Quality of orthodontic care-A multicenter cohort study in a German convenience sample : Part 2: Cross-sectional patient-reported outcomes after orthodontic treatment.

OBJECTIVES: In light of the growing interest in orthodontic care and its effectiveness in Germany, part 2 of this multicenter cohort study evaluated patient-reported outcomes such as oral health-related quality of life (OHRQoL), oral hygiene habits, oral health beliefs, and potential influencing factors. METHODS: Of 586 patients screened from seven German study centers, data from 343 patients were analyzed for this part of the study. At the end of their orthodontic treatment, study participants filled out a questionnaire of either the German long version of the Oral Health Impact Profile (OHIP-G 49) or the German short version of the Child Oral Health Impact Profile (COHIP-19), depending on their age, as well as questions about their oral hygiene behavior and beliefs. Patient-, treatment- and occlusion-related factors were analyzed to account for potential influencing factors with regard to patients' OHRQoL after orthodontic treatment. RESULTS: In all, 222 study participants filled out the OHIP-based and 121 the COHIP-based questionnaire. The mean OHIP-G 49 score was 12.68 and the mean OHIP-G 14 score was 3.09; the mean COHIP-19 score was 6.52 (inverted score 69.48). For OHIP-G 49 scores, a nonsignificant trend towards a higher score for male patients (14.45 vs 11.54; p = 0.061) was detected, while this trend was inverse for the COHIP-19 scores, i.e., female patients reported more impairment (total score 6.99 vs. 5.84; p = 0.099). Analyses suggested a trend towards better OHRQoL for patients who classified for the Peer Assessment Rating (PAR) Index improvement rate group 'greatly improved' as well as for nonsmokers. Oral hygiene habits and beliefs after orthodontic treatment were estimated to be good. CONCLUSION: In this German cohort, OHRQoL proved to be good and was rather unimpaired after orthodontic treatment. Furthermore, self-reported oral hygiene behavior and oral health beliefs represented good health awareness.

White spot lesions after fixed appliance treatment-Can we expect spontaneous long-term (≥15 years) improvement?

OBJECTIVE: To investigate the extent to which post-orthodontic white spot lesions (WSLs) change in appearance over a period of ≥15 years and whether an association with caries data exists. SUBJECTS AND METHODS: Seventy-two patients treated with a Herbst-Multibracket appliance at age 14.0 ± 2.7 years for 20.1 ± 5.1 months who attended a recall 18.3 ± 2.9 years post-treatment. Post-treatment (T1) intraoral photographs were assessed by a panel of five dentists using a modified version of the WSL-Index by Gorelick. For affected incisors, photographs from before treatment (T0) and recall (T3) were evaluated. In addition, the WSL-Change Index by Pancherz and Muehlich was assessed for all adequately visible incisors considering T1, T2 (if available), and T3. Radiographic (T0, T1, and T2-if available) and clinical (T3) MFT data were used. RESULTS: 37.5% of the patients exhibited WSLs on ≥ 1 incisor at T1; in total, 81 incisors (14.9%) were affected. At T3, 48% of the WSLs had improved. The modified WSL-Index decreased from 1.2 ± 0.4 to 0.8 ± 0.6 (P < .001), with a score 0 in 28% of the previously affected incisors. When comparing T2 vs. T3, additional improvement after T2 occurred in 11% of the teeth. While no difference existed at T0, the MFT values at T1, T2, and T3 were higher (P ≤ .05) in patients with WSLs at T1 than in those without. LIMITATIONS: The homogeneity of the subjects was limited and no patient-reported outcome was assessed. CONCLUSIONS: Long-term, post-orthodontic WSLs showed spontaneous full recovery in 28% and improvement in 48% of the teeth. Patients affected with WSLs exhibited higher post-treatment MFT values.

What to Prefer in Patients with Multibracket Appliances? Digital vs. Conventional Full-Arch Impressions-A Reference Aid-Based In Vivo Study.

