International Journal of Clinical Pediatric Dentistry

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2021 | Special Issue (Pediatr Orthodont) | Volume 14 | Issue S1

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Guest Editorial

Srikrishna Chalasani


[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:1] [Pages No:S1 - S1]

   DOI: 10.5005/jp-journals-10005-2052  |  Open Access | 


Guest Editorial

Joby Peter

Change is Inevitable Progress is Optional

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:2] [Pages No:S2 - S3]

   DOI: 10.5005/jp-journals-10005-2051  |  Open Access | 



Hemant Garg, Kailash Kaldhari, Kanika Singh, Priyanshi Purwar, Rashmi Rukshana

Intermolar and Intercanine width Changes among Class I and Class II Malocclusions Following Orthodontic Treatment

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:6] [Pages No:S4 - S9]

Keywords: Class II malocclusion, Index for orthodontic treatment need, Malocclusion

   DOI: 10.5005/jp-journals-10005-2049  |  Open Access | 


Introduction: Arch width discrepancy is important to predict treatment outcome as it affects the space availability and stability of dentition. Negligence to maintain arch form has been recognized as a prime cause of relapse. Aim and objective: To assess the differences in intermolar and intercanine distances among class I, class II division 1, and class II division 2 malocclusion following orthodontic treatment. Materials and methods: The study was performed on models of pre- and posttreatment from records of 100 patients visiting the Department of Orthodontics, MMCDSR using a digital Vernier caliper to measure intermolar and intercuspid distance. The sample comprised of both male and female patients of age group 14–25 years divided into three different groups, group I—class I malocclusion, group II—class II division 1 malocclusion, and group III—class II division 2 malocclusion. The results obtained were subjected to statistical analysis. Group II showed higher pretreatment intercanine width than group I whereas group III had lower pretreatment intercanine width than both group I and group II. Group I showed higher pretreatment intermolar width than group II. Pretreatment intercanine width was higher in group II compared with group I whereas it was lower for group III when compared with group I for the mandible.



Savitha Satyaprasad, Hurlihal Sharath Chandra, Ambili Raj, Nandan Suresh

A Comparative Evaluation of the Dentoskeletal Treatment Effects Using Twin Block Appliance and Myobrace System on Class II Division I Malocclusion

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:8] [Pages No:S10 - S17]

Keywords: Class II malocclusion, Myobrace system, Myofunctional, Twin block

   DOI: 10.5005/jp-journals-10005-2013  |  Open Access | 


The study aimed to evaluate the dentoskeletal effects of twin block appliance and myobrace system in treating skeletal Class II Division I malocclusions in growing children taking into account the effects of normal growth in an untreated control group. Twenty subjects with Class II Division I malocclusion considered as study group were allocated randomly to two treatment groups of 10 each, consecutively treated with twin block appliances (mean age 10.850 ± 1.37 years) and myobrace system (mean age 10.40 ± 1.89 years). Ten children (mean age 10.60 ± 1.77 years) with untreated Class II Division I malocclusion were considered as a control group to eliminate possible growth effects. At the start of the treatment and end of the observation period of 18–24 months, lateral cephalograms were taken. All the angular and linear parameters measured were subjected to statistical analysis. Twin block group subjects produced more measurable and statistically significant skeletal and dentoalveolar changes at the end of the observation period, demonstrated by correction of full cuspal Class II molar relationship to Class I molar relationship and yielding mandibular growth in increments greater in magnitude than the myobrace system. Meanwhile, the myobrace system-induced favorable dentoalveolar changes by a significant reduction of overjet. The retrognathic profile, however, improved in both the intervention groups as the upper lip protrusion, mentalis strain, and the lower lip curl were eliminated in striking contrast to the untreated control group. The study demonstrates that with appropriate patient selection both myobrace system and twin block appliances can be used in conjunction with the fixed appliance therapy to achieve more stable Class II corrections.



