Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Research Protocol
Year : 2023 | Month : April | Volume : 17 | Issue : 4 | Page : ZK19 - ZK22 Full Version

Comparative Evaluation of Rate of Intrusion and Amount of Periapical Root Resorption with Temporary Anchorage Devices and Connecticut Intrusion Arch in Adult Population- A Prospective Interventional Study


Published: April 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/58749.17909
Japneet Kaur Kaiser, Ranjit Kamble, Sunita Shrivastav, Sumukh Nerurkar, Nandlal Girijalal Toshniwal

1. Postgraduate, Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College and Hospital, Wardha, Maharashtra, India. 2. Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, DMIMS, Wardha, Maharashtra, India. 3. Professor, Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, DMIMS, Wardha, Maharashtra, India. 4. Postgraduate, Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College, DMIMS, Wardha, Maharashtra, India. 5. Professor and Head, Department of Orthodontics and Dentofacial Orthopaedics, Rural Dental College, Loni, Maharashtra, India.

Correspondence Address :
Japneet Kaur Kaiser,
Postgraduate, Department of Orthodontics and Dentofacial Orthopaedics, Sharad Pawar Dental College and Hospital, Wardha-442001, Maharashtra, India.
E-mail: japneetkaiser@gmail.com

Abstract

Introduction: Deep bite is a complaint where, an increase in the vertical overlap between the upper and lower arch front teeth is seen. Deep bite is a relatively short face with a square gonial angle and flat mandibular plane are related to the skeletal dimensions that influence this condition. An untreated, deep overbite leads to the problems such as: abnormally increased wear and harm to the teeth, periodontal complains issues with occluding and chewing food, headaches and Temporomandibular Disorders (TMD), painful sores or ulcers, loss of tooth structure and tooth itself. There are various treatment modalities which aid in correction of these anomalies, such as mini screw implants {Temporary Anchorage Devices (TADs)} and various intrusion arches.

Need of the study: Due to the paucity of evidence regarding rate of intrusion and the correlation of root resorption with use of bilateral TADs and Connecticut Intrusion Arch (CIA), with the aid of Cone Beam Computed Tomography (CBCT), the present study will be conducted to provide an insight into the efficacy of both treatment modalities to correct deep bite and identify which of the two modalities provide less damage to the root and surrounding structure.

Materials and Methods: This prospective interventional study will be conducted in the Department of Orthodontics and Dentofacial Orthopaedics at Sharad Pawar Dental College, Sawangi, Meghe, Wardha, Maharashtra, India. The duration of study will be two years. A sample of 20 patients will be split into two groups to perform the study. Bilateral TADs will be implanted in group A, while CIA will be placed in group B to allow for the intrusion of front teeth. All the patients will be started with initial levelling and alignment using MBT 0.022” bracket prescription. After leveling and alignment, miniscrew implants (TADs) will be placed in the labial cortical plates in between the lateral and canine bilaterally in group A and CIA will be placed in patients allotted to group B. CBCT records will be collected in the following time intervals: Before applying intrusion mechanics (T0), after one month of applying intrusion mechanics (T1), three months after applying intrusion mechanics; (T2) and six months after applying intrusion mechanics (T3). Rate of intrusion and amount of root resorption will be assessed and compared between these time intervals.

Expected outcome: The rate of intrusion using different intrusion mechanics have been assessed by other studies, however, they have not been correlated with the amount of root resorption caused by these technique. Therefore, the present study intends to evaluate and compare the rate of intrusion and the amount of root resorption of maxillary anterior teeth using TADs and CIA, thereby assessing better modality in correction of deep bite.

Keywords

Deep bite, Miniscrews, Overbite, Temporomandibular disorders

Deep bite is a condition caused by skeletal proportions that generate a relatively short face with a square gonial angle and flat mandibular plane. If complains of deep bite is not treated, it can lead to further complications such as: abnormally increased wear and harm to the teeth, periodontal complains, issues with occluding and chewing food, headaches and TMD, painful sores or ulcers, loss of tooth structure and tooth itself (1). There are different types of overbite: skeletal, dental and combination or both. Treatment of dental deep overbite can be achieved by intrusion and extrusion of anterior and posterior teeth respectively or by combining the two approaches. Idea; such as the position of incisor tooth, clip-to-tooth relationships and the lower vertical dimension are the key determining factors for taking the decision (2). According to study conducted by Nanda R et al., he stated that as the intrusion arch is not directly engaged in the incisal brackets, its action of force delivery is significantly different. The intrusion arch will not only tip the molars in backward direction but also intrude the incisors simultaneously when designed properly. Further, only a single design is able to solve multiple problems without requiring changes in the wire and with no or minimal adjustment of the appliances (2). There are various treatment modalities which aid in correction of these anomalies, such as mini screw implants (TADs) and various intrusion arches.

