews as part of their orthodontic treatment completed two more sets of questions after 6 and 24 hours of miniscrew insertion. After 6 hours of miniscrew insertion, there was a significant difference in pain perception between men (mean =2.6±2.2) and women (mean =2.1±1.5; P=0.03). After 24 hours, there was no difference between men (0.2±0.4) and women (0.2±0.5; P>0.05). Postplacement, 32.5% did not require any pain medication, while 59.1% required a single dose and only 8.4% required two doses. A total of 76 patients (91.6%) said that they would recommend this procedure.Conclusion: Patients do accept miniscrew as a treatment option in orthodontics. Postoperative pain is significantly low. The acceptance of miniscrews was not related to patient’s previous knowledge of the device, and patients preferred miniscrews to extractions. Keywords: orthodontic treatment, miniscrew, temporary anchorage device, patient acceptance

Khalid H Zawawi,1 Ghadah A Malki,2 Mohammad S Al-Zahrani,3 Yaser M Alkhiary4 1Department of Preventive Dental Science, Faculty of Dentistry, King Abdulaziz University, 2Consultant Pediatric Dentist, North Jeddah Dental Specialty Center, 3Department of Oral Basic and Clinical Sciences, Faculty of Dentistry, 4Department of Oral and Maxillofacial Rehabilitation, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia Aim: The aim of this study was to evaluate the influence of education on the perception of female college students on the effect of lip position and gingival display upon smiling and esthetics. Methods: A photograph of a smiling subject was altered to show varying degrees of gingival display. Female students, who were studying in different colleges, assessed a total of five images, using a numerical rating scale. Results: A total of 440 college students from eight educational faculties (dentistry, dental assistants, medicine, medical technology, nursing, science, arts, and pharmacology) participated in this study. There was no difference found between students' ratings of the altered images (P

Ahmed R Afify,1 Khalid H Zawawi,1 Hisham I Othman,2 Ayman A Al-Dharrab31Department of Preventive Dental Sciences, 2Department of Basic Oral and Clinical Sciences, 3Department of Oral and Maxillofacial Rehabilitation, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi ArabiaObjectives: The objective of this study is to investigate the correlation between the psychomotor skills and the academic performance of dental students.Methods: Didactic and preclinical scores were collected for students who graduated from the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, in 2011. Three courses (Dental Anatomy, Removable Prosthodontic Denture, and Orthodontics) were selected. Correlations comparing didactic and practical scores were done for the total samples, then for the males and females separately.Results: There was no significant correlation between the practical and didactic scores for the three courses for the total sample. There was a significant correlation between all three subjects in the didactic scores. For females, the results showed that there was only a significant correlation between the practical and didactic scores for Dental Anatomy. For males, no correlation was observed between the practical and didactic scores for all subjects.Conclusion: In the present sample, didactic performance did not correlate well with the students' psychomotor performance.Keywords: psychomotor performance, didactic performance, dental students, correlation study, dental education, practical performance

The authors performed a review of the literature to evaluate the efficacy of low level laser therapy (LLLT) for the treatment of temporomandibular disorders (TMD). Selection criteria included: 1) human subjects, 2) articles written in English, and 3) randomized placebo-controlled trials. Evaluation was performed according to the CONSORT 2010 criteria. A total of 14 articles were included in the review. Studies varied considerably in terms of methodological design, particularly regarding the site of application of the laser beam, the number of applications performed, their duration, the laser beam features (wavelength, frequency, output, dosage), and outcome measures. The outcome of the trials was controversial and not particularly related to any features of the laser beam, to the number of laser applications, and their duration. Based on the results of this review no definitive conclusions can be drawn on the efficacy of LLLT for the treatment of TMD. Many methodological differences among the studies, especially regarding the number and duration of laser applications and characteristics of the laser beam (wavelength, frequency, output), do not allow for standardized guidelines for effective treatment with LLLT. The only indication seems to be that LLLT is probably more effective for the treatment of TMJ disorders, and less effective for the treatment of masticatory muscle disorders. [ABSTRACT FROM AUTHOR]

