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

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On Sep 2018




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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
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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."



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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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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.
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Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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




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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

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : ZC10 - ZC14 Full Version

Tongue Adaptation and Airway Changes in Two Different Bracket Systems: A Randomised Clinical Trial


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60882.18051
Sowmithra Devi Saravanan, Aravind Kumar Subramaniyan

1. Postgraduate, Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India. 2. Dean and Head, Professor, Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India.

Correspondence Address :
Sowmithra Devi Saravanan,
A-1008, Radiance Royale Apartment, Poonamalle High Road, Velappanc Havadi, Chennai-600056, Tamil Nadu, India.
E-mail: 152008001.sdc@gmail.com

Abstract

Introduction: Orthodontics apart from correcting the malocclusions provide an invariably indirect effects on surrounding musculature and airway by means of creating room for proper tongue posture which helps in improvement of oropharyngeal airway dimensions along with dentoalveolar corrections which in this study was experimented with two different bracket systems- MBT and Damon self-ligating systems.

Aim: To assess the adaptation of tongue and oropharyngeal airway changes following treatment with two different bracket systems.

Materials and Methods: This randomised clinical trial was conducted in the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India, and included 20 participants and categorised into two groups: Group 1 and Group 2 included participants who underwent orthodontic treatment with Damon appliance therapy with Damon Copper NiTi (CuNiTi) wires and MBT prescription with Damon CuNiTi wires. Lateral cephalogram and intraoral scanning was done at the start of orthodontic treatment (T0) and after one year (T1). Cephalometric and occlusal model assessment to determine the adaptation of tongue and Oropharyngeal Dimensions (OD) were determined (T0-T1) using the Facad® and 3-shape software. Independent t-tests and paired t-tests were done to compare T0 and T1 for both the groups were done using Statistical Package for the Social Sciences (SPSS) software.

Results: Results of paired t-tests showed a statistically significant difference at the Interpremolar distance (IPM1) region of both groups 1 and 2 between T0 and T1 (p=0.034, p=0.011), Intercanine distance (IC) of group 2 upper (p=0.043) and IPM2 of both the groups in the upper arch (p=0.042, p=0.022). Cephalometric results showed a significant increase in all the assessed parameters within the groups between T0 and T1 (p<0.05). Oropharyngeal space did not show any difference in both the systems however comparatively increased in group 1 than in group 2.

Conclusion: Treatment with Damon and MBT prescriptions with Damon Cuniti wires showed significant alterations in adaptation of tongue and oropharyngeal space and also in bringing about arch expansion in maxilla and mandible with the greatest expansion noted for first premolar of both the groups and IC and Interpremolar (second premolar) width of the upper arch of both the groups.

Keywords

Arch development, Arch expansion, Damon system, Mclaughlin bennett trevisi system, Self-ligating brackets

Tongue is the most powerful musculature in the craniofacial region. It helps in performing various physiological actions. An unconstricted airway helps in proper ventilation and sleep quality. The genioglossus muscle originates at the inner surface of the mandibular symphysis and inserts into the tongue, genioglossus muscle is the main protruder of the tongue, and acts as an accessory respiratory muscle, resulting in advancement of the base of the tongue and dilation of the upper airway (1). Tongue plays an important role in maintenance of equilibrium by stability of arch shape and teeth positions [2,3]. According to a study by Fatima F and Fida M tongue posture did not differ among different sagittal skeletal relationships (4). However, tongue has been found to be important in establishing sagittal skeletal relationships (5). Another study proved that resting pressure from the tongue in the mandibular arch did not differ in different malocclusions (6).

Various treatment modalities have been employed to improve the tongue posture and increase the airway volume. A previous study by Iwasaki T et al., concluded that expansion of maxilla assisted by rapid maxillary expansion helped in relief of nasal obstruction and improvement of tongue posture (7). In the present study, we have used two appliance systems, Damon system and MBT system. Former is the self-ligating bracket system and the latter requires elastomeric modules or ligature wires to secure the arch wire to the bracket. Arch expansion helps to create more room for the tongue to rest and raises the tongue posture thereby improving the oropharyngeal airway [8,9].

