Autotransplantation of a Maxillary Premolar to Replace a Central Incisor: A Seven-Year Follow-Up.

Purpose: To discuss the transplantation of a maxillary premolar to replace a maxillary central incisor in a seven-year follow-up period.
Methods: An avulsed permanent maxillary central incisor was reimplanted by a pediatric dentist but it presented progressive external root resorption. Transplantation of the maxillary right first premolar was planned, as the patient presented a Class II malocclusion with increased overjet that would be treated with extractions of the maxillary premolars.
Results: The transplanted tooth did not present any negative symptoms other than discoloration, which was treated with bleaching for three years. At the end of a three- year follow-up period, a full ceramic restoration was done to improve translucency properties to provide better esthetics. The transplanted tooth presented healthy periapical and periodontal tissues in both clinical and radiographic examinations at the end of the seven-year follow-up period.
Conclusions: Autotransplantation of maxillary premolars can be a viable alternative to provide adequate physiologic and esthetic components for avulsed and reimplanted permanent incisors that presented unsuccessful results.

Comparative evaluation of fluoride varnishes, self-assembling peptide-based remineralization agent, and enamel matrix protein derivative on artificial enamel remineralization in vitro.

BACKGROUND: One of the most unfavorable side effects of fixed orthodontic treatment is white spot lesions (WSLs). Although the most important approach is prevention of WSLs, it is also essential to evaluate the efficacy of the remineralization agents. However, there is no concurrence in the literature with respect to the remineralization process of these agents. The objective of the present study was to evaluate the effects of different fluoride varnishes, enamel matrix protein, and self-assembling peptide derivatives with varying chemical compositions on remineralization of artificially created WSLs in vitro using quantitative light-induced fluorescence (QLF). METHODS: Artificial WSLs were created on bovine enamel samples using acidic buffer solution (pH 5, 10 days). Specimens were randomly allocated to six groups (n = 10/group): (1) Emdogain (Straumann, Basel, Switzerland), (2) Curodont Repair (Credentis AG, Switzerland), (3) Duraphat (Colgate-Palmolive, New York, NY), (4) Clinpro XT (3 M ESPE, Pymble, New South Wales, Australia), (5) Enamel Pro Varnish (Premier Dental Products, PA, USA), and (6) control (untreated). The agents were applied to the WSLs according to the manufacturers' instructions. Fluorescence loss (ΔF), lesion area (area), and impact (ΔQ) values of enamel surfaces were quantified by QLF-D BiluminatorTM (Inspektor-Pro, Amsterdam, The Netherlands) at baseline and after 7, 14, and 21 days of application of the respective materials. RESULTS: ΔF value presented a significantly decreasing trend throughout the 21 days for all groups except the Duraphat and Enamel Pro varnishes. The changes between 14th and 21st days of the Clinpro XT varnish application were significantly higher than Emdogain, Curodont, and Enamel Pro. The Curodont group showed higher lesion area changes between the first and second week in comparison to the Emdogain, Clinpro XT, and Enamel Pro groups, whereas Clinpro XT assured the highest reduction from the second to the third week of the observation period. CONCLUSIONS: The fluorescence loss was significantly reduced with enamel matrix protein, self-assembling peptide, and light-curable fluoride varnishes in the analysis for 21 days. Curodont and Clinpro XT were effective in diminishing the fluorescence loss and lesion area compared to the Duraphat, Enamel Pro fluoride varnishes, and Emdogain in different time points.

Low-Viscosity Resin Infiltration Efficacy on Postorthodontic White Spot Lesions: A Quantitative Light-Induced Fluorescence Evaluation.

