Validation of the American Board of Orthodontics Objective Grading System for assessing the treatment outcomes of Chinese patients.

INTRODUCTION: Orthodontics in China has developed rapidly, but there is no standard index of treatment outcomes. We assessed the validity of the American Board of Orthodontics Objective Grading System (ABO-OGS) for the classification of treatment outcomes in Chinese patients. METHODS: We randomly selected 108 patients who completed treatment between July 2005 and September 2008 in 6 orthodontic treatment centers across China. Sixty-nine experienced Chinese orthodontists made subjective assessments of the end-of-treatment casts for each patient. Three examiners then used the ABO-OGS to measure the casts. Pearson correlation analysis and receiver operating characteristic curve analysis were conducted to evaluate the correspondence between the ABO-OGS cast measurements and the orthodontists' subjective assessments. RESULTS: The average subjective grading scores were highly correlated with the ABO-OGS scores (r = 0.7042). Four of the 7 study cast components of the ABO-OGS score-occlusal relationship, overjet, interproximal contact, and alignment-were statistically significantly correlated with the judges' subjective assessments. Together, these 4 accounted for 58% of the variability in the average subjective grading scores. The ABO-OGS cutoff score for cases that the judges deemed satisfactory was 16 points; the corresponding cutoff score for cases that the judges considered acceptable was 21 points. CONCLUSIONS: The ABO-OGS is a valid index for the assessment of treatment outcomes in Chinese patients. By comparing the objective scores on this modification of the ABO-OGS with the mean subjective assessment of a panel of highly qualified Chinese orthodontists, a cutoff point for satisfactory treatment outcome was defined as 16 points or fewer, with scores of 16 to 21 points denoting less than satisfactory but still acceptable treatment. Cases that scored greater than 21 points were considered unacceptable.

[Experts consensus on diagnostic and therapeutic strategies for malocclusions at early developing stage].

Early orthodontic intervention remains a controversial notion in current dental care regime. Whilst early orthodontic treatment for children is the province for orthodontic specialists, a growing number of general practitioners, who may not possess sufficient specialty knowledge, are also involved, raising the concerns about the propriety and quality of their treatment modalities. However, orofacial development of children and adolescents is in a very complicated environment. Comprehensive theoretical knowledge and a great wealth of practical experience are required to ensure the final treatment effect. The possible complications should be kept under control and fully informed to patients and their parents. In order to unify and standardize early orthodontic treatment protocol and help to promote healthy and orderly development of early orthodontic treatment, this consensus summarized the practical experience of orthodontic experts from many famous colleges and affiliated hospitals for clinical reference.

[Mechanical properties of thermoplastic materials].

OBJECTIVE: To investigate the mechanical properties of various brands of thermoplastic materials under different test conditions so as to analyze their influencing factors so as to provide a reference for improving the effect of invisible orthodontics. METHODS: Three brands of thermoplastic materials, DR, Biolon and Erkodent, were selected. They were tested by Instron testing machine to measure their maximal stress and modulus under different processing modes, including pre-thermoforming, post-thermoforming and dipped in artificial saliva for two weeks after thermoforming. The data were analyzed by SPSS 11.5. Analyzed the mechanical properties change-trend under each test condition. RESULTS: The modulus (MPa) and maximum stress (MPa) of control group were significantly higher than those of thermoforming group (DR: 9.63±0.68 vs 7.85±0.61, 267±8 vs 199±6; Erkodent: 8.28±0.28 vs 7.59±0.45, 226±6 vs 199±6; Biolon: 8.85±0.41 vs 7.07±0.22, 237±6 vs 169±7, all P<0.05). The modulus (MPa) and maximum stress (MPa) of thermoforming group were significantly lower than those of saliva immersion group (DR: 7.85±0.61 vs 9.14±0.41, 199±6 vs 243±7; Erkodent: 7.59 ± 0.45 vs 8.38±0.29, 199±6 vs 212±7; Biolon: 7.07±0.22 vs 7.90±0.31, 169±7 vs 197±5, all P<0.05). CONCLUSIONS: The different brands of thermoplastic materials have different mechanical properties. The different processing modes influence the mechanical properties of thermoplastic materials. The mechanical properties decrease after thermoforming and increase after saliva immersion.

Dehiscence and fenestration in anterior teeth : Comparison before and after orthodontic treatment.

