Outcomes of clear aligner treatment with and without Dental Monitoring: A retrospective cohort study.

INTRODUCTION: The effects of Invisalign clear aligner treatment with and without Dental Monitoring (DM) were compared for treatment duration, number of appointments, refinements and refinement aligners, and accuracy of Invisalign in achieving predicted tooth positions (aligner tracking). The null hypothesis was that there are no differences between Invisalign with and without DM in these parameters. METHODS: A sample of 90 consecutively treated Invisalign patients (45 control, 45 DM) fitted the inclusion and exclusion criteria. Treatment duration, number of refinements, number of refinement aligners, time to first refinement, number of appointments, number of emergency visits, and accuracy of predicted tooth movement were observed for differences. RESULTS: The 2 groups were homogeneous (P >0.05) for sample size, age, gender, Angle classification, maxillary and mandibular irregularity index, and the number of initial aligners. There was a significant (P = 0.001) reduction in the number of appointments by 3.5 visits (33.1%) in the DM group. There was also a significant (P = 0.001) reduction in the time to the first refinement (1.7 months) in the DM group. Compared with Invisalign predicted tooth positions, actual tooth positions were statistically (P <0.05) more accurate for the DM group for the maxillary anterior dentition in rotational movements and mandibular anterior dentition for buccal-lingual linear movement. Invisalign therapy without DM was closer to predicted tooth positions for the maxillary posterior dentition for the tip. None of these differences surpassed the clinically significant thresholds (>0.5 mm or >2°); however, the DM group achieved this in 1.7 fewer months. CONCLUSIONS: DM with Invisalign therapy resulted in a reduced number of appointments by 3.5 visits (33.1%). The DM group also achieved a clinically similar accuracy in obtaining predicted tooth movements compared with the control group in 1.7 fewer months, indicating improved aligner tracking in the DM group.

Has Invisalign improved? A prospective follow-up study on the efficacy of tooth movement with Invisalign.

INTRODUCTION: The purpose of this research was to provide an update on the accuracy of tooth movement with Invisalign (Align Technology, Santa Clara, Calif). METHODS: This prospective clinical study included 38 patients treated with Invisalign Full or Invisalign Teen. All teeth, from the central incisor to the second molar, were measured on digital models created from intraoral scans. Predicted values were determined by superimposing the initial and final ClinCheck models, and achieved values were determined by superimposing the initial ClinCheck models and the digital models from the posttreatment scans. Individual teeth were superimposed with a best-fit analysis and measured using Compare software (version 8.1; GeoDigm, Falcon Heights, Minn). The types of tooth movements studied were a mesial-distal crown tip, buccal-lingual crown tip, extrusion, intrusion, and mesial-distal rotation. RESULTS: The mean accuracy of Invisalign for all tooth movements was 50%. The highest overall accuracy was achieved with a buccal-lingual crown tip (56%), whereas the lowest overall accuracy occurred with rotation (46%). The accuracies for mesial rotation of the mandibular first molar (28%), distal rotation of the maxillary canine (37%), and intrusion of the mandibular incisors (35%) were particularly low. CONCLUSIONS: There was a marked improvement in the overall accuracy; however, the strengths and weaknesses of tooth movement with Invisalign remained relatively the same.

A nonpyrrolysine member of the widely distributed trimethylamine methyltransferase family is a glycine betaine methyltransferase.

COG5598 comprises a large number of proteins related to MttB, the trimethylamine:corrinoid methyltransferase. MttB has a genetically encoded pyrrolysine residue proposed essential for catalysis. MttB is the only known trimethylamine methyltransferase, yet the great majority of members of COG5598 lack pyrrolysine, leaving the activity of these proteins an open question. Here, we describe the function of one of the nonpyrrolysine members of this large protein family. Three nonpyrrolysine MttB homologs are encoded in Desulfitobacterium hafniense, a Gram-positive strict anaerobe present in both the environment and human intestine. D. hafniense was found capable of growth on glycine betaine with electron acceptors such as nitrate or fumarate, producing dimethylglycine and CO2 as products. Examination of the genome revealed genes for tetrahydrofolate-linked oxidation of a methyl group originating from a methylated corrinoid protein, but no obvious means to carry out corrinoid methylation with glycine betaine. DSY3156, encoding one of the nonpyrrolysine MttB homologs, was up-regulated during growth on glycine betaine. The recombinant DSY3156 protein converts glycine betaine and cob(I)alamin to dimethylglycine and methylcobalamin. To our knowledge, DSY3156 is the first glycine betaine:corrinoid methyltransferase described, and a designation of MtgB is proposed. In addition, DSY3157, an adjacently encoded protein, was shown to be a methylcobalamin:tetrahydrofolate methyltransferase and is designated MtgA. Homologs of MtgB are widely distributed, especially in marine bacterioplankton and nitrogen-fixing plant symbionts. They are also found in multiple members of the human microbiome, and may play a beneficial role in trimethylamine homeostasis, which in recent years has been directly tied to human cardiovascular health.

