Upper airway morphology in adults with positional obstructive sleep apnea.

PURPOSE: To compare the anatomical balance and shape of the upper airway in the supine position between adults with positional obstructive sleep apnea (POSA) and adults with non-positional OSA (NPOSA). METHODS: Adults diagnosed with OSA (apnea-hypopnea index (AHI) > 10 events/h) were assessed for eligibility. POSA was defined as the supine AHI more than twice the AHI in non-supine positions; otherwise, patients were classified as NPOSA. Cone beam computed tomography (CBCT) imaging was performed for every participant while awake in the supine position. The anatomical balance was calculated as the ratio of the tongue size to the maxillomandibular enclosure size. The upper airway shape was calculated as the ratio of the anteroposterior dimension to the lateral dimension at the location of the minimal cross-sectional area of the upper airway (CSAmin-shape). RESULTS: Of 47 participants (28 males, median age [interquartile range] 56 [46 to 63] years, median AHI 27.8 [15.0 to 33.8]), 34 participants were classified as having POSA (72%). The POSA group tended to have a higher proportion of males and a lower AHI than the NPOSA group (P = 0.07 and 0.07, respectively). After controlling for both sex and AHI, the anatomical balance and CSAmin-shape were not significantly different between both groups (P = 0.18 and 0.73, respectively). CONCLUSION: Adults with POSA and adults with NPOSA have similar anatomical balance and shape of their upper airway in the supine position. TRIAL REGISTRATION: This study was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR Trial ACTRN12611000409976).

Dentoskeletal effects of mini-screw assisted, non-surgical palatal expansion in adults using a modified force-controlled polycyclic protocol: a single-centre retrospective study.

OBJECTIVES: This study assessed the dental and skeletal effects of pure bone-borne, non-surgical maxillary expansion, using a modified force-controlled polycyclic protocol. METHODS: Records of 17 adult patients, mean age 24.1 years; range 18-39 years, who had undergone maxillary expansion using a bone-borne Quad-expander (with 4 mini-screws), were analysed. In all patients, 0.17 mm/day of expansion was completed for 1 week, followed by a cyclic protocol of expansion of forward and backward turns until the force needed to turn the expander was below 400 cN, assessed weekly. After this, expansion continued at a rate of 0.17 mm/day until the desired amount of expansion was achieved. Cone beam computer tomography scans were taken pre- and post-expansion. RESULTS: The mid-palatal suture was successfully opened in 100% of patients included in this study. Axially, the amount of skeletal opening at the posterior nasal spine was 61% of the anterior nasal spine. Expansion was pyramidal in the coronal plane. Significant increases at the dental and skeletal levels were achieved, with changes at the skeletal level reaching 73%. The alveolar bone angle increased more than the angular changes at the molars and premolars. LIMITATIONS: This is a retrospective study with short-term results. CONCLUSION: The Quad-expander, with a force-controlled polycyclic expansion protocol, effectively produced a significant increase in maxillary width in skeletally mature subjects in the short term.

The effect of piezocision vs no piezocision on maxillary extraction space closure: A split-mouth, randomized controlled clinical trial.

INTRODUCTION: The aim of this 2-arm-parallel, split-mouth trial was to investigate the effects of piezocision compared with no piezocision on maxillary canine distalization and to evaluate patient perceptions on the surgical procedure. METHODS: Twenty-two participants requiring extractions of maxillary first premolars were recruited from the Department of Orthodontics (Sydney Dental Hospital) waiting list. After leveling and alignment, a minimum of 3 mm space was required for canine retraction. Piezocision cuts distal to the canines were 4 mm long and 3 mm deep into the buccal cortical plate. The canine retraction was initiated on both sides immediately after surgery, with coil springs delivering 150 g of force per side. Random assignment of piezocision or control intervention on the patient's right side was performed (www.randomisation.com) for the random number generation, and allocation concealment was accomplished with opaque, sealed envelopes. Patients were assessed every 6 weeks for coil activation and alginate impressions over 18 weeks. The primary outcome was the amount of tooth movement in mm. Secondary outcomes were canine rotation, anchorage loss measured on scanned dental models, and patient pain levels and perception on piezocision using visual analog scale questionnaires. Blinding was feasible for the dental model measurements. RESULTS: Twenty patients completed the trial. The treatment × time interaction showed no statistically or clinically significant differences in maxillary extraction space closure (b = -0.02; 95% confidence interval [CI], -0.29 to 0.25; P = 0.89) canine rotation (b = -1.45; 95% CI, -4 to 1.09; P = 0.26) and anchorage loss (b = -0.02; 95% CI, -0.38 to 0.34; P = 0.92). All patients except for one had minimal pain associated with the piezocision surgery but found the procedure tolerable and would recommend it. No harm occurred during the trial. CONCLUSIONS: Piezocision-assisted maxillary canine distalization was similar to distalization with conventional orthodontics with patients tolerating the procedure.

