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Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study

Authors:
  • Saveetha Institute of Medical and Technical Sciences
Pavithra H Dave, Nivethigaa B, Mahesh Ramakrishnan. Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study. Int J Dentistry Oral Sci. 2020;S5:02:0023:129-133..
129
Special Issue on: Prosthodontics and Maxillofacial Prosthetics. OPEN ACCESS https://scidoc.org/IJDOS.php
Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study
Research Article
Pavithra H Dave1, Nivethigaa B2*, Mahesh Ramakrishnan3
1 Saveetha Dental College And Hospitals, Saveetha Institute Of Medical and Technical Sciences, Saveetha University, Chennai, 600050, India.
2 Senior Lecturer, Department of Orthodontics, Saveetha Dental College and Hospitals, Saveetha Institute Of Medical And Technical Sciences, Saveetha
University, Chennai, India.
3 Reader, Department of Pedodontics and Preventive Dentistry, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical
Sciences (SIMATS), Saveetha University, Chennai -77, India.
International Journal of Dentistry and Oral Science (IJDOS)
ISSN: 2377-8075
*Corresponding Author:
Nivethigaa B,
Senior Lecturer, Department of Orthodontics, Saveetha Dental College and Hospitals, Saveetha Institute Of Medical And Technical Sciences, Saveetha University, Chennai, India.
Tel: +91 9791972324
E-mail: nivethigaab.sdc@saveetha.com
Received: July 26, 2020
Accepted: August 20, 2020
Published: August 30, 2020
Citation: Pavithra H Dave, Nivethigaa B, Mahesh Ramakrishnan. Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study. Int J Dentistry Oral Sci.
2020;S5:02:0023:129-133.
Copyright: Nivethigaa B©2020. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribu-
tion and reproduction in any medium, provided the original author and source are credited.
Introduction
A number of epidemiological studies on malocclusion and or-
thodontic treatment need have been performed worldwide which
have reported wide variations in the incidence of malocclusion.
The lack of suitable universal methods for recording and grad-
ing malocclusion and the different criteria used to dene maloc-
clusion have been a considerable factor that has inuenced such
extreme of variation [14, 29].
Development of malocclusion is determined by a combination
of genetic and environmental inuences. In recent years, the etio-
logical importance of genetic factors has been reduced, consider-
ing that many malocclusions recognize a post-natal origin [21].
Oral habits, particularly if they continue beyond the preschool
age, have been associated as an essential environmental determi-
nant correlated with the development of malocclusion [14]. The
role of continued digital sucking habit on the progress of maloc-
clusion has been reviewed by many researchers. Furthermore the
effect of abnormal swallowing patterns has been notably docu-
mented in the literature [30, 32].
Malocclusion has a tremendous physical, social and psychologi-
cal inuence on people and society; consequently, epidemiologi-
cal studies are vital to achieving comprehensive data for building
public health strategies for orthodontic prevention [17]. During
the last three decades, a striking increment in orthodontic therapy
demand has occurred as a result of the high understanding rate of
malocclusions, along with greater application to aesthetics. Many
Abstract
Background: Oral habits, particularly if they continue beyond the preschool age, have been associated as an essential environ-
mental determinant correlated with the development of malocclusion. Tongue thrusting habit is a state in which the tongue comes
between with any teeth when swallowing. The knowledge of prevalence and etiology of malocclusion can help form strategies for
prevention, interception, and corrective treatment. The study aimed to assess the prevalence of tongue thrusting and malocclusion
and to nd, if any correlation exists between the presence of tongue thrusting oral habits and the malocclusion status.
Materials and Method: This study association between tongue thrust and malocclusion, was done at a private dental college and
hospital. The cast sheets of patients were obtained from the patient record system. The data of each patient was obtained and
tabulated.
Results: In this study, we infer that there is a signicant association between tongue thrusting habit and malocclusion, in which
open bite was found to be the most commonly seen malocclusion with a p value of 0.001 done using Chi square test.
Conclusion: There was a high predominance of malocclusion in patients with tongue thrusting habits, in which open bite was
found to be the most commonly seen malocclusion. Other signicant malocclusion included crowding, spacing and proclination
in some cases. Hence adequate care should be taken from the younger age to stop the parafunctional oral habits from resulting
into a severe malocclusion.
Keywords: Incidence; Malocclusion; Oral Habits; Tongue Thrusting.
