A case series of wind instrument players with cleft lip and/or palate.

It might be more difficult for patients with cleft lip and/or palate (CL/P) to generate sufficient muscle tension of the upper lip and intraoral air pressure to play a wind instrument. We aimed to explore and describe the key aspects of wind instrument playing with a repaired cleft. An in-depth interview was conducted among ten patients with CL/P and one with a functionally comparable problem and we found that: individuals with CL/P can achieve a professional level on a wind instrument; the oboe and trumpet may be less suitable for patients with CL/P because of the high lip muscle tension and intraoral air pressure that must be generated; air leakage through a fistula, unrepaired alveolus or velopharyngeal insufficiency can be troublesome; and for people with CL/P, a brass instrument with a large mouthpiece is easier than a small mouthpiece. While dentists, doctors and music teachers should discuss the probability that wind instrument playing might be more difficult for patients with CL/P, they should not discourage it.

Corrosion of orthodontic brackets: qualitative and quantitative surface analysis.

OBJECTIVES: To determine and compare surface characteristics and presence of corrosion in new and used brackets with optical light microscopy (OLM) and scanning electron microscopy (SEM), and with elemental chemical analysis with energy-dispersive X-ray spectroscopy (EDS). MATERIALS AND METHODS: OLM and SEM were used to analyze 24 new and 24 used conventional premolar brackets. EDS analysis was performed in six used brackets and four new brackets with corrosion-suspected spots. RESULTS: OLM and SEM images showed wear/abfraction signs, striations, pits/crevices, and adherent material. Used brackets showed more deterioration than new brackets. SEM images disclosed more morphological features than OLM images. EDS analysis revealed a significantly higher phosphorus (P = .001) and sodium (P < .005) weight fraction and significantly lower amounts of chromium (P < .001) in used brackets. The iron, chromium, and nickel weight fractions did not differ significantly between the clean and corrosion-suspected spots. Of the corrosion-suspected spots analyzed by combined SEM and EDS, 44.14% and 6.90% remained corrosion-suspected on used and new brackets, respectively. CONCLUSIONS: Used brackets showed more signs of corrosion than new ones. Combined assessment of SEM and EDS indicates that the bracket surface is affected during orthodontic treatment as a result of corrosion.

Attractiveness assessment by orthodontists and laypeople judging female profile modifications of Class II Division 1 malocclusion.

INTRODUCTION: The objective of this study was to evaluate the differences in preference between orthodontists and laypeople, judging soft tissue digital alterations of a Class II Division 1 profile of a female patient with mandibular retrognathia, produced by simulated camouflage and mandibular advancement therapy. METHODS: The profile image of a White woman with a Class II Division 1 mandibular retrognathic profile was digitally modified to produce 7 pictures: 1 baseline, 3 stepwise increase in the nasolabial angle of 113°, 121°, and 129°, and 3 stepwise increase in chin-neck length of 51 mm, 54 mm, and 57 mm. Forty-four orthodontists and 162 laypeople assessed these 7 images. RESULTS: The untreated baseline profile was found to be least attractive for both orthodontists and laypeople, with orthodontists scoring significantly lower than laypeople. The profiles representing mandibular advancement therapy were judged significantly better by both groups than camouflage therapy. Orthodontists preferred straighter profiles than laypeople, giving the highest-ranking to a chin-neck length of 57 mm, whereas laypeople gave the highest rank to a chin-neck length of 54 mm. CONCLUSIONS: Orthodontists prefer straighter profiles and gave a lower ranking to the untreated Class II Division 1 female profile compared with laypeople. Orthodontists and laypeople favor mandibular advancement therapy over camouflage therapy. However, both groups seem to prefer the effect of both treatment modalities over the untreated baseline Class II Division 1 profile.

Development of a clinical practice guideline for orthodontically induced external apical root resorption.