Aim: This in vitro study aimed to evaluate and compare the bone-miniscrew contact surface area (BMC) and the cortical bone microcracks (CM) resulting from manual (hand-driven) and automated (motor-driven) orthodontic miniscrew (OM) insertion methods., Methods: Thirty-three OM were inserted in the femurs of nine New Zealand rabbits using manual (n = 16) and automated (n = 17) insertions. After euthanizing the rabbits, bone blocks, each including one OM, were sawed. Micro-CT scanning was performed, and data analysis included reconstruction, binarization and quantification of morphometric parameters of BMC and the number and length of CM. Means and standard deviations for complete BMC, complete BMC proportion, cortical BMC, cortical BMC proportion, and length and number of CM were calculated. Mixed model analysis was used to adjust for more than one sample/CM per animal. A paired t-test was used to compare the number of CM between the two groups., Results: Compared to the automated insertion, manually inserted miniscrews had significantly lower complete BMC (7.54 ± 1.80 mm 2 vs. 11.99 ± 3.64 mm 2 ), cortical BMC (5.91 ± 1.48 mm 2 vs. 8.48 ± 1.90 mm 2 ) and cortical BMC proportion (79.44 ± 5.84% vs. 87.94 ± 3.66%). However, it was not statistically significant in complete BMC proportion (p = .052). The automated insertion also resulted in a significantly lower mean number of CM than the manual method (p = .012). However, the length of the cracks was shorter in the manual group but with no significant difference (p = 0.256)., Conclusion: Motor-driven OM insertion results in superior BMC and reduction in the number of CM, which may lead to better miniscrew stability., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This study aimed to compare the surface roughness and friction of different orthodontic archwires after exposure to salbutamol sulphate inhalation, an anti-asthmatic medication., Methods: Orthodontic archwires (stainless-steel [StSt], nickel-titanium [NiTi], beta-titanium [β-Ti], and copper-NiTi [Cu-NiTi]) were equally divided into two groups. The exposed groups were subjected to 20 mg salbutamol sulphate for 21 days and kept in artificial saliva. The control groups were only kept in artificial saliva. Surface changes were visualized using scanning electron microscopy (SEM). The average surface roughness (Ra) was evaluated using atomic force microscopy (AFM), and friction resistance forces were assessed using a universal testing machine. Statistical analyses were performed using t-tests and ANOVA followed by post hoc tests., Results: Salbutamol sulphate did not change the surface roughness of StSt and NiTi archwires (p > .05). However, the change in the surfaces of β-Ti and Cu-NiTi archwires was significant (p < .001). The frictional forces of exposed StSt, NiTi, and Cu-NiTi archwires did not change (p > .05). However, the frictional forces of β-Ti archwires increased significantly after exposure to salbutamol sulphate (p = .021). Brushing with fluoride after exposure to salbutamol sulphate increased the frictional forces of β-Ti only (p = .002)., Conclusions: Salbutamol sulphate inhalation significantly affected the surface texture of β-Ti and Cu-NiTi orthodontic archwires and increased the friction of β-Ti archwires. These deteriorating effects were not detected on the surface of StSt and NiTi archwires. Therefore, we suggest that β-Ti and copper titanium archwires should be used cautiously in individuals under salbutamol sulphate inhalation treatment., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: We aimed to assess adult Saudi patients' facial anthropometry and cephalometric characteristics with skeletal Class III malocclusions compared to Class I malocclusion patients., Materials and Methods: Our cross-sectional study included a review of the orthodontic records of 108 patients: 54 patients with skeletal Class III malocclusions and 54 patients with skeletal Class I malocclusions, equally distributed between males and females. Using anthropometric landmarks, seven angular and eight linear measurements were recorded and compared between Class III and Class I patients. In addition, we compared three horizontal facial proportions and three horizontal neoclassical canons between the two groups. Finally, we used Student's t -tests to compare continuous variables and Chi-square tests for categorical variables., Results: Class III patients had significantly larger mandibular length, mandibular plane angle, mid- and lower-anterior face height, and posterior face height ( P < 0.05) compared to Class I patients. Class III patients had significantly proclined upper incisors, retroclined lower incisors, and an obtuse interincisal angle ( P < 0.05). The mouth: nose ratio differed significantly between skeletal Class III and I patients ( P = 0.008). The orbital canon was valid in 14.8% of Class I and 9.3% of Class III patients, respectively. The orbitonasal proportion applied only to 31.5% and 20.4% of Class I and III patients, respectively. The naso-oral canon occurred in 18.5% and 1.9% of Class I and III patients, respectively., Conclusion: Saudis with Class III skeletal profiles have some distinctive Class III characteristics not observed in most other ethnic groups. The established horizontal facial proportions, neoclassical facial canons, and Class III skeletal profile did not apply to Saudis with skeletal Class I malocclusions, indicating that these proportions and characteristics may not be suitable as references when planning the surgical treatment for these patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Contemporary Clinical Dentistry.)

Introduction: This study aimed to evaluate the maxillary sinus volume (MSV) in both genders in a Saudi sample and among different skeletal patterns., Materials and Methods: This retrospective cross-sectional study included 52 cone-beam computed tomography (CBCT) scans of 18 years or older individuals with complete dentition and healthy medical history. MSV was measured as the mean value of both sides in cubic millimeters (mm 3 ) using OnDemand three-dimensional™ Dental. Cephalometric tracings were conducted on cephalograms obtained from CBCT scans. The beta, A × B, and Frankfort-mandibular plane angles were selected to determine the sagittal and vertical skeletal patterns of the study subjects. Descriptive statistics and other tests were conducted. The significance level was set at P < 0.05., Results: Fifty-two CBCT scans were included in this study (23 males and 29 females), with a mean age of 36 (±14) years. The mean MSV was 14887 (±5030.79) mm 3 . Males had statistically significantly larger MSV (16517 ± 5335 mm 3 ) compared with females (13595 ± 4,452 mm 3 ) ( P = 0.036). There was no statistically significant difference in MSV among all other cephalometric measurements ( P > 0.05)., Conclusions: The MSV in the studied Saudi sample was larger among males. However, different skeletal patterns have no statistically significant differences in MSV., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Contemporary Clinical Dentistry.)

Objective: To analyze bite force distribution in subjects with different occlusal characteristics., Methods: This prospective study included 132 candidates (50 males, 82 females) seeking orthodontic treatment, who were divided into four groups based on Angle's classification of malocclusion. T-Scan® III Version 7.0 was used to record their relative distribution of bite forces, which were compared using gender, Angle's occlusal classification, overjet, overbite, space analysis, sagittal, and transverse skeletal relations variables., Results: ANOVA revealed significant differences in posterior/anterior bite force ratios between sagittal dental and skeletal relationships, overjet, and overbite groups ( p < 0.05). No significant difference was found between different space analysis and transverse relationship groups ( p > 0.05) or between genders ( p > 0.05)., Conclusion: Subjects with Class III, decreased overjet and decreased overbite displayed higher bite force in posterior teeth compared to other groups. This feature must be considered when evaluating patients with dental and periodontal pathologies that might be affected by excessive tooth stress, especially in subjects with oral parafunctions and bruxism.

Introduction: This study aimed to investigate the influence of orthodontists' demographics and patient characteristics on the orthodontic treatment plan decision for borderline Class II Division 1 malocclusion in growing patients., Methods: An electronic survey was distributed to orthodontists through the American Association of Orthodontists. Participating orthodontists were asked to select their preferred orthodontic treatment plan for 3 patients with borderline Class II Division 1 malocclusion. The survey also included questions about the patient-related factors contributing to the treatment decision for each patient., Results: A total of 113 orthodontists completed the survey. United States-trained orthodontists were more likely to select growth modification and nonextraction relative to extraction (odds ratio, 3.50; 95% confidence interval, 1.01-12.12; odds ratio, 3.59; 95% confidence interval, 1.18-10.91, respectively). Clinicians with >15 years of experience were 72% less likely to prefer nonextraction relative to extraction in 1 patient and were 67% less likely to prefer growth modification relative to extraction in another patient. Working solely in private practice was associated with higher, but not statistically significant, odds of growth modification and nonextraction. The practice location was also associated with treatment plan decisions; however, findings were inconsistent between the patients., Conclusions: The orthodontist's experience, place of education, location, and type of practice appear to influence the preferred treatment plan for Class II malocclusion. Overall, the patient's profile and age were the most considered patient-related factors for growth modification, whereas the patient's profile, amount of crowding, and smile esthetics were the most considered factors for preferring extraction and nonextraction treatment modalities., (Copyright © 2022 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective : To investigate the role of oral myofunctional therapy for the treatment of temporomandibular disorders. Methods : A search of the literature was carried out looking for randomized controlled trials performed on humans and written in English, Italian, French, and Arabic. Results : Four randomized controlled trials were found and evaluated by using the Study Quality Assessment Tool of the National Institute for Health and Clinical Excellence.Oral myofunctional therapy was shown to be effective for the treatment of temporomandibular disorders, alone or associated with other treatments, in three out of four studies, with significant reduction of pain intensity when compared to other conservative treatments and no treatment. Discussion : Even though scientific evidence is weak, oral myofunctional therapy appears to be effective for the treatment of temporomandibular disorders with favorable cost-benefit and risk-benefit ratios.

