Early Class II treatment.

The treatment of children presenting with a Class II division I malocclusion involves one of two approaches. The first provides treatment in two phases; one of intervention during the mixed dentition (phase I) followed by a second definitive course of appliance treatment in early adolescence (phase II). The second approach involves providing a single course of comprehensive therapy during adolescence. The debate for and against early treatment is discussed alongside key, clinically relevant evidence related to Class II division I malocclusions.

Supplemental vibrational force during orthodontic alignment: a randomized trial.

This prospective 3-arm parallel-group randomized clinical trial investigated the effect of supplemental vibrational force on rate of orthodontic tooth alignment with fixed appliances. Eighty-one subjects (40 males, 41 females; mean age, 14.1 y) undergoing first premolar extraction-based fixed appliance treatment were randomly allocated to treatment supplemented with daily use (20 min) of a removable intraoral vibrational device (AcceleDent; OrthoAccel Technologies Inc.; n = 29), an identical nonfunctional (sham) device (n = 25), or fixed appliances only (n = 27). Mandibular study casts were taken at baseline (treatment start: placement of 0.014-in. nickel-titanium arch wire), initial alignment (0.018-in. nickel-titanium arch wire), and final alignment (0.019 x 0.025-in. stainless steel arch wire). Overall mean irregularity index in the mandibular arch at baseline was 8.5 ± 3.8 mm (95% CI, 7.6 to 9.3) with no significant difference between groups (P = 0.73). For the total sample, mean irregularity index at initial alignment was 2.7 ± 2.8 mm (95% CI, 2.2 to 3.4) with no significant difference between groups (P = 0.40). Mean time from baseline to initial alignment was 59 ± 25 d (95% CI, 54.5 to 65.6); from initial to final alignment, 150 ± 62.5 d (95% CI, 136 to 165); and baseline to final alignment, 209 ± 65 d (95% CI, 195 to 224). Kaplan-Meier analysis demonstrated that patterns of alignment were not significantly different among the 3 groups (P = 0.66). Multivariate linear regression for initial and overall alignment rates using initial irregularity index as the covariate showed no significant differences among groups. The most important influence on both initial and overall rates of alignment was initial irregularity (P = 0.1 × 10(-4)). This prospective randomized clinical trial found no evidence that supplemental vibrational force can significantly increase the rate of initial tooth movement or reduce the amount of time required to achieve final alignment when used in conjunction with a preadjusted edgewise fixed appliance (ClinicalTrials.gov NCT02314975).

The use of functional appliances in contemporary orthodontic practice.

Functional appliances have been used for over 100 years in orthodontics to correct Class II malocclusion. During this time numerous different systems have been developed often accompanied by claims of modification and enhancement of growth. Recent clinical evidence has questioned whether they really have a lasting influence on facial growth, their skeletal effects appearing to be short term. However, despite these findings, the clinical effectiveness of these appliances is acknowledged and they can be very useful in the correction of sagittal arch discrepancies. This article will discuss the clinical use of functional appliances, the underlying evidence for their use and their limitations.

What is the value of orthodontic treatment?

Orthodontic treatment is as popular as ever. Orthodontists frequently have long lists of people wanting treatment and the cost to the NHS in England was £258m in 2010-2011 (approximately 10% of the NHS annual spend on dentistry). It is important that clinicians and healthcare commissioners constantly question the contribution of interventions towards improving the health of the population. In this article, the authors outline some of the evidence for and against the claims that people with a malocclusion are at a disadvantage compared with those without a malocclusion and that orthodontic treatment has significant health benefits. The authors would like to point out that this is not a comprehensive and systematic review of the entire scientific literature. Rather the evidence is presented in order to stimulate discussion and debate.

A comparison of two different techniques for early correction of Class III malocclusion.