This study aimed to investigate the transfer accuracy and required time for digital full-arch impressions obtained from intraoral scanners (IOSs) versus conventional alginate impressions (CAIs) in patients with multibracket appliances (MBA). Thirty patients with buccal MBAs (metal brackets, archwire removed) were examined using an established reference aid method. Impression-taking using four IOSs (Primescan, Trios 4, Medit i700, Emerald S) and one CAI with subsequent plaster casting were conducted. One-hundred-twenty (n = 30 × 4) scans were analyzed with 3D software (GOM Inspect) and 30 (n = 30 × 1) casts were assessed using a coordinate measurement machine. Six distances and six angles were measured and compared to the reference aid values (ANOVA; p < 0.05). Except for the intermolar distance, transfer accuracy was significantly higher with IOSs than with CAIs (p < 0.05). No such difference was found regarding the six angles. In patients with MBAs, digital impression-taking using IOSs can be recommended. For all measured variables except one, the transfer accuracy of IOSs was better than or at least equivalent to the data from CAIs. In addition, significantly (p < 0.001) less time was necessary for all IOSs in comparison to CAIs plus plaster casting.

Long-term (≥ 15 years) outcome quality after Class II:1 bionator or Herbst multibracket appliance treatment : A comparison.

PURPOSE: To compare the long-term outcome quality (≥ 15 years) of Class II:1 treatment using either a bionator (BIO) or a Herbst-multibracket appliance (HMB). METHODS: Patients who underwent functional treatment during the ideal treatment period for the respective approach (prepuberty vs. peak/postpeak) were assessed. Inclusion criteria were overjet ≥ 4 mm, skeletal Class II and availability of study casts from before, after and ≥ 15 years after treatment. The study casts were assessed using the Peer Assessment Rating (PAR) index and standard orthodontic cast measurements. RESULTS: During treatment, PAR score, overjet and sagittal occlusal relationship improved significantly in all groups. Long-term, there was a significant increase of incisor irregularity in the upper (HMB) and lower (BIO) arch and a significant decrease of lower arch width 3 - 3 (BIO). PAR score, overjet, and sagittal occlusal relationship remained stable long-term. Intergroup comparisons revealed significant differences between the BIO and HMB groups in terms of lower arch width (6 - 6), upper and lower arch width (3 + 3/3 - 3) as well as sagittal molar relationship. CONCLUSIONS: The achieved improvement in PAR score, overjet, and sagittal occlusion remained comparably stable long-term in all groups. The long-term changes are probably a consequence of natural aging.

The transfer accuracy of digital and conventional full-arch impressions influenced by fixed orthodontic appliances: a reference aid-based in vitro study.

OBJECTIVES: The aim of this in vitro study was to investigate the influence of fixed orthodontic appliances (FOAs) on the transfer accuracy of full-arch impressions by five intraoral scanners (IOSs): CS3600, Primescan, Trios 4, Medit i500, Emerald S, and one conventional alginate impression (CAI). MATERIALS AND METHODS: To compare the data with the actual model situation, an established reference aid-based method was applied. A test model with human teeth was used and modified for each testing group, resulting in five different settings: natural teeth (group A), metal brackets without/with wire (groups B/C), ceramic brackets without/with wire (groups D/E). A total of 300 (n = 12 × 5 × 5) scan datasets of IOSs were analyzed using a 3D software (GOM Inspect) and 60 (n = 12 × 5) plaster casts of CAI were measured with a coordinate measurement machine. The deviations between the reference aid and the impressions were determined. RESULTS: For all groups with brackets (B to E), IOSs showed a higher transfer accuracy compared to CAI, even for long-span distances. However, some significant differences between the IOSs were observed (p < 0.05). CONCLUSIONS: Within the limitations of this in vitro study, IOSs can be recommended for impressions with and without FOAs, even if CAI showed the smallest average deviations in settings without FOAs. CLINICAL RELEVANCE: IOSs are widely used in orthodontics and the current study demonstrated that their use enables fast impression taking even in settings with fixed orthodontic appliances. In addition, for these settings, the transfer accuracy is higher than with conventional alginate impressions. Nevertheless, a re-investigation in a clinical setting should be performed to verify the current in vitro findings.

Efficiency and outcome quality of Herbst-Multibracket appliance therapy in Class II:2 patients.