Isolation and characterization of a tetramethylammonium-degrading Methanococcoides strain and a novel glycine betaine-utilizing Methanolobus strain.

Two novel strains of methanogens were isolated from an estuarine sediment with the capability to utilize quaternary amines. Based on the 16S rRNA analysis, strain B1d shared 99 % sequence identity with Methanolobus vulcani PL-12/M(T) and strain Q3c shared 99 % identity with Methanococcoides sp. PM1 and PM2, but our current isolates display clearly different capabilities of growth on quaternary amines and were isolated based on these capabilities. Strain Q3c was capable of growth on tetramethylammonium and choline, while strain B1d was capable of growth on glycine betaine. Ml. vulcani PL-12/M(T) was incapable of growth on glycine betaine, indicating an obvious distinction between strains B1d and PL-12/M(T). Strain Q3c now represents the only known tetramethylammonium-utilizing methanogen in isolation. Strain B1d is the first quaternary amine-utilizing methanogen from the genus Methanolobus. This study suggests that quaternary amines may serve as ready precursors of biological methane production in marine environments.

The effect of alpha binaural beat music on orthodontic pain after initial archwire placement: A randomized controlled trial.

OBJECTIVE: The objective of this article was to evaluate the effect of alpha binaural beat music on pain level after initial placement of a maxillary fixed appliance, compared to music without binaural beats (placebo) and no music (control). METHODS: 60 patients undergoing maxillary fixed orthodontic appliance and initial archwire placement were randomly allocated into the three aforementioned groups. The pain level experienced was monitored for the following seven days, using the short-form McGill pain questionnaire (SF-MPQ). RESULTS / DESCRIPTORS: Intensity of both sensory and psychological aspects of pain reduced significantly in the binaural beat music (BBM) group, compared to the control, after the 5th day. Statistically significant lower affective and total pain scores were also found on day 6 for the placebo group, compared to the control. Present Pain Intensity (PPI): Statistically significant lower scores were found between the BBM group and the control group from days 3 to 7. Statistically significant lower scores were also found between the placebo and the control groups on days 4, 5 and 6. Visual Analog Scale (VAS): Compared to the control group, the placebo group had a lower VAS score on day 4, and the BBM group had lower scores on days 6 and 7. CONCLUSIONS: There was a significant reduction of pain demonstrated in the BBM group, compared to the control, toward the end of the first week of treatment. There was no difference in reported pain between the BBM and placebo groups for any of the scores.

Isolation and characterization of a novel choline degrading Citrobacter amalonaticus strain from the human gut.

Gut microbiota metabolism can have profound effects on human health. Choline, a quaternary amine (QA) highly abundant in our diet, is canonically cleaved by a glycyl radical enzyme, choline trimethylamine lyase (CutC), and its SAM-dependent radical activator, CutD. CutC cleaves choline to form trimethylamine (TMA) and acetaldehyde. TMA is oxidized to TMAO by FMO3 in the liver, which plays a role in causing atherosclerosis. We hypothesized that alternative pathways for choline degradation occur within gut microbes and that certain gut microbiota can anaerobically respire or ferment QAs, such as choline. Based on this prediction we established QA-supplemented enrichment cultures using fecal material from healthy volunteers as the inocula. We have isolated, from a choline-supplemented enrichment of a human fecal sample, a strain of Citrobacter amalonaticus, that we have designated CJ25. This strain is capable of anaerobically utilizing choline as its sole carbon and energy source. Its genome does not contain the cutCD genes or genes encoding any COG5598 methyltransferases. We have confirmed the degradation of choline and production of acetate by the organism during growth of the strain. However, we used multiple analytical methods to confirm that no TMA accumulated in the medium during growth. Hence, strain CJ25 is a unique bacterium that degrades choline without the production of the proatherogenic metabolite TMA.

