Bimaxillary transverse constriction in adults: Short-term follow-up of non-surgical arch expansion.

OBJECTIVE: Concurrent maxillary and mandibular expansion is a treatment option for patients with maxillary and mandibular transverse constriction. These patients do not present with crossbite but require expansion due to narrow arches and associated crowding, dark buccal corridors and decreased anterior arch contour. The objective of the study is to first establish Bimaxillary Transverse Constriction as an under-recognized malocclusion and second to evaluate whether in adults the maxillary and mandibular arches can be successfully and safely expanded. SETTING AND SAMPLE POPULATION: Pre- and post-treatment study models and lateral cephalograms of 31 adults with Bimaxillary Transverse Constriction expanded non-surgically were analysed. Thirty adult orthodontic patients who did not require expansion served as a control. Expanders were turned no more frequently than every other day in the maxilla and every third day in the mandible. MATERIALS AND METHODS: Measurements in both arches made on OrthoCAD models were transarch widths, molar and premolar axial angulation, clinical crown height of posterior teeth and cuspids, and mandibular divergence. Retrospective comparison of the 2 groups used independent Student's t tests for mean differences between groups. RESULTS: At pre-treatment, the expansion group demonstrated significant transverse constriction compared with the control. Increased widths were achieved in the expansion group (4 mm in the maxilla and 2.5 mm in the mandible), while the control group was unchanged. The mandibular plane was unchanged. There was no buccal attachment loss. CONCLUSION: Non-surgical expansion in the maxilla and mandible is a viable treatment option for adult patients with Bimaxillary Transverse Constriction.

ROC surface assessment of the ANB angle and Wits appraisal's diagnostic performance with a statistically derived 'gold standard': does normalizing measurements have any merit?

OBJECTIVE: To assess the ANB angle's and Wits appraisal's diagnostic performance using an extended version of Receiver Operating Curve (ROC) analysis, which renders ROC surfaces. These were calculated for both the conventional and normalized cephalometric tests (calculated by exchanging the patient's reference landmarks with those of the Procrustes superimposed sample mean shape).The required 'gold standard' was derived statistically, by applying generalized Procrustes superimposition (GPS) and principal component analysis (PCA) to the digitized landmarks, and ordering patients based upon their PC2 scores. METHODS: Digitized landmarks of 200 lateral cephalograms (107 males, mean age: 12.8 years, SD: 2.2, 93 females, mean age: 13.2 years, SD: 1.7) were subjected to GPS and PCA. Upon calculating the conventional and normalized ANB and Wits values, ROC surfaces were constructed by varying not just the cephalometric test's cut-off value within each ROC curve, but also the gold standard cut-off value over different ROC curves in 220 steps between -2 and 2 standard deviations along PC2. The volume under the resulting ROC surfaces (VUS) served as a measure of overall diagnostic performance. The statistical significance of the volume differences was determined using permutation tests (1000 rounds, with replacement). RESULTS: The diagnostic performance of the conventional ANB and Wits was remarkably similar for both Class I/II (81.1 and 80.75% VUS, respectively, P > 0.05). Normalizing the measurements improved all VUS highly significantly (91 and 87.2 per cent, respectively, P < 0.001). CONCLUSION: The conventional ANB and Wits do not differ in their diagnostic performance. Normalizing the measurements does seem to have some merit.

Stability of open bite correction with sagittal split osteotomy and closing rotation of the mandible.

PURPOSE: To determine the long-term stability of bilateral sagittal split osteotomies with counterclockwise (closing) rotation of the mandible combined with rigid internal fixation in the correction of anterior open bite deformities. MATERIALS AND METHODS: A total of 28 patients who had completed orthodontic therapy and had at least 1 year of postoperative follow-up were evaluated using cephalometric analysis for dental and skeletal changes. We evaluated 7 angular and 6 linear measurements cephalometrically at 3 points for each patient: immediately preoperatively, immediately postoperatively, and after a minimum of 1 year of postoperative follow-up. RESULTS: Of the 28 patients, 12 exhibited some degree of opening rotation (range 1% to 64%, mean 16%), and 16 showed no open rotation or continued to experience bite closure. However, all patients had a positive overbite at 1 year of follow-up, indicating that even though skeletal relapse was observed postoperatively, dental compensation resulted in the maintenance of the occlusal relationships. CONCLUSIONS: Bilateral sagittal split osteotomies and closing rotation of the mandible using rigid fixation is a relatively stable procedure and a viable surgical treatment option for the correction of anterior open bite in instances in which maxillary osteotomies are not indicated to improve or enhance facial esthetics.