The Damon system used in the present study presents an idea of lateral arch expansion which was put forward by Dwight Damon in 1996. CuNiTi wires along with self-ligating brackets provide an added advantage of low friction, low force and benefits arch expansion gradually. The concept of “atraumatic remodelling” of periodontal tissues has been evident with Damon appliance therapy as it helps in individual tooth movement with less force yet grouping all the teeth together ultimately resulting in faster alignment when compared to conventional bracket system (10). The lateral arch expansion, especially at the premolar-molar region could be attributed to the wider arch form of the CuNiTi wires used than that determined by the appliance system itself (11).

On the other hand, a conventional bracket system although not self-ligated it does help in arch expansion. Williams MAR and Stone ERM studied the dental arch dimensions in conventional and Damon system and concluded that both the appliance system equally provided expansion in the premolar region and found no significant difference, also he claims that conventional bracket system with full slot wires overpowers the muscular force thus unwanted proclination cannot be prevented whereas in Damon, the lip musculature helps in alignment of teeth (12). Another study by Eslami et al., found no difference between conventional and Damon system in terms of changes in incisor position and dental arch dimensions (13).

Thus this study was undertaken to evaluate the positional changes of tongue and airway improvement from the two appliance prescriptions, as no previous research has studied the tongue and airway changes in MBT prescription using Damon CuNiTi wires. This will allow us to determine, if the wider CuNiTi wires that were employed in this trial with both Damon and MBT prescriptions and the ligation system are responsible for the arch expansion that happens with Damon therapy. The null hypothesis of the study is that no difference exists between conventional and Damon bracket systems.

Material and Methods

This study was conducted as a randomised clinical trial in the Department of Orthodontics, Saveetha Dental College and Hospital, Chennai, Tamil Nadu, India and was approved by the Institutional Scientific Review Board of Saveetha University with an approval number of IHEC/SDC/ORTHO-2001/21/638. The study participant recruitment was done in November-December 2021 and study was completed by December-January 2022.

Sample size calculation: It was done using G*Power 3.1.9.4 software (Germany) with a significance of 5% (0.05) and a power of 90% obtaining a sample size of 20 with 10 participants in each group. The authors had obtained appropriate written and video consent from all the participants included in the study according to recent Helsinki declaration guidelines 2013.

Inclusion criteria:

• Participants with no missing teeth (except for third molars)
• More than 18 years of age
• Crowding ranging from 3-6 mm and greater than 6 mm
• Class 1 skeletal base with an ANB relationship of +2.67°±0.127°
• Ovoid arch forms with Angle’s Class I dental relationships
• Non extraction treatment
• Normal vertical proportions mandibular plane angles ranging from 26°-32°
• Mandibular incisor positions ranged from 88°-97° to the mandibular plane
• The maxillary incisor positions to the Sella-nasion plane ranged from 105°-112°.

Exclusion criteria:

• No history of oral and maxillofacial surgeries
• No history of nasal or pharyngeal obstruction and related surgeries
• No residual growth evident (CVMI 6)
• No sign of ankyloglossia.

Study Procedure

Randomisation of participants was done by placing concealed envelopes which had letters D (Damon bracket system) or C (conventional bracket system) placed in a black box. Participants were asked to pick one envelope from the black box and were allocated to the groups accordingly with the Damon group being group 1 and the conventional group being group 2. The second investigator allocating the participants into two groups was blinded. The blinding of the clinician (primary investigator) who provides treatment to the participants with either of the bracket systems could not be blinded. Initially, 31 participants were randomly selected and checked for eligibility to take part in the study. Of the 31 participants, nine of them were under 18 years of age and one underwent surgical rhinoplasty for esthetic correction. A total of 21 participants were eligible for the study. To get an equal distribution of participants in both the groups’ one eligible participant was excluded from the study thus giving a total recruitment of 20 participants with 10 participants randomly distributed into two groups (Table/Fig 1).

