Original Research

Year : 2025 | Volume : 16 | Issue : 4 | Page : 52-62

Orthodontists’ Experiences with Clear-Aligner Treatment Discontinuation: A Cross-Sectional Survey.

Pervin Bilginer1, Merve Kurnaz2, Osman Bilal Kandaz3, Sibel Biren4

1Private Practice, 2Assistant Professor, 3PhD Student, 4Professor, Istanbul Kent University, Faculty of Dentistry, Department of Orthodontics, Istanbul, Turkey.

Address for Correspondence:

Dr Osman Bilal Kandaz

PhD Student, Istanbul Kent University

Faculty of Dentistry, Department of Orthodontics, İstanbul, Turkey

Cihangir, Sıraselviler Cd. No:71, 34433 Beyoğlu/İstanbul

Phone: +90 539 318 20 21

E-mail: bikandaz@gmail.com

ABSTRACT

Background: The aim of this study was to evaluate orthodontists’ reported experiences with clear aligner therapy and fixed appliances, with particular emphasis on treatment discontinuation, compliance, and conversion to alternative treatment modalities. By analyzing the collected responses, the study seeks to clarify the key contributors to patient discontinuation.

Methodology: A cross-sectional survey was distributed to orthodontists in Türkiye who actively provided clear aligner therapy. Eligibility required orthodontic training and clinical practice in Türkiye. A priori power analysis determined a sample size of 134 respondents. Clinicians reported aligner-related outcomes based on clinical records. Data was analyzed using descriptive statistics and Chi-square tests (SPSS v25, p < 0.05).

Results: Among the orthodontists, 31.34% (42/134) with more than 10 years of experience reported having over 100 ongoing cases, and 9.70% (13/134) had completed more than 100 clear aligner (CAT) treatments. Treatment discontinuation was predominantly attributed to patient abandonment (63.43%, 85/134), while 31.34% (42/134) of patients transitioned to alternative fixed appliance therapy. Additionally, 5.22% (7/134) of patients who discontinued aligner therapy completed their treatment through restorative dental procedures. 46.27% (62/134) of patients who discontinued treatment had exhibited poor oral hygiene, non-compliance, or motivational issues prior to withdrawal. Among surveyed orthodontists, 45.52% (61/134) reported challenges with CAT planning, while 58.96% (79/134) handled the planning independently. Significant correlation was found between limited clinical experience (1–5 years) and higher discontinuation rates (9.68%, 13/134; p = 0.006). Strong correlation was identified between orthodontists treating 1–10 patients and having more than five discontinuations (3.13%, 4/134; p = 0.009). Discontinuation rates were notably higher among patients under 18 years (65%, 87/134).

Conclusions: Orthodontists reported higher discontinuation and conversion rates in clear aligner therapy, emphasizing the importance of realistic treatment planning, regular monitoring, and continued professional education. Standardized tracking systems may provide more precise insights into factors associated with treatment discontinuation.
Keywords: Clear aligners, Patient compliance, Orthodontic treatment

CONFLICT OF INTEREST

The authors have no conflict of interests to declare.

FUNDING

Nil.
How to cite this article: Pervin Bilginer, Merve Kurnaz, Osman Bilal Kandaz, Sibel Biren. Orthodontists’ Experiences with Clear-Aligner Treatment Discontinuation: A Cross-Sectional Survey.

Int J Orthod Rehabil 2025; 16 (4): 52-62.

Original Research

Year : 2025 | Volume : 16 | Issue : 4 | Page : 39-51

Comparison of Efficacy and Rate of Alignment using Three Different Arch wires: A Randomized Clinical Trial

 B Edward Giftson Noah1, S.D. Milling Tania2, S. Veerasankar3, Bevin Shaga3, Jebilla Pringle4, Razick Nishadh M4, Shahina Juneith4

 1Postgraduate Resident, 2Professor, 3Associate Professor, 4Assistant Professor, Department of Orthodontics, Rajas Dental College, Rajas Dental College And Hospital, Thirurajapuram, Kavalkinaru Jn, Tirunelveli - 627 105

Address for Correspondence:

Dr. S.D. Milling Tania,

Professor and HOD,
Rajas Dental College And Hospital

Thirurajapuram, Kavalkinaru Jn, Tirunelveli - 627 105
Email ID - drtania_d@yahoo.co.in

ABSTRACT

Aim: To compare the rate and efficiency of Niobium-Titanium-Tantalum Zirconium archwire (Gummetal), Copper Nickel Titanium archwire (CuNiTi) and conventional nickel titanium archwire (NiTi) on initial alignment.

Materials And Methods: A single-center randomized controlled clinical trial was conducted in 33 fully erupted dentition patients and Little’s Irregularity Index (LII) >2 mm. Patients were randomly assigned to three groups (n=11 each) treated with 0.014-inch NiTi, CuNiTi, or Gummetal archwires. Impressions were taken at baseline (T0) and at 3-week intervals for 4 times (T1–T4). LII, Intercanine width (ICW) and intermolar width (IMW) were measured and analyzed using SPSS v20.0 with Repeated Measures ANOVA, Bonferroni post-hoc, and Chi-square tests with p value <0.05 as statistical significance.

Results: All groups showed statistically significant reduction in LII from T0 to T4 (p<0.001). Group 1 showed a decrease from 3.76±0.75 to 1.02±0.53, Group 2 from 3.74±0.64 to 0.90±0.25, and Group 3 from 3.04±0.59 to 1.33±0.66. ICW increased significantly in all groups: Group 1 from 25.93±2.86 to 26.58±2.78 (p<0.001), Group 2 from 25.59±2.68 to 26.64±2.76 (p < 0.001), and Group 3 from 25.79±2.86 to 26.52±2.83 (p=0.008). IMW changes were significant in Group 2 (40.76±2.66 to 41.11±2.63, p<0.001) and Group 3 (40.95±2.61 to 41.11±2.63, p<0.001), but not in Group 1 (41.01±2.64 to 41.08±2.62, p=0.136). Intergroup comparison revealed no statistically significant difference in LII, ICW, or IMW (p≥0.051).

Conclusions: CuNiTi and NiTi archwires were more effective in initial alignment and mild arch expansion than Gummetal, making them preferable for early orthodontic correction.

Keywords: Archwires, Copper NiTi, Gummetal, Intercanine arch width

CONFLICT OF INTEREST

The authors have no conflict of interests to declare.

FUNDING

Nil.
How to cite this article: B Edward Giftson Noah, S.D. Milling Tania, S. Veerasankar, Bevin Shaga, Jebilla Pringle, Razick Nishadh M, Shahina Juneith.Comparison of Efficacy and Rate of Alignment using Three Different Arch wires: A Randomized Clinical Trial. Int J Orthod Rehabil 2025; 16 (4): 39-51.

Review Article

Year : 2025 | Volume : 16 | Issue : 4 | Page : 14-38

Antimicrobial, Biocompatibility, and Durability Outcomes of Nanoparticle-Coated Orthodontic Materials: A Systematic Review of In Vivo Evidence

Avula Samata1, Gowri Sankar Singaraju2, Prasad Mandava2, P V Sravya Silpa1

1-Postgraduate Resident, 2-Professor, Department of Orthodontics, Narayana Dental College, Nellore, Andhra Pradesh, India-524003
Address for Correspondence:

Dr. Prasad Mandava,

Professor and Head, Department of Orthodontics,

Narayana Dental College,

Nellore, Andhra Pradesh, India -524003.

Email ID: mandavabruno9@gmail.com

ABSTRACT

Objective: To systematically review available in vivo evidence from animal and human studies evaluating the antimicrobial efficacy, biocompatibility, and durability of metallic nanoparticle-coated orthodontic materials, excluding all in vitro research.