OBJECTIVES: The aim of this retrospective investigation was to generate representative data on the efficiency and outcome quality of Class II:2 Herbst-Multibracket appliance (Herbst-MBA) treatment. SUBJECTS AND METHODS: All Class II:2 patients who had started Herbst-MBA treatment at the study centre since 1986 were included. Study casts from before treatment, after Herbst-MBA treatment, and (if available) after ≥24 months of follow-up were evaluated using standard occlusal variables, the Peer Assessment Rating (PAR)-Index, and the Ahlgren-Scale. RESULTS: During treatment, the pre-treatment PAR score was reduced from 23.6 ± 7.66 to 5.6 ± 3.85 (n = 192); during the follow-up period, a slight increase to 6.0 ± 3.60 occurred (n = 127). The percentage of patients who could be assigned to the PAR category 'greatly improved' was 30% after treatment and 33% after follow-up; only 1%, respectively, 2% had to be assigned to the category 'worse/no different'. The outcome ratings according to the Ahlgren-Scale revealed 20% excellent, 32% good, 46% acceptable, and 2% unsuccessful results. LIMITATIONS: Retrospective study design with follow-up data not available from all subjects and no data from untreated controls. CONCLUSIONS: Herbst-MBA is an efficient treatment approach in orthodontic care of Class II:2 malocclusions. High-quality results (mean/median PAR score: 5.6/5.0) with very good short-term stability (2.2 years' follow-up) were achieved. Unfortunately, no appropriate control group or groups, where other treatment approaches had been applied, exist.

Long-term effects of Class II Herbst treatment on the pharyngeal airway width.

Objective: The aim was to assess the long-term effects of Class II malocclusion treatment with the Herbst appliance on the pharyngeal airway (PA) width in comparison to untreated individuals with Classes I and II malocclusion. Methods: Lateral cephalometric radiographs of 13 male Class II patients from before (T1) and after (T2) treatment with the Herbst appliance as well as after the end of growth (T3) were retrospectively analyzed and compared to two untreated age- and gender-matched samples with Class I (n = 13) or Class II (n = 13) malocclusion. The PA dimensions were measured using the parameters p (narrowest distance between the soft palate and the posterior pharyngeal wall) and t (narrowest distance between the base of the tongue and the posterior pharyngeal wall). In addition, standard cephalometric measurements were performed. Results: Relevant changes in PA dimensions were only seen for the post-treatment period, during which the distances p and t showed a significant increase in the Herbst group only (∆p: 2.3 mm, ∆t: 3.3 mm) while remaining similar in both untreated groups (∆p: 0.5 mm, ∆t: 0.5 mm, respectively, ∆p: 0.7 mm, ∆t: 1.6 mm). During the same period, posterior face height showed a significantly larger increase in the Herbst group than in both control groups (8.2 versus 5.8 mm, respectively, 5.4 mm), whereas anterior face height (NL-Me) showed a similar development in all groups (4.6 versus 4.4 mm, respectively 3.2 mm). Conclusion: In the long term, Herbst treatment resulted in a significant post-treatment increase of PA width, possibly due to an increased lower posterior facial height development compared to untreated individuals.

Replantation of a displaced incisor in a boy with a cleft lip and alveolus: a case report.

BACKGROUND: Tooth replantation after traumatic avulsion or transplantation is a challenge in oral surgery. A special method named auto-alloplastic replantation, in which a titanium post is used after extraoral endodontic treatment, combines several advantages. The treatment is performed in one step with no further endodontic intervention, no wide root canal instrumentation, no recontamination, and reduced endodontic infection. This is the first report on replantation of an ectopic tooth in a patient with a cleft lip and alveolus using this method. CASE PRESENTATION: This case report presents the treatment of a 13-year-old white boy with a cleft lip and alveolus who had an ectopic incisor in the cleft region. His rehabilitation was performed by a tooth transposition using the auto-alloplastic replantation technique. After preparation of the displaced incisor from the vestibule, extraoral endodontic treatment followed using a titanium post prior to replantation in a newly formed socket. In the follow-up, the tooth is still in place and functioning after 2 years. CONCLUSIONS: This method can be used to bridge the years while a patient is young and jaw growth is incomplete until bone augmentation and implantation can be performed. The tooth will preserve the remaining alveolar ridge and help the adolescent psychologically.

Severe external apical root resorption--local cause or genetic predisposition?