OBJECTIVE: The aim of this in vivo study was to evaluate the efficacy of low-viscosity light-cured resin infiltration on postorthodontic white spot lesions (WSLs) on incipient and advanced lesions using quantitative light-induced fluorescence (QLF). METHODS: The study subjects were patients with clinically diagnosed postorthodontic WSLs (n=57). QLF images of the lesions were obtained using a QLF device (Inspektor-Pro, Amsterdam, The Netherlands) before any treatment. Images were processed using the built-in software (QLF patient v2.0.0.48), which produced fluorescence loss (ΔF1), lesion area (Area1), and impact (ΔF1 x Area1, ΔQ1) values. Lesions were categorized as incipient (-5<ΔF1<-12, n=14) or advanced (-12<ΔF1<-25, n=43). They were then infiltrated with low-viscosity resin (Icon-DMG, Hamburg, Germany) according to the manufacturer's instructions. QLF imaging was repeated (ΔF2, Area2, and ΔQ2) from the same aspects assured by the relative software. Kolmogorov-Smirnov, Wilcoxon, and Mann-Whitney tests were used for data evaluation. RESULTS: ΔF1 (-8.40±0.73) and Area1 (3.44±5.19) decreased to -6.58±0.88 and 0.18±0.33 for incipient lesions (p<0.001 and p=0.002, respectively). ΔF1 (-13.20±5.32) and Area1 (4.71±5.56) decreased to -7.51±2.7 and 0.29±1.86 for advanced lesions (p<0.001). When ΔF, lesion area, and ΔQ changes between the groups were compared, the decrease in ΔF was greater for advanced lesions (p<0.001), whereas the decrease in the lesion area and ΔQ was similar (p=0.690, p=0.291). CONCLUSIONS: Infiltration treatment provides improvement of WSLs in terms of fluorescence loss, lesion area, and impact for both incipient and advanced lesions, with the latter group presenting higher fluorescence loss reduction.

Do Adhesive Flash-free Brackets Affect Bacterial Plaque in Patients with Adequate Oral Hygiene? A Randomised Controlled Clinical and Microbiological Assessment.

PURPOSE: To compare adhesive flash-free (FF) and adhesive pre-coated (APC) brackets in terms of plaque retention and constituents, gingival biomarkers and enamel demineralisation. MATERIALS AND METHODS: Fifty adolescents (mean age ± SD; 14.23 ± 0.15 years, age range: 13-18 years) were randomly distributed to receive FF or APC ceramic brackets in the maxillary right or left quadrant. Plaque and gingival indices, quantitative light-induced fluorescence (QLF) imaging, gingival crevicular fluid (GCF) and plaque sampling were performed at baseline and at 1, 2 and 3 months (T0, T1, T2, T3) after bracket placement. QLF was repeated following debonding. GCF samples were analysed for biomarkers by immunoassay and plaque by real-time PCR for bacterial content. Data were analysed using the Wilcoxon test on dependent samples and 2-tailed ANOVA. RESULTS: Plaque index, gingival index and fluorescence changes were similar for the two adhesive-bracket systems. GCF volumes and interleukin (IL)-1ß levels increased compared to baseline (p < 0.05). IL-17A levels and RANKL:OPG ratios were similar in both groups. In dental plaque, Aggregatibacter actinomycetemcomitans numbers were higher in the APC group at T3. Fusobacterium nucleatum (Fn) counts statistically significantly decreased at T1 and T3 as compared to T0 in the FF group (p < 0.05 and p < 0.01, respectively), whereas Fn counts increased in the APC group at T3 (p < 0.01). Porphyromonas gingivalis, Streptococcus oralis and total bacterial counts were significantly higher in the APC group than in the FF group at T3 (p < 0.01). CONCLUSION: In orthodontic patients with good oral hygiene, the quantity of plaque on adhesive flash-free brackets and conventional brackets did not differ, but the constituents of plaque differed, with less pathogenic bacteria detected around adhesive flash-free brackets. Further studies also including a group of individuals with poor oral hygiene and longer follow-up periods may better clarify the issue.

Influence of Lateral Cephalometric Radiographs on Orthodontic Treatment Planning of Class II Patients.

