Erbil Dental Journal (EDJ)

Evaluation of Skeletal Variations and Establishment of Cephalometric Norms in a sample of Kurdish Population Using Bjork-Jarabak’s Analysis

Saya Salar Yousif — 2025-06-30

Background and Objective: Cephalometric analysis is essential in orthodontics for diagnosing malocclusion and understanding craniofacial growth. The Bjork-Jarabak analysis is widely used to evaluate skeletal variations and establish normative data for different populations, Bjork-Jarabak analysis is essential for effective diagnosis and treatment planning. This study aimed to establish cephalometric norms for the Kurdish population in Erbil city/ Iraq, using the Bjork-Jarabak method, addressing the lack of localized data.

Methods: The study enrolled 222 Kurdish adults aged 18 - 47 years at Hawler Medical University’s College of Dentistry. Participants with no orthodontic history, balanced facial profiles, and no craniofacial anomalies were included. Lateral cephalographs were taken using the Newtom Giano machine and analyzed with WEBCEPH Imaging Software “A.I. Web-based Orthodontic & Orthognathic Platform”. Cephalometric measurements, including the Jarabak quotient, facial height ratio, and polygon “Jarabak sum”, were compared to Bjork-Jarabak norms. Gender-specific analyses were also conducted.

Results: Most cephalometric measurements significantly differed from Jarabak norms, except SNB. Gonial angle, Bjork sum, and facial length on the Y-axis were lower, while ramus height, ANB, posterior and anterior facial heights, and facial concavity were higher. Males had greater posterior facial height, mandibular body length, and ramus height, whereas females had higher facial convexity. Normodivergence was observed in, 85.6 %, with males showing more hypo- and hyperdivergence. Significant cephalometric differences were found between male and female Kurdish participants.

Conclusion: The study reveals significant cephalometric differences in the Kurdish population compared to Bjork-Jarabak norms, showing a hypodivergent profile and gender-based variations. These findings emphasize the need for population-specific standards to improve orthodontic diagnosis and treatment outcomes.

Efficacy of Hyaluronic Acid Injection for Temporomandibular Joint Disorders with and without Arthrocentesis

Twana Hoshyar Saleem — 2025-06-30

Temporomandibular disorder affects millions of people worldwide. Temporomandibular joint internal derangement, is a common condition. Temporomandibular joint internal derangement is a progressive disorder that begins with clicking during nor- mal opening and progresses to restricted mouth opening (closed lock). Arthrocentesis and Visco supplementation as Hyluronic acid are minimally invasive techniques that involves wash out the joint and replacement of synovial fluid by intra-articular injection of Hyaluronic Acid which restores its concentration and molecular weight in joint cavity.

Aims for this study is to comparison the effect of Hyaluronic acid injection to temporomandibular joint in addition to Arthrocentesis and without arthrocentesis, to see the effect of Hyaluronic acid injection to temporomandibular joint without arthrocentesis.

Patient and Methods: The study was prospective, randomized, and clinical, with a period of 3 months follow-up comparing the efficacy of arthrocentesis with HA injection to that of HA injection alone. The data were collected after first and third months in order to gauge the effectiveness of the treatment modality at Rizgary Teaching Hospital. It included patients from November 2023 to February 2024.

Result: A total of (60) patients 13 males and 47 females, as they distributed on three groups (Group A: 20 patients undergone Arthrocentesis and Hyaluronic acid injection, Group B1: 20 patients undergone single time Hyaluronic acid injection and Group B2: 20 patients undergone double time Hyaluronic acid injection).

P value were highly significant for pain, maximum mouth opening and joint sound for group A and B2 in compare to group B1, while there were no significant different seen between group A and B2.

Conclusion: The combination of arthrocentesis and HA injection showed much better outcome than hyaluronic acid injection alone, but procedure HA injection alone is less invasive.

Evaluation of Minimally Invasive Vertical Extraction Technique of Crowded Lower Incisors: A Case Series Study

Saeed Hameed Tutmayi — 2025-06-30

Background and Objective: Innovations in tooth extraction techniques and instruments have evolved over time to minimize trauma to surrounding tissues. In severely crowded cases, extracting anterior teeth poses a challenge for surgeons due to the risk of traumatizing adjacent teeth and surrounding hard and soft tissues. This study aims to evaluate the applicability and popularization of a novel a traumatic vertical extraction technique, known as minimally invasive vertical extraction of lower anterior teeth.

Methods: A prospective interventional clinical study was conducted at a private clinic from November 2019 to December 2021. Fifteen patients with severely crowded lower anterior teeth, where conventional extraction was not possible without trauma to adjacent teeth and tissues, were enrolled. The surgical technique involved the administration of local anesthesia, drilling a small hole in the tooth crown, passing a surgical wire through the hole, applying vertical traction force to extract the tooth, and post-extraction care.

