Comparison of transverse dimensional and incisor changes between wide and narrow orthodontic archwires: a randomized controlled trial.

OBJECTIVES: To clinically compare the effects of broader archwires to standard archwires, using conventional brackets in both cases, on the transverse and incisor changes in maxillary and mandibular arches during leveling and alignment. MATERIALS AND METHODS: Fifty-two patients presenting with crowding were allocated into two groups; one group received the broad Damon archwires while the other received standard 3M OrthoForm III Ovoid archwires. All participants were treated with conventional brackets using similar archwire sequences (0.014, 0.018, 0.016 × 0.022/0.016 × 0.025, 0.019 × 0.025 NiTi/CuNiTi archwires). Digital casts were obtained from alginate impressions before treatment (T0) and six weeks after inserting 0.019 × 0.025 NiTi archwires (T1). Pretreatment (T0) and post-alignment (T1) lateral cephalograms were obtained for each patient. The primary outcomes were the changes in the transverse arch dimensions and incisor inclination. The secondary outcomes were the horizontal and vertical linear changes in incisor position. RESULTS: Complete data were collected for 47 patients. There was a significant increase in arch width during treatment within each group, except for upper inter-molar width in 3M group (P = 0.071). Damon wire induced a statistically significant increase in maxillary inter-second premolar width (P = 0.042), and mandibular inter-first premolar (P = 0.043), inter-second premolar (P = 0.008) and inter-molar widths (P = 0.033) compared to 3M group. The increase in incisor proclination and the linear change in incisor position were significant within each group, with less mandibular incisor proclination (P = 0.004) and horizontal advancement (P = 0.038) in the Damon group. CONCLUSIONS: Damon archwires created a comparatively greater increase in the maxillary inter-second premolar width and the mandibular inter-first premolar, inter-second premolar, and inter-molar widths, and less proclination and horizontal advancement in mandibular incisors. The study provides invaluable evidence that using broad archwires with self-ligating brackets is the reason behind any greater expansion observed in this system rather than the unique mechanical and biological features exerted by the self-ligating system. CLINICAL RELEVANCE: Our results suggest that Damon archwire might be a better alternative compared to the narrower standard archwires that are usually used with conventional brackets, especially in the mandibular arch, in cases where mild to moderate crowding is planned to be resolved with a non-extraction approach. However, as arch expansion in the absence of posterior crossbites raises the question of long-term stability, the reported advantage of the use of wide wires should be interpreted with caution and should be considered in the retention phase, bearing in mind that achieving a good post-treatment occlusion is important for enhancing post-treatment stability.

A comparison between two orthodontic archwire sequences in terms of speed of alignment and root resorption: a randomized controlled clinical trial.

OBJECTIVES: To compare between two archwire (AW) sequences in terms of alignment speed and root resorption (RR). MATERIALS AND METHODS: Fifty-four patients (14 males, 40 females) requiring orthodontic treatment were randomly allocated into two groups; in group A (mean age 18.3) treatment started with 0.014″ nickel titanium (NiTi) followed by 0.019″×0.025″ NiTi AW while group B (mean age 18.9) the AW sequence was 0.014″ NiTi, 0.018″ NiTi, 0.016″×0.022″ NiTi, 0.019″×0.025″ NiTi. The primary outcome was to compare the alignment speed of the crowded upper and lower teeth between the two different AW sequences. The secondary outcome was to assess the magnitude of upper and lower incisors' root resorption (RR) measured by digital periapical radiographs taken at the start of treatment and 1 month after the placement of the working AW. t-test was used to compare the alignment speed and RR between the two groups. Statistical significance was predetermined at the P ≤ 0.05 level for all tests. RESULTS: The 54 patients were randomized in a 1:1 ratio to either group. Seven patients were excluded and complete data were obtained for 47 patients; 24 and 23 patients in group A and group B, respectively. There was no significant difference between the two groups in the alignment speed in the lower arch (P>0.05, mean difference=-0.44, 95% CI=-0.9 to 0.03) and root resorption (P>0.05). Alignment of upper arch was faster in group A (P < 0.0001, mean difference= - 0.9, 95% CI =-1.4 to -0.5). CONCLUSIONS: There is no significant difference between the two groups in the alignment speed in the lower arch and incisors' RR. Upper arch alignment was faster in group A. TRIAL REGISTRATION: Not registered.