OBJECTIVES: To develop a clinical practice guideline on orthodontically induced external apical root resorption (EARR), with evidence-based and, when needed, consensus-based recommendations concerning diagnosis, risk factors, management during treatment, and after-treatment care. MATERIALS AND METHODS: The Appraisal of Guidelines for Research and Evaluation II instrument and the Dutch Method for Evidence-Based Guideline Development were used to develop the guideline. Based on a survey of all Dutch orthodontists, we formulated four clinical questions regarding EARR. To address these questions, we conducted systematic literature searches in MEDLINE and Embase, and we performed a systematic literature review. The quality of evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. After discussing the evidence, a Task Force formulated considerations and recommendations. The drafted guideline was sent for comments to all relevant stakeholders. RESULTS: Eight studies were included. The quality of evidence (GRADE) was rated as low or very low. Only the patient-related risk factors, 'gender' and 'age', showed a moderate quality of evidence. The Task Force formulated 13 final recommendations concerning the detection of EARR, risk factors, EARR management during treatment, and after-treatment care when EARR has occurred. Stakeholder consultation resulted in 51 comments on the drafted guideline. After processing the comments, the final guideline was authorized by the Dutch Association of Orthodontists. The entire process took 3 years. LIMITATIONS: The quality of the available evidence was mainly low, and patient-reported outcome measures were lacking. CONCLUSIONS/IMPLICATIONS: This clinical practice guideline allows clinicians to respond to EARR based on current knowledge, although the recommendations are weak due to low-quality evidence. It may reduce variation between practices and aid in providing patients appropriate information.

Differences in attractiveness comparing female profile modifications of Class II Division 1 malocclusion.

INTRODUCTION: Our objective was to study the perceptions of laypeople for digital alterations and the amount of nasolabial angle increase that is tolerable and how much chin-neck length increase is needed to achieve a desirable profile in Class II Division 1 women with mandibular retrognathia. METHODS: The profile image of a white woman with a Class II Division 1 mandibular rethrognatic profile was digitally modified to create 6 images: 3 with stepwise increased nasolabial angles of 113°, 121°, and 129°, and 3 with stepwise increased chin-neck distances of 51, 54, and 57 mm. These images were assessed and ranked by 155 white laypeople. RESULTS: The baseline profile was judged significantly as the least attractive. A nasolabial angle of 129° was judged as unattractive as the baseline profile. Profiles with a chin-neck length of 54 and 57 mm were equally judged as most attractive. CONCLUSIONS: The untreated (baseline) profile was found to be least esthetic, as well as the profile with the largest nasolabial angle. Nasolabial angle increases up to 121° seem to be acceptable. Profiles simulating a chin-neck length increase as produced by surgery seem to be most favored.

Overjet reduction in relation to wear time with the van Beek activator combined with a microsensor.

INTRODUCTION: The aim of this study was to use a microsensor to investigate the association among overjet reduction, treatment duration, and wear time of the van Beek activator. METHODS: The study sample comprised patients (n = 28) with a mean age of 11.60 (±1.25) years at start of treatment treated with the van Beek activator. The prescribed wear time was 12 hours per day. The evaluation period was limited to the first 3 appointments. The wear times during the 3 intervals were assessed. Treatment periods with good compliance were characterized by a wear time of 8 hours or more per day. RESULTS: The medians of overjet were 9.00 mm at the start of treatment and 5.75 mm at the third appointment. The mean total wear time throughout the evaluation period was 7.75 (±3.66) hours per day. Significant correlations were found at the 3 intervals. Patients with a mean wear time of 8 hours or more per day achieved significantly greater overjet reductions. Patients with good compliance of at least 5 months showed significantly greater overjet reductions. CONCLUSIONS: Significant overjet reduction was achieved with a minimum daily wear time of 8 hours for at least 5 months. The level of compliance had a strong tendency to be maintained throughout the treatment period. No patient achieved the prescribed wear time of 12 hour per day.

The reliability of assessing rotation of teeth on photographed study casts.

