Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea.

PURPOSE: Oral appliances (OA) are used to treat patients with obstructive sleep apnea (OSA). The purpose of this study is to evaluate the efficacy of OA treatment in patients with rapid eye movement (REM)-related OSA. METHODS: Forty-six patients with REM-related OSA and 107 with non-stage-specific OSA were prescribed OA treatment after diagnosis by polysomnography (PSG) and a follow-up sleep test by PSG was conducted. Efficacy and treatment outcome predictors were evaluated according to the following criteria for treatment success: #1, reduction of the apnea-hypopnea index (AHI) to less than 5 and > 50% compared with baseline; #2, AHI reduction to less than 10 and > 50% compared with baseline; and #3, > 50% AHI reduction compared with baseline. RESULTS: Success rates according to criteria #1, #2, and #3 were 45.7%, 50.0%, and 50.0% in REM-related OSA and 36.4%, 52.3%, and 63.6% in non-stage-specific OSA, respectively. No significant differences in success rate were found between the two groups. In multivariate logistic regression analysis with each criterion as the response variable, only BMI was extracted as a significant predictor. The BMI cutoff values defined based on the maximum Youden index according to the three criteria were 26.2 kg/m2, 25.6 kg/m2, and 26.2 kg/m2, respectively. CONCLUSIONS: No significant differences in success rate of OA treatment were found between REM-related OSA and non-stage-specific OSA. BMI has greater impact on treatment outcome of OA in patients with REM-related OSA.

[Evaluation of dental medical devices: Focus on the definition of needs]. / Évaluation des dispositifs médicaux dentaires pour un appel d'offres : privilégier la haute définition des besoins.

OBJECTIVES: As a university teaching hospital, the call for tender for dental medical devices (dental implants and consumables) is done with the help of a team of hospital pharmacists and users. In order to optimize the definition of needs and evaluation criteria, an exhaustive review of the products was carried out. METHODS: Dental medical devices suppliers were consulted in 2017 for reviewing their products. Their technical, clinical and economic data were compared. The products have been gathered into categories and its results had been submitted to a commission of dental experts of our university hospital for clinical opinion. RESULTS: More than 30,000 references from 30 different suppliers were analyzed (orthodontics, dental implants, membranes and bone substitutes, various dental consumables). Relating to oral implantology, the opinions converged on clinical studies. On the contrary, diverging opinions have been proffered on the systematic use of single-use drills and customized guides for surgery and on the implant's choice. The definition of needs has been specified for orthodontics and consumables. Other criteria played a great role: single packaging (unit doses), product's sterility, paediatric needs, presence of allergens, traceability of devices and supplier diversity. CONCLUSIONS: This review led to the identification of new needs in more precise terms. The complexity and diversity of dental products and techniques requires this careful review and a better collaboration with practitioners.

Distortion and magnification of four digital cephalometric units.

OBJECTIVES: To assess the validity of using the calibration ruler for correcting magnification of linear measurements and to explore and compare the vertical and horizontal magnification of four digital cephalometric units. METHODS: An acrylic box was imaged at seven sagittal positions using four digital cephalometric units: Orthopantomograph OC100, Orthopantomograph OC200, Sirona Orthophos CD, and Sirona Orthophos DS. The true linear lengths of the phantom, corrected, and uncorrected linear lengths on the images were measured and compared. The validity of measurements using the calibration ruler was assessed. The magnification values and distortion indices were calculated and compared among the four cephalometric units. RESULTS: For linear measurements on the mid-sagittal plane and averaged linear measurements on bilateral symmetric sagittal planes, the bias 1.96 STD of the calibration ruler ranged from 1% to 2% for the four cephalometric testing units. For linear measurements on the single lateral sagittal plane, the bias 1.96 STD ranged from 3% to 6%. The vertical scanning charge-coupled device cephalometric unit produced the greatest distortion, ranging from 1.029 to 0.964. CONCLUSION: The metal millimeter calibration ruler is an accurate reference for linear measurement magnification correction. Because of unpredictability and machine specificity, the magnification and distortion of a cephalometric unit should be calibrated for the estimation of cephalometric measurement error.