BACKGROUND: Current data suggest that a large extent of the variation in orthodontic root resorption may be explained by differences in individual genetic predisposition. This would imply, however, a similar root resorption reaction in all teeth. OBJECTIVE: To determine the incidence and extent of severe external apical root resorptions (SEARR) in maxillary incisors during multibracket (MB) appliance treatment. PATIENTS AND METHODS: Of the whole sample of patients having completed MB treatment at the University of Giessen between 1991 and 2010 (P(Total)=3198), all subjects exhibiting severe root resorptions on at least one maxillary incisor were selected. SEARR were defined according to Malmgren et al. [39] (grade-IV RR=resorption >1/3 root length). Evaluation was performed using orthopantomograms from before and after MB treatment. The crown and root length of the affected teeth were measured. The extent of SEARR was assessed taking pretreatment crown length into consideration. RESULTS: SEARR was detected in 16 patients. Thus, the incidence of SEARR on maxillary incisors during MB treatment totalled 0.5%. The median of SEARR of the affected incisors was 38.6% of the initial root length (minimum=33.4%, maximum=61.0%). Most subjects exhibited only single affected teeth. Only two subjects (0.06% absolute/12.5% relative) presented four maxillary incisors with SEARR. CONCLUSIONS: The incidence of SEARR on maxillary incisors during MB treatment (0.5%) was very low compared to the literature. With only 12.5% of SEARR patients presenting four affected teeth, local rather than systemic/genetic factors seem to have predisposed the present subjects to SEARR.

Occlusal stability of adult Class II Division 1 treatment with the Herbst appliance.

INTRODUCTION: During recent years, some articles have been published on Herbst appliance treatment in adult patients, an approach that has been shown to be most effective in Class II treatment in both early and late adulthood. However, no results on stability have yet been published. Our objective was to analyze the short-term occlusal stability of Herbst therapy in adults with Class II Division 1 malocclusions. METHODS: The subjects comprised 26 adults with Class II Division 1 malocclusions exhibiting a Class II molar relationship > or =0.5 cusp bilaterally or > or =1.0 cusp unilaterally and an overjet of > or =4.0 mm. The average treatment time was 8.8 months (Herbst phase) plus 14.7 months (subsequent multi-bracket phase). Study casts from before and after treatment and after an average retention period of 32 months were analyzed. RESULTS: After retention, molar relationships were stable in 77.6% and canine relationships in 71.2% of the teeth. True relapses were found in 8.2% (molar relationships) and 1.9% (canine relationships) of the teeth. Overjet was stable in 92.3% and overbite in 96.0% of the patients; true relapse did not occur. CONCLUSIONS: Herbst treatment showed good occlusal stability 2.5 years after treatment in adults with Class II Division 1 malocclusions.

Facial profile and lip position changes in adult Class II, Division 2 subjects treated with the Herbst-Multibracket appliance. A radiographic cephalometric pilot study.

OBJECTIVE: To examine the treatment and post-treatment effects of the Herbst-Multibracket (MB) appliance on facial profile and lip position in adult Class II, Division 2 subjects. MATERIAL AND METHODS: Lateral head films of 16 consecutively-treated adult Class II, Division 2 subjects (8 males, 8 females) with an average age of 18.8 years pre-treatment were analyzed on three occasions: before treatment (T1), after Herbst-MB treatment (T2) and 2 years post-treatment (T3). RESULTS: Treatment period (T2-T1): an increase occurred in the hard tissue profile angle (2.5 degrees; p < 0.001), the soft tissue profile angle excluding the nose (2.6 degrees ; p < 0.01), and the soft tissue profile angle including the nose (1.8 degrees; p < 0.05). The upper lip became more retrusive in relation to the Esthetic line (EL) (0.8 mm; p < 0.05) while the lower lip's position was unchanged. Lower lip coverage of the upper incisors was reduced (0.8 mm; p < 0.05). Post-treatment period (T3-T2): the soft tissue profile angle (excluding the nose) increased (1.6 degrees; p < 0.01), while the hard and soft tissue profile angles including the nose remained unchanged. Both, the upper and lower lips became more retrusive in relation to the EL (0.9 mm; p < 0.01 and 1.0 mm; p < 0.001). The lower lip coverage of the upper incisors remained unchanged. CONCLUSION: The hard and soft tissue profiles were straightened during Herbst-MB treatment, including a brief follow-up period. The lips became more retrusive while the lower lip coverage of the upper incisors was reduced.