Pavithra H Dave, Nivethigaa B, Mahesh Ramakrishnan. Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study. Int J Dentistry Oral Sci. 2020;S5:02:0023:129-133..
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studies have been published on the prevalence of malocclusion
and the need for orthodontic treatment in different ethnic groups.
Oral habits like nger and thumb sucking, lip sucking, mouth
breathing, nail-biting and so on can happen transitorily; however,
these habits, when extreme or maintained, can lead to poor den-
tal well-being or malocclusion. A study the prevalence of maloc-
clusions, oral habits and the need for orthodontic treatment in a
sample of 7- to 15-year-old Albanese schoolchildren and stated
that oral habits were present in 80.6% of their subjects [16]. A
previous study done in 2008 also conrmed that there was a posi-
tive association between deleterious oral habits and malocclusion.
However, Luzzi et al. in 2011 reported that no statistically sig-
nicant associations could be detected between the non-nutritive
sucking habits and malocclusion [3].
The tongue plays an essential role in respiration, mastication, de-
glutition, and speech. In normal deglutition, the tip of the tongue
rests on the lingual part of the maxillary anterior dentoalveolar
area; the teeth come in temporary contact and there is a least con-
traction of the perioral muscles, is least during deglutition, during
swallowing, and there is neither a tongue thrust nor a constant
forward posture. Tongue thrusting is a potent swallowing pattern
in infants. By age 2-4 years, functionally mature swallows emerge
[11].
Tongue thrusting habit is a condition in which the tongue makes
contact with any teeth anterior to the molars during swallowing
[23]. Most frequent signs of tongue thrusting are said to be for-
ward tongue posture and tongue thrusting during swallowing,
contraction of the perioral muscles, excessive buccinator hyper-
activity, and swallowing without the momentary tooth contact
normally required.
The knowledge of the prevalence and resultant malocclusion can
help form strategies for prevention, interception, and corrective
treatment. Given scal restraints due to high expenses of ortho-
dontic services and lack of publicly nanced dental treatment
plans in developing countries, such as India, it becomes more im-
portant to understand orthodontic treatment demand according
to the severity and to recognize modiable factors that can be
targeted by preventive and interceptive orthodontics.
Previously our team had conducted numerous studies which in-
clude clinical trials [31, 27, 15, 33, 34, 7, 26, 12, 22, 25, 9, 5, 8], in
vitro studies [13] and case reports [6] and hence the present study
was designed, to assess and quantify the prevalence of tongue
thrusting and malocclusion and to nd, if any correlation exists
between the presence of tongue thrusting oral habits and the mal-
occlusion status.
Materials and Methods
The present retrospective study was carried out in the Depart-
ment of Orthodontics of Saveetha Dental College and Hospital,
Chennai, Tamil Nadu. The study was of university setting and
carried out using data collected from patient records from June
2019-April 2020. The advantage of using a university setting is
that data is readily available and patients are of similar ethnicity.
The disadvantage of this type of setting is that it covers a specic
geographic area and trends in other locations are not assessed.
Ethical approval was obtained from the institution. The data was
reviewed by 2 reviewers. Case verication was done by 2 review-
ers. Non probability sampling of the available data was done. The
sample size consisted of 500 patients who had tongue thrusting
habits. Inclusion criteria included all the patients who had tongue
thrusting habits.
Data collection was carried out using dental details obtained from
the patient records. Data verication was carried out. The data
was tabulated using Microsoft Excel. Censored or incomplete
data was excluded from the study.
Statistical Analysis
The data was imported to SPSS software developed by IBM for
statistical analysis. Frequency, percentage of parameters was em-
ployed in the analysis. Chi square test was used to detect the sig-
nicance between gender, age, habit, and malocclusion. p value
less than to 0.05 was considered statistically signicant.
Result And Discussion
In our study, we conclude that there was a signicant association
between tongue thrusting habit and malocclusion, in which open
bite was found to be the most commonly seen malocclusion- p –
value 0.001< 0.05 [Chi square test]
Figure 1 shows the age distribution, in which 63% belonged to the
age group of less than 20 years, 28 % in the age group 21 to 40
years and 9 % in the age group 41 to 60 years.
Figure 2 shows the gender distribution, 52 % male population and
48 % female population.
Figure 3 shows the association between age and malocclusion,
less than 20 years had proclination 76 %, 21 to 40 years had open
bite of 72 % and 41 to 60 years had crowding 21 %. Thus from
graph 3 we infer that open bite is highly prevalent in the 21 to 40
years age group.
