[Oral and periodontal hygiene in orthodontic patients]. / Hygiène orale et parodontale chez les patients porteurs de dispositifs orthodontiques.

INTRODUCTION: Orthodontic appliances promote dental plaque retention and make tooth-brushing less easy. They result in both quantitative and qualitative changes in dental plaque, exposing orthodontic patients to dental caries and periodontal diseases. MATERIALS AND METHODS: The authors explain the effects of orthodontic treatments on dental plaque and the occurrence of dental and periodontal problems; they emphasize the role of pathogenic bacteria and highlight the need for efficient (both individual and professional) control of dental plaque. DISCUSSION: Therefore, orthodontists have to educate their patients on oral and periodontal hygiene in order to control this bacterial factor and to avoid the occurrence of dental and/or periodontal complications.

Orthodontically induced external apical root resorption in patients treated with fixed appliances vs removable aligners.

OBJECTIVE: To determine whether orthodontic treatment with removable aligners vs fixed orthodontic appliances is associated with a different frequency of orthodontically induced external apical root resorption (OIEARR) when genetic, radiographic, and clinical factors are accounted for. MATERIALS AND METHODS: Three hundred seventy-two orthodontic patients treated with removable aligners (Invisalign) or fixed appliances were genetically screened for interleukin 1B gene (IL1B) (rs1143634), interleukin 1 receptor antagonist gene (IL1RN) (rs419598), and osteopontin gene (SPP1) (rs9138/rs11730582). Twelve clinical variables, potentially associated with OIEARR, were also considered. Subjects were divided according to the presence of radiographically determined OIEARR (>2 mm). The association between OIEARR and appliance type, and radiographic, clinical and genetic factors, was assessed using backward stepwise conditional logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS: Reliability of the methods was adequate. Clinical case complexity (American Board of Orthodontics [ABO] Discrepancy Index) (OR: 1.032; 95% CI: 1.005-1.061; P = .021) and extent of incisor apical displacement in the sagittal plane (OR: 1.478; 95% CI: 1.285-1.699; P = .001) were associated with an increased OIEARR risk. After adjusting for associations between clinical/radiographic/genetic factors, there were no statistically significant differences with respect to OIEARR or type of orthodontic appliance used, whether removable aligners or fixed appliances (OR: 1.662; 95% CI: 0.945-2.924; P = .078). Only subjects homozygous for the T allele of IL1RN (rs419598) were more prone to OIEARR during orthodontic treatment (OR: 3.121; CI: 1.93-5.03; P < .001). CONCLUSIONS: A similar OIEARR predisposition was identified using either removable aligners (Invisalign) or fixed appliances.

Objective assessment of compliance with intra- and extraoral removable appliances.

OBJECTIVE: To conduct an objective assessment of the level of compliance in young patients prescribed various types of removable appliances and to determine the influence of device type, treatment duration, and patient age, gender, psychological maturity, and awareness of monitoring on compliance. MATERIALS AND METHODS: A total of 30 patients were fitted with either a class 2 (Frankel or bionator) or a class 3 (face mask) removable appliance, each bearing a compliance indicator chip, and they were instructed to wear them for 13 hours per day. Compliance was monitored by means of the sensor for an average of 8 months. Of the patients, 14 were informed that their appliance was fitted with a monitoring sensor, and 16 were not. The psychological maturity of all patients was assessed on the Nowicki-Strickland Locus of Control Scale, and the effect on compliance of this score as well as the patient- and treatment-related variables considered were determined via statistical analysis Results: The mean compliance recorded by the chips was 8.6 ± 2.9 hours, far lower than the 13 hours prescribed, and younger patients showed significantly greater compliance than adolescents (P < .01). However, no significant differences in compliance were found between intra- and extraoral appliances, and neither gender, psychological scores, treatment duration, nor awareness of being monitored had any significant effect. CONCLUSIONS: Compliance is generally very poor in young patients, regardless of their gender and psychological maturity. Although awareness of monitoring does not appear to boost compliance, such systems may be a valuable means of providing a dentist with objective information regarding their patients' compliance.

A randomized controlled trial of self-perceived pain, discomfort, and impairment of jaw function in children undergoing orthodontic treatment with fixed or removable appliances.