Rapid palatal expansion for spontaneous Class II correction.

INTRODUCTION: Palatal expanders have been advocated for spontaneous correction of some Class II malocclusions. However, little research has been done to determine whether correction or improvement actually occurs with expansion. Past research has not shown whether an anterior functional shift is achieved in patients who have Class II improvement. The objective of this study was to determine whether maxillary expansion causes spontaneous correction or improvement of a Class II malocclusion. METHODS: This was a retrospective study of subjects from an orthodontic office in which models are mounted (articulator) in centric occlusion and maximum intercuspation before and after treatment. The sample included Class II patients (n = 13; mean age, 10 years 3 months) who, during the preceding 2 years, had been treated with expansion alone. Study models made before and after expansion were measured to compare the centric occlusion to the maximum intersuspation position. Condyle position indicator paper was also used to determine whether there was a functional shift after expansion. RESULTS: The only measurements with statistically significant changes from pretreatment to postexpansion were the maxillary intermolar widths. Seven of the 13 patients showed Class II improvement, but none had an anterior functional shift after expansion. CONCLUSIONS: Maxillary expansion does not predictably improve Class II dental relationships.

Outcome of one-visit and two-visit endodontic treatment of necrotic teeth with apical periodontitis: a randomized controlled trial with one-year evaluation.

The choice of one-visit versus two-visit root canal therapy for necrotic teeth with apical periodontitis is a source of current debate. The primary objective of this randomized controlled clinical trial was to compare radiographic evidence of periapical healing after root canal therapy completed in one visit or two visits with an interim calcium hydroxide/chlorhexidine paste dressing. Ninety-seven patients met the inclusion criteria and consented to participate in this study. Patients were randomly assigned to either the one-visit or two-visit group, and root canal therapy was performed with a standardized protocol. Patients in the two-visit group received an intracanal dressing of calcium hydroxide/chlorhexidine paste. Sixty-three patients, 33 in the one-visit group and 30 in the two-visit group, were evaluated at 12 months. The primary outcome measure was change in apical bone density by using the periapical index (PAI). Secondary outcome measures were proportion of teeth healed or improved in each group. Both groups exhibited equally favorable periapical healing at 12 months, with no statistically significant differences between groups.

Bond strength analysis of custom base variables in indirect bonding techniques.

INTRODUCTION: Various methods are used to prepare the cured composite-adhesive interface for orthodontic indirect bonding. The intent of this study was to determine the effect on the shear bond strength of the following variables: use of a filled flowable composite resin as an adhesive, light air-abrasion of the cured composite bracket pad, and wetting the cured composite bracket pad with an unfilled resin. METHODS: The sample of 240 brackets was divided into 2 groups of 120 each. The first group was further divided into 4 groups of 30 each. Brackets were bonded to bovine incisors with a filled flowable composite resin (Filtek, 3M ESPE, St Paul Minn), but the bracket pads were prepared differently in the 4 groups: unfilled resin was applied (Orthosolo, Ormco, Glendora, Calif), the surface was air abraded, the surface was air abraded followed by application of an unfilled resin (Orthosolo), and a control group. A matching sample of 120 brackets was bonded without the flowable composite as an adhesive. The different bracket pad preparations were chosen to represent the various techniques clinicians use in indirect bonding. The shear bond strength was measured on a universal testing machine. RESULTS: Two-way ANOVA analysis showed significant differences in the shear bond strength among the different surface preparations, but not between the use and nonuse of flowable composite. The Scheffé test showed that the mean shear bond strength of the air-abraded surface was significantly higher than all other surface preparations. CONCLUSIONS: Air abrading orthodontic bracket-pad composite surfaces in indirect bonding increased the shear bond strength, whereas the use of flowable composite did not affect bond strengths.