Aim: In this review, several gastrointestinal diseases that dentists may encounter in practice are highlighted and discussed., Materials and Methods: Using MEDLINE (PubMed), a comprehensive review of gastrointestinal diseases and their oral cavity manifestations was performed., Results: Many gastrointestinal diseases present with oral symptoms that are detectable by dentists and dental hygienists. Often, oral manifestations of the disease may appear before systemic signs and symptoms. Managing patients with these conditions requires dentists to adjust their treatment and/or involve other health professionals., Conclusion: Care must be taken when providing periodontal therapy or dental implants to patients suffering gastrointestinal diseases who are at high risk of bleeding, infection, or malnutrition, for example. Also, pharmacological therapy for these patients may need to be customized., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Introduction: After orthodontic treatment, some teeth undergo external root resorption due to different factors, such as the root shape, oral habits, biological and genetic factor, gender, and age. Furthermore, extraction cases, long treatment duration, and the amount of force applied during the treatment might be related to root resorption., Materials and Methods: Panoramic radiographs for 226 patients treated in the orthodontic department were screened. The lower first permanent molars, lower second premolars, and lower first premolars were measured in centimeters on a ruler using ImageJ System. Teeth were measured from the cusp tip to the cementoenamel junction (CEJ) and from the CEJ to the root apex, and then, the tooth was measured as a whole before and after the treatment., Results: Multiple analysis of variance showed that there were no interactions between the root lengths of all teeth tested and either gender, treatment type, or treatment duration ( P > 0.05)., Conclusion: Based on the results of this study, no statistically significance relationship between external apical root resorption and gender, type of treatment, and treatment duration was found., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Pharmacy and Bioallied Sciences.)

Objective: Depression and tooth loss are significant health problems that affect individuals' functionality and quality of life. Comorbidity between depression and oral diseases has been reported. The aim of this study was to investigate the association between depression and tooth loss in a US representative adult sample., Methods: This study included data from 22,532 adults ≥18 years by combining six 2-year cross-sectional cycles of the National Health and Nutrition Examination Survey (NHANES) administered between 2005 and 2016. Data were analyzed using descriptive statistics and multinomial logistic regression adjusted for gender, age, race/ethnicity, smoking, education, socioeconomic status, body mass index, diabetes, and alcohol intake., Results: Of the total sample, 4.5 percent were edentulous, 10.3 percent were lacking functional dentition (1-19 remaining teeth) and 85.2 percent had functional dentition (≥20 remaining teeth); among whom, the prevalence of depression was 12.4, 11.7, and 5.9 percent, respectively. Compared to individuals without depression, those with depression were more likely to be edentulous or lacking functional dentition versus having functional dentition (adjusted odds ratios (95% CI): 1.48 (1.16-1.89) and 1.43 (1.18-1.75), respectively)., Conclusions: Depression was associated with edentulism and a lack of functional dentition. Further longitudinal and interventional studies are needed to elucidate the nature and direction of the relationship between depression and tooth loss., (© 2020 American Association of Public Health Dentistry.)

Purpose: Sleep deficiency is implicated as a risk factor for several systemic conditions. Loss of teeth has a profound effect on the individual's physiologic and psychologic health and quality of life. This study aimed to assess the association between tooth loss and sleep duration and determine if anterior and/or posterior tooth loss is a significant predictor., Methods: A total of 22,483 individuals ≥ 18 years who participated in the United States National Health and Nutrition Examination Survey (NHANES) 2005-2016 cycles were included. Multinomial logistic regression adjusted for age, gender, race/ethnicity, smoking, diabetes, body mass index, socioeconomic level, education, alcohol, and depression was performed to examine the association between sleep duration and tooth loss., Results: Compared to individuals with > 20 remaining teeth, those who were completely edentulous, had 1-10 or 11-20 teeth remaining were more likely to be in the deficient sleep category (OR [95% CI] = 1.59 [1.35-1.87], 1.29 [1.07-1.54], and 1.26 [1.11-1.43], respectively). When the numbers of both missing anterior and posterior teeth were entered in the model, only posterior teeth were significant. There was a 4% increase in the odds of being in the deficient sleep category for each missing posterior tooth (OR [95% CI] = 1.04 [1.02-1.05])., Conclusions: Tooth loss was significantly associated with deficient sleep and posterior tooth loss appeared to be the main contributor. Although further research is needed to clarify the nature of this association, our results suggest that improving oral health might have an impact on overall health and quality of life.

Aims: This cross-sectional study compared and contrasted the morphological characteristics of Class I, II and III malocclusions in an adolescent Saudi population., Methods: Adolescent Saudis with Angle's Class I, II and III malocclusions were selected from orthodontic patients' records. Angular and linear measurements were compared between the three groups. Cephalometric analysis was performed using the VistadentOC® software. Multifactorial ANOVA for angular and linear measurements between and within groups., Results: Orthodontic records of 300 patients were included. There was no significant difference between and within groups in age and distribution of Angle's classification, p > 0.05. Multifactorial ANOVA showed that there were significant interactions between gender and malocclusions in skeletal, dental and soft tissue measurements, p < 0.05. There were significant differences in the sagittal and vertical skeletal measurements between groups, p < 0.05. The dental measurements were also significantly different in most of the measurements (p < 0.05). Moreover, there were significantly different readings among the groups in the soft tissue analysis., Conclusion: Morphological characteristics of adolescent Saudis show unique differences between gender and malocclusions, more so in Class III malocclusions. Class II and III malocclusions also show skeletal differences amongst the groups., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Authors.)