Physical properties of root cementum: Part 29. The effects of LED-mediated photobiomodulation on orthodontically induced root resorption and pain: a pilot split-mouth randomized controlled trial.

OBJECTIVES: To examine the effects of light-emitting diode (LED)-mediated photobiomodulation (PBM) on orthodontic root resorption and pain. METHODS: Twenty patients (3 males, 17 females, mean age 15 years 6 months) needing bilateral maxillary first premolar extractions for orthodontic treatment were included in this single-centre, split-mouth randomized controlled trial. Both premolars received 150 g of buccal tipping force for 28 days. One side was randomly assigned to receive intraoral 850 nm wavelength, 60 mW/cm2 power, continuous LED illumination via OrthoPulse device (Biolux Research Ltd, Vancouver, British Columbia, Canada) for 5 minutes/day. The other side served as control. After 28 days, both premolars were extracted and scanned with micro-computed tomography for primary outcome assessment of root resorption crater volume measurements. For secondary outcome assessment, visual analogue scale pain questionnaires were used for both sides at 24 hours, 48 hours, 72 hours, and 7 days. Randomization was generated using www.randomization.com and allocation was concealed in sequentially numbered, opaque, sealed envelopes. Blinding was not possible during the experiment due to the use of tape to block light on control side of the devices. Assessors were blinded during outcome assessments. RESULTS: All 40 premolars from 20 patients were included. There was no significant difference in the mean total root resorption between the LED PBM and control sides (mean 0.216 versus 0.284 mm3, respectively, P = 0.306). The LED side was associated with less pain at 24 hours (P = 0.023) and marginally more pain at subsequent time points, which was not statistically significant. No harms were observed. LIMITATIONS: Short study duration and the inability to blind patients and clinician during clinical part of study. CONCLUSION: This 28-day randomized split-mouth controlled trial showed that daily, LED-mediated PBM application, when applied for 5 minute/day, does not influence orthodontic root resorption. It is associated with significantly less pain 24 hours after the application of orthodontic force, but no difference thereafter. These results should be tested on patients undergoing a full course of orthodontic treatment. TRIAL REGISTRATION: Clinical Trials Registry ACTRN12616000652471.

The effect of micro-osteoperforations on orthodontic space closure investigated over 12 weeks: a split-mouth, randomized controlled clinical trial.

OBJECTIVES: To evaluate the effects of minimally invasive micro-osteoperforations (MOPs) on orthodontic tooth movement and pain. DESIGN: Prospective, split-mouth, randomized controlled trial. SETTING: Single-centre, university hospital. METHODS: Twenty subjects requiring maxillary first premolar extractions were included. Right and left sides of the maxilla were randomly allocated into experimental and controls. Space closure was initiated following alignment on 0.20″ stainless steel archwires, using 150 g force, applied by coil springs on power arms. Nance-TPA was used for anchorage. On the experimental side, two 5 mm deep MOPs in vertical alignment on distal aspect of the maxillary canine mid-root region were performed prior to space closure. OUTCOMES: The primary outcome was the amount of tooth movement during space closure, measured every 4 weeks for 12 weeks (T1, T2, and T3). Secondary outcome was the pain levels related to MOP, measured using Visual Analogue Scale (VAS) questionnaires. Significance was set at P < 0.01. RANDOMIZATION: Randomization was generated using a randomization table, and allocation was concealed in sequentially numbered, opaque, sealed envelopes. BLINDING: Blinding was not possible during the experiment but assessor was blinded during outcome assessment. RESULTS: All subjects completed the study, with tooth movement measurements available for all 20 patients for T0-T2. In three patients, space was closed on one side at T2. The average tooth movement between sides at three intervals (T0-T1, T1-T2, and T2-T3) were not significantly different. Overall difference following 12 weeks (T0-T3) was 0.69 mm higher on the experimental side (P < 0.001). No harms were observed. LIMITATIONS: Short-term study, cast measurements done with digital callipers. CONCLUSION: This 12-week randomized split-mouth controlled clinical trial showed two MOPs that are 5 mm deep, applied once prior to space closure, did not create clinically significant increase in maxillary premolar space closure. PROTOCOL: The protocol was not published before trial commencement. REGISTRATION: Trial was not registered. FUNDING: The Australian Society of Orthodontists Foundation for Research and Education.

