Effect of treatment with dental space maintainers after the early extraction of the second primary molar: a systematic review.

BACKGROUND: Early loss of second primary molars may lead to different malocclusions, mainly caused by the mesial migration of the first permanent molar. To prevent space loss in the dental arch, different types of space maintainers (SM) are used. OBJECTIVES: The main objective of this systematic review is to examine the evidence in the literature regarding the effect of SM, including the clinical effect, risk of developing caries and periodontal disease, patient satisfaction, and cost-effectiveness after the premature loss of the second primary molar in children. SEARCH METHODS: The present systematic review was made according to PRISMA. The literature search was performed using four databases (last search 30/8/2022): PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science. SELECTION CRITERIA: The studies included were randomized controlled trials, economic evaluations, and non-randomized clinical studies with a defined control group. DATA COLLECTION AND ANALYSIS: Data collected by the two authors were in regard to reports, studies, participants, research designs, and interventions. The assessment of the risk of bias was made using the ROBINSON-I tool. RESULTS: The search yielded 1058 articles after the removal of duplicates. Two studies were included in the final review with a moderate risk of bias, and measured space changes in the dental arch and the periodontal status of patients treated with SM. The main results indicate that treatment with SM can preserve arch length, but also cause an increase in plaque accumulation and other periodontal parameters. However, there is an overall lack of scientific evidence regarding the effect of the treatment. LIMITATIONS: No studies that fulfilled the eligibility criteria were found on cost-effectiveness, risk of caries development, and patient satisfaction. CONCLUSIONS: The scientific evidence is lacking regarding the clinical effect, cost effect, and side-effects such as caries and periodontal disease when using SM in children with a premature loss of the second primary molar. REGISTRATION: PROSPERO Registration (CRD 42021290130).

Apical root resorptions in girls with Turner syndrome: a controlled longitudinal study.

OBJECTIVES: To study, longitudinally, the development of apical root resorptions (ARRs) in Turner syndrome (TS) and to correlate these to the karyotype and orthodontic treatment. MATERIALS AND METHODS: Thirty girls with TS participated in the study, mean age 10.8 years (6.6-23.4) at the first registration (T1), and 14.3 years (9.2-25.2) at the second registration (T2). Forty girls without TS, orthodontically untreated, served as controls. ARR was diagnosed in panoramic radiographs, and root/crown ratios of the lower permanent first molar were measured at T1 and T2 with a mean follow-up period of 42 (11-89) months. RESULTS: During the follow-up period, ARR was seen in 40% of all TS patients and in 2.5% in the control group. The majority displayed ARR on the distal root of the mandibular first permanent molars (30%). ARR at T2 was seen in 56% of 45,X and isochromosome karyotype and 21% of every other TS karyotype patients. AAR was seen in 5 out of 12 TS patients with orthodontic treatment. No statistically significant differences in root/crown ratios between T1 and T2 were found. LIMITATIONS: The number of patients studied is limited, thus possible differences might be disguised for this reason. Spatial projection errors in panoramic radiograph recordings might have influenced measurement, resulting in an underestimation of ARR. CONCLUSIONS: There is a higher risk for ARR in girls with TS and probably the risk is therefore probably also higher during orthodontic treatment. Thus, if treated, frequent radiographic follow-ups should be taken during the treatment. PROTOCOL: The protocol was not published before trial commencement.

Dental Caries and Risk Factors in Swedish Adolescents about to Start Orthodontic Treatment with Fixed Appliances.