Figure 4 shows association between gender and malocclusion in
which the female population 37% had open bite and male popula-
tion 60 % had open bite. Thus from graph 4 we infer that open
bite is the highly prevalent malocclusion in the male population
than in the female population.
Malocclusion is established close to its full expression in an indi-
vidual with the eruption of all permanent teeth, thereby young
adolescents at the late mixed dentition and early permanent denti-
tion stage provide a much clearer prevalence of malocclusion and
orthodontic treatment needs than younger children. The study
by Giugliano et determined the prevalence of malocclusion, or-
thodontic treatment need, and the relationship of malocclusion
with associated factors, such as deleterious oral habits, in a North
Indian school going population of 12 and 15-year-old children in
Shimla city [10].
Results of the regression models revealed that mouth breathing
and thumb-sucking habits had a signicant impact on malocclu-
sion, signicantly affecting the presence of crowding and irregu-
larities in anterior segments, and increased maxillary overjet. Also,
tongue thrusters signicantly developed a reverse overjet, spacing
Pavithra H Dave, Nivethigaa B, Mahesh Ramakrishnan. Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study. Int J Dentistry Oral Sci. 2020;S5:02:0023:129-133..
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in incisal segments, and anterior open-bite. Abundant reports in
the literature have stated that malocclusion in relation to these
traits is observed with a higher prevalence amongst those with
habits than without. Shetty et al found that when tongue thrust-
ing, mouth breathing, and thumb sucking were taken into con-
sideration, about 28.95% had malocclusion with a higher preva-
lence in relation to anterior maxillary protrusion [28]. Melson et
al, stated that both tongue-thrust swallow and teeth apart swallow
favor development of disto-occlusion, extreme maxillary overjet,
and open bite [20].
Oral habits like mouth breathing, abnormal swallowing, thumb
sucking, lip sucking, and nail-biting can have a primary inuence
on the essence of life and can affect the stomatognathic system
Figure 1. Age distribution in patients with tongue thrusting habits. Of the overall 500 patients, pink colour denotes patients
in the age group of less than 20 years is 63%, black colour denotes patients in age group 21-40 years is 28% and brown
denotes patients in age group 41-60 years is 9%. The presence of tongue thrusting was seen to be increased in the younger
age groups, indicating the need for strict measures to avoid the habit to prevent the occurrence of severe dental deformity.
Figure 2. Gender distribution in patients with tongue thrusting habits. Of the overall 500 patients, grey colour denotes the
male population of the study is 51.60% and purple colour denotes the female population of the study is 48.40%. The gender
distribution in the prevalence of malocclusion showed comparative increase in the male population.
Figure 3. The graph represents the association between age and malocclusion in patients with tongue thrusting habits.
Blue denotes open bite, red denotes proclination, green denotes spacing, orange denotes cross bite and yellow denotes
crowding. X axis represents the age distribution and the Y axis represents the number of patients with malocclusion. In the
age group of less than 20 years, cross bite was the most common and open bite was the least occurring malocclusion. In the
age group 21-40 years, open bite was the most and cross bite was the least occurring malocclusion and in the age group of
41-60 years, crowding was the most and cross bite was the least occurring malocclusion. (Pearson Chi-Square value-181.516
, p value-0.001 , <0.05) Chi- square test was used p<0.001, association between the two parameters age group and type of
malocclusion were statistically signicant.
Pavithra H Dave, Nivethigaa B, Mahesh Ramakrishnan. Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study. Int J Dentistry Oral Sci. 2020;S5:02:0023:129-133..
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of the body [1]. This study showed that notable relationships ex-
isted between harmful oral habits and malocclusions. In a similar
study, evaluated the relationship between arch width and certain
oral habits in 3 to 6-year-old children and found that a model hab-
it leads to a decrease in maxillary arch width and mouth breathing
causes a decrease in the size of both arches [2].
An association exists amidst the etiology of an anterior open bite,
harmful oral habits, and a few orofacial defects. A connection
between the history of deleterious habits and the existence of
lingual interposition when swallowing, and with speech distur-
bances were recognized. These results highlight the signicant
interplay between orthodontists and speech-language patholo-
gists throughout the treatment of patients. The recovery role of
speech-language therapy stands out, through the oral myofunc-
tional therapy, indicating the positioning of the tongue during
swallowing, speech and when in habitual position [10, 4].