BACKGROUND: Lateral Cephalometric Radiographs (LCR) are a common decision-making aid in orthodontic treatment planning and are routinely used in clinical practice. The aim of this present study was to test the null hypothesis that LCR evaluation does not alter specific components of orthodontic treatment planning in Class II patients. MATERIALS AND METHODS: Records of 75 patients, who had been treated at the Department of Orthodontics, Centre of Dental Medicine, University of Zurich comprised the study material. Inclusion criteria were: (1) adolescents between the age of 12-15, (2) permanent dentition with Class II buccal segment relationship (3) absence of craniofacial and dento-alveolar malformations. Fifteen orthodontists from the dental faculties of Istanbul University, Istanbul and Ege University, Izmir filled out Likert-type linear scale questionnaires without knowing that they would repeat the same procedure with and without LCRs at two different time points. Equivalence and clinical relevance were assessed using (%95 CI) Wilcoxon signed rank tests. RESULTS: Extraction decision did not differ between groups (p=0.68). Preference of functional appliance use (p=0.006) and inter-maxillary fixed functional appliance (p=0.043) was different among groups. CONCLUSION: LCR evaluation has minor influence on treatment planning procedure of Class II patients. It might be beneficial to consider its prescription not in a routine manner but as a supplementary tool considering possible reduction of radiation exposure.

Volumetric Cleft Changes in Treatment With Bone Morphogenic Protein/ß-Tricalcium Phosphate Versus Grafts From the Iliac Crest or Symphysis.

PURPOSE: To compare the volumetric changes in successfully treated clefts with secondary alveolar grafting using recombinant human bone morphogenic protein-2 (rhBMP-2) delivered in ß-tricalcium phosphate (ßTCP) scaffold versus autogenous grafts obtained from the iliac crest and mandibular symphysis. PATIENTS AND METHODS: We performed a retrospective cohort study of cone-beam computed tomography scans of 25 subjects with unilateral or bilateral clefts. Of the 25 patients, 7 received an iliac crest bone graft, 9 received a mandibular symphyseal bone graft, and 9 subjects received the rhBMP-2/ßTCP bone substitute. Volumetric rendering software was used to calculate the amount of new bone formation and residual bone defect present in the cleft area. The data were analyzed using Wilcoxon and Kruskal-Wallis tests and Pearson's correlation coefficient. RESULTS: The mean percentage of new bone formation for the iliac crest, symphysis, and rhBMP-2/ßTCP was 85.47, 80.56, and 81.22%, respectively (P = .0854). The initial cleft volume had a weak positive correlation with the percentage of new bone formation (r = 0.18), but the postoperative residual cleft volume had a strong negative correlation (r = 0.71). CONCLUSIONS: rhBMP2 delivered in a ßTCP scaffold in alveolar cleft patients can be a viable alternative to autogenous iliac crest and symphysis grafts, eliminating donor site morbidity.

Patients' and Parents' Perception of Functional Appliances: A Survey Study.

OBJECTIVE: To evaluate patients' and parents' perception of removable, fixed rigid, and fixed hybrid functional appliances and to compare their impacts on anxiety and discomfort during treatment in different age groups and genders. METHODS: Data were gathered by means of a questionnaire that included items presumed to be associated with orthodontic compliance. A self-administered questionnaire was used to quantify patients' and parents' perceptions. Three groups were formed regarding the type of functional appliance used: fixed rigid (Functional Mandibular Advancer, FMA), fixed hybrid (Forsus Fatigue Resistant Device, FRD), and removable (Twin Block, TB). Two separate questionnaires were used for the patients and their parents comprising the necessary context. Chi-square, Mann-Whitney U, and Kruskal-Wallis tests were used for data analysis. RESULTS: Patients needed less time to adapt to the FRD appliance. Eating difficulties were encountered by patients in the FMA group. Adolescents who had completed functional orthodontic treatment with a removable appliance had difficulties in controlling their saliva. Patients' and parents' perceptions were found to be in accordance with each other. CONCLUSION: Adolescents who had completed functional orthodontic treatment with fixed appliances had more difficulty in their daily life. Orthodontists should be aware of this impact caused by functional orthodontic treatment and should regularly encourage patients by reminding them of the improvements to be had by fixing the malocclusion.

Social smile reproducibility using 3-D stereophotogrammetry and reverse engineering technology.

