Raj AT, Patil S, Sarode SC, Sarode GS. Is Oral Verrucous Hyperplasia a Distinct Entity or a Precursor of Oral Verrucous Carcinoma? World J Dent 2017;8(4):247.

Gingival recession is characterized by apical positioning of the gingival side in relation to the cementoenamel junction. Thus, this study aimed at evaluating the effectiveness of two surgical techniques for root coverage in patients with gingival recession of Miller class I or II.

A total of 13 patients were selected, from the age group of 20 to 50 years, with bilateral gingival recession Miller class I or II, totaling 34 recessions. When the basic periodontal treatment was accomplished, every recession was included in one of both selected groups according to the surgical technique: Control group—Subepithelial connective tissue graft associated with coronally positioned flap technique and test group—Subepithelial connective tissue graft associated with the modified envelope technique. Patients were evaluated for 180 days, and the periodontal parameters were analyzed in 0, 90, and 180 days.

The results showed that both surgeries were effective since they kept probe depths with periodontal health and clinical attachment gain (p < 0.05) in both groups, up from 90 days. The reduction was kept for 180 days, mainly for the control group that showed a clinical attachment gain that was still statistically significant at 180 days (p < 0.05). Regarding the root coverage, the control group showed a 90.2% of coverage while the test group showed 89.5%.

Thus, it can be concluded that both techniques, after 180 days, were effective for the health of periodontal tissues; however, a greater emphasis can be observed on the subepithelial connective tissue graft-associated coronally positioned flap technique because this technique demonstrated a greater significant gain in the clinical attachment level.

The subepithelial connective tissue graft is used for gaining the clinical attachment level in the root coverage of patients with gingival recession Miller classes I and II.

Spada VJ, Nassar PO, Cardoso N, Caldato KMB, Pandini JH, Randon DM, Nassar CA. Root Coverage in Miller Classes I and II associated with Subepithelial Connective Tissue Graft: A comparative Clinical Trial of Two Techniques. World J Dent 2017;8(4):248-254.

To evaluate the effects of energy drinks on glass ionomers (GI) restorative materials color stability after different periods of aging time.

Glass ionomers disks, 8 mm diameter, 3 mm thickness within Teflon beverages are Code Red, Red Bull, and Power Horse. Specimens were tested for aging in beverages (Code Red, Red Bull, and Power Horse). The distilled water was used as a control. The variations in color were evaluated in the CIELAB [CIE L*a*b* (CIELAB) is a color space specified by Commission International de Eclairage (CIE)] using a colorimeter pre- and post-storage period. Color differences (ÄE*ab, Äb*) in each specimen were recorded. The t-test analysis was performed (p < 0.05 was considered as significant).

The color changes by Code Red, Red Bull, and Power Horse energy drinks were significantly different for all tested materials (p < 0.05). Each specimen exhibited total color changes toward yellowness, after a period of 1, 7, and 30 days. The greatest color difference (ÄE*ab) was observed in the case of Red Bull group following 1 week.

The energy beverages affected the color stability of tested GI restorative materials with the increase of aging time. The effect on the color stability of GI was influenced by factors, such as the type of solution and the presence of the acids causing erosion.

Glass ionomer is used as cosmetic filling material. Energy beverages have erosive effect on glass ionomer which influences clinical importance by influencing on mastication and TMJ problem.

Al-Samadani KH. Glass Ionomer Restorative Materials Response to Its Color Stability with Effect of Energy Beverages. World J Dent 2017;8(4):255-261.

The aim of this study was to examine the effect of in vivo air-powder polishing on the surface roughness and topography of aged orthodontic stainless steel arch wires.

A total of 20 stainless steel arch wires were used in this study. Ten wires (experimental) were aged and exposed to air-powder polishing, and 10 wires asreceived from the manufacturer served as the controls. The experimental group of wires was aged in the patient's oral cavity for an average of 5.3 ± 2.7 months. An air-powder polishing system was used to remove external stains and plaque deposits. The powder was sodium bicarbonate. The surface topography measurements were performed using an optical profilometer. Following the profilometer analysis, a scanning electron microscope (SEM) was used to evaluate the experimental and control arch wires.