Results: The mean± (SD) age of the patients was 26.5±1.24 years, with an age range of 25-38 years. The patients included nine (60%) male and six (40%) females. 15 lower anterior teeth in15 patients were successfully extracted using this technique, indicating an overall success rate of 100%.

Conclusion: The results suggest that atraumatic vertical extraction by this novel technique may be used with a high success rate for extraction of severely crowded teeth, and its use causes no force on the adjacent teeth and hard and soft tissue investing the extracted tooth.

Prevalence of Psoriasis in Cases Diagnosed with Fissured And/or Geographic Tongue in Clinics of College of Dentistry- Hawler Medical University: A Retrospective- Prospective- Study

Sameeh Sdiq Omer — 2025-06-30

Background: Both psoriasis and tongue surface changes like fissured and geographic tongue are sharing some common features like surface changes nature, inflammation process and linking to autoimmune. There is a chance for these conditions to occur simultaneously.

Aim: This research aims to find prevalence of psoriasis, in patients diagnosed as to have fissured and/or geographic tongue, in outpatient clinics of college of dentistry/ Hawler Medical University.

Patient and method: A retrospective-prospective study was conducted in the oral diagnosis department at the College of Dentistry at Hawler Medical University. The study included patients who visited the clinic from September 3, 2022, to March 3, 2024. All three pathologies were searched for in history, clinical examination and documented by both data entry and digital photography.

Results: The total number of involved cases was 298. Out of which 158 (53%) are male and 140 (47%) are female. Out of all patients included, 219 (73.5%) presented with fissured tongue, 68 (22.8%) had geographic tongue, and 11 (3.7%) had both fissured and geographic tongue. Out of all cases, only 3 (1%) cases had psoriasis.

Conclusion: This study demonstrated that the incidence of fissured tongue is higher in younger individuals, followed by geographic tongue. Additionally, a correlation between fissured and geographic tongue was observed. However, there was a weak or nonexistent association between both abnormalities and psoriasis.

The Effect of Cyclosporine and Tacrolimus Systemic Therapy on Gingival Overgrowth in Renal Transplant Patients Aged Between 18-70 Years in Erbil City-Iraq

Aveen A. Jalal — 2025-06-30

Background: Gingival overgrowth has been linked to systemic therapy with Cyclosporine and Tacrolimus in Renal transplanted cases.

Aim: The prevalence and characteristics of gingival overgrowth and periodontal treatment will be examined in patients taking cyclosporine and tacrolimus after renal transplantation in patients aged 18-70 in Erbil city.

Patients and Methods: In this study, sixty kidney transplanted patients on immunosuppressive maintenance therapy in the renal transplant unit of Hawler teaching hospital in Erbil city, Kurdistan region/ Iraq were randomly selected and retrospectively examined All patients aged over 18 years old. In medical records information regarding: drug use duration; oral hygiene index; bleeding index; and clinical gingival overgrowth index were transported into a specific data file made for research purpose. Clinical evaluations were done at baseline and three months after periodontal treatment. Using SPSS version 24.0, descriptive statistics were used to assess demographics and periodontal parameters at a significance level of p < 0.05.

Results: The trial comprised 56.66% cyclosporine and 43.33% tacrolimus. The cyclosporine group included 61.76% male while the tacrolimus group included 73.07% female. The average treatment duration was 79.69±10.27 days in cyclosporine and 67.11±9.79 in tacrolimus. The majority of individuals brushed twice daily (52.94% cyclosporine, 46.15% tacrolimus) and had acceptable oral hygiene (70.58%, 73.07%) respectively. Cyclosporine caused grade 2 gingival overgrowth in 55.88% compared to 11.53% in tacrolimus. Both groups had lower plaque and bleeding indices after scaling and polishing. The tacrolimus group showed more improvement.

Conclusion: Compared to cyclosporine, the tacrolimus group showed less prevalence and severity of gingival overgrowth and better response to periodontal therapy.

Glossodynia And Its Associated Risk Factors In Patients with Geographic And/Or Fissured Tongue at Hawler Medical University: A Retro-Prospective Cross-Sectional Study

Rezao Omar Hasan — 2025-06-30

Background: Glossodynia is characterized by a painful sensation in the tongue, often accompanied by sleep disturbances, exhaustion, and psychological issues, including anxiety and depression. Glossodynia manifests with a typical oral symptom, such as a burning mouth sensation. Hence, it is important for oral healthcare practitioners to possess knowledge about this clinical condition.

