Orthodontic Journal of Nepal https://www.nepjol.info/index.php/OJN <p>The official journal of the Orthodontic and Dentofacial Orthopedic Association of Nepal (ODOAN). The Orthodontic Journal of Nepal is a peer reviewed journal published biannually with an open access and dealing with the applied as well as theoretical researches in the field of orthodontics. The journal does not charge article processing fees or submission charges.</p> <p>From August 2018, the journal is accepting online submissions. Please register and follow the 5 step submission process.</p> Orthodontic and Dentofacial Orthopedics Association of Nepal en-US Orthodontic Journal of Nepal 2091-1327 <p>Copyright © held by Orthodontic &amp; Dentofacial Orthopedic Association of Nepal</p> <ul> <li class="show">Copyright on any research article is transferred in full to the&nbsp;Orthodontic &amp; Dentofacial Orthopedic Association of Nepal upon publication in the journal.&nbsp; The copyright transfer includes the right to reproduce and distribute the article in any form of reproduction (printing, electronic media or any other form).</li> <li class="show">Articles in the Orthodontic Journal of Nepal are Open Access articles published under the Creative Commons CC BY License (<a href="https://creativecommons.org/licenses/by/4.0/">https://creativecommons.org/licenses/by/4.0/</a>)</li> <li class="show">This license permits use, distribution and reproduction in any medium, provided the original work is properly cited.</li> </ul> The Season of Orthodontic Harvesting https://www.nepjol.info/index.php/OJN/article/view/39039 <p>No abstract available.</p> Dashrath Kafle Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 2 2 10.3126/ojn.v11i1.39039 “A Century of Orthodontic Progress” – Innovations in Orthodontics https://www.nepjol.info/index.php/OJN/article/view/39091 <p>Innovation is the roadmap towards improvement .Creation, implementation and execution of new ideas, methods and technology aiming at efficiency and improvement is known as innovation. Innovation is the roadmap towards improvement. The speciality of orthodontics has obtained new dimensions due to innovations such as holistic orthodontic approach, Laser assisted orthodontics, digitization in diagnosis and treatment planning, nanotechnology, genetically driven orthodontic treatment plans with gene therapy, interactive self ligating bracket and flash free adhesive coated appliance system, robotic wire bending, 3D bioprinted scaffolds to treat osseous defects of the craniofacial complex, forensic orthodontics, mobile apps in orthodontics and dentoalveolar distraction modalities. These innovations have lead to an accurate treatment with reduced clinician efforts, enhanced treatment precision and better patient compliance. The future of orthodontic speciality with these adjunts is bright and progressive. With reduced clinician’s efforts and improved patient’s compliance these advancement are certainly a boon to our orthodontic speciality</p> Sonam Sehrawat M S Sidhu Seema Grover Mona Prabhakar Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 65 71 10.3126/ojn.v11i1.39091 Management of missing maxillary lateral incisor: A contemporary review https://www.nepjol.info/index.php/OJN/article/view/39092 <p>Missing maxillary lateral incisor is the most prevalent developmental dental anomaly. The management of missing lateral incisor, either need to be closed and use canine as substitution or create space orthodontically for the prosthetic replacement of the missing lateral incisors. A careful diagnosis and treatment plan are deemed essential to address the patient’s needs as the spacing is present in the esthetic region of the jaw which is very challenging so it should be managed by multidisciplinary approach including specialists in orthodontics, prosthodontics, operative dentistry and periodontist. Space closure with canine lateralization option seems less invasive, treatment can be completed relatively in short period of time and it’s adaptation with the facial changes throughout life without having artificial prosthesis provided other factors favoring for this option. This review article describes the various treatment options and their ideal indications, contraindications, advantages and disadvantages as well as emphasize on some modifications in the treatment mechanics which is crucial to achieve the optimal esthetic and to improve the occlusion.