Rajiv Gandhi University Of Health Sciences, Karnataka, Bangalore
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / Name of Candidate / DR. HARSHAVARDHAN REDDYPermanent Address / H.NO. 2- 909/69/161,badepur chinde layout,swastik nagar,behind toyota showroom, GULBARGA-585105
2. / Name of the Institution / H.K.E. Society’s S. Nijalingappa Institute of Dental Sciences AND RESEARCH, Gulbarga,
KARNATAKA.
3. / Course of study and subjects / Master of Dental Surgery – ORTHODONTICS AND DENTOFACIAL ORTHOPEDICS
4. / Date of admission to the course / 31st MAY 2012
5. / Title of Topic / COMPARING THE ACCURACY OF direct versus a new technique of indirect bracket placement. the clinical trial.
6. / Brief Resume of Intended work
6.1 / NEED FOR THE STUDY :-
The aim of modern orthodontics is to create the finest occlusal relationship within the framework of acceptable facial aesthetics and stability which requires positioning the crown of each individual tooth in its appropriate position for optimum function and appearance.1
Misplacement of a bracket in the pre-adjusted appliances can cause deviations in rotation, tipping, intrusion or extrusion, and torque.2
Correct bracket placement in necessary to achieve maximum advantages from fixed orthodontic appliances, especially pre-adjusted once. This in turn facilitates the final phase of the treatment and leads to an optimal occlusion.3
Compared to direct bracket placement methods, indirect bracket placement method is more accurate and also it helps in reducing the chair side time of the patient and the operator.4
The purpose of this study is to compare and evaluate the precision of bracket placement of direct versus indirect bonding.
6.2 / REVIEW OF LITERATURE
1) Bon Chan Koo et al (1999)
An in vitro study was conducted to evaluate the accuracy of Bracket placement for direct and indirect bonding techniques. Nineteen sets of duplicated Class II malocclusion models were divided into three groups: (1) one set for ideal bracket placement, (2) nine sets for direct bonding on mannequins, and (3) nine sets for indirect bonding. Both direct and indirect bondings were performed on all teeth except molars by nine faculty members from the Department of Orthodontics, University of Pennsylvania. Their results indicated that both direct and indirect bonding techniques failed to execute ideal bracket placement.5
2) T. M. Hodge et al(2004)
Twenty -six consecutive patients requiring upper and lower MBT™ pre-adjusted Edgewise appliances had their labial segments bonded directly or indirectly according to a split mouth system of allocation. Before and after bond-up all brackets were photographed and measured from tracings to determine positional differences from the ideal. Mean bracket placement errors were similar with both techniques.6
3) Nir Shpack et.al (2007)
This study was done to examine the ultimate accuracy of bracket placement in labial versus lingual systems and in direct versus indirect bonding techniques.
Forty pretreatment dental casts of 20 subjects were selected. For each dental cast, four types of bracket placement were compared: labial direct (LbD), labial indirect (LbI), lingual direct (LgD), and lingual indirect (LgI). Direct bonding was performed with the casts held in a mannequin head. Labial brackets were oriented with a Boone gauge, and lingual brackets were oriented with the Lingual- Bracket-Jig System. Torque error (TqE) and rotation deviation(RotD) were measured with
a torque geometric triangle and a toolmaker’s microscope, respectively. Both torque and rotational measurements were evaluated statistically as algebraic and absolute numeric values, using analysis of variance with repeated measures. They concluded that Labial and Lingual system have same level of inaccuracy. For both techniques indirect bonding significantly reduces TqE and RotD.7
4) Lahcen Ousehal, Laila Lazrak(2011)
An in vitro study was conducted in ten models from a natural maxillary teeth model in order to compare the accuracy of brackets placement between two direct bonding instruments: the pole-like Bracket Positioning Gauge and the star-like Bracket Positioning Gauge. The results have shown that: the star-like Bracket Positioning Gauge is more precise in placing brackets vertically, whereas the pole-like Bracket Positioning Gauge allows a better angulation of the bracket.8
6.3 / OBJECTIVES OF THE STUDY
The goal of this study is to compare the accuracy of bracket placement between direct versus a new indirect bonding technique in following aspects:-
A. Vertical bracket position
B. Mesio-distal bracket position
C. Angulation of bracket
`7. / MATERIALS AND METHODS
7.1 / Source Of Data
Source—Subjects who are seeking orthodontic treatment in the department of Orthodontics in H.K.E.S. S. Nijalingappa institute of Dental Sciences and Research, Gulbarga, Karnataka.
7.2 / Study Design :- IN-VIVO
Materials :
1. 20 Samples
2. Inclusion criteria:
a) Subjects requiring upper and lower MBTTM pre-adjusted Edgewise appliances.
b) Patient’s with all permanent teeth up to II molars fully erupted
c) Patient’s with average teeth size and normal shape
d) Patient’s with alignment of teeth enough to permit ideal bracket placement
3. Exclusion criteria:
a) Subjects with worn dentitions, fractured/restored incisal edges or cusp-tips, an apparent tooth size discrepancy and when anterior teeth were absent
b) where observation of the mesio-distal and angular position of
the brackets was obscured by crowding and the patient’s with retained deciduous teeth.