Reshmi Janardhanan, Anandaraj Soman, Ashok Sukumaran, Sheen A John

Evaluation of the Association of Oral Stereognosis with Malocclusion in Children

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:4] [Pages No:S18 - S21]

Keywords: Index of orthodontic treatment needs, Malocclusion, Oral stereognosis, Sensory-motor development

   DOI: 10.5005/jp-journals-10005-2050  |  Open Access | 


Aim and objective: To evaluate the association between oral stereognosis with malocclusion in children. Materials and methods: Stereognostic investigation was made with a set of seven different geometric configurations (circle, square, triangle, star, clover, diamond, and heart shapes) cut out from fresh, raw carrots using preformed iron molds. Any five of the seven geometric forms were randomly placed inside the mouth on the dorsum of the tongue by the investigator with the subject's eyes closed. A minimum of three shapes correctly identified out of the five offered to each child was considered as an indicator of the adequate stereognostic ability of that particular child. Results: Among the children under Index of Orthodontic Treatment Needs (IOTN) grade I group, 82.4% of children came under the positive response group. Among IOTN grades II, III, and IV, the percentages of children with positive responses were 72.1%, 58.1%, and 18.8%, respectively. There is a statistically significant (p < 0.001) decrease in positive response with increasing IOTN grades. Conclusion: The observations from the present study show that there is altered oral sensory perception in children graded as with malocclusion according to the index used and belonging to the age group selected in the study. Clinical significance: Sensory and motor components of the orofacial region, like any other part of the human body, are inseparable in their structure and function, the association between orofacial growth and development and sensory maturation cannot be overlooked.



Alok Singh, Monika Rathore, Somya Govil, Vinay Umale, Rohit Kulshrestha, Tushar Kolhe

Prevalence of Malocclusion and Orthodontic Treatment Needs in Primary and Mixed Dentition Using Baby Roma Index and Index of Orthodontic Treatment Needs

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:7] [Pages No:S22 - S28]

Keywords: Baby-ROMA Index, IOTN, Treatment need

   DOI: 10.5005/jp-journals-10005-2014  |  Open Access | 


Aim and objective: To find the prevalence of malocclusion and orthodontic treatment need in children of East Lucknow city. Materials and methods: The present study was conducted in the Department of Pedodontic and Preventive Dentistry, Babu Banarasi Das College of Dental Sciences, Lucknow. The nursery and primary schools of East Lucknow were included in the study. Baby-ROMA Index and Index of Orthodontic Treatment Needs (IOTN) were tested on 400 children, which were divided into two groups of 200 in each group, referred from the Out Patient Department and school camps. A single operator who was trained and calibrated for the use of indices evaluated children. Results: Intra-reliability test showed higher reproducibility of the index. It is shown that around 70% of the patient presented malocclusion from both indices. Conclusion: Baby-ROMA Index and IOTN were helpful to assess the severity of malocclusion and the timing for orthodontic malocclusion in young patients (primary and mixed dentition).



Tanuja Prabahar, Nithin Kumar Sonnahalli, Vundela Rajashekar Reddy

Comparative Evaluation of Occlusal Bite Force in Relation to the Muscle Activity in the Mixed Dentition Children of Age Group 9–12 Years: A T-scan Analysis

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:6] [Pages No:S29 - S34]