OBJECTIVE: To compare patients' perceptions of fixed and removable appliance therapy for correction of anterior crossbite in the mixed dentition, with special reference to perceived pain, discomfort, and impairment of jaw function. MATERIAL AND METHODS: Sixty-two patients with anterior crossbite and functional shift were recruited consecutively and randomized for treatment with fixed appliances (brackets and archwires) or removable appliances (acrylic plates and protruding springs). A questionnaire, previously found to be valid and reliable, was used for evaluation at the following time points: before appliance insertion, on the evening of the day of insertion, every day/evening for 7 days after insertion, and at the first and second scheduled appointments (after 4 and 8 weeks, respectively). RESULTS: Pain and discomfort intensity were higher for the first 3 days for the fixed appliance. Pain and discomfort scores overall peaked on day 2. Adverse effects on school and leisure activities were reported more frequently in the removable than in the fixed appliance group. The fixed appliance group reported more difficulty eating different kinds of hard and soft food, while the removable appliance group experienced more speech difficulties. No significant intergroup difference was found for self-estimated disturbance of appearance between the appliances. CONCLUSIONS: The general levels of pain and discomfort were low to moderate in both groups. There were some statistically significant differences between the groups, but these were only minor and with minor clinical relevance. As both appliances were generally well accepted by the patients, either fixed or removable appliance therapy can be recommended.

In vivo evaluation of the genotoxic effects of Hyrax auxiliary orthodontic appliances containing silver-soldered joints.

Auxiliary appliances consisting of silver-soldered joints may be present in the patient's oral cavity for a long time. The aim of this study was to investigate, in vivo, the potential genotoxic effects of Hyrax-type maxillary expanders containing silver-soldered joints on the cells of the buccal mucosa. Buccal cells were collected from 20 patients and processed to perform the buccal comet assay (BCA) and the buccal micronucleus cytome (BMCyt) assay, to investigate DNA and chromosomal damage, respectively. For the BCA, patients were evaluated before and 14 days after the appliances were installed. For the BMCyt assay, the patients were evaluated longitudinally; before the insertion of the appliance and after one, six, and twelve months. The BCA showed significant increases in damage frequency and damage index in exfoliated buccal cells, following insertion of the appliance. For the BMCyt assay, the endpoints related to cell proliferation, cell death, and chromosomal damage (micronuclei and nuclear buds) resulted in no significant differences over the 12-month study period. In conclusion, the use of orthodontic appliances containing silver-soldered joints can significantly increase DNA damage as measured by the BCA.

The impact of orthodontic appliances on eating - young people's views and experiences.

OBJECTIVES: Orthodontic appliances are known to cause patients difficulty with eating. Learning more about the issues patients face, while eating with orthodontic appliances in place, will allow us to create more informative and relevant patient information, thereby improving patient compliance and treatment success. This study aims to understand how orthodontic appliances impact on eating in the broader context and to explore adolescent patients' perceptions of eating with orthodontic appliances. METHODS: Purposive sampling was used and 19 participants currently undergoing orthodontic treatment and aged 11-14 years were selected for either a focus group or semi-structured interview to explore eating-related issues. Data collection and analysis were carried out as an iterative process broadly following principles of thematic analysis. Data collection ceased when no new themes emerged. RESULTS: Two main themes relating to eating problems emerged: restriction of food choice and problems associated with the eating process. Participants reported restricting food choice due to physical aspects of the appliance, advice given by their orthodontist, fear of breakage and also to minimize embarrassment. Participants also reported problems with the time taken to eat, chewing problems, taste change and being messy while eating. Additionally, time in treatment, the location of eating and relationship with those present during eating influenced emotions. Some participants indicated a positive impact of orthodontic appliances on their diet. CONCLUSIONS: These results can be used to further inform dietary advice offered to patients. Factors were identified which may not be considered in clinical practice but which could improve the value of dietary advice given to patients.

Craniofacial imaging in orthodontics--past present and future.

Images of the craniofacial region are an important component of the orthodontic patient record. The gold standard that orthodontic records attempt to achieve is the accurate replication or portrayal of the "anatomic truth". The anatomic truth is the accurate three-dimensional anatomy, static and in function, as it exists in vivo. Despite the diverse image acquisition technologies currently available, the types and standards for imaging presently used in practice have been adopted in an effort to balance the anticipated benefits with associated costs and risks to the patient. Because of these considerations, orthodontists routinely use an array of two-dimensional static imaging techniques to record the three-dimensional anatomy of the craniofacial region. The development of an interactive 3D digital model of a patient's anatomy would greatly improve our ability to determine different treatment options, to monitor changes over time (the fourth dimension), to predict and display final treatment results, and to measure treatment outcomes more accurately. This review explores the different techniques of 3D imaging of the teeth, as well as the recent efforts to create the 'virtual orthodontic patient' by using 3D soft and hard tissue data. A brief overview of some of the commercially available 3D-based technologies, such as OrthoCAD and Invisalign is given at the end. The objective of this review is to provide the clinician with an overview of the currently used imaging methods along with those of the past and also a look at the innovations in craniofacial imaging that are likely to greatly enhance the depiction of craniofacial structures.

