This study examined the effectiveness and efficiency of early treatment versus late treatment for Class II malocclusions. The researchers conducted a randomized controlled trial comparing early treatment using headgear or functional appliances to a control group receiving no early treatment. Results showed that while early treatment produced small changes to jaw growth, this initial advantage was not sustained. There were no differences found between the groups in final skeletal or dental measurements, need for extractions, treatment time, or quality of dental occlusion after treatment. Therefore, the study concluded that early treatment was generally no more effective than conventional late treatment for most cases of Class II malocclusion.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Treatment planning in rpd/certified fixed orthodontic courses by Indian dent...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
Controversies in early orthodontic treatment /certified fixed orthodontic cou...Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Treatment planning in rpd/certified fixed orthodontic courses by Indian dent...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
Controversies in early orthodontic treatment /certified fixed orthodontic cou...Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Early treatment of class ii malocclusion /certified fixed orthodontic courses...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Early orthodontic treatment /certified fixed orthodontic courses by Indian de...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Early and interceptive orthodontic treatment /certified fixed orthodontic cou...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Early vs late orthodontic treatment /certified fixed orthodontic courses by I...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Expansion in orthodontics,/certified fixed orthodontic courses by Indian dent...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
is a diagnostic imaging modality that provide high quality ,CBCT uses systems that are ideal in capturing images of hard tissues especially in the maxillofacial region
Arch expansion in orthodontics /certified fixed orthodontic courses by Indian...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
Early treatment in orthodontics /certified fixed orthodontic courses by India...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Early orthodontic treatment /certified fixed orthodontic courses by Indian de...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Age limitation on provision of orthopedic therapy and orthognathic surgery.pptxMaen Dawodi
Abnormal dental relationships may be corrected by orthopedic therapy, the application of orthodontic appliance pressure to elicit bone remodeling, or by orthognathic surgery, the surgical repositioning of jaw segments. Patient age appears to influence orthodontists’ treatment recommendations for orthopedic therapy and orthognathic surgery. Surgeons who recommend orthognathic surgery for children with facial deformities may be concernedabout whether the surgery will adversely affect future facial skeletal growth. Occlusal changes due to postpubertal growth concern orthodontists who provide orthodontics in combination with orthognathic surgery for the adolescent or young adult patient.
There is no absolute consensus about age limits on orthopedic therapy or orthognathic surgery. The purpose of this study was to determine orthodontists’ perceptions of skeletal age limits on orthopedic therapy and orthognathic surgery.
On the basis of a literature review and interviews with four orthodontic graduate students and two orthodontic faculty, age was identified as a potential influence on orthodontists’ treatment recommendations. By using a survey method a 45-minute questionnaire was constructed and administered. To reduce the influence of individual variation in timing of the growth spurt, skeletal age was specified for orthopedic therapy and earliest orthognathic surgery. The population surveyed consisted of Canadian orthodontists licensed in 1991, including some retired and excluding six involved with study development.
Age Categorization For the purposes of this study, the following age categories were defined: 1. Normal peak height velocity: From onset of the pubertal growth spurt to normal peak height velocity for a child of average growth tempo.2. Late peak height velocity: Year of peak height velocity for late maturing persons and decelerating height velocity for children of average growth tempo.3. Deceleration: A period of decelerating height velocity but still noticeable whole-year height increase for both normal and late maturers.4. Adult growth: A period when whole-year height increase is negligible, normal maturing females and males have both reached 99.6% completion of growth in height, and adult cranial size increase rather than active growth increase is expected.
68.Dr. Afreen Kauser; Dr. Rahul VC Tiwari; Dr. Ankita Khandelwal; Dr. Heena Tiwari; Dr. Sourabh Ramesh Joshi; Dr. Fawaz Abdul Hamid Baig; Dr. Anil Managutti. "Preference Of Orthodontic Treatment Versus Orthognathic Surgery In Class Iii Malocclusion Cases: A Research Survey". European Journal of Molecular & Clinical Medicine, 8, 1, 2021, 1271-1276.
Class 2 malocclusion /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
2. was made between those who had received early
treatment and those who had not. This second phase of
the trial, which is the emphasis of this report, was
designed to address whether early treatment to modify
growth makes a difference in terms of treatment out-
come or treatment procedures.
The sample included more boys than girls (57.8%
vs 42.2%), with a mean age of 9.4 years (range,
7.3-12.6 years) and a mean OJ of 8.4 mm (range, 7-15.5
mm). Most of the children (91%) had a bilateral Class
II molar relationship. There was no statistically signif-
icant difference between the 3 groups formed by the
initial randomization. Of the 175 children starting the
trial, 166 completed phase 1, and 143 started and
completed phase 2; 4 children were deemed by their
parents not to need further treatment, and 19 either
moved from the area or withdrew from the study.