Evaluation of Various Sterilization Processes of Orthodontic Instruments using Biological Indicators and Conventional Swab Test Method: A Comparative Study.

AIM: This study aimed to compare the efficiency of various sterilization procedures using conventional spore monitoring method, i.e., by using swab test and biological indicators and to determine the efficiency of cold sterilization by using Bioclenz-G (2% glutaraldehyde) solution. MATERIALS AND METHODS: Each group was divided into medium load (containing 15 sets of instruments) and heavy load (containing 30 sets of instruments). Each group was tested 15 times for medium and heavy loads. Two groups are swab tested control group and experimental group with three different methods of sterilization: hot air oven, cold sterilization, and ethylene dioxide sterilization. RESULTS: Spores were present in all the groups tested for 10 minutes cycle, in comparison with no spore growth in any of the groups tested for a 10-hour cycle. CONCLUSION: All methods of sterilization showed complete sterilization of instruments when monitored with biological indicators. One group of heavy load in steam autoclave and one group each of medium load and heavy load in hot air oven sterilizer showed sterilization failure when monitored with the conventional swab test method. CLINICAL SIGNIFICANCE: This study proves the efficacy and durability of various sterilization procedures.

Accuracy of a computed tomography scanning procedure to manufacture digital models.

INTRODUCTION: Accurate articulation of the digital dental casts is crucial in orthodontic diagnosis and treatment planning. We aimed to determine the accuracy of manufacturing digital dental casts from computed tomography scanning of plaster casts regarding linear dimensions and interarch relationships and to test whether eventual differences in interarch relationships between plaster and digital casts would affect orthodontic diagnostics. METHODS: Plaster casts with the wax bites of 2 patients were used to create digital dental casts with a computed tomography scanner. This was repeated 4 times with a 1-week interval. Linear distances were measured on plaster and digital models twice by 2 observers. Next, the 4 digital models of each patient were scored twice by 5 observers for interarch variables. RESULTS: Digital vs plaster measurements showed high Pearson correlation coefficients (>0.954), whereas the mean difference was small (<0.1 mm) and not significant. The interarch scorings, however, showed significant differences for all variables, except overjet for model 1. CONCLUSIONS: We found substantial interarch inaccuracies of the digital models. These inaccuracies are probably due to a lack of built-in "collision control" in the software and manual articulation of the digital models by a human operator.

Unclear if non-surgical adjuncts accelerate orthodontic treatment.

Data sourcesCochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, LILACS, the metaRegister of Controlled Trials, the US National Institutes of Health Trials Register and the WHO International Clinical Trials Registry Platform.Study selectionRandomised controlled trials of orthodontic treatment using fixed appliances along with non-surgical adjunctive interventions to accelerate tooth movement.Data extraction and synthesisTwo reviewers independently selected studies, abstracted data and assessed risk of bias. Meta-analysis was not possible.ResultsTwo studies involving a total of 111 patients were included, both were at high risk of bias. The studies compared the use of Tooth Masseuse and OrthoAccel with conventional treatment mechanics. Using OrthoAccel with 30 Hz at 0.25 N for 20 minutes daily produced a higher rate of maxillary canine distalisation in comparison to the control group (MD 0.37 mm/month; 95% CI -0.07 to 0.81; P = 0.05). Whilst this difference suggested 50% faster tooth movement using the vibrational appliance, the absolute differences were marginal and deemed clinically unimportant. Similar levels of non-serious adverse effects were reported in the intervention and control groups with a risk ratio of 0.96 (95% CI 0.32 to 2.85). Overall, the quality of the evidence was very low and therefore we cannot rely on the findings.ConclusionsThere is very little clinical research concerning the effectiveness of non-surgical interventions to accelerate orthodontic treatment. The available evidence is of very low quality and so it is not possible to determine if there is a positive effect of non-surgical adjunctive interventions to accelerate tooth movement. Although there have been claims that there may be a positive effect of light vibrational forces, results of the current studies do not reach either statistical or clinical significance. Further well-designed and rigorous RCTs with longer follow-up periods are required to determine whether non-surgical interventions may result in a clinically important reduction in the duration of orthodontic treatment, without any adverse effects.