The upper airway volume effects produced by Hyrax, Hybrid-Hyrax, and Keles keyless expanders: a single-centre randomized controlled trial.

OBJECTIVE: To assess upper airway volume changes after rapid maxillary expansion (RME) with three different expanders. TRIAL DESIGN: Three-arm parallel randomized clinical trial. METHODS: Sixty-six patients, 10-16 years old, in permanent dentition, with maxillary transverse deficiency were recruited and assigned with block randomization (1:1:1 ratio) and allocation concealment to three groups of 22 patients each (Hyrax, Hybrid-Hyrax, and Keles keyless expander). The primary outcome (overall upper airway volume change) and secondary outcomes (volume changes in the nasal cavity, nasopharynx, oropharynx, and hypopharynx) were blindly assessed on the initial (T0) and final (T1, 6 months at appliance removal) cone beam computed tomography. Differences across groups were assessed with crude or adjusted for confounders (gender, age, growth stage, skeletal pattern, baseline airway volume, and amount of expansion) linear regression models. RESULTS: Fifty-one patients were analysed (19, 19, and 13 in the Hyrax, Hybrid-Hyrax, and Keles groups). Maxillary expansion resulted in considerable increases in total airway volume in the Hybrid-Hyrax group (+5902.1 mm3) and less in the Hyrax group (+2537.9 mm3) or the Keles group (+3001.4 mm3). However, treatment-induced changes for the primary and all secondary outcomes were of small magnitude and no significant difference was seen among the three expanderes in the total airway volume in either crude or adjusted analyses (P > 0.05 in all instances). Finally, among pre-peak patients (CVM 1-3), the Hybrid-Hyrax expander was associated with significantly greater increases in total airway volume compared to the Hyrax expander (P = 0.02). CONCLUSIONS: RME resulted in relatively small increases in total upper airway volume and its separate compartments, with mostly no statistically significant differences across the Hyrax, Hybrid-Hyrax, and Keles groups. LIMITATIONS: Significantly greater attrition was found in the Keles group due to appliance failure. The current trial might possibly be under-powered to detect differences between groups, if such exist. HARMS: Keles expanders blocked during activations and required substitution for completion of treatment. PROTOCOL: The protocol was not published before trial commencement. REGISTRATION: Australian and New Zealand Clinical Trial Registry (ACTRN12617001136392).

The public perception of the differences between specialist orthodontists and general dentists: A comparison between Australia and Sweden.

INTRODUCTION: In Australia and Sweden, orthodontic treatments may be performed by either a general dental practitioner (GDP) or a specialist orthodontist. Evidence suggests that the public may easily confuse a GDP who provides orthodontic treatment with a specialist orthodontist. We conducted a survey of people in Australia and Sweden to assess their understanding of the differences between a specialist orthodontist and a GDP who provides orthodontic treatments. METHODS: The sample comprised 2006 Australian adults and 1010 Swedish adults who completed an online questionnaire. The survey examined the respondents' understanding of the difference between a GDP and a specialist orthodontist. Demographic data and the respondents' preference concerning future practitioner type were also collected. RESULTS: Although most of the responses between the countries were different with statistical significance (P <0.001), many similarities in the responses were observed. More than 90% of the respondents in both countries did not know the difference between a GDP who provides orthodontic treatment and a specialist orthodontist. Almost 75% believed that a specialist orthodontist was the most qualified practitioner to perform orthodontic treatment. Fewer than 10% of the respondents preferred to see a GDP for orthodontic treatment over a specialist. These people tended to be male, have less education, and be younger. Cost was identified as an important factor in choosing an orthodontic practitioner, particularly in the Australian sample. CONCLUSIONS: The clear majority of both Australian and Swedish respondents were unable to identify the difference between a specialist orthodontic and a GDP who provides orthodontic treatments.