Maxillary Expansion: A Comparison of Damon Self-Ligating Bracket Therapy with MARPE and PAOO.

Purpose: The aim of this study was to investigate arch parameters and dentoalveolar changes from pretreatment to posttreatment by comparing the Miniscrew Assisted Rapid Palatal Expansion (MARPE), Periodontally Accelerated Osteogenic Orthodontics (PAOO), and Damon self-ligating bracket therapies. Materials and Methods: Seventy-nine patients underwent maxillary expansion followed by or in conjunction with Damon (n = 23), PAOO (n = 28), and MARPE (n = 28) therapies. Nine maxillary dental arch parameters were compared at pretreatment, posttreatment as well as, increments of treatment change. Measurements were made on STL study casts using 3Shape Ortho Analyzer 3D scanner software. Results: All groups showed significant posterior width increase in the molar area. The mean increase in inter-molar distance was more than 8X greater in MARPE group compared to Damon and more than 4X greater compared to PAOO. MARPE showed significantly greater increments of change in inter-molar width and palatal vault area. Conclusions: All groups showed a significant width increase in the canine and molar area. MARPE showed the greatest increase in inter-molar width, followed by PAOO and Damon. MARPE was the only group to show a significant increase in palatal vault area.

Structure of the alpha2epsilon2 Ni-dependent CO dehydrogenase component of the Methanosarcina barkeri acetyl-CoA decarbonylase/synthase complex.

Ni-dependent carbon monoxide dehydrogenases (Ni-CODHs) are a diverse family of enzymes that catalyze reversible CO:CO(2) oxidoreductase activity in acetogens, methanogens, and some CO-using bacteria. Crystallography of Ni-CODHs from CO-using bacteria and acetogens has revealed the overall fold of the Ni-CODH core and has suggested structures for the C cluster that mediates CO:CO(2) interconversion. Despite these advances, the mechanism of CO oxidation has remained elusive. Herein, we report the structure of a distinct class of Ni-CODH from methanogenic archaea: the alpha(2)epsilon(2) component from the alpha(8)beta(8)gamma(8)delta(8)epsilon(8) CODH/acetyl-CoA decarbonylase/synthase complex, an enzyme responsible for the majority of biogenic methane production on Earth. The structure of this Ni-CODH component provides support for a hitherto unobserved state in which both CO and H(2)O/OH(-) bind to the Ni and the exogenous FCII iron of the C cluster, respectively, and offers insight into the structures and functional roles of the epsilon-subunit and FeS domain not present in nonmethanogenic Ni-CODHs.

The effect of vestibular, lingual, and aligner appliances on the quality of life of adult patients during the initial stages of orthodontic treatment.

BACKGROUND: Patient quality of life (QoL) during orthodontic treatment is an important consideration that requires greater academic investigation as greater focus is placed on enhancing patient experience. Quality of life (QoL) was assessed in three orthodontic appliance groups, i.e., vestibular, lingual, and aligners during the initial stages of treatment. The sample was comprised of 117 adult patient-subjects distributed into 3 groups: vestibular (n = 41), lingual (n = 37), and aligner (n = 39). A WHOQOL-BREF questionnaire surveyed four domains (physical health, psychological health, social relationships, and environment). RESULTS: Mean scores for domain 1, physical health, showed that the aligner group (28.1) had significantly greater scores than that of the vestibular (22.7) or lingual (22) groups. Domain 2, psychological health, demonstrated significant differences (P < 0.001) between all groups, with the aligner group scoring the highest (23.2), followed by the lingual (18.4) and vestibular (15.2) groups. Domain 3, social relationship, showed that aligner (10.9) and lingual (10.2) scores were significantly greater (P < 0.001) than those of the vestibular group (7.8). Domain 4, environment, displayed significant differences between all groups, with the aligner group scoring highest (32.1), followed by the lingual group (29.3), and lastly the vestibular group (26.4). Overall, the highest mean score was obtained by the aligner group (23.1) and the lowest mean score was by the vestibular group (18). The mean domain scores for all three groups were significantly different (P ≤ 0.005) from each other (Table 2). CONCLUSIONS: Overall, patients undergoing Aligner therapy reported the overall highest QoL scores, followed by lingual and vestibular groups.