AIM: The aim of this study is to investigate the caries situation in a group of Swedish adolescents, who were scheduled for orthodontic treatment with fixed appliances. MATERIALS AND METHODS: An age- and gender-matched control group was selected from the same city (Malmö, Sweden). Caries and fillings on smooth surfaces and fillings on occlusal surfaces were diagnosed clinically and caries and fillings on approximal surfaces by bitewings. Numbers of mutans streptococci (MS) and lactobacilli (LB) were analyzed in saliva. RESULTS: There were no significant differences regarding manifest caries lesions and fillings on smooth surfaces. Numbers of occlusal-filled surfaces (FS) and approximal decayed and filled surfaces were around 10%, but did not differ between the groups. However, 53% had approximal enamel caries lesions in the test group and 46% in the control group. The prevalence of approximal decayed surfaces (DS) and FS was low in both groups, 0.57 ± 1.41 in the test group and 0.65 ± 1.38 in the control group (p > 0.05), i.e., somewhat more DS in the control group (p < 0.05). Most individuals had low/medium counts of cariogenic bacteria in their saliva and less than 10% high counts in both groups. CONCLUSION: Most Swedish adolescents who have been scheduled for treatment with fixed appliances appear to have a low-to-medium caries risk nowadays. However, around 10% of all approximal tooth surfaces of premolars/molars had enamel caries and one-third of the individuals had medium/high counts of cariogenic bacteria in their saliva, which may be risk factors for future caries during orthodontic treatment. CLINICAL SIGNIFICANCE: Bitewing radiographs are important before starting orthodontic treatment and approximal caries and many cariogenic bacteria may be risk factors for orthodontic treatment.

The use of panoramic radiographs to decide when interceptive extraction is beneficial in children with palatally displaced canines based on a randomized clinical trial.

Objective: To evaluate which palatally displaced canines (PDCs) benefit from interceptive extraction of the deciduous canine, to assess possible side effects from the extraction, and to analyse other dental deviations in patients with PDCs. Design, settings, participants, and intervention: A sample of 67 patients (40 girls, mean age: 11.3 ± 1.1; 27 boys, mean age ± SD: 11.4 ± 0.9) with unilateral (45) or bilateral (22) PDCs were consecutively recruited and randomly allocated to extraction or non-extraction using block randomization. No patients dropped out after randomization or during the study. The patients were given a clinical examination and panoramic radiographs were taken at baseline and after 6 (T1) and 12 months (T2). An individual therapy plan was made for the PDCs that had not erupted at T2. Measurements were performed blindly and the outcome measures were: canine position and angulation, root development, midline shift, rotation, or movement of adjacent teeth into the extraction site, and frequency of other dental deviations. Results: Interceptive deciduous canine extraction is beneficial if the alpha angle is between 20 and 30 degrees. A PDC located in sector 4 with an alpha angle >30 degrees should have immediate surgical exposure, while canines angulated less than 20 degrees and located in sector 2 can be observed without prior interceptive extraction. Deciduous canine extraction was more beneficial in younger patients with less advanced root development. Minor side effects, such as rotation or migration of teeth into the extraction space, were observed in 15 out of 35 patients. A majority of the patients had other dental deviations than PDC in the dentition. Limitations: The results are only valid for patients with no space deficiency in the maxilla and with PDCs located in sector 2-4. Harms: No harms were detected. Conclusions: The alpha angle and sector position are good diagnostic predictors of when interceptive extraction is beneficial. Minor side effects are seen after the extraction and the majority of the patients had other dental deviations too. Registration: This trial was registered at http://www.fou.nu/is/sverige, registration number: 211141.

A cost-minimization analysis of large overjet reduction with two removable functional appliances based on a randomized controlled trial.

Objective: The purpose of this study was to assess and relate the societal costs of reducing large overjet with a prefabricated functional appliance (PFA), or a slightly modified Andresen activator (AA), using a cost-minimization analysis (CMA). Design, settings, and participants: A multicentre, prospective, randomized clinical trial was conducted with patients from 12 general dental practices. Ninety-seven patients with an Angle Class II, division 1 malocclusion, and an overjet of ≥6 mm were randomly allocated by lottery to treatment with either a PFA or an AA. The PFA and AA groups consisted of 57 and 40 subjects, respectively. Blinding was not performed. Duration of treatment, number of scheduled/unscheduled appointments, and retreatment were registered. Direct and indirect costs were analysed with reference to intention-to-treat (ITT), successful (S), and unsuccessful (US) outcomes. Societal costs were described as the total of direct and indirect costs, not including retreatments. Interventions: Treatment with a PFA or an AA. Results: The direct and societal costs were significantly lower for the PFA than for the AA group. The number of visits was lower in the PFA group, when ITT was considered, and for the US cases as well. No difference in retreatment rate could be seen between the groups. Limitations: Costs depend on local factors and thus should not be generalized to other settings. Harms: No harms were detected during the study. Conclusion: The success rate of the both appliances was low. However, the PFA was the preferred approach for reduction of a large overjet in mixed dentition, since it minimized costs and there were no difference in clinical outcomes between PFA and AA. Registration: This trial was registered at 'FoU i Sverige' (http://www.fou.nu/is/sverige), registration number: 97131. Protocol: The protocol was not published before trial commencement.

