Metal release profiles of orthodontic bands, brackets, and wires: an in vitro study.

AIM: The present study evaluated the temporal release of Co Cr, Mn, and Ni from the components of a typical orthodontic appliance during simulated orthodontic treatment. MATERIALS AND METHODS: Several commercially available types of bands, brackets, and wires were exposed to an artificial saliva solution for at least 44 days and the metals released were quantified in regular intervals using inductively coupled plasma quadrupole mass spectrometry (ICP-MS, Elan DRC+, Perkin Elmer, USA). Corrosion products encountered on some products were investigated by a scanning electron microscope equipped with an energy dispersive X-ray microanalyzer (EDX). RESULTS: Bands released the largest quantities of Co, Cr, Mn, and Ni, followed by brackets and wires. Three different temporal metal release profiles were observed: (1) constant, though not necessarily linear release, (2) saturation (metal release stopped after a certain time), and (3) an intermediate release profile that showed signs of saturation without reaching saturation. These temporal metal liberation profiles were found to be strongly dependent on the individual test pieces. The corrosion products which developed on some of the bands after a 6-month immersion in artificial saliva and the different metal release profiles of the investigated bands were traced back to different attachments welded onto the bands. CONCLUSION: The use of constant release rates will clearly underestimate metal intake by the patient during the first couple of days and overestimate exposure during the remainder of the treatment which is usually several months long. While our data are consistent with heavy metal release by orthodontic materials at levels well below typical dietary intake, we nevertheless recommend the use of titanium brackets and replacement of the band with a tube in cases of severe Ni or Cr allergy.

Long-term skeletal and dental effects of facemask versus chincup treatment in Class III patients : A retrospective study.

OBJECTIVES: To investigate the skeletal and dental changes during chincup versus facemask treatment, to compare the long-term effects of the two appliances, and to document the impact of each on treatment success. METHODS: In all, 61 patients with Class III syndrome were retrospectively analyzed at three examination times: 7.8 ± 1.7 years of age (T0, pretreatment), 9.6 ± 2.4 years of age (T1, posttreatment), and around 15-20 years later (T2, long-term follow-up). RESULTS: Significant changes of specific cephalometric parameters for all treatment times: T0-T1 (SNA, interbase and gonial angle, Björk's sum angle, maxillomandibular differential, and distance of upper lip to esthetic line), T1-T2 (NL-NSL, SNB, mandibular-body length, effective mandibular length, and effective maxillary length), and T0-T2 (mandibular-body length, effective mandibular length, effective maxillary length, maxillomandibular differential, SNB, ANB, gonial angle, Björk's sum angle, and Wits appraisal). The T1-T2 results illustrate that in both treatment groups the typical Class III growth pattern often reappeared after treatment, including gains in SNB angle, condylion-gnathion length, and gonion-menton distance. CONCLUSIONS: Either a facemask or a chincup may be effectively used to treat Class III malocclusion. There were differences in long-term stability. Maxillary development was similarly favorable in both groups of patients with successful outcome. The subgroup in whom chincup treatment had failed were mainly characterized by excessive mandibular growth, or lack of maxillary catch-up growth, with deterioration of the maxillomandibular relationship notably in the initial phase of treatment. Early chincup treatment did not have an adverse impact on the temporomandibular joints.

Retrospective 25-year follow-up of treatment outcomes in angle Class III patients : Early versus late treatment.

OBJECTIVES: To assess early versus late treatment of Class III syndrome for skeletal and dental differences. METHODS: Thirty-eight Class III patients treated with a chincup were retrospectively analyzed. Baseline data were obtained by reviewing pretreatment (T0) anamnestic records, cephalograms, and casts. The cases were assigned to an early or a late treatment group based on age at T0 (up to 9 years or older than 9 years but before the pubertal growth spurt). Both groups were further compared based on posttreatment data (T1) and long-term follow-up data collected approximately 25 years after treatment (T2). RESULTS: Early treatment was successful in 74% and late treatment in 67% of cases. More failures were noted among male patients. The late treatment group was characterized post therapeutically by significantly more pronounced skeletal parameters of jaw size relative to normal Class I values; in addition, a greater skeletal discrepancy between maxilla and mandible, higher values for mandibular length, Cond-Pog, ramus height, overjet, anterior posterior dysplasia indicator (APDI), lower anterior face height, and gonial angle were measured at T1. The angle between the AB line and mandibular plane was found to be larger at T0, T1, and T2, as well as more pronounced camouflage positions of the lower anterior teeth at T0. The early treatment group was found to exhibit greater amounts of negative overjet at T0 but more effective correction at T1. CONCLUSIONS: Early treatment of Class III syndrome resulted in greater skeletal changes with less dental compensation.

Remodelling of the palatal dome following rapid maxillary expansion (RME): laser scan-quantifications during a low growth period.

OBJECTIVES: To evaluate changes in the palatal vault after rapid maxillary expansion (RME) with bonded splint appliances. SETTING AND SAMPLE POPULATION: The sample comprised 24 children (12 boys and 12 girls) with mixed dentition (mean age 8.3 years; range 6.4-10.4 years). MATERIALS AND METHODS: Following expansion, the splint appliance was used as a retainer for 6 months and then removed. Study casts were taken before RME (T0) and when the appliance was removed (T1). Then, 3D laser scans were taken to build complete 3D jaw models. Frontal cross sections were constructed at 53-63, 55-65 and 16-26, exported as coordinates, and finite element calculated to quantify their area, width and height. Maxillary length was also determined. RESULTS: Paired t-tests indicated statistically significant increases in the average palatal width (T1-T0=6.53-6.79 mm) and cross-sectional area (T1-T0=20.39-21.39 mm2) after RME (p<0.001). However, small but statistically significant reductions were observed in palatal height (T1-T0=-0.49 mm, only at 55-65; p<0.001) and length (T1-T0=-0.54 mm; p<0.01). Linear regression analysis showed statistically significant (p<0.001) direct correlations between the widths and respective cross-sectional areas. Age did not influence any measurement. The reliability of the measurements was examined with an intraclass correlation coefficient (ICC). We found an ICC>0.99 (p<0.001) for all tested parameters. CONCLUSIONS: Rapid maxillary expansion distinctly increased mean palatal widths and cross-sectional areas. However, palatal height (55-65) and maxillary length decreased to a small extent.