Keywords: EMG, Mixed dentition, Occlusal bite force, T-scan

   DOI: 10.5005/jp-journals-10005-2019  |  Open Access | 


Aim and objective: Compare and evaluate the muscle activity and the occlusal force between the mixed dentition boys and girls of 9–12 years. Materials and methods: The study included 15 boys and 15 girls. The occlusal force and activity of the masseter and temporalis muscle were measured with a T-scan device using a sensor, a module to transmit the signals to a computer and the complete data of the bite force and muscle activity with the EMG recordings and data were collected and evaluated. Results: Relative occlusal force in the primary and permanent molars between the boys and girls showed no significant difference on the left side compared to the right. The electromyography values of masseter and temporalis in boys and girls showed a significant difference in which (TAR and MMR), (TAR and MML), (TAL and MMR), and (TAL and MML) are significant. The overall paired sample statistics showed higher muscle activity in masseter. Conclusion: T-scan analysis has proved to be a dependable method for the evaluation of occlusal bite force with the muscle activity interpretation using EMG. This study concluded that there is a difference in the occlusal pattern and muscle activity in the mixed dentition that showed the maximum force was on the permanent molars and the symmetry of EMGs activity in children was on the right masseter comparatively with higher bite values in boys compared to girls. Clinical significance: T-scan is a computerized analysis system that helps in the proper assessment of the patient's occlusion and assists in the proper treatment planning and diagnosis accurately without much effort.



Jigar R Doshi, Preet Jain, Meetu Jain, Ambika Singh Rathore, Rahul N Gaikwad, LV Soujanya Nallamilli

Mount Vernon Index vs Yen Angle for Assessment of Anteroposterior Apical Jaw Base Relationship

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:4] [Pages No:S35 - S38]

Keywords: A-P skeletal relationship, Class I malocclusion, Mount Vernon Index, Yen angle

   DOI: 10.5005/jp-journals-10005-2020  |  Open Access | 


Aims and objectives: This research aimed to determine the predictability and variability of the Yen angle and Mount Vernon Index (MVI) in relation to the other four sagittal discrepancy parameters, as well as to evaluate and explain any correlations that exist. The Lateral Cephalograms of 100 Class I Indian participants aged 17–24 years were recorded. The lateral cephalograms were traced for six distinct AP characteristics, including ANB, Wits appraisal, facial convexity, and beta angle, Yen angle, and MVI. The gathered data were evaluated statistically using S.P.S.S. version 10. To determine the difference between males and females, an independent “t” test was used. The coefficient of variability and correlation methods were used to determine the correctness of the Yen angle and MVI, as well as the association between the variables. Results: The results of this study indicate that the most predictable and highly dependable parameter was the Yen angle (CV = 5.63), followed by the beta angle (5.63), the MVI (CV = 13.6), the ANB, Rickett's analysis, and Wit's analysis. Throughout all five analyses, the most statistically significant positive association between the MVI and the BETA angle was determined. Conclusion: The derived inferences from the study included the high reliability of the yen angle for assessing the AP skeletal patterns of a patient, followed by the beta angle and MVI.



Yasaman Bozorgnia, Shahin Mafinezhad, Pardis Pilehvar, Soheil Salari

Introducing a Removable Orthodontic Appliance and Its Effects on Dental Arch Dimensions

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:5] [Pages No:S39 - S43]

Keywords: Anterior dental crossbite, Malocclusion, Mixed dentition

   DOI: 10.5005/jp-journals-10005-2023  |  Open Access | 


Introduction: Guiding anterior crossbite to a normal position is one of the most important responsibilities of a pediatric dentist or orthodontist to gain both esthetic and function. Crossbite with dental etiology can be treated by a variety of appliances. We describe a removable appliance with a different spring design for proclination of more than one incisor in mixed dentition. Materials and methods: This study is an observational study that was performed on sixteen children, 7–11 years of age, who needed incisor proclination in more than one tooth. In this study, patients were followed until the end of their orthodontic therapy. The variables evaluated were the maxillary arch length, arch depth, intercanine distance, and intermolar distance in pre- and posttreatment. To assess intra-examiner reliability, 10 plaster models were randomly selected and re-measured. Results: In all the cases, the newly designed removable appliance was used and in all showed a significant increase in arch length, arch depth, intercanine distance, and intermolar distance. The correction was achieved within 1–9 months depending on the patient's compliance. Conclusion: There was a significant increase in all aspects of arch length and depth after using this appliance. The procedure is a simple and effective method that is recommended for compliant patients needing proclination of more than one anterior tooth; especially in dental class III, pseudo-class III patients, and the first phase of class II division 2 skeletal treatments.



