How orthodontic records can influence torque choice decisions?

INTRODUCTION: The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. METHODS: Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. RESULTS: The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. CONCLUSIONS: This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.

Accidental debondings: Buccal vs fully individualized lingual multibracket appliances.

INTRODUCTION: The aim of this study was to retrospectively assess the frequency and localizations of bond failures (BFs) in patients treated with either lingual (TOP-Service für Lingualtechnik GmbH, a 3M Company, Bad Essen, Germany) or buccal (Mini Diamond brackets/Accent molar tubes; Ormco, Orange, Calif) full multibracket appliances in both dental arches. METHODS: Data were acquired by an independent investigator from the patient records of 3 practitioners. To establish a standardized observation period, the first year of treatment was analyzed for each patient. Statistical analysis comprised the Kruskal-Wallis, Wilcoxon, Mann-Whitney U, and Fisher exact tests. The significance level was set at P <0.05. RESULTS: The mean number of BFs per patient in the first year of treatment did not differ significantly between the lingual group (n = 59; mean age, 31.1 years; mean BFs per patient, 2.63; SD, 2.77; minimum, 0; maximum, 13) and the buccal group (n = 44; mean age, 15.14 years; mean BFs per patient, 2.61; SD, 3.41; minimum, 0; maximum, 14) (P = 0.428) or with respect to sex (lingual group, P = 0.251; buccal group, P = 0.414) or practitioner (lingual group, P = 0.755; buccal group, P = 0.060), but molar attachments were more prone to BFs than were premolar brackets (lingual group, P = 0.015; buccal group, P = 0.049), and premolar brackets were more prone to BF than anterior brackets (lingual group, P = 0.005; buccal group, P = 0.004). CONCLUSIONS: With both appliances, a mean of 2.62 BFs per patient in the first year of treatment can be expected; this benchmark provides a reference for patient briefing, which is very important considering the large interindividual variances and budgeting considerations.

Three-dimensional deformation comparison of self-ligating brackets.

INTRODUCTION: Archwire rotation is used in orthodontic treatment to alter the labiolingual orientation of a tooth. Measurement of the 3-dimensional (3D) motion of the orthodontic brackets requires a new configuration of the orthodontic torque simulator. METHODS: The orthodontic torque simulator was coupled with a stereo microscope and 2 cameras to allow for the 3D bracket motion to be determined during wire twisting. The stereo camera images were processed with a 3D digital image correlation technique to determine the 3D deformation of the orthodontic brackets. Three self-ligating brackets (Damon Q, Ormco, Orange, Calif; In-Ovation R, GAC, Bohemia, NY; and Speed, Strite Industries, Cambridge, Ontario, Canada) were compared by using the 3D digital image correlation method to demonstrate the difference in 3D motion of self-ligating brackets components. RESULTS: Contour plots of the 3 brackets demonstrate the 3D motion of the bracket tie-wings and the archwire retentive component. The 3D motion of the bracket tie-wings and archwire retentive component were quantified. The displacement values of the archwire retentive component measured with the 3D orthodontic torque simulator were found to be 2.0 and 3.5 times less for the In-Ovation and Damon Q brackets than the values in previous studies that examined the compliance of the archwire retentive component. CONCLUSIONS: The 3D digital image correlation method used to quantify bracket deformation showed the 3D motion of the bracket tie-wings and the motion of the archwire retentive component. The use of a 3D optical measurement system is useful to understand the motion of the archwire retentive component but is not necessary to quantify bracket tie-wing motion. This measurement technique can be used to evaluate brackets of varying designs.

Reproducibility of bracket positioning in the indirect bonding technique.