A comparative study between the effect of reverse curve of Spee archwires and anterior bite turbos in the treatment of deep overbite cases.

OBJECTIVES: To compare deep overbite treatment using 0.016 × 0.022 nickel-titanium lower reverse curve of Spee archwire (LRCA) or metal anterior bite turbos (ABTs). MATERIALS AND METHODS: 48 patients with deep overbite malocclusion were randomly allocated into two groups. Group I (age = 18.4 ± 2.8 years, overbite = 5.8 ± 0.6 mm) was treated with LRCA, while Group II (age = 18.2 ± 3.1 years, overbite = 5.2 ± 0.4 mm) was treated with ABTs bonded to the palatal surface of the upper central incisors. Two cephalograms were taken for each patient, at post-alignment stage (T1) and post-leveling stage (T2). The primary outcomes were the anteroposterior and vertical changes of the lower teeth. The secondary outcomes were the effect on upper incisor inclination and the vertical linear changes of upper teeth, to assess the sagittal and vertical skeletal changes, and to compare the duration of overbite correction. RESULTS: 42 of the 48 patients recruited completed the study (21 in each group). At T2, the lower incisors proclined more in Group I (P ≤ .001). Both lower second molars (P ≤ .001) and lower first molars (P = .001) tipped more distally, while the lower first premolar tipped more mesially, in Group I (P < .05). All cusps of both lower molars showed more extrusion in Group II (P < .05) except for the mesial cusp of lower second molars (P = .095). The duration of overbite correction was shorter using the ABTs by 1.7 months (4.85 ± 1.56 and 3.15 ± 0.93 months for Group I and Group II, respectively). CONCLUSIONS: LRCA causes lower incisor proclination with distal tipping of lower molars, while ABTs result in lower posterior tooth extrusion.

Pain experience during initial alignment with three types of nickel-titanium archwires: a prospective clinical trial.

OBJECTIVE: To clinically evaluate the pain intensity during the week following initial placement of three different orthodontic aligning archwires. MATERIALS AND METHODS: A consecutive sample of 75 patients requiring upper and lower fixed orthodontic appliances were alternately allocated into three different archwires (0.014-inch superelastic NiTi, 0.014-inch thermoelastic NiTi or 0.014-inch conventional NiTi). Assessments of pain/discomfort were made on a daily basis over the first 7-day period after bonding by means of visual analog scale and consumption of analgesics. The maximum pain score was recorded. The possible associations between age, gender, degree of crowding, and teeth irregularity and the pain intensity were also examined. Demographic and clinical differences between the three groups were compared with chi-square test or analysis of variance (ANOVA) test. RESULTS: No statistically significant differences were found in the pain intensity when the three aligning NiTi archwires were compared (P  =  .63). No significant differences in pain perception were found in terms of gender, age, lower arch crowding, and incisor irregularity. The intake of analgesics was the least in the superelastic NiTi group. CONCLUSION: The three forms of NiTi wires were similar in terms of pain intensity during the initial aligning stage of orthodontic fixed appliance therapy. Gender, age, and the degree of crowding have no effect on the perceived discomfort experienced by patients undergoing fixed orthodontic treatment.

A clinical comparison of three aligning archwires in terms of alignment efficiency: A prospective clinical trial.

OBJECTIVES: To clinically evaluate the effectiveness of three orthodontic aligning archwires in relation to tooth alignment speed during the initial alignment stage of treatment. MATERIALS AND METHODS: A consecutive sample of 74 patients requiring lower only or upper and lower fixed orthodontic appliances were randomly allocated into three different archwires (0.014-inch superelastic nickel-titanium [NiTi], 0.014-inch thermoelastic NiTi, or 0.014-inch conventional NiTi). Good quality impressions were taken of the lower arch before archwire placement (T0) and at designated serial stages of alignment (every 2 weeks: T2, T4, T6, …, T16). The change in tooth alignment was measured in millimeters from the resultant casts using Little's irregularity index. Demographic and clinical differences among the three groups were compared with the chi-square or analysis of variance (ANOVA) test. The difference in the change of lower anterior tooth alignment over time among the three groups was explored with a Split Plot ANOVA (SPANOVA, or within- and between-groups ANOVA). The Kruskal-Wallis nonparametric test was used when data were not normally distributed. RESULTS: The SPANOVA and Wilks Lambda Multivariate test confirmed that the wire type had no influence on the rate of change in alignment (P  =  .98). CONCLUSION: The three forms of NiTi wires were similar in terms of their alignment efficiency during the initial aligning stage of orthodontic fixed appliance therapy.