OBJECTIVE: To assess the range of social smile reproducibility using 3-D stereophotogrammetry and reverse engineering technology. MATERIALS AND METHODS: Social smile images of white adolescents (N  =  15, mean age  =  15.4 ±1.5 years; range  =  14-17 years) were obtained using 3dMDFlex (3dMD, Atlanta, Ga). Each participant was asked to produce 16 social smiles at 3-minute intervals. All images were obtained in natural head position. Alignment of images, segmentation of smile area, and 3-D deviation analysis were carried out using Geomagic Control software (3D Systems Inc, Cary, NC). A single image was taken as a reference, and the remaining 15 images were compared with the reference image to evaluate positive and negative deviations. The differences between the mean deviation limits of participants with the highest and the lowest deviations and the total mean deviations were evaluated using Bland-Altman Plots. RESULTS: Minimum and maximum deviations of a single image from the reference image were 0.34 and 2.69 mm, respectively. Lowest deviation between two images was within 0.5 mm and 1.54 mm among all participants (mean, 0.96 ± 0.21 mm), and the highest deviation was between 0.41 mm and 2.69 mm (mean, 1.53 ± 0.46 mm). For a single patient, when all alignments were considered together, the mean deviation was between 0.32 ± 0.10 mm and 0.59 ± 0.24 mm. Mean deviation for one image was between 0.14 and 1.21 mm. CONCLUSIONS: The range of reproducibility of the social smile presented individual variability, but this variation was not clinically significant or detectable under routine clinical observation.

Cone Beam Computed Tomography in Orthodontics.

The advent of three-dimensional (3D) imaging technology has caused a significant change in the diagnostic approach practiced in dentistry, and in particular, orthodontics. Although conventional imaging methods such as orthopantomography and lateral cephalometric and anteroposterior graphs provide sufficient information in mild to moderate orthodontic anomalies, 3D imaging can be a necessity in severe skeletal anomalies or tooth impactions. Computed tomography (CT) has been frequently used when detailed 3D imaging is necessary despite its relatively high cost, low vertical resolution, and high dose of radiation. In contrast to conventional CT application, the development of cone beam computed tomography (CBCT) technology has had important advantages over the conventional method, such as minimization of the radiation dose, image accuracy, rapid scan time, fewer image artifacts, chair-side image display, and real-time analysis. These advantages have provided dental practitioners the opportunity to benefit more frequently from 3D imaging by relatively diminishing radiation dose considerations, financial burden, and availability, in particular. Therefore, the aim of this review is to highlight the current understanding of CBCT practice in orthodontics and to summarize clinically relevant conditions.

Influence of Lateral Cephalometric Radiography on Treatment Planning and Preferences in Skeletal Open-Bite Patients: Do Lateral Cephalograms Influence Treatment Planning?

OBJECTIVE: To investigate the influence of diagnostic data derived from lateral cephalometric radiographs (LCR) on treatment preferences of specialists planning skeletal open-bite treatment. METHODS: Diagnostic records of 25 patients who had been treated at the University of Zurich, Department of Orthodontics, between 1988 and 2007 comprised the study material. Inclusion criteria were 1) skeletal open-bite with no marked antero-posterior discrepancy, 2) dental open-bite, and 3) crowding less than 5 mm. Records consisted of extra-intraoral photographs, panoramic-cephalometric X-rays, casts, and results of analyses. Records, with cephalograms of randomly chosen patients removed, were digitally presented to two orthodontists (A and B), and treatment preferences were asked using Likert-type questionnaires. Three months later, the same records were redelivered with missing cephalograms provided and present cephalograms removed with the questionnaire. Data were evaluated for consistency and tendency to extract using Kappa-κ and McNemar tests. RESULTS: Orthodontist B had no poor-agreement scores, whereas orthodontist A presented very-poor agreement for headgear use. Both A (κ=0.833) and B (κ=0.737) had good to very-good agreement in terms of extraction decisions. Neither orthodontist had any significant tendency for extraction/non-extraction therapy (A=0.99; B=0.5). CONCLUSION: Information deduced from LCRs had limited influence on treatment planning preferences in skeletal/dental open-bite patients with no marked antero-posterior discrepancy and no influence on extraction/non-extraction decision.