INTRODUCTION: Current studies have compared indirect bonding with direct placement of orthodontic brackets; many of these have shown that indirect bonding is generally a more accurate technique. However, the reproducibility of an indirect bonding setup by an orthodontist has yet to be described in the literature. Using cone-beam computed tomography and computer-assisted modeling software, we evaluated the consistency of orthodontists in placing orthodontic brackets at different times. METHODS: Five orthodontists with experience in indirect bonding were selected to place brackets on 10 different casts at 3 time periods (n = 30 per orthodontist). Each participant completed an initial indirect bonding setup on each cast; subsequent bracket placements were completed twice at monthly intervals for comparison with the initial setup. The casts were scanned using an iCAT cone-beam computed tomography scanner (Imaging Sciences International, Hatfield, Pa) and imported into Geomagic Studio software (Geomagic, Research Triangle Park, NC) for superimposition and analysis. The scans for each time period were superimposed on the initial setup in the imaging software, and differences between bracket positions were calculated. For each superimposition, the measurements recorded were the greatest discrepancies between individual brackets as well as the mean discrepancies and standard deviations between all brackets on each cast. RESULTS: Single-factor and repeated-measure analysis of variance showed no statistically significant differences between time points of each orthodontist, or among the orthodontists for the parameters measured. The mean discrepancy was 0.1 mm for each 10-bracket indirect bonding setup. CONCLUSIONS: Orthodontists are consistent in selecting bracket positions for an indirect bonding setup at various time periods.

Long-term evaluation of clinical performance of direct-bonded brackets: an epidemiologic survey.

AIM: The objective of the current epidemiologic study was to investigate characteristics associated with bracket failure in bonded brackets. MATERIALS AND METHODS: A retrospective study on data of 144 patients treated during 2009 to 2012 was done. Baseline data including age, gender, malocclusion, bite type and debonding incidences per teeth were retrieved. ANOVA analysis and t-test were used to evaluate the data. RESULTS: Second premolar teeth had significantly higher debonding incidences. Patients' age was negatively correlated with debonding incidences. No difference was observed for various types of malocclusion (class I, II and III), arch side (right or left) or arch location (upper or lower). However, deep bite patients had significantly higher failure incidents. CONCLUSION: For a total of 144 patients with 2,524 bonded brackets, the overall failure rate was 7.8%. Deep bite was the only factor that was associated with higher bracket failure. The bracket failure incidents tend to decrease as patients age increase. CLINICAL SIGNIFICANCE: Deep bite patients and also second premolar teeth seem to be especially prone to debonding incidents. Care must be taken to avoid premature contacts in deep bite patients. Also strict adherence to moisture control protocols when bonding second premolar teeth is recommended since these teeth are at increased risk for debonding.

2013 survey of Australian orthodontists' procedures.

AIM: This survey of Australian orthodontists was conducted to assess treatment preferences. METHODS: Email invitations to participate in an online survey were sent to a total of 433 Australian Society of Orthodontists (ASO) members and 158 replies were received (36% response). RESULTS: For Class II treatment, most practitioners preferred to wait and treat later but when early treatment was performed, the Twin Block was the most popular appliance. For fixed appliance treatment, the 0.022 inch slot was the most commonly used (73%) and the median treatment time was 20 months. The median extraction rate was 23% which was similar to that reported in a 2008 USA survey. Sequential plastic aligners were used by 73% of respondents and Temporary Skeletal Anchorage Devices were used by 77%. The most common research question clinicians would like answered related to retention. CONCLUSION: The responses were similar Australia-wide but some areas of difference were revealed and discussed.

Frequency of orthodontic treatment in German children and adolescents: influence of age, gender, and socio-economic status.

Orthodontic treatment is a common dental procedure in developed countries. However, the frequency and factors associated with treatment demand are different between countries. The aim of this study was to examine the frequency of orthodontic treatment in German children and adolescents and to analyse the influence of age, gender, and socio-economic status (SES; education and region) on the frequency of treatment. Subjects in a random population sample of 1538 German children and adolescents, aged 11-14 years, were interviewed at home in the autumn of 2008 regarding current orthodontic treatment and associated factors. Approximately one-third (33.5 per cent) of the subjects interviewed were undergoing orthodontic treatment at that time. In a multivariable logistic regression model, the likelihood of receiving orthodontic treatment was higher for girls [odds ratio (OR) = 1.32, 95 per cent confidence interval (CI): 1.06-1.65], for high school pupils (OR = 1.19, 95 per cent CI: 1.06-1.34), and for children and adolescents living in the western part of Germany (OR = 1.45, 95 per cent CI: 1.00-2.08) and increased with age (OR = 1.13 per year, 95 per cent CI: 1.02-1.25). Subjects undergoing orthodontic treatment more often received prophylactic measures (OR = 2.06, 95 per cent CI: 1.63-2.59) compared with those not currently receiving orthodontic treatment. The frequency of orthodontic treatment in Germany largely depends on gender and SES.