Orthodontic treatment of anterior open bite: a review article--is surgery always necessary?

INTRODUCTION: Anterior open bite cases are very difficult to treat satisfactorily because of their multifactorial aetiology and their very high relapse rate. Dependent on the origin of the anterior open bite malocclusion and the patient's age, there are several treatment possibilities ranging from deterrent appliances, high-pull headgear, fixed appliances with and without extractions to orthognathic surgery, and skeletal anchorage with miniplates or miniscrews. METHODS: The gold standard treatment of skeletal anterior open bite cases is the combined approach of orthodontic treatment with fixed appliances and orthognathic surgery. In recent years, temporary anchorage devices (TAD) have been developed to correct anterior open bites orthodontically. With the introduction of TAD as an effective treatment modality, orthognathic surgery may be avoidable in selected anterior open bite cases. CONCLUSION: This is a relatively new technique and to date there remains a lack of evidence of long-term stability of anterior open bite closure with TAD.

Orthodontic treatment by general practitioners in consultation with orthodontists--a survey of appliances recommended by Swedish orthodontists.

The aim of the present study was to disclose the treatment procedures most frequently recommended by Swedish orthodontists for use by general practitioners and to determine whether these recommendations are reflected in the undergraduate dental program in orthodontics at Malmö University. Potential differences between the ortho- dontists' recommendations were also investigated. A questionnaire was sent to 169 consulting orthodontists, seeking their recommenda- tions for appliance therapy to be undertaken by general practitioners: 129 (63 males and 66 females) responded. The Quad Helix was the appliance most commonly recommended for correction of posterior crossbite, a plate with Z-springs for correction of anterior crossbite and the headgear activator for correction of Class II malocclusions. A significant gender difference was disclosed with respect to orthodontists' recommendations for treatment of Class II malocclusions by general practitioners, namely that female orthodontists recommended the headgear activator more frequently than males. However, this difference is most likely attributable to the gender distribution among orthodontists qualifying as specialists during the last five decades: more recently qualified orthodontists are predominantly female. The choice of appliances corresponded well with undergraduate training in orthodontics at the Faculty of Odontology in Malmö.

Outcome of orthodontic care and residual treatment need in Swedish 19-year-olds.

The purpose of the study was to assess the outcome of orthodontic care in Linköping, Sweden. The dental records of 207 (107 M, 100 F) 19-year-olds registered at one public dental health clinic were studied. A clinical examination was performed where malocclu- sions were registered, where after residual orthodontictreatment need was measured using the Index of Complexity, Outcome and Need (ICON). The 19-year-olds also filled in a questionnaire regarding residual subjective orthodontic treatment demand. Differences between genders were analysed. One hundred and ten (47 M, 63 F) individuals (53.1%) had partaken in orthodontic consultations. Orthodontic appliance treatment had been received by 86 (38 M, 48 F) individuals (41.6%). A residual orthodontic treatment need was registered in 28 (22 M, 6 F) individuals (13.5%). Residual subjective orthodontic treatment demand was expressed by 9 (3 M, 6 F) indi- viduals (4.3%). Eight (2 M, 6 F) of those had no residual treatment need. A higher (p = 0.006) rate of females (63.0%) than males (44.0%) had participated in ort- hodontic consultations. The proportion of males (35.5%) who had experienced orthodontic treatment was not significantly lower (p = 0.069) than among the females (48.0%). However, a lower (p = 0.009) proportion of treated males (55.3%; n = 21 out of 38) than of treated females (81.3%; n = 39 out of 48) had received their treatment by orthodontic specialists. At 19 years of age, the proportion of males with residual treatment need (20.6%) was higher (p = 0.002) than among the females (6.0%). Every patient with orthodontic treatment need and -demand at 19 years of age had previously been offered orthodontic treatment. The conclusion was drawn that the orthodontic care scheme had successfully diagnosed and treated orthodontic problems in the population. However, notable differences between genders regarding treatment modalities and the amount of residual treatment need at age 19 were found.

Acceptability and attractiveness of intra- and extra-oral orthodontic appliances.