The effects of a clinically feasible application of low-level laser therapy on the rate of orthodontic tooth movement: A triple-blind, split-mouth, randomized controlled trial.

INTRODUCTION: This split-mouth trial aimed to investigate the effect of low-level laser therapy (LLLT) on the amount of maxillary canine distalization when applied every 4 weeks over 12 weeks. METHODS: Twenty-two adolescents and young adults (15 female, 7 male; aged 13-25 years; n = 22) requiring bilateral maxillary first premolar extractions were recruited. After extractions and leveling-alignment, canines were retracted using closed-coil nickel-titanium springs delivering 150 g of force. LLLT was applied to 8 intraoral points on the buccal and palatal sides around the canine root for 10 seconds per point, on day 0, 28, and 56 with the control side receiving sham application. Alginate impressions were taken every 4 weeks on day 0, 28, 56, and 84. The amount of tooth movement, anchorage loss, and canine rotation were measured digitally. Randomization was generated using www.randomisation.com and allocation concealment through sequentially numbered, opaque, sealed envelopes. Participants, operator, and statistic assessor were blinded. Linear regression modeling accounting for clustering within each patient was used to identify differences between LLLT and control sides. RESULTS: Twenty-one patients completed the study. The total amount of tooth movement was similar in the LLLT (2.55 ± 0.73 mm) and control group (2.30 ± 0.86 mm), whereas 0.25 mm (95% confidence interval, -0.21, 0.71 mm) of difference was insignificant (P = 0.27). No significant differences were found for anchorage loss (P = 0.22) or canine rotation (P = 0.25). No harms were reported. CONCLUSIONS: Application of LLLT every 4 weeks did not result in differences in the amount of tooth movement, anchorage loss, and canine rotation during extraction space closure.

Changes in sleep and airway variables in patients with obstructive sleep apnea after mandibular advancement splint treatment.

INTRODUCTION: Obstructive sleep apnea (OSA) is an extensive public health problem that imposes considerable morbidity. Mandibular advancement splint (MAS) therapy is a well tolerated treatment, but success rates are difficult to predict. Our objective was to investigate the relationship of oropharyngeal airway dimensions, sleep characteristics, patient biometrics, and treatment response within an OSA patient sample. METHODS: Records of 33 adults were assessed retrospectively with the use of Dolphin 3D and Image J to measure the airway on pretreatment supine cone-beam computed tomography images and derived lateral cephalograms. The patients used Somnodent (Somnomed; Crows Nest, Australia) MAS appliances, which were titrated over 6-8 weeks. Appliance titration measurements and pre- and posttreatment polysomnograms were assessed. Respiratory disturbance index (RDI), absolute and percentage changes in RDI, non-rapid eye movement (NREM) RDI, rapid eye movement (REM) RDI, supine and nonsupine NREM and REM RDI, and minimal blood-oxygen saturation variables were evaluated. The associations of measurements from 2D and 3D minimal anterior-posterior linear distance and 3D airway variables with MAS treatment response were estimated. RESULTS AND CONCLUSIONS: Combined effects of baseline total airway volume, body mass index, neck circumference, location of minimal cross sectional area, and OSA severity were associated with treatment response. Patients with higher initial OSA and more superiorly located airway constriction showed enhanced treatment response to MAS therapy. Airway constriction due to maxillofacial disproportions rather than soft tissue obstruction also showed better treatment response. No significant relationships were found in lateral cephalogram measurements.

A comparative histomorphological and micro computed tomography study of the primary stability and the osseointegration of The Sydney Mini Screw; a qualitative pilot animal study in New Zealand rabbits.