Bonded molar tubes: a survey of their use by specialist orthodontists.

OBJECTIVE: To investigate the use of bonded molar tubes (BMTs) by specialist orthodontists. DESIGN: Prospective postal questionnaire. SETTING: Ireland. PARTICIPANTS: Registered members of the Orthodontic Society of Ireland. METHODS: A questionnaire was posted to registered members of the Orthodontic Society of Ireland. It investigated demographics, pattern of use, reasons for use and techniques for placement of BMTs. RESULTS: A 74% response rate was obtained. In more than 80% of cases, BMTs were used on first and second permanent molars by 52% and 33% of orthodontists respectively. BMT usage was adopted by 97% of respondents in the previous decade. Direct bonding was used by all for BMT placement. Etch times for molars, compared to other teeth, increased from 15 to 30 seconds by 51% of orthodontists. Of the respondents, 97% used light-cured adhesives and 17% used self-etching primers. Molar tube holders were preferred by 54% for placement. Only with a history of epilepsy, were bands preferred to BMTs. BMTs were regarded as more cost-effective than molar bands by 66% of responding clinicians. CONCLUSIONS: Specialist orthodontists preferred BMTs to bands on first permenent molars. Direct bonding was favoured using a 30-second etch, a light-cured primer and adhesive with specialized molar tube holders. BMTs were perceived to be more cost-effective than molar bands.

Prevalence of banding and bonding molar brackets in orthognathic surgery cases.

PURPOSE: Orthodontic treatment in the orthognathic surgical patient commonly involves banding or bonding of erupted molars. Appliance displacement during surgery is a potentially serious complication. However, limited data exist about the prevalence of banding or bonding and the frequency of appliance failure in this patient population. The purpose of this study was to determine the prevalence of banding and bonding and appliance failure in a large cohort of patients undergoing orthognathic surgery at a single institution. PATIENTS AND METHODS: All patients who underwent orthognathic surgery from 2004 to 2006 at Kaiser Permanente Oakland Medical Center were identified, and preoperative and postoperative radiographs were retrospectively reviewed. Study variables included age at time of surgery, gender, date and type of surgery, Angle classification of occlusion, type of orthodontic appliance (band or bond) on erupted molar teeth, and failure as detected from postoperative imaging. RESULTS: In the 1,003 patients there was a greater overall prevalence of molar bands (74.3%) than bonds (19.2%) with the vast majority (84.4%) of first molars and fewer (64.2%) second molars having banded appliances. The prevalence of bonded first and second molars was lowest in 2004 and highest in 2006. Appliance failure occurred in 19 patients (1.9%), most often involving maxillary second molars, and all were bonds. Of the 19 failed bonds, 2 were displaced into the mandibular osteotomy site and 1 was displaced into the posterior pharynx. CONCLUSION: The prevalence of bonded molars in surgical patients increased from 2004 to 2006. Appliance malfunction occurred most often in bonded maxillary second molars. Although rare, failure and displacement of bonded appliances may have significant consequences.

The use of fixed appliances in the UK: a survey of specialist orthodontists.

OBJECTIVE: To investigate the use of fixed appliances in the UK. DESIGN: Prospective postal questionnaire. SETTING: UK. PARTICIPANTS: All members of the General Dental Council Specialist List in Orthodontics still in active practice and not in training posts. METHOD: A preemptive letter of explanation was sent inviting orthodontists to participate in the survey. The questionnaire was subsequently posted to 935 specialists. Data analysis investigated differences in clinical practice related to varying provider groups, level of operator experience and geographical region. RESULTS: The response rate achieved was 66.3%. A majority of orthodontists routinely used the 0.022 inch pre-adjusted edgewise system, standard size Siamese pattern stainless steel brackets, conventionally ligated and bonded using standard etch and light cured composite. Nickel titanium and stainless steel were the most popular archwire materials. Anchorage was supported routinely by palatal and lingual arches in up to 25% and by headgear in over a third of respondents. Newer innovations showed variable popularity. Self-etching primer was used routinely by one-third of respondents with 11% use of self-ligating brackets. Banding of first molars was preferred by over 60% of clinicians. Bone screw implants were used by only 0.2% of respondents. Clinicians with less than 10 years experience used more headgear, light curing, MBT prescription and molar bonding. Operators with over 20 years experience used more chemically cured bonding, Roth prescription, banded first molars, 0.018 inch slot size and Tip-Edge(TM), with less use of headgear. Fixed appliance use differed from that reported in the US with lower use in the UK of standard edgewise and Roth systems, aesthetic, miniaturised and 0.018 inch slot brackets and rapid maxillary expansion. CONCLUSION: Most UK orthodontic specialists routinely used the 0.022 inch pre-adjusted edgewise system with standard size Siamese steel brackets bonded using standard etch and light cured composite with conventional ligation. Variations were seen between different provider groups, types of treatment funding, levels of operator seniority and geographical regions. Differences were noted particularly in the use of bracket prescription and design, types of molar attachment and anchorage control.