Stability of two resin combinations used as sealants against toothbrush abrasion and acid challenge in vitro.

OBJECTIVE: To test the stability of two conventional adhesives when combined with a low-viscosity caries infiltrant used for sealing sound enamel against toothbrush abrasion and acid challenge in vitro. MATERIALS AND METHODS: Bovine enamel discs (Ø = 3 mm) randomly assigned to three groups (n = 10/group) were etched with 37% phosphoric acid for 30 s and treated with resins of different monomer contents forming three test groups: (1) Untreated specimens (Control); (2) Infiltrant (Icon, DMG) + conventional enamel bonding adhesive (Heliobond, Ivoclar Vivadent); and (3) Infiltrant + conventional orthodontic adhesive (Transbond XT Primer, 3M Unitek). All specimens were immersed in hydrochloric acid (pH 2.6) for up to 9 days, during which they were exposed to 1825 toothbrush-strokes per day. Calcium dissolution was assessed using Arsenazo III method at 24-h intervals. Data were analyzed by Kruskal-Wallis and Wilcoxon signed ranks tests. RESULTS: Cumulative calcium dissolution for the untreated specimens (39.75 ± 7.32 µmol/ml) exceeded the sealed groups (Icon + Heliobond: 23.44 ± 7.03 µmol/ml; Icon + Transbond XT Primer: 22.17 ± 5.34 µmol/ml). Untreated specimens presented a relatively constant calcium dissolution rate throughout the experimental period, whereas the sealed groups presented a gradual increase indicating weakening of the seal by toothbrush abrasion. Both sealed groups presented significantly lower daily calcium dissolution at all time points compared to the control, except for Group 2 on the last measurement day. CONCLUSIONS: Low-viscosity caries infiltrant application on sound enamel prior to conventional resin application provided a protective effect against enamel demineralization, but this effect was not stable when challenged mechanically by toothbrush abrasion.

Colour improvement and stability of white spot lesions following infiltration, micro-abrasion, or fluoride treatments in vitro.

SUMMARY BACKGROUND/OBJECTIVES: White spot lesions (WSLs) are unwelcome side effects of fixed appliances that compromise the treatment outcome. Recently, infiltration of WSLs has been introduced as a viable treatment alternative. The objective was to evaluate the colour improvement of WSLs and their stability against discolouration following infiltration, fluoride, or micro-abrasion treatments in vitro. MATERIALS/METHODS: Artificial WSLs were created in bovine enamel (N = 96) using acidic buffer solution (pH 5, 10 days) and were randomly allocated to four groups. Specimens were treated with infiltration (Icon, DMG), fluoride (Elmex Caries Protection, GABA), and micro-abrasion (Opalustre, Ultradent) or remained untreated (control). Groups were discoloured for 24 hours in tea or tea + citric acid. Colour components and visible colour change (L*, a*, b*, ΔE) were measured spectrophotometrically on following time points: baseline, after WSL formation, after treatment, and during discolouration (8, 16, and 24 hours). Data were analysed using Kruskal-Wallis and Mann-Whitney tests. RESULTS: WSL formation increased (L*) in all groups. Only infiltration reduced this effect to baseline. Highest ΔE improvement was obtained by infiltration and micro-abrasion followed by fluoride. This improvement was stable only for infiltration during discolouration. L*, a*, and b* changed significantly during discolouration in all groups except infiltration. Within the same treatment group, discolouration solutions did not differ significantly. LIMITATIONS: In vitro testing cannot replicate the actual mode of colour improvement or stability but can be used for ranking materials and techniques. CONCLUSIONS/IMPLICATIONS: Infiltration and micro-abrasion treatments were capable of diminishing the whitish appearance of WSLs. Only infiltrated WSLs were stable following discolouration challenge.

Influence of lateral cephalometric radiographs on extraction decision in skeletal class I patients.