Kimi Mittal, Mridula Trehan, Shantanu Sharma

Evaluation of Skeletal Maturation Using Mandibular 1st Premolar and 2nd Molar Calcification Stages: A Cross-sectional Radiographic Study

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:6] [Pages No:S44 - S49]

Keywords: Cervical vertebral maturity index, Demirjian system, Peak velocity of growth, Skeletal age

   DOI: 10.5005/jp-journals-10005-2027  |  Open Access | 


Aim and objective: The study aimed at, whether the calcification stages of mandibular 1st premolar and 2nd molar can be used to assess skeletal maturity. Materials and methods: Lateral cephalogram and OPG of 72 growing subjects with good health (38 girls and 34 boys; age-group of 8–17 years) were selected for a cross-sectional study, in which the identity of patients was not revealed to the investigator. The dental calcification stage of mandibular 1st premolar and 2nd molar were estimated in accordance with the Demirjian system (DI) and skeletal maturation was estimated according to cervical vertebral maturation index (CVMI) given by Hassel and Farman and these two indices were compared. Results: Chi-square test and Spearman rank-order correlation coefficient test showed that a significant relationship of mandibular 1st premolar and 2nd molar calcification stages with CVMI exists, for both males and females. In females, CVMI stage 2 showed maximum correlation to DI stage E of lower 2nd molar. In males, CVMI stage 2 showed maximum correlation to DI stage E of lower 1st premolar. Conclusion: The result of this study revealed that each stage developed prior in female subjects compared to male subjects and the calcification stages of lower 1st premolar and 2nd molar can be used to assess the peak of growth.



U Pooja, NK Lokesh, Rajkumar S Alle, Mayank Trivedi

A Study to Compare and Correlate the Status of Maturation in Growing Individuals Using Chronological Age Dental Maturation and Cervical Vertebrae Maturation

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:4] [Pages No:S50 - S53]

Keywords: Cervical vertebral maturation, Chronological age, Dental calcification stages, Skeletal maturity

   DOI: 10.5005/jp-journals-10005-2021  |  Open Access | 


Aim and objective: To compare and correlate the status of maturation in growing individuals using orthopantomograph (OPG) and lateral cephalogram to establish a reliable relationship between chronological age (CA) and dental maturation (DM) with cervical vertebrae maturation index (CVMI). Materials and methods: Lateral cephalometric radiographs and OPGs of 50 children within the circumpubertal period were collected (male n = 25, age 12–17 years, female n = 25, age 10–15 years) and evaluated for the status of maturation using CA, DM (of mandibular left canine and second molar using Demirjian Index-DI), and CVMI stages. Results: Chronological age shows a positive correlation with CVMI stages in both groups. Gender-based association and distribution between DI stages of canine and CVMI stages shows that in both male and female sample groups DI G correlates with CVMI stage 1 and 2, DI H correlates with CVMI stage 3. Gender-based association and distribution between DI stages of 2nd molar and CVMI stages show that in the male sample group DI E shows a higher correlation with CVMI stage 1, DI F shows a higher correlation with CVMI stage 1 and 2. DI G shows a higher correlation with CVMI stages 2 and 3. DI H shows a higher correlation with CVMI stage 3. In the female sample group, DI F shows a higher correlation between CVMI stage 1 and 2, DI G and F show a higher correlation with CVMI stage 3. Conclusion: Mandibular canine, second molar calcification stages, and CA show a positive correlation with CVMI stages in the present study, hence, this can be considered as a reliable indicator in skeletal maturity assessment.