OBJECTIVE: To examine the intra- and interexaminer reliability of assessing rotation of teeth on photographed study casts. In addition, the reliability parameters of two examiners scoring in mutual consultation were compared with the reliability parameters by one observer. MATERIALS AND METHODS: Standardized photographs of sets of maxillary and mandibular plaster casts of 10 patients before treatment (T1), after treatment (T2), and a long time after retention (T3) were digitized. Tooth rotation was assessed relative to a correct position in the ideal dental arch form. A computer analysis program was used to process the measurements. Two examiners assessed each study cast twice with a washout period of 3 weeks. A third examiner assessed each cast, together with one of the other examiners. The intra- and interexaminer agreements were calculated using intraclass correlation coefficients (ICCs). Wilcoxon signed-rank tests were used to determine significant differences between the intra- and interexaminer reliability coefficients of the three examiners. RESULTS: The ICCs ranged from 0.430 to 0.991. Incisors showed the highest ICCs and molars showed the lowest ICCs. Intraexaminer ICCs of the experienced examiners were significantly higher than those of the examiner with less experience. No significant differences in the reliability between a single examiner and the combination of two examiners were found. CONCLUSION: The method of assessing tooth rotation in the present study has proved to be reproducible, except for the molars. This method can be helpful for clinicians assessing tooth rotation from photographed study casts.

Relationship between dental anomalies and orthodontic root resorption of upper incisors.

The aim of this study was to examine the potential relationship between the occurrence of orthodontic root resorption and presence of dental anomalies such as tooth agenesis and pipette-shaped roots. Dental anomalies and root resorption were assessed on dental panoramic tomographs (DPT) of 88 subjects, 27 males and 61 females, mean age 28.4 (SD = 11.3 years), selected from orthodontic patients on the basis of the following exclusion criteria: previous fixed appliance treatment, bad quality of the DPTs and no visibility of the periodontal ligament of every tooth, and younger than 15 years of age at the onset of treatment with fixed edgewise appliance lasting at least 18 months. A pipette-shaped root was identified as defined by a drawing. Tooth agenesis was assessed on DPTs and from subjects' dental history. Root resorption was calculated as the difference between the root length before and after treatment, with and without a correction factor (crown length post-treatment/crown length pre-treatment). If one of the four upper incisors showed root resorption of ≥2.3 mm with both formulas, the patient was scored as having root resorption. Chi-square tests indicated that there was no relationship between orthodontic root resorption and agenesis (P = 0.885) nor between orthodontic root resorption and pipette-shaped roots (P = 0.800). There was no relationship between having one of the anomalies and root resorption either (P = 0.750). In the present study, it was not possible to confirm on DPTs a relationship between orthodontic root resorption and dental anomalies, such as agenesis and pipette-shaped roots.

Assessment of dental anomalies on panoramic radiographs: inter- and intraexaminer agreement.

The presence of dental anomalies has been rated radiographically in a number of studies. However, since the reliability of the assessment of these anomalies has rarely been investigated, the aim of this study was to examine inter- and intraexaminer agreement in identifying morphological dental anomalies, such as tooth agenesis, dilacerated, pipette-shaped, blunt, pointed, and short roots. Pre-treatment panoramic radiographs of 40 patients (13 males and 27 females; mean age 27.7 ± 10.8 years) treated between 1983 and 2008 were selected. Four examiners independently assessed the radiographs twice. For a dilacerated root and agenesis, a definition was given. For pipette-shaped, blunt, or pointed roots, a drawing was shown, and for a short root, a ratio was used to identify the anomaly. Intraexaminer agreement of the assessments of the dental anomalies was presented by Cohen's Kappa and varied between -0.01 for short roots and 1.00 for agenesis. With respect to short roots, three of the examiners did not rate them to be present on at least one measurement occasion. This implies that intraexaminer agreement could not be calculated for these three examiners. Interexaminer agreement for dilacerated roots varied between 0.14 and 0.50, for pipette-shaped roots between -0.01 and 0.33, for blunt roots between 0.05 and 0.32, and for pointed roots between 0.17 and 0.37. All values for agenesis were 1.00. It can be concluded that assessing agenesis on panoramic radiographs is reliable. Rating the presence of dilacerated, pipette-shaped, blunt, pointed, and short roots on panoramic radiographs, however, does not result in a reliable assessment.

Effect of long-term repeated deflections on fatigue of preloaded superelastic nickel-titanium archwires.