Background: Orthodontic treatment may result in undesirable side effects, such as root resorption and a decrease in the size of the pulp tissue which could be associated with the duration of the orthodontic treatment. Piezocision-assisted tooth movement was introduced as a minimally invasive surgical procedure to shorten orthodontic treatment time. This prospective randomized clinical trial was aimed to compare the pulp volume changes of maxillary anterior teeth after en-masse retraction with or without piezocision-assisted orthodontics., Methods: Patients who required orthodontic treatment with bilateral maxillary first premolar extractions and en-masse retraction were recruited. Patients were randomly divided into extraction with piezocision, or only extraction, serving as controls. Pulp volume and root length changes of the maxillary six anterior teeth were measured and compared between the two groups using a 3-Dimensional analytical software. Paired and independent sample t-tests were used to compare within and between groups. Bivariate correlation was done between the mean change in pulp volume and its corresponding root length. The significance level was set at α = 0.05., Results: A total of 23 patients were included, 12 in the piezocision, and 11 in the control group. At the end of the en-masse retraction phase, (mean = 122.74 ± 3.06 days) pulp volume was significantly decreased in all six anterior teeth in both groups (P < 0.01). The decrease in pulp volume was not statistically different between both groups, (P > 0.05). There was a statistically significant but moderate correlation only between the pulp volume change of the right canine and its root length, r = 0.44, P = 0.034., Conclusions: The effect of piezocision-assisted orthodontic tooth movement on the pulp volume was comparable to the conventional orthodontic treatment. The degree of change in pulp volume does not appear to be related to the amount of root resorption. Trial registration NCT03180151. Registered December 25, 2016, retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT03180151 .

Background: Few studies have investigated the volumetric relationship between the condyles and the mandible bilaterally., Materials and Methods: Condylar and mandibular segmentations from a sample of cone-beam computed tomography for 37 individuals were selected. T-test, correlation and linear regression analyses were performed to assess the relationships between the volumes of the condyles and mandible., Results: The volume of the condyles and the mandible was significantly different between genders (p < 0.05). There was a significant but moderate correlation between the volumes of the condyle and the rest of the mandible on the same side (p < 0.01). A regression analysis model demonstrated that condylar volume is related to the volume of the mandible., Conclusions: The relationship between the condylar volume and the rest of the mandible was found to be moderate. The relation between the condylar volume and mandibular volume is described by the regression equations for each side of the jaw. Sexual dimorphism exists in condylar and mandibular volumes.

Background: The aim of this cross-sectional study was to compare the dimensions of mandibular symphysis (MS) between gender and the different sagittal and vertical skeletal relationships., Material and Methods: Pre-treatment records of orthodontic patients were divided according to gender, sagittal (Class I, II and III) and vertical (decreased, average and increased mandibular plane [MP] angle) skeletal relationships. Measurements of MS parameters were performed on lateral cephalograms using IMAGEJ software. Comparisons between MS parameters and gender and the different skeletal relationships was performed using multifactorial and one-way ANOVA, and independent sample t-tests., Results: A total of 104 records (25 males and 79 females) fulfilled the inclusion criteria. Males had significantly greater MS surface area, dentoalveolar length, skeletal symphysis length, total symphysis length, vertical symphysis dimension and symphysis convexity ( p  < 0.05). Skeletal Class II patients had significantly greater dentoalveolar and skeletal symphysis lengths while Class III had greater chin length, vertical symphysis dimension and symphysis convexity ( p  < 0.05). Patients with decreased vertical dimension had greater skeletal symphysis length (p = 0.026) and those with an average vertical relationship had greater chin length (p < 0.001)., Conclusions: The morphology of the mandibular symphysis is affected by gender, sagittal and vertical skeletal patterns. Males had increased mandibular symphysis surface area and linear dimensions. Class II patients had greater dentoalveolar length. Chin length was greater in patients with an average MP angle., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2020 The Author(s).)

Objectives: To analyse occlusion time, occlusal balance and lateral occlusal scheme in subjects with various dental and skeletal characteristics., Methods: A total of 132 subjects (50 males and 82 females) seeking orthodontic treatment were included in this prospective study. Using the T-Scan III version 7.0 (Tekscan Inc, South Boston, MA, USA), the occlusion time, occlusal balance and lateral occlusal schemes were recorded and compared with gender, Angle's occlusal classification, overjet, overbite, space analysis, skeletal and transverse relations. ANOVA, t test and contingency tables analyses were performed. Statistical significance was set at P < .05., Results: Occlusion time was significantly shorter in subjects with balanced occlusion (0.18 seconds, P < .001), Class I normal occlusion (0.35 seconds, P = .028) and Class I skeletal profile (0.37 seconds, P = .002). Occlusion time was significantly longer in subjects with decreased overjet (0.60 seconds, P = .003). There were significant associations between the distribution of occlusal balance and Angles' classes of occlusion, skeletal relationship, overjet, overbite and space analysis (P < .05). Lateral occlusal schemes were only associated with Angle's classes of occlusion and skeletal relationship (P < .05)., Conclusions: Patients with Class I occlusion showed the least occlusion time, the most balanced occlusion and a higher frequency of canine guidance. Nonetheless, potentially balanced occlusion and group function were highly prevalent in all groups; therefore, ideal occlusion must be considered an ideal to inspire and aim for, but cannot be considered an essential requirement of every dental treatment., (© 2020 John Wiley & Sons Ltd.)

Objectives: To compare the amount of en-masse retraction with or without piezocision corticotomy, to assess the type of tooth movement, to evaluate root integrity after retraction, and to record reported pain levels., Materials and Methods: This randomized, controlled clinical trial included 26 orthodontic patients requiring premolar extraction. The patients were divided into two groups: (1) an extraction with piezocision corticotomy group (PCG) and (2) an extraction-only group, which served as the control group (CG). Cone-beam computed tomography images were acquired before and 4 months after the initiation of en-masse retraction utilizing miniscrews. The following variables were assessed: the amount of en-masse retraction, incisor inclination, incisor and canine root resorption, and patient-reported pain., Results: Twelve and 11 participants completed the entire study in the PCG and CG, respectively. The amount of en-masse retraction was significantly greater in the PCG compared to the CG (mean = 4.8 ± 0.57 mm vs 2.4 ± 0.33 mm, respectively [P < .001]). There was also significantly less tipping and root resorption of incisors in the PCG (P < .05). The reported pain was significantly higher on the first day in the PCG compared to the CG (P < .001); however, it became similar between the groups after 24 hours., Conclusions: Piezocision corticotomy enhanced the amount of en-masse retraction two times more with less root resorption. However, future studies are required to assess the long-term effects of this technique., (© 2020 by The EH Angle Education and Research Foundation, Inc.)