The TADs compose a broad range of implants used to sustain orthodontic treatment. As currently claimed, all TADs are aggressively used treatment modalities and are best for treating complaints that cannot be managed with the traditional mechanism. Recently, miniscrews are manufactured using titanium (Ti) or titanium alloys, constructed with a smooth, machined surface designed in a way that it does not osseointegrate. By definition, TADs are temporary devices which are not functional for long term or aesthetic role is planned (3). Utility arches have many uses in different stages of orthodontic treatment. It was developed according to the biomechanical principles described by Bur Stone and were then refined for its incorporation in bioprogressive therapy. There has been use of utility arches for the intrusion of maxillary anteriors as well (4). Nickel Titanium (NiTi) alloys are presently the materials of choice for conveying light, uninterrupted forces under great activation. NiTi alloys have great memory and decreased load-deflection rates, creating smaller increments of deactivation over the period of time. This helps to reduce activation appointments and provides greater patient compliance (5).

The most common application of the CIA is for the intrusion of front teeth, but it can also be used for a variety of other purposes, including molar tipback for Class II correction, incisor flaring, treating minor open bites, levelling anterior occlusal cants, and finishing (2). It is necessary to choose the optimal orthodontic therapy in order to prevent harm to the tissue structures nearby. Therefore, before its clinical use, biomechanical computation and validation of the defined orthodontic force system is recommended (6). Orthodontic treatment can cause some amount of root resortption, well known as External Apical Root Resorption (EARR). The forces that are applied for the correction or alignment of the teeth or movement of teeth causes a mechanical effect that leads to resorption at the root apex. Another cause of resorption is said to be due to deviated root shapes or excessive orthodontics forces (4).

Different modalities have differences in the rate and duration at which the teeth intrude. A study was conducted by Arora A et al., where they compared the rate of intrusion between unilateral TADs and utility arch and found significant intrusion with both modalities, while TADs provided greater intrusion amongst the two (4). However, there was no mention regarding the root resorption caused by either of the intrusion mechanics.

Due to the paucity of evidence regarding rate of intrusion and the correlation of root resorption with use of bilateral TADs and CIA, with the aid of CBCT, the present study will be conducted to provide an insight into the efficacy of both treatment modalities to correct deep bite and identify which of the two modalities provide less damage to the root and surrounding structure.

The aim of the present research is:

• To evaluate the rate of intrusion in males and females using CIA-one, three, and six months after application of intrusive forces
• To evaluate the rate of intrusion in males and females using Tads-one, three, and six months after application of intrusive forces.
• To compare the rate of intrusion caused by both intrusion techniques in males and females-one, three, and six months after application of intrusive forces.
• To evaluate root resorption of upper anterior teeth in males and females after using TADs-one, three, and six months after application of intrusive forces.
• To evaluate root resorption of upper anterior teeth in males and females after using CIA-one, three, and six months after application of intrusive forces.
• To compare the amount of root resorption in males and females caused by both intrusion techniques before application of intrusive forces and one, three and six months after application of intrusive forces.

Material and Methods

The following prospective interventional study will be conducted in the Department of Orthopaedics, and Dentofacial Orthopaedics, Sharad Pawar Dental College, Sawangi Meghe, Wardha, Maharashtra, India. The duration of study will be two years. The present study has been approved by the Institutional Ethics Committee (IEC) of Datta Meghe Institute of Medical Sciences, Deemed to be University with reference number: DMIMS (DU)R&D/2022/277.

Inclusion criteria:

• Patients with increased overbite. (i.e., ≥5 mm).
• Patients having reduced lower anterior facial height less than 64 mm for males and less than 57 mm {i.e., Anterior Nasal Spine to Gnathion (ANS to Gn) i.e., less than 68.6 mm±3.8 mm in males and less than 61.3 mm±3.3 mm in females}.
• Patients of post pubertal age.