</p> Sanjay Prasad Gupta Shristi Rauniyar Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 72 78 10.3126/ojn.v11i1.39092 Prevalence of Dental Fear and Anxiety among Orthodontic patients visiting Nobel Medical College https://www.nepjol.info/index.php/OJN/article/view/39040 <p><strong>Introduction:</strong> Anxiety is the state of feeling nervous or worried that something bad is going to happen. Dental anxiety is defined as a patient’s response to stress that is associated with a dental procedure. The aim of our study is to investigate the anxiety status of dental patients visiting Orthodontic department at Nobel Medical College Teaching Hospital, Biratnagar.</p> <p><strong>Materials and Method</strong>: Total 80 ongoing orthodontic patients (M =21 F=59) who completed modified Dental Anxiety Scale questionnaire were included in the study.</p> <p><strong>Result:</strong> Majority of patients (65%) had moderate anxiety where as 25% had mild anxiety and around 9% had severe to extreme anxiety. Patients’ age and education level had significant association with the level of dental anxiety.</p> <p><strong>Conclusion:</strong> Dental anxiety in orthodontic patients is unavoidable but needs appropriate counseling. Orthodontist’s role is crucial in bridging the gap between patients’ perception towards orthodontic treatment and the actual treatment.</p> Anand Acharya Bhushan Bhattarai Nidhi Giri Jitendra Singh Tarakant Bhagat Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 3 6 10.3126/ojn.v11i1.39040 Bolton tooth size discrepancy among different malocclusion groups in two different ethnic groups of Nepalese population https://www.nepjol.info/index.php/OJN/article/view/39041 <p><strong>Introduction:</strong> The tooth size ratios may vary among different ethnic groups and different malocclusion groups. The objective of this study is to see the tooth size discrepancies in two major ethnic groups of Nepal; Indo-Aryans and Tibeto-Burmans and different malocclusion groups and compare it with the Bolton’s study.</p> <p><strong>Materials and Method:</strong> The anterior and overall ratios were compared between Indo-Aryans and Tibeto-Burmans according to different malocclusion groups with Bolton’s study with one sample t-test. The differences in ratios in ethnic groups and gender were seen with one sample t-test. The differences in mesio-distal tooth width amongst the two ethnic groups were seen. One sample ANOVA was used to see any correlation between the ethnic groups and the different malocclusion groups.</p> <p><strong>Result:</strong> The anterior ratio and overall ratio in Indo- Aryans and Tibeto-Burmans in all the malocclusion groups were greater than the Bolton’s study but was not statistically significant. There was significant differences in anterior ratio between Indo-Aryans (77.63 + 2.74%) and Tibeto-Burmans (78.51 + 2.76%), p value= 0.024. There were no statistical significant differences in the anterior and overall ratio amongst males and females. The mesio-distal tooth size was greater in Tibeto-Burmans as compared to Indo-Aryans expect for maxillary right and left central incisors.</p> <p><strong>Conclusion:</strong> The Tibeto-Burmans had higher anterior ratio as compared to Indo-Aryans. The Tibeto-Burmans had broader teeth as compared to Indo-Aryans except for maxillary central incisors.</p> Umesh Parajuli Alok Kumar Jaiswal Manish Bajracharya Manju Pandey Sapna Laxmi Tuladhar Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 7 13 10.3126/ojn.v11i1.39041 Orthodontic Assessment of Lip Prominence in Pakistani population https://www.nepjol.info/index.php/OJN/article/view/39042 <p><strong>Introduction:</strong> Many reference planes are being used to determine prominence of upper and lower lip for orthognathic face profile. E-line and S-line are being used to determine lip position in local popuation of Multan city of Pakistan.</p> <p><strong>Materials and Method:</strong> Execution of present study was done in Nishtar Institute of Dentistry, Multan during the period of November 2019-March 2020. 300 (112 Males and 188 Females) subjects were selected for this study from all provinces of Pakistan. Their radiographic records (Lateral cephalograms) were taken from radiographic department of related institution. Acetate matte sheets were used to construct reference planes by using 3H pencil. Steiner’s E-line and Rickett’s S-line were used to find Upper and Lower lip position from these reference lines. SPSS was used to analyze data after applying independent t-test.