Variability of slot size in orthodontic brackets.

Objective: The accuracy of the information incorporated into brackets is a determining factor for the efficacy of torque applied to teeth. The aim of this study was to compare the dimensions of a bracket's slots with the nominal values announced by the manufacturer. Materials and methods: A total of 730 maxillary right central brackets manufactured by seven companies (Dentsply Gac, American Orthodontics, Rocky Mountain Orthodontics, GC Orthodontics, 3M Unitek, and Dentaurum) were studied. The sample included 0.018 × 0.025 and 0.022 × 0.028 in., metal and ceramic, conventional and self-ligating brackets. Images were obtained with an Olympus BX51 optical microscope. Slot dimensions were measured at the base and at the face on both mesial and distal sides using ImageJ software. Data were analyzed using Wilcoxon, sign tests, two- and three-way ANOVA, and Tukey's tests. Intraclass correlation coefficient was employed to assess the intraobserver and interobserver variability. The threshold for statistical significance was p ≤ .05. Results: Statistical analysis showed that the slot dimensions of 90% to 97% of studied brackets were significantly different from nominal values. In general, slot size was oversized, with a face size larger than the base size. Comparison between mesial and distal sides showed that up to 45% of the brackets were significantly asymmetrical. The manufacturer had a significant effect for base and face widths (p = .0001) and for length (p = .003). Conclusion: This study shows that a large proportion of measured brackets displays dimensional inaccuracies when compared with stated values. Clinically, the slot oversize and the divergence of slot walls cause an increase of wire-slot play, inducing a loss of torque control. Practitioners cannot fully trust the precision of used appliances and should be aware that adjustments could be needed in the finishing stages of the treatment.

Variation in bracket slot sizes, ligation methods and prescriptions: UK national survey.

OBJECTIVE: This study designed to investigate the use of fixed bracket slot sizes, ligation method and prescriptions in the UK using an online survey/questionnaire comprised of seven questions. MATERIAL AND METHODS: The questionnaire link along with an explanation of its nature was circulated via the British Orthodontic Society (BOS) to all 978-email addresses of the Consultant Orthodontists Group (COG) and Orthodontic Specialists Group (OSG) (registered on the UK Specialist List for Orthodontics) members inviting them to participate. Two email reminders were sent to increase the response rate. Chi2 analyses determined the statistical differences in the use of bracket slots and prescriptions according to the regions and years of experience. RESULTS: The respondents represented 31.2% of the BOS specialist orthodontic members. Most of the respondents practised in the South of England with experience between 11-30years. The vast majority of the respondents routinely used brackets with the multibracket appliance treatment (MBT) prescription (81.6%) and 0.022-inch slot size (98.7%), which was statistically significantly higher in all geographical regions and experience levels (P<0.001). The majority of the respondents reported either 100% or 90% use of conventional brackets when compared to self-ligating brackets. CONCLUSION: The vast majority of UK specialist orthodontists use conventional ligating MBT prescription brackets with the 0.022-inch slot size. This was mainly because they perceive that this combination provides better treatment outcomes, whilst many respondents also indicated that they were taught and trained using this combination and that there was not enough evidence to support a change in their clinical practice.

Differences between active and passive self-ligating brackets for orthodontic treatment : Systematic review and meta-analysis based on randomized clinical trials.

