No abstract

The field of orthodontia has been witnessing numerous reforms in terms of treatment modalities through the years, under which the concept of absolute anchorage employing mini-implants can be well subsumed. The usage of orthodontic bone screws has witnessed growing popularity and has been deemed to revitalize the management of complex malocclusions. Orthodontic bone screws are larger in diameter (2 mm) in comparison with the average mini-implant and are placed in areas of high bone mineral density like the infrazygomatic crest in the maxilla and the buccal shelf area in the mandible. Owing to a difference in size, they are placed away from the roots and hence, the term extra-radicular implants seem a befitting one. With an expansion of the envelope of discrepancy to skeletal anchorage, the employment of these bone screws in practice will have to be appraised further in terms of biological limits. Orthodontic bone screws have been successfully utilized as an absolute anchorage system in well-chosen cases, pushing the realm of treatment possibilities further ahead in the sands of time. This chapter aims to provide you with a narrative insight into the salient features of orthodontic bone screws starting right from its inception to its contemporary usage in practice.

Objectives: Various fluoride varnishes have shown promising result in preventing enamel demineralization around orthodontic brackets as they do not depend on patient compliance. The objective of the study was to compare the effect of light-curable fluoride varnish (Clinpro XT) and conventional topical fluoride varnish (Fluoritop SR) in preventing enamel demineralization adjacent to orthodontic brackets. Methods: 20 patients who required extraction of four first premolars for orthodontic treatment were bonded with orthodontic brackets and each premolar received single application of Clinpro XT and Fluoritop SR fluoride varnish in 2 diagonally opposite quadrants and rest 2 premolars acted as control. The sample teeth were debonded and extracted after 1 month and 2 months of varnish application. The samples were sectioned using hard tissue microtome and evaluated under polarized light microscopy to measure the depth of demineralization. Results: Kolmogorov Smirnov test showed normal distribution of data. Comparison between the study groups with depth of demineralization scores showed statistically significant variation in one-way analysis of variance test. Turkey’s multiple post hoc procedures showed statistically significant difference in the depth of demineralization between all the 3 groups after 1 month and 2 months. Dependent t test showed statistically significant increment in the depth of demineralization in all the 3 groups between 1 month and 2 months. Conclusion: This study concluded that single application of both Fluoritop SR and Clinpro XT was effective in reducing significant depth of demineralization compared to control. Clinpro XT showed significantly less demineralization compared to Fluoritop SR after 1 month and 2 months of varnish application.

Demineralization/decalcification of the enamel around orthodontic brackets, seen clinically as white spot lesions, remain a sometimes neglected part of orthodontic care. Even though there are numerous studies on decalcification, most of them are based on subjective evaluation of enamel samples. The various techniques used to determine enamel demineralization associated with orthodontic treatment have not been directly compared and the operator is left with limited choice. Since these techniques have their own limitations, the selection of a protocol for the study of demineralization of enamel should be based on the true merit of the technique and its relevance to the study. Hence, the various methods used to determine demineralization of enamel during orthodontic treatment have been critically evaluated and their application in clinical orthodontics and research discussed. Clinical Relevance: Dental enamel has very limited regenerative capacity; hence prevention of its demineralization is of prime concern to a dentist in general and to an orthodontist specifically. The appearance of white spots/damage to healthy enamel after orthodontic treatment is both unaesthetic and legally questionable. Further, there is a lack of correlation among the various methods suggested to evaluate enamel demineralization. The current article not only summarizes the various methods but also suggests relevant steps to prevent the demineralization of enamel.

This case report demonstrates the successful use of intraoral distractor/hygenic rapid expander (HYRAX) for rapid maxillary expansion in anteroposterior direction with an adjunctive use of face mask therapy for anterior orthopedic traction of maxillary complex in a cleft patient with concave profile. The patient was a 13-year-old girl who reported with a chief complaint of backwardly positioned upper jaw and a severely forward positioned lower jaw. Therefore, a treatment was chosen in which acrylic bonded rapid maxillary expansion was done with tooth tissue borne intraoral distractor/HYRAX having a different activation schedule along with Dr Henri Petit facemask to treat maxillary retrognathism. As a result, crossbite got corrected and attained a positive jet with no bone loss in cleft area over a period of 5 months which was followed by fixed mechanotherapy achieving a well settled occlusion in 1 year. After completion of expansion and fixed mechanotherapy, ANB became +1 post-treatment which was −4 pretreatment. The prognathic profile was markedly improved by expansion and taking advantage of the remaining growth potential, thus minimizing the chances of surgery later in life. This provided a viable alternative to orthognathic surgery with good long-term stability.