Background: Orthodontic miniscrews are commonly used as temporary anchorage devices. Bone thickness and bone depth are important factors when placing miniscrews. There are no studies to assess the maxillary bone thickness for optimum miniscrew placement in a Saudi population., Objective: Assess the proximity of the maxillary sinus and nasal cavity in areas where miniscrews are usually inserted using cone beam computed tomography (CBCT)., Design: Retrospective, cross-sectional., Setting: Department of maxillofacial radiology in a Saudi dental school., Patients and Methods: Using CBCT images, we measured the distance between the maxillary sinus and nasal cavity to the palatal bone, buccal intra-radicular and infrazygomatic crest areas. Mean values (SD) were compared at various locations, including by gender, and correlation with age was calculated., Main Outcome Measure: Mean bone thickness at commonly used sites for orthodontic miniscrew placements in the maxilla. Secondary outcome was the insertion angle in the infrazygomatic crest area., Sample Size: CBCT images of 100 patients (50 males and 50 females)., Results: The mean (standard deviation) age for the sample was 25.4 (6.5) years with no significant difference between males and females. In the palate, the distance to the nasal cavity and maxillary sinus was greater anteriorly and decreased significantly posteriorly ( P <.001). Buccally, the interdental bone depth was significantly greater between the second premolar and first molar (11.96 mm) compared to between the central and lateral incisors (7.53 mm, P <.001). The mean bone thickness of the infrazygomatic crest area at a 45° insertion angle was 4.94 mm compared to 3.90 at a 70° insertion angle ( P <.001). No correlation was found between age and bone thickness., Conclusion: The distance to the nasal cavity and maxillary sinus was greater in the anterior than posterior areas. There is minimal risk of injuring the maxillary sinus or nasal cavity using the buccal approach. Caution is needed when placing miniscrews in the infrazygomatic crest area., Limitations: Cross-sectional study from one center; hence, findings cannot be generalized to other populations., Conflict of Interest: None.

Granulomatous diseases may present with oral manifestations that are detectable by dental care providers. In certain cases, oral manifestations may precede systemic signs and symptoms. Dentists managing patients with these conditions may modify the dental treatment plan and possibly retain the support of other health professionals. This review gives an update on granulomatous diseases that can be faced by the dental practitioner., Competing Interests: We declare that we have no conflict of interest., (© 2019 The Authors.)

Background: There are limited data from Saudi Arabia on the prevalence and characteristics of maxillary sinus septa., Objective: Determine the prevalence and morphological characteristics of septa in the maxillary sinus and their relationship to gender and age using cone beam computed tomography (CBCT)., Design: Cross-sectional SETTING: CBCT images acquired from the maxillofacial radiology department in a dental school., Patient and Methods: CBCT scans of 1010 maxillary sinuses from 505 patients were analyzed to determine the prevalence, location, type, and orientation of maxillary sinus septa. Descriptive statistics, chi-square tests and t tests were used to analyze the data., Main Outcome Measures: The prevalence, location, type, and orientation of maxillary sinus septa., Sample Size: 1010 sinuses from 505 patients., Result: Approximately 46% of the studied patients had maxillary septa, which were present in 370 (37%) sinuses. About 64% of the septa were present on the right side and 85.7% of all septa were mediolater-ally oriented. The mean height of the septa was 6.06 mm (0.84) in the right sinuses and 5.70 mm (0.93) in the left sinuses. Multiple septa were found in 101 patients (20%). Among males, 58.5% had septa compared to 34% of females ( P <.001.) A significant positive association was found between age and the presence and number of septa, P <.001., Conclusions: Maxillary sinus septa were highly prevalent with various heights and directions among the studied sample. Careful assessment of different anatomic variation must be conducted prior to any maxillary sinus augmentation, particularly in older patients., Limitations: Cross-sectional evaluation of CBCT images from one dental school patient population; thus, the findings cannot be generalized to other populations., Conflict of Interest: None.

Aim: Because the use of non-steroidal anti-inflammatory drugs and opioids has several restrictions, this review evaluates the efficacy and safety of acetaminophen and caffeine for the management of dental pain., Methods: A search of the literature was carried out looking for randomized controlled trials on the use of acetaminophen and caffeine for the management of dental pain, performed on humans and written in English, Italian, French or Arabic languages. The following databases were searched: PubMed, The Cochrane Central Register of Controlled Trials (CENTRAL), Ovid Medline and Scopus., Results: Three controlled clinical trials were retrieved and evaluated by using the Study Quality Assessment Tool of the National Institute for Health and Clinical Excellence., Conclusion: The use of acetaminophen and caffeine appears to be effective in achieving good control of acute dental pain compared to placebo and other analgesic medications, but clinical recommendations cannot be made for the limited number of studies assessed., (© 2019 The Authors.)

The current study aimed at examining surface and chemical composition changes of retrieved mini-implants after different periods of service as aids of anchorage for orthodontic patients. This study examined 72 retrieved orthodontic self-tapping and self-drilling mini-implants, 1.7 mm in diameter and 8 mm in length (OrthoEasy system, Forestadent, Pforzheim, Germany) from 36 adult orthodontic patients (18 men and 18 women, mean age = 23 years). The retrieved mini-implants were divided into 3 groups according to service period: 3-6 months (3M-6M) group, 6-12 months (6M-12M) group, and 12-24 months (12M-24M) group, with 24 mini-implants in each group. The control group (As Received) comprised of 24 unused mini-implants of the same type (AR group). All mini-implant heads and threaded bodies were examined for chemical characterization and topographical features by SEM-EDS. The average weight percentages for the following elements Ti, Al, and O 2 were obtained and compared among the 4 groups. There was significant decrease in titanium content and deterioration for the surface properties for all parts of the mini-implants after being used inside patients' oral cavities for more than 6 months p < 0.05. The period of mini-implant service inside patients' oral cavities should not exceed 6 months.

Objective: The aim was to evaluate differences in the cervical vertebral skeletal maturity of unilateral cleft lip and palate (UCLP) and non-cleft lip/palate (non-CLP) Saudi male orthodontic patients., Method: This cross-sectional multicenter study took place at the dental school, King Saud University and King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia, between October 2014 and September 2015. The records of Saudi male orthodontic patients with UCLP ( n = 69) were collected. Cervical vertebral maturation was assessed using their cephalometric radiographs. The records of 138 age-matched non-CLP Saudi male orthodontic patients served as controls., Results: There was a significant difference in skeletal maturity between the UCLP and non-CLP groups, as evident in the delayed skeletal development among the UCLP participants. Moreover, pubertal growth spurt onset was significantly earlier in the non-cleft participants in comparison with the UCLP participants ( p = 0.009)., Conclusions: There is delayed skeletal maturity among the UCLP Saudi male population in comparison with their non-CLP age-matched peers.