BACKGROUND: Radiographic examination is considered 'justified' only when detection of a condition that would change the mechanisms and timing of treatment is possible. Radiographic safety guidelines have restricted the indication of lateral cephalometric radiographs (LCRs) to presence of distinct skeletal Class II or Class III. However, they are taken routinely in clinical practice and considered to be part of the 'gold' standard for orthodontic diagnosis. Therefore, the aim of this study was to test the null hypothesis that lateral cephalometric radiograph (LCR) evaluation would not alter the extraction/non-extraction decision in orthodontic treatment planning of skeletal Class I patients. MATERIALS AND METHODS: Intraoral and extraoral photographs, dental casts and extraoral radiographs of 60 skeletal Class I patients were prepared digitally for assessment using a presentation software. One experienced (EO) and inexperienced orthodontist (IO) was asked to decide on extraction or non-extraction on a Likert-type linear scale for treatment planning. This procedure was repeated 4 weeks later with a mixed order of patients and the LCRs being omitted. Kappa, Weighted Kappa (WK) and McNemar scores were computed to test decision consistency and Bland-Altman plots together with 95% limits of agreement were used to determine measurement accuracy and presence of systematic bias. RESULTS: Both EO (WK = 0.67) and IO (WK = 0.64) had good level of decision agreement with and without LCR evaluation. EO did not present a shift towards extraction nor non-extraction with LCR evaluation (McNemar = 0.999) whereas IO showed a tendency to extraction (McNemar = 0.07) with LCR data. Including LCR evaluation created a systematic inconsistency between EO and IO (Line of equality = 0.8, Confidence interval = 0.307-0.707). CONCLUSIONS: Lateral cephalometric radiograph evaluation did not influence the extraction decision in treatment planning of skeletal Class I patients. Reconsidering the necessity of lateral cephalograms in orthodontic treatment of skeletal Class I patients may reduce the amount of ionizing radiation. Key words: Lateral cephalometric radiograph, extraction, treatment planning, skeletal Class I.

Fatigue resistance, debonding force, and failure type of fiber-reinforced composite, polyethylene ribbon-reinforced, and braided stainless steel wire lingual retainers in vitro.

OBJECTIVE: To analyze the fatigue resistance, debonding force, and failure type of fiber-reinforced composite, polyethylene ribbon-reinforced, and braided stainless steel wire lingual retainers in vitro. METHODS: Roots of human mandibular central incisors were covered with silicone, mimicking the periodontal ligament, and embedded in polymethylmethacrylate. The specimens (N = 50), with two teeth each, were randomly divided into five groups (n = 10/group) according to the retainer materials: (1) Interlig (E-glass), (2) everStick Ortho (E-glass), (3) DentaPreg Splint (S2-glass), (4) Ribbond (polyethylene), and (5) Quad Cat wire (stainless steel). After the recommended adhesive procedures, the retainers were bonded to the teeth by using flowable composite resin (Tetric Flow). The teeth were subjected to 10,00,000 cyclic loads (8 Hz, 3 - 100 N, 45° angle, under 37 ± 3℃ water) at their incisoproximal contact, and debonding forces were measured with a universal testing machine (1 mm/min crosshead speed). Failure sites were examined under a stereomicroscope (×40 magnification). Data were analyzed by one-way analysis of variance. RESULTS: All the specimens survived the cyclic loading. Their mean debonding forces were not significantly different (p > 0.05). The DentaPreg Splint group (80%) showed the highest incidence of complete adhesive debonding, followed by the Interlig group (60%). The everStick Ortho group (80%) presented predominantly partial adhesive debonding. The Quad Cat wire group (50%) presented overlying composite detachment. CONCLUSIONS: Cyclic loading did not cause debonding. The retainers presented similar debonding forces but different failure types. Braided stainless steel wire retainers presented the most repairable failure type.

Effect of chlorhexidine varnish application on streptoococcus mutans colonisation in adolescents with fixed orthodontic appliances.