RESULTS
Can you change growth? The results from the first
phase of the trial showed tremendous variability in both
normal growth and treatment response. Both early
treatment methods (headgear and modified bionator)
did, on average, produce a very similar small mean
reduction in jaw relationship when compared with the
patients who were simply observed for an equivalent
period (15 months). The mechanism of change was
different for the 2 appliances; the headgear group
showed a restriction in the forward movement of the
maxilla when compared with the control and the
bionator groups, while the functional appliance group
showed both an increase in mandibular length com-
pared with the control and the headgear groups and an
increase in chin projection. These changes, though
small, were statistically significantly different between
the groups. Concentrating on mean changes, however,
tends to mask the variability in treatment response. The
distribution of categories of skeletal change, from
highly favorable to unfavorable showed that more than
75% of the patients in the early treatment groups had
favorable or highly favorable changes, while only about
25% of those in the control group showed similar
favorable changes. The differences in distribution of
response categories between the early treatment and the
control groups were statistically significant (P Ͻ
.0001). However, no reliable predictors of the magni-
tude or the likelihood of favorable changes have yet
been determined.3
Does early treatment make a difference? The re-
sults of the second phase of the trial focus on 2 types of
outcome: clinician-centered outcomes, such as change
in skeletal jaw relationship or the alignment and the
occlusion of the teeth, and more patient- or parent-
centered outcomes, such as the duration of treatment or
the need for extractions or other surgical procedures.4
In Class II treatment, reducing the skeletal jaw dis-
crepancy and straightening the profile are generally the
treatment goals. The degree to which parents and patients
concur with these clinician-centered goals is not clear. The
impact of early treatment is therefore described in terms of
the change in skeletal jaw relationship and the proportion
of patients with convex profiles at the end of treatment.
Skeletal jaw relationship was measured in various ways,
including linear, angular, and positional. The results from
each measurement method concurred. However, only the
ANB angle is reported here, because this measurement is
most frequently used in the literature to designate a
skeletal Class II condition.5
There was no difference
between the groups in the ANB angle either at the start or
after phase 2 of treatment. Although the 2 early treatment
groups experienced an early reduction in the ANB angle
during phase 1, this initial advantage was not sustained
during phase 2. Neither was there a difference in the
proportion of patients with convex profiles (A-B differ-
ence Ͼ 7 mm) after phase 2. This should probably not be
interpreted as meaning that early treatment provides only
a transient benefit in skeletal change but, rather, that
conventional orthodontic treatment in the early permanent
dentition might be equally effective in correcting these
problems. The treatment mechanics clinicians use to
correct a moderate-to-severe skeletal problem in a grow-
ing child in the early permanent dentition are likely to be
different from those used for patients with only small
disproportions remaining after early treatment.
The peer assessment rating system (PAR) was used to
assess objectively and systematically the alignment and
the occlusion of the teeth in 3 planes.6
There were no
differences in the quality of the dental occlusion between
the children who had early treatment and those who did
not when evaluated as the mean PAR score for each group
at the end of phase 2, in the percentage of children
achieving excellent, satisfactory, or disappointing occlu-
sions, or in the average reduction in PAR score. There was
approximately the same distribution of successes and
failures with and without early treatment.
Early treatment did not reduce the percentage of
children needing extraction of premolars or other teeth
during phase 2 treatment, nor did it influence the
eventual need for orthognathic surgery.
Treatment time was measured in 2 ways: length of
time in phase 2, and time spent wearing fixed appli-
ances. There was tremendous variability in these meas-
urements, both in the children who had early treatment
and those who did not. Surprisingly, there was very
little difference in the time both groups spent wearing
American Journal of Orthodontics and Dentofacial Orthopedics
Volume 121, Number 6
Proffit and Tulloch 561
3. fixed appliances. Early treatment had only a very small
effect in reducing the subsequent time in treatment.
DISCUSSION
These data all suggest that early treatment, at least
as carried out in this trial, while quite consistently
producing an initial differential growth change depend-
ing on the appliance selected, was not, on average, any
more effective than conventional later treatment in
correcting skeletal and dental Class II malocclusion.
The severity of the initial condition measured by either
the PAR score or the skeletal discrepancy was not
correlated with improvement in the occlusion or the jaw
relationship, or time in fixed appliances. Not only did
early treatment fail to provide any advantage in final
treatment outcome or simplification of subsequent pro-
cedures, but also it took longer. It was no more
effective and somewhat less efficient.
This should not to be taken to negate the value of
early treatment for some children. There are many
reasons for recommending early treatment for some,
including children with psychological distress, those
who are particularly accident-prone, and those whose
skeletal maturity is well ahead of their dental develop-
ment. Possibly, children who have both vertical and
Class II problems might have more of an indication for
early treatment. However, data from our trial cannot
address this important issue well.
CONCLUSION
The conclusion from this randomized trial is that, in
most instances, there does not seem to be a clear
advantage for early treatment for Class II malocclusion.
As additional data on phase 2 outcomes become avail-
able from other well-controlled clinical studies, clini-
cians will have more unbiased evidence on which to
base their treatment decisions.
REFERENCES
1. Tulloch JFC, Phillips C, Koch G, Proffit WR. The effect of early
intervention on skeletal pattern in Class II malocclusion: a
randomized clinical trial. Am J Orthod Dentofacial Orthop 1997;
111:391-400.
2. Fields HW, Proffit WR, Nixon WL, Phillips C, Stanek E. Facial
pattern differences in long face children and adults. Am J Orthod
1984;85:217-23.
3. Tulloch JFC, Proffit WR, Phillips C. Influences on the outcome of
early treatment for Class II malocclusion. Am J Orthod Dentofa-
cial Orthop 1997;111:533-42.
4. Tulloch JFC. The timing of treatment for Class II malocclusion.
In: Kuijpers-Jagtman AM, Leunisse M, editors. Orthodontics at
the turn of the century. Proceedings of the 10th International
Orthodontic Studyweek. Nijmegan: Nederlandse Vereniging voor
Orthodontische Studie; 2001.
5. Simon LS. A quantitative analysis of the measurements used to define
and describe Class II malocclusion and the effects of treatment on
growth [thesis]. Chapel Hill: University of North Carolina; 1993.
American Journal of Orthodontics and Dentofacial Orthopedics
June 2002
562 Proffit and Tulloch