In a previous study, it was observed that tongue thrusting is the
most common oral habit constituting 29.5%. It can be dened
because tongue tip function during swallowing is directly related
to the variations in the contiguous anterior dentoskeletal circum-
stances. The changing patterns of tongue tip movement seem to
describe a functional adaptation to the variations in the arrange-
ment of the anterior malocclusion. Reasonably this functional
adaptation describes an effort to obtain an anterior oral seal dur-
ing swallowing and benet to the difference in the anterior oral
environment [19].
Thus, an alteration to an existing environment may yet be another
expression for the possible predominance of tongue thrusting in
young age groups. Several critics have noted that the intermo-
lar distance was statistically shorter in mouth-breathing subjects
while contrasted with that of nasal breathers, which symbolizes
a larger narrowing of the maxillary arch in the second molar area
[18, 24].
Conclusion
Within the limitations of the study, there was a high predomi-
nance of malocclusion in patients with tongue thrusting habits, in
which open bite was found to be the most commonly seen maloc-
clusion. Other signicant malocclusion included crowding, spac-
ing, and proclination in some cases. Hence adequate care should
be taken from a younger age to stop the parafunctional oral habits
from resulting in a severe malocclusion that would involve more
cost as well time for its correction when it persists in adulthood.
Author’s Contribution
First author (Pavithra H Dave) performed the analysis, interpre-
tation and wrote the manuscript. Second author (Dr.Nivethigaa
B.) contributed to conception, data design, analysis, interpretation
and critically revised the manuscript. Third author (Dr.Mahesh)
participated in the study and revised the manuscript. All the three
authors have discussed the results and contributed to the nal
manuscript.
Acknowledgement
The authors are thankful to Saveetha Dental College for provid-
ing permission to access the database and for giving a platform to
express our knowledge.
References
[1]. Agarwal SS, Nehra K, Sharma M, Jayan B, Poonia A, Bhattal H. Association
between breastfeeding duration, non-nutritive sucking habits and dental
arch dimensions in deciduous dentition: a cross-sectional study. Prog Or-
thod. 2014 Oct 31;15(1):59. Pubmed PMID: 25679374.
[2]. Aznar T, Galán AF, Marín I, Domínguez A. Dental arch diameters and re-
lationships to oral habits. Angle Orthod. 2006 May;76(3):441-5. Pubmed
PMID: 16637724.
[3]. Cavalcanti LA, Bezerra MK, Moura C, Bezerra MP, Granville-Gracia FA.
Relationship between malocclusion and deleterious oral habits in preschool
children in Campina Grande, PB, Brazil. Stomatološki Glasnik Srbije.
2008;55(3):154-62.
[4]. Chour RG, Pai SM, Chour GV, Kenchappannavar SM, Parameshwarappa
P, Altunsoy M, et al. Assessment of various deleterious oral habits and its
eects on primary dentition among 3-5 years old children in Davangere city.
Journal of Pediatric Dentistry/May-Aug. 2014;2(2).
[5]. Dinesh SP, Arun AV, Sundari KK, Samantha C, Ambika K. An indigenously
designed apparatus for measuring orthodontic force. J Clin Diagn Res. 2013
Figure 4. The graph represents the association between gender and malocclusion in patients with tongue thrusting habit,
where blue denotes open bite, red denotes proclination, green denotes spacing, orange denotes cross bite and yellow
denotes crowding. X axis represents the gender distribution and the Y axis represents the number of patients with maloc-
clusion. In the male population, open bite was the most and spacing was the least occurring malocclusion and in the female
population, spacing was the most and open bite was the least occurring malocclusion. (Pearson Chi-Square value-11.820, p
value-0.019 , <0.05) Chi- square test was used-p<0.019, association between the two parameters gender and type of maloc-
clusion were statistically signicant.
Pavithra H Dave, Nivethigaa B, Mahesh Ramakrishnan. Association Between Tongue Thrusting Habit And Malocclusion: A Retrospective Study. Int J Dentistry Oral Sci. 2020;S5:02:0023:129-133..
133
Special Issue on: Prosthodontics and Maxillofacial Prosthetics. OPEN ACCESS https://scidoc.org/IJDOS.php
Nov;7(11):2623-6. Pubmed PMID: 24392423.