Accuracy and mechanical properties of orthodontic models printed 3-dimensionally from calcium sulfate before and after various postprinting treatments.

INTRODUCTION: Dental models fabricated with 3-dimensional printing technologies are revolutionizing the practice of orthodontics, but they generally comprise polymeric materials that may not be suitable for certain applications, such as soldering appliances. The objective of this study was to investigate the dimensional accuracy and mechanical properties of 3-dimensional printed ceramic-based models before and after various treatments intended to improve their mechanical properties. METHODS: Thirty identical models were printed 3-dimensionally from a calcium sulfate-based substrate and divided into 3 groups for treatment: high heat (250°C for 30 minutes), low heat (150°C for 30 minutes), and Epsom salt treatment. Each model was scanned before and after treatment with a laser scanner, and dimensional stability was analyzed by digital superimpositions using a best-fit algorithm. The models were weighed before and after treatment to evaluate mass changes. Additionally, 3-dimensional printed cylinders treated as described above and an untreated control group were subjected to compressive mechanical testing (n = 11 per group). RESULTS: The Epsom salt treatment group had statistically significant increases in both peak compressive stress and modulus of elasticity when compared with the other treatment groups. All treatment groups had statistically significant changes in mass, with the Epsom salt group gaining mass and the 2 heat-treatment groups losing mass. The low-temperature treatment group had a statistically significantly lower mean average for dimensional deviations (0.026 ± 0.010 mm) than did the other treatment groups (0.069 ± 0.006 and 0.059 ± 0.010 mm for high temperature and Epsom salt, respectively). CONCLUSIONS: Dental models printed 3-dimensionally with calcium sulfate and treated with Epsom salt showed significant improvement in compressive mechanical properties and retained clinically acceptable dimensional stability.

Joining characteristics of titanium-based orthodontic wires connected by laser and electrical welding methods.

This study investigated the possibility of electrical and laser welding to connect titanium-based alloy (beta-titanium and nickel-titanium) wires and stainless-steel or cobalt-chromium alloy wires for fabrication of combination arch-wires. Four kinds of straight orthodontic rectangular wires (0.017 × 0.025 inch) were used: stainless-steel (S-S), cobalt-chromium (Co-Cr), beta-titanium alloy (ß-Ti), and nickel-titanium (Ni-Ti). Homogeneous and heterogeneous end-to-end joints (15 mm long each) were made by electrical welding and laser welding. Non-welded wires (30 mm long) were also used as a control. Maximum loads at fracture (N) and elongation (%) were measured by conducting tensile test. The data (n = 10) were statistically analyzed using analysis of variance/Tukey test (P < 0.05).The S-S/S-S and Co-Cr/Co-Cr specimens showed significantly higher values of the maximum load (ML) at fracture and elongation (EL) than those of the Ni-Ti/Ni-Ti and ß-Ti/ß-Ti specimens for electrical welding and those of the S-S/S-S and Co-Cr/Co-Cr specimens welded by laser. On the other hand, the laser-welded Ni-Ti/Ni-Ti and ß-Ti/ß-Ti specimens exhibited higher values of the ML and EL compared to those of the corresponding specimens welded by electrical method. In the heterogeneously welded combinations, the electrically welded Ni-Ti/S-S, ß-Ti/S-S and ß-Ti/Co-Cr specimens showed significantly (P < 0.05) higher ML and EL than those of the corresponding specimens welded by laser. Electrical welding exhibited the higher values of maximum load at fracture and elongation for heterogeneously welded combinations than laser-welding.

Influence of CO2 (10.6 µm) and Nd:YAG laser irradiation on the prevention of enamel caries around orthodontic brackets.

