White spot enamel lesions - is treatment or prevention the answer to this 'no win scenario'?

DESIGN: Prospective, randomized, double-blind, multicenter clinical trial. CASE SELECTION: Participants between 12 and 25 years old, who were generally healthy, with 2 or more white spot lesions on the labial surface of anterior dentition. DATA ANALYSIS: 79 patients who developed white spot lesions (WSL) on the labial surface of anterior teeth following orthodontic treatment were randomly assigned to 4 intervention groups. Group 1 received 5% sodium fluoride varnish every 6 months, the second group received CPP-ACP every 6 months, the third group was treated with resin infiltration at the initial visit followed by placebo every 6 months, and the final group which was the control group was coated with 1400 ppm fluoride toothpaste every 6 months. All the candidates were instructed to brush twice daily using a specific toothbrush and 1400 ppm fluoride toothpaste. The study lasted for 12 months, and photographs of the teeth with WSL were taken before and after completion of the intervention. Photographs were analyzed using ImageJ software to compare the changes in the percentage of WSL area to total tooth surface area among the four study groups. The distribution differences among groups were compared using nonparametric tests and differences between baseline and 1-year follow-up parameters were analyzed using paired chi-square tests. RESULTS: Reduction in the area of WSL were noted in all groups, with different levels of significance. The percentage reduction was 46.62% in the resin infiltration group and it was significantly higher than the remaining interventions. Fluoride varnish group had 26.57% reduction, the CPP-ACP group had 28.64% reduction and the control group had 29.75% reduction in the WSL area. Plaque index was noted to have significant correlation with the change in WSL area with higher plaque index scores demonstrating lesser reduction in WSL. CONCLUSIONS: The study found that resin infiltration significantly reduced the WSL area after 1-year follow-up. Fluoride toothpaste with or without CPP-ACP and fluoride varnish produced some therapeutic effects.

Reinventing serial extraction with a fresh perspective: does it inspire a change in current practice?

OBJECTIVE: To analyze the skeletal and dental effects of serial extraction with and without expansion on severe crowding. DATA SOURCE AND STUDY DESIGN: A retrospective controlled study using lateral cephalograms of 78 children of age 8.5 + /- 1.4 years. STUDY DESIGN: The study sample involved 52 orthodontic patients treated for severe crowding and 26 age matched controls who did not undergo orthodontic treatment. The treated cases were sorted into serial extraction (EX) only group and serial extraction and expansion (EX-EXP) group. Vertical and anteroposterior skeletal and dental cephalometric measurements of these subjects were analyzed at baseline time point and following eruption of posterior permanent dentition. RESULTS: The study found significant changes in vertical skeletal dimensions with a decrease in mandibular and occlusal plane angles in the experimental groups at the follow up. The facial height index was noted to be increased. The upper gonial angle decreased significantly in the groups that had extractions. There was no significant change in the inter-incisal angle among the groups, yet at follow-up the inter-incisal angle of the control group was significantly smaller than the intervention groups. CONCLUSIONS: The article concludes that serial extraction alone or in combination with expansion treatment performed prior to pubertal growth phase have comparable skeletal cephalometric findings primarily affecting the vertical dimension.

Is remote monitoring a reliable method to assess compliance in clear aligner orthodontic treatment?

Data source and study design Retrospective cohort study using the data obtained from PlusDental - a Berlin-based health-tech companyCohort selection and data analysis Patients who completed clear aligner therapy (CAT) in 2019 were selected for this study. A digital-based app was utilised for analysing compliance among patients who underwent non-extraction orthodontic treatment with clear aligners. The sample included 2,644 adult orthodontic patients, three-fourths of them being women and one-fourth men. The primary outcome involved patient compliance, which was evaluated using a questionnaire in the app, completed by the patient. The questionnaire required patients to enter details about the aligner change date, daily wear time and pressure exerted by each aligner. The effect of variables including age, sex, previous orthodontic treatment and satisfaction with one's smile on compliance, were also analysed. Statistical analysis was performed using two-sided chi-square tests.Results Only 36% of the patient sample were fully compliant and poor compliance was exhibited by 25%. Authors observed that women were less compliant than men and patients with no prior orthodontic treatment were better compliant towards CAT. Also, patients treated with removable appliances exhibited better compliance among those who had a history of previous orthodontic treatment.Conclusions The authors concluded that non-compliant patients can be identified early, using their results as a guideline. This will help in timely intervention of addressing compliance issues during clear aligner orthodontic treatment.