Methods: Electronic searches were performed in PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, Ovid, and ClinicalTrials.gov for studies published from January 2015 to August 2025, supplemented by manual and grey-literature searches. Eligible studies included in vivo animal or human investigations assessing surface coatings of orthodontic components—brackets, archwires, ligatures, elastomeric modules, or aligners—with metallic or metal-oxide nanoparticles (Ag, TiN, TiO₂, N-TiO₂, ZnO, Au). Primary outcomes were antimicrobial efficacy (CFU, qPCR, or biofilm indices); secondary outcomes included biocompatibility (ion release, cytotoxicity, mucosal response) and coating durability. Quality appraisal used SYRCLE, RoB 2, and ROBINS-I tools; evidence certainty was graded using GRADE. Registration: OSF (https://doi.org/10.17605/OSF.IO/5CZSG).

Results: Of 1,499 records, eight in vivo studies met the inclusion criteria—six human and two animal. Nanoparticles evaluated were Ag, TiN, TiO₂, N-TiO₂, ZnO, and Au. All demonstrated reduced Streptococcus mutans or related bacterial loads compared with uncoated controls. Silver coatings produced early antibacterial effects but released trace Ag⁺ (0.16–0.35 ppb). TiO₂ and TiN coatings reduced bacterial adhesion up to four weeks but showed partial delamination (~60%). N-doped TiO₂ extended efficacy to 60 days, while ZnO coatings-maintained suppression and enamel protection for 12 months despite early surface degradation. Gold nanoclusters exhibited short-term antibacterial and excellent biocompatibility in animal models. Biocompatibility was acceptable across studies, but durability and long-term stability were inconsistently assessed. Meta-analysis was precluded by heterogeneity of outcomes and timepoints. Overall risk of bias ranged from low to serious; certainty of evidence was low to moderate.

Conclusions: In vivo data indicate short-term antibacterial and biocompatible benefits of metallic nanoparticle coatings on orthodontic materials; however, evidence for coating durability and long-term safety is limited. Well-designed randomized clinical trials with standardized microbial, biocompatibility, and durability outcomes are essential for clinical translation.
Keywords: Metallic nanoparticles; Orthodontic materials; Antimicrobial; Biocompatibility; Durability; In vivo; Systematic review.

CONFLICT OF INTEREST

The authors have no conflict of interests to declare.

FUNDING

Nil.
How to cite this article: Avula Samata, Gowri Sankar Singaraju, Prasad Mandava, P V Sravya Silpa. Antimicrobial, Biocompatibility, and Durability Outcomes of Nanoparticle-Coated Orthodontic Materials: A Systematic Review of In Vivo Evidence. Int J Orthod Rehabil 2025; 16 (4): 14-38.

Original Research

Year : 2025 | Volume : 16 | Issue : 4 | Page : 1-13

Antimicrobial Potential Of Pycnogenol® Coated Orthodontic Modules Against Oral Pathogens: An Invitro Study

Divya Devraj,1 Ratna Parameswaran,2 Monikaa Marappan,1 Seerab Husain,3

1-Postgraduate Resident, 2-Professor, 3-Assistant Professor, Department of Orthodontics, Meenakshi Ammal Dental College and Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India

Address for Correspondence:

Dr. Ratna Parameswaran

Department of Orthodontics, Meenakshi Ammal Dental College and Hospital

Meenakshi Academy of Higher Education and Research (Deemed to be University)

Alapakkam Main Road, Chennai – 600 095

Tamil Nadu, India

Email ID: drratna.ortho@madch.edu.in

ABSTRACT

Introduction: Fixed orthodontic treatment increases the oral microbial count, leading to a series of oral health problem. Incorporating products containing antimicrobial effects into the orthodontic materials reduces the escalation of harmful effects of these pathogens. Pycnogenol ®, an extract from the bark of French pine tree (Pinus pinaster Aiton) is a major constituent of over 1000 dietary supplements and variety of other products worldwide, used for treating various illness. However, its potential in orthodontics remains to be explored.

Materials and Methods: Pycnogenol ® extract was prepared and coated onto the orthodontic modules. Drug loading and drug release kinetics was studied using UV visual spectrometry. The coated modules were subjected to antimicrobial testing against common oral pathogens. SEM imaging was done to analyse the surface coating of the orthodontic modules.

Results: The antimicrobial activity for S. mutans, E. coli, and S. aureus were studied at 1, 8, and 24 hours. The mean rank obtained from MIC showed that there is a highly significant difference between the bacterial groups in all the time duration. Direct agar diffusion test showed profound zone of inhibition of 20 mm for S. mutans. Additionally, Pycnogenol ® coated modules also demonstrates antimicrobial activity against E. coli and S. aureus.

Conclusion: Increased microbial adhesion to orthodontic appliances and modules causes a sequelae of oral health problems. Pycnogenol® is a potent antioxidant possessing antimicrobial and anti-inflammatory properties. The study exhibits the release of the Pycnogenol® from the modules after coating and the coated modules also demonstrate antimicrobial activity.

Keywords: Fixed Orthodontic Appliances, Pycnogenol, antioxidant, reactive oxygen species, ROS, Antimicrobial, Oral Pathogens, Modules.

FUNDING

This study was funded by Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai. Ref: MADC/IEC/041/2021

CONFLICT OF INTEREST

The authors declare that there is no conflict of interest in this study.

How to cite this article: Divya Devraj, Ratna Parameswaran, Monikaa Marappan, Seerab Husain. Antimicrobial Potential Of Pycnogenol® Coated Orthodontic Modules Against Oral Pathogens: An Invitro Study. Int J Orthod Rehabil 2025; 16 (4): 1-13.

Original Research

Year : 2025 | Volume : 16 | Issue : 3 | Page : 82-92

Assessment Of the Correlation Between Cephalometric Measurements and Facial Attractiveness

Udit Chaudhary,1 Monis Raza,2 Achint Juneja,3 Ridhi Kothari,4 Tanvi Gupta,5

 1-Postgraduate Resident, 2-Associate Professor, 3-Professor, 4-Assistant Professor, Department of Orthodontics & Dentofacial Orthopaedics, Institute of Dental Studies and Technologies (IDST), Modinagar, Uttar Pradesh, India, 5-Postgraduate Resident, Department of Orthodontics, Himachal Institute of Dental Sciences, India

Address for Correspondence:

Dr. Monis Raza
Associate Professor,

Department of Orthodontics & Dentofacial Orthopaedics
Institute of Dental Studies and Technologies (IDST),

Modinagar, Uttar Pradesh, India
Email: monis8raza@gmail.com

ABSTRACT

Aim: This study aimed to evaluate both linear and nonlinear (quadratic) correlations between cephalometric variables and facial attractiveness in North Indian adults.

Methods: Pretreatment frontal and profile photographs and lateral cephalograms of 30 adults (10 Class I, 10 Class II, 10 Class III) were analysed. Attractiveness was rated on a 10-cm visual analog scale by 40 evaluators (orthodontists, prosthodontists, general dentists, and laypersons). Cephalometric variables were traced using Nemoceph software and correlated with attractiveness scores through linear and quadratic regression analyses.

Results: No significant differences in attractiveness were observed among malocclusion groups (p = 0.120). Only the glabella-to-true vertical line (G′-TVL) distance showed a significant quadratic correlation with profile attractiveness (r = 0.63, p = 0.010).

Conclusion: In North Indian adults, malocclusion class was not associated with perceived facial attractiveness. Glabella position relative to the true vertical line showed a quadratic association, suggesting that forehead morphology may influence esthetic perception.
Keywords: Cephalometry; Facial Aesthetics; Orthodontics; India; Soft Tissue

 SOURCE OF FUNDING

Nil

CONFLICTS OF INTEREST

Nil

How to cite this article: Udit Chaudhary, Monis Raza, Achint Juneja, Ridhi Kothari, Tanvi Gupta. Assessment Of the Correlation Between Cephalometric Measurements and Facial Attractiveness. Int J Orthod Rehabil 2025; 16 (3): 82-92.