</p> <p><strong>Result:</strong> Mean Upper and lower lip position from E- line was -1.74mm &amp; -0.33mm and from S-line was 0.82mm and 1.47mm</p> <p><strong>Conclusion:</strong> Cephalometric lip morphology assessment in Multan, Pakistani adults by using Steiner’s and Ricketts<br />reference planes on lateral cephalogram is slightly different as compare to other populations</p> Faisal Rasheed Asia Khalid Zubair Hassan Awaisi Abid Hussain Kanju Farhan Ali Saad Amin Malik Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 14 17 10.3126/ojn.v11i1.39042 Alveolar bone changes around upper incisors in Class I non extraction patient after orthodontic treatment using cone beam computed tomography https://www.nepjol.info/index.php/OJN/article/view/39043 <p><strong>Introduction:</strong> The position and movement of incisors play important role in orthodontics. Efficient tooth movement and stable position cannot be ensured without adequate alveolar bone support. The bone loss estimated by traditional radiograph is always less than real bone loss so CBCT is currently best to evaluate bone changes. The purpose of this study was to use CBCT to evaluate and compare changes in alveolar bone thickness and Vertical alveolar bone height around maxillary anterior teeth of Class I malocclusion patient after orthodontic treatment.</p> <p><strong>Materials and Method:</strong> Forty patients with Class I occlusion between ages of 12 to 18 years were selected. The cone beam computed tomography (CBCT) and lateral cephalograms were taken before treatment (T0) and after treatment (T1). The lateral cephalograms were used to assess the change in tooth inclination whereas CBCT was used to assess the alveolar bone change. All the data were statistically analyzed using paired sample t-test and independent sample test.</p> <p><strong>Result:</strong> Significant changes in alveolar bone thickness and vertical bone height were found on the palatal surface of the anterior teeth compared to that of labial surface with significant change in tooth inclination.</p> <p><strong>Conclusion:</strong> Based on the results, we can conclude that the palatal alveolar bone loss and vertical bone loss was greater than that of the labial alveolar bone.</p> Wimby Tuladhar Alok Kumar Jaiswal Umesh Parajuli Binita Singh Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 18 23 10.3126/ojn.v11i1.39043 Vertical Proportion of the Face: A Cephalometric study https://www.nepjol.info/index.php/OJN/article/view/39044 <p><strong>Introduction:</strong> Balance in vertical facial proportion is an important criteria for good esthetics. Variations in vertical growth are common and have certain orthodontic implications. The objectives of this study were to determine mean upper anterior facial height and lower anterior facial height, ratio between UAFH to LAFH and their difference among genders in skeletal Class I patients with different vertical growth pattern among patients visiting department of Orthodontic and Dentofacial orthopedics, Tribhuvan University Dental Teaching Hospital, Kathmandu.</p> <p><strong>Materials and Method:</strong> This study was descriptive observational cross sectional study with 105 sample aged from 18-25 years. Pretreatment cephalometric radiograph of Skeletal Class I patients were taken and divided into three growth patterns as group I (normal growth pattern), group II (horizontal growth pattern ) and group III (vertical growth pattern ). Upper anterior facial height (N-ANS) and lower anterior facial height (ANS-Me) of all samples were measured on lateral cephalogram with cephalometric tracing ruler parallel to true vertical line. Descriptive statistics was used to calculate mean, minimum, and maximum values standard deviations with p value &lt;0.05.</p> <p><strong>Result:</strong> The upper anterior facial height (UAFH) and lower anterior facial height (LAFH) measurements in normal growth pattern was 52.37 and 64.4 , in horizontal growth pattern was 53.0 and 62.2, in vertical growth pattern was 53.37 and 64.42 respectively. The mean ratio of upper and lower anterior facial height in normal, horizontal and vertical growth pattern was 0.81, 0.85 and 0.79 respectively. There was no statistically significant difference in upper and lower facial heights between males and females. There was no statistically significant difference in UAFH between normal, horizontal and vertical growth pattern but statistically significant difference was observed in LAFH between groups.