FSA Angle: A Soft Tissue Approach for Assessing Sagittal Skeletal Discrepancy

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:3] [Pages No:S54 - S56]

Keywords: Anteroposterior relation, Cephalometric study, Malocclusion, Orthodontics, Soft tissue

   DOI: 10.5005/jp-journals-10005-2017  |  Open Access | 


Introduction: Lateral cephalograms are taken as a diagnostic aid for the evaluation of the anteroposterior relationships. The assessment of anteroposterior soft tissue relationships is by using skeletal points and cranial reference planes. The anteroposterior relationships are, however, clinically affected by soft tissue structures. In this pilot study, we aim to assess the anteroposterior relationships based on soft tissue landmarks. Materials and methods: Lateral cephalograms were collected from 100 patients and evaluated on Facad software. The subject consisted of a mean age of 20 ± 7 years. Fifty-four cephalograms selected were used to perform the analysis. A new angle FSA was measured based on soft tissue landmarks. A new plane used for this analysis is the SA plane. Using this angle, we classified the cephalograms as class I, II, and III. Results: There is a statistically significant value to differentiate the profile of patients using the FSA angle. Thus, this new angle is created to determine the anteroposterior soft tissue relationship using soft tissue landmarks on a cephalometric analysis and from our data, the value was 81 ± 7.57° for class 1 patients that is consistent with the previous studies which evaluate sagittal skeletal relationships. Conclusion: There are various difficulties and errors in the previous analysis that is used to determine the anteroposterior jaw relations. Skeletal landmarks have been used previously and most of these points are not stable points. Thus, this new analysis that will be using soft tissue landmarks can be used to differentiate in the various profiles of patients with different malocclusions.



Saumya Paul, Megha Chawla, Siji E Saji

Arch Measurements, Bigonial Width, Dental Caries, and Their Effect on Occurrence of Mandibular Incisors Crowding in Early Mixed Dentition Period

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:6] [Pages No:S57 - S62]

Keywords: Available space, Mandibular incisor crowding, Mixed dentition, Total incisor width

   DOI: 10.5005/jp-journals-10005-2018  |  Open Access | 


Aim and objective: To assess the effect of various arch parameters, bigonial angle, and caries occurrence on mandibular incisors crowding during the early mixed dentition period. Materials and methods: Sixty children (mean age of 7.5 years) with mandibular anterior incisors crowding and class I molar relationship in early mixed dentition were selected. Bigonial width (BW) and caries occurrence were recorded during patient examination. The study casts were prepared divided into a normal group (NG) and crowded group (CG). Different vertical and transverse arch perimeters along with space available for the permanent mandibular incisors were measured manually. Statistical analysis was done to establish the association of all these variables with two crowding groups. Results: The total incisor width or the tooth material was significantly more, and all arch parameters were less in measurements in CG than NG. The available space, BW, and caries occurrence did not differ significantly between NG and CG. Conclusion: The amount of tooth material and individual variations in arch parameters significantly contribute to mandibular anterior crowding in the early mixed dentition period irrespective of the age and gender of the child. Clinical significance: All cases of early mixed dentition mandibular incisors crowding should be individually assessed for arch length discrepancy, and transverse discrepancy results of this study help in the prediction of crowding before an establishment of a customized treatment plan with the use of lingual arch or lip bumper appliances in patients with anterior mandibular crowding may be valuable.



Manisha Tyagi, Vivek Rana, Nikhil Srivastava, Noopur Kaushik, Vidisha Gaur

Comparison of the Conventional Band and Loop Space Maintainers with Modified Space Maintainers: A Split-mouth Randomized Clinical Trial

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:6] [Pages No:S63 - S68]

Keywords: Band and loop, Bonded space maintainer, Nikhils appliance, Space maintainers, Tube and loop