OBJECTIVE: To compare the effectiveness of Reverse Twin-Block therapy (RTB) and protraction face mask treatment (PFM) with respect to an untreated control in the correction of developing Class III malocclusion. MATERIALS AND METHODS: A retrospective comparative study of subjects treated cases with either PFM (n  =  9) or RTB (n  =  13) and untreated matched controls (n  =  10) was performed. Both the PFM and control group samples were derived from a previously conducted clinical trial, and the RTB group was formed of consecutively treated cases. The main outcome variables assessed were skeletal and dental changes. Lateral cephalograms were taken at the start and end of treatment or during the observation period. Analysis of variance was used to compare changes in cephalometric variables arising during the study period in the lateral group. Linear regression analysis and an unpaired t-test were used to determine the impacts of treatment duration and gender, respectively. RESULTS: Significantly greater skeletal changes arose with PFM therapy than with RTB therapy or in the control group (SNA, SNB, and ANB; P < .001). The dentoalveolar effects of RTB therapy exceeded those of PFM treatment, with significantly more maxillary incisor proclination (P < .001) and mandibular incisor retroclination (P < .006) arising with treatment. CONCLUSIONS: Both appliances are capable of correction of Class III dental relationships; however, the relative skeletal and dental contributions differ. Skeletal effects, chiefly anterior maxillary translation, predominated with PFM therapy. The RTB appliance induced Class III correction, primarily as a result of dentoalveolar effects.

Bullying in schoolchildren - its relationship to dental appearance and psychosocial implications: an update for GDPs.

Bullying in school-aged children is a global phenomenon. The effects of bullying can be both short- and long-term, resulting in both physiological and psychological symptoms. It is likely that dental care professionals will encounter children who are subjected to bullying. The aim of this narrative review is to discuss the incidence of bullying, the types of bullying, the effects of bullying and the interventions aimed at combating bullying in schoolchildren. The role of dentofacial aesthetics and the relationship of bullying and the presence of a malocclusion are also discussed.

Revisiting the supernumerary: the epidemiological and molecular basis of extra teeth.

Supernumerary teeth are a common clinical and radiographic finding and may produce occlusal and dental problems. The aetiological basis of extra teeth is poorly understood in human populations; however, the mouse provides a useful model system to investigate the complex genetics of tooth development. This article describes recent advances in our understanding of the genetic basis of supernumerary teeth. We have reviewed biological evidence that provides insight into why supernumerary tooth formation may occur. Indeed, many of the molecular signalling pathways known to be involved in normal development of the tooth germ can also give rise to additional teeth if inappropriately regulated. These include components of the Hedgehog, FGF, Wnt, TNF and BMP families, which provide a useful resource of candidate genes that may potentially play a role in human supernumerary tooth formation.

Pain experience during initial alignment with a self-ligating and a conventional fixed orthodontic appliance system. A randomized controlled clinical trial.

OBJECTIVES: To test the hypotheses that (1) there is no difference in the pain experience during the week following initial placement of two orthodontic appliances (SmartClip and Victory; 3M Unitek, Monrovia, Calif); and (2) there is no difference in the pain experience during removal and insertion of orthodontic archwires with these brackets. MATERIALS AND METHODS: Sixty-six consecutive patients were treated with a self-ligating bracket system (SmartClip) or a conventional appliance (Victory) on the basis of computer-generated random allocation. After appliance placement and engagement of a 0.016'' nickel-titanium archwire, pain experience was recorded after 4, 24, and 72 hours and after 7 days with the use of a visual analog system (VAS) questionnaire. At a subsequent visit, participants documented pain experiences during removal and insertion of 0.019 x 0.025'' archwires on an additional 100 mm VAS questionnaire. Independent t-tests and analyses of covariance were used to analyze normally distributed data; the Mann-Whitney U-test was used for skewed distributions. RESULTS: Forty-eight (72.2%) and fifty-one (77.3%) subjects completed the first and second parts of the study, respectively. Bracket type had no influence on pain experience at 4 hours (P = .958), 24 hours (P = .289), 72 hours (P = .569), and 7 days (P = .756) following appliance placement. However, bracket type significantly influenced pain experience during archwire removal (P = .001) and insertion (P = .013). CONCLUSIONS: Hypothesis 1 cannot be rejected. The bracket type had no effect on subjective pain experience during the first week after initial placement of two preadjusted orthodontic appliances. Hypothesis 2 was rejected. Significantly greater discomfort was experienced during archwire insertion and removal with the SmartClip appliance.

I want braces: factors motivating patients and their parents to seek orthodontic treatment.