Objective: This study was aimed to evaluate the dental age in Saudi children from panoramic radiographs using the Demirjian method to estimate their chronological age., Materials and Methods: This retrospective cross-sectional study consisted of 1902 panoramic radiographs of 955 boys and 947 girls between the ages of 3-17 years. All children were placed in the age group closest to their chronological age. The dental age was scored on all seven left mandibular teeth by calibrated examiners. Bivariate analyses using the t -test and Pearson correlation were performed., Results: There was significant difference in both boys and girls in all the age groups between their chronological age and dental age. Even though there was a slight overestimation in boys in some age groups and slight underestimation in girls in some groups, correlation analysis showed that there was a highly significant correlation between the chronological age and dental age for both boys ( r 2 = 0.96, P < 0.001) and girls ( r 2 = 0.98, P < 0.001). Moreover, correlation analyses for each age group showed a significant correlation between the chronological age and the dental age, using the Demirjian method, in most age groups ( P < 0.01). When comparing the maturation score between boys and girls, the Student's t -test showed that there were no statistical differences between boys and girls in most age groups., Conclusion: Saudi boys and girls living in the western region of Saudi Arabia exhibited similar pattern of dental development when compared to the Demirjian method. Hence, the Demirjian method could be used as reference in children from the western region of Saudi Arabia., Competing Interests: There are no conflicts of interest.

Introduction: Dental caries and periodontal diseases are all induced by oral biofilm (dental plaque). This study was conducted to evaluate if fluoride-impregnated miswak is as effective in plaque removal and fluoride release as toothbrushing with fluoride toothpaste., Materials and Methods: This single-blind, randomized, crossover study was conducted at the Department of Cariology, University of Gothenburg, Gothenburg, Sweden, from February 2010 to January 2011. Fifteen healthy subjects participated in this study. The participants were instructed to use the following: (1) 0.5% NaF-impregnated miswak, (2) nonfluoridated miswak, (3) toothbrush with nonfluoride toothpaste, and (4) toothbrush with 1450 ppm fluoride toothpaste. Each method was used twice a day for 1 week after which plaque amount and fluoride concentration in resting saliva were measured. There was a 1-week washout period between each method., Results: No significant difference between miswak and tooth-brushing was found regarding plaque removal on buccal and lingual surfaces. A somewhat higher fluoride concentration in resting saliva was found after using impregnated miswak when compared with toothbrushing with fluoride toothpaste (p < 0.05)., Conclusion: Miswak and toothbrushing showed the same plaque removing effect on buccal and lingual surfaces. Miswak impregnated with 0.5% NaF resulted in a higher concentration of fluoride in saliva than brushing with 1450 ppm fluoride toothpaste., Clinical Significance: Miswak impregnated with 0.5% NaF and toothbrushing results in comparable plaque removal and about the same fluoride concentration in saliva even it was somewhat higher for impregnated miswak.

Introduction: Understanding the changes in bone density of patients affected by aggressive periodontitis could be useful in early disease detection and proper treatment planning., Aim: The aim of this study was to compare alveolar bone density in patients affected with aggressive periodontitis and periodontally healthy individuals using Cone Beam Computed Tomography (CBCT)., Materials and Methods: This cross-sectional study was conducted on 20 patients with a confirmed diagnosis of aggressive periodontitis. Twenty periodontally healthy patients attending the dental clinics for implant placement or extraction of impacted third molars served as controls. Alveolar bone density was measured using CBCT scanning. Comparisons between aggressive periodontitis group and controls for age and alveolar bone density of the anterior and posterior regions were performed using an independent sample t-test. Multivariable linear regression models were also performed., Results: The differences between groups in regard to age, anterior and posterior alveolar bone density was not statistically significant (p<0.05). In the posterior region, the multivariable regression model showed that bone density was not associated with age, gender or the study groups. Whereas, in the anterior region, patient's age was found to be significantly associated with bone density, p=0.014., Conclusion: Alveolar bone density as measured by CBCT in aggressive periodontitis patients was not different from periodontally healthy individuals. Further studies are needed to confirm these findings.

Objectives: To investigate the relationship between the presence of periapical lesions (PL) and levels of glycosylated hemoglobin (HbA1c), and C-reactive protein (CRP) in patients with type 2 diabetes.  Methods: This cross-sectional study was conducted at Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia, between September 2013 and February 2015. Medical and dental history and Sociodemographic data were obtained from participants. Dental and periodontal examinations were conducted and blood samples were obtained to determine levels of HbA1c and CRP. The presence of PL was recorded from panoramic and periapical radiographs. Descriptive statistics and multivariable linear and logistic regression models were used for data analyses.  Results: One hundred patients were included; mean age was 48.9 ± 8.5 years. Of these patients, 14% had no PL, whereas 25% had one or 2 lesions, 32% had 3 or 4 lesions, and 29% had ≥5 PL. The mean HbA1c was 9.8% (± 2.5) mg/L and CRP was 6.9 mg/L (± 6.3). The presence of PL was significantly associated with a higher level of HbA1c independent of age, gender, probing depth, and plaque index (p=0.023). Individuals with PL were also more likely to have a high CRP level (greater than 3 mg/L) independent of the previous covariates (odds ratio: 1.19; 95% confidence interval: 1.01-1.41).  Conclusion: Periapical lesions are associated with a poorer glycemic control and a higher CRP level in type 2 diabetic patients.

Objectives: This study was aimed to investigate the prevalence of maxillary lateral incisor agenesis and associated skeletal characteristics in an orthodontic patient population., Materials and Methods: The records of the 1066 patients seeking orthodontic treatment were screened for maxillary lateral incisor agenesis (MLIA). The following data were recorded for each subject: age; gender; unilateral or bilateral agenesis of MLI and side. The lateral cephalogram of each subject with MLIA was digitally traced. The data were compared to age-matched control orthodontic patients with skeletal Class I., Results: The prevalence of maxillary lateral incisor agenesis was 4.9% (52 patients) in which 63.5% were females. There was a significant difference between MLIA patients and controls in sagittal relationships (ANB, Wits, AB plane, angle of convexity and Co-A/Co-Gn differential analyses) p < 0.05., Conclusions: Patients with maxillary lateral incisor agenesis showed a significant tendency for skeletal Class III compared with the Class I control. This could be attributed to maxillary hypoplasia/retrognathia.