Aim: The objective of this study was to assess the frequency of tongue pain and burning sensation (glossodynia) in patients with geographic and/or fissured tongue. Additionally, the study aimed to identify the influence of age and gender as risk fac- tors in patients with glossodynia. Furthermore, the study investigated the correlation between geographic tongue and fissured tongue with glossodynia.

Patient and method: An investigation using retrospective-prospective cross-sectional design was carried out at the Oral Diagnosis Department of the College of Dentistry/Hawler Medical University. Two hundreds and ninety-five patients who sought medical attention at this Department's clinic between September 4, 2022, and May 1, 2024 were included in the research. The patients underwent clinical diagnosis and digital imaging were undertaken to evaluate fissure tongue and geographic tongue.

Results: A total of 295 individuals, with an average age of 36.81 years, were assessed. Among them, 156 (52.9%) were men and 139 (47.1%) were females categorized into age groups: 15-30, 31-45, 46-60, and >60 years in age. Among the 295 patients analyzed in this study, 216 cases (73.2%) had fissured tongue, 68 cases (23.1%) had geographic tongue, and 11 cases (3.7%) had both geographic tongue and fissure tongue as characteristics. Only 17 cases, representing a mere 5.8% of the overall number, have received a diagnosis of glossodynia. Among the 156 male patients, a mere 5 individuals (1.7%) had glossodynia. Within the group of 139 female patients, 12 cases (4.1%) had glossodynia.

CONCLUSION: The study suggests that glossodynia is often seen in female patients and serves as a significant risk factor in the development and worsening of symptoms. Glossodynia continues to be a consequential medical disorder that often requires a substantial interdisciplinary approach in the psychology of the patient and the oral health care system.

Comparative Efficacy of Lidocaine, Benzocaine, and Combination Topical Therapy for Pain Reduction in Pediatric Local Anesthesia: A Randomized Clinical Trial Study

Sazgar Muhammed Sabir — 2025-06-30

Background and objective: Topical anesthetics are highly used in the field of pediatric dentistry such as (Lidocaine and Benzocaine) which are used to relieve pain during needle insertion. The aim of this study to compare and evaluate the effectiveness of multiple topical anesthetic agents prior to anesthetic delivery undergoing pediatric and minor oral procedures.

Material and Methods: This study included 60 children of 6-12 years of age, the total number of the samples were divided into 3 groups; Group I: 20 cases (lidocaine gel 20%), Group II: 20 cases (benzocaine gel 20%), and Group III: 20 cases both lidocaine gel 20% and benzocaine gel 20%) were applied before needle insertion during inferior alveolar nerve block and infiltration. In addition, the child's pain assessment was done using the Visual Analog Scale (VAS).

Results: 33 boys (55%) and 27 girls (45%) of 6-12 years old participated in the study, the two-step application of both (20% Benzocaine and 20% Lidocaine) showed lower mean scores when it was compared with Benzocaine and Lidocaine, but the results were statistically insignificant. Lidocaine and Benzocaine alone or together are equivalent in efficiency when used as a topical anesthetic agent. The results showed that females and males have no difference in Visual Analogue Scale scores, and with increasing age the VAS score decreased.

Conclusion: This study concluded the two-step application of both (20% Benzocaine and 20% Lidocaine) is more effective in reducing pain upon needle penetration into the oral mucosa than each agent used alone, and 20% benzocaine demonstrated better results than 20% lidocaine in reducing pain upon needle penetration. But it was statistically non-significant. The findings highlight the potential benefit of combining topical anesthetics for improved pain management in pediatric dental procedures.

Prevalence of Lower Back Pain among Dentists in Kurdistan Region-Iraq

Nabeel Abdulrazzaq Fattah — 2025-06-30

Background and Objective: Lower back pain caused by professional activities often develops over time due to repetitive work. Dentists are particularly prone to low back discomfort because of their working posture during patient treatment, as they spend most of their workday in static, uncomfortable positions. This study aimed to investigate the incidence of risk factors for low back pain in dentists and examine the potential relationship between these factors and working posture.

Methods: A prospective study was conducted involving 206 dentists. Data was collected and analyzed to assess the prevalence of lower back pain and associated occupational factors.

Results: The findings revealed that 67% of participants reported lower back discomfort. Additionally, the study showed that lower back pain was not age-related. Most participants indicated that they worked long hours with minimal breaks between procedures.

Conclusion: The research confirms that dentists are at a higher risk of developing lower back pain due to their working posture during patient treatment. To mitigate this risk, work postures should be adjusted to reduce the likelihood of work-related musculoskeletal disorders among dental professionals.