</p> <p><strong>Conclusion:</strong> The cephalometric values for different vertical groups in skeletal class I can be used more specifically for diagnosis and treatment planning of Nepali population.</p> Rajiv Yadav Kishor Dutta Nabin Gosain Anil K Yadav Neelam Yadav Kaushal K Singh Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 24 28 10.3126/ojn.v11i1.39044 A study on orthodontic retention practices in Nepal https://www.nepjol.info/index.php/OJN/article/view/39075 <p><strong>Introduction:</strong> Retainers are used after all orthodontic treatment, to prevent or minimize relapse and recurrence. Among various retainers used, Hawley retainer and ‘invisible’ retainers are the most common. Most of the orthodontists favored permanent retention. It is obvious that the retention procedures are variable and depended largely on personal preferences, and there does not seem to be any consistent pattern in the application of retention methodologies. The purpose of this study was to survey the retention protocols among orthodontists in Nepal.</p> <p><strong>Materials and Method:</strong> The complete lists of the names and addresses of orthodontists in Nepal was obtained from the ODOAN. The questionnaire was sent to them which consisted of multiple-choice questions and short answer, related to background information of the individual orthodontist, retention use in general, the frequency of different types of bonded or removable retainers that are used, the retention protocol, the type of retainer used in specific situation. All statistical analyses were performed using the Statistical Package for Social Sciences (SPSS), version 12.0.1 (SPSS Inc, Chicago, Illinois, USA)</p> <p><strong>Result:</strong> The survey questionnaires were completed by 90.42% of the 94 orthodontists of Nepal, 58.8% males and 41.2% females with a mean age of 36.7 years. Most of the orthodontists used a clear (vacuum) retainer (80%) in the maxilla and fixed bonded retainer in the mandible. Most of them prefer the use of retainer for a continuous 24 hours except during eating and brushing for 6 months to 1 year (56.5%) and if possible, for 1 to 2 years (28.2%).</p> <p><strong>Conclusion:</strong> Majority of Nepalese orthodontists provide vacuum formed retainer on maxillary arch and bonded retainer in mandibular arch. There is no specific consensus on other type of retainers, duration of wear and follow up visits which is affected by various other factors.</p> Anjana Karmacharya Dashrath Kafle Ram Bhakta Adhikari Nirjalla Malla Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 29 33 10.3126/ojn.v11i1.39075 Psychological factors influencing motivation, cooperation, participation, satisfaction, self appraisal, and individual quality of life in adolescents and adults undergoing Orthodontic treatment https://www.nepjol.info/index.php/OJN/article/view/39078 <p><strong>Introduction:</strong> To bring the best outcome from both the sides i.e. the orthodontist and the patient , it is of prime importance to understand certain psychological factors, and to treat every patient with an individualistic approach. The need was to study all such psychological factors and to find a method to deal with the same; to evaluate the psychological factors that influences the self appraisal and individual Quality of life. To compare psychological factor affecting the self appraisal and individual quality of life before treatment and after treatment, to study psychological factors of patients which influences the treatment outcome and to find a method to manage them.</p> <p><strong>Materials and Method:</strong> This In-vivo study, includes case study and survey. Two separate sets of questionnaires (before and after undergoing orthodontic treatment) were given to patients. The study also included psychological test scales like OHIP-14 and 12-CSES. The sample size of patient was 150.</p> <p><strong>Result:</strong> The study revealed that esthetics (95%) is the main concern for getting treatment especially for female (56%). There is improvement in OHIP and CSES (interval of 12.63, 14.66) score of patients before and after treatment. Patients’ satisfaction (94.7%) increases on having healthy orthodontist-patient relationship.