OBJECTIVE: The aim of this study was to assess the potential of improving orthodontic miniscrews' (MSs) primary stability in vivo by evaluating the dispersion capacity of an injectable bone graft substitute (iBGS) through a newly designed hollow MS [The Sydney Mini Screw (SMS)] and its integration with the cortical and trabecular bone by using the femur and tibia in a New Zealand rabbit animal model. METHODS: In total, 24 MSs were randomly placed in each proximal tibia and femur of 6 New Zealand rabbits with an open surgery process. Aarhus MSs were used as controls and the effect of injection of iBGS was studied by implanting SMSs with and without iBGS injection. The dispersion of iBGS and the integration of the SMS were studied by using micro Computed Tomography (µCT) and histochemical analysis at two time points, 0 day and 8 weeks post-implantation. RESULTS: iBGS was successfully injected through the SMS and hardened in situ. After 8 weeks, µCT results revealed that the iBGS particles were resorbed and bone tissue was formed around the SMS and within its lateral exit holes. CONCLUSIONS: This pilot animal study showed the high potential of the combined use of iBGS and SMS as a newly developed technique to promote the primary stability of MSs.

Differences in three-dimensional craniofacial anatomy between responders and non-responders to mandibular advancement splint treatment in obstructive sleep apnoea patients.

AIM: The primary aim of this study was to assess the differences in the upper airway morphology between responders and non-responders to mandibular advancement splint (MAS) treatment in obstructive sleep apnoea (OSA) management. The secondary aim was to assess the correlation between the minimum cross-sectional area of the upper airway and the anatomical structures (i.e. mandibular external length, maxillary length, soft palate length, area of the tongue, maxillomandibular enclosure size, and anatomical balance ratio) surrounding the upper airway. The third aim was to assess the differences in the overall skeletal configuration between responders and non-responders to MAS treatment. METHODS: Data from 64 patients (23 females and 41 males) diagnosed with OSA by polysomnography (PSG) at baseline and provided with an adjustable MAS were analysed. All patients had NewTom3G cone beam computed tomography (CBCT) scans, performed in the supine position, at baseline. After acclimatization to MAS, follow-up PSG tests were performed to assess the apnoea-hypopnea index (AHI) with the MAS in situ. Responders were defined by a post-treatment AHI less than 10/hour and at least 50 per cent reduction in AHI, and non-responders by a post-treatment AHI at least 10/hour or less than 50 per cent reduction in AHI. Several upper airway and anatomical variables surrounding the upper airway based on CBCT images were measured to determine the differences between responders and non-responders to MAS. RESULTS: There were 36 responders (AHI = 24.8 ± 11.9 at baseline) and 28 non-responders (AHI = 31.2 ± 20.3 at baseline) to MAS. There were no significant differences in the upper airway morphology between responders and non-responders (P = 0.17-0.93) or in the anatomical structure surrounding the upper airway (P = 0.24-0.58). CONCLUSION: Within the limitations of this study, it can be concluded that there are no significant differences in upper airway morphology and in anatomical structures surrounding the upper airway between responders and non-responders to MAS treatment. These findings suggest that the craniofacial anatomical structures analyzed in this study cannot explain the response to MAS treatment.

Big toenail and hair samples as biomarkers for fluoride exposure - a pilot study.

BACKGROUND: Biomarkers can aid in detecting and preventing clinical disease through the recognition of change in biological samples. The objective of this case-control study was to further the knowledge on the use of big toenail and hair samples as biomarkers for fluoride exposure. METHODS: A total of 48 participants from an endemic (IC) and a non-endemic (SC) fluorosis region were included. Big toenail and hair samples were collected from each participant and the fluoride concentration was determined. The results of 42 participants were reported: 21 participants (11 males and 10 females, mean age 15.66 + 2.61 years) from IC and 21 participants (11 males and 10 females, mean age 15.06 + 0.79 years) from SC. RESULTS: The mean fluoride concentration of big toenail (2.34 ± 0.26 mg/kg) and hair (0.24 ± 0.04 mg/kg) in the endemic region was significantly higher than the mean fluoride concentration of big toenail (0.98 ± 0.08 mg/kg) and hair (0.14 ± 0.02 mg/kg) in the non-endemic region (p < 0.001 and p = 0.004, respectively). The Receiver Operating Characteristic (ROC) analysis showed that the Area Under the Curve (AUC) value was 0.889 for big toenail (p < 0.001) and 0.762 for hair (p = 0.004) samples. The fluoride assay for big toenails exhibits greater observed accuracy than does the fluoride assay for hair. CONCLUSION: Nail and hair samples can serve as biomarkers to detect biological fluoride exposure according to the data of this pilot study. Nevertheless, hair is less sensitive and specific as a biomarker when AUC values of big toenail and hair samples were compared.