The average roughness (Sa) of the experimental upper and lower surfaces exposed to air-powder polishing was significantly higher than the control arch wires (p < 0.01). The root mean square of the surface topography (Sq) and the 10-point height of the surface topography (Sz) were significantly higher on the upper and lower surfaces of the experimental arch wires compared with the controls (p < 0.05 and <0.01 respectively). The SEM photomicrographs of the experimental and control arch wires indicated that the experimental arch wires were pitted and filled with surface impurities.

An air-powder polishing system using sodium bicarbonate powder alters the surface topography and increases the surface roughness of aged orthodontic arch wires in vitro.

The air-powder polishing system used along with scaling alters the surface roughness of orthodontic wire.

Talic NF. Effect of Air-powder Polishing on the Surface Topography of Orthodontic Stainless Steel Wires. World J Dent 2017;8(4):262-266.

The aim of the study was to evaluate and compare the clinical probing and cone beam computed tomography (CBCT) imaging technique for examination of the furcation involvement with the true level of involvement seen during open flap surgery (OFS).

The study included 22 patients (50 molar teeth) who met the inclusion and exclusion criteria with at least one molar tooth with grade II or III furcation involvement. After phase I therapy, furcation involvement was measured using both clinical probing and CBCT imaging technique. The measurements obtained during the OFS were then compared with those obtained by clinical probing and CBCT. To avoid bias, the assessments of furcation involvement by all three techniques were done by three different examiners.

The agreement in the furcation gradings between clinical and CBCT findings gave a Cohen Kappa value of 0.03 [statistically insignificant (p = 0.80)] and between clinical and open surgical measurements gave a Cohen Kappa value of 0.11 [statistically insignificant (p = 0.38)]. However, agreement in the furcation gradings between CBCT and open surgical measurements gave a Cohen Kappa value of 0.89 and it was statistically significant (p = 0.001).

Thus, the results indicated that there was the highest agreement between measurements obtained using CBCT imaging technique and true level of involvement seen during OFS (89%) when compared to clinical and OFS measurements (11%) and clinical and CBCT measurements (3%).

Thus, CBCT can be considered as an efficient diagnostic tool to accurately assess osseous defects at furcation sites when compared to clinical probing.

Aghanashini S, Jayachandran C, Mundinamane DB, Nadiger S, Bhat D, Andavarapu S. Comparison of the Furcation Involvement by Clinical Probing and Cone Beam Computed Tomography with True Level of Involvement during Flap Surgery. World J Dent 2017;8(4):267-272.

Dentofacial injuries are usually the result of sporting activities, falls at home, road traffic accidents, fights, or intentional assaults. Tooth avulsion among the victims of such accidents is quite common. Soon after the accident, most victims seek help from medical professionals.

This study was designed to evaluate the knowledge, attitude, and practice of emergency management of avulsed teeth among medical students in Melaka, Malaysia, and the need to include dental trauma emergency management as a part of their undergraduate training.

A self-administered questionnaire was distributed among medical students to gather data on their profile and self-assessed perceived knowledge of dental avulsion and its emergency management.

Of the 190 students, 187 (98.4%) had low knowledge and 3 (1.6%) had some knowledge on the emergency management of tooth avulsion.

Medical students in Melaka have low knowledge regarding dental avulsion and its emergency management. Therefore, it is recommended to introduce dental trauma emergency management as a part of their undergraduate training.

Introducing dental trauma emergency management as a part of the medical curriculum can help educate and train the students to be competent future medical professionals with sound knowledge on first-aid management of avulsed teeth. They would be able to act efficiently and effectively, thereby reducing the extra-alveolar time and, hence, contributing to the better prognosis of such teeth.