All the participants were treated by a single clinician being the primary investigator of the study to avoid any bias. The selected participants of the study were given the brackets both in the upper and lower arch respective of their groups. For group 1 Damon 11appliance system and for group 2 conventional system 3M Unitek APC with MBT 0.022 prescription was used. Both the groups were given the following sequence of Damon CuNiTi wires: 0.013, 0.014×0.025, 0.018×0.025 and a stainless steel wire of dimension 0.019×0.025 (Table/Fig 2). For group 2 ligature wires were used to secure the wire to the bracket. The participants were taken lateral cephalograms and intraoral scans at the end of one year, by the time which the patients should have completed the leveling and aligning stage of orthodontic treatment. All the 20 participants were taken for a lateral cephalogram using CS 9600 machine and intraoral scans using 3-shape intraoral scanners before the bracket placement. Cephalometric landmarks were marked and reference lines were digitally traced on the cephalogram using FACAD software by the primary investigator to avoid error in marking the landmarks. Landmarks and reference lines were marked manually in the FACAD software and not by auto generation of landmarks, a built-in feature of the software. Description of landmarks and reference lines used in evaluating the positional changes of tongue and airway dimensions are mentioned in [Table/Fig-3,4] (14). For evaluating the occlusal parameters all the participants were taken intraoral scans with TRIOS 3-shape intraoral scanners at the start of treatment (T0) and one year after treatment (T1) (Table/Fig 5)a,b. The measurements to determine the IC, IPM1, IPM2, Intermolar (IM) were done using the 3-shape digital system software. The intraoral scans were taken at T0 and T1 by a single investigator to avoid bias.

Statistical Analysis

The differences in cephalometric and occlusal parameters were entered in excel spreadsheet and was imported to version 23.0 SPSS software. Descriptive statistics to record the mean IC, IPM1, IPM2, IM was done. The intergroup and intragroup differences between T0 and T1 of both the groups were subjected to independent t-tests and paired t-tests at a significance level of p<0.05.

Results

Of the 20 participants included in the study, eight of them were males and 12 of them were females and all of them were 28±4 years of age. Paired t-test done to evaluate the intragroup changes for adaptation of tongue using lateral cephalogram shows a statistically significant difference between T0 and T1 that was noted for both the groups except for OD (PHW-Tb) (p<0.05) (Table/Fig 6). This shows both the groups perform equally well in improving the position of tongue and regardless of the bracket system used. However, no difference in terms of oropharyngeal airway was noted within the groups (p<0.05).

(Table/Fig 3) shows the mean IC, IPM1, IPM2, IM in regard to both the groups but the increase was statistically not significant (p<0.05) (Table/Fig 7). Mean increase in IPM1 and IPM2 at T1 was noted for both the groups however it was greater with group 1 than for group 2 especially for IPM1. Minimal increase in IM width for both the groups was noted at T1 (Table/Fig 7). Statistically significant differences between T0 and T1 were noted for IPM1 (upper and lower arch) of both the groups and IPM2 showed a significant increase only in the upper arch (p<0.05) (Table/Fig 7). Inter-group comparison between the groups did not show any statistically significant difference except for Od, which favoured Damon group (p<0.05) (Table/Fig 8),(Table/Fig 9).

Discussion

The study focuses on alteration of tongue position with two different appliance systems which can be greatly altered with skeletal relationships, malocclusion, muscular imbalances [4,5,11]. The airway changes induced by orthodontic movements affect the room for the tongue, thereby affecting the position of the hyoid bone and causing a subsequent change in the dimensions of the posterior airway (14).

The results of the study show a statistically significant difference (p<0.05) between pre (T0) and post (T1) one year of orthodontic treatment with two different appliance systems, indicating both the appliance systems are equally effective in improving the tongue position for all the parameters evaluated for tongue position in horizontal and vertical dimensions except for Od-MBT and Od-Damon. This shows an improved tongue position to a more forward direction which will eventually adapt to this newer position. However, the oropharyngeal airway did not show much of a difference between T0 and T1. This shows the extent of arch expansion to gain room for the tongue is not sufficient enough to increase the airway. The results are similar to a study conducted by Ozdemir F et al., in which he had evaluated the oropharyngeal airway changes with a fixed functional appliance and found even with mandibular repositioning with fixed functional appliances the airway does not improve in young adults (14).