Discomfort, expectations, and experiences during treatment of large overjet with Andresen Activator or Prefabricated Functional Appliance: a questionnaire survey.

BACKGROUND: The purpose of this study was to investigate the amount of functional and social discomfort experienced after 1 and 6 months of appliance wear, comparing a slightly modified Andresen Activator (AA) and a Prefabricated Functional Appliance (PFA). METHODS: Ninety-seven patients randomly selected by lottery in an AA (40 subjects), and a PFA (57 subjects) group, with an Angle Class II, Division 1 malocclusion, were eligible for the study. One month and 6 months after start of treatment, a questionnaire, addressing discomfort, perception of treatment need and outcome, was used. RESULTS: The response rate was 69% after 1 month, and 45% after 6 months. The most common discomfort reported was the 'appliance falling out during sleep' followed by 'difficulties in remembering it'. The only difference was for pain, which was experienced more extensively in the AA group after 1 month of treatment. The dentist appeared to have the greatest impact on the decision to initiate treatment. Teasing, because of appearance, occurred in 13% of the cases. CONCLUSIONS: No difference could be seen between groups for the experience of functional or social discomfort after 6 months of appliance use. Adequate time should be allowed for clarifying treatment difficulties, using treatment need as motivation. PRACTICAL IMPLICATIONS: The PFA eliminates the need for taking impressions. Furthermore, it can be economically advantageous to both patients and clinicians.

Treatment of large overjet in Angle Class II: division 1 malocclusion with Andresen activators versus prefabricated functional appliances-a multicenter, randomized, controlled trial.

OBJECTIVES: The purpose of this study was to compare the clinical effectiveness in reducing large overjet between a prefabricated functional appliance (PFA) and a slightly modified Andresen activator (AA). SETTING AND SAMPLE POPULATION: Public Dental Service, Gothenburg, Sweden. PARTICIPANTS, STUDY DESIGN, AND METHODS: A multicentre, prospective randomized clinical trial was conducted with patients from 12 general dental practices. One hundred and five patients with an Angle Class II, division 1 malocclusion and an overjet of ≥6mm were eligible for the study. Eight patients were excluded due to various reasons and the sample consisted thus of 97 subjects (44 girls, 53 boys) with a mean age of 10.3 years. The study was designed as intention to treat and the patients were randomly allocated by lottery to treatment with either a PFA or an AA. The PFA and AA group consisted of 57 subjects (28 girls, 29 boys) and 40 subjects (16 girls, 24 boys), respectively. Overjet, overbite, lip seal, and sagittal molar relationship were recorded before, at the end of treatment and 1-year post-treatment. Blinding was not performed. The endpoint of treatment was set to overjet ≤3mm and after this a 6 months retention period followed. RESULTS: No significant difference was found in overjet, overbite, sagittal relation, and lip seal between the two groups for the total observation period. The treatment of 40 (70 per cent) patients with PFA and 21 (53 per cent) with AA were considered unsuccessful mainly due to poor compliance. LIMITATIONS: No cephalometric records were taken as only patient-centred clinical outcome were used as an indicator for treatment success. The criteria of reduction of overjet to as low as 3mm could have affected the success rate. CONCLUSION: No difference in effectiveness could be shown between PFAs and AAs in correcting overjet, overbite, sagittal molar relation, and lip seal. The success rate in treatment with both appliances is, however, low. REGISTRATION: This trial was registered in "FoU i Sverige" (http://www.fou.nu/is/sverige), registration number: 97131. PROTOCOL: The protocol was not published before trial commencement.