Varghese E, Zhen-Ying JN, Law LL, Samson RS, Soe HHK. Knowledge, Attitude, and Practice of Emergency Management of Tooth Avulsion among Medical Students in Melaka, Malaysia: A Cross-sectional Study. World J Dent 2017;8(4):273-280.

This study was designed to compare the efficiency of conebeam computed tomography (CBCT) with panoramic radiography to discern external root resorption (ERR) in second molars.

This was a retrospective study with a sample size of 50 participants who had a total of 120 impacted third molars visible on panoramic radiographs and CBCT images. The presence of ERR on the neighboring second molar was assessed and the position of impacted third molar was determined using Pell and Gregory classification. The ERR was registered according to Al-Khateeb and Bataineh's criteria. The location and severity were assessed by Ericson et al criteria, and grading of ERR was done as per the criteria given by Nemcovsky.

The CBCT was able to locate and identify extremely large number of cases with ERR on second molars in comparison with the panoramic radiographs. Based on Pell and Gregory classification, position B was most common. The ERR on second molars was most commonly seen at the cervical region. Most of the cases had mild severity. As per grading mentioned by Nemcovsky, maximum number of cases were given grade A followed by grade B.

According to our study and considering the threedimensional information obtained from CBCT, we found that ERR was better detected with CBCT.

If on panoramic radiographs, a close contact is detected between the second molar and an impacted third molar, CBCT can be advised taking into account the “risk vs reward ratio.”

D'Costa ZV, Ahmed J, Ongole R, Shenoy N, Denny C, Binnal A. Impacted Third Molars and Its Propensity to stimulate External Root Resorption in Second Molars: Comparison of Orthopantomogram and Cone Beam Computed Tomography. World J Dent 2017;8(4):281-287.

Adhesion of bacteria, especially Streptococcus mutans (S. mutans), to the surface of tooth restorations is a factor in the etiology of secondary caries. Given the ever-increasing popularity of bleaching procedures, the aim of the present study was to evaluate adhesion of S. mutans and surface roughness (SR) of microhybrid composite resin and giomer subsequent to the application of 15% carbamide peroxide.

Twenty disk-shaped samples were prepared from each material, measuring 8 mm in diameter and 2 mm in thickness. Then, the samples of each material were divided into two groups (n = 10): (a) microhybrid without bleaching; (b) microhybrid with bleaching; and (c) giomer without bleaching; and (d) giomer with bleaching. The samples in groups I and III were immersed in artificial saliva for 14 days without any bleaching procedure; the samples in groups II and IV underwent a bleaching procedure on their polished surfaces with 15% carbamide peroxide for 14 days (4 hours of bleaching and 20 hours of immersion in artificial saliva). The SR of all the samples was determined with the use of a profilometer. The samples were added to the culture medium after 4 hours of placement in a microbial suspension at 37°C; after 24 hours of incubation at 37°C, the bacterial counts, indicating the number of bacteria adhering to the surface, were determined by counting them in the plates containing the solid culture medium.

The type of the restorative material had a significant effect on SR, with greater SR in giomer (p = 0.03). However, bleaching had no significant effect on SR (p = 0.099). In relation to the rate of bacterial adhesion (BA), both the types of the restorative materials and bleaching procedures were significantly effective; in this context, there was more BA in microhybrid composite resin samples that did not undergo bleaching (p < 0.001). Bleaching resulted in the adhesion of S. mutans to the surface of both materials decrease. Pearson's correlation coefficient did not reveal any correlation between BA and SR (p = 0.42).

The BA was higher in microhybrid composite resin, and SR was higher in giomer. The BA was higher in samples that did not undergo a bleaching procedure.

There is no change in the SR of microhybrid composite resin and giomer after application of 15% carbamide peroxide; therefore, it is not necessary to polish or replace these restorative materials after bleaching. In addition, use of 15% carbamide peroxide does not increase caries risk.