OBJECTIVE: To determine patients' and parents'/guardians' motivation for orthodontic treatment. BASIC RESEARCH DESIGN: A self-completion postal questionnaire survey of new patients referred for orthodontic assessment. CLINICAL SETTING: Kent and Canterbury Hospital (January 2003-January 2004). PARTICIPANTS: Five hundred patients referred from general dental practice and community dental service within East Kent. RESULTS: Response rate was 66%. Fifty percent of the patients were between 11 and 13-years-old. In 81% of cases referral was initiated by the dentist. Most of the patients (87%) were concerned with the appearance of their teeth, 38% reported teasing related to their dental appearance. Only 20% of patients thought there was nothing wrong with their teeth. CONCLUSIONS: The patients' general dental practitioner initiated referral for orthodontic treatment in the majority of the cases. Most patients and parents appeared to be highly motivated and accepting of appliances for orthodontic treatment. Teasing was a commonly reported consequence of malocclusion with negative psychosocial impact.

Systematic reviews in orthodontics: what have we learned?

UNLABELLED: The literature is becoming replete with systematic reviews of orthodontic-related topics. However, their findings have not been appraised and summarised collectively. METHODS: Systematic reviews related to orthodontics published between 1 January 2000, and 31 January 2007 were identified and reviewed. RESULTS: Fifty-one orthodontic systematic reviews were identified in the defined period. A highly significant percentage of reviews (29%) failed to reach conclusions. Conclusions were made in the remaining reviews although many relied on secondary levels of evidence to do so. In this narrative review the findings from these studies are summarised. CONCLUSIONS: Systematic reviews in orthodontic-related areas have produced some interesting findings. However an unacceptably high number continue to be inconclusive, reflecting methodological inadequacies of the review process and exposing inadequacies in our evidence base.

How to ... manage the transition from functional to fixed appliances.

This paper presents the methods of transfer from functional to fixed appliances. The aim of transition should be maintenance of Class II correction in a time-efficient manner without compromising long-term patient co-operation.

A new technique for symmetry determination in tooth morphology using image analysis: application in the diagnosis of solitary maxillary median central incisor.

OBJECTIVE: To develop a new technique for determining symmetry in tooth morphology and to evaluate this in the investigation of a patient with a solitary maxillary median central incisor (SMMCI) and a control group. DESIGN: A 9-year-old Caucasian female presented with SMMCI. Clinically the tooth appeared symmetrical. Morphology measurements of the maxillary central incisor were made using an image analysis system. Symmetry was determined by outlining the tooth from labial and axial views. These images were block filled, duplicated, flipped horizontally and then superimposed on the original image. The coincident area and perimeter of the two images from both views were measured. The method was repeated for the maxillary central incisors of 20 sets of control study models for young adult patients from which reference intervals for comparison with the SMMCI case were prepared. RESULTS: From the labial view, the area and perimeter of the two images of the SMMCI tooth were 98.85% and 98.97% coincident, respectively. From the axial view the area of the two images was 96.17% coincident, while the perimeter was 99.03% coincident. In all but one comparison for coincidence the SMMCI was above the upper limit of the reference range from the control group. CONCLUSIONS: This new technique is a valid method of assessing symmetry and is a useful clinical tool in cases of SMMCI.

Mandibular first and second molar tooth transposition: a case report.

A case is reported of what appears to be a transposition affecting the mandibular first, second, and third molars. The possible aetiology is discussed in relation to previously published studies. In the case described the primary actilogical factor appears to intraosseous migration of the developing tooth germ.

Class III Twin Blocks: a case series.

OBJECTIVE: To evaluate the use of Class III Twin Blocks for the early treatment of Class III malocclusion. DESIGN: Retrospective analysis. SUBJECTS AND METHOD: 14 subjects were consecutively treated with a modified version of the Class III Twin Block appliance. Lateral cephalometric radiographs taken at the start and end of treatment were assessed digitally. RESULTS: The mean age of subjects was 10 years and mean treatment time was 6.6 months. The cephalometric analysis of changes during treatment shows proclination of the upper incisors [mean 5.1 degrees, SD 5.1], retroclination of the lower incisors [mean -4.5 degrees, SD 3.9], reduction in angle SNB [mean -1.3 degrees, SD 1.8] and an increase in the maxillary/ mandibular planes angle (mean 2.1 degrees, SD 2.2]. Average cephalometric digitizations and photographs of a clinical case are shown. CONCLUSIONS: Class III Twin Blocks can be used successfully for early treatment of Class III malocclusion. A randomly allocated prospective study is required to fully evaluate the efficacy of this appliance.

The relationship between arch dimensions and the 5-year index in the primary dentition of patients with complete UCLP.