Extraction of the deciduous canine as an interceptive treatment in children with palatally displaced canines - part II: possible predictors of success and cut-off points for a spontaneous eruption.

AIM: To analyse factors affecting the success rate of palatally displaced canines (PDCs) and eruption time and to find cut-off points to predict when interceptive extraction is beneficial versus unnecessary. MATERIALS AND METHODS: Sixty-seven patients, 40 girls, 27 boys (10-13 years) with uni- (45) or bilateral (22) PDCs, persisting deciduous canine and no previous orthodontic treatment were randomly allocated for extraction or non-extraction using the block randomization method. There were no dropped out after the randomization or during the trial. Clinical examination and cone beam computed tomography was performed at 0, 6, and 12 months. Blinded measurements were done on baseline images. RESULTS: Erupted PDCs had a significantly smaller mesioangular angle, shorter distance of canine cusp tip-dental arch plane, and larger distance of canine cusp tip-midline, and the patients were younger compared to the non-erupted group. Faster eruption was noted of PDCs in the extraction group. Spontaneous eruption was achieved without prior deciduous canine extraction with cut-off points: initial canine cusp tip-midline of 11mm, canine cusp tip-dental arch plane of 2.5mm, or a mesioangular angle of 103 degrees. PDCs with a less favourable position, i.e. an initial cusp tip-midline of 6mm, a canine cusp tip-dental arch plane of 5mm, or a mesioangular angle of 116 degrees, will need surgical exposure despite interceptive extraction of the deciduous canine. The canine cusp tip-midline had the best predictive measure for assessing the outcome. LIMITATIONS: Decision on where to place the cut-off points may differ from one operator to another, therefore results from several studies are needed to get average cut-off points. CONCLUSIONS: Deciduous canine extraction is the variable that affects the spontaneous eruption of the canine most. Canine cusp tip-midline, canine cusp tip-dental arch plane, and mesioangular angle might be useful for distinguishing when an interceptive extraction of the deciduous canine is beneficial or when exposure of the PDC should be implemented without previous interceptive treatment. REGISTRATION: This trial was registered in 'FoU i Sverige' (http://www.fou.nu/is/sverige), registration number: 40921. PROTOCOL: The protocol was not published before trial commencement.

Extraction of the deciduous canine as an interceptive treatment in children with palatal displaced canines - part I: shall we extract the deciduous canine or not?

OBJECTIVES: To analyse whether extraction of the deciduous canines facilitates eruption of the palatal displaced canines (PDCs), and to analyse root resorption in adjacent teeth caused by the PDCs. MATERIALS AND METHODS: Eligibility criteria for participants were as follows: children at age 10-13 years with either maxillary unilateral or bilateral PDC, persisting deciduous canine and no previous experience of orthodontic treatment. Sixty-seven patients (40 girls and 27 boys; age: mean ± standard deviation: 11.4±1.0) with unilateral (45) or bilateral (22) PDCs were consecutively recruited and randomly allocated using permuted block randomization method to extraction or non-extraction. No patients dropped out after the randomization or during the study. Patients underwent a clinical examination and cone beam computed tomography at baseline (T0), after 6 (T1) and 12 months (T2). The total observation time was 24 months. Outcome measures were eruption, positional changes, length of time until eruption, and root resorption of adjacent teeth. The baseline images were measured blinded while the 6- and 12-month control images were not, since it was not possible to blind the extracted canine. RESULTS: Significantly more spontaneous eruptions of the PDCs were seen in the extraction group (EG) than in the control group (CG), with rates of 69 and 39 per cent, respectively, with a mean eruption time of 15.6±5.6 months in the EG and 18.8±5.8 months in the CG. Significant differences in changes between the groups, in favour of the EG, were found for all variables except for the sagittal angle. In the EG, the changes in the distances of the canine cusp-tip were larger during the first 6 months, while the change of apex was larger between 6 and 12 months. There were no significant differences in resorption of adjacent teeth between the groups. LIMITATIONS: Imputation values were used for the PDCs who had erupted at T2, since no x-rays were taken for ethical reasons, which might have given uncertainty in the positional changes between T1 and T2. CONCLUSIONS: Extraction of the deciduous canine is an effective treatment in patients with PDCs. Significantly more positional changes and shorter mean eruption time were seen in the EG. Resorptions of lateral incisors were seen in both groups, but none exceeded grade 2 (resorption up to half of the dentine thickness to the pulp). REGISTRATION: This trial was registered in "FoU i Sverige" (http://www.fou.nu/is/sverige), registration number: 40921. PROTOCOL: The protocol was not published before trial commencement.