OBJECTIVES: To evaluate the acceptability of different intra-oral and extra-oral orthodontic appliances, to rank orthodontic appliances from the most to the least attractive and to investigate the factors that may affect the acceptance of orthodontic treatment. SUBJECTS: A random sample of 800 students (schoolchildren and university students) were invited to participate in this study and a total of 688 students were included (86%). METHODS: A self-administrated structured questionnaire was constructed for the purpose of this study. RESULTS: More than one-half in each age group (53%) claimed that they would accept to have orthodontic treatment. Acceptance of the different orthodontic appliances was affected by gender, age and type of school. Removable appliance was reported as the most acceptable and facemask was reported as the least acceptable orthodontic appliances. Majority of subjects ranked ceramic and facemask appliances as the most and the least attractive orthodontic appliances, respectively. The predictor variables for the acceptance of orthodontic treatment were perceived demand for orthodontic treatment, perceived positive effect of orthodontic treatment and expected benefits from orthodontic treatment. CONCLUSIONS: Removable appliance was the most acceptable orthodontic appliance whereas ceramic appliance was ranked as the most attractive one. Facemask was the least acceptable and the least attractive option.

Intraoral distalizer effects with conventional and skeletal anchorage: a meta-analysis.

INTRODUCTION: The aims of this meta-analysis were to quantify and to compare the amounts of distalization and anchorage loss of conventional and skeletal anchorage methods in the correction of Class II malocclusion with intraoral distalizers. METHODS: The literature was searched through 5 electronic databases, and inclusion criteria were applied. Articles that presented pretreatment and posttreatment cephalometric values were preferred. Quality assessments of the studies were performed. The averages and standard deviations of molar and premolar effects were extracted from the studies to perform a meta-analysis. RESULTS: After applying the inclusion and exclusion criteria, 40 studies were included in the systematic review. After the quality analysis, 2 articles were classified as high quality, 27 as medium quality, and 11 as low quality. For the meta-analysis, 6 studies were included, and they showed average molar distalization amounts of 3.34 mm with conventional anchorage and 5.10 mm with skeletal anchorage. The meta-analysis of premolar movement showed estimates of combined effects of 2.30 mm (mesialization) in studies with conventional anchorage and -4.01 mm (distalization) in studies with skeletal anchorage. CONCLUSIONS: There was scientific evidence that both anchorage systems are effective for distalization; however, with skeletal anchorage, there was no anchorage loss when direct anchorage was used.

Partial glossectomy as an auxiliary method to orthodontic treatment of dentofacial deformity

Introduction: macroglossia is a condition which influences the size and shape of the teeth employed due to the forces on teeth. Objective: To establish bases for the indication of partial glossectomy associated with orthodontic treatment and surgical dento-facial deformity in patients without tumors and Down syndrome as a cause of macroglossia. Case reports: Three patients underwent orthognathic surgery associated with partial glossectomy under general anesthesia. All patients had macroglossia relative and underwent clinical assessment taking into account the respiratory function, swallowing and speech deficits and radiological evaluation. The technique used consist of segmental resection along the median raphe of the tongue and suture by planes. We used rigid skeletal fixation with titanium plates and screws so that patients could stay without intermaxillary block in the immediate postoperative period. Were followed over five years. The symptoms regressed completely and all skeletal segments remained stable. Discussion: The decision to refer the patient to partial glossectomy should be based on the volume of the language, mobility, position, function, symptoms, speech intelligibility, skeletal anterior open bite, interference in orthodontic treatment, drooling, swallowing and tongue trauma applicant...

Comparison of the orthodontic load systems created with elastomeric power chain to close extraction spaces on different rectangular archwires.

INTRODUCTION: The 3-dimensional load system (forces and moments) was quantified at the canine bracket during space closure with sliding mechanics with elastomeric chain on dry and wet stainless steel and beta-titanium 0.019 × 0.025-in archwires. METHODS: A custom-made maxillary dentoform simulating first premolar extractions was attached to an orthodontic force tester. The canine was attached to a load cell through an adaptor with silicone simulating the periodontal ligament. The orthodontic force tester simultaneously measured the entire load system produced at the canine bracket by an elastomeric chain. The effects of archwire material, time (activation and 1 hour), and lubrication were analyzed by using 3-way repeated measures analysis of variance (ANOVA, α = 0.05). RESULTS: Stainless steel provided a greater (P = 0.001) load system than did beta-titanium. The force was greatest on the canine in the lingual axis. The greatest moment was about the y-axis. The moment-to-force ratio, the most critical ratio, was greater for beta-titanium than stainless steel; however, both were close to the ideal 10:1. CONCLUSIONS: With a stainless steel archwire for retraction sliding mechanics, a canine will experience a greater load system in all 3 dimensions than with a beta