The effect of the two appliance systems used in the present study to gain room for tongue is much less compared to that achieved by a fixed functional therapy (14). Hence, it is not surprising to note insignificant differences in oropharyngeal airway dimension.

The results of intergroup comparison of T0 and T1 for both groups did not show any significant difference for all the cephalometric parameters studied except for the Od dimensions which was significant statistically favouring Damon group. A similar study by Bruno da Silva V on Cone Beam Computed Tomography (CBCT) assessment of airway changes in Damon group of patients did not find any improvement in Od, which is in contrast to the results of the present study (15). The observable statistical significant difference is small that it cannot be generalised to the results that the Damon group does actually help in improving the Od.

Significant difference was noted for IC in group 1 only in the upper and not in the lower arch. This could be attributable to variable cortical bone thickness in maxilla and mandible (16). Both the groups showed greatest expansion in the region of first premolars which is similar to the results of the study by Williams MAR and Stone ERM (12). Least expansion was noted in the first molar region in both the groups and in the second premolar region, especially in the lower arch which might be attributable to cortical bone thickness which is greater in the posterior region of maxilla and mandible (17). However, compared to group 2, the Damon group showed greatest expansion for almost all the occlusal parameters although a statistically significant difference was observed only for IC, IPM1, IPM2 of upper arch and IPM1 of lower arch. This shows the Damon group (group 1) is comparatively more effective in expansion of arches than the conventional bracket system (Group 2) even though a statistical difference was not obtained. Also, results from the study depicts a major contribution to the arch expansion is majorly by the wider arch form CuNiTi wires as both the groups were employed the same wires and significant difference was noted among the groups for T0 and T1 and partly by the type of bracket (Damon group showed increase in arch width when compared to MBT group), as no statistical difference is appreciated between the two groups.

Limitation(s)

Difference in gender distribution, different brands of brackets used could influence the results of the study.

Conclusion

Within the limitations of the study, the results of the study showed arch width increased in both the groups, with the Damon group being more effective than conventional group, thus rejecting the null
hypothesis. The greatest expansion was observed in the IPM1 region of both groups with a statistically significant difference between T0 and T1. Statistically significant difference was also observed for IC of Group-2 upper and IPM2 of both the groups in the upper arch. The Od improved comparatively in Damon group. Further research with larger sample size is required in future, to provide stable results.

Acknowledgement

The authors would like to acknowledge the effort of the co-authors, to get involved in interdisciplinary research topics, involving matters of concern for orthodontic purposes.

Authors’ contributions: The study design, manuscript correction, and formatting were done by Dr. AK; study execution, data collection, data analysis, and manuscript preparation were done by Dr. SD; and data analysis was rechecked by Dr. AK. All authors have made substantial contributions to the present study, and all have reviewed the final paper prior to its submission. Finally, all authors have given approval for publication.