   DOI: 10.5005/jp-journals-10005-2046  |  Open Access | 


Aim and background: Space maintainers (SMs) are used to preserve space created by premature loss of primary teeth. The most commonly used band and loop (B&L) SMs have several demerits, e.g., non-functional, poor gingival health, limited survival, laboratory work for fabrication and multi-sitting procedure, etc. This study aimed to compare the efficacy of conventional B&L SMs with conventional tube and loop (CTL), bonded tube and loop (BTL) and bonded B&L in terms of gingival health, survival time, and patients’ and parents’ satisfaction. Materials and methods: Fifteen children between 4 years and 8 years of age with at least two fresh extraction sites of primary molars contra- or bilaterally in each child (total 30 fresh extraction sites) were included in the study. Conventional B&L on one site while bonded loop (BL)/CTL or BTL on the other site were delivered, based on random allocation. An evaluation was done at 1st, 3rd, 6th, and 9th months for survival time, gingival health, and patients’/parents’ satisfaction. Results were statistically analyzed using independent t-test and Chi-square test under SPSS version 20.0 software. Results: 100% B&L and CTL while only 60% BL and 80% BTL survived till the end of the study. For gingival health, statistically significant differences were obtained at 1st, 3rd, 6th, and 9th month's intervals (p < 0.05) when CTL was compared with B&L, BL, and BTL. In terms of patients’ acceptance, all the SMs were well accepted by the patients. However, on the intergroup comparison, patients’ acceptance was higher with bonded SMs. Conclusion: Conventional tube and loop SMs were found to be most efficacious in terms of survival time, gingival health, and patients’ satisfaction. Clinical significance: To find a better alternative for the conventional B&L SMs.



Kiran GS Dhanotra, Rupinder Bhatia

Digitainers—Digital Space Maintainers: A Review

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:7] [Pages No:S69 - S75]

Keywords: 3D printing, CAD/CAM, Digital technology, Pediatric dentistry, Space maintainers

   DOI: 10.5005/jp-journals-10005-2040  |  Open Access | 


To summarize the limitations of commonly used space maintainers (SMs) and provide an insight into the field's technological advances to overcome them, this review was conducted. With the rapid advancement of digital technologies, there is always something new to learn while also redefining the current fads. Digital workflow is not a new concept in dentistry, but it has only just begun to be used in pediatric dentistry. The curiosity to explore has led to the development of digital devices as SMs. They appear potential for usage in children because of their impressive advantages of precision, comfort, and a time-saving approach. This workflow helps lessen fear and improve children's cooperation and enthusiasm for dental appointments by cutting down on chairside time and shortening procedures.



Sunita Shrivastav

Effect of Lingual Arch Space Maintainer on the Position of Mandibular Molars and Incisors in the Vertical Direction during the Resolution of Mandibular Incisors Crowding: A Systematic Review of Clinical Trials in Humans

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:6] [Pages No:S76 - S81]

Keywords: Fixed lingual arch, Passive lingual arch, Space maintainer

   DOI: 10.5005/jp-journals-10005-2039  |  Open Access | 


Introduction: This systematic review was designed to define and measure the changes in the position of mandibular molars and incisors in the vertical direction while using a lingual arch appliance as a space maintainer. Materials and methods: The source of data collection used was PubMed, Medline, Cochrane Central, and Cochrane Database of Systematic Reviews for articles published until March 2021. Inclusion criteria: Studies on human subjects in the English language using either prospective or retrospective methods considering the effect of the lingual arch used as a space maintainer in the mandibular arch. Results: Four out of 465 studies acknowledged in the literature search met the final inclusion criteria. Conclusion: A lingual arch is an effective appliance for controlling the position of mandibular molars and incisors in the vertical direction.



Henpu Kamki, Hemraj Badhe

Clinical Effectiveness of Fiber-reinforced Composite Space Maintainer and Band and Loop Space Maintainer in a Pediatric Patient: A Systematic Review and Meta-analysis

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:12] [Pages No:S82 - S93]

Keywords: Band and loop space maintainer, Fiber-reinforced composite space maintainer, Primary dentition, Space maintainer, Systematic review