Mohammadi N, Mowlaie S, Savadi- Oskoee S, Ebrahimi ME, Rikhtegaran S, Rahbar M, Pirzadeh T. Effect of 15% Carbamide Peroxide on the Surface Roughness and Adhesion of Streptococcus mutans to Microhybrid Composite Resin and Giomer. World J Dent 2017;8(4):288-295.

The aim of this study is to compare whether there are differences in the value content of secondary metabolites (saponins, tannins, and flavonoids) between the group treated with Binahong leaves (administration of colchicines) and the group treated with Binahong leaves without the application of colchicines.

The design of this study is an experimental research laboratory study. This research was done in four different places in which colchicines were applied to improve the quality of Binahong, conducted in the USU Agricultural Faculty's Greenhouse, whereas no application of colchicines was done in the Desa Simpang Pergendangan Kelurahan Tiga Binanga Kabupaten Karo harvesting Binahong plant. The pharmacy faculty of USU was chosen as a place to obtain the extract and the Laboratory of the Research Institute for Spices and Medicinal Plants (Balitro) was where the phytochemical analysis was conducted.

The results showed that there were differences in the descriptive values of secondary metabolites in the Binahong leaf extract, such as saponins, tannins, and flavonoids, wherein the group with colchicines was higher than groups without colchicines, but there was no statistical differences between the groups treated with colchicines and those not treated with colchicines (value p > 0.05).

Administration of colchicines can improve the content of secondary metabolites in Binahong leaf extract and the plant morphology without affecting the content of the plant extract.

Secondary metabolites in herbal plants, such as saponins, flavonoids, and tannins are able to speed up the healing process. One of the plants that have all three of these active compounds is Binahong (Anredera cordifolia). Binahong leaf extract can stimulate the process of fibroblasts and collagen formation that will accelerate the process of wound healing. Colchicine as a reagent for the mutation is able to affect the number of leaves and morphological characteristics of the Binahong plant.

Hanafiah OA, Hanafiah DS, Bayu ES, Abidin T, Ilyas S, Nainggolan M, Syamsudin E. Quantity Differences of Secondary Metabolites (Saponins, Tannins, and Flavonoids) from Binahong Plant Extract (Anredera Cordifolia (Ten.) Steenis) treated and untreated with Colchicines that play a Role in Wound Healing. World J Dent 2017;8(4):296-299.

To determine the actual position of point A by performing incisor inclination correction in class II division 2 and class III. Also, to determine the relation between the degree of incisor inclination correction and anteroposterior movement of point A by studying pre- and postalignment lateral cephalograms.

The pre- and postalignment lateral cephalograms of 33 class II division 2 and 33 class III patients treated orthodontically were traced manually and analyzed. The linear anteroposterior measurements of point A and center of rotation in relation to the vertical reference plane and angular measurements of upper incisor to maxillary plane were calculated.

In class II division 2 category, the mean change in inclination from pre- to postalignment was 15.27°, mean change in position of center of rotation was -1.29 mm, and mean change in position of point A from pre- to postalignment was -2.67 mm. In class III category, the mean change in inclination from pre- to postalignment was -5.85°, mean change in position of center of rotation from pre- to postalignment was 1.94 mm, and mean change in position of point A from pre- to postalignment was 1.77 mm.

The results of the study confirmed that for every 10° proclination of the upper incisor in class II division 2, point A moves 0.3 mm palatally and for every 10° retroclination of the upper incisor in class III, point A moves 0.73 mm labially.

In the clinical scenario of severely retroclined/proclined incisors, point A cannot depict the actual anterior limit of maxilla. Hence, when we use SNA to determine the anteroposterior position of maxilla and ANB to determine maxillomandibular difference, invariably we get altered values. Therefore, it is necessary to find an equation between the degree of incisor inclination correction and anteroposterior movement of point A.

Shivamurthy PG, Krishnamurthy S, Mehta P, Mathew S. Equation between Incisor Inclination Correction and Anteroposterior Movement of Point A to determine the Actual Magnitude of Maxillomandibular Difference. World J Dent 2017;8(4):300-303.