</p> <p><strong>Conclusion:</strong> Esthetics is the main concern. Most patients wants improvement in smile. Lack of awareness and lack of financial supports is the main reason for delay in getting treatment. The main discomfort about the treatment reported by participants was pain after activation appointments, ulcers and change in food eating habit. The orthodontic therapy improves confidence, satisfaction, individuals’ appraisal and quality of life. There were no variations in response for patients’ satisfaction by gender, age, education or by treatment duration.</p> Oshin Pawar Purva Joneja Deepak Singh Choudhary Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 34 39 10.3126/ojn.v11i1.39078 Estimation of Dental Age by Demirjian and Willems Method in a Tertiary Care Hospital of Nepal https://www.nepjol.info/index.php/OJN/article/view/39084 <p><strong>Introduction:</strong> Dental age estimation using orthopantomogram is very useful in pediatric dentistry, orthodontics in clinical diagnosis and treatment planning and also has forensic application. Demirjian method is widely used for age estimation and Willems method has been suggested to be accurate than Demirjian in various populations. To estimate the dental age of children in a specific population of Nepal by Demirjian and Willems method, compare them with the chronological age and assess their applicability.</p> <p><strong>Materials and Method:</strong> Digital orthopantomograms of 5 to 14 years of children were used to estimate the dental age by Demirjian’s 7- teeth method and Willems method. Descriptive statistics was used and mean with standard deviation was calculated for gender and age of the samples. Paired t-test was used for comparison of chronological age with dental age. P &lt; 0.05 was considered as statistically significant.Pearson correlation was used to assess the correlation between chronological and dental age in both the genders.</p> <p><strong>Result:</strong> By Demirjian method, there was an underestimation of 0.276 years in males and 0.194 in females and by Willems method, 0.652 in males and 0.847 in females which were statistically significant. There was an underestimation of dental age in all the age groups except in the age group of 5,7 and 14 for Demirjian age which was statistically nonsignificant. Pearson correlation demonstrated strong positive correlation between chronological age and dental age.</p> <p><strong>Conclusion:</strong> The underestimation of dental age was more by Willems method as compared to Demirjian method. There was a strong positive relationship between chronological age and dental age in both the genders. Demirjian’s 7- teeth method was more applicable as compared to Willems method when tested in selected Nepalese children population</p> Sumita Upadhyay Sijan Paudyal Prashant Khatiwada Bibardha Khanal Rasna Shrestha Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 40 45 10.3126/ojn.v11i1.39084 Prevalence of Malocclusion among School Children of Biratnagar, Nepal https://www.nepjol.info/index.php/OJN/article/view/39086 <p><strong>Introduction:</strong> Various forms of malocclusion are a matter of serious concern in Nepalese population. This study was carried out to understand the prevalence of malocclusion among the school children of Biratnagar. The objective of this research is to find out the prevalence of malocclusion of children from different schools of Biratnagar visiting the Pedodontics and Orthodontics department of Nobel Medical College and Teaching Hospital, Biratnagar.</p> <p><strong>Materials and Method:</strong> A descriptive cross sectional study method was used in this research. Data was collected by using direct observation of the subjects and occlusal assessment was done according to Angle’s classification and Dewey’s modification types of class I, class II and class III malocclusion.</p> <p><strong>Result:</strong> Subjects with normal occlusion was found to be 39 % and with malocclusion was found to be 61%. Among them, class I malocclusion (60%) and angles class II div I subjects (88.33%) were in majority of the total study population.