Objectives: To evaluate the accuracy of using routine 2-dimensional (2D) radiographs (panoramic and periapical) when evaluating the position of orthodontic temporary anchorage devices (mini-implants) in the maxilla, and to compare the results to 3-dimensional cone-beam computed tomography (CBCT)., Methods: This cross-sectional study was conducted at King Abdulaziz University, Faculty of Dentistry, Jeddah, Kingdom of Saudi Arabia from February 2014 to January 2015. Panoramic and periapical radiographs were used to examine the position of mini-implants in relation to the adjacent roots. Rating of mini-implants position was performed by 82 dentists from different specialties, using 2D images according to the following criteria: 1) away from the root; 2) mini-implant tip appears touching the lamina dura; and 3) mini-implant overlays the lamina dura. The results were compared with CBCT findings., Results: There was no difference between dentists from different specialties when rating the position of the mini-implants (Cronbach's alpha=0.956). The accuracy of the periapical images was 45.1%, while the panoramic images 33.6%. However, both panoramic and periapical radiographs were significantly inaccurate when assessing the mini-implant position when compared with the CBCT findings (p=0.0001)., Conclusion: Three-dimensional CBCT technology allows better visualization of mini-implant placement. The use of CBCT when assessing the position of mini-implants is recommended.

Occlusal dysesthesia (OD) is a disorder characterised by the sensation of uncomfortable bite with no obvious occlusal discrepancy. It is usually associated with emotional distress and is elicited by dental occlusal procedures. Multiple dental treatments are often provided to try to resolve the symptoms, but the outcome is usually dissatisfying for the dentist and disappointing for the patient. To summarise the specific features of OD, a PubMed search was carried out looking for all papers related to the topic. The references from the studies selected and from review articles were also examined for further relevant papers. A total of 138 articles were first identified, of which 18 of them were considered relevant to the topic. This article reviews the epidemiology, taxonomy and etio-pathophysiology, symptomatology, diagnosis and treatment of OD, with special relevance to issues of clinical importance and dental therapy. Any dental treatment must be avoided in patients with OD, because the results could be inadequate and it usually worsens the symptoms., (© 2015 John Wiley & Sons Ltd.)

Objectives: To compare periodontal findings in systemic lupus erythematosus (SLE) patients and healthy controls, and to determine, whether there is a correlation between periodontal parameters and SLE biomarkers., Methods: This cross-sectional study was conducted in the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia between November 2012 and February 2014. Twenty-five participants diagnosed with SLE and 50 healthy controls were selected. Periodontal assessment consisted of clinical attachment level (CAL), probing depth (PD), bleeding on probing, and plaque scores. For the SLE group, several laboratory tests were obtained, such as, white blood cell count, hemoglobin level, platelet count, anti-nuclear antibody, anti-double-stranded DNA antibody, calcium level, and vitamin D., Results: Periodontal findings in SLE patients and controls were not significantly different. The SLE patients who had no flare-ups for more than a year showed significant bleeding on probing and deeper PD compared with those who had flare-ups less than a year before starting the study. The SLE patients with arthritis symptoms showed more CAL than those without arthritis. In the SLE patients, no significant correlation was found between their periodontal findings and SLE biomarkers., Conclusion: Periodontal health was not different between SLE patients and healthy controls. In SLE patients however, flare-ups and presence of arthritis had a significant relation with periodontal health.

Objectives: To study the association between gingival biotypes and inclination and position of the maxillary and mandibular incisors., Methods: This cross-sectional study included 142 consecutive orthodontic patients (64 males and 78 females) who were seeking orthodontic treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia from February 2013 to January 2014. Gingival biotype was assessed independently for the maxillary and mandibular central incisors using the transparency of periodontal probe method. Maxillary and mandibular incisors' inclination and position were measured using cephalometric analysis., Results: The mean age was 23.56 (±2.55) years. The prevalence of thin gingival biotype was 43% for the maxillary and 52.1% for the mandibular incisors. Females were 4 times more likely to have thin gingiva for the maxillary incisors and 5 times more likely for the mandibular incisors. A significant association was found between mandibular incisor inclination and position and thin gingival biotype, while there was no association between the maxillary incisor inclination and position and gingival biotypes., Conclusion: Mandibular incisor proclination and protrusion is associated with thin gingival biotype while no association is found in the maxilla. The evaluation of the gingival biotype is essential during diagnosis and treatment planning for potential orthodontic patients.

Objective: The aim of this study was to compare the amount of root resorption after orthodontic treatment between the bidimensional and the Roth straight-wire techniques. Another objective was to compare the amount of root resorption in the whole sample studied and record the prevalence of root resorption., Materials and Methods: The sample consisted of 40 patients (age ranged between 11 and 18 years) with Angle Class II division 1 malocclusions, treated nonextraction. Twenty patients were treated with bidimensional technique and 20 with a 0.018-inch Roth straight-wire technique. Root lengths of the maxillary incisors were measured on pre- and post-treatment periapical radiographs., Results: The results demonstrated that the bidimensional and Roth straight-wire groups showed significant root resorption after treatment, 1.11 (0.17) and 0.86 (0.05), respectively, P < 0.001. When comparing the amount of root shortening between the bidimensional and Roth straight-wire groups, there was no significant difference between the mean change from pre- to post-treatment between bidimensional group (mean = 1.00 ± 1.34) and Roth straight-wire group (mean = 0.88 ± 0.86), P = 0.63. Considering the whole sample, there was no root resoprtion in 32.5% of the analysed teeth. There was only mild resorption in 56.2%, moderate in 8.8% and severe in only 2.5% of the teeth., Conclusions: Treatment with the bidimensional technique did not produce an increase in the amount of root resorption. The prevalence and amount of root resorption was similar between bidimensional and Roth straight-wire techniques.

Objective: To assess the effect of ovariectomy on the expression of estrogen receptor-beta (ER-beta) in periodontal ligament and alveolar bone., Methods: This animal study was conducted at King Fahad Research Center, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from March to October 2012. Thirty 12-week-old female Wistar rats were divided into 2 groups (15 each): ovariectomized (OVX) and sham-operated. Levels of estrogen and progesterone in the sera were measured using the enzyme linked immunosorbent assay (ELISA). To detect the expression of ER-beta, immunostaining was performed on the tibia, alveolar bone, and periodontal ligament specimens followed by quantitative histomorphometric analysis., Results: Estrogen (p=0.001) and progesterone (p=0.007) levels were significantly decreased in the OVX rats compared to their controls. Histologically, the thickness and area percentage of the tibia and alveolar bone trabeculae were significantly reduced in OVX rats compared to the controls (p=0.001). The periodontal ligament fibers in the control group exhibited well-organized and appropriately oriented fibers, while in the OVX group they appeared disrupted with loss of orientation. The ER-beta expression in the OVX rats was significantly decreased in the periodontal tissues (p=0.005) and tibia (p=0.008)., Conclusion: Estrogen deficiency resulted in a significant decrease in the expression of ER-beta in both tibia and periodontal tissues.