References

1.
Fregosi RF, Ludlow CL. Activation of upper airway muscles during breathing and swallowing. J Appl Physiol. 2014;116(3):291-301. [crossref][PubMed]
2.
Winders RV. A study in the development of an electronic technique to measure the forces exerted on the dentition by the perioral and lingual musculature. American Journal of Orthodontics. 1956;42:645-57. http://dx.doi. org/10.1016/0002-9416(56)90017-3. [crossref]
3.
Baker RE. The tongue and dental function. American Journal of Orthodontics. 1954;40:927-39. http://dx.doi.org/10.1016/s0002-9416(54)90044-5. [crossref]
4.
Fatima F, Fida M. The assessment of resting tongue posture in different sagittal skeletal patterns. Dental Press Journal of Orthodontics. 2019;24(3):55-63. Doi: 10.1590/2177-6709.24.3.055-063.oar. [crossref][PubMed]
5.
Primozic J, Farcnik F, Perinetti G, Richmond S, Ovsenik M. The association of tongue posture with the dentoalveolar maxillary and mandibular morphology in Class III malocclusion: A controlled study. The European Journal of Orthodontics. 2013;35:388-93. http://dx.doi.org/10.1093/ejo/cjs015. [crossref][PubMed]
6.
Ruan WH, Su JM, Ye XW. Pressure from the lips and the tongue in children with class III malocclusion. J Zhejiang Univ Sci B. 2007;8(5):296-301. Available from: http://dx.doi.org/10.1631/jzus.2007.b0296. [crossref][PubMed]
7.
Iwasaki T, Saitoh I, Takemoto Y, Inada E, Kakuno E, Kanomi R, et al. Tongue posture improvement and pharyngeal airway enlargement as secondary effects of rapid maxillary expansion: A cone-beam computed tomography study. American Journal of Orthodontics and Dentofacial Orthopedics. 2013;143:235- 45. Available from: http://dx.doi.org/10.1016/j.ajodo.2012.09.014. [crossref][PubMed]
8.
Pradhan T, Sethia A. Effects of various dentofacial orthopedic and orthognathic treatment modalities on pharyngeal airway. Current Trends in Orthodontics. 2022. http://dx.doi.org/10.5772/intechopen.101719. [crossref]
9.
Carlo GD, Di Carlo G, Saccucci M, Ierardo G, Luzzi V, Occasi F, et al. Rapid maxillary expansion and upper airway morphology: A systematic review on the role of cone beam computed tomography. BioMed Research International. 2017;2017:5460429. Available from: http://dx.doi.org/10.1155/2017/5460429. [PubMed]
10.
Damon DH. The rationale, evolution and clinical application of the self-ligating bracket. Clinical Orthodontics and Research. 1998;1:52-61. http://dx.doi.org/ 10.1111/ocr.1998.1.1.52. [crossref][PubMed]
11.
Graber LW, Vanarsdall RL Jr, Vig KWL. Orthodontics: Current Principles and Techniques-Pageburst Retail. Mosby Incorporated; 2011. Pp. 944.
12.
Askari M, Williams R, Romberg E, Stone M, Alexander SA. CBCT assessment of dental and skeletal changes using the damon versus conventional (MBT) system. Dentistry. 2015;5(10):01-10. http://dx.doi.org/10.4172/2161-1122.1000336. [crossref]
13.
Eslami N, Sharifi F, Nasseri A, Jahanbin A. Comparison of changes in incisors inclination and dental arch dimensions in damon and MBT systems using Dolphin software. Iran J Ortho. 2020;15(1):01-09. http://dx.doi.org/10.5812/ijo.114444. [crossref]
14.
Ozdemir F, Ulkur F, Nalbantgil D. Effects of fixed functional therapy on tongue and hyoid positions and posterior airway. The Angle Orthodontist. 2014;84:260- 64. Available from: http://dx.doi.org/10.2319/042513-319.1. [crossref][PubMed]
15.
Bruno da Silva V. Cone-beam computed tomography evaluation of upper airway, dental arches dimensions and buccolingual inclination through of cases treated with Damon System [thesis]. Bauru: Faculdade de Odontologia de Bauru; 2017 [cited 2023-01-11]. Doi: 10.11606/T.25.2018.tde-26112021-155423. [crossref]
16.
Vakil JK, Sable RB. A retrospective study on Indian population to evaluate cortical bone thickness in maxilla and mandible using computed tomography images. The Journal of Indian Orthodontic Society. 2014;48:149-55. http:// dx.doi.org/10.5005/jp-journals-10021-1236. [crossref]
17.
Chugh T, Ganeshkar SV, Revankar AV, Jain AK. Quantitative assessment of interradicular bone density in the maxilla and mandible: Implications in clinical orthodontics. Prog Orthod. 2013;14:38. https://doi.org/10.1186/2196-1042-14-38.[crossref][PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/60882.18051

Date of Submission: Oct 18, 2022
Date of Peer Review: Dec 09, 2022
Date of Acceptance: Jan 14, 2023
Date of Publishing: Jun 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: Oct 25, 2022
• Manual Googling: Dec 28, 2022
• iThenticate Software: Jan 13, 2023 (10%)

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