Diagnosing the severity of buccal caries lesions in orthodontic patients at de-bonding using digital photographs.

OBJECTIVE: The aims of this study were (1) to evaluate the severity of buccal caries lesions according to the International Caries Detection and Assessment System (ICDAS) criteria via scoring buccal caries lesions on digital photographs at the time of de-bonding and (2) to compare this method with clinical examination. MATERIALS AND METHODS: In total, 89 patients treated with upper and lower fixed appliances were clinically examined immediately after de-bonding by the first author and buccal caries were scored according to the ICDAS-II. Close-up digital photographs were taken of 245 teeth with different buccal caries lesion scores according to the ICDAS-II. Thirteen postgraduate orthodontics students independently scored the buccal caries lesions in the digital photographs using the modified clinical criteria (ICDAS-II). Intra- and inter-examiner reliabilities were evaluated by calculating the weighted kappa. To evaluate the validity of diagnosing the severity of buccal caries lesions using digital photographs compared to clinical examination, Spearman's correlation coefficient was calculated. RESULTS: Intra-examiner reliability and the reliability between each examiner and the clinical examination showed moderate-to-excellent agreement, with kappa values of 0.52-0.83. Scoring buccal caries lesions via clinical examinations and scoring via photographs were well correlated according to the modified ICDAS-II criteria (Spearman's correlation coefficient, 0.76). CONCLUSIONS: Thus, scoring buccal caries lesions on digital photographs according to ICDAS-II criteria is a reliable and valid method for assessing the severity of buccal caries lesions.

A long-term controlled follow-up study of objective treatment need on young adults treated with functional appliances.

The aims of this study were to 1) evaluate the objective success rate of Class II malocclusion treatment with functional appliances five years after completion of treatment and 2) to compare the remaining objective treatment need with an untreated control group. Records of all listed patients between 18-20 years (n=1054) treated in a general practice were reviewed for the purpose of finding treatments with removable functional appliances. Among all subjects (n=61) who previously had been treated, 58 accepted to participate in the study.The test group was matched with an orthodontically untreated group with no history of objective treatment need. Clinical examination was performed and study casts and photos were taken from both groups.The objective treatment need was evaluated through clinical examination and study cast analysis with weighted Peer Assessment Rating index (wPAR). Twenty patients, (34.5%) (mean wPAR 13.8), succeeded with the functional appliance treatment.The wPAR score (mean 15.0) of the entire test group was significantly higher than the one of the control group (mean 7.3).The group that was treated exclusively with functional appliances had a mean wPAR score of 17.4. Eighteen patients (31.0%) who received retreatment with fixed appliances had a slightly higher mean wPAR (8.6) than the control group. Treatments with functional appliances in a general practice showed a high failure rate and a remaining treatment need. It is the treating dentist's responsibility to motivate the patient to cooperate to the treatment, because as it previously has been shown the treatment with functional appliances is a well-functioning treatment alternative with the cooperation of the patient being sufficient. It is also of importance, already before starting treatment, to estimate the child's cooperation ability and to avoid treatment with removable appliances if the child or parents are reluctant about such a treatment.

Bite force and its association with stability following Class II/1 functional appliance treatment.