One possible undesirable consequence of orthodontic therapy is the development of incipient caries lesions of enamel around brackets. The aim of this study was to compare the effects of CO2 (λ = 10.6 µm) and Nd:YAG (λ = 1,064 nm) lasers associated or not with topical fluoride application on the prevention of caries lesions around brackets. Brackets were bonded to the enamel of 65 premolars. The experimental groups (n = 13) were: G1--application of 1.23% acidulated fluoride phosphate gel (AFP, control); G2--Nd:YAG laser irradiation (0.6 W, 84.9 J/cm(2), 10 Hz, 110 µs, contact mode); G3--Nd:YAG laser irradiation associated with AFP; G4--CO2 laser irradiation (0.5 W, 28.6 J/cm(2), 50 Hz, 5 µs, and 10 mm focal distance); and G5--CO2 laser irradiation associated with AFP. Quantitative light-induced fluorescence was used to assess enamel demineralization. The data were statistically compared (α = 5%). The highest demineralization occurred in the Nd:YAG laser group (G2, 26.15% ± 1.94). The demineralization of all other groups was similar to that of the control group. In conclusion, CO2 laser alone was able to control enamel demineralization around brackets at the same level as that obtained with topical fluoride application.

Orthodontic scanners: what's available?

The popularity and availability of virtual technology in orthodontics for the replacement of hard-copy records with electronic records is growing rapidly, with a move towards a 'digital' patient for diagnosis, treatment planning, monitoring of treatment progress and outcome. As part of this ongoing development, three-dimensional digital models of the dental arches have the potential to replace traditional plaster models and their associated limitations for treatment planning, appliance construction and simulated treatment outcomes. This article provides the reader with a summary of the currently available benchtop model scanners and intraoral scanners. It is likely that this technology will become increasingly common-place within the orthodontic profession over the next decade.

Comparison of Antimicrobial Activity between Chemical Disinfectants on Contaminated Orthodontic Pliers.

AIM: To compare the antimicrobial activity of the chemical substances--70% isopropyl alcohol, 2% glutaraldehyde (GTA) and 0.25% peracetic acid (PAA) in disinfecting orthodontic pliers contaminated in vitro with Streptococcui mutani, Staphylococci aureui and Candida albicani. MATERIALS AND METHODS: Distal end cutter pliers were divided into five groups: group 1 (negative control--sterilized pliers), group 2 (positive control--sterilized plier, subsequently contaminated), group 3 (disinfected with 70% isopropyl alcohol, friction method), group 4 (disinfected with 2% GTA, immersion method for 30 minutes), group 5 (disinfected with 0.25% peracetic acid (PAA), immersion method for 10 minutes). After the pliers were treated with one disinfectant and submitted to microbiological evaluation (by counting colony forming units), they were submitted to the same cleansing, sterilizing and contaminating processes, and were used in the following groups (crossover and washout study). The two-factor analysis of variance (ANOVA) test, followed by the Tukey test, was used to compare the groups. RESULTS: The results showed that there was no statistically significant difference between the three tested disinfectants. CONCLUSION: Although there were no statistically significant differences between the disinfectants, the chemical agents 2% glutaraldehyde and 0.25% PAA were effective in inhibiting the growth of the three microorganisms tested; however, 70% isopropyl alcohol was unable to completely eliminate S. aureui. CLINICAL SIGNIFICANCE: The chemical substances 2% glutaraldehyde and 0.25% PAA completely eliminated the microorganisms tested.

Comparison of shear bond strength of rebonded brackets with four methods of adhesive removal.

Rebonding of a dislodge bracket is considered as an economic saving option which can be done with use of in-office methods or by commercial recycling. The aim of this study was to compare the shear rebond strength (SRS) of brackets recycled with different resin removal methods. Eighty premolars were divided into four experimental groups. The teeth were bonded with metal brackets. The brackets were debonded and adhesive remnants were removed from bracket bases by means of Er:YAG laser, sandblasting, direct flame, and CO2 laser, respectively. Following adhesive removal from enamel surfaces with carbide bur, recycled brackets were rebonded. Finally, all brackets were debonded with a Dartec testing machine and the SRS values were determined. The SRS values of groups 3 and 4 were significantly lower compare to other groups (P value < 0.001). SEM examination showed complete adhesive removal from bracket base cleaned with Er:YAG laser irradiation. Microroughening of the base of sandblasted bracket was observed in the SEM image. Resin removal with direct flame and CO2 laser irradiation was incomplete. Er:YAG laser recycling of brackets is an efficient in-office method of reconditioning which caused minimum damage to the bracket base.

Determinants for success rates of temporary anchorage devices in orthodontics: a meta-analysis (n > 50).