OBJECTIVE: The aim of this prospective study was to evaluate the re-colonisation pattern of Streptococcus mutans (MS) in highlevel MS-colonised patients with fixed orthodontic appliances following 40% chlorhexidine varnish application prior to bracket placement. MATERIALS AND METHODS: The subjects of this single-blinded clinical trial were 13-14year-old adolescents (N = 14) with significant orthodontic treatment need, a high salivary MS count but without any carious lesions. Baseline MS levels were determined by the cultivation of saliva collected from each subject using strips developed for this purpose (Strip-mutans, Orion Diagnostica, Espoo, Finland). Prior to the bonding of orthodontic brackets, 40% chlorhexidine varnish (EC 40, Explore, Nijmegen, Netherlands) was applied to all teeth for 10 minutes. The re-colonisation of MS was assessed at one, two, four and six week time periods. The data obtained were subjected to a repeated measures design. RESULTS: Chlorhexidine varnish reduced salivary MS significantly at the first, second and fourth weeks compared to baseline values. Significant MS suppression lasted less than six weeks and MS colonisation gradually returned to baseline level. CONCLUSION: Repeated application of chlorhexidine varnish in orthodontic patients with high MS levels may be beneficial throughout fixed appliance orthodontic treatment.

Effect of a low-viscosity adhesive resin on the adhesion of metal brackets to enamel etched with hydrochloric or phosphoric acid combined with conventional adhesives.

PURPOSE: This study investigated the effect of a low-viscosity adhesive resin (Icon) applied after either hydrochloric (HCl) or phosphoric acid (H3PO4) on the adhesion of metal brackets to enamel. Failure types were analyzed. MATERIALS AND METHODS: The crowns of bovine incisors (N = 20) were sectioned mesio-distally and inciso-gingivally, then randomly assigned to 4 groups according to the following protocols to receive mandibular incisor brackets: 1) H3PO4 (37%)+TransbondXT (3M UNITEK); 2) H3PO4 (37%)+Icon+TransbondXT; 3) HCl (15%)+Icon (DMG)+TransbondXT 4) HCl (15%)+Icon+Heliobond (Ivoclar Vivadent)+TransbondXT. Specimens were stored in distilled water at 37°C for 24 h and thermocycled (5000x, 5°C to 55°C). The shear bond strength (SBS) test was performed using a universal testing machine (1 mm/min). Failure types were classified according to the Adhesive Remnant Index (ARI). Contact angles of adhesive resins were measured (n = 5 per adhesive) on ceramic surfaces. RESULTS: No significant difference in SBS was observed, implying no difference between combinations of adhesive resins and etching agents (p = 0.712; ANOVA). The Weibull distribution presented significantly lower Weibull modulus (m) of group 3 (m = 2.97) compared to other groups (m = 5.2 to 6.6) (p < 0.05). The mean SBS results (MPa) in descending order were as follows: group 4 (46.7 ± 10.3) > group 1 (45.4 ± 7.9) > group 2 (44.2 ± 10.6) > group 3 (42.6 ± 15.5). While in groups 1, 3, and 4 exclusively an ARI score of 0 (no adhesive left on tooth) was observed, in group 2, only one specimen demonstrated score 1 (less than half of adhesive left on tooth). Contact angle measurements were as follows: Icon (25.86 ± 3.81 degrees), Heliobond (31.98 ± 3.17 degrees), TransbondXT (35 ± 2.21 degrees). CONCLUSION: Icon can be safely used with the conventional adhesives tested on surfaces etched with either HCl or H3PO4.

Caries infiltrant combined with conventional adhesives for sealing sound enamel in vitro.