The aims of this study were to investigate the value of pre-treatment maximal molar bite force as a predictive variable in determining post-treatment changes and stability following functional appliance treatment in Class II malocclusion children. Twenty-eight Class II malocclusion children having undergone functional appliance treatment were followed for at least 1 year post-treatment. Maximal molar bite force measurements, lateral cephalograms, and study casts were taken before treatment, after treatment, and after post-treatment follow-up. Relationships between pre-treatment maximal molar bite force and dental or cephalometric changes post-treatment were examined. Patients were divided into stable and unstable groups, based on dental sagittal changes (overjet and molar relationship), and differences between the two groups of patients determined. Post-treatment changes varied widely. Thirteen children showed dentoalveolar sagittal relapse, namely a shift in molars towards a Class II relationship and an increase in overjet, while 15 did not. The unstable group demonstrated a lower pre-treatment maximal molar bite force, as well as a more obtuse gonial angle, than the stable group. The gonial angle was found to be negatively correlated to maximal molar bite force and may thus be a cephalometric indicator partly reflecting the functional condition of the masticatory muscles. Children with a lower pre-treatment maximal molar bite force were more prone to dentoalveolar sagittal relapse following functional appliance treatment.

Palatal height and dental arch dimensions in Turner syndrome karyotypes.

The aim of this project was to study the impact from Turner syndrome (TS) karyotype and age on dental arch morphology and palatal height and to compare the variables in TS with reference data from non-TS females with normal occlusion. Plaster casts from 76 females with TS (6-50 years) were analysed with respect to dentoalveolar arch dimensions and palatal height. The TS females were divided into the karyotype categories: i) 45,X ii) 45,X/46,XX iii) isochromosome, and iv) other. The 45,X/46,XX karyotype exhibited fewer statistically significant variables differing from the reference group compared with other karyotypes. TS females showed increased dentoalveolar depths, decreased maxillary but increased mandibular width, decreased posterior segments, and decreased mandibular circumference compared with the reference group. In opposition to previous reports, the palatal height did not differ compared with non-TS females. Age had an impact on nine of the variables. We conclude that the present dental arch deviations are reflecting the high frequency of malocclusions reported in TS and the subsequent need for orthodontic treatment, which might possibly be lower in the 45,X/46,XX karyotype. The palatal height did not differ from the reference group, but instead the narrow maxilla might contribute to an illusion of a higher palate. We therefore suggest using the nomination 'narrow palatal vault' instead of the commonly used term 'high palatal vault'.

45,X/46,XX karyotype mitigates the aberrant craniofacial morphology in Turner syndrome.

The aim of this project was to study the impact on craniofacial morphology from Turner syndrome (TS) karyotype, number of intact X chromosomal p-arms, and age as well as to compare craniofacial morphology in TS with healthy females. Lateral radiographs from 108 females with TS, ranging from 5.4 to 61.6 years, were analysed. The TS females were divided into four karyotype groups: 1. monosomy (45,X), 2. mosaic (45,X/46,XX), 3. isochromosome, and 4. other, as well as according to the number of intact X chromosomal p-arms. The karyotype was found to have an impact on craniofacial growth, where the mosaic group, with presence of 46,XX cell lines, seems to exhibit less mandibular retrognathism as well as fewer statistically significant differences compared to the reference group than the 45,X karyotype. Isochromosomes had more significant differences versus the reference group than 45,X/46,XX but fewer than 45,X. To our knowledge, this is the first time the 45,X/46,XX and isochromosome karyotypes are divided into separate groups studying craniofacial morphology. Impact from p-arm was found on both maxillary and mandibular length. Compared to healthy females, TS expressed a shorter posterior and flattened cranial base, retrognathic, short and posteriorly rotated maxilla and mandible, increased height of ramus, and relatively shorter posterior facial height. The impact of age was found mainly on mandibular morphology since mandibular retrognathism and length were more discrepant in older TS females than younger.

Pain, discomfort, and use of analgesics following the extraction of primary canines in children with palatally displaced canines.