Evaluation of Accuracy of OPG in Determining Root Morphology of Lower Third Molar When Compared with Gross Examination

Khurshid Abubakir Kheder Khrwatany — 2025-06-30

Dentists widely use Orthopantomogram (OPG). The accuracy of this device in providing information on root number and morphology has been the point of concern for many years.

Aim: to evaluate the accuracy of OPG in determining the root morphology of the lower third molar (LTM).

Patients and method: During 6 months, thirty-five cases of patients who needed surgery for LTM removal were included. A single machine OPG was used to take X-rays for all patients. On OPG and by gross examination after surgery, information about the number of roots, the relation of roots to each other, and the pattern of a single root was evaluated and put in the Excel sheet. Statistical analysis was carried out using accuracy, sensitivity, and specificity.

Results: OPG had an accuracy of 50.72% for one-rooted, 79.55% for two-rooted, and 50.00% for three- and four-rooted teeth. The relation of roots to each other had an accuracy of 55.56% for fused roots, 58.33% for convergent roots, 50.00% for divergent roots, and 58.33% for other forms. The mesial root pattern accuracy was 54.69% for straight, 77.73% for distally, and 50.00% for buccally and lingually curved. Distal root pattern accuracy was 100.00% for straight, 58.18% for mesially, 55.56% for distally, and 50.72% for buccally curved. The other roots' accuracy was 50.00% for mesially, distally, and buccally curved.

Conclusion: The OPG can be considered accurate in determining the number of roots only for two-rooted teeth and the mesial curvature of the mesial roots. Its accuracy is at a low level in all other morphological specifications of the lower third molar.

Archwire Preferences and Rationale Among Iraqi Orthodontists During the Alignment Stage of Fixed Orthodontics: An Online Survey-Based Study

Dina Jawhar Butrus — 2025-06-30

Background: Archwire selection is critical for optimizing tooth movement and patient comfort in orthodontic treatment. However, data on archwire preferences in Iraq is limited.

Objectives: To examine archwire preferences and selection practices among Iraqi orthodontists during the alignment stage of fixed orthodontic treatment.

Methods: A cross-sectional survey was conducted among 83 Iraqi orthodontists using an online questionnaire. Questions assessed demographics, archwire preferences, factors influencing selection, and perceptions of treatment efficiency.

Results: Traditional super-elastic nickel-titanium was the most frequently used archwire (55.4%), followed by 35°C thermo-active copper Ni-Ti (39.8%). Main factors influencing selection were achieving fast tooth movement (27.4%) and ease of manipulation (23.1%). Ease of manipulation and market availability showed statistically significant associations with archwire selection (p<0.05). Most respondents (71.1%) reported an average alignment duration of 6 months. According to 50.6% of respondents, Super-elastic Ni-Ti were the most effective in reducing treatment duration. However, 35°C copper Ni-Ti was rated as most clinically efficient (53% of respondents).

Conclusion: Iraqi orthodontists prefer super-elastic NiTi archwires for alignment, influenced by biomechanical properties and practical factors. Perceptions of efficiency varied between wire types. Further research is needed to directly compare clinical outcomes with different archwires.

Prevalence and Patterns of Upper and Lower Third Molar Impaction: A Radiographic Retrospective Study based on a population in Erbil, Iraq.

Layla Muhammad Fatah — 2025-06-30

Background and objective: The most impacted teeth in the human oral cavity are the lower third molars. Although they may cause pathology, the unerupted teeth are not pathogenic lesions by themselves. Impaction can manifest at various degrees and in various patterns.

Aim: The aim of this study is to evaluate the prevalence and position of impacted third molars based on the classifications of Pell & Gregory and Winter’s classification in a sample of Erbil population, Kurdistan, Iraq.

Methods: This retrospective study examined 880 orthopantomograms (OPG) of patients who were referred to the faculty of dentistry at Tishk International University in Erbil City between September 2022 and October 2023. Age, gender, angulation, and depth of wisdom tooth impactions were among the variables assessed using the Chi-Square test and classified using the methods of Pell & Gregory and Winter’s classification.

Results: We found that 65.7% of patients had impaction, and patients with third molar impactions in one jaw had a higher frequency of impaction than patients with impactions in both jaws. The left and right sides of the jaws did not differ significantly from one another. There was a very significant correlation between mandibular and maxillary impaction regarding impaction level and angulation, with mandibular impaction occurring 1.6 times more frequently than maxillary impaction. Additionally, males were more likely than females to exhibit impaction.

Conclusion: The high prevalence of impacted third molars in the studied population, with vertical impaction more predominant in the maxilla and mesioangular impaction more common in the mandible.