Exclusion criteria:

• Patients with persistent or recurrent periodontal diseases.
• Endodontically treated anterior teeth. In a study carried out by Esteves T et al., the results showed that 50% of endodontically treated teeth had a greater root resorption compared to the vital group, however the other 50% showed more resorption in the vital teeth group (6). The authors also mentioned that all teeth showed some degree of resorption during orthodontic tooth movement.
• Patients having any systemic disease.
• Patients with previous orthodontic treatment.
• Patients with bone deformities.
• Patients having malformed roots.

Sample size calculation: Sample size formula for difference between two means:

n=(Zα+Zβ)2 (σ12+σ22/K)/ ?

Where;
Zα is the level of significance at 5% i.e.,
95% Confidence Interval=1.96
Zβ is the power of test=80%=0.84
σ1=SD of central incisor in mini implant group=1.095
σ2=SD of central incisor is utility arch group=0.742
?=Difference between two means=23.55-22.28=1.27
K=1

n=(1.96+0.84)2 (1.0952+0.742/1)/ 1.272

=8.59
=> n=10 patients needed in each group.

Study Procedure

Random selection of patients (patients coming in Department of Orthodontics OutPatient Department (OPD) will be selected on the basis of the inclusion criteria, following which males and females will be separated and chits (lucky draw method) will be picked to allot particular treatment modality to each patient) (7). A sample of 20 patients- 10 males and 10 females- will be split into two groups to perform the study. Bilateral TADs will be implanted in group A, while CIA will be placed in group B to allow for the intrusion of anterior teeth. Complete case history and study records will be obtained from both groups, after obtaining approval from the IEC and informed consent from the selected patients. All the patients will be started with initial leveling and alignment using MBT 0.022” bracket prescription, following the wire sequences- 0.016” NiTi followed by 0.016×0.022” NiTi and 0.017×0.025” NiTi wires, further placing 0.017×0.025 Stainless Steel (SS) wires, followed by placement of 0.019×0.025” SS wires. After leveling and alignment, it will be made sure that the maxillary incisors are in the center of the cancellous bone and are not in contact with the cortical bone. Following this miniscrew implants (TADs) will be placed in the labial cortical plates in between the lateral and canine bilaterally in group A and CIA will be placed in patients allotted to group B.

Cone Beam Computed Tomography (CBCT) records will be collected in the following time intervals:

• Before applying intrusion mechanics (T0)
• After one month of applying intrusion mechanics (T1)
• Three months after applying intrusion mechanics (T2)
• Six months after applying intrusion mechanics (T3)

Four CBCT exposure in a period of six months=Four Intra-Oral Periapical Radiograph (IOPA) in six months. As stated in White, Stuart C Oral Radiology (8), Dental Panaromic Radiograph=9-26 μSv and CBCT (focus field of view) for dentoalveolar region is 5-38.3 μSv. His field of view is smaller than the panoramic view i.e., only maxillary six anteriors. Hence, the exposure is reduced. All the measures will be taken to reduce the exposure, as much as possible by the use of lead jackets, collars etc.,

Rate of intrusion and amount of root resorption will be assessed and compared between these time intervals. CBCT is readily available to dentists and has shown high accuracy in calculation of root volume and is considered as a gold standard in identifying root anatomy. This accuracy is mainly due to its three dimensional (3D) imaging, and CBCT voxels are isotropic (9).

Expected Outcome

The rate of intrusion using different intrusion mechanics have been assessed by other studies, however they have not been correlated with the amount of root resorption caused by these technique. Therefore, the present study intends to assess and compare the amount of intrusion and the amount of root resorption of upper anterior teeth using TADs and CIA and thereby, assessing better modality in correction of deep bite.

Statistical Analysis

All data will be analysed using Social Package for the Social Sciences (SPSS) statistical software version 27.0, GraphPad prism (7.0). All the descriptive and inferential data will be subjected to statistical analysis, which will be done using Chi-square test.

Discussion

A study was conducted by Barros SE et al., where he retracted the central incisors with and without skeletal anchorage to evaluate the amount of root resorption caused by these retraction techniques (3). The study was non randomised control type, inclusive of 37 patients diagnosed with anterior retraction more than normal and treated with two upper arch bicuspids. Total of 22 patients i.e., 11 females and 11 males were included in group 1 in whom non skeletal anchorage was provided for the retraction of anterior teeth. Fifteen patients were included in group 2 (3 males, 12 females) that were provided with skeletal anchorage for anterior retraction. IOPA was considered as a diagnostic tool to assess amount of root resorption by a scoring system. After evaluation, the number of patients with increased resorption in the 1st group was significantly higher.