   DOI: 10.5005/jp-journals-10005-2044  |  Open Access | 


Background: Objectives: This systematic review aimed to evaluate the clinical effectiveness of fiber-reinforced composite space maintainer (FRCSM) and band and loop space maintainer (BLSM) in a pediatric patient. Materials and methods: Eligibility criteria: Randomized controlled trials (RCTs) were conducted on 3–12-year-old children who received FRCSM and BLSM. Information sources: Literature search of electronic databases such as PubMed, Cochrane, and Google Scholar for the time period of 2000 to October 2020. Risk of bias: Cochrane collaboration's risk of bias tool was used to assess the risk of bias. Results: Included studies: The search resulted in 147 published studies. After the removal of duplicate studies and full-text analysis, eight studies were selected. Synthesis of results: Fiber-reinforced composite restoration (FRCSM) was judged to be good for short-term space maintenance with good esthetics, less time-consuming, and good patient and parental acceptance. Meta-analysis was done for failure rate at 6 months and 12 months. After 6 months, the FRCSM group showed less failure, with a risk ratio of 0.83 (95% CI = 0.47–1.49; Z value = 0.61). However, after 12 months, the FRCSM group showed more failure, with a risk ratio of 1.30 (95% CI = 0.04–4.23; Z value = 0.44). Description of the effect: FRCSM performed better than BLSM for a short-term, i.e., around 6 months but after 12 months of space maintainer placement BLSM performed better than the FRCSM. Discussion: Strengths and limitations of evidence: The strength of this systematic review is its complete adherence to the PRISMA statement 2009. This review attempted to evaluate the effectiveness of FRCSM when compared with BLSM which has not been evaluated before. Additionally, only RCTs were included in this review adding to its validity. This review also included a meta-analysis that compared the failure rate at the 6th and 12th month. The main shortcoming of this systematic review is the limited number of databases searched and the limited number of existing studies. Interpretation: Within the limitations of this review, it can be stated that the FRCSM is an effective space maintainer for short-term space maintenance. However, it is necessary to conduct more RCTs with larger sample size, preferably using a split-mouth design to improve the longevity of FRCSM. Additionally, it is also necessary to standardize the technique of fabrication of FRCSM since an existing study showed high heterogeneity in the technique of fabrication. Other: Funding: None. Registration: The protocol of this systematic review was registered on PROSPERO (ID-CRD42020165831).



Chandrashekar M Yavagal, Sucheta P Matondkar, Puja C Yavagal

Efficacy of Laser Photobiomodulation in Accelerating Orthodontic Tooth Movement in Children: A Systematic Review with Meta-analysis

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:7] [Pages No:S91 - S97]

Keywords: Laser, Meta-analysis, Movement, Orthodontic, Photobiomodulation

   DOI: 10.5005/jp-journals-10005-1964  |  Open Access | 


Aim and background: This systematic review aimed to investigate the efficacy of laser photobiomodulation (PBM) on the acceleration of orthodontic tooth movement (OTM). Review methods: The study protocol was registered at PROSPERO (CRD42019121465). An extensive electronic search for randomized control trials and clinical control trials via Medline (via PubMed), The Cochrane Controlled Clinical Trials Register, and Scopus up to date 24/02/2019 was done. Hand searching was performed for relevant journals. Reference articles were retrieved and exported to Mendeley Desktop 1.13.3 software. The risk of bias was assessed using the Cochrane risk of the bias assessment tool. Articles were further analyzed using Revman5.3 software. Results: A total of 14 articles were considered for systematic review and 9 articles were considered for meta-analysis. The results of the meta-analysis showed a significant difference between the laser group and conventional orthodontic treatment with Forest plots showing more tooth movement in the laser group compared to the control group in 2–3 months (mean difference = 1.73; CI: 0.9–2.57; p = 0.00001; I2 = 89 %). Conclusion: Although the analysis of the results shows that laser PBM favors OTM, the results are inconclusive as the heterogeneity across studies was high. Clinical significance: Laser PBM may be considered as novel, safe, and noninvasive adjuvant therapy for the acceleration of OTM in children.