Antimicrobial effect of triclosan and triclosan with Gantrez on five common endodontic pathogens.

Microbial control of the root canal system is one of the key objectives of root canal therapy. Triclosan is a widely accepted broad spectrum antimicrobial agent proven to be effective against many gram-positive and gram-negative bacteria. Triclosan acts by blocking bacterial fatty acid biosynthesis. The addition of Gantrez copolymer has been shown to enhance the antimicrobial activity of triclosan. The purpose of this study was to determine the minimum inhibitory and bactericidal concentrations of triclosan and triclosan with Gantrez against Prevotella intermedia, Fusobacterium nucleatum, Actinomyces naeslundii, Porphyromonas gingivalis, and Enterococcus faecalis. The minimum inhibitory concentration (MIC) of both test solutions was determined for each of the 5 microorganisms by using microtiter serial dilutions. Samples were streaked on 5% sheep blood agar plates and placed in an anaerobic incubator to determine the minimum bactericidal concentration (MBC). The MBC of triclosan ranged from 12-94 microg/mL. The MBC of triclosan with Gantrez ranged from <0.3-10.4 microg/mL. The addition of Gantrez enhanced the bactericidal activity of triclosan. Both triclosan and triclosan with Gantrez demonstrated bactericidal activity against the 5 specific endodontic pathogens.

Relationship between index of complexity, outcome and need, dental aesthetic index, peer assessment rating index, and American Board of Orthodontics objective grading system.

INTRODUCTION: The objectives of this study were to examine the relationships among 4 indexes that are used to score orthodontic treatment need and outcome, and to determine whether 1 index could replace the other 3. The index of complexity, outcome, and need (ICON), the dental aesthetic index (DAI), the peer assessment rating (PAR) index, and the American Board of Orthodontics objective grading system (ABO-OGS) were studied. The use of the ICON is desirable because it is faster to use than separate indexes for assessing different treatment facets. METHODS: One hundred pretreatment and posttreatment study models were randomly selected from an accredited graduate orthodontic clinic at University of Illinois at Chicago, Chicago, Ill. The sample was assessed by using the PAR index, the DAI, the ABO-OGS, and the ICON. The data were analyzed descriptively and the relationships evaluated by using the Spearman rank order correlation coefficient. RESULTS: The study showed a significant correlation between the DAI and the ICON with respect to treatment need (r = .5523, P <.001). The PAR index and the ABO-OGS had significant correlations with the ICON for treatment outcome (pretreatment PAR vs ICON, r = .6840, P <.001; posttreatment PAR vs ICON, r = .3466, P <.001; ABO-OGS vs ICON, r = .2654, P <.01). CONCLUSIONS: The ICON can be used in place of the PAR and the ABO-OGS for assessing treatment outcome and in place of the DAI for assessing treatment need.

Use of an Electronic Patient Record system to evaluate restorative treatment following root canal therapy.

Electronic Patient Record (EPR) systems are rapidly gaining acceptance as an important tool for managing patient information. The purpose of this project was to evaluate the use of an EPR system for assessment of quality of care in an academic dental institution. The primary outcome of interest was the timeliness and completeness of restorative care following completion of nonsurgical root canal therapy. An initial query of the EPR database was performed using the following inclusion criteria: root canal treatment performed in the postgraduate endodontics clinic between September 2002 and June 2004, patient age > or =18 years old, and posterior tooth (premolars and molars). A total of 925 patients with 1,014 endodontically treated teeth met the inclusion criteria. A random sample of 30 percent of the treated teeth (302 teeth on 281 patients) was selected for detailed review. This sample of 302 teeth was then screened to determine if any restorative treatment had been performed between September 2002 and November 2005. Forty-eight percent (n=146) of the 302 teeth did not receive any form of permanent restoration over the time period studied. Twenty-five percent (n=75) of the teeth received a buildup only, and 27 percent (n=82) received the recommended treatment, a full occlusal coverage restoration. This study documents the use of an EPR system to objectively and efficiently assess one aspect of quality of care in a dental school environment.

Orthodontic treatment--improvement and standards using the peer assessment rating index.