BACKGROUND: Previous studies have reported incidence rates of dehiscence (DEH) and fenestration (FEN) as high as 36.51 and 51.09%, respectively. Only a few studies comparing DEH and FEN before and after orthodontic treatment (OT) are available in the literature. PURPOSE: The aim of this study was to evaluate the occurrence of DEH and FEN in anterior teeth, before and after OT, using cone-beam computed tomography (CBCT). In addition, findings may provide a clinical basis for avoiding DEH and FEN during therapeutic tooth alignment. PATIENTS AND METHODS: CBCT images of 21 patients near the end of their peak growth and development were included. DEH and FEN in the anterior teeth and thicknesses of the alveolar bone at the palatal (TP) and labiolingual (LL) sides of each anterior tooth were measured before and after OT. RESULTS: After OT, the incidence rates of mandibular anterior labial DEH, maxillary anterior TP-bone defect, and mandibular anterior lingual bone defect were increased by 20, 19, and 30%, respectively. Assessment of CT images prior to treatment showed that the teeth developing bone defects were significantly different regarding the apical alveolar bone thicknesses compared to the teeth that did not develop bone defects after OT, i.e., the incidence of DEH and FEN after OT was lower if the thickness of the apex to labiolingual alveolar bone before OT was as follows: the apex to labial alveolar bone thickness of the maxillary central incisor and maxillary lateral incisor was >4 mm, the apex to palatal alveolar bone thickness of the maxillary lateral incisor was >3 mm; the apex to labiolingual alveolar bone thickness of the lower incisor was >5 mm. CONCLUSION: The incidence of post-OT DEH at the maxillary anterior and mandibular anterior lingual surfaces were increased significantly compared to before treatment. In general, the smaller the apex to labiolingual alveolar bone thickness, the greater the likelihood of bone defects occurring after OT. Evaluation of the apical position of anterior teeth in alveolar bone can help minimize the occurrence of bone defects after OT.

Biomechanical and histomorphometric characterizations of osseointegration during mini-screw healing in rabbit tibiae.

OBJECTIVE: To evaluate effects of different healing times on integration of titanium mini-screws and bones under unloaded conditions. MATERIALS AND METHODS: Biomechanical stability measurements and histomorphometric observations were performed in a rabbit tibia model after different healing times: 0 (immediate) and 1, 2, 4, and 8 weeks. RESULTS: Biomechanical stability and both maximum torque and maximum pullout load increased with healing time but increased significantly only after 4 weeks. Maximum torque and maximum pullout load both significantly correlated with healing time and with each other. Similarly, histomorphometric analyses showed that new bone formation increased with healing time but increased dramatically only after 4 weeks. The data may provide guidance for determining optimal implant plans in clinical practice. CONCLUSION: Mini-screw healing is a continuous process, and week 4 is a critical time point in this process.

Phase transformation analysis of varied nickel-titanium orthodontic wires.

BACKGROUND: The shape memory effect of nickel-titanium (NiTi) archwires is largely determined by the phase transition temperature. It is associated with a reversible transformation from martensite to austenite. The aim of this study was to characterize austenite, martensite and R phase temperatures as well as transition temperature ranges of the commonly used clinical NiTi orthodontic arch wires selected from several manufacturers. METHODS: Differential scanning calorimetry (DSC) method was used to study the phase transformation temperatures and the phase transition processes of 9 commonly used clinical NiTi alloys (types: 0.40 mm (0.016 inch), 0.40 mm x 0.56 mm (0.016 inch x 0.022 inch)). RESULTS: The austenite finish temperatures (Af) of 0.40 mm Smart, Ormco and 3M NiTi wires were lower than the room temperature, and no phase transformation was detected during oral temperature. Therefore, we predicted that these types of NiTi did not possess shape memory property. For 0.40 mm and 0.40 mm x 0.56 mm Youyan I NiTi wires, no phase transformation was detected during the scanning temperature range, suggesting that these two types of wires did not possess shape memory either. The Af of 0.40 mm x 0.56 mm Smart, L&H, Youyan II Ni-Ti wires were close to the oral temperature and presented as martensitic-austenitic structures at room temperature, suggesting the NiTi wires listed above have good shape memory effect. Although the 0.40 mm x 0.56 mm Damon CuNiTi wire showed martensitic-austenitic structures at oral temperature, its Af was much higher than the oral temperature. It means that transformation from martensite to austenite for this type of NiTi only finishes when oral temperature is above normal. CONCLUSION: The phase transformation temperatures and transformation behavior varied among different commonly used NiTi orthodontic arch wires, leading to variability in shape memory effect.

Novel rechargeable calcium phosphate nanoparticle-containing orthodontic cement.