OBJECTIVE: To compare dental arch dimensions of children in the primary dentition with repaired unilateral clefts of the lip and palate (UCLP) to a noncleft group of a similar age and determine how the dimensions of the cleft arches relate to an index of treatment outcome. METHOD: Dental study casts of 44 5- to 6-year-olds with complete UCLP (22 boys and 22 girls) from a single center, whose primary surgery had been carried out by one surgeon, were matched for age, sex, and ethnicity with dental study casts from a longitudinal growth study. Analysis of variance was used to ascertain differences in arch dimensions between the two groups. The cleft group casts were then assessed with an established index of surgical outcome, the 5-year-old index. Spearman's rank correlation coefficient was used to see how the arch dimensions of the cleft group related to the categories of the index. RESULTS AND CONCLUSIONS: Maxillary arch dimensions were significantly smaller in the cleft group than in the noncleft group, irrespective of sex (p < .05). In the mandibular arch, there was no difference between the cleft and noncleft groups (p > .05). Maxillary arch dimensions of the cleft group correlated significantly with the 5-year-old index for arch length and intercanine width (p < .05) but not intermolar width (p = .842). This would suggest that the 5-year-old index is a suitable tool for assessing the outcome of treatment in the primary dentition for anteroposterior and anterior transverse arch dimensions.

Changes in circumferential neck measurements during movements of the head in children and their relevance to extraoral traction.

One of the causes of facebow injuries to patients wearing extraoral traction has been the catapult effect of the simple elasticized materials used in the past. A variety of safety or self-releasing modular systems to counteract this catapult effect are currently available. However, the strap extension provided by these modules varies considerably. To reduce the catapult effect to a minimum, it is desirable to fit a system with the minimal travel that will accommodate any changes in distance between the facebow and the back of the head or neck. To ascertain the minimal travel required for the straps, circumferential neck measurements were carried out on 105 children aged between 9 and 14 years. The change in circumference was recorded for 3 different head positions. The mean distance change between the back of the neck and the end of the facebow was 25 mm per side, with a range of 4 mm to 50 mm. This study suggests that on average, modules with a 25-mm extension will be required for cervical traction.

Malocclusion, orthodontics and bullying.

Bullying is endemic among schoolchildren, and the effects can be devastating and long lasting. The persistently bullied child appears to represent a certain psychological type, with poorly developed social skills and a submissive nature. Physical appearance does appear to play a role, which includes facial and dental appearance, although these tend not to be primary factors. Teasing related to dental appearance appears to be particularly hurtful. There is little evidence of a marked increase in self-esteem following orthodontic treatment in children, but in adults following treatment there is an improvement of body concept. The long-term psychological benefits of orthodontic treatment are difficult to measure but there is an increasing awareness of malocclusion with age.

Does orthodontics damage faces?

With the increasing provision of orthodontic care in this country, certain practitioners have raised concerns regarding the use of elective extractions and retraction mechanics, especially the effects on the facial profile and the TMJ. The non-extraction versus extraction debate spans the history of orthodontics, and the concepts of facial attractiveness are subject to change as fashions change. Within the realms of evidence-based practice, there is little or no evidence to suggest that the philosophies and mechanics of contemporary orthodontics, in the vast majority of cases, cause damage to the profile or are directly linked to the development of TMJ dysfunction.

Hazards of orthodontics appliances and the oropharynx.

Occasionally orthodontic appliances or parts of orthodontic appliances have caused problems with either the airway or the gastrointestinal tract. The type of appliances that have caused problems and their clinical management are discussed. A case is described in which an upper removable appliance with inadequate retention became lodged in a patient's pharynx lacerating the palatine tonsils. Suggestions are made to try and avoid the problems that were encountered in this case and others reported in the literature in patients undergoing orthodontic treatment.

Primary failure of eruption in the permanent dentition of siblings.

Primary failure of eruption is a condition where there is eruption failure in the permanent dentition with no obvious mechanical cause. It has previously been reported in the literature as a cause of posterior openbite, with a varying degree of familial inheritance. This case report describes two sisters that experienced eruption failure in the permanent dentition, most notably of the first and second molars, with greater severity in the younger sister. Teeth were exposed in both patients and orthodontic traction was applied with little or no success. The report provides further evidence of the genetic contribution to the aetiology of this condition and also highlights the problems in attempting treatment, including exposing to the oral environment teeth that are infra-occluded and difficult to clean effectively.