This article is aimed at assessing the orthodontic treatment outcome in an accredited graduate orthodontic clinic in the United States, using the original Peer Assessment Rating (PAR) Index. A sample of 100 pre- and posttreatment study models was randomly selected from the clinic model storage. One investigator assessed all the components of the PAR Index. Descriptive statistics and Scheffe test were used to analyze the data. The mean weighted PAR point reduction was 22.11, and mean percentage reduction was 86.20. "Greatly improved" conditions were seen in 50% of patients while 47% accounted for the "improved category." Only 3% belonged to the "worse or no different" group. Statistically significant differences were observed between the three improvement groups for weighted pre- and posttreatment PAR scores, reduction, and percentage reduction. The results indicated an excellent improvement of the patients, with patients being treated to a high standard and a great proportion of patients with a clear need for treatment.

Orthodontic treatment need in an accredited graduate orthodontic center in north america: a pilot study.

AIM: To assess the objective orthodontic treatment needs of patients treated in an accredited Orthodontic Clinic in North America using a retrospective cross sectional study and the Dental Aesthetic Index (DAI). METHODS AND MATERIALS: One hundred pre- and post-treatment study models were randomly selected from the model storage facility of the clinic. Only the pre-treatment study models were assessed using the DAI. The pre-treatment and post-treatment ages for each case were noted as recorded on the corresponding study models. The range for the pre-treatment age was 10 to 52 years, and from 12 years, 4 months to 54 years for the post-treatment age range. The duration of treatment for each case was calculated by subtracting the pre-treatment age from the post-treatment age (range of treatment duration, 9 to 125 months). Descriptive statistics as well as chi-square statistics were employed to analyze the data. RESULTS: Fifteen cases had normal or minor malocclusions with no treatment or slight need for treatment. Definite malocclusions with treatment highly desirable accounted for 22 cases and severe malocclusion with treatment highly desirable was found in 16 cases. Forty-seven cases had handicapping malocclusion with treatment considered mandatory. While a statistically significant association (p<0.05) was found between duration of treatment and severity levels of malocclusion (DAI scores), the association between pre-treatment age and DAI scores was not significant (p > 0.05). CONCLUSIONS: Eighty-five percent of the study sample needed orthodontic treatment with different malocclusion severity levels, while 47% of the cases qualified for publicly subsidized treatment due to handicapping malocclusions. The association between duration of treatment and DAI score groups (malocclusion severity levels) was found statistically significant. It could be helpful for more clinic-based (demand populations) studies on treatment needs be undertaken across the globe using the DAI, at least for the purposes of comparison.

Prognostic factors associated with the success rates of posterior orthodontic miniscrew implants: A subgroup meta-analysis.

OBJECTIVE: To systematically review previous studies and to assess, via a subgroup meta-analysis, the combined odds ratio (OR) of prognostic factors affecting the success of miniscrew implants (MIs) inserted into the buccal posterior region. METHODS: Three electronic searches that were limited to articles on clinical human studies using MIs that were published in English prior to March 2015 were conducted. The outcome measure was the success of MIs. Patient factors included age, sex, and jaw of insertion (maxilla vs. mandible), while the MI factors included length and diameter. A meta-analysis was performed on 17 individual studies. The quality of each study was assessed for non-randomized studies and quantified using the Newcastle-Ottawa Scale. The meta-analysis outcome was a combined OR. Subgroup and sensitivity analyses based on the study design, study quality, and sample size of miniscrews implanted were performed. RESULTS: Significantly higher success rates were revealed for MIs inserted in the maxilla, for patients ≥ 20 years of age, and for long MIs (≥ 8 mm) and MIs with a large diameter (> 1.4 mm). All subgroups acquired homogeneity, and the combined OR of the prospective studies (OR, 3.67; 95% confidence interval [CI], 2.10-6.44) was significantly higher in the maxilla than that in the retrospective studies (OR, 2.10; 95% CI, 1.60-2.74). CONCLUSIONS: When a treatment plan is made, these risk factors, i.e. jaw of insertion, age, MI length, and MI diameter, should be taken into account, while sex is not critical to the success of MIs.

The effect of human immunodeficiency virus on endodontic treatment outcome.