Maxillary palatal canine impaction displacement in subjects with congenitally missing maxillary lateral incisors.

INTRODUCTION: The aims of this research were to study the prevalence of palatally displaced maxillary canines (PDCs) in subjects with congenitally missing maxillary lateral incisor (MxI2) teeth and to assess the dental and occlusal features associated with this displacement in these subjects. METHODS: The material for this study consisted of the pretreatment orthodontic casts of 246 subjects (78 male, 168 female) with missing MxI2 teeth. These were divided into 2 groups: subjects with PDC (displacement group) and subjects with no PDC (nondisplacement group). A nondisplacement comparison group was selected by matching the displacement group according to age, sex, type of malocclusion, and unilateral or bilateral absence of the MxI2 teeth. RESULTS: Of 246 subjects, 31 (12.6%) were found to have PDC. Sex distribution and type of congenital absence of MxI2 teeth were not different in the displacement and the nondisplacement groups. There was no significant difference between the dental and occlusal features in the displacement and the comparison groups. CONCLUSIONS: There was a strong association between PDC and missing MxI2; this supports the guidance theory. In subjects with MxI2 agenesis, no other dental or occlusal features were found to play a role in PDC.

Functional occlusal patterns and their relationship to static occlusion.

OBJECTIVES: To test the hypothesis that there is no relationship between static occlusion and dynamic occlusion. MATERIALS AND METHODS: The relationship between static and dynamic occlusion was investigated in a sample of 94 dental students (39 males and 55 females) with an age range of 21-30 years. Static occlusion was determined by intraoral examination. Dynamic occlusion was determined in regulated lateral (0.5 mm and 3 mm lateral to the intercuspal position) and protrusive movements of the mandible by intraoral examination with the aid of shimstock. RESULTS: At the 0.5 mm lateral excursion, 24.5% had bilateral group function and 12.7% had bilateral canine guidance. At the 3 mm positions, the guidance pattern changed to a predominantly canine guidance. Fifty percent of subjects had bilateral canine guidance, and only 8.8% had bilateral group function. In terms of the anterior guidance pattern, a predominant anterior contact with posterior disocclusion (77.5%) was noted. Examination of the relationship between static and dynamic occlusions revealed that at the 0.5 mm position, the pattern of dynamic occlusion was different in relation to various static occlusion features but without reaching a significant level. While at the 3 mm position, the pattern of dynamic occlusion was significantly affected by incisor relationship. The distribution of protrusive excursion patterns was significantly influenced by incisor, canine, and molar relationships. CONCLUSIONS: The hypothesis is rejected. An association exists between dynamic occlusion and different aspects of static occlusion.

Maxillary incisor proclination effect on the position of point A in Class II division 2 malocclusion.

OBJECTIVE: To test the hypothesis that the magnitude of alteration in the position of point A is not associated with proclination of the upper incisors in Class II division 2 malocclusion. MATERIALS AND METHODS: Cephalometric films were taken for 30 Class II division 2 patients (8 males and 22 females; average age, 18.3 years) before and after upper incisor proclination. The total change in the position of point A was measured by superimposing the pretreatment and postproclination lateral cephalograms on the sella-nasion line at the sella. To determine the local effect of alveolar bone remodeling associated with upper incisor proclination on the position of point A, postproclination tracing of the maxilla was superimposed on the pretreatment tracing according to the Bolton template of maxillary superimposition. RESULTS: The total vertical displacement in Point A position was downward by 0.84 mm (P = .002), and the total horizontal displacement was forward by 0.45 mm (P = .054). Assessment of local changes in point A revealed that the position of point A had moved backward by 0.60 mm (P = .001). No significant change was observed in the value of the sella-nasion-point A angle (SNA). CONCLUSION: The hypothesis is rejected. The position of point A is affected by local bone remodeling associated with proclination of the upper incisor in Class II division 2 malocclusion, but this minor change does not significantly affect the SNA angle.

Postoperative pain after surgical exposure of palatally impacted canines: closed-eruption versus open-eruption, a prospective randomized study.