Original Research

Year : 2025 | Volume : 16 | Issue : 3 | Page : 64-81

Comparing the Efficacy Of Riboflavin and Chlorhexidine Varnish in Controlling Oral Microflora in Orthodontic Patients – A Randomized Controlled Trial

      Sobika Sudhakar,1 Sumanth Rangarajan,2 Ramasamy M,2 Thrivikhraman K,3 Haritha Prakriti Bose C,3 Pavithra Devi S,3

1-Postgraduate Resident, 2-Professor, 3-Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics,
Sri Venkateswara Dental College and Hospital (Affiliated to The Tamilnadu Dr.M.G.R Medical University), Chennai, Tamil Nadu, India

Address for Correspondence:

Dr. Sobika Sudhakar

Postgraduate Resident,

Department of Orthodontics and Dentofacial Orthopaedics,

Sri Venkateswara Dental College and Hospital,

(Affiliated to The Tamilnadu Dr.M.G.R Medical University)

Chennai, Tamil Nadu, India
Email: sobikaortho@gmail.com

ABSTRACT

Background: The occurrence of white spot lesions (WSL) seems to be unavoidable during orthodontic treatment. Maintaining proper oral hygiene can be difficult for individuals with fixed orthodontic appliances. Traditional antimicrobials, such as chlorhexidine, have certain drawbacks, side effects and potential for resistance. The present study investigates a novel approach known as Antimicrobial Photodynamic Therapy (APDT) to evaluate its effectiveness in decreasing bacterial load and the duration of effectiveness.

Aim: To compare the efficacy of 0.2% chlorhexidine varnish, riboflavin-mediated photodynamic therapy, and riboflavin + sodium dodecyl sulfate (SDS)-mediated photodynamic therapy in reducing the bacterial colony count across different time periods, and to validate the effectiveness of the compound by assessing the live and dead cells using confocal laser scanning microscopy. (CLSM)

Materials and Methods: Thirty participants undergoing fixed orthodontic treatment were randomized into three groups (n = 10 each): 0.2% CHX, Riboflavin-APDT (PDT), and Riboflavin + SDS-APDT (PDT+S). Treatments were performed weekly for 4 weeks. Plaque samples were collected at baseline (T0), 30 days (T1), and 2 months (T2). Microbial colony counts were assessed at various time intervals. To validate the microbial analysis, representative samples were collected, coated on sterilized brackets and analyzed using CLSM to evaluate the status of cells and viability of biofilm.

Results: Intra-group analysis revealed significant reductions in S. mutans and L. acidophilus from baseline to T1 across all groups, with Riboflavin showing a more sustained effect. Riboflavin-surfactant group exhibited minimal variation, suggesting a delayed yet stable response. Inter-group differences were significant at T1, especially between Riboflavin-surfactant and others, but diminished by T2. For L. acidophilus, the combination therapy achieved greater reduction than control at both T1 and T2.The CLSM results indicate that Riboflavin group showed reduced biofilm viability (13.28%) compared to CHX (22.51%) and PDT+S (40.90%). At T2, bacterial rebound was noted in all groups, most prominently in the CHX group. SDS addition did not improve efficacy.

Conclusion: Riboflavin- and Riboflavin–surfactant–mediated APDT effectively reduced S. mutans and L. acidophilus in orthodontic patients. Riboflavin produced a more sustained effect, while the surfactant combination achieved a delayed but significant reduction, particularly for L. acidophilus. Despite microbial rebound at T2, both therapies maintained lower bacterial counts than control, highlighting riboflavin-mediated APDT as a safe and promising adjunct for bacterial control during orthodontic treatment.

Keywords: Riboflavin; Photodynamic therapy; Chlorhexidine; Orthodontic biofilm; Confocal Laser Scanning Microscopy (CLSM); Streptococcus mutans; Lactobacillus acidophilus.

SOURCE OF FUNDING

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

ACKNOWLEDGMENTS

The authors gratefully acknowledge the cooperation of the participating patients and their parents.

PRIOR PRESENTATION

This manuscript has not been previously published or presented at any conference.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest related to this manuscript.

ETHICAL APPROVAL

Institutional ethical clearance was obtained prior to the study. Informed consent was acquired from parents/guardians.
How to cite this article:Sobika Sudhakar, Sumanth Rangarajan, Ramasamy M, Thrivikhraman K, Haritha Prakriti Bose C, Pavithra Devi S.Comparing the Efficacy Of Riboflavin and Chlorhexidine Varnish inControlling Oral Microflorain Orthodontic Patients – A Randomized Controlled Trial.IntJOrthodRehabil2025;16(3):64-81.

Original Research

Year : 2025 | Volume : 16 | Issue : 3 | Page : 49-63

Evaluating the Use of Pretreatment Diagnostic Records among Orthodontists in Saudi Arabia: A Cross-Sectional Study

Doaa H. Alsaggaf 1

1-Assistant Professor, Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia

Address for Correspondence:

Doaa H. Alsaggaf, BDS, DScD, ABO-Board Certified

King Abdulaziz University, Faculty of Dentistry,

Department of Orthodontics, Alsulemaneya,

PO Box 80209, Jeddah 21589, Saudi Arabia

Tel: +966 506357194

Email: dalsaggaf@kau.edu.sa

ABSTRACT

Background: Accurate diagnosis is essential for effective treatment planning and achieving successful outcomes in orthodontics. Limited research has explored the use of pretreatment diagnostic records by orthodontists in Saudi Arabia. This study aimed to evaluate the diagnostic records routinely used by orthodontists in Saudi Arabia and to examine demographic trends influencing their diagnostic practices.

Methods: A computer-based questionnaire was completed by 194 orthodontists practicing in Saudi Arabia. The survey collected demographic information and data on the routine use of diagnostic records including, photographs, panoramic radiographs, lateral cephalograms, full-mouth intraoral radiographs, cone beam computed tomography (CBCT) scans, conventional study models, and digital models. Descriptive statistics were used to summarize response frequencies. Demographic variations in diagnostic record utilization were analyzed using Pearson’s chi-square and Fisher’s Exact tests with Holm-Bonferroni adjustment for multiple comparisons.

Results: The most frequently used diagnostic records among participating orthodontists were photographs and panoramic radiographs, reported by 94.3% of respondents. Lateral cephalometric radiographs were used by 91.2% and CBCT was utilized by 10.8%. Conventional study models were employed by 66.5% of orthodontists, while 25.3% used digital models. Significant demographic differences were observed, particularly in the type of study models used. More experienced orthodontists were significantly more likely to use digital study models (P = 0.01), as were orthodontists practicing exclusively in private practice (P = 0.003), and those in urban areas (P = 0.003).

Conclusion: Photographs, panoramic radiographs, and lateral cephalograms were the most frequently used diagnostic records. The use of digital study models remains emerging. Orthodontists’ demographics appear to influence their diagnostic record selection. This study provides valuable baseline data on the diagnostic practices of orthodontists in Saudi Arabia and offers a reference point for future longitudinal studies and international comparisons.

Keywords: Orthodontics; Diagnosis; Demographics; Dental Records; Treatment Planning; Survey.

SOURCE OF FUNDING

No funding was received for the study.

CONFLICT OF INTEREST

The author has no conflict of interest to declare.
How to cite this article: Doaa H. Alsaggaf. Evaluating the Use of Pretreatment Diagnostic Records among Orthodontists in Saudi Arabia: A Cross-Sectional Study. Int J Orthod Rehabil 2025; 16 (3): 49-63.