The purpose of this retrospective study was to compare periradicular healing between HIV positive and negative patients 1 yr after endodontic treatment of necrotic teeth with chronic apical periodontitis. The preoperative radiographs of 33 patients diagnosed with HIV and 33 medically healthy patients were scored by three endodontists using the Periapical Index (PAI) Scoring Method. Follow-up radiographs were taken 12 months after endodontic treatment and also scored with the PAI. The degree of healing, as determined by the mean PAI change, was compared between the two groups. There were no statistically significant differences between the two with respect to the degree of periradicular healing. In addition, the three evaluators were found to have very high inter-examiner agreement. The results indicate that clinicians do not have to alter their expectations for healing and resolution of periradicular lesions based solely on the HIV status of their patients.

Bimaxillary dentoalveolar protrusion: traits and orthodontic correction.

A group of 48 ethnically diverse patients with bimaxillary protrusion was used to study the pretreatment cephalometric traits of this malocclusion and the effect of orthodontic correction. All patients were treated with four premolar extractions and retraction of the anterior teeth. Pre- and posttreatment lateral cephalograms were evaluated using a series of 18 linear and angular measurements, and the effect of orthodontic correction was determined using paired t-tests. Cephalometric standards were developed for bimaxillary protrusions, which clarify the overall presentation of this malocclusion for clinicians. Patients with bimaxillary protrusion demonstrated increased incisor proclination and protrusion, a vertical facial pattern, increased procumbency of the lips, a decreased nasolabial angle, and thin and elongated upper and lower anterior alveoli. This study also showed that the extraction of four premolars can be extremely successful in reducing the dental and soft tissue procumbency seen in patients with bimaxillary protrusion, thus providing a stronger evidence-based rationale for this treatment modality.

The Relationship between Caries and Malocclusion in Chinese Migrant Workers' Children in Shanghai.

OBJECTIVE: To evaluate the relationship between caries and malocclusion in the early and late mixed dentition in a population of children of Chinese migrant workers in Shanghai. METHODS: Dental charts were obtained for 646 children in the mixed dentition, aged between 6 and 13 years old. The decayed, missing, and filled teeth (DMFT) index and interproximal tooth structure lost due to caries (ITSLC) were evaluated. RESULTS: In the early mixed dentition, overbite was more likely to be ideal in subjects with DMFT > 0. In the late mixed dentition, crowding in both arches was greater in subjects with DMFT > 0. In the total sample, crowding in the lower arch only was greater in subjects with DMFT > 0. In the early mixed dentition, upper crowding was lower in subjects with ITSLC in the upper arch and in both arches and the rate of anterior crossbite was higher in subjects with ITSLC in the upper arch. In the late mixed dentition, overjet was more likely to be ideal in subjects with ITSLC in the upper arch and upper crowding was greater in subjects with ITSLC in both arches. In the total sample, overjet was more likely to be ideal in subjects with ITSLC in the upper arch and lower crowding was greater in subjects with ITSLC in both arches. CONCLUSION: A relationship exists between caries and malocclusion, and between ITSLC and malocclusion, and some relationships may change with dental age.

Effect of magnification on locating the MB2 canal in maxillary molars.

The purpose of this study was to determine if the surgical operating microscope and/or dental loupes could enhance the practitioner's ability to locate the second mesiobuccal canal (MB2) canal of maxillary molars in an in vivo, clinical setting. The participating endodontists documented 312 cases of root canal therapy on maxillary first and second molars. Participants that used the microscope or dental loupes located the MB2 canal with a frequency of 57.4% and 55.3%, respectively. Those using no magnification located the MB2 canal with a frequency of 18.2%. When no magnification was used, significantly fewer MB2 canals were located based by Chi-square analysis at p < 0.01. There was no significant difference between the use of the microscope and dental loupes in the frequency of locating the MB2 canal. When the maxillary first molars were considered separately, the frequency of MB2 canal detection for the microscope, dental loupes, and no magnification groups was 71.1%, 62.5%, and 17.2%, respectively. The results of this study show that the use of magnification in combined groups leads to a MB2 detection rate approximately three times that of the nonmagnification group and that the use of no magnification results in the location of significantly fewer MB2 canals. Based on these results, more emphasis should be placed on the importance of using magnification for locating the MB2 canal.