Physical properties of root cementum: Part 26. Effects of micro-osteoperforations on orthodontic root resorption: A microcomputed tomography study.

INTRODUCTION: Studies have demonstrated the potential efficacy of micro-osteoperforations in accelerating tooth movement by amplifying the expression of inflammatory markers. The aim of this investigation was to examine the effects of micro-osteoperforations on orthodontic root resorption with microcomputed tomography. METHODS: This prospective controlled clinical trial involved 20 subjects requiring extraction of the maxillary first premolars as part of their orthodontic treatment. A buccal tipping force of 150 g was applied to both premolars. Using the Propel appliance (Propel Orthodontics, San Jose, Calif), micro-osteoperforations were applied at a depth of 5 mm on the mesial and distal aspects in the midroot region of the experimental side of the first premolar root; the contralateral side served as the control. After 28 days, both premolars were extracted. The teeth were scanned under microcomputed tomography, and the volumes of root resorption craters were calculated and compared. RESULTS: Premolars treated with micro-osteoperforation exhibited significantly greater average total amounts of root resorption than did the control teeth (0.576 vs 0.406 mm3). The total average volumetric root loss of premolars treated with micro-osteoperforation was 42% greater than that of the control teeth. CONCLUSIONS: This 28-day trial showed that micro-osteoperforations resulted in greater orthodontic root resorption. However, these results should be verified in patients who are undergoing full-length orthodontic treatment.

Physical properties of root cementum: Part 27. Effect of low-level laser therapy on the repair of orthodontically induced inflammatory root resorption: A double-blind, split-mouth, randomized controlled clinical trial.

INTRODUCTION: The purpose of this 2-arm-parallel split-mouth trial was to investigate the effect of low-level laser therapy (LLLT) on the repair of orthodontically induced inflammatory root resorption (OIIRR). METHODS: Twenty patients were included in this study, with 1 side randomly assigned to receive LLLT, and the other side served as a sham. Eligibility criteria included need for bilateral maxillary first premolar extractions as part of fixed appliance treatment. OIIRR was generated by applying 150 g of buccal tipping force on the maxillary first premolars for 4 weeks. After the active force was removed, the teeth were retained for 6 weeks. LLLT commenced with weekly laser applications using a continuous beam 660-nm, 75-mW aluminum-gallium-indium-phosphorus laser with 1/e2 spot size of 0.260 cm2, power density of 0.245 W/cm2, and fluence of 3.6 J/cm2. Contact application was used at 8 points buccally and palatally above the mucosa over each tooth root for 15 seconds with a total treatment time of 2 minutes. After 6 weeks, the maxillary first premolars were extracted and scanned with microcomputed tomography for primary outcome OIIRR calculations. Subgroup analysis included assessment per root surface, per vertical third, and sites of heaviest compressive forces (buccal-cervical and palato-apical). Randomization was generated using www.randomization.com, and allocation was concealed in sequentially numbered, opaque, sealed envelopes. Blinding was used for treatment and outcome assessments. Two-tailed paired t tests were used to determine whether there were any statistically significant differences in total crater volumes of the laser vs the sham treated teeth. RESULTS: Total crater volumes were 0.746 mm3 for the laser treated teeth and 0.779 mm3 for the sham. There was a mean difference of 0.033 ± 0.39 mm3 (95% CI, -0.21 to 0.148 mm3) greater resorption crater volume in the sham group compared with the laser group; this was not statistically significant (P = 0.705). No harm was observed. CONCLUSIONS: No significant difference was found between LLLT and sham control groups in OIIRR repair.