[6]. Felicita AS. Orthodontic management of a dilacerated central incisor and
partially impacted canine with unilateral extraction - A case report. Saudi
Dent J. 2017 Oct;29(4):185-193. Pubmed PMID: 29033530.
[7]. Felicita AS. Quantication of intrusive/retraction force and moment
generated during en-masse retraction of maxillary anterior teeth using
mini-implants: A conceptual approach. Dental Press J Orthod. 2017 Sep-
Oct;22(5):47-55. Pubmed PMID: 29160344.
[8]. Felicita AS. Orthodontic extrusion of Ellis Class VIII fracture of maxillary
lateral incisor - e sling shot method. Saudi Dent J. 2018 Jul;30(3):265-
269. Pubmed PMID: 29942113.
[9]. Felicita AS, Chandrasekar S, Shanthasundari KK. Determination of cranio-
facial relation among the subethnic Indian population: a modied approach
- (Sagittal relation). Indian J Dent Res. 2012 May-Jun;23(3):305-12. Pub-
med PMID: 23059564.
[10]. Giugliano D, d'Apuzzo F, Jamilian A, Perillo L. Relationship between maloc-
clusion and oral habits. Current Research in Dentistry. 2014 Jul 1;5(2):17.
[11]. Hanson ML, Barnard LW, Case JL. Tongue-thrust in preschool children. Am
J Orthod. 1969 Jul;56(1):60-9. Pubmed PMID: 5255277.
[12]. Jain RK, Kumar SP, Manjula WS. Comparison of intrusion eects on maxil-
lary incisors among mini implant anchorage, j-hook headgear and utility
arch. J Clin Diagn Res. 2014 Jul;8(7):ZC21-4. Pubmed PMID: 25177631.
[13]. Kamisetty SK, Verma JK, Arun, Sundari S, Chandrasekhar S, Kumar A. SBS
vs Inhouse Recycling Methods-An Invitro Evaluation. J Clin Diagn Res.
2015 Sep;9(9):ZC04-8. Pubmed PMID: 26501002.
[14]. Kharbanda OP, Sidhu SS, Sundaram K, Shukla DK. Oral habits in school
going children of Delhi: a prevalence study. J Indian Soc Pedod Prev Dent.
2003 Sep;21(3):120-4. Pubmed PMID: 14703220.
[15]. Krishnan S, Pandian S, Kumar S A. Eect of bisphosphonates on orthodon-
tic tooth movement-an update. J Clin Diagn Res. 2015 Apr;9(4):ZE01-5.
Pubmed PMID: 26023659.
[16]. Laganà G, Masucci C, Fabi F, Bollero P, Cozza P. Prevalence of malocclu-
sions, oral habits and orthodontic treatment need in a 7- to 15-year-old
schoolchildren population in Tirana. Prog Orthod. 2013 Jun 14;14:12. Pub-
med PMID: 24326142.
[17]. Liu Z, McGrath C, Hägg U. e impact of malocclusion/orthodontic treat-
ment need on the quality of life. A systematic review. Angle Orthod. 2009
May;79(3):585-91. Pubmed PMID: 19413386.
[18]. Maciel CT, Leite IC. Aspectos etiológicos da mordida aberta anterior e
suas implicações nas funções orofaciais [Etiological aspects of anterior
open bite and its implications to the oral functions]. Pro Fono. 2005 Apr-
Dec;17(3):293-302. Portuguese. Pubmed PMID: 16389786.
[19]. Mattar SE, Anselmo-Lima WT, Valera FC, Matsumoto MA. Skeletal and oc-
clusal characteristics in mouth-breathing pre-school children. J Clin Pediatr
Dent. 2004 Summer;28(4):315-8. Pubmed PMID: 15366619.
[20]. Melsen B, Stensgaard K, Pedersen J. Sucking habits and their inuence
on swallowing pattern and prevalence of malocclusion. Eur J Orthod.
1979;1(4):271-80. Pubmed PMID: 298212.
[21]. Nobile CG, Pavia M, Fortunato L, Angelillo IF. Prevalence and factors re-
lated to malocclusion and orthodontic treatment need in children and ad-
olescents in Italy. Eur J Public Health. 2007 Dec;17(6):637-41. Pubmed
PMID: 17400542.
[22]. Pandian KS, Krishnan S, Kumar SA. Angular photogrammetric analysis of
the soft-tissue facial prole of Indian adults. Indian J Dent Res. 2018 Mar-
Apr;29(2):137-143. Pubmed PMID: 29652003.