Aims: To evaluate the role of third molars in the development of crowding or relapse after orthodontic treatment in the anterior segment of the dental arch., Methods: PubMed search of the literature was performed selecting all the articles relevant to the topic and limiting the studies to controlled trials on humans and written in English language. Systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) statement., Results: A total of 12 clinical studies were included in the review. A high risk of bias was found in most of the articles, either because the relative items assessed were inadequate or because they were unclearly described. The third molars were not correlated with more severe anterior tooth crowding in most of the studies. However, four of them described a different outcome., Conclusion: Definitive conclusions on the role of the third molars in the development of anterior tooth crowding cannot be drawn. A high risk of bias was found in most of the trials, and the outcomes were not consistent. However, most of the studies do not support a cause-and-effect relationship; therefore, third molar extraction to prevent anterior tooth crowding or postorthodontic relapse is not justified.

Mandibular incisor extraction for orthodontic treatment is considered an unusual treatment option because of the limited number of patients that meet the criteria for such treatment. Accurate diagnosis and treatment planning is essential to achieve the desired results. Adult orthodontic patients are increasingly motivated by esthetic considerations and reject the idea of conventional fixed appliances. In recent years, Invisalign appliances have gained tremendous attention for orthodontic treatment of adult patients to meet their esthetic demands. In this case report, a case of Class I malocclusion was treated with mandibular incisor extraction using the Invisalign appliance system. Successful tooth alignment of both arches was achieved. The use of Invisalign appliance is an effective treatment option in adult patients with Class I malocclusion that requires incisor extraction due to moderate to severe mandibular anterior crowding.

Objective: To compare the expression of human beta-defensins (HBD) in the gingival tissues of obese and normal weight systemically healthy subjects., Methods: This cross-sectional study was conducted at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia from March 2010 to November 2011. Twenty obese (10 affected with periodontitis and 10 periodontally healthy), and 20 normal weight subjects (10 affected with periodontitis and 10 periodontally healthy) were selected. Gingival tissue samples were collected and subjected to immunohistochemistry assay to evaluate the expression of HBD-1 and -2., Results: In the epithelium, the staining was almost limited to the basal and supra-basal cells, while the superficial layers and keratin were negative. In the connective tissue, some of the chronic inflammatory cells and fibroblasts were also stained. Endothelial cells lining blood or lymphatic vessels were mostly positive with HBD-2 and were almost negative with HBD-1. The percentage of positively stained areas did not show any differences in the expression of HBD-1 and -2 in obese compared to normal weight subjects whether they were affected or not affected with periodontitis., Conclusion: The results of this study did not demonstrate an association between the expression of HBD-1 and -2 and obesity and periodontitis.

Objectives: The Wits values for various ethnic groups are different and the applicability of the norms described in these analyses to different populations is difficult. The objectives of this study were to establish the normal values of Wits appraisal in a sample from the western region of Saudi Arabia and to evaluate the existence of gender dimorphism. Also, to compare the results with previously published Wits values., Materials and Methods: A total of 66 lateral cephalometric digital radiographs of Saudi patients from the western region (25 males and 41 females, mean age 19.32±8.16 years and 20.88±8.77 years, respectively). All subjects had angle class-I occlusion, well-balanced faces, all premolars had erupted and in occlusion, and no history of orthodontic treatment. Tracing was performed using the VistadentOC(®) software., Results: Wits mean values were greater in males (-0.73±2.48) than females (1.79±2.06), with significant gender difference (P<0.001). Comparisons with previously published showed that there is a significant differences between ethnic groups, especially in females' data., Conclusion: Wits appraisal appears to be gender-specific and ethnicity-specific for female values.

Objective: To study the prevalence of different gingival biotypes in a sample of patients and the association between gingival biotype and different dental malocclusions., Methods: Two hundred adult patients (100 males and 100 females) who presented for treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia were recruited from February 2011 to February 2012. Gingival thickness was assessed for the maxillary central incisors using the transparency of periodontal probe technique. Angle's classification of malocclusion and smoking habit were also recorded., Results: The mean age was 32.1 (+/-11.0) years. Thin gingival biotype was observed in 44.5% of the sample, of which 64% were females and 25% were males (p=0.001). Only 31.4% of current smokers had thin gingival biotype compared to 51.9% of subjects who never smoked (p=0.011). No significant association between dental malocclusions and the presence of thin gingival biotype was found (Class I = 42.9%, Class II = 44.1%, and Class III 53.9%, p=0.6)., Conclusion: A high prevalence of thin gingival biotype especially among females was observed. Smokers had thicker gingival biotype. No relationship was found between gingival biotypes and Angle's classification of malocclusion.

Objective. The aim of this cross-sectional study was to investigate the prevalence of dental anomalies that could be a cause of malocclusion in the western region of Saudi Arabia. Materials and Methods. A retrospective study of 878 digital orthopantomograms (OPGs) taken of patients, age ranging between 12 and 30 years, who presented to treatment at the Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia between 2002 and 2011. The OPGs and dental records were reviewed for congenitally missing teeth, supernumerary teeth, impactions, ectopic eruption, transposition, germination, fusion, dilacerations, taurodontism, dens in dent, and any other unusual conditions that can be assessed with OPG. Results. The prevalence of patient that exhibited at least one dental anomaly was 396 (45.1%) patients. The prevalence of congenitally missing teeth was 226 (25.7%), impacted teeth 186 (21.1%), dilacerated teeth 10 (1.1%), supernumerary teeth 3 (0.3%), odontoma 1 (0.1%), and taurodontism was also 1 case (0.1%) of the total radiographs reviewed. Conclusions. Congenitally missing teeth were found to be the most prevalent anomaly (25.7%), and the second frequent anomaly was impacted teeth (21.1%), whereas root dilacerations, supernumerary teeth, and taurodontism were the least frequent anomalies (1.1%, 0.3% and 0.1%, resp.).