A contemporary review of white spot lesions in orthodontics.

UNLABELLED: White spot lesions (WSL) associated with fixed orthodontic appliances are a common adverse effect of orthodontic treatment and represent a significant challenge to achieving esthetic excellence. The purpose of this article is to review the current evidence regarding diagnosis, risk assessment, prevention, intratreatment management, and postorthodontic treatment of WSL, and to provide clinical recommendations useful for both the orthodontist and the general dentist. Caries risk assessment should be incorporated into initial evaluations of orthodontic patients, and risk-specific prevention and management protocols can help to eliminate or minimize this clinical problem. There are multiple options for treatment of WSL, ranging from conservative to invasive techniques; the severity of lesions is a determinant of which option is most appropriate. CLINICAL SIGNIFICANCE: White spot lesions associated with orthodontic treatment are a common problem that can be minimized with appropriate prevention, management, and treatment approaches.

Three-dimensional assessment of maxillary changes associated with bone anchored maxillary protraction.

INTRODUCTION: Bone-anchored maxillary protraction has been shown to be an effective treatment modality for the correction of Class III malocclusions. The purpose of this study was to evaluate 3-dimensional changes in the maxilla, the surrounding hard and soft tissues, and the circummaxillary sutures after bone-anchored maxillary protraction treatment. METHODS: Twenty-five consecutive skeletal Class III patients between the ages of 9 and 13 years (mean, 11.10 ± 1.1 years) were treated with Class III intermaxillary elastics and bilateral miniplates (2 in the infrazygomatic crests of the maxilla and 2 in the anterior mandible). Cone-beam computed tomographs were taken before initial loading and 1 year out. Three-dimensional models were generated from the tomographs, registered on the anterior cranial base, superimposed, and analyzed by using color maps. RESULTS: The maxilla showed a mean forward displacement of 3.7 mm, and the zygomas and the maxillary incisors came forward 3.7 and 4.3 mm, respectively. CONCLUSIONS: This treatment approach produced significant orthopedic changes in the maxilla and the zygomas in growing Class III patients.

Three-dimensional analysis of maxillary protraction with intermaxillary elastics to miniplates.

INTRODUCTION: Early Class III treatment with reverse-pull headgear generally results in maxillary skeletal protraction but is frequently also accompanied by unfavorable dentoalveolar effects. An alternative treatment with intermaxillary elastics from a temporary anchorage device might permit equivalent favorable skeletal changes without the unwanted dentoalveolar effects. METHODS: Six consecutive patients (3 boys, 3 girls; ages, 10-13 years 3 months) with Class III occlusion and maxillary deficiency were treated by using intermaxillary elastics to titanium miniplates. Cone-beam computed tomography scans taken before and after treatment were used to create 3-dimensional volumetric models that were superimposed on nongrowing structures in the anterior cranial base to determine anatomic changes during treatment. RESULTS: The effect of the intermaxillary elastic forces was throughout the nasomaxillary structures. All 6 patients showed improvements in the skeletal relationship, primarily through maxillary advancement with little effect on the dentoalveolar units or change in mandibular position. CONCLUSIONS: The use of intermaxillary forces applied to temporary anchorage devices appears to be a promising treatment method.

Superimposition of 3-dimensional cone-beam computed tomography models of growing patients.

INTRODUCTION: The objective of this study was to evaluate a new method for superimposition of 3-dimensional (3D) models of growing subjects. METHODS: Cone-beam computed tomography scans were taken before and after Class III malocclusion orthopedic treatment with miniplates. Three observers independently constructed 18 3D virtual surface models from cone-beam computed tomography scans of 3 patients. Separate 3D models were constructed for soft-tissue, cranial base, maxillary, and mandibular surfaces. The anterior cranial fossa was used to register the 3D models of before and after treatment (about 1 year of follow-up). RESULTS: Three-dimensional overlays of superimposed models and 3D color-coded displacement maps allowed visual and quantitative assessment of growth and treatment changes. The range of interobserver errors for each anatomic region was 0.4 mm for the zygomatic process of maxilla, chin, condyles, posterior border of the rami, and lower border of the mandible, and 0.5 mm for the anterior maxilla soft-tissue upper lip. CONCLUSIONS: Our results suggest that this method is a valid and reproducible assessment of treatment outcomes for growing subjects. This technique can be used to identify maxillary and mandibular positional changes and bone remodeling relative to the anterior cranial fossa.

Implantable devices as orthodontic anchorage: a review of current treatment modalities.

UNLABELLED: Recently, there has been a dramatic increase in the use of implantable devices as direct adjuncts to orthodontic treatment. Whereas the use of conventional dental implants has been researched extensively, the body of literature associated with the more recent uses of implantable devices in orthodontics is relatively small. Currently, a limited number of such devices are used to aid in orthodontic treatment. The options include conventional titanium endosseous dental implants, palatal implants, titanium miniscrews (also known as micro- or mini-implants), and mini-bone plates. Integration of dental implants or implantable devices into contemporary orthodontic practice has the following possible advantages: serving as a means of increasing orthodontic anchorage, virtually eliminating patient compliance issues with regard to wearing of appliances, decreasing overall treatment time, and occasionally permitting orthodontic treatments previously thought to be impossible without surgery. CLINICAL SIGNIFICANCE: This article is a review of the currently available options for use of implantable devices as sources of temporary skeletal anchorage in orthodontics.