[23]. Peng CL, Jost-Brinkmann PG, Yoshida N, Chou HH, Lin CT. Compari-
son of tongue functions between mature and tongue-thrust swallowing-
-an ultrasound investigation. Am J Orthod Dentofacial Orthop. 2004
May;125(5):562-70. Pubmed PMID: 15127025.
[24]. Pruthi N, Sogi GM, Fotedar S. Malocclusion and deleterious oral habits in a
north Indian adolescent population: a correlational study. European Journal
of General Dentistry. 2013 Sep 1;2(3):257.
[25]. Ramesh Kumar KR, Shanta Sundari KK, Venkatesan A, Chandrasekar S.
Depth of resin penetration into enamel with 3 types of enamel conditioning
methods: a confocal microscopic study. Am J Orthod Dentofacial Orthop.
2011 Oct;140(4):479-85. Pubmed PMID: 21967934.
[26]. Rubika J, Sumathi Felicita A, Sivambiga V. Gonial angle as an indicator for
the prediction of growth pattern. World Journal of Dentistry. 2015;6(3):161-
3.
[27]. Samantha C, Sundari S, Chandrasekhar S, Sivamurty G, Dinesh S. Com-
parative Evaluation of Two Bis-GMA Based Orthodontic Bonding Adhesives
- A Randomized Clinical Trial. J Clin Diagn Res. 2017 Apr;11(4):ZC40-
ZC44. Pubmed PMID: 28571259.
[28]. Shetty SR, Munshi AK. Oral habits in children--a prevalence study. J Indian
Soc Pedod Prev Dent. 1998 Jun;16(2):61-6. Pubmed PMID: 11813757.
[29]. Singh S, Sharma A, Sandhu N, Mehta K. e prevalence of malocclusion
and orthodontic treatment needs in school going children of Nalagarh,
Himachal Pradesh, India. Indian J Dent Res. 2016 May-Jun;27(3):317-22.
Pubmed PMID: 27411663.
[30]. Singh SP, Utreja A, Chawla HS. Distribution of malocclusion types among
thumb suckers seeking orthodontic treatment. J Indian Soc Pedod Prev
Dent. 2008;26 Suppl 3:S114-7. Pubmed PMID: 19127028.
[31]. Sivamurthy G, Sundari S. Stress distribution patterns at mini-implant site
during retraction and intrusion--a three-dimensional nite element study.
Prog Orthod. 2016;17:4. Pubmed PMID: 26780464.
[32]. Tewari A. Abnormal oral habits relationship with malocclusion and inu-
ence on anterior teeth. J Indian Dent Assoc. 1970 Mar;42(3):81-4. Pubmed
PMID: 5268514.
[33]. Vikram NR, Prabhakar R, Kumar SA, Karthikeyan MK, Saravanan R. Ball
Headed Mini Implant. J Clin Diagn Res. 2017 Jan;11(1):ZL02-ZL03. Pub-
med PMID: 28274084.
[34]. Viswanath A, Ramamurthy J, Dinesh SP, Srinivas A. Obstructive sleep apnea:
awakening the hidden truth. Niger J Clin Pract. 2015 Jan-Feb;18(1):1-7.
Pubmed PMID: 25511335.
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The aim of this paper is to evaluate the efficacy of forced extrusion using the sling shot elastic. A 21 year adult patient reported with an Ellis Class VIII fracture of the maxillary right lateral incisor. Root canal treatment followed by a fiber reinforced composite post was placed and core build up was done. A metal button was bonded to the tooth. Begg brackets were placed from the second premolar on one side to the second premolar on the opposite side. 0.016″ × 0.025″ stainless steel was placed in ribbon mode. The ligature wire was placed as a sling shot from the button on the fractured tooth to the two adjacent teeth. 4 mm of extrusion was achieved and there was no evidence of root resorption. Forced extrusion was achieved in four months. The sling shot method is a very effective method of ligation. Light forces are delivered over a long duration with definitive results as compared to the inconsistent force delivery with conventional extrusion mechanics.