Effect of clear aligner wear protocol on the efficacy of tooth movement.

OBJECTIVES: To compare the efficacy of orthodontic tooth movement with three aligner wear protocols: 7 day, 10 day, and 14 day. MATERIALS AND METHODS: Eighty patients were randomly allocated into three groups: group A (7-day changes), group B (10-day changes), and group C (14-day changes). The posttreatment scans were compared with the final virtual treatment simulations through digital superimposition. The differences between predicted and actual achieved treatment outcomes were computed in six angular and six linear dimensions. Differences >0.5 mm for linear measurements and >2° for angular measurements were considered clinically relevant. RESULTS: Within groups, and irrespective of wear protocol, all linear discrepancies in both jaws were deemed clinically insignificant (<0.5 mm) while nearly all angular discrepancies were considered clinically significant (>2.0°). When the three groups were compared, group C (14-day changes) showed significantly greater accuracy in the posterior segment for maxillary intrusion, distal-crown tip and buccal-crown torque, and mandibular intrusion and extrusion. The mean treatment duration in the 7-day aligner change group was nearly half that of the 14-day aligner change group (5 months vs 9 months). CONCLUSIONS: Fourteen-day changes were statistically significantly more accurate in some posterior movements. However, this difference in accuracy did not exceed the threshold for clinical significance (>0.5 mm/>2.0°). Achieving a clinically similar accuracy between the 7-day protocol and 14-day protocol in half the treatment time suggests a 7-day protocol as an acceptable treatment protocol. Clinicians may consider slowing down to a 14-day protocol if challenging posterior movements are desired.

Severe Mandibular Crowding Treated with Nonextraction Periodontally Accelerated Osteogenic Orthodontics.

This case report describes a patient with severe (11-mm) mandibular anterior crowding who received periodontally accelerated osteogenic orthodontics (PAOO) nonextraction treatment, showing 5-year follow-up. A 15-year-old female presented with severe dental crowding, Angle Class I skeletal and molar relationships and a Class II canine relationship, and excessive overjet and overbite. Following fixed-appliance placement (0.022-inch, MBT prescription), full-thickness periosteal flaps beyond the tooth apices were raised bilaterally from the second molars in both arches, and selective decortication of cortical bone was performed on the facial and lingual sides using a surgical tool. Bone grafting material, comprised of a mixture of demineralized freeze-dried bone allograft (DFDBA) and bovine bone (Bio Oss, Geistlich), was placed at the corticotomy sites. The patient was seen every 2 weeks after the surgery for orthodontic adjustments; the total active orthodontic treatment time was 9 months. Limits of tooth movement (the scope of treatment) were increased by the bone-graft augmentation. At the 5-year follow-up, cephalometric comparisons to baseline conditions showed dramatic incisor changes and stable dentoalveolar effects. This case demonstrates the efficacy of PAOO as a useful adjunct orthodontic strategy for adult patients who require treatment of severe crowding, ie, treatment that would be considered unreasonable if conventional orthodontics were employed. When conventional orthodontics cannot achieve the treatment goal and orthognathic surgery is not feasible, PAOO expands the scope of conventional orthodontic treatment in the adult 2-fold to 3-fold in most spatial dimensions.

Examination of the Glycine Betaine-Dependent Methylotrophic Methanogenesis Pathway: Insights Into Anaerobic Quaternary Amine Methylotrophy.