BACKGROUND. Pain following the extraction of the primary canine in children with palatally displaced canines (PDC) as an interceptive treatment has not been investigated. AIMS. To describe pain, discomfort, dental anxiety, and use of analgesics following the extraction of primary canines in children with PDC. DESIGN. Forty-four children, aged 10-13 with PDC, were included. Pain intensity, discomfort, and analgesic consumption were rated the first evening and 1 week after the extraction of the primary canine. Dental anxiety was assessed pre-extraction, using the dental anxiety scale (DAS). A matched reference group also completed the DAS. RESULTS. No significant differences were found between the study and the reference group regarding the pre-extraction assessments. Post-extraction pain and discomfort was low. The experience of the injection was graded worse than the extraction, and more pain was rated at the evening post-extraction than during the extraction. Analgesics were used only the first evening. High correlation was detected between DAS and pain during injection and extraction. CONCLUSIONS. The experience of pain and discomfort during and after extraction of the primary canines is low, despite that 42% of the children used analgesics. Therefore, appropriate analgesics and recommendation doses pre- and post-extraction should be prescribed.

A systematic review of the interceptive treatment of palatally displaced maxillary canines.

The aim of this study was to assess whether interceptive treatment in the mixed dentition prevents impaction of palatally displaced canines (PDC) by systematically reviewing the literature. A literature search of PubMed, the Cochrane Library electronic databases, and Scopus was performed covering the period from January 1966 to May 2009. The inclusion criteria were mixed dentition with unilateral or bilateral PDC, randomized controlled trials (RCT), prospective and retrospective studies with untreated controls, and clinical trials comparing at least two treatment strategies. Three reviewers selected and extracted the data independently and evaluated the quality of the studies. Inter-examiner reliability was measured using the intraclass correlation coefficient (ICC). The search strategy resulted in 686 articles, of which two met the inclusion criteria. Because of the unequivocal results and heterogeneity in the study methods, the scientific evidence was too weak to fully evaluate the effect that interceptive treatment might have on PDC and which treatment modalities are most effective. The quality of the studies was rated as low because of inadequate sample selection and deficient description of sample size, confounding factors, uncertainty of randominization, and no blinding in measurements. The ICC value for total scores was >0.80, e.g. perfect agreement. To obtain reliable scientific evidence as to whether interceptive treatment prevents impaction of PDC and which treatment modalities are the most effective, better controlled and well-designed RCTs are needed. Future studies should also include assessment of patient satisfaction and pain experience as well as analysis of the costs and side-effects of treatments.

Altered inorganic composition of dental enamel and dentin in primary teeth from girls with Turner syndrome.

In Turner syndrome (TS) one X-chromosome is missing or defective. The amelogenin gene, located on the X-chromosome, plays a key role during the formation of dental enamel. The aim of this study was to find support for the hypothesis that impaired expression of the X-chromosome influences mineral incorporation during amelogenesis and, indirectly, during dentinogenesis. Primary tooth enamel and dentin from girls with TS were analysed and compared with the enamel and dentin of primary teeth from healthy girls. Qualitative and quantitative changes in the composition of TS enamel were found, in addition to morphological differences. Higher frequencies of subsurface lesions and rod-free zones were seen in TS enamel using polarized light microscopy. Similarly, scanning electron microscopy showed that the enamel rods from TS teeth were of atypical sizes and directions. Using X-ray microanalysis, high levels of calcium and phosphorus, and low levels of carbon, were found in both TS enamel and dentin. Using microradiography, a lower degree of mineralization was found in TS enamel. Rule induction analysis was performed to identify characteristic element patterns for TS. Low values of carbon were the most critical attributes for the outcome TS. The conclusion was that impaired expression of the X-chromosome has an impact on dental hard tissue formation.

Oral fluoride retention in orthodontic patients with and without fixed appliances after using different fluoridated home-care products.