[A new method for the quantitative and qualitative measurement of tooth movements]. / Eine neue Methode zur quantitativen und qualitativen Messung von Zahnbewegungen.

A new method for the in vivo measurement of the movements of teeth is described. Measuring blocks are attached to brackets and tubes. Calibrated holes are drilled in each side of the blocks. Using an electronic sliding caliper, measurements are made in all three dimensions between moving teeth and blocks of anchored segments. With the aid of a computer programme, these measurements can be used to construct pictures of various teeth. By taking measurements at different stages of treatment, the movements of the teeth can be shown in three-dimensional images.

[The tooth transplant in orthodontic treatment planning]. / Das Zahntransplantat in der kieferorthopädischen Behandlungsplanung.

The analysis of all examined transplant cases combined treated with orthodontics shows a success rate of 76%. It must be underlined that the germ development at the time of the transplantation is of utmost importance. The best possible time proved to be at a root development of 2/3 to 3/4. Exact indication position, a careful atraumatic operation method and a short time of operation are also important factors of a successful transplantation. If all these preconditions are met, this method can be recommended.

[The effect of the vertical bracket position on the orthodontic finish]. / Der Einfluss der vertikalen Bracketposition auf das kieferorthopädische Finish.

As during orthodontic treatment and in particular during the phase of the precise adjustment of occlusion by applying the "straight-wire technique" problems arise as far as the vertical dimensions are concerned, the usual distances between the bracket slots and the edges of the incisors respectively the top of the cusps have been verified. Measurements were done on models at the end of treatment of ten patients treated with fixed attachments who may represent ideal occlusion as far as profile radiographs and gnathology were concerned. After regulation of the plane of occlusion the vertical distances between the slot base plane (parallel to the plane of occlusion) and the edge of the incisors respectively tops of cusps were measured by means of a modified parallelometer in connection with a special slot and tube support as well as a specially developed dial test indicator, while a maximum fit between bracket base and buccal crown surface was given. In case of the upper front brackets (torque + 22 degrees) large vertical measurement to the edge of the incisors were recorded, 8.25 respectively 8.33 mm). This may be attributable to excessive torque of the applied brackets. Only approximate figures for the vertical positioning for other teeth could be given, as anatomical variations have to be considered.

[The positioner--a possibility for the fine adjustment of the occlusion objectively assessed by condylar measurements of the discrepancy between the ICP and RCP]. / Der Positioner--eine Möglichkeit zur Feineinstellung der Okklusion, objektiviert durch Kondymetermessungen der Diskrepanz zwischen IKP und RKP.

A group of ten adolescents was treated with fixed appliances at the Department of Stomatology and Oral and Maxillofacial Surgery, Graz. Subsequently the patients were fitted with a gnathological positioner. On the day of band removal ten sets of models were made and subsequently two, four and twelve weeks later. They were mounted on an articulator and cephalometric measurements were taken three times by each of the examiners. These records served to provide evidence of discrepancies of the condylar position between ICP and RCP in all three planes. In the second part of the examination, the patients were instructed to wear the appliance at night for another year. Casting of models, mounting in articulators and condymetric measurements were repeated as above. After wearing the positioner for three months, we observed a definite improvement of the occlusion and a wide conformity of the RCP and ICP measurements. After one year of night-time retention there was a slight increase of the mean values. In addition, we could establish statistically that condymetric model measurements are independent of the examiner and the method employed.

[Fixed appliances current state of the art]. / Standortbestimmung für die Anwendung festsitzender kieferorthopädischer Geräte.

Recent advances in fixed appliances are reviewed and discussed. These include cosmetically more appealing brackets (ceramic, lingual); new wires (nickel-titanium and titanium-molybdenum alloys); new biomechanical approaches (accurate computation of forces and torques according to Burstone resulting in the use of new mechanical concepts); experiences in the treatment of transplanted teeth made in the past 15 years; new approaches to the orthodontic finish (implementation of Andrews' "six keys to normal occlusion" with straight wires, accurate positioning of brackets, and gnathological positioners). Cases will be demonstrated.

[Adhesive strength and bonding behavior in graphite-marked bracket positioning]. / Adhäsionskräfte und Kleberverhalten bei graphitmarkierter Bracketposition.

During a one-year observation period eleven patients treated with fixed appliances and 164 brackets which had been bonded in pairs, were checked at periodic intervals. Every patient had brackets positioned on the teeth in the first and fourth quadrant without graphite marking and in the second and third quadrant with graphite marking. In a parallel in-vitro study with eight pairs of teeth the above described conditions were applied. These specimens were examined in an universal testing machine in order to determine the magnitude of the shear forces. In the in-vivo as well as in the in-vitro study no statistically significant correlations were revealed between the graphite marking and the durability of adhesion as well as the required shear force of the examined brackets. Utilising light microscopy studies, the penetration of adhesive was determined in relation to the position of the graphite marking in etched enamel; at was harmlessness of the reference medium.