Pi-Shan Lai, Claudia Fierro, Lorena Bravo, Antonieta Perez-Flores

Benefits of Using Low-level Laser Therapy in the Rapid Maxillary Expansion: A Systematic Review

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:6] [Pages No:S101 - S106]

Keywords: Low-level laser, Low-level laser therapy, Rapid maxillary expansion and osteogenesis distraction

   DOI: 10.5005/jp-journals-10005-1966  |  Open Access | 


Aim and objective: Determine the benefits of low-level laser therapy (LLLT) as a complement to rapid maxillary expansion (RME), through a systematic review. Background: Transversal maxillary compression is a common skeletal problem that can be treated with different devices. This RME technique consists of the separation and regeneration of the midpalatal suture. Low-level laser therapy has been suggested to be able to accelerate bone healing after trauma or bone defects. Review results: Thirty-two publications were found by electronic search during July to August of 2019 on Medline (PubMed) and Google Scholar, using the terms “Low-Level Laser”, “LLLT”, “Rapid Maxillary Expansion”, and “Osteogenesis Distraction”. Only 16 were used (2 systematic reviews, 6 articles on humans, and 8 on animals). Even though all the studies had different intervention protocols, they all revealed that LLLT has the effect of accelerating bone regeneration after RME. Conclusion: The use of LLLT as a complement to RME has shown promising results with cellular biostimulation, promoting angiogenesis and bone regeneration of the midpalatal suture. Clinical significance: This study provides scientific evidence of the benefits of using LLLT as a complement to RME during orthopedic and orthodontic treatments, accelerating bone regeneration and reducing the time of consolidation of the maxillary.



Ajit V Parihar, Kavin Prasanth Angamuthu, Rojalin Sahoo, Shivam Verma

Management of Asymmetric Mandibular Retrognathia with Differential Loading Technique: A Case Report

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:7] [Pages No:S107 - S113]

Keywords: Asymmetry, Congenital torticollis, Differential loading, Fixed functional appliance, Mandibular retrognathia, Plagiocephaly, PowerScope 2

   DOI: 10.5005/jp-journals-10005-1969  |  Open Access | 


Class II malocclusion cases possess a constant challenge to orthodontists since time immemorial. Mandibular retrusion is the most common feature of class II malocclusion, rather than maxillary prognathism. Association of class II with asymmetry, a condition called asymmetric mandibular retrognathia (AMR), gives a tougher challenge to orthodontists for management. The following case presents effective management of AMR using differential loading technique. A young boy aged 12 years presented with mandibular retrognathia associated with facial asymmetry. He was treated with a differential force loading technique using a fixed functional appliance. Results: Improved facial profile with increased mandibular length achieved. A significant reduction in facial asymmetry was also appreciable. Conclusion: Differential force loading technique using fixed functional appliance while being least troublesome for the patient may prove beneficial to harness excellent and satisfactory results with minimal efforts in such cases of mandibular retrusion with facial asymmetries and also decrease the need for surgical correction.



Louis S Simon, Udaya Kumar Deepika, Shilpa Philip, Choondathodi Jishad

Quad Helix—A Versatile Appliance in Pedodontist's Arsenal: A Case Series

[Year:2021] [Month:Special Issue (Pediatr Orthodont)] [Volume:14] [Number:S1] [Pages:3] [Pages No:S114 - S116]

Keywords: Interceptive orthodontics, Quad helix, Slow maxillary expansion

   DOI: 10.5005/jp-journals-10005-2045  |  Open Access | 


This case series aims to elaborate and discuss the use of the quad helix, a type of slow maxillary expansion appliance in the mixed dentition period in three different clinical scenarios. Especially, in the field of pediatric dentistry, mixed dentition is the most critical stage in the development of occlusion and any malocclusion that can be corrected by the simple appliance in this stage is recommended. The appliance selection is one of the most important steps in the process of treatment planning to obtain the desired result.


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