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Objective: The aim of the present study was to clarify the biomechanics of en-masse retraction of the upper anterior teeth and attempt to quantify the different forces and moments generated using mini-implants and to calculate the amount of applied force optimal for en-masse intrusion and retraction using mini-implants. Methods: The optimum force required for en-masse intrusion and retraction can be calculated by using simple mathematical formulae. Depending on the position of the mini-implant and the relationship of the attachment to the center of resistance of the anterior segment, different clinical outcomes are encountered. Using certain mathematical formulae, accurate measurements of the magnitude of force and moment generated on the teeth can be calculated for each clinical outcome. Results: Optimum force for en-masse intrusion and retraction of maxillary anterior teeth is 212 grams per side. Force applied at an angle of 5o to 16o from the occlusal plane produce intrusive and retraction force components that are within the physiologic limit. Conclusion: Different clinical outcomes are encountered depending on the position of the mini-implant and the length of the attachment. It is possible to calculate the forces and moments generated for any given magnitude of applied force. The orthodontist can apply the basic biomechanical principles mentioned in this study to calculate the forces and moments for different hypothetical clinical scenarios.
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Objective: To assess the prevalence of malocclusion and deleterious oral habits among 12 and 15-year-old school children in Shimla city, India and to find, if any correlation exists between the two. Design: Correlational study design. Setting: Twelve schools in Shimla city, India. Materials and Methods: Prevalence of malocclusion and orthodontic treatment need was assessed using the Dental Aesthetic Index (DAI) among a sample of 961, 12 and 15-year-old school children in Shimla city, who received no orthodontic treatment before or during the study. Subjects were also assessed for deleterious oral habits. Statistical Analysis: Chi-square and Mann-Whitney U tests were used. Multivariate regression analysis was used to test the correlation of habits with mean DAI score and malocclusion traits. Results: Mean DAI score was 26.81±5.25. Nearly 53% of the study sample presented with malocclusion, ranging from ′definite′ to ′handicapping′ based on the DAI scores. The prevalence of various deleterious oral habits was 25.9%. About 29% of children with any oral habit developed malocclusion as compared to those without any habit (P value=0.023). Tongue thrusting, mouth breathing and thumb sucking habits had a significant impact on malocclusion. Conclusion: There was high prevalence of malocclusion (52.7%). Abnormal oral habits, particularly mouth breathing and tongue thrusting had a significant impact on malocclusion, resulting in higher frequency of crowding in anterior teeth, open bite, and spacing.
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Background: The purpose of this study was to evaluate the stress patterns produced in mini-implant and alveolar bone, for various implant dimensions, under different directions of simulated orthodontic force, using a three-dimensional finite element method. Methods: Eight finite element (FE) models of mini-implant and bone were generated with insertion angles of 30° and 60°, diameters of 1 and 1.3 mm, and lengths of 6 and 8 mm. A simulated constant orthodontic force of 2 N was applied to each of these FE models in three directions simulating anterior retraction, anterior intrusion and retraction, and molar intrusion. Results: Comparison of the maximum von Mises stress in the mini-implant showed that the 1-mm diameter produced significantly high stress, and the amount of stress produced was more for a mini-implant inserted at an angle of 60°. The cortical bone showed that high stresses were generated for the 1-mm-diameter mini-implant and on increasing the insertion angulation from 30° to 60°, the stress produced increased as well. The comparison of von Mises stress in the cancellous bone was insignificant as the amount of stress transmitted was very low. Conclusions: The 1-mm-diameter mini-implants are not safe to be used clinically for orthodontic anchorage. The 1.3 × 6 mm dimension mini-implants are recommended for use during anterior segment retraction and during simultaneous intrusion and retraction, and the 1.3 × 8 mm dimension mini-implant is recommended for use during molar intrusion. All mini-implants should be inserted at a 30° angle into the bone for reduced stress and improved stability.
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In addition to heredity, oral habits are considered important factors in the etiology of malocclusion. This study was taken to assess the relationship between Malocclusion and Oral Habits. The sample comprised of 674 orthodontically untreated subjects, 324 males (48%) and 350 females (52%) 12 to 15-year-old schoolchildren from the southern part of Italy. Orthodontic variables and oral habits including mouth breathing and swallowing pattern; thumb, finger and lip sucking; and nail biting of the patients were evaluate. Two examiners, who had been previously trained in the use of occlusal indices, screened all the schoolchildren. The chi-square and binomial test was used to evaluate the data. A total of 589 of the subjects were found to have deleterious oral habits. Nail biting was found to be the most common habit (65.5%) followed by lip sucking (42.7%), mouth breathing (28.6%), abnormal swallowing pattern (22.7%) and thumb sucking (13.2%). Positive association exist between deleterious oral habits and malocclusions; however, there is no significant relationship between the type of oral habit and malocclusions.