The effect of low-level laser therapy on orthodontically induced root resorption: a pilot double blind randomized controlled trial.

Background: The effect of low-level laser therapy (LLLT) on accelerating orthodontic tooth movement has been extensively studied; however, there is limited knowledge on the use of LLLT on orthodontic root resorption. Objective: To investigate the effect of LLLT on orthodontically induced inflammatory root resorption (OIIRR) and to compare the difference between pulsed and continuous LLLT on OIIRR. Trial design: Double-blind, single-centre 3-arm parallel split-mouth randomized controlled trial. Participants: Twenty adolescent patients who required bilateral maxillary first premolar (MFP) orthodontic extractions were recruited from the Sydney Dental Hospital between October 2014 and December 2014. Intervention: All MFPs were tipped buccally for 28 days to induce OIIRR. The experimental premolars (n = 20) received LLLT and the control premolars (n = 20) received placebo-laser on days 0, 1, 2, 3, 7, 14, and 21. Ten experimental premolars received LLLT via continuous delivery and 10 received pulsed delivery. Laser parameter: AlGaAs diode laser of 808 nm wavelength, 0.18 W power, 1.6 J per point, and duration of 9s for continuous mode and 4.5 s for pulsed mode. Outcome: The difference in root resorption crater volume between LLLT and placebo-laser and continuous or pulsed laser delivery after 28 days. Randomization: Randomization was computer-generated, with allocation concealment by opaque sequentially numbered sealed envelopes. Blinding: The participants and operator were blinded. Results: Eighty-eight patients were screened and 20 patients were randomized. Forty premolars were analysed. LLLT resulted in 23 per cent less root resorption compared to the placebo (P = 0.026). Pulsed laser delivery resulted in 5 per cent less root resorption than continuous; however, this was not statistically significant (P = 0.823). No harm was observed. Conclusion: Teeth treated with LLLT had less total root resorption than placebo-laser. Furthermore, there was minimal difference between pulsed or continuous delivery of LLLT. Trial Registration: Clinical Trials Registry (ACTRN12616000829415). Protocol: The protocol was not published before trial commencement.

Differences in attractiveness comparing female profile modifications of Class II Division 1 malocclusion.

INTRODUCTION: Our objective was to study the perceptions of laypeople for digital alterations and the amount of nasolabial angle increase that is tolerable and how much chin-neck length increase is needed to achieve a desirable profile in Class II Division 1 women with mandibular retrognathia. METHODS: The profile image of a white woman with a Class II Division 1 mandibular rethrognatic profile was digitally modified to create 6 images: 3 with stepwise increased nasolabial angles of 113°, 121°, and 129°, and 3 with stepwise increased chin-neck distances of 51, 54, and 57 mm. These images were assessed and ranked by 155 white laypeople. RESULTS: The baseline profile was judged significantly as the least attractive. A nasolabial angle of 129° was judged as unattractive as the baseline profile. Profiles with a chin-neck length of 54 and 57 mm were equally judged as most attractive. CONCLUSIONS: The untreated (baseline) profile was found to be least esthetic, as well as the profile with the largest nasolabial angle. Nasolabial angle increases up to 121° seem to be acceptable. Profiles simulating a chin-neck length increase as produced by surgery seem to be most favored.

Effect of piezocision on root resorption associated with orthodontic force: A microcomputed tomography study.

INTRODUCTION: The purpose of this study was to investigate the effect of piezocision on orthodontically induced inflammatory root resorption. METHODS: Fourteen patients were included in this split-mouth study; 1 side was assigned to piezocision, and the other side served as the control. Vertical corticotomy cuts of 4 to 5 mm in length were performed on either side of each piezocision premolar, and 150-g buccal tipping forces were applied to the premolars. After 4 weeks, the maxillary first premolars were extracted and scanned with microcomputed tomography. RESULTS: There was a significantly greater total amount of root resorption seen on the piezocision sides when compared with the control sides (P = 0.029). The piezocision procedure resulted in a 44% average increase in root resorption. In 5 patients, there was noticeable piezocision-related iatrogenic root damage. When that was combined with the orthodontic root resorption found on the piezocision-treated teeth, there was a statistically significant 110% average increase in volumetric root loss when compared with the control side (P = 0.005). CONCLUSIONS: The piezocision procedure that initiates the regional acceleratory phenomenon may increase the iatrogenic root resorption when used in conjunction with orthodontic forces. Piezocision applied close to the roots may cause iatrogenic damage to the neighboring roots and should be used carefully.