The aim of this study was to assess the association of dental caries and dental anomalies among 5- to 15-year-old children with cleft lip and cleft palate.

A cross-sectional study was conducted among 500 children with cleft lip and/or cleft palate and 500 children without cleft of the age group 5 to 15 years. The clinical examination was carried out using decayed, missing, and filled teeth (DMFT) by Klein Plamer and Knutson, and dmft by Grubbel and 1997 World Health Organization (WHO) pro forma.

The results showed a statistically significant increase in the prevalence of dental caries in children with cleft lip and/or cleft palate. The mean DMFT was found to be significantly higher in operated children than in the children who were not operated. Other dental abnormalities included an increased frequency of enamel hypoplasia (p < 0.001), hyperdontia (p < 0.014), anterior, unilateral and bilateral cross-bite (p < 0.001), and open bite (p < 0.001).

The results of this study show that children with cleft have higher prevalence of dental anomalies than the normal children. With increased occurrence of hypoplasia in children with cleft, reduced access for cleaning upper anterior teeth after surgical repair leads to poor oral hygiene status, leading to increased risk to dental caries.

Given the high caries experience among the children with cleft lip and cleft palate, it is necessary to advocate a more rigorous approach to the prevention of dental disease in these high-risk children. They should therefore, be subjected to regular checkups, oral hygiene advice, diet advice, appropriate fluoride supplementation, and, when required, appropriate referral for secondary care.

Kamble S, Hiremath SS, Puranik MP, Gaikwad R, Biradar A, Gadbail AR, Sarode SC, Sarode GS, Patil S. Dental Caries and Dental Anomalies in Children with Cleft Lip and Cleft Palate in Bengaluru City, India. World J Dent 2017;8(4):304-308.

Patients suffering from problems related to teeth crowding and misalignment require braces for realignment and restoring of perfect teeth. This process of realignment is a long-term treatment varying from 6 to 12 months including many stages during which teeth alignments are achieved in small steps. Patients are always eager to view their futuristic teeth alignment condition at the beginning of their treatment. This requires a predictive methodology on the part of the dentist, which is achievable using software tools and finally reproducing these software-designed stages using rapid prototyping.

Dental molds, 3D Scanner, 3D Printer, and 3D computer-aided design software, such as 3-Matic, Maestro ortho studio, 3D Orchestrate, or 3Shape ortho studio for manipulations.

According to the quantitative analysis, average variation between the preprint and postprint is 0.32. Threedimensional (3D) printed models of these stages are within the units of 0.01 mm; hence, the rapid prototyping method supplements automation of the complete procedure of teeth alignment. Whereas, qualitative analysis of the scans after printing shows little-distorted boundaries due to which clarity has been slightly decreased but, according to the experts, this is clinically acceptable.

In this study, we provide an insight into generating different aligned stages or steps using available 3D software and further 3D printing of these stages using polylactic acid models.

These models are expected to provide very important and tangible information related to the treatment purpose to both patients and dentists. These 3D models further provide platform for the manufacturing of customized transparent teeth aligners which are specific to the patient, better in esthetics, easy to wear, and is inexpensive than traditional teeth braces.

Thakur N, Chaudhary N, Juneja M, Jindal P. Modeling and Printing of Successive Misaligned Teeth Stages. World J Dent 2017;8(4):309-314.

The management of facial trauma is one of the most important and demanding aspects of maxillofacial surgery. Mandible is the most movable and prominent bone of facial skeleton. The management of the injuries to the maxillofacial complex remains a challenge for oral and maxillofacial surgeons. The aim of mandibular fracture treatment is the restoration of anatomical form and function with particular care to establish occlusion. The lag screw technique was first introduced to maxillo facial surgery by Brons and Boering in 1970, who cautioned that at least two lag screws are necessary to prevent rotational movement of the fragments in oblique fractures of mandible.

The aim of the study was to evaluate the outcome of lag screw osteosynthesis in the management of mandibular body, symphysis, and parasymphysis fractures.