OBJECTIVE: To evaluate oral fluoride (F) retention after using fluoridated toothpastes, rinsing solutions and chewing sticks (Miswaks) in orthodontic patients with and without orthodontic appliances. MATERIAL AND METHODS: Nine orthodontic patients, with a mean age of 16 years, were included in a randomized, cross-over, experimental study. Six different home-care F products, two NaF toothpastes (0.32% and 1.1%), two NaF mouthwash solutions (0.05% and 0.2%) and two NaF-impregnated Miswaks chewing sticks (0.05% and 0.5%), were used both during the orthodontic treatment and 1 week after debonding. Unstimulated whole saliva and approximal saliva were collected from two interdental sites, before and up to 60 min after using each product for 2 min. The retention of F was calculated as the area under the 60-min F-clearance curve (AUC). RESULTS: In general, the F concentrations at the various sites were higher before than after debonding. Moreover, the products with a high F content (toothpaste, mouthwash and Miswaks) resulted in higher F retention than the corresponding products with a lower F content. In whole saliva, the highest AUC values were found in patients using 0.2% NaF mouthwash, followed by 1.1% NaF toothpaste (p < 0.05). In approximal saliva, the retention values were highest after using 0.5% NaF-impregnated Miswaks in patients wearing orthodontic appliances (p < 0.001). CONCLUSIONS: The insertion of fixed orthodontic appliances appears to favor oral F retention for all the tested home-care F products. In addition, products with a high F content increase oral F retention.

Combination of high-fluoride toothpaste and no post-brushing water rinsing on enamel demineralization using an in-situ caries model with orthodontic bands.

OBJECTIVE: To compare the effects on enamel demineralization and fluoride (F) retention of two different brushing­rinsing regimens. MATERIAL AND METHODS: An in-situ caries model with orthodontic bands was used for 8­9 weeks. A total of 20 orthodontic patients participated. They were randomized into two groups: (1) a test group using 5000 ppm F (n = 10) with no post-brushing water rinsing; and (2) a control group using 1450 ppm F (n = 10) with three sessions of post-brushing water rinsing. Orthodontic stainless-steel bands were applied to the two upper first premolars, leaving 2­3 mm of space away from the exposed buccal surface in order to accumulate plaque and provoke initial caries development. The teeth were extracted after 8 and 9 weeks, then analysed using quantitative light-induced fluorescence (QLF). Additionally, oral F retention was compared for the two groups. RESULTS: In comparison to the control group, the test regimen resulted in a non-significant smaller QLF lesion area and a significantly lower average QLF loss of fluorescence (P < 0.05). The highest F retention concentration under the band was found in the test group (P < 0.001). CONCLUSIONS: The combination of using a 5000 ppm F toothpaste and no post-brushing water rinsing had a greater anti-caries potential and resulted in elevated oral F retention compared to a 1450 ppm F toothpaste with three sessions of post-brushing water rinsing.

Oral health status in a group of children and adolescents with myotonic dystrophy type 1 over a 4-year period.

AIM: The aim of this longitudinal study was to evaluate changes in oral health, orofacial function, and dental care in children with myotonic dystrophy type 1 (DM1) in comparison with a control group. METHODS: Thirty-six DM1 patients and 33 control patients out of originally 37 in each group were examined on two occasions about 4 years apart. Caries, plaque, and gingivitis were registered, mouth opening capacity assessed and the ability to cooperate in dental treatment estimated. Questionnaires concerning different aspects of oral health and care, symptoms of temporomandibular dysfunction (TMD), and dental trauma were also used. RESULTS: The DM1-patients, in particular the boys, had significantly more caries, plaque, and gingivitis than the control patients on both occasions and the increase in decayed missing or filled permanent teeth (DMFT) and surfaces (DMFS) was significantly larger. They received more dental care and had lower cooperation ability. Mouth opening capacity and increase of it was significantly lower and symptoms of TMD were significantly more frequent. CONCLUSIONS: DM1 patients, as they grow older, have increasing amounts of plaque and risk of caries and gingivitis. They have more TMD problems. Behaviour management problems do not seem to decrease with age. Increased prophylactic care is essential for DM1 patients.