PURPOSE: In orthodontic treatment, the effects of differences in the design between active and passive self-ligating bracket (ASLB and PSLB, respectively) are usually neglected. This study investigated differences in effectiveness and efficiency between ASLBs and PSLBs. METHODS: To identify randomized, controlled clinical trials (RCTs) comparing ASLB with PSLB, the electronic databases Medline, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Chinese Medical Journal Database were searched without language or time limits. Relevant available dental journals and reference lists from included studies were manually searched for applicable reports. Meta-analyses were conducted with the Review Manager program. Two independent reviewers performed all search processes; disagreements were discussed with a third reviewer. RESULTS: Eight studies were included in the systematic review, of which six were included in the meta-analysis due to the data consistency. Three had a low risk of bias, four had an unclear risk of bias, and one had a high risk of bias. With regard to alignment efficiency, meta-analysis favors ASLB [mean difference (MD) -10.24 days, 95% confidence interval (CI) -17.68 to -2.80]. However, the same analysis does not favor either design in terms of width change due to treatment for intercanine (MD -0.49 mm, 95% CI -1.10 to 0.13 mm) interfirst premolar (MD -0.07 mm, 95% CI -0.69, 0.56 mm) intersecond premolar (MD -0.58 mm, 95% CI -1.25 to 0.08 mm) and intermolar (MD 0.10 mm, 95% CI -0.82 to 1.02 mm) width. CONCLUSIONS: Based on current clinical evidence from RCTs, ASLB appears to be more efficient for alignment, while neither design shows an advantage for width change. Further research is needed to confirm present results.

Oral health-related quality of life after orthodontic treatment for anterior tooth alignment: Association with emotional state and sociodemographic factors.

OBJECTIVES: The aim of this work was to evaluate associations of oral health-related quality of life (OHRQoL) with sociodemographic factors and with emotional state in adults after orthodontic treatment for anterior tooth alignment. Few studies have examined these specific associations in the past, one reason presumably being a lack of specific instruments. PATIENTS AND METHODS: A total of 128 adult patients consecutively treated with multibracket appliances were contacted during the retention period. The response rate was 68 %. They were asked to complete both an emotional well-being test (Zerssen Mood Scale, Bf-S) and a 52-item orthodontic survey of OHRQoL, which we had developed based on the German version of the Oral Health Impact Profile (OHIP-G14). RESULTS: The study demonstrated a high association of self-perceived apperance with OHRQoL and a strong role of the teeth and mouth. Aside from a few exceptions, the patients' responses in the survey did not reveal any significant gender-specific or age-specific differences. By contrast, patients in lower-than-normal spirits were found to also respond with significantly less favorable ratings to the survey items dealing with self-perceived overall attractiveness, facial attractivenss, and course of treatment. CONCLUSION: Dental appearance has a psychosocial impact on private and job-related interactions, which can increase the motivation of those affected to seek treament. Our orthodontic OHRQoL survey proved to be informative and practical. Findings that were especially striking included the patients' high acceptance of the changes induced by treatment and their high willingness to recommend such treatment to other adults.

Frictional evaluations of dental typodont models using four self-ligating designs and a conventional design.

Abstract: After a previous study using typodonts and three standardized archwire (AW) sizes, the frictional evaluations of four self-ligating brackets were directed toward the optimal AW-bracket system. Four participating manufacturers suggested three AWs, which were a representation of the three stages of orthodontic treatment, to be coupled with their respective self-ligating design. Four replicated typodont models were mounted with a self-ligating design, and a fifth model was mounted with a conventional design that served as a control. The first experiment evaluated the manufacturer-suggested AWs against the respective self-ligating design. Because no third-stage AWs could engage their respective designs, a second experiment was implemented to gain more detailed analyses of the designs. This experiment included any successful manufacturer-suggested AWs from the first experiment against the four self-ligating designs and the control design. All self-ligating designs performed with the efficiency and reproducibility associated with expectations. Specifically, self-ligation outperformed the conventional brackets when coupled with up to 0.020- x 0.020-inch wires. The clearance of the various AW sizes and alloys changed with malocclusion. Furthermore, the parameter that best correlated with drawing forces was the bending stiffness of the AW, which was directly associated with the nominal dimension of each wire. The best AW-bracket system can be selected, when taking into account the stiffness (elastic modulus and size of the AW) along with the amount of malocclusion present, once the treatment plan is determined.