Recent studies indicate that environmentally abundant quaternary amines (QAs) are a primary source for methanogenesis, yet the catabolic enzymes are unknown. We hypothesized that the methanogenic archaeon Methanolobus vulcani B1d metabolizes glycine betaine (GB) through a corrinoid-dependent GB:coenzyme M (CoM) methyl transfer pathway. The draft genome sequence of M. vulcani B1d revealed a gene encoding a predicted non-pyrrolysine MttB homolog (MV8460) with high sequence similarity to the GB methyltransferase encoded by Desulfitobacterium hafniense Y51. MV8460 catalyzes GB-dependent methylation of free cob(I)alamin indicating it is an authentic MtgB enzyme. Proteomic analysis revealed that MV8460 and a corrinoid binding protein (MV8465) were highly abundant when M. vulcani B1d was grown on GB relative to growth on trimethylamine. The abundance of a corrinoid reductive activation enzyme (MV10335) and a methylcorrinoid:CoM methyltransferase (MV10360) were significantly higher in GB-grown B1d lysates compared to other homologs. The GB:CoM pathway was fully reconstituted in vitro using recombinant MV8460, MV8465, MV10335, and MV10360. Demonstration of the complete GB:CoM pathway expands the knowledge of direct QA-dependent methylotrophy and establishes a model to identify additional ecologically relevant anaerobic quaternary amine pathways.

Forced-eruption time for palatally impacted canines treated with and without ostectomy-decortication technique.

OBJECTIVES: To compare forced-eruption times for palatally impacted canines treated with and without the ostectomy-decortication technique and to assess the influence of palatally impacted canine pretreatment position and angle on forced-eruption time. MATERIALS AND METHODS: The sample was composed of 118 patient-subjects with 151 palatally impacted canines treated with the ostectomy-decortication technique (n = 72) and without (n = 79). The orthopantomogram radiographs (OPGs) were analyzed for palatally impacted canine angle and horizontal and vertical position. Recovery time was measured from the start of forced eruption until the canine was within ±1 mm of final dental arch position. RESULTS: The time of forced canine eruption with ostectomy-decortication technique was significantly shorter than without (6.6 vs 21.0 months). Pretreatment canine position significantly increased forced-eruption time in the ostectomy-decortication group but not in the control sample. CONCLUSIONS: Forced-eruption time of palatally impacted canines using the ostectomy-decortication technique was 3.2 times more rapid than without. Forced-eruption time increased significantly as a function of pretreatment palatally impacted canine position severity in the ostectomy-decortication group but not in the control.

Modeling of trabecular bone and lamina dura following selective alveolar decortication in rats.

BACKGROUND: Modifying the balance between resorption and apposition through selectively injuring the cortical plate of the alveolus has been an approach to speed tooth movement and is referred to as periodontally accelerated osteogenic orthodontics. The aim of this study was to investigate the alveolar response to corticotomy as a function of time and proximity to the surgical injury in a rat model. METHODS: Maxillary buccal and lingual cortical plates were injured in 36 healthy adult rats adjacent to the upper left first molars. Twenty-four animals were euthanized at 3, 7, or 11 weeks. In one group, the maxillae were removed and stripped of soft tissues, and histomorphometric analysis was performed to study alveolar spongiosa and periodontal ligament (PDL) modeling dynamics. Catabolic activity was analyzed with tartrate-resistant acid phosphatase-positive osteoclasts and preosteoclasts. Anabolic actions were measured using a fluorescent vital bone stain series followed by sacrifice at 30 and 51 days. To further analyze the new bone formation, a separate group of animals were fed with calcein fluorescent stain and processed for non-decalcified fluorescent stain histology. RESULTS: At 3 weeks, the surgery group had significantly (P <0.05) less calcified spongiosa bone surface, greater periodontal ligament surface, higher osteoclast number, and greater lamina dura apposition width. The catabolic activity (osteoclast count) and anabolic activity (apposition rate) were three-fold greater, calcified spongiosa decreased by two-fold, and PDL surface increased by two-fold. Surgical injury to the alveolus that induced a significant increase in tissue turnover by week 3 dissipated to a steady state by postoperative week 11. The impact of the injury was localized to the area immediately adjacent to the decortication injury. CONCLUSION: Selective alveolar decortication induced increased turnover of alveolar spongiosa, and the activity was localized; dramatic escalation of demineralization-remineralization dynamics is the likely biologic mechanism underlying rapid tooth movement following selective alveolar decortication.

Frequency of impacted teeth and categorization of impacted canines: A retrospective radiographic study using orthopantomograms.