INTRODUCTION: The aim of this study was to review the literature and evaluate the failure rates and factors that affect the stability and success of temporary anchorage devices (TADs) used as orthodontic anchorage. METHODS: Data were collected from electronic databases: MEDLINE database, Scopus, and Web of Knowledge. Four combinations of term were used as keywords: screw orthodontic failure, screw orthodontic success, implant orthodontic failure, and implant orthodontic success. The following selection criteria were used to select appropriate articles: articles on implants and screws used as orthodontic anchorage, data only from human subjects, studies published in English, studies with more than 50 implants/screws, and both prospective and retrospective clinical studies. RESULTS: The search provided 209 abstracts about TADs used as anchorage. After reading and applying the selection criteria, 26 articles were included in the study. The data obtained were divided into two topics: which factors affected TAD success and to what degree and in how many articles they were quoted. Clinical factors were divided into three main groups: patient-related, implant-related, and management-related factors. CONCLUSIONS: Although all articles included in this meta-analysis reported success rates of greater than 80 per cent, the factors determining success rates were inconsistent between the studies analysed and this made conclusions difficult.

Tips for maintaining sterilization in your orthodontic work station.

Sterilization and disinfection have been a matter of concern amongst dental health care workers since long. Delicate materials, electrical parts, orthodontic pliers, orthodontic wire cutters, are to be treated according to the manufacturer's instructions to safe guard the life of the instrument as well as to claim warranty for any damage incurred. Sterilization procedures used in Orthodontics should be simple but effective and of relatively short duration so that there is a readily available supply of sterile instruments and materials. The procedure should not cause any appreciable damage to dental instruments and other materials. An attempt has been made through this article, to provide information concerning methods and means of disinfection and sterilization of orthodontic clinics, instruments, materials and also waste disposal which can be adopted in private clinics as well as in hospital set ups.

Creation of 3D multi-body orthodontic models by using independent imaging sensors.

In the field of dental health care, plaster models combined with 2D radiographs are widely used in clinical practice for orthodontic diagnoses. However, complex malocclusions can be better analyzed by exploiting 3D digital dental models, which allow virtual simulations and treatment planning processes. In this paper, dental data captured by independent imaging sensors are fused to create multi-body orthodontic models composed of teeth, oral soft tissues and alveolar bone structures. The methodology is based on integrating Cone-Beam Computed Tomography (CBCT) and surface structured light scanning. The optical scanner is used to reconstruct tooth crowns and soft tissues (visible surfaces) through the digitalization of both patients' mouth impressions and plaster casts. These data are also used to guide the segmentation of internal dental tissues by processing CBCT data sets. The 3D individual dental tissues obtained by the optical scanner and the CBCT sensor are fused within multi-body orthodontic models without human supervisions to identify target anatomical structures. The final multi-body models represent valuable virtual platforms to clinical diagnostic and treatment planning.

Assessment of phantom dosimetry and image quality of i-CAT FLX cone-beam computed tomography.

INTRODUCTION: The increasing use of cone-beam computed tomography in orthodontics has been coupled with heightened concern about the long-term risks of x-ray exposure in orthodontic populations. An industry response to this has been to offer low-exposure alternative scanning options in newer cone-beam computed tomography models. METHODS: Effective doses resulting from various combinations of field of view size and field location comparing child and adult anthropomorphic phantoms with the recently introduced i-CAT FLX cone-beam computed tomography unit (Imaging Sciences, Hatfield, Pa) were measured with optical stimulated dosimetry using previously validated protocols. Scan protocols included high resolution (360° rotation, 600 image frames, 120 kV[p], 5 mA, 7.4 seconds), standard (360°, 300 frames, 120 kV[p], 5 mA, 3.7 seconds), QuickScan (180°, 160 frames, 120 kV[p], 5 mA, 2 seconds), and QuickScan+ (180°, 160 frames, 90 kV[p], 3 mA, 2 seconds). Contrast-to-noise ratio was calculated as a quantitative measure of image quality for the various exposure options using the QUART DVT phantom. RESULTS: Child phantom doses were on average 36% greater than adult phantom doses. QuickScan+ protocols resulted in significantly lower doses than standard protocols for the child (P = 0.0167) and adult (P = 0.0055) phantoms. The 13 × 16-cm cephalometric fields of view ranged from 11 to 85 µSv in the adult phantom and 18 to 120 µSv in the child phantom for the QuickScan+ and standard protocols, respectively. The contrast-to-noise ratio was reduced by approximately two thirds when comparing QuickScan+ with standard exposure parameters. CONCLUSIONS: QuickScan+ effective doses are comparable with conventional panoramic examinations. Significant dose reductions are accompanied by significant reductions in image quality. However, this trade-off might be acceptable for certain diagnostic tasks such as interim assessment of treatment results.