Volumetric upper airway changes after rapid maxillary expansion: a systematic review and meta-analysis.

BACKGROUND: Although Rapid Maxillary Expansion (RME) has been used for over a century, its effect on upper airways has not yet adequately been assessed in an evidence-based manner. OBJECTIVE: To investigate the volumetric changes in the upper airway spaces following RME in growing subjects by means of acoustic rhinometry, three-dimensional radiography and digital photogrammetry. SEARCH METHODS: Literature search of electronic databases and additional manual searches up to February 2016. SELECTION CRITERIA: Randomized clinical trials, prospective or retrospective controlled clinical trials and cohort clinical studies of at least eight patients, where the RME appliance was left in place for retention, and a maximum follow-up of 8 months post-expansion. DATA COLLECTION AND ANALYSIS: After duplicate data extraction and assessment of the risk of bias, the mean differences and 95 per cent confidence intervals (CIs) of upper airway volume changes were calculated with random-effects meta-analyses, followed by subgroup analyses, meta-regressions, and sensitivity analyses. RESULTS: Twenty studies were eligible for qualitative synthesis, of which 17 (3 controlled clinical studies and 14 cohort studies) were used in quantitative analysis. As far as total airway volume is concerned patients treated with RME showed a significant increase post-expansion (5 studies; increase from baseline: 1218.3mm3; 95 per cent CI: 702.0 to 1734.6mm3), which did not seem to considerably diminish after the retention period (11 studies; increase from baseline: 1143.9mm3; 95 per cent CI: 696.9 to 1590.9mm3). LIMITATIONS: However, the overall quality of evidence was judged as very low, due to methodological limitations of the included studies, absence of untreated control groups, and inconsistency among studies. CONCLUSIONS: RME seems to be associated with an increase in the nasal cavity volume in the short and in the long term. However, additional well-conducted prospective controlled clinical studies are needed to confirm the present findings. REGISTRATION: None. FUNDING: Australian Society of Orthodontics Foundation for Research and Education Inc.

The extent of root resorption and tooth movement following the application of ascending and descending magnetic forces: a prospective split mouth, microcomputed-tomography study.

OBJECTIVE: Various factors have been examined in the literature in an attempt to reduce the incidence and severity of root resorption. The purpose of the present investigation is to test the null hypothesis that there is no difference in relation to force level using gradually increasing (ascending) and decreasing (descending) orthodontic force generated by magnets on the severity of Orthodontically Induced Inflammatory Iatrogenic Root Resorption (OIIRR) and amount of tooth movement. METHODS: Twenty maxillary first premolars from 10 patients were subjected to ascending (25-225 g, magnets in attraction) and descending (225 to 25 g, magnets in repulsion) buccal forces using a split mouth design over an 8-week period. Polyvinyl siloxane impressions were taken at week 0, 4, and 8 to record the tooth movement. After 8 weeks, the teeth were extracted, scanned, with micro-CT in 16.9 µm resolution, and the root resorption craters were localized circumferentially and quantified at each level of the root. RESULTS: The total volume of OIIRR with ascending force was 1.20 mm3, and with descending force was 1.25 mm3, and there was no statistically significant difference between them. OIIRR on the palatal surface (0.012 mm3) was significantly less than on the buccal surface (0.057 mm3) and than on the mesial surface (0.035 mm3). There is no statistically significant difference in the degree of OIIRR between different level of the root (cervical, middle, and apical) at different surfaces. Moreover, the amount of tooth movement, at 0-, 4-, and 8-week interval, secondary to an ascending and descending force application was not statistically significant. CONCLUSIONS: There is no short-term (8 weeks) statistically significant difference between orthodontic ascending and descending forces, from 25 to 225 g and from 225 to 25 g, respectively, in term of severity and location of OIIRR as well as the amount of tooth movement. The buccal surface of the root showed highest degree of OIIRR compared to other root's surfaces.