About 15 cases presenting with mandibular oblique, sagittally displaced mandibular fractures, and requiring open reduction and internal fixation (ORIF) were selected. Titanium lag screws were placed in such a way that their axes bisect the angle between a perpendicular drawn to the fracture line and perpendicular to the bone surface. About 3 months postoperatively, follow-up was done to evaluate the duration of surgery intraoperatively, stability of fracture segments, occlusion, biting efficiency postoperatively, and record any postoperative complications with lag screw fixation technique.

The maximum intraoperative time was 120 minutes and minimum was 40 minutes. The average intraoperative time was 72 minutes. In postoperative complications, deranged occlusion was seen in two patients; in one patient, it was due to associated condylar fracture and technical error in the placement of lag screw in another patient; but, it was not significant statistically with a p-value of 0.483 and which was managed easily by placing guiding elastics for 2 weeks in both patients. All the patients in the study showed good stability of fixation and significant increase in biting efficiency over a period of time. No postoperative complications, such as lag screw exposure, neurosensory disturbance, and malunion/nonunion were seen in any of the patients.

Titanium lag screw fixation was found to have good stability, rigidity, was inexpensive, and less time consuming in some types of mandibular fractures, though there exist few contraindications regarding its usage. This technique is a very sensitive procedure, requiring strict adherence to the lag screw placement principle and sufficient knowledge about the surgical anatomy of the mandible.

Fixation of the anterior mandible fracture using this technique can achieve good stability and appropriate compression. The technique reduces the chances of infection due to less exposure and promotes the healing process by producing stress in the fracture lines. Lag screw showed faster improvement in terms of biting efficiency and a significant reduction in fracture gap, which is not seen in miniplate fixation.

Bansal P, Kumar S, Mishra V, Jaiswal Y, Das G. Evaluation of Titanium Lag Screw Osteosynthesis in the Management of Mandibular Fractures. World J Dent 2017;8(4):315-320.

The aim of this study was to assess factors influencing the oral health and utilization patterns of oral health services by fishermen community in Mangaluru city, Karnataka, India.

A house-to-house survey was conducted among 840 individuals in fishermen population. Oral health status was evaluated by employing the World Health Organization basic oral health survey form. A self-administered questionnaire was used to assess patterns of utilization of dental services and their sociodemographic details.

Mean decayed, missing, and filled teeth (DMFT) of the population was 3.78 ± 6.02 and prevalence of caries and periodontal conditions was 55 and 99% respectively. About 55% participants had never visited a dentist. Age, gender, and education of the respondents showed significant associations with DMFT status. Periodontal health showed significant association with age, gender, education, and income of the respondents. Visit to the dentist was associated with age, gender, education, and dental caries. The major barrier recognized in seeking dental care was the perception of not having any dental problem.

The dental care utilization was poor, and majority of the dental visits were for tooth extraction. Lack of perceived oral health care need was the main barrier to the utilization of dental services.

The fishing population had high dental caries and poor periodontal health due to low utilization of dental care.

Bhatt S, Rajesh GR, Rao A, Shenoy R, Pai MBH, Nayak V. Factors influencing Oral Health and Utilization of Oral Health Care in an Indian Fishing Community, Mangaluru City, India. World J Dent 2017;8(4):321-326.

To determine the psychological response of the patient to twin-block therapy. To design and formulate a questionnaire to patient on twin-block therapy in the orthodontic clinic and the result will be evaluated.

A total of 14 patients within the age group of 12 to 14 years on twin-block therapy for treatment of skeletal class II malocclusion with a mandibular deficiency in the Department of Orthodontics were selected. A questionnaire was formulated at the end of twin-block therapy. The completed questionnaire was analyzed and the patient responses to the different aspects of twin-block treatment were recorded.