OBJECTIVE: To test the null hypothesis that combining low-viscosity caries infiltrant with conventional adhesive resins would not improve sealing of sound enamel against demineralization in vitro. MATERIALS AND METHODS: Bovine enamel discs (N = 60) with diameter of 3 mm were randomly assigned to six groups (n = 10). The discs were etched with 37% phosphoric acid for 30 seconds and treated with resins of different monomer content forming the following groups: (1) Icon (DMG), (2) Transbond XT Primer (3M ESPE), (3) Heliobond (Ivoclar Vivadent), (4) Icon + Transbond XT Primer, and (5) Icon + Heliobond. Untreated etched samples served as the negative control. Specimens were subjected to demineralization by immersion in hydrochloric acid (pH 2.6) for 80 hours. Calcium dissolution into the acid was assessed by colorimetric analysis using Arsenazo III method at 16-hour intervals. Groups presenting high protection against demineralization were subjected to further acidic challenge for 15 days with calcium measurements repeated at 24-hour intervals. Data were analyzed by Kruskal-Wallis test and Mann-Whitney U-test. RESULTS: Untreated specimens showed the highest amount of demineralization. Icon and Transbond XT primer decreased the mineral loss significantly compared to the control. Heliobond performed significantly better than both Icon and Transbond XT primer. Combination of Icon both with Transbond XT primer or Heliobond served as the best protective measures and maintained the protective effect for the additional 15-day acidic challenge. CONCLUSIONS: Within the limitations of this in vitro study, it could be concluded that the use of low-viscosity caries infiltrant prior to application of the tested conventional adhesives increases their protective effect against demineralization.

Effects of different chlorhexidine pretreatments on adhesion of metal brackets in vitro.

OBJECTIVE: To investigate the effect of chlorhexidine applications in various forms and concentrations on adhesion and failure modes of metal brackets in vitro. MATERIAL AND METHODS: Ninety bovine enamel specimens were allocated to six groups (n=15). Metal brackets were bonded on all specimens after chlorhexidine pre-treatments forming the following groups: (1) untreated specimens (control); (2) 40% varnish (EC40, Biodent BV, Netherlands), remnants removed with brushing mimicking patient cleaning; (3) 40% varnish (EC40), remnants removed with brushing mimicking professional cleaning; (4) 1% varnish (Cervitec Plus, Ivoclar vivadent, Schaan, Liechtenstein), remnants not removed; (5) brushed with% 1 gel (Corsodyl, GlaxoSmithKline, Münchenbuchsee, Germany), remnants not removed; (6) immersed in 0.07% mouthrinse (Corsodyl, GlaxoSmithKline, Münchenbuchsee, Germany), remnant not rinsed. Debonding of brackets was performed using a universal testing machine. Data were analysed using one-way ANOVA and post-hoc Scheffé test. RESULTS: Group 4 performed significantly inferior than all the other groups and the control. Group 4 presented the highest number of adhesive failures at the enamel-resin interface whereas in other groups no failures at adhesive-resin interface was observed. CONCLUSION: Presence of chlorhexidine varnish prior to bracket bonding adversely affects adhesion. Concentration of chlorhexidine pre-treatment has no influence on shear bond strength.

Multidisciplinary management and long-term follow-up of mesiodens: a case report.

Supernumerary teeth are relatively common in the oral cavity and are characterized by an excessive number of teeth. The term "mesiodens" refers to a supernumerary tooth located in the midline of the maxilla between the central incisors. Mesiodens may cause a variety of pathological complications such as impaction of the maxillary central incisors, tooth retention or delayed eruption of the permanent incisors, crowding, eruption within the nasal cavity, formation of diastema, intraoral infection, root anomaly, root resorption of adjacent teeth and cyst formation accompanied by bone destruction. Therefore it is recommended to follow-up with regular radiographic examination. Early diagnosis minimizes treatment needs and prevents associated complications. The present case, followed for 7 years, presented bilateral mesiodens resulting in delayed eruption of the permanent incisors and emphasizes the importance of multidisciplinary management and long-term follow-up.

Combined apexification and orthodontic extrusion of a hypoplastic permanent canine.

Localized infection in the primary teeth was reported as an etiological factor in the formation of a hypoplastic defect in the underlying permanent teeth. The purpose of this report is to present the case of a 10-year-old girl with an unusual local hypoplasia in the mandibular left permanent canine and emphasize the importance of multidisciplinary management, including combined apexification and orthodontic extrusion. The 12-month recall examination revealed no pathology associated with the rehabilitation, and the patient's esthetic and functional expectations were satisfied.