OBJECTIVES: The aim of this prospective randomized clinical study was to compare the duration of surgery and the patient's perception of pain after closed and open surgical exposure of unilateral palatally impacted maxillary canines. STUDY DESIGN: Palatally impacted canines were exposed in 32 subjects. Half of these subjects had closed-eruption exposure, and the other half had open-eruption exposure. The duration of surgery was measured, and the degree of pain was assessed in the first postoperative week. RESULTS: The mean surgical duration for the open-eruption technique was 30.9 +/- 10.1 min compared with 37.7 +/- 8.4 min for the closed-eruption technique. This difference was statistically significant (P = .006). Postoperative pain in the 2 groups was not significantly different. However, pain regression was faster in the closed-eruption group. CONCLUSIONS: The surgical duration was significantly shorter in the open-eruption exposure. Postoperative pain was comparable after open- and closed-eruption surgical exposures.

Outcome of secondary alveolar bone grafting before and after eruption of the canine in Jordanian patients with cleft lip and palate.

This prospective study was carried out at the Cleft Lip and Palate Centre at King Abdullah University Hospital and Maxillofacial Unit at Jordan University of Science and Technology during the period of 2000 to 2006. The sample consisted of 77 secondary alveolar bone grafts (62 patients), which were performed according to the same standardized surgical technique by a single maxillofacial surgeon. The objective was to assess the outcome of secondary alveolar bone grafting (SABG) before (early SABG) and after (late SABG) the eruption of the permanent maxillary canine in unilateral and bilateral Jordanian cleft subjects. Patients were divided into four groups: early unilateral SABG (22), late unilateral SABG (25), early bilateral SABG (8), and late bilateral SABG (7). Follow-up period ranged from 6 months to 5 years. Periapical or occlusal radiographs were used to assess the outcome of SABG. The degree of bony fill in the cleft area was assessed using the 4-point Kindelan scale. Only Grade 1 (more than 75% bony fill) cases were considered successful. Early unilateral SABG had a success rate of 90% while late unilateral SABG rate was 80%. The overall success rate of the unilateral SABG (85%) was higher than the rate for the bilateral cases (56%). Our findings support the conclusion that the outcome of early SABG is superior to late SABG. The overall success rate of SABG sample (74%) compared relatively well with other published results.

Vertical changes in class II division 1 malocclusion after premolar extractions.

The purpose of this study was to compare changes in the facial vertical dimension in patients with Class II division 1 malocclusion after the extraction of either mandibular first premolars or mandibular second premolars. The records of two groups of patients were used: one group was treated with extraction of mandibular first premolars (age: 13.2 +/- 1.5 years) and the other group with extraction of mandibular second premolars (age: 13.4 +/- 1.4 years). Each group consisted of 26 subjects (16 boys and 10 girls). Maxillary first premolars were extracted in both groups. The two groups were matched by sex, age (within six months), and facial divergence measured by maxillary-mandibular plane angle (MM angle) and ratio of posterior facial height to the total anterior facial height. Student's t-test was used to compare the two groups. Significance was predetermined at P < .05. Second premolar extraction was associated with more forward movement of the mandibular molars, but there was no significant difference in vertical facial growth between the two groups. In both groups, there was no significant change in the mandibular plane angle and the MM angle. The results of this study do not support the hypothesis that mandibular premolar extraction is associated with mandibular overclosure or reduction in the vertical dimension, or both, in subjects with Class II division 1 malocclusion.

Prevalence of malocclusion in 13-15 year-old North Jordanian school children.

OBJECTIVES: This study was carried out to determine the prevalence of malocclusion in 13-15-year-old North Jordanian schoolchildren. METHODS: One thousand and three children aged 13-15 years (619 females, 384 males) were examined using Björk et al. (1964) registration method. A full clinical examination was carried out in the school premises using a mouth mirror under natural lighting. Alginate impressions were then taken for each student together with a wax bite. The impressions were poured the same day by an orthodontic technician. Peri-apical radiographs were taken for the students when hypodontia was suspected. RESULTS: Overall, the prevalence of malocclusion was 92%. Class II and III molars were found in 18.8% and 1.4% of the sample respectively. The malocclusion traits detected were crowding (50.4%), midline shift (31.7%), spaced dentition (26.7%), increased overjet (24.7%), deepbite (16.9%), crossbite (6.8), abnormal tooth form (7.7%), median diastema (6.9%), missing teeth (6%), ectopic canines (5.9%), inverted incisors (5.2%), high frenal attachment (3.9%), openbite (2.9%), tooth impaction (1.8%), reversed overjet (1.9%), scissorbite 0.3%. There was no statistically significant difference between males and females in the overall prevalence of malocclusion and the occlusal traits investigated. However, some dental anomalies showed significant differences. CONCLUSIONS: Prevalence of malocclusion among north Jordanians is comparable with other populations.

