Evaluation of a novel palatal suture maturation classification as assessed by cone-beam computed tomography imaging of a pre- and postexpansion treatment cohort.

OBJECTIVES: To test the reliability and usefulness of the midpalatal suture maturation classification and methodology proposed in 2013 by Angelieri et al. for successful prediction of rapid maxillary expansion (RME) treatment results. MATERIALS AND METHODS: Reliability testing focused on 16 patients aged 9.5-17 years with early mixed to full permanent dentition, representing all proposed palatal maturation stages, from available preexpansion cone-beam computed tomography (CBCT). A retrospective observational longitudinal (cohort) study evaluated 63 preadolescent and adolescent patients aged 11-17 years with full permanent dentition treated with tooth-borne RME appliances who had CBCT records taken at pre- (T1) and postexpansion (T2). CBCT three-dimensional landmarking produced skeletal and dental widths and dental angulations used to evaluate the extent of skeletal and/or dental expansion. A regression model was used to assess the prediction capability of the T1 palatal suture classification of each subject for dental and skeletal changes. RESULTS: There was almost perfect intraexaminer agreement and slight to poor interexaminer agreement, differing from previously reported reliability, affected by necessary operator calibration and the degree of postacquisition image sharpness and clarity. Further exploration of its scientific basis suggested that the proposed classification was ill-founded. Results from the cohort study were also wholly unsupportive of efficacy of the proposed palatal suture maturation classification in predicting the magnitude of portrayed changes. CONCLUSIONS: Clinicians should be cautious in applying this classification. Although it has merits, the palatal classification still needs much more research and validation.

Novel methodologies and technologies to assess mid-palatal suture maturation: a systematic review.

INTRODUCTION: A reliable method to assess midpalatal suture maturation to drive clinical decision-making, towards non-surgical or surgical expansion, in adolescent and young adult patients is needed. The objectives were to systematically review and evaluate what is known regarding contemporary methodologies capable of assessing midpalatal suture maturation in humans. METHODS: A computerized database search was conducted using Medline, PubMed, Embase and Scopus to search the literature up until October 5, 2016. A supplemental hand search was completed of references from retrieved articles that met the final inclusion criteria. RESULTS: Twenty-nine abstracts met the initial inclusion criteria. Following assessment of full articles, only five met the final inclusion criteria. The number of subjects involved and quality of studies varied, ranging from an in-vitro study using autopsy material to prospective studies with in vivo human patients. Three types of evaluations were identified: quantitative, semi-quantitative and qualitative evaluations. Four of the five studies utilized computed tomography (CT), while the remaining study utilized non-invasive ultrasonography (US). No methodology was validated against a histological-based reference standard. CONCLUSIONS: Weak limited evidence exists to support the newest technologies and proposed methodologies to assess midpalatal suture maturation. Due to the lack of reference standard validation, it is advised that clinicians still use a multitude of diagnostic criteria to subjectively assess palatal suture maturation and drive clinical decision-making.

The effect of buccal-lingual slot dimension size on third-order torque response.

Introduction: The focus of the presented study was to investigate the effect of buccal-lingual (B-L) orthodontic bracket slot dimension on third-order torque mechanics. Materials and methods: Three types of orthodontic brackets and two archwire sizes were considered. Ortho Classic H4 (0.026″ B-L slot, passive), Ormco Damon Q (0.028″ B-L slot, passive), and In-Ovation R (0.028″ slot, active) brackets were tested using 0.017″ × 0.025″ and 0.019″ × 0.025″ beta-titanium archwires. An in vitro orthodontic torque simulator (OTS) was used to rotate archwires relative to a single bracket while recording forces and moments in three directions. For each bracket-archwire combination, a total of n = 47 samples were tested. Repeated measures analysis of variance between brackets was conducted for third-order torque values at 3° increments between 9° and 30° during loading and unloading for each archwire size. Results: Statistically significant differences between H4 and Q brackets were only found for 0.017″ × 0.025″ archwires during loading, and 0.019″ × 0.025″ archwires during unloading. Conversely, differences between H4 and R brackets were found for both archwires during loading and unloading phases. Finally, when using a 0.017″ × 0.025″ archwire the H4 brackets reached the 5 Nmm threshold before R and Q brackets; however, there was little difference found when using a 0.019″ × 0.025″ archwire. Conclusions: The concept of using a smaller B-L bracket slot dimension in orthodontic treatment showed it may theoretically allow for more options, primarily using smaller archwires to correct third-order rotational misalignments. However, it is suspected that bracket material limitations and added loading on the door currently prevent this from being clinically applicable.

Assessing near infrared optical properties of ceramic orthodontic brackets using cross-polarization optical coherence tomography.

Secondary decay (caries) under ceramic orthodontic brackets remains a significant dental problem and near infrared cross-polarization optical coherence tomography (CP-OCT) has the potential to detect underlying demineralization. The purpose of this study was to determine the effect of crystalline structure and chemical composition of ceramic brackets on CP-OCT imaging. Four ceramic brackets types, which were divided into monocrystalline and polycrystalline, were examined using CP-OCT. The results of this study demonstrated that the crystallinity of the ceramic brackets affected the 1310 nm CP-OCT imaging with the greatest attenuation seen in polycrystalline alumina brackets. The alumina polycrystalline bracket materials had significantly higher attenuation and scattering than alumina monocrystalline brackets (p < 0.05, ANOVA, Bonferroni). Additionally, bracket base morphology and composition affected NIR light attenuation. There was considerable attenuation in bracket bases that contained additive zirconium spheres (∼30 µm) and this alteration was significantly greater than the jagged alumina crystallographic alterations found in the other bracket systems (p < 0.05, ANOVA, Bonferroni). Noninvasive, near infrared (NIR) cross-polarization optical coherence tomography (CP-OCT) has potential to effectively image through portions of ceramic brackets; however, further investigation into the optical effects of resin integration in the base portion of the brackets is warranted.

Xerostomia: the "invisible" oral health condition.

Xerostomia, or dry mouth, is perhaps one of the most underappreciated, underdiagnosed, and undermanaged oral health conditions. Recognition of a xerostomic condition is important because it can significantly affect the overall quality of life and contribute to diminishing oral health in a number of ways. This article will provide an overview of the etiology of xerostomia, the sequelae of the condition, and suggestions for pharmacological and non-pharmacological management of the condition to improve a patient's quality of life.

Xerostomia: the "invisible" oral health condition.

Xerostomia, or dry mouth, is perhaps one of the most underappreciated, underdiagnosed, and undermanaged oral health conditions. Recognition of a xerostomic condition is important because it can significantly affect the overall quality of life and contribute to diminishing oral health in a number of ways. This article will provide an overview of the etiology of xerostomia, the sequelae of the condition, and suggestions for pharmacological and nonpharmacological management of the condition to improve a patient's quality of life.