Doi: 10.56501/Intjorthodrehabil.v16i3.ijor0008

Original Research

Year : 2025 | Volume : 16 | Issue : 3 | Page : 35-48

Design Of A Mobile Application For Orofacial Muscle Exercise Delivery

Rajkumar Parthasarathy1, Sedhubharath Senthilkumar2, Umarevathi Gopalakrishnan3, Narayanasamy Krishnasamy4, Kalpana Singaram5, Haritha Prakriti Bose C6

 1-Post Graduate Resident, 2-Intern, 3-Professor, Department of Orthodontics and Dentofacial Orthopaedics, Sri Venkateswara Dental College and Hospital, Chennai,  4-Vice Chancellor, 5-Research Officer, Department of Epidemiology, The TamilNadu Dr. MGR Medical University, Chennai, Tamil Nadu, India,  6-Assistant Professor, Department of Orthodontics and Dentofacial Orthopaedics, Sri Venkateswara Dental College and Hospital, Chennai, Tamil Nadu, India,  

Address for Correspondence:

Dr. Umarevathi Gopalakrishnan

Professor, Department of Orthodontics and Dentofacial Orthopaedics,
Sri Venkateswara Dental College and Hospital,

Chennai, Tamil Nadu, India
E-mail: umarevathigopalakrishnan@gmail.com
ABSTRACT

Background: Persistence of oral habits such as thumb sucking, tongue thrusting, nail biting, lip biting, and mouth breathing, can disrupt orofacial muscular equilibrium. Early identification and interception are needed to address these imbalances. Corrective muscular exercises can serve as adjuncts to commonly practiced usage of habit breaking appliances, intercepting these imbalances and also to minimise long-term general health hazards caused by oral habits. These orofacial exercises are particularly useful in rural populations where access to orthodontic care is limited.

Objective: The objectives were 1) to assess prevalence of parafunctional oral habits among children of 5 -12 years in Chengalpattu, 2) to develop a mobile application for delivering corrective orofacial muscle exercises for the assessed habit positive individuals. 3) to implement refinements in the application through feedbacks received from the users.

Methodology: A cross-sectional study was conducted among 404 children using a structured questionnaire and clinical examination. Association between oral habits and medical, behavioral, and cognitive parameters were analyzed using the chi-square test with level of significance (p < 0.05).

Results: Prevalence of oral habits was 18.56%. Significant associations were found between oral habits and issues like breathing difficulty (p=0.01), ear infections (p=0.01), and speech issues (p<0.001). A mobile application demonstrating 31 lip, tongue, and cheek exercises in English and Tamil was developed. User feedback led to feature enhancements such as enhanced search functionality, inclusion of disclaimer and other updates for improved navigation.

Conclusion: The study highlights the increased association of oral habits with medical problems reinforcing the need for early intervention in children with oral habits and imbalance in orofacial muscular tonicity. To address this, we offer a digital solution that delivers easily accessible orofacial muscle exercises. The application is intended to improve muscle tonicity and restore the equilibrium between orofacial muscular equilibrium between tongue, cheeks and lips which are planned to be evaluated in future studies.

Keywords: Oral muscle exercise, Oral facial exercise application, oral habits, mobile application.

PRIOR PRESENTATION
This manuscript has not been previously published or presented at any conference.

CONFLICTS OF INTEREST
The authors declare no conflicts of interest related to this manuscript.

ETHICAL APPROVAL
Institutional ethical clearance was obtained prior to the study. Informed consent was acquired from parents/guardians.

How to cite this article: Rajkumar Parthasarathy, Sedhubharath Senthilkumar, Umarevathi Gopalakrishnan, Narayanasamy Krishnasamy, Kalpana Singaram, Haritha Prakriti Bose C. Design Of A Mobile Application For Orofacial Muscle Exercise Delivery. Int J Orthod Rehabil 2025; 16 (3): 35-48.

Review Article

Year : 2025 | Volume : 16 | Issue : 3 | Page : 17-34

Long-Term Evaluation of White Spot Lesion Treatment with Resin Infiltration in Orthodontic Subjects- A Systematic Review And Meta- Analysis

Daphane Anishya1, Ravindra Kumar Jain2, Arthi Balasubramaniam3 

1-Post Graduate Resident, 2-Professor and Head, Department of Orthodontics, 3-Associate Professor, Department of Public Health Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai-600 077, India

Address for Correspondence:

Dr Ravindra Kumar Jain

Professor and Head,

Department of Orthodontics, Saveetha Dental College and Hospitals,

Saveetha Institute of Medical and Technical Sciences,

Chennai, India.

E-mail: ravindrakumar@saveetha.com

ABSTRACT

Background: Resin infiltration (RI) has been used to treat white spot lesions (WSLs) and minimize caries development. The non-cavitatedinitial carious lesions can be filled with resin to prevent further caries progression. Long-term effects of RI have been reported but there is a need to systematically review the literature.

Aim and objectives: To systematically search, collate, and assess the literature on treatment effectiveness and stability with RI technique for the management of WSLs in orthodontic patients over a six to twenty-four-month follow-up period.

Materials and methods: A literature search was performed from January 2019 to December 2023 in four electronic databases (PubMed, Cochrane library, Google Scholar and Scopus). Studies including patients with permanent dentition treated for WSLs during or after orthodontic treatment, with at least 6 months of follow-up were only included in the review. Risk of bias assessment was done using the Cochrane ROB-2 tool forrandomized clinical trials (RCTs) and the ROBINS-I tool for non- RCTs. GRADE assessment was done for the certainty of evidence of the included studies. A random effects model was used to perform the meta-analysis of the color change and area of lesion regression.

Results: Eight studies including six RCTs and two non- RCTs were included. Treatment with RI showed significant lesion area regressionand negligible color change over 6-24 months. The meta-analysis showed no significant difference in lesion area between RI and CPP-ACP at 12 months(effect size z = 1.42), and a significant improvement in color change at 6 months (effect size z=4.38, favoring RI over micro abrasion, with no heterogeneity. (I2 = 0%).

Conclusion: This systematic review based on strong evidence reports that RI is an effective treatment for WSLs, with significant improvement in color and lesion area regression. Moreover, its effectiveness was maintained over six months, hence it is stable and long-lasting.

Keywords: Composite Resins, Tooth Demineralization, Orthodontics, Treatment Outcome, Follow- Up Studies, color change, lesion regression, mask.

DECLARATION OF CONFLICTING INTERESTS

No potential conflicts of interest were disclosed by the author(s).

ETHICAL APPROVAL

Not applicable.

FUNDINGS

No fundings was given.
How to cite this article: Daphane Anishya, Ravindra Kumar Jain, Arthi Balasubramaniam. Long-Term Evaluation of White Spot Lesion Treatment with Resin Infiltration in Orthodontic Subjects- A Systematic Review And Meta- Analysis. Int J Orthod Rehabil 2025; 16 (3): 17-34.

Case Report

Year : 2025 | Volume : 16 | Issue : 3 | Page : 1-16

Anchorage-Driven Management of Vertical Class II Malocclusion: Role Of Hybrid Segmental Mechanics in Preventing Round-Tripping

Harsh Ashok Mishra1, Waseem Khan1, Parag Vishnu Gangurde2, Shashank Udaykumar3, Diksha Vinod Wali3 

1-Associate Professor, 2-Professor, 3-Postgraduate Resident, Department of Orthodontics and Dentofacial Orthopaedics, Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai, Bharati Vidyapeeth (DU) University, Pune.

Address for Correspondence:

Dr. Harsh Ashok Mishra

Associate Professor, Department of Orthodontics and Dentofacial Orthopaedics,

Bharati Vidyapeeth (Deemed to be University) Dental College and Hospital, Navi Mumbai,

Bharati Vidyapeeth (DU) University, Pune

Email: dr.mishraharsh@gmail.com

ABSTRACT  

This case report describes the orthodontic management of a 25-year-old male presenting with a skeletal Class II maxillomandibular relationship, vertical growth pattern, and Class II subdivision molar relationships. Clinically, the patient exhibited a Class I molar relationship on the left and an end-on molar relationship on the right, with crowding, retroclined maxillary and mandibular incisors, and highly positioned maxillary canines. An asymmetric extraction protocol—removal of teeth 14, 24, 34, and 42—was implemented to optimize the space distribution while maintaining facial balance and occlusal harmony.

Hybrid segmental mechanics were employed, incorporating anchorage control via a Nance palatal arch, segmental canine retraction using T-loop mechanics, molar distalization with a sliding jig, and Class II elastics. This was later supplemented by the infrazygomatic crest (IZC) skeletal anchorage on the right side. This approach minimizes the risk of round-tripping, enhances biomechanical precision, and avoids excessive incisor proclination or anchorage loss.

