Editorial

The overarching theme of patient-centric care should serve as the fundamental basis for our treatment plans. Treatment plans that best utilize knowledge; training and technology must be developed on current evidence that rests on soundly researched principles. In orthodontics, the evolution of cone beam computed tomography as a new three-dimensional imaging modality has brought a paradigm shift in the radiographic evaluation of the maxillofacial structures. However, the coming of new technology does not warrant its use in routine practice and tight imaging protocols must be developed to include and promote the evidence-based patient-centric approach. This principle is best approached if the effort is a collaborative one. Collaboration between all the disciplines that contribute to patient care must act as a unified force to deliver superior care. In this editorial, we present a successful collaborative effort between orthodontics and oral and maxillofacial radiology that have engaged in collaborative efforts to deliver superior patient care, better predoctoral and postdoctoral training programs and how this effort has yielded excellent contribution to research.

Context The cranial base and variations in its morphology affect the anterior-posterior positioning of jaws causing changes in the glenoid fossa and condylar position. Aims To evaluate the condylar position in patients with different skeletal sagittal malocclusion patterns. Materials And Methods Pretreatment lateral cephalometric radiographs of 112 subjects (both males and females) were categorized into three classes (Class I, Class II, Class III) based on their ANB angulation and studied for N-S-Ar (saddle angle), S-Ar-Go (articular angle), S-Ar (posterior cranial base length). Statistical Analysis Shapiro-Wilk test was done to check for normality of the distribution of values. Groups were evaluated using parametric tests (one-way ANOVA). Significance for all tests was predetermined as P < 0.05. Results N-S-Ar and S-Ar-Go and also S-Ar did not vary significantly in all the three classes. N-S-Ar and S-Ar-Go angles have shown a significant negative correlation in all the three classes. Conclusions There is no significant difference in condylar position in different skeletal malocclusion patterns. N-S-Ar and S-Ar-Go angles show a negative correlation in any skeletal malocclusion pattern.

Aim To determine the effect of two different ligating systems that is, elastomeric modules and self-ligating (SL) bracket systems (Smartclip - 3M Unitek) with respect to harboring bacterial plaque in fixed orthodontic treatment. Objectives To assess, evaluate, and compare the amount of plaque accumulation and Streptococcus mutans colonization around elastomeric ligation and SL clips in the smart clip appliance. Materials And Methods A total of 111 orthodontic patients scheduled for fixed orthodontic treatments were selected for this split maxillary arch study. All the patients were bonded with smart-clip (3M Unitek) SL brackets, and the wire was placed into the bracket slots, on the randomly selected hemi arch, elastomeric modules were placed for the study to be conducted. Microbial and periodontal plaque accumulation was recorded at 3-time intervals post ligation. Plaque index-by Silness and Loe, modified Quigely Hein index, bleeding on probing were evaluated, and biofilm was collected from the tooth surface after 30 days and placed in petri dishes containing Mitis Salivarius agar for bacterial culturing. Result It was observed that the side where ligation was done with elastomeric modules accumulated more plaque and increase in S. mutans colony forming units as compared to the side without external ligation (P < 0.05). Conclusion Reduced bacterial colonization and better plaque control was seen with SL orthodontic bracket appliance system as compared to conventional ligation method.

The paper describes modified tiebacks for space closure with the MBT prescription preadjusted appliance. This modification solves the problems associated with the original design.

Objective To determine the reliability of Computer Assisted Digital Cephalometric Analysis System (CADCAS) in terms of landmark identification on the values of cephalometric measurements in comparison with those obtained from original radiographs. Materials And Methods The study material consisted of Twenty five lateral cephalograms selected randomly, 16 cephalometric points together with 10 angular and 5 linear cephalometric measurements. The landmarks were manually picked on the tracing & the measurements of X &Y axis done with reference grid. The same tracing was digitized & image loaded in the software (ViewBox 3.1.1) was checked for the magnification (metal ruler) & distortion. The second part of the study compared manual and the CADCAS since the landmarks were manually digitized on screen as against the manually picked ones on the tracing paper. The x and y-coordinates for 16 landmarks were measured, mean and standard deviation calculated, linear and angular measurements compared. Statistical Analysis A paired t-test was done to calculate the statistical significance of the differences. Intraclass reliability coefficient (signifying reproducibility) of the variable was recorded. The observations were tabulated and analysis was done using the paired t test at a P value <0.05. Results Out of 47 variables looked for, 21 showed statistical significance. Direct digitization onscreen (CADCAS) was the quickest and least tedious method. CADCAS was unreliable with linear measurements involving bilateral structures such as Gonion & Articulare. Conclusions Both the methods are equally reliable and reproducible. The intra-class reliability coefficient of all variables differed only slightly, which is not clinically significant.

The orthodontic treatment of Class III malocclusion with a maxillary deficiency is often treated with maxillary protraction either with or without maxillary expansion. The routine procedure for rapid maxillary expansion includes banding on first premolars/first deciduous molars and the permanent first molars. However in some patients who are esthetically very conscious, banding of the first premolar would not be a good esthetic option. So for such circumstances we have designed a modified hyrax splint, which does not need the first premolars to be banded.

Invisible or Inconspicuous Orthodontic appliances are an integral part of the orthodontists armamentarium in current protocols. Customisation have made mechanics with Lingual orthodontics more predictable and operator friendly. The leading lingual system in the world, Incognito™ (3M Unitek) has introduced Incognito™ Lite as a popular and efficient system for correction of minor malocclusions. This clinical showcase discusses the rationale, scope and clinical uses of this system.