Summary Background Proper oral hygiene and absence of periodontal inflammation is pre-requisite for orthodontic treatment. Chlorhexidine (CHX) is an established oral antiseptic used in the treatment of periodontal disease, but its role in orthodontic therapy is unclear. Objectives To assess the efficacy of adjunct use of CHX-containing products in maintaining gingival health among orthodontic patients with fixed appliances. Search methods Five databases were searched without limitations up to August 2021. Selection criteria Randomized clinical trials (RCTs) assessing Gingival Index (GI) (primary outcome), Plaque Index (PI), Bleeding Index (BI), or Pocket Probing Depth (PPD). Data collection and analysis Study selection, data extraction, and risk of bias assessment were done independently in duplicate. Random-effects meta-analyses of mean differences (MDs) or standardized mean differences (SMDs) with their 95% confidence intervals (CIs) were conducted, followed by sensitivity and Grades of Recommendations, Assessment, Development and Evaluation analysis. Results Twenty RCTs (1001 patients) were included assessing CHX-containing mouthwashes (n = 11), toothpastes (n = 2), gels (n = 3), or varnishes (n = 4) compared to placebo/control (n = 19) or sodium fluoride-products (n = 4). In the short-term, CHX-containing mouthwash was associated with lower GI (n = 9; MD = −0.68; 95% CI = −0.97 to −0.38; P < 0.001; high quality), lower PI (n = 9; MD = −0.65; 95% CI = −0.86 to −0.43; P < 0.001; high quality), lower BI (n = 2; SMD = −1.61; 95% CI = −2.99 to −0.22; P = 0.02; low quality), and lower PPD (n = 2; MD = −0.60 mm; 95% CI = −1.06 to −0.14 mm; P = 0.01; low quality). No considerable benefits were found from the use of CHX-gel or CHX-varnish in terms of GI, PI, or PPD (P > 0.05/low quality in all instances). Use of a CHX-containing toothpaste was more effective in lowering PI (Heintze-index) than adjunct use of fluoride-containing mouthwash (n = 2; MD = −5.24; 95% CI = −10.46 to −0.02; P = 0.04), but not GI (P = 0.68) or BI (P = 0.27), while sensitivity analyses indicated robustness. Conclusions Adjunct use of CHX mouthwash during fixed-appliance treatment is associated with improved gingival inflammation, plaque control, and pocket depths, but caution is warranted and recommendations about CHX use during orthodontic treatment of children/adults should consider the heterogeneous patient response, cost-effectiveness, and potential adverse effects. Registration PROSPERO registration (CRD42021228759).

Objective: To compare the mesiodistal widths of the maxillary and mandibular central incisors of cleft lip and palate individuals with non-cleft individuals, in a local population. Methodology: A total of 80 casts (40 of cleft patients and 40 normal) were selected by the department of orthodontics from January, 2021 to February, 2022, dividing them it into 4 groups by consecutive non-probability technique. The mesiodistal width of the maxillary and mandibular central incisors was measured with vernier caliper.  Independent t test was applied to compare the mesiodistal width of maxillary and mandibular central incisors between normal and cleft patients. Descriptive statistics were calculated for all four groups. Results: The mean MD width for the maxillary central incisors was 6.58 ± 1.16mm and 7.67 ±1.18mm for the CLP and control group respectively. The mean MD width for the mandibular central incisors was 4.22± 0.91 mm and 4.67 ± 0.9 mm for the CLP and control group respectively. The student t test showed a significant difference in the MD width of both the maxillary and mandibular central incisors between the CLP and control group. Conclusion: Patients suffering from cleft lip and palate are associated with diminutive central incisors in both jaws.

Background: The separators are a preliminary step for band insertion, but there is a potential risk of bacteraemia during their placement, particularly in susceptible patients. The objective of the study is to determine the effect of separators on the bacterial count in gingival crevicular fluid (GCF) and to assess the efficacy of chlorhexidine mouth rinse and saline irrigation in the reduction of the bacterial count. Methods: This randomized controlled trial was conducted on 51 participants who were divided into three equal groups randomly (brushing only/control, saline irrigation, and 2% chlorhexidine mouthwash rinse). The inclusion criteria were age between 18–25 years, good oral hygiene, gingival and plaque index <1, no previous orthodontic treatment, and healthy individuals. The bacterial count was obtained from GCF samples after two hours, on the third day, and on the seventh day. Kruskal Wallis test was used to compare the bacterial count among the three groups, and post hoc analysis was done using Dunn's test. Friedman test was applied to see the difference at three-time points in each group. Results: In both saline and chlorhexidine groups the mean bacterial count decreased significantly from baseline to 3rd day and 7th day after separator placement (p<0.001). For the third day, a significant difference was found in control versus saline and control versus chlorhexidine. No significant difference was found between saline and chlorhexidine on the third day. Similar results were found on the 7th day. For controls, the bacterial count increased with time and for both saline and chlorhexidine groups the bacterial count decreased. The highest decrease in the bacterial count was found for the chlorhexidine group. Conclusion: After the placement of separators, there was an increase in the bacterial count in GCF. Notably, chlorhexidine was found to be more effective than saline irrigation in reducing the bacterial count.

OBJECTIVES To determine the correlation between skeletal maturity and mandibular second molar calcification. METHODOLOGY A descriptive cross-sectional study was conducted at the Saidu College of Dentistry from 15th January to 30th October 2022. One hundred participants of Pakistani descent, aged 8-16 years (both genders), with ANB greater than 50 and presence of all permanent teeth excluding 3rd  molars, were included. Medically compromised, syndromic patients, those who had undergone previous orthodontic treatment, and cases with extracted permanent teeth were excluded. Skeletal maturity was determined by analyzing the cervical vertebrae maturation index (CVMI) on lateral cephalogram according to Baccetti et al. and mandibular second molar calcification according to the Demijian Index from panoramic radiographs. The Spearman correlation test was run for correlation assessment.RESULTSThe mean age was 11.81±1.62 years. There were 49 (49%) males and 51 (51%) females. A perfect correlation (100%) was found between CVM stage I and dental stage C. The concordance between CVM stage II and dental stage D was found in 21 (91.30%). The correlation between tooth mineralization and CVM stages was very high and statistically significant (r=0.97, p<0.001). Similarly, the correlation between CVM and chronological age was also high and statistically significant (r=0.8, p<0.001). The correlation was also significantly increased in males and females (r=0.97, p<0.001). CONCLUSION The tooth mineralization stages of the mandibular second molar can be used to assess growth as an alternative to cervical maturation staging.