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Introduction:: Soft-tissue analysis has become an important component of orthodontic diagnosis and treatment planning. Photographic evaluation of an orthodontic patient is a very close representation of the appearance of the person. The previously established norms for soft-tissue analysis will vary for different ethnic groups. Thus, there is a need to develop soft-tissue facial profile norms pertaining to Indian ethnic groups. Aim and objectives:: The aim of this study is to establish the angular photogrammetric standards of soft-tissue facial profile for Indian males and females and also to compare sexual dimorphism present between them. Materials and methods: The lateral profile photographs of 300 random participants (150 males and 150 females) between ages 18 and 25 years were taken and analyzed using FACAD tracing software. Inclusion criteria were angles Class I molar occlusion with acceptable crowding and proclination, normal growth and development with well-aligned dental arches, and full complements of permanent teeth irrespective of third molar status. This study was conducted in Indian population, and samples were taken from various cities across India. Descriptive statistical analysis was carried out, and sexual dimorphism was evaluated by Student's t-test between males and females. Results: The results of the present study showed statistically significant (P < 0.05) gender difference in 5 parameters out of 12 parameters in Indian population. Conclusion: In the present study, soft-tissue facial measurements were established by means of photogrammetric analysis to facilitate orthodontists to carry out more quantitative evaluation and make disciplined decisions. The mean values obtained can be used for comparison with records of participants with the same characteristics by following this photogrammetric technique.
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Aim: To measure the vertical linear cephalometric dimensions of the anterior and posterior segments of the craniofacial complex and establish ratios between vertical linear dimensions in subjects with normal occlusion, pleasing profile, and facial harmony. Setting and Sample Population: Department of Orthodontics, Saveetha University. Lateral cephalograms of 120 subjects of both sexes in the age group of 17-28 years with normal occlusion belonging to Chennai, India. Materials and Methods: The vertical segments measured are anterior maxilla, posterior maxilla, and ramus-cranial floor vertical. The facial heights were measured in the anterior and posterior region of the craniofacial complex. Establish ratios and proportions between the vertical segments and different facial heights. Results: In both the sexes, the ratio between anterior maxilla, posterior maxilla, and ramus-cranial floor vertical is 1:1:1, PTFH:ATFH is 1:1, AUFH:ATFH is 2:5, ALFH:ATFH is 3:5, PUFH:PTFH is 1:2, PLFH:PTFH is 1:2, AUDH:ALDH is 2:3, and facial depth is 2:1. PUDH:PLDH is 7:9 in females and 3:4 in males. There was a statistically significant difference in posterior total facial height:anterior total facial height ratio between the two sexes with a "P" value of 95%. Conclusion: Thus, the anterior maxilla, posterior maxilla, and cranial floor-ramus vertical composite are in dimensional balance in subjects with normal occlusion and facial harmony. This analysis helps to identify skeletal deviations in size and position in the vertical dimension and allows the clinician to outline an appropriate treatment.
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Objective: The aim of this study was to determine the prevalence of malocclusion and orthodontic treatment need in 13–18-year-old schoolchildren of Nalagarh, Himachal Pradesh, India using the Index of Orthodontic Treatment need (IOTN) and to analyze the treatment needs between males and females and correlation between the esthetic component (AC) and dental health component (DHC) of IOTN. Subjects and Methods: The sample comprised 2000 school children (1125 females and 875 males) who had not undergone orthodontic treatment. No radiographs, study casts, were used; IOTN was calculated from clinical examination. Results: DHC results showed that little need for orthodontic treatment was found in 31.6% and moderate need in 30.85%. A great need was estimated at 37.55%. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by increased overjet, impeded eruption of teeth, and anterior or posterior cross bite. AC results showed that little need for orthodontic treatment was in 86.15%, moderate need in 8.90%, and great need in 4.95%. Limitations: Index does not consider midline discrepancy, soft tissue abnormalities, and AC does not include Class III and Class II div 2 malocclusion photographs. Conclusions: There seems a discrepancy in the proportion of children needing orthodontic treatment on esthetic and dental health grounds. This study provides baseline data on the need and demand for orthodontic treatment among the sample which is important for planning public orthodontic and dental services.