A study was conducted by Kumar P et al., on 30 subjects with Class II Division 1 malocclusion having an overbite of more than 6 mm (9). In the present study, he treated group 1 using TADs and group 2 using CIA. Rate of intrusion of 0.51 mm/month was achieved using TADs and 0.34 mm/month using CIA. He established that the amount of intrusion is higher in the group using TADs. In a study conducted by Bhat M, Madhur V with an aim of comparing the degree of root resorption in patients getting orthodontic treatment to intrude the anteriors with the help of utility arches and TADs in maxilla (1). Study sample consisted of two groups, i.e., group A and group B with 10 patients in each group. Titanium TADs were placed in group A and 0.017×0.25” TMA was used in group B. Study models and Radio Visio Graphy (RVG) was recorded twice to maintain diagnostic records, T1 (before placement of TADs or utility arches) and T2 (6 months later). Intrascan DC software was used for comparision of the pre and post radiographic images. Root resorption was evaluated by calculating the difference between the pre and post-treatment total tooth length. As SPSS 27.0 software was used for the present study, the values of this study remains concealed.

It was established by the results that, there was visible amount of root resorption in both the groups. Higher scale of resorption was seen in the group A. TADs outperformed utility arches in terms of better or more effective effects while treating deep bite. Thus, it was determined that small implant intrusion was more efficient at intruding the incisors than utility arch, although it caused greater root resorption (1). For the evaluation of root resorption of front teeth following miniscrew aided en masse retraction in grown-up biolveolar protrusion patients, Chen Y and Liu D undertook a retrospective, analytical examination in 2020 (10). The research included 36 adult patients with bimaxillary protrusion who underwent extraction of all four first premolars and subsequent implantation of miniscrews to provide anchoring. CBCT scans were done both before and after the therapy (T1 and T2) (T2). A novel improvement project for the 3D CBCT registration evaluation of root morphology was offered. To compare changes from T1 to T2, a paired t-test was utilised. Pearson’s correlation coefficient analysis was used to analyse the association between root resorption and anterior tooth movement. Significant changes were only identified in the apical third of the root, and the palatal and distal sectors always show the most resorption in the apical third of the root. The quantity of anterior tooth retraction and intrusion were found to have significant relationships in root loss in the distal and palatal sectors, root length, and volume.

Li W et al., conducted a study in which they measured the amount of root resorption caused after doing intrusion using a molar mini-screw implant (11). He measured the amount of root resorption using CBCT as it provided volumetric measurements. The study was done with a sample size of eight patients. Pre and post-treatment results from the CBCT were compared for the amount of evaluation of the root resorption caused by the particular treatment modality. He concluded that the difference between the CBCT results of pre and postintrusion was statistically significant for the roots that were investigated.

References

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Bhat M, Madhur V. Evaluation of apical root resorption in orthodontic patients with maxillary anterior intrusion using utility arches and mini screws: A comparative clinical trial. APOS Trends Orthodontics. 2014;4(3):2321-407. [crossref]
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Nanda R, Marzban R, Kuhlberg A. The connecticut intrusion arch. J Clin Orthod. 1998;32(12):708-15. PMID: 10388402.Textbook of temporary anchorage devices in orthodontics by Ravindra Nanda, Flavio Andres Uribe.
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Barros SE, Janson G, Chiqueto K, Baldo VO, Baldo TO. Root resorption of maxillary incisors retracted with and without skeletal anchorage. Am J Orthod Dentofacial Orthop. 2017;151(2):397-406. [crossref][PubMed]
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White, Stuart C. Oral Radiology: Principles and Interpretation, 6th Edition. Mosby, 2008.
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Kumar P, Datana S, Londhe SM, Kadu A. Rate of intrusion of maxillary incisors in Class II Div 1 malocclusion using skeletal anchorage device and Connecticut intrusion arch. Med J Armed Forces India. 2017;73(1):65-73.[crossref][PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2023/58749.17909

Date of Submission: Jun 30, 2022
Date of Peer Review: Sep 15, 2022
Date of Acceptance: Nov 15, 2022
Date of Publishing: Apr 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jul 01, 2022
• Manual Googling: Oct 06, 2022
• iThenticate Software: Nov 14, 2022 (10%)

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