Self-perception of malocclusion among north Jordanian school children.

This study was undertaken to assess the factors affecting self-perception and the demand for orthodontic treatment among north Jordanian school children. In total, 1404 students randomly selected to represent five geographical areas of northern Jordan were examined. The students were further subgrouped according to gender (858 females, 546 males), age (985 13 year olds, 419 17 year olds) and rural/urban place of residence (212 rural, 1192 urban). The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) was used as an assessment measure of the need for orthodontic treatment. The self-perception of malocclusion was evaluated by asking each student to identify which photograph on the AC scale most closely matched the appearance of their anterior teeth. The demand for orthodontic treatment was measured by asking the students: "Do you feel it is necessary to have your teeth straightened by an orthodontist?" Differences between the self-perception of malocclusion among the different groups were tested using the chi-squared test.The results showed that the majority of students rated their dentition from grades 1 to 4, with a tendency for the females and older school children to score their teeth as more attractive than males and younger children (P < 0.05, P < 0.001, respectively). Rural and urban school children did not differ in the perception of their own dentition. The self-perception scores of subjects within the no aesthetic need, borderline need and definite need groups differed significantly (P < 0.001). The subjects who reported a definite need perceived their teeth to be worse than the other two groups. The demand for orthodontic treatment was found to be affected by gender (P < 0.01) and rural/urban areas of living (P < 0.05).

Orthodontic treatment need and demand in 12-14-year-old north Jordanian school children.

This study was undertaken to assess the need and demand for orthodontic treatment among 12-14-year-old north Jordanian school children. In total, 1002 students randomly selected to represent five geographical areas of Irbid were examined. The examinations were carried out twice, first on the pupils in the school premises and then using study models taken from each student. The dental health (DHC) and aesthetic (AC) components of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment. The demand for orthodontic treatment was measured by asking the students 'if it was necessary, would they like to have their teeth straightened by an orthodontist'. The results showed that approximately one-third (34 per cent) of the children examined had a definite need for orthodontic treatment. Within this group, 73.5 per cent were in need of orthodontic treatment according to the DHC, 23.5 per cent had both DHC and AC great need scores, and 3 per cent were in need according to the AC only. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by impeded eruption of teeth, hypoplasia of a single tooth and increased overjet of more than 6 mm but less than or equal to 9 mm. The demand for orthodontic treatment among the students was 49 per cent. Approximately half of them (54 per cent) had a definite need for orthodontic treatment. This study provides baseline data on the need and demand for orthodontic treatment among a Jordanian population, which is important for planning public orthodontic and dental services.

Changes in mandibular incisor position in Class II Division 1 malocclusion treated with premolar extractions.

The aim of this study was to investigate the magnitude of mandibular incisor retraction to be expected during full fixed appliance mechanotherapy in Class II Division 1 malocclusions treated with premolar extractions when mandibular incisor retraction was not part of the treatment plan. The material consisted of pretreatment and posttreatment cephalometric films and dental casts of 70 Class II Division 1 malocclusion patients (33 males and 37 females) treated with the preadjusted edgewise appliances. The mandibular first premolars were extracted in 31 subjects, and the mandibular second premolars were extracted in 39. The pretreatment factors that suggested a basis for the extraction choice in the mandibular arch in these patients were found to include the ratio between posterior and anterior facial heights, the maxillary-mandibular plane angle, and the residual space in the mandibular arch. The mandibular incisors were retracted in only 65% of the patients. On average, the mandibular incisors were retracted by 1.02 mm relative to the nasion-pogonion line; there was no significant difference between the 2 extraction groups. Multiple regression analysis showed that the change in the mandibular incisor position is significantly correlated with the residual space in the mandibular arch, the initial distance between the mandibular incisor and the nasion-pogonion line, maxillary-mandibular angle, and the duration of crown labial torque in the mandibular incisors. In combination, these 4 factors could explain 61% of the change in the mandibular incisor position.