White spot lesions (WSLs), due to enamel demineralization, occur frequently in orthodontic treatment. We recently developed a novel rechargeable dental composite containing nanoparticles of amorphous calcium phosphate (NACP) with long-term calcium (Ca) and phosphate (P) ion release and caries-inhibiting capability. The objectives of this study were to develop the first NACP-rechargeable orthodontic cement and investigate the effects of recharge duration and frequency on the efficacy of ion re-release. The rechargeable cement consisted of pyromellitic glycerol dimethacrylate (PMGDM) and ethoxylated bisphenol A dimethacrylate (EBPADMA). NACP was mixed into the resin at 40% by mass. Specimens were tested for orthodontic bracket shear bond strength (SBS) to enamel, Ca and P ion initial release, recharge and re-release. The new orthodontic cement exhibited an SBS similar to commercial orthodontic cement without CaP release (P>0.1). Specimens after one recharge treatment (e.g., 1 min immersion in recharge solution repeating three times in one day, referred to as "1 min 3 times") exhibited a substantial and continuous re-release of Ca and P ions for 14 days without further recharge. The ion re-release did not decrease with increasing the number of recharge/re-release cycles (P>0.1). The ion re-release concentrations at 14 days versus various recharge treatments were as follows: 1 min 3 times>3 min 2 times>1 min 2 times>6 min 1 time>3 min 1 time>1 min 1 time. In conclusion, although previous studies have shown that NACP nanocomposite remineralized tooth lesions and inhibited caries, the present study developed the first orthodontic cement with Ca and P ion recharge and long-term release capability. This NACP-rechargeable orthodontic cement is a promising therapy to inhibit enamel demineralization and WSLs around orthodontic brackets.

Mechanical Properties of Orthodontic Thermoplastics PETG/ PC2858 after Blending.

OBJECTIVE: To characterise and compare the tensile characteristics after multi-proportional blending, to determine the proper blending ratio for new thermoplastic material and to compare its mechanical performance with commercial thermoplastics. METHODS: PETG and PC2858 aggregates were blended in five different ratios. Standard specimens of each ratio were molded and tested to determine their mechanical performance. Then the new material with the proper blending ratio was chosen and compared against commercial thermoplastics. RESULTS: With the increase of PC2858 content, the tensile and impact strength increased but elongation at break decreased. When blending ratio (wt %) was 70/30, the PETG/PC2858 exhibited optimal mechanical properties, with a tensile strength of 63.42 ± 1.67 MPa, and a stress relaxation rate of 0.0080 ± 0.0005 N/s, which exceeded those of Erkodur and Biolon. CONCLUSION: By blending PETG and PC2858 at the weight ratio 70/30, we obtained new thermoplastic material which outperformed commercial products.

Effects of quaternary ammonium chain length on the antibacterial and remineralizing effects of a calcium phosphate nanocomposite.

Composites containing nanoparticles of amorphous calcium phosphate (NACP) remineralize tooth lesions and inhibit caries. A recent study synthesized quaternary ammonium methacrylates (QAMs) with chain lengths (CLs) of 3-18 and determined their effects on a bonding agent. This study aimed to incorporate these QAMs into NACP nanocomposites for the first time to simultaneously endow the material with antibacterial and remineralizing capabilities and to investigate the effects of the CL on the mechanical and biofilm properties. Five QAMs were synthesized: DMAPM (CL3), DMAHM (CL6), DMADDM (CL12), DMAHDM (CL16), and DMAODM (CL18). Each QAM was incorporated into a composite containing 20% NACP and 50% glass fillers. A dental plaque microcosm biofilm model was used to evaluate the antibacterial activity. The flexural strength and elastic modulus of nanocomposites with QAMs matched those of a commercial control composite (n = 6; P > 0.1). Increasing the CL from 3 to 16 greatly enhanced the antibacterial activity of the NACP nanocomposite (P < 0.05); further increasing the CL to 18 decreased the antibacterial potency. The NACP nanocomposite with a CL of 16 exhibited biofilm metabolic activity and acid production that were 10-fold lesser than those of the control composite. The NACP nanocomposite with a CL of 16 produced 2-log decreases in the colony-forming units (CFU) of total microorganisms, total streptococci, and mutans streptococci. In conclusion, QAMs with CLs of 3-18 were synthesized and incorporated into an NACP nanocomposite for the first time to simultaneously endow the material with antibacterial and remineralization capabilities. Increasing the CL reduced the metabolic activity and acid production of biofilms and caused a 2-log decrease in CFU without compromising the mechanical properties. Nanocomposites exhibiting strong anti-biofilm activity, remineralization effects, and mechanical properties are promising materials for tooth restorations that inhibit caries.

Integrated three-dimensional digital assessment of accuracy of anterior tooth movement using clear aligners.

OBJECTIVE: To assess the accuracy of anterior tooth movement using clear aligners in integrated three-dimensional digital models. METHODS: Cone-beam computed tomography was performed before and after treatment with clear aligners in 32 patients. Plaster casts were laser-scanned for virtual setup and aligner fabrication. Differences in predicted and achieved root and crown positions of anterior teeth were compared on superimposed maxillofacial digital images and virtual models and analyzed by Student's t-test. RESULTS: The mean discrepancies in maxillary and mandibular crown positions were 0.376 ± 0.041 mm and 0.398 ± 0.037 mm, respectively. Maxillary and mandibular root positions differed by 2.062 ± 0.128 mm and 1.941 ± 0.154 mm, respectively. CONCLUSIONS: Crowns but not roots of anterior teeth can be moved to designated positions using clear aligners, because these appliances cause tooth movement by tilting motion.