Postoperative pain after 1- and 2-visit root canal therapy.

OBJECTIVES: The factors that influence postoperative pain after root canal treatment are not completely understood. The purpose of this prospective clinical study was to evaluate postoperative pain after root canal therapy performed in 1 appointment versus 2 appointments. STUDY DESIGN: Seventy-two patients requiring root canal therapy on permanent molars were included in this study. Patients were randomly assigned to either the 1-appointment or the 2-appointment group. Both vital and nonvital teeth were included. The standardized protocol for all teeth involved local anesthesia, isolation and access, engine-driven rotary nickel-titanium canal instrumentation to a minimum size #5 (.028 mm).04 taper Profile with step-back flaring, and irrigation with 2.5% NaOCl. Teeth in group 1 (n = 39) were obturated at the first appointment by using laterally condensed gutta-percha and Roth 811 sealer. Teeth in group 2 (n = 33) were closed with a sterile dry cotton pellet and Cavit restoration and were obturated at a second appointment 7 to 14 days later. A modified Visual Analogue Scale was used to measure preoperative pain and pain at 6, 12, 24, and 48 hours after the first appointment. Statistical analysis was performed to compare groups at each interval by using an independent-samples t test with Bonferroni adjustment. RESULTS: There was no statistically significant difference between groups at preoperative intervals or at any of the 4 postoperative intervals (P <.01). CONCLUSIONS: There was no difference in postoperative pain between patients treated in 1 appointment and patients treated in 2 appointments. The majority of patients in both groups reported no pain or only minimal pain within 24 to 48 hours of treatment.

Effects of orthodontic treatment on mandibular rotation and displacement in Angle Class II division 1 malocclusions.

The aim of this retrospective cephalometric study was to investigate the effects of orthodontic treatment on rotation and displacement of the mandible in Angle Class II, division 1 malocclusions. Thirty patients in the treated group (15 boys and 15 girls; mean age at pretreatment, 12.27 +/- 1.36 years) were compared with 28 subjects who had untreated Class II, division 1 malocclusions (15 boys and 13 girls; mean age at T1, 12.01 +/- 0.07 years). The patients in the first group were treated nonsurgically, without extraction, and without the use of functional appliances. Cephalometric data were obtained from three lateral cephalograms per case representing pretreatment (T1), posttreatment (T2), and at least 2-years postretention (T3). Thirty-seven variables were measured representing craniofacial morphology, tooth measurements, and mandibular displacement. Some variables were obtained from cranial base, maxillary, or mandibular superimposition. Statistical significance was established at P < .05, P < .01, and P < .001. The findings indicated that orthodontic treatment of Class II, division 1 malocclusions induced a more vertical mandibular growth direction associated with an increased vertical displacement of pogonion. Occlusal or vertical movement of maxillary and mandibular molars was not correlated to mandibular rotation or horizontal displacement of pogonion. When compared with controls, the treated group did not exhibit a significant difference in mandibular rotation or occlusal movement of maxillary molars; however, it did show a greater occlusal movement of mandibular molars during treatment.

Severity of occlusal disharmonies in down syndrome.

Objective. To quantify the severity of malocclusion and dental esthetic problems in untreated Down syndrome (DS) and untreated non-Down syndrome children age 8-14 years old using the PAR and ICON Indices. Materials and Methods. This retrospective study evaluated pretreatment study models, intraoral photographs, and panoramic radiographs of 30 Down syndrome and two groups of 30 non-Down syndrome patients (private practice and university clinic) age 8-14 years. The models were scored via PAR and ICON Indices, and descriptive characteristics such as Angle classification, missing or impacted teeth, crossbites, open bites, and other dental anomalies were recorded. Results. The DS group had significantly greater PAR and ICON scores, as well as 10 times more missing teeth than the non-DS group. The DS group possessed predominantly Class III malocclusions, with the presence of both anterior and posterior crossbites in a majority of the patients. The non-DS group had mostly Class I or II malocclusion with markedly fewer missing teeth and crossbites. The DS group also had more severe malocclusions based upon occlusal traits such as open bite and type of malocclusion. Conclusion. The DS group had very severe malocclusions, while the control group from the university clinic had more severe malocclusions than a control group from a private practice.