</p> <p><strong>Conclusion:</strong> The present study helps to determine the prevalence of malocclusion and need of orthodontic treatment for the school children of Biratnagar</p> Nidhi Giri Anand Acharya Kanika Yadav Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 46 48 10.3126/ojn.v11i1.39086 Growth Pattern in Skeletal Class I Malocclusion: A Cephalometric Study https://www.nepjol.info/index.php/OJN/article/view/39088 <p><strong>Introduction:</strong> Great emphasis has been given to the evaluation of sagittal apical base relationship in orthodontic diagnosis and treatment planning. The prediction of magnitude and direction of facial growth based on sagittal relationship will help in orthodontic treatment with growth modification. The objective of the study is to assess the growth pattern in skeletal Class I malocclusion.</p> <p><strong>Materials and Method:</strong> 104 subjects (52 male and 52 female) with the age between 18-30 years with Class I skeletal relation was selected from lateral cephalograms of patients visiting the Department of Orthodontics, Kantipur Dental College. The ANB angle was measured to assess the sagittal jaw relationship and the Jarabak’s ratio to access the growth pattern. Descriptive statistics were calculated for each parameter. Pearson’s test was done to evaluate the correlation between the parameters. Independent t-test was done to compare Anterior Facial height (AFH), Posterior Facial Height (PFH) and Jarabak’s ratio between male and female subjects.</p> <p><strong>Result:</strong> Among the total subjects with skeletal Class I malocclusion; hyperdivergent growth pattern was least (10.57%), followed by normodivergent (18.26%) and hypodivergent growth pattern (71.15%). Mean Jarabak’s ratio for hyperdivergent, normodivergent and hypodivergent growth pattern were 58.65±1.94, 63.98±0.85 and 69.98±4.13 respectively. Very strong correlation was found between AFH and PFH in hyperdivergent (r = 0.821) and normodivergent group (r =0.978). Strong correlation was found in hypodivergent group between AFH and PFH (r =0.743). Also, strong correlation was found in hypodivergent group between PFH and Jarabak’s ratio (r =0.643).</p> <p><strong>Conclusion:</strong> Hypodivergent growth pattern was the dominant growth pattern in skeletal Class I malocclusion. PFH influenced the determination of Jarabak’s ratio more than the AFH in hypodivergent growth pattern. Hypodivergent growth pattern is correlated with large SNB angle.</p> Sujal Amatya Rabindra Man Shrestha Shristi Napit Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 49 54 10.3126/ojn.v11i1.39088 Suffocated Maxillary Central Incisors (Surgical and Orthodontic Management): A Report of Two Cases https://www.nepjol.info/index.php/OJN/article/view/39089 <p>Clinically, supernumerary teeth are able to cause different local disorders and the most common one is impaction of maxillary incisors. Impacted maxillary incisors substantially affect esthetics, function, and self‑esteem of patients. Impaction of maxillary permanent incisor is a rare clinical entity in dental practice. Although impaction of a permanent tooth is rarely diagnosed during the mixed dentition period, an impacted central incisor is usually diagnosed accurately when there is delay in the eruption of tooth. Multiple treatment options are available for impacted incisors. Surgical-orthodontic treatment is one of the alternative option for the correction. Early diagnosis and management of supernumer¬ary teeth is important to prevent the need for more complex surgical and orthodontic treatment. Here, we present a report of two cases of impacted maxillary incisors and its management</p> Barun Kumar Sah Jamal Giri Bandana Koirala Mamta Dali Sneha Shrestha Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 55 60 10.3126/ojn.v11i1.39089 Skeletal Expansion with GSR Expander https://www.nepjol.info/index.php/OJN/article/view/39090 <p>This article reports two cases treated with a modified Miniscrew Assisted Rapid Palatal Expander (MARPE) that was fabricated in-office. Two female patients aged 15 years and 18 years were treated for maxillary expansion. An in-office modified GSR Expander was used. The appliance was secured in the patient’s maxillary arch using four miniscrews. Expansion was carried out for 4 weeks and 2 weeks respectively. Considerable opening of mid palatal suture with skeletal expansion was observed. An economical and effective alternative to stock made MARPE with better adaptability and clinical modifiability.</p> Garauv Saluja Akanksha Shukla Gurkeerat Singh Varun Goyal Raj Kumar Singh Nishant Gupta Copyright (c) 2021 Orthodontic & Dentofacial Orthopedic Association of Nepal http://creativecommons.org/licenses/by/4.0 2021-08-16 2021-08-16 11 1 61 64 10.3126/ojn.v11i1.39090