4. Mouth mirror, Probe, Kidney tray, Tweezer and Cotton rolls
5. Alginate impression material and impression trays.
6. Dental Orthokal
7. 3M Unitek MBTTM brackets
8. Marking pencil and height bracket positioning gauge
9. Bracket holder
10. Glue Gun
11. Separating medium
12. Starch(paste of rice)
13. Etchant, primer, composite and light cure unit
14. Rubber base impression material
15. Digital caliper and Nikon SLR camera and software.
Procedure :
Method :
Ten patients requiring upper and lower MBT pre-adjusted edgewise appliances are involved in the study and each patient is subjected to split mouth system of allocation. The labial aspect of dentition of each patient is divided into upper and lower segment.
In each segment, half of quadrant is bonded with direct bonding and other half by indirect bonding randomly.
Indirect bonding:-The patient’s alginate impression is obtained and cast is poured using dental Orthokal. Markings will be done on the quadrant of the cast in which indirect bonding has to be carried out. The prepared paste of the rice is applied on the base of the bracket and then the bracket is secured on tooth in already marked position. Apply separating medium on the occlusal, labial and lingual surface of the teeth excluding brackets. After this Glue Gun is used to prepare a tray which covers all the teeth.
In the next procedure, the prepared tray is placed in patient’s mouth and checked. Then after removal of the tray, etchant is applied for 20 seconds for each tooth and then washed and dried. Then primer will be applied to the teeth which are to be bonded by indirect technique and apply composite to brackets bases present in tray and place the tray in the mouth of the patient and cure it. All this procedure will be done maintaining complete isolation.
Direct bonding:-The remaining teeth in the upper and lower segment of the patient are prepared for direct bonding. Etchant will be applied for 20 seconds for each tooth and then washed and dried. Then the primer is applied to the tooth and the composite will be applied on the bracket base held by the bracket holder and place on the tooth. The bracket is positioned by the operator using marking gauge and is followed by curing. This procedure is repeated for each tooth which is to be bonded by direct technique.
After direct and indirect bonding on the patient, the rubber-base impression is obtained and cast is poured by using orthokal.
Photographs of cast will be taken using SLR camera and measurements are done by using the required measuring tools.
7.3 / Methods of Data of Collection
Method
After indirect and direct bonding, rubber-base impression will be taken of each patient and the photographs of the cast will be taken by keeping the lens perpendicular to the labial surface of each tooth at specific focal length and magnification. All photographs are scanned into PC and stored as JPEG files and the measurements will be done by using software.
Statistical analysis
ANOVA statistical tests will be applied to correlate finding of the study.
7.4 / Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so please describe briefly.
YES, The study includes the placing of direct and indirect brackets and taking of alginate and rubber-base impressions of human subjects after obtaining their consent.
7.5 / Has ethical clearance have been obtained from college?
Yes
8. / List of References
1. MR Balasubramaniam, R Krishnaraj, Anju Mary Varghese, R Poornima.SRM University journal of Dental sciences: vol-1;issue 2,july-sept 2010
2. Balut N, Klapper L, Sandrik J, Bowman D. Variations in bracket placement in the preadjusted orthodontic appliance.
3. Am J Orthod Dentofacial Orthop. 1992;102:62–67.
Amir Mohammadi, Seyed Hossein Moslemzadeh; JODDD, November 2011
4. R. Rajagopal, A. Venkatesan, K. Gnanashanmugham, S. Harish Babu
JCO/November 2004, vol 38, No.11.
5. Bon Chan Koo, DDS, MSD,a Chun-Hsi Chung, DMD, MS,b and Robert L. Vanarsdall, DDSc; AJODO: vol 116,number 3,sept 1999.
6. T. M. Hodge, A. A. Dhopatkar and W. P. Rock, D. J. Spary; Journal of Orthodontics, Vol. 31, 2004, 132–137
7. Nir Shpacka; Silvia Geronb; Ioannis Florisc; Moshe Davidovitchb; Tamar Broshd; Alexander Dan Vardimone. Angle orthodontist,
vol 77, No 3, 2007
8. Lahcen Ousehal, Laila Lazrak; Open Journal of Stomatology, 2011, 1, 121-125.
9. / Signature of Candidate
10. / Remarks of Guide / Approved and forwarded
11. / 11.1 / Name and Designation of
The Guide (In block letters) / Dr. BASANAGOUDA .C. PATIL
MDS
( READER )
Dept of orthodontics & dentofacial orthopedics
11.2 / Signature
11.5 / Head of the Department / Dr. M.SURESH
MDS
(Professor & HOD )
Dept of orthodontic Dentofacial Orthopedics
11.6 / Signature
12. / 12.1 / Remarks of Chairman and Principal / Dr. Smt. JAYASHREE A. MUDDA
(PRINCIPAL)
H.K.E. SOCIETY’S S. NIJALINGAPPA INSTITUTE OF DENTAL SCIENCES, GULBARGA, KARNATAKA.
12. 2 / Signature