Post-treatment records revealed well-aligned dentition, stable bilateral Class I molar and canine relationships, and improved overjet, overbite, and facial esthetics. This case highlights the effectiveness of combining hybrid segmental mechanics with skeletal anchorage in managing asymmetric extractions and achieving esthetically and functionally favorable orthodontic outcomes.
KEYWORDS: Class II malocclusion, hybrid segmental mechanics, asymmetric extraction, Nance palatal arch, IZC screws, anchorage, round tripping, biomechanics.

FUNDING

Nil

CONFLICT OF INTEREST

Nil
How to cite this article: Harsh Ashok Mishra, Waseem Khan, Parag Vishnu Gangurde, Shashank Udaykumar, Diksha Vinod Wali. Anchorage-Driven Management of Vertical Class II Malocclusion: Role Of Hybrid Segmental Mechanics in Preventing Round-Tripping. Int J Orthod Rehabil 2025; 16(3): 1-16.

Original Article

Year : 2025 | Volume : 16 | Issue : 2 | Page : 55-68

Knowledge, Outlook, and Practices among Dental Professionals about Aligner Disposal and Recycling – A Cross-Sectional Study

Mohamed Shafi Nalla Mohamed1, S.D. Milling Tania2, I. Bevin Shaga3, S. Veerasankar3, A. Jebilla Pringle4, Mary Sheloni Missier4, C.Priyadharshini4

1-Postgraduate Resident, 2-Professor, 3-Reader, 4-Senior Lecturer, Department of Orthodontics, Rajas Dental College and Hospital, Kavalkinaru, Tamil Nadu-627105.

Address for Correspondence:

Dr. Mohamed Shafi Nalla Mohamed

Postgraduate Student, Department of Orthodontics

Rajas Dental College and Hospital,

Kavalkinaru, Tirunelveli-627105

Tamil Nadu, India

Email address: nmohamedshafi97@gmail.com

ABSTRACT  

BACKGROUND: The growing use of clear aligners in orthodontics raises environmental concerns due to inadequate disposal and recycling knowledge among dental professionals. This study evaluates their awareness, attitudes, and practices regarding clear aligner disposal and recycling.

MATERIALS AND METHODS: A cross-sectional study was conducted using an electronic survey created with Google Forms, which was distributed to orthodontists, undergraduate practitioners, and non-orthodontic practitioners who had their postgraduate degree. The questionnaire consisted of 25 closed-ended questions divided into three sections: Knowledge (8 questions), Outlook (10 questions), and Practice (7 questions). The responses obtained were tabulated and then statistically analysed using the Statistical Package for Social Sciences software version 21.0. A P-value less than 0.05 was considered statistically significant.

RESULTS: A total of 384 participants completed the survey. Most of the participants had a lack of proper awareness regarding the disposal practices and recycling of the aligners. Orthodontists demonstrated significantly higher knowledge (6.10 ± 1.80) and outlook (8.22 ± 3.71) scores than practitioners of other specialities (2.79 ± 1.91, 6.09 ± 3.59 for knowledge and outlook, respectively) (P ≤ 0.001). Knowledge regarding aligner disposal and recycling was highly statistically significant between general practitioners with an undergraduate degree, postgraduate degree holders other than orthodontics, and orthodontists (p < 0.001).

CONCLUSION: There is a noticeable gap in the knowledge and practices of dental professionals regarding the proper disposal and recycling of clear aligners. This study demonstrates that heightened awareness among clinicians and patients is key to reducing aligner use's environmental impact.

KEYWORDS: Dental Practice Patterns, Dentists, Environmental Biodegradation, Knowledge, Orthodontics, Sustainable Development.

FINANCIAL SUPPORT AND SPONSORSHIP

Nil.

CONFLICTS OF INTEREST

There are no conflicts of interest.
How to cite this article: Mohamed Shafi Nalla Mohamed, S.D. Milling Tania, I. Bevin Shaga, S. Veerasankar, A. Jebilla Pringle, Mary Sheloni Missier, C.Priyadharshini. Knowledge, Outlook, and Practices among Dental Professionals about Aligner Disposal and Recycling – A Cross-Sectional Study. Int J Orthod Rehabil 2025; 16 (2): 55-68.

Original Article

Year : 2025 | Volume : 16 | Issue : 2 | Page : 41-54

Exploring Therapeutic Insights: Computational Docking Analysis of 5HTR2A Protein Structure involved in Temporomandibular Joint Disorders

Shravani VP1, Nagachandran K.S.2, Remmiya Mary Varghese3, Sivakamavalli J4

1-Postgraduate Resident, 2-Professor, 3-Associate Professor, Department of Orthodontics, 4-Research Scientist, Lab in Biotechnology and Bio signal Transduction, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai-77, Tamil Nadu, India

Address for Correspondence:

Dr. Nagachandran K.S.

Professor, Department of Orthodontics

Saveetha Dental college and Hospitals

SIMATS University, Chennai- 600077

Tamil Nadu, India

Email address: shraasvp98@gmail.com

ABSTRACT  

INTRODUCTION: Dysregulated HTR2A receptor function and serotonin signaling pathways can contribute to TMJ disorders, underscoring the significance of comprehending structural variations in the HTR2A gene protein for pioneering therapeutic strategies. This study aims to explore the molecular interactions between HTR2A receptor and potential therapeutic ligands via computational docking, aiming to pinpoint innovative targets for intervening pain in TMJ disorders.

METHODS: A virtual screening of 100 candidate compounds was performed based on drug-likeness, molecular docking scores, and ADMET profiles. The 3D structure of the HTR2A receptor was retrieved (PDB ID: 6A94), and docking simulations were conducted using AutoDock Vina and BIOVIA Discovery Studio. Pharmacophore models were generated using LigandScout, and key ligands were analyzed using PyRx, PyMOL, and pkCSM tools.

RESULTS: The PyRx molecular docking analysis identified two novel compounds, 2,5-Dimethoxy-4-iodoamphetamine and 2,5-dimethoxy-4-methylamphetamine, displaying robust binding affinities with the HTR2A gene in comparison to conventional compounds. In addition, these newly identified compounds satisfied stringent pharmaceutical criteria, meeting criteria such as Lipinski's Rule, Ghose's Rule, Veber's Rule, Egan's Rule, and Muegge's Rule, suggesting their potential as promising therapeutic options for treating TMJ disorders.

CONCLUSION: The study highlights the strong binding affinity between the 5HTR2A gene and novel compounds, suggesting their potential as effective therapeutic agents for TMJ disorders, with promising pharmacokinetic profiles and implications for advancing computational drug discovery in medical research.

KEYWORDS: Temporomandibular Joint, Gene, 5HTR2A, Serotonin, Pain
CONFLICTS OF INTEREST

The author(s) declare that there is no conflict of interest regarding the publication of this article.

FUNDING STATEMENT

No funding was received regarding this research.

How to cite this article: Shravani VP, Nagachandran K.S, Remmiya Mary Varghese, Sivakamavalli J. Exploring Therapeutic Insights: Computational Docking Analysis of 5HTR2A Protein Structure involved in Temporomandibular Joint Disorders. Int J Orthod Rehabil 2025; 16 (2): 41-54.

Review Article

Year : 2025 | Volume : 16 | Issue : 2 | Page : 28-40

Impact of Orthodontic Closure on Pulpal Health of Teeth Adjacent to Orofacial Clefts: A Systematic Review and Meta-analysis

Ibraheem K Bamaga1, Haytham Jaha2

1-Assistant Professor, Department of Basic and Clinical Oral Science, School of Dental Medicine, Umm AI-Qura University, 2-Assistant Professor and Consultant in Endodontics, Endodontic Division, Restorative Dentistry Department, Faculty of Dental Medicine at Umm Al-Qura University, Makkah, Saudi Arabia.