OBJECTIVE: The objective of this study is to determine the frequency of impacted maxillary canines using seven subtype classification system. For this purpose, impacted maxillary canines have been divided into seven various subtypes. MATERIALS AND METHODS: This is a descriptive, cross-sectional, and retrospective study conducted using radiographic data of residents of Madinah, Al Munawwarah. Radiographic data of 14,000 patients, who attended College of Dentistry, Taibah University, from January 2011 to February 2015, were screened against the selection criteria for the presence of impacted teeth. The individuals with maxillary impacted canines were matched to maxillary canine impaction. The occurrence of each subtype of impacted canines was calculated. RESULTS: Impacted teeth are more common in the maxilla compared to mandible. The impacted canine represented the highest proportion of all impacted maxillary teeth followed by the second premolars and the central incisors. According to the classification system represented, Type II of canine impaction comprised the highest proportion (51%) while Type IV (0.5%) comprised the lowest frequency. The maxillary canine is the most frequently impacted tooth followed by mandibular canines. CONCLUSIONS: Although there are many variations, the majority of impacted canines fall into Type II of the classification of impacted canines.

The effect of alpha binaural beat music on orthodontic pain after initial archwire placement: A randomized controlled trial

ABSTRACT Objective: The objective of this article was to evaluate the effect of alpha binaural beat music on pain level after initial placement of a maxillary fixed appliance, compared to music without binaural beats (placebo) and no music (control). Methods: 60 patients undergoing maxillary fixed orthodontic appliance and initial archwire placement were randomly allocated into the three aforementioned groups. The pain level experienced was monitored for the following seven days, using the short-form McGill pain questionnaire (SF-MPQ). Results / Descriptors: Intensity of both sensory and psychological aspects of pain reduced significantly in the binaural beat music (BBM) group, compared to the control, after the 5th day. Statistically significant lower affective and total pain scores were also found on day 6 for the placebo group, compared to the control. Present Pain Intensity (PPI): Statistically significant lower scores were found between the BBM group and the control group from days 3 to 7. Statistically significant lower scores were also found between the placebo and the control groups on days 4, 5 and 6. Visual Analog Scale (VAS): Compared to the control group, the placebo group had a lower VAS score on day 4, and the BBM group had lower scores on days 6 and 7. Conclusions: There was a significant reduction of pain demonstrated in the BBM group, compared to the control, toward the end of the first week of treatment. There was no difference in reported pain between the BBM and placebo groups for any of the scores.

RESUMO Objetivo: O objetivo deste artigo foi avaliar o efeito da música alfa com ritmo binaural sobre o nível de dor após a instalação de um aparelho fixo superior com arco inicial, em comparação com a música sem ritmos binaurais (placebo) e sem música (controle). Métodos: 60 pacientes submetidos a instalação de aparelho ortodôntico fixo superior e do arco inicial foram alocados aleatoriamente nos três grupos acima mencionados. O nível de dor experimentado foi monitorado durante os sete dias seguintes, usando a forma curta do questionário de dor McGill (SF-MPQ). Resultados: Após o quinto dia, a intensidade dos aspectos sensoriais e psicológicos da dor foi significativamente reduzida no grupo de música com ritmo binaural (BBM), em comparação com o grupo controle. Escores significativamente menores de dor afetiva e total também foram encontrados no dia 6 para o grupo placebo, comparado ao controle. Intensidade da Dor Presente (PPI): escores significativamente menores foram encontrados para o grupo BBM, em comparação ao grupo controle, nos dias 3 a 7. Escores significativamente menores também foram encontrados para o grupo placebo, em comparação ao grupo controle, nos dias 4, 5 e 6. Escala Visual Analógica (VAS): comparado ao grupo controle, o grupo placebo teve um escore VAS menor no dia 4, e o grupo BBM teve escores menores nos dias 6 e 7. Conclusões: No final da primeira semana de tratamento, houve redução significativa da dor no grupo BBM, em comparação ao grupo controle. Não houve diferença entre a dor relatada nos grupos BBM e placebo para qualquer um dos escores.

Full-thickness flap/subepithelial connective tissue grafting with intramarrow penetrations: three case reports of lingual root coverage.