Of the 14 patients, 12 patients liked wearing the appliance. All the patients wore it comfortably full time. About 3 out of 14 had pain, 1 had ulcer, 9 14 had difficulty in eating, 6 patients had altered taste, and 3 had altered speech. A total of 13 patients observed improvement in lower jaw position. A total of 13 patients considered recommending the appliance to families and friends.

The response of the patient to twin-block appliance was positive. The twin block appears to be well accepted by the patients despite their age.

Patient compliance directly affects the treatment outcome of the appliance.

Thirumurthi AS, Felicita AS, Jain RK. Patient's Psychological Response to Twin-block Therapy. World J Dent 2017;8(4):327-330.

To differentiate between gemination and fusion as both are consequences of the developmental anomalies resulting in the formation of a wide tooth, difficult to differentiate clinically.

Gemination is often confused with fusion. Fusion occurs when two tooth buds unite, while gemination is said to occur when one tooth bud tries to divide. Various terms, such as double tooth, connation, linking tooth, synodontia, and shizodontia are also used for describing fusion or gemination.

This article presents the case report of a 6-yearold girl with an asymptomatic wide primary canine present in the right mandibular arch.

The tooth was finally diagnosed as gemination, although clinical features suggested fusion, but radiographic evaluation led to gemination.

Gemination ranges from 0.5 to 2.5%. Early and correct diagnosis of such cases helps clinician in the proper treatment planning and avoiding of complications.

Lakshmi V, Marwah N, Goenka P. Gemination of Primary Canine with Congenitally Missing Primary Central Incisors. World J Dent 2017;8(4):331-333.

The aim of this study is to evaluate the treatment effects of the clear block appliance during comprehensive correction of class II malocclusion in growing patients.

Sagittal discrepancy commonly exists in skeletal class II malocclusions. The popular of the class II malocclusions is division 1 type among them. The presence of original skeletal jaw abnormality is the origin of the class II malocclusions. The treatment result of such skeletal malocclusion depends on the age, latent growth, and cooperation of the individual. The class II division 1 malocclusion in a growing individual can be successfully treated with different types of myofunctional appliance. The present article illustrates a new approach (clear block appliance) to correct sagittal discrepancy to make optimal use of the patient's pubertal growth spurt to achieve best possible results. Based on the results in these patients, the clear block appliance was very effective in correcting class II malocclusions. Although the results are positive, they should be tested on a large sample size.

Clear block appliance proved to be the best alternative to other myofunctional appliances, where side effects in the form of anchorage loss or proclination of lower incisor do not occur with similar results.

Sharma N, Shrivastav S, Kamble R, Sharma P. A Tailored Approach for Growth Modification: An Innovative Approach. World J Dent 2017;8(4):334-342.

This article is intended to provide an overview of the Surgery First Approach (SFA) mainly including case selection, diagnosis, treatment protocols, success rate and the potential problems encountered.

The most important indication of the need for orthognathic surgery is usually the psychosocial effect resulting from the unaesthetic appearance of a dentofacial deformity. The conventional approach in treatment of such deformities till today has been an orthodontics-first approach.

Available evidence suggest that both the SFA and the conventional approach had similar outcomes in dentofacial relationships however the relapse tendency was greater with the SFA but the total treatment duration was substantially shorter.

SFA treats facial aesthetics (and the skeletal malrelation) first and then occlusion, i.e. orthognathic surgery antecedes the orthodontic therapy. The concept of this technique is to utilize orthognathic surgery to eliminate the displeasing pre-surgical facial profile and promptly accomplish facial aesthetic enhancement that is usually the patient's chief complaint at the beginning of the treatment. SFA also facilitates accelerated orthodontic tooth movement thus reducing the length of post-surgical orthodontic therapy.

The optimal esthetic and functional results, significant reduction in total treatment time and high patient satisfaction led us to the postulation that SFA may represent a reasonable, cost-effective method to manage skeletal malocclusions in selected cases and that it has the potential to become a standard approach to orthognathic surgery in the future.

Shah YA, Deshmukh SV, Patil AS. Surgery-first Approach. World J Dent 2017;8(4):343-350.