Diagnostic accuracy of impression-free digital models.

INTRODUCTION: Impression-free techniques might eliminate the potential shortcomings of digital dental models. Chairside scanners offer the advantage of obtaining digital dental models directly from the patient without the need for dental impressions. The aim of this study was to evaluate the accuracy of 3-dimensional digital models acquired from a chairside intraoral scanner compared with both manual and cone-beam computed tomography measurements of the same dental anatomy. METHODS: The study sample comprised 60 dry skulls. Each skull had the maxillary and mandibular arches scanned with a Cadent iTero scanner (Align Technology, San Jose, Calif) and had a cone-beam computed tomography scan taken with a CS 9300 unit (Carestream Health, Atlanta, Ga). Linear measurements in all 3 dimensions of the space in each dental arch together with tooth-size arch-length analysis for both the maxillary and mandibular arches were carried out manually on the dry skulls with calipers and digitally on the scanned 3-dimensional models and cone-beam computed tomography images. Intraclass correlation (ICC) analysis was performed for all variables tested in the study groups, with the manual measurements on the dry skulls as the gold standard. The Bland-Altman analysis was also applied to the data to graphically display the agreement of the diagnostic measurements obtained from these methods. RESULTS: Measurements from the iTero models demonstrated near-perfect agreement (ICC, 0.91-0.99) with the caliper measurements. Cone-beam computed tomography measurements had moderate to high levels of agreement (ICC, 0.65-0.99) compared with the caliper measurements. CONCLUSIONS: Direct digital acquisition of the dental arches with a chairside scanner provided almost 1-to-1 diagnostic information of the investigated anatomy and was superior to the cone-beam computed tomography measurements.

Impact of cone-beam computed tomography on orthodontic diagnosis and treatment planning.

INTRODUCTION: In this study, we measured the impact of cone-beam computed tomography (CBCT) on orthodontic diagnosis and treatment planning. METHODS: Participant orthodontists shown traditional orthodontic records for 6 patients were asked to provide a diagnostic problem list, a hypothetical treatment plan, and a clinical certainty. They then evaluated a CBCT scan for each patient and noted any changes, confirmations, or enhancements to their diagnosis and treatment plan. RESULTS: The number of diagnosis and treatment plan changes varied widely by patient characteristics. The most frequently reported diagnosis and treatment plan changes occurred in patients with unerupted teeth, severe root resorption, or severe skeletal discrepancies. We found no benefit in terms of changes in treatment plan for patients when the reason for obtaining a CBCT scan was to examine for abnormalities of the temporomandibular joint or airway, or crowding. Orthodontic participants who own CBCT machines or use CBCT scans frequently in practice reported significantly more diagnosis and treatment plan changes and greater confidence after viewing the CBCT scans during the study. CONCLUSIONS: The results of this study support obtaining a CBCT scan before orthodontic diagnosis and treatment planning when a patient has an unerupted tooth with delayed eruption or a questionable location, severe root resorption as diagnosed with a periapical or panoramic radiograph, or a severe skeletal discrepancy. We propose that CBCT scans should be ordered only when there is clear, specific, individual clinical justification.

Evaluation of effectiveness of chemical disinfectants in reducing bacterial growth on orthodontic instruments.

Infection control requires serious effort in all fields of dentistry including orthodontics. Though there are various means of sterilization and disinfection in dental office, chemical disinfection is the most preferred method among orthodontists. The purpose of this study is to evaluate different chemical sterilization and disinfection methods used in orthodontic offices, which would guide the orthodontists in infection control.