Three case reports are presented that demonstrate the use of full-thickness flap/subepithelial connective tissue grafting for root coverage on the lingual surfaces of the mandibular anterior teeth. This is accomplished using an envelope full-thickness flap technique with intramarrow penetrations at the recipient site. Miller Class I, II, and III gingival recession defects and gingival perforation defects were treated. Complete root coverage was achieved in two Miller Class I gingival recession defects, in one Miller Class II gingival recession defect, and in two gingival perforation defects in areas that exhibited no radiographic evidence of bone loss. Partial root coverage was achieved in two Miller Class III gingival recession defects in an area that exhibited radiographic evidence of bone loss. Although the majority of the exposed root surface was covered in these two Miller Class III defects, about 1 mm of root surface remained exposed, which seemed to closely correspond to the amount of bone loss that was noted radiographically. A grafting technique has been presented that can be used to restore the functional properties of the lingual gingiva of the mandibular anterior teeth by repairing gingival defects and re-establishing the continuity and integrity of the zone of keratinized gingiva. Our clinical impression is that this has made it easier for the three patients presented in this report to maintain the lingual surfaces of the mandibular anterior teeth with routine oral hygiene measures.

A comparison of two maxillary molar distalizing appliances with the distal jet.

AIMS: Previous studies on maxillary molar distalization have usually concentrated on only one appliance and featured small sample sizes. The purpose of this retrospective study was two-fold: (1) to determine the skeletal, dental, and soft tissue effects of 3 molar distalization appliances, 2 of which do not depend upon patient compliance (ie, distal jet and Greenfield molar distalizing appliance) and 1 that does (ie, sagittal appliance combined with cervical headgear); and (2) to determine differences in treatment effects among the 3 appliances. METHODS: Pretreatment and post-distalization cephalometric radiographs were obtained for each appliance (14 females and 11 males for the distal jet; 12 females and 13 males for the Greenfield molar distalizing appliance; and 17 females and 13 males for the sagittal appliance with headgear). RESULTS: Pretreatment to transition evaluation showed significant distal movement of the first molars for the distal jet (3.4 mm), the Greenfield molar distalizing appliance (3.9 mm), and the sagittal appliance with headgear (2.1 mm). Distal tipping of the first molar was seen in all samples, but significantly more so in the Greenfield molar distalizing appliance (6.5 degrees +/- 6.6) and the sagittal appliance with headgear (13.5 degrees +/- 8. 1) than in the distal jet (3.2 degrees +/- 2.8). CONCLUSIONS: Maxillary molar distalization was effective using the distal jet, the Greenfield molar distalizing appliance, and the sagittal appliance with headgear, but better control of molar bodily movement was reported with the distal jet.

Keratinized Gingiva Height Increases After Alveolar Corticotomy and Augmentation Bone Grafting.

BACKGROUND: The aim of the present study is to compare the keratinized gingival tissue (KT) height labial to the mandibular incisors after active orthodontic treatment (AOT) with and without alveolar corticotomy and bone grafting. METHODS: Two orthodontically treated groups of 35 patients each, with (Cort) and without (Conv) alveolar decortication and augmentation bone grafting, are matched in this case-control study for sample size, sex, mandibular premolar extractions, pretreatment age, post-treatment observation period, and pretreatment KT height. Standardized digital frontal occlusion photographs taken before and at least 1 year after AOT were adjusted to 96 dots per inch and measured with image analysis software for vertical KT height labial to each mandibular incisor. RESULTS: An average of 1.5 years after completion of AOT, KT height had increased significantly by 0.78 mm (P < 0.001) in the Cort group and decreased 0.38 mm (P = 0.002) in the Conv group; a 1.28-mm KT height gain was demonstrated in the subgroup representing the lowest half of Cort KT height at pretreatment. Mandibular incisor inclination and prominence explained neither the decrease in KT height in Conv nor the KT height gain in Cort. CONCLUSIONS: Orthodontic therapy combined with alveolar decortication and augmentation bone grafting resulted in a significant increase in KT height. Although KT height surrounding the dentition has been devalued by evidence-based studies, the value-added protection of KT height increase after decortication and augmentation bone grafting offsets the concerns of orthodontic proclination or expanding mandibular incisors facially.