INTRODUCTION: The aim of this in-vitro study was to investigate the changes in force delivery of superelastic nickel-titanium archwires used in combination with a self-ligating bracket system after dynamic fatigue-loading in a 3-bracket model under controlled temperature. METHODS: Samples of 2 superelastic nickel-titanium (active austenitic) wires, a conventional nickel-titanium wire, and a stainless steel wire, all 0.014-in round, were divided into 2 groups: static deflection and dynamic deflection. The static specimens were under a constant deflection of 3.0 mm. The dynamic specimens had the same constant deflection of 3.0 mm but were subjected to additional repeated deflections of 0.5 mm, applied by a fatigue tester. The test situation simulates a patient's archwire under deflection and subjected to occlusal contact during 1, 100, 10,000, and 100,000 cycles. Fatigue changes were assessed with a 3-point bending test. RESULTS: Type of wire, loading or unloading, and number of cycles as within-subject factors were statistically significantly different. No statistically significant difference between the test condition, static vs dynamic, was found. The repeated deflections of 0.5 mm were not enough to induce an extra effect of fatigue. CONCLUSIONS: Occlusal forces transferred to a considerably deflected archwire, such as in the large malalignments in the early stages of orthodontic treatment, will have no fatigue effect on the unloading force of that archwire.

Dentoalveolar compensation in subjects with vertical skeletal dysplasia.

INTRODUCTION: The purpose of this cephalometric study was to investigate vertical dentoalveolar compensation in untreated adults with excessive (long-face) and deficient (short-face) lower anterior face heights. METHODS: Vertical and sagittal base relationships, vertical dentoalveolar dimension in the anterior region of the jaws, incisor inclination, overbite, and overjet were assessed in 112 short-face and 95 long-face subjects. The contribution of skeletal and dentoalveolar components to achieve a normal overbite was assessed by means of regression analysis. For the 2 most important independent variables of the regression equation, the values were calculated that would render an overbite of 2 mm. It was subsequently investigated whether the calculated value fell within the range of the sample. RESULTS: In long-face subjects, overbite was mainly related to lower anterior face height; in short-face subjects, it was mainly related to mandibular anterior alveolar and basal heights. Dentoalveolar compensation occurred in both groups mainly by adaptations in mandibular incisor alveolar and basal heights. Molar height was unrelated to overbite. Cutoff values for achieving a positive overbite were calculated for lower face height and mandibular incisor alveolar and basal heights. CONCLUSIONS: The lower face height mainly determines the overbite in long-face subjects, while in short-face subjects, lower dentoalveolar morphology influences overbite. Lower dentoalveolar compensation can maintain a normal overbite in long-face subjects to a limited extent.

Post-treatment development of the curve of Spee.

The aim of this study was to investigate the post-treatment development of the curve of Spee (CS) and to predict its post-treatment stability on the basis of cephalometric parameters. Lateral cephalograms and study models of 135 subjects (50 males and 85 females) were taken before orthodontic treatment (T1; 12.0 +/- 1.5 years), at the end of orthodontic treatment (T2; 14.6 +/- 1.5 years), and at least 3 years out of retention (T3; 26.6 +/- 5.0 years); the curve depth (CD), location of the deepest point (LDP) of the curve, and eight cephalometric parameters were assessed. The sample was divided into a treated and an untreated lower arch group. The upper arch was treated in all patients. The sample consisted of 25 per cent Class I, 73 per cent Class II, and 2 per cent Class-III-treated malocclusions. The results showed that the post-treatment CD was frequently unstable and unexpected changes were relatively common. The LDP was displaced distally during T1-T2 and showed mesial relocation during T2-T3. Assessment of potential predictors of the post-treatment changes in CD and LDP using stepwise regression analysis showed that a deep curve at T2 was associated with a decrease of the CD during T2-T3. A combination of distal location of the LDP with proclination of the lower incisors at T2 and extraction treatment was associated with mesial relocation of the LDP during T2-T3. The results also suggest that an optimal CD of about 2.0 mm at T2 was associated with the least amount of post-treatment change.