Address for Correspondence:

Dr. Ibraheem K Bamaga  DDS, MSD, PhD

Assistant Professor, Department of Basic and Clinical Oral Science,

School of Dental Medicine, Umm AI-Qura University,

Makkah, Saudi Arabia. Makkah, Saudi Arabia.

E-mail: Ikbamaga@uqu.edu.sa

ABSTRACT  

BACKGROUND: Orofacial clefts, including cleft lip and/or palate (CLP), are common congenital deformities often associated with various dental anomalies. Orthodontic space closure adjacent to cleft sites is an integral part of rehabilitative care, but its impact on pulpal health remains uncertain. This systematic review aimed to assess the effects of orthodontic movement on the vitality of teeth adjacent to cleft areas in CLP patients.

MATERIALS AND METHODS: This review followed PRISMA guidelines and was registered in PROSPERO (CRD420251040142). A systematic search was performed in PubMed, Google Scholar, Scopus, and LILACS using defined keywords. Inclusion criteria focused on human studies evaluating pulpal health of teeth adjacent to clefts undergoing orthodontic space closure. The included articles were assessed on their demographic data, type of tooth involved both on cleft and non-cleft sides along with their vitality status and interventions done to the non-vital teeth. Risk of bias was assessed using ROB 2.0 and Modified REMARK tools. Meta-analysis was conducted using JASP software.

RESULTS: The review included six studies with unilateral cleft patients as a prevalent group. Of the six studies, three were rated as having low risk of bias, while two were labelled questionable and one as high risk. The results demonstrated a higher incidence of pulpal necrosis (12% increased risk) on cleft-side teeth post-orthodontic movement with statistically significant differences (p<0.0001). Significant heterogeneity and variability in diagnostic methods were observed, with publication bias evident.

CONCLUSION: This meticulous review of articles concluded that the cleft lip and palate pose a greater risk of vitality alteration in teeth close to the bone defect area. The use of various vitality testing measures throughout the literature helped achieve rehabilitation treatment as early to restore quality of life.
KEYWORDS: Orofacial clefts, Pulpal Health, Orthodontic Correction, Tooth Vitality

CONFLICT OF INTEREST

The authors have no conflict of interests to declare.

FUNDING

Nil
How to cite this article: Ibraheem K Bamaga, Haytham Jaha. Impact of Orthodontic Closure on Pulpal Health of Teeth Adjacent to Orofacial Clefts: A Systematic Review and Meta-analysis. Int J Orthod Rehabil 2025; 16 (2): 28-40.

Original Article

Year : 2025 | Volume : 16 | Issue : 2 | Page : 11-27

Predictive Value of 2D Radiographic Skeletal and Airway Measurements for Sleep Apnea in Children: A Cross-sectional Sleep Study on Airway Indicators and Diagnostic Cut-Off

Farhan H. Alwadei1, Ahmed I. Masoud2, Ayas K. Makki3, Abdurahman H. Alwadei4, Saleh H. Alwadei1 ; Chang G. Park5,  David W. Carley6

1-Assistant Professor, Dept of Pediatric Dentistry, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, 2-Clinical Associate Professor, Dept of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia, 3-Clinical Assistant Professor, Dept of Orthodontics, College of Dentistry, University of Illinois, Chicago, IL , 4-Associate Professor, Dept of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia, 5-Assistant Research Professor, College of Nursing, 6-Professor Emeritus, Dept of Biobehavioral Health Science, Medicine and Bioengineering, University of Illinois, Chicago, IL
Address for Correspondence:

Dr Farhan H. Alwadei

Assistant Professor, Department of Pediatric Dentistry,

Prince Sattam Bin Abdulaziz University

College of Dentistry, Al Kharj, Saudi Arabia

E-mail: f.alwadei@psau.edu.sa

ABSTRACT  

OBJECTIVES: (a) To evaluate the link between 2D radiographic measurements of skeletal structures, airways and the likelihood of sleep apnea in children, and (b) to determine threshold values for predicting sleep apnea prior to diagnostic testing.

MATERIALS AND METHODS: The study included 99 participants (7-17 years, median 11), referred to a sleep center for an overnight sleep study. Participants were divided into two age groups: 7-11 years and 12-17 years. CBCT scans were conducted within 30 days of the assessment. Lateral cephalograms were reconstructed for skeletal and airway analyses. Skeletal parameters included SNA, SNB, FMA, and SN-MP angles. Airway measurements included Retropalatal Airway space (RPA), PNS to adenoid point 1 (ad1), PNS to adenoid point 2 (ad2), and Adenoid to Nasopharynx (A/N) ratio). After verifying reliability, correlations between skeletal and airway measurements with the apnea-hypopnea index (AHI) were examined. ROC curves were generated, and sensitivity, specificity values were calculated to predict AHI levels of ≥5 and ≥10.

RESULTS: Significant correlations were found between AHI and airway measurements of adenoid enlargement (RPA, PNS-ad1, PNS-ad2, and A/N ratio; p<0.05) in both groups. ROC curve analyses yielded significant predictive values, with proposed cut-off values for AHI ≥ 5 and AHI ≥ 10. No significant association was found between AHI and skeletal measurements (p>0.05).

CONCLUSION: OSA prediction values were slightly better for 2D measurements, including the RPA, PNS-ad1, PNS-ad2, and A/N ratio, compared to previously reported 3D measurements. Two-dimensional radiographs, which offer equivalent or better predictive value with lower radiation exposure, are supported for OSA prediction, especially in younger children where adenoid enlargement is a key factor.
KEYWORDS: CBCT, Adenoid Enlargement, Sleep, OSA, Airway, Snoring, Breathing.

FUNDING

This research received no external funding.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

How to cite this article: Farhan H. Alwadei, Ahmed I. Masoud, Ayas K. Makki, Abdurahman H. Alwadei, Saleh H. Alwadei, Chang G. Park,  David W. Carley. Predictive Value of 2D Radiographic Skeletal and Airway Measurements for Sleep Apnea in Children: A Cross-sectional Sleep Study on Airway Indicators and Diagnostic Cut-Off. Int J Orthod Rehabil 2025; 16 (2): 11-27.

Original Article

Year : 2025 | Volume : 16 | Issue : 2 | Page : 1-10

Comparative Analysis Of Polymer Leaching From Different Clear Aligners Materials– An In-Vitro Study

Xavier Dhayananth1, Mohamed Nizamuddeen 2, Nitish T N 2, Shahul Hameed Faizee 1, Hemamalini D3, Jyosthna A3

1-Professor, 2-Intern, 3-Assistant Professor, Department of Orthodontics & Dentofacial Orthopaedics, Sathyabama Dental College & Hospital, Chennai, India
Address for Correspondence:

Dr Xavier Dhayananth

Professor, Department of Orthodontics and Dentofacial Orthopaedics

Sathyabama Dental College & Hospital,

Chennai, India

E-mail: drxavy@gmail.com

ABSTRACT  

AIM: To assess and compare the polymer leaching of various clear aligner materials in an in vitro environment.

METHODS: An in vitro study was conducted on four groups of commercially available clear aligner materials: SmartTrack™, PET-G, Polyurethane, and Photopolymer (n = 5 samples per group). Each material was pulverized using an acrylic bur and immersed in two concentrations of potassium permanganate (KMnO₄): concentrated (0.01 M) and diluted (0.005 M). Polymer leaching was quantified by measuring absorbance using a colorimeter at 525 nm after 24 hours. The outcome parameter assessed was the mean absorbance value (AU), indicating the extent of leaching. Intergroup comparisons were performed using ANOVA followed by post hoc Tukey’s test.

RESULTS: All materials exhibited measurable leaching. In concentrated KMnO₄, SmartTrack showed the least leaching (mean absorbance: 0.078 ± 0.005 AU), significantly lower than PET-G (0.154 ± 0.008 AU, p < 0.001). In diluted KMnO₄, Photopolymer showed the least leaching (0.065 ± 0.006 AU), also significantly lower than PET-G (0.139 ± 0.007 AU, p < 0.001). PET-G consistently exhibited the highest leaching in both solutions (p < 0.001 across comparisons).

CONCLUSION: Clear aligner materials differ significantly in their polymer leaching potential. SmartTrack and Photopolymer materials demonstrated superior leaching resistance compared to PET-G. Material selection plays a critical role in minimizing polymer release and ensuring biocompatibility.

KEY WORDS: Leaching, Aligners, Biocompatibility, Polymers, Toxicity.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

SOURCE OF FUNDING

This research received no external funding.

How to cite this article: Xavier Dhayananth, Mohamed Nizamuddeen, Nitish T N, Shahul Hameed Faizee, Hemamalini D, Jyosthna A. Comparative Analysis Of Polymer Leaching From Different Clear Aligners Materials– An In-Vitro Study. Int J Orthod Rehabil 2025; 16 (2): 1-10.

Case Series

Year : 2025 | Volume : 16 | Issue : 1 | Page : 63-80

Long-Term Stability Of Ortho-Surgical Management Of Skeletal Class III Malocclusion: A Case Series With A Five-Year Follow-Up

Ashish Kamboj 1, SS Chopra 2, Paras Angrish 3, Pulkit Lakhani 4, Tushar Deshmukh 5, Apoorva Sharma 6

1-Orthodontist, Dept. of Orthodontics, Military Dental Centre, 2-Professor and Head, Dept. of Orthodontics, Army Dental Centre (R&R), Delhi Cantt, Delhi, India, 3-Pedodontist, Air Force Institute of Dental Sciences, Bengaluru, India, 4-Orthodontist, Maven Dental Clinics, GC, Australia, 5-Oral and Maxillofacial Surgeon, Military Dental Centre, Agra, Uttar Pradesh, India, 6- Orthodontist, The Smile Outlet Clinic, GC, Australia.

Address for Correspondence:

Dr Paras Angrish

Pedodontist,

Air Force Institute of Dental Sciences

Bengaluru, India

E-mail: drparasangrish@gmail.com

Mob: Number: +91 9051813036

ABSTRACT

Diagnosing and treating Class III malocclusion is an enigma for an orthodontist, owing to complex etiology, multiple components, and varied treatment options. The most challenging part is to achieve stable treatment outcomes in such cases. This article illustrates two cases of Class III malocclusion managed with an ortho- surgical approach and followed up for 5 years. The cases were treated with single-jaw and bi-jaw surgical techniques respectively, and were assessed for various skeletal, dental and soft tissue parameters to determine treatment stability over five years. Both cases exhibited stable treatment outcomes. However, the case managed by a combination of maxillary-mandibular (bi-jaw) surgical techniquesportrayed a more promising stable result. Appropriate case selection, correct diagnosis, meticulous treatment planning and flawless execution oftreatment are essential for long-term success and stable treatment outcomes. Therefore, more studies with a higher level of evidence are recommended for a better understanding of the treatment response and stability, in order to improve the form, function, esthetics, and psychosocial well-being of the patient.

KEYWORDS: Ortho-surgical, Skeletal Class III malocclusion, Long-term Stability

CONFLICT OF INTEREST 

The authors declare no conflict of interest.

SOURCE OF FUNDING

This research received no external funding.
How to cite this article: Ashish Kamboj, SS Chopra, Paras Angrish, Pulkit Lakhani, Tushar Deshmukh, Apoorva Sharma. Long-Term Stability OfOrtho-Surgical Management Of Skeletal Class III Malocclusion: A Case Series With A Five-Year Follow-Up. Int J Orthod Rehabil 2025; 16 (1):63-80.

Review Article

Year : 2025 | Volume : 16 | Issue : 1 | Page : 48-62

Effects of Digital Health Interventions on Oral Hygiene and Treatment Compliance in Orthodontic Patients: A Systematic Review

Shekhar K Asarsa 1, Manisha Singh 2, Mansi Mehta 1, Vibhuti Madhad 4, W R Gnanasagar 5, P Hema 6

1,3-Tutor, Department of Orthodontics & Dentofacial Orthopaedics, 4-Tutor, Department of Periodontology, Siddhpur Dental College & Hospital, Dethali, Patan, Gujarat, India, 2-Consultant Orthodontist, New Delhi, India, 5-Reader, Department of Periodontics, Priyadarshini Dental College and Hospital, Thiruvallur, 6-Reader, Department of Periodontics, Adhiparasakthi Dental College, Melmaruvathur, India

Address for Correspondence:

Dr Shekhar K Asarsa

Tutor, Department of Orthodontics and Dentofacial Orthopaedics

Siddhpur Dental College & Hospital,

Dethali, Patan, Gujarat, India

E-mail: shekh.asarsa95@gmail.com

ABSTRACT

BACKGROUND: Oral hygiene and treatment compliance are critical for successful orthodontic outcomes. Despite their importance, patient non-adherence remains a significant challenge, contributing to complications such as plaque accumulation, gingivitis, and delayed treatments. Digital health interventions, including mobile apps, telemonitoring, and gamified platforms, offer innovative approaches to address these issues.

OBJECTIVE: This systematic review evaluates the effectiveness of digital health interventions in improving oral hygiene and treatment compliance among orthodontic patients, compared to traditional methods.

METHODS: A comprehensive search was conducted across databases including MEDLINE, Cochrane Library, EMBASE, and Scopus. Peer-reviewed randomized controlled trials (RCTs) and controlled clinical trials (CCTs) assessing digital health tools in orthodontics were included. Data were extracted and analyzed descriptively, focusing on outcomes such as Plaque Index (PI), Gingival Index (GI), compliance rates, and patient engagement.

RESULTS: Seven studies involving 504 participants aged 10–36 years were included. Digital tools demonstrated consistent improvements in oral hygiene, with significant reductions in PI and GI. Gamified apps, motivational protocols via social platforms, and telemonitoring enhanced compliance and reduced white spot lesions. However, short study durations and variability in interventions limited long-term effectiveness assessments.

CONCLUSION: Digital health interventions show promise in enhancing orthodontic care by improving oral hygiene and compliance. Further research with standardized methodologies, long-term follow-up, and cost-effectiveness analyses is needed to validate their integration into routine practice.

KEYWORDS: Orthodontics, Digital health interventions, Oral hygiene, Patient compliance, Mobile health (mHealth), Telemonitoring, Gamification.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

SOURCE OF FUNDING

This research received no external funding.
How to cite this article: Shekhar K Asarsa, Manisha Singh, Mansi Mehta, Vibhuti Madhad, W R Gnanasagar, P Hema. Effects of Digital Health Interventions on Oral Hygiene and Treatment Compliance in Orthodontic Patients: A Systematic Review. Int J Orthod Rehabil 2025; 16 (1): 48-62.

Original Article

Year : 2025 | Volume : 16 | Issue : 1 | Page : 38-47

Evaluation of the Cytotoxicity and Anti-biofilm Activity Of A Novel Dentifrice Containing 4-Hydroxycinnamic Acid: An In-Vitro Study

Manjiri Bhate1, Ravindra Kumar Jain2, A.S. Smiline Girija3, Raghunandhakumar4

1-Post Graduate Resident, 2-Professor and Head, Department of Orthodontics, 3-Professor, Department of Microbiology, 4-Associate Professor, Cancer and Stem Cell Research Lab, Department of Pharmacology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai-600 077, India

Address for Correspondence:

Dr Ravindra Kumar Jain

Professor and Head,

Department of Orthodontics, Saveetha Dental College and Hospitals,

Saveetha Institute of Medical and Technical Sciences,

Chennai, India.

E-mail: ravindrakumar@saveetha.com

ABSTRACT

INTRODUCTION: Evaluating biocompatibility is critical for assessing the safety and therapeutic potential of compounds, often serving as a preliminary step in product development. This study aims to evaluate the biocompatibility and anti-biofilm activity of a novel dentifrice containing 4-hydroxycinnamic acid (4-HCA) against Streptococcus mutans (SM) and Lactobacillus acidophilus (LA).

MATERIALS AND METHODS: The present in vitro study involved three groups- Group 1- commercially available dentifrice as control, Group 2- 0.2% 4-HCA dentifrice, Group 3- 0.4% 4-HCA dentifrice. The antibiofilm efficacy of the test dentifrices was assessed using colony-forming unit (CFU) counts and the Crystal Violet assay. The cytotoxicity was evaluated using the MTT assay and microscopic examination of human gingival fibroblast (HGF) cells.

RESULTS:

ANTIBIOFILM ACTIVITY: The CFU counts for SM and LA were highest in the control group, followed by the 0.2% 4-HCA group, and lowest in the 0.4% 4-HCA group. Crystal Violet assay results showed significant inhibition of biofilm formation in both 4-HCA groups compared to the control.

BIOCOMPATIBILITY: The MTT assay indicated that Group 3 had the highest cell viability and proliferation rates 24 horse after a 2 minute exposure to the conditioned medium across the different dilutions (1:40, 1:100, and 1:1000), as compared to Groups 2 and 1, indicating better biocompatibility. Morphological analysis of HGF cells showed normal spindle-shaped morphology in cells treated with Groups 2 and 3.

CONCLUSION: The novel dentifrice containing 0.4% 4-HCA demonstrates significant anti-biofilm activity against SM and LA and is biocompatible with HGF cells. This study supports the development of 4-HCA-based dentifrices as safe and effective oral hygiene products.

KEYWORDS: Cytotoxicity, Antibiofilm, Dentifrice, Orthodontic, Hydroxycinnamic Acid

CONFLICT OF INTEREST

None.

SOURCES OF FUNDING

None

How to cite this article: Manjiri Bhate, Ravindra Kumar Jain, A.S. Smiline Girija, Raghunandhakumar. Evaluation of the Cytotoxicity and Anti-biofilm Activity Of A Novel Dentifrice Containing 4-Hydroxycinnamic Acid: An In-Vitro Study. Int J Orthod Rehabil 2025; 16 (1) 38-47.

Review Article

Year : 2025 | Volume : 16 | Issue : 1 | Page : 24-37

Prognostic Factors for Successful Functional Appliance Therapy in Skeletal Class II Malocclusion- A Systematic Review

Rajkumaran Rajamanickam1, Bhadrinath Srinivasan2, Keerthi Venkatesan3 , Vignesh Kailasam4

1-Post Graduate Resident, 2-Associate Professor, 3-Senior Lecturer, 4-Professor and Head, Department of Orthodontics and Dentofacial Orthopedics, Sri Ramachandra Dental College & Hospital, Porur, Chennai-600116, India.

Address for Correspondence:

Dr Bhadrinath Srinivasan

Associate professor,

Department of Orthodontics and Dentofacial Orthopedics,

Sri Ramachandra Dental College & Hospital, Porur, Chennai-600116.

E-mail – bhadrinath.s@sriramachandra.edu.in

Phone - +91 9841879224

ABSTRACT

AIM: To investigate clinical or cephalometric parameters that contribute to favourable outcomes with functional appliance therapy in skeletal class II malocclusion.

MATERIALS AND METHODS: Six electronic databases were searched PubMed, Ovid, Lilacs, Cochrane, Scopus, and Web of Science up to 25thFebruary 2025. All study designs which evaluated factors associated with favourable and unfavourable outcome with functional appliance therapy for the treatment of skeletal class II malocclusion were included. The electronic search, initial screening, data extraction, risk of bias assessment was independently performed by the two reviewers. The collected data were analysed from the finally selected articles based on type of study, sample size, type of functional appliance used, and patient characteristics or factors studied which could be considered as positive predictive factors for functional appliance.

RESULTS: Seven retrospective studies and one prospective study were included. Prognostic factors like  the Co-Go-Me angle, chin position, growth pattern and other occlusal factors such as overbite, overjet were evaluated in the selected studies. Four studies were rated very good with 9 points and four other studies were rated as satisfactory with 7 points using the Newcastle Ottawa Scale. Due to heterogeneity of the factors studied, a meta–analysis could not be conducted in this systematic review.

CONCLUSION: Two included studies reported Co- Go-Me angle as the single most important predictive factor for successful outcome. Cephalometric factors pointing to horizontal growth pattern or hypo divergence, chin position and occlusal variables like increased overbite and overjet were identified as positive predictive factors. However future studies with definitive comparison groups can strengthen the current evidence.

REGISTRATION: PROSPERO(CRD42022312039).

CONFLICT OF INTEREST DISCLOSURE

All the authors disclose they do not have any financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

 All the authors declare that the manuscript has been read and approved by all  of them , that the requirements for authorship as stated earlier in this document have been met, and that each author believes that the manuscript represents honest work.

All the authors declare that they do not have any competing interests

FUNDING

There was no external funding.

How to cite this article: Rajkumaran Rajamanickam, Bhadrinath Srinivasan, Keerthi Venkatesan , Vignesh Kailasam. Prognostic Factors for Successful Functional Appliance Therapy in Skeletal Class II Malocclusion- A Systematic Review. Int J Orthod Rehabil 2025; 16 (1) 24-37.

Case Series

Year : 2025 | Volume : 16 | Issue : 1 | Page : 1-23

Revision of Lingual Bracket Direct Bonding Clinical Procedures

Viet Anh Nguyen1

 1-Faculty of Dentistry, PHENIKAA University, Yen Nghia, Ha Dong, Hanoi 12116, Vietnam.

Address for Correspondence:

Dr Viet Anh Nguyen

Faculty of Dentistry, PHENIKAA University,

Yen Nghia, Ha Dong, Hanoi 12116, Vietnam,

Email: anh.nguyenviet1@phenikaa-uni.edu.vn

Phone: +84984822484

ABSTRACT

Rationale: Lingual brackets are typically bonded indirectly based on setup models with ideal tooth alignment to overcome the variability in lingual tooth anatomy and difficulties in measuring bracket position. However, direct bonding is the original philosophy of the inventor of lingual orthodontics and is still performed by a minority of lingual orthodontists. This article aims to revise the clinical procedures of direct bonding of lingual brackets and forming of lingual archwires and prove the effectiveness of the direct bonding philosophy through two case reports.

Patient concerns: The patient in Case 1 was a 29-year-old female who presented with moderate crowding and normal inclinations of the maxillary and mandibular incisors. The patient in Case 2 was a 25-year-old female patient who presented with severe crowding and proclined maxillary and mandibular incisors.

Diagnoses: The patient in Case 1 was diagnosed with a half-cusp Class II relationship on a Class I skeletal relationship. The patient in Case 2 was diagnosed with Class I dental and skeletal relationships. Both patients had a normodivergent facial pattern.

Interventions and outcomes: The treatment option in Case 1 was to extract all third molars combined with total distalization of both arches and interproximal stripping. The treatment option in Case 2 was to extract maxillary and mandibular first premolars to create spaces for relieving crowding. The post-treatment records in both cases showed improved smile aesthetics and occlusion.

Conclusions: Direct lingual bracket bonding offers some advantages and disadvantages compared to indirect one. Successful treatment results of two case reports demonstrate the accuracy and effectiveness of the direct lingual bracket bonding approach.

Keywords: Lingual Orthodontics, Mushroom Archwire, Direct Bonding, Lingual Brackets, Offset Bends.

CONFLICTING INTEREST STATEMENT

The authors declare no potential conflicts of interest concerning the research, authorship, or publication of this article.

ETHICS STATEMENT

Informed consent was obtained from the patient, and the patient consented to the publishing of all images and clinical data included in the manuscript.

DATA AVAILABILITY

All data generated or analyzed during this study are included in this manuscript.

FUNDING STATEMENT

This research received no external funding.

How to cite this article: Viet Anh Nguyen. Revision of Lingual Bracket Direct Bonding Clinical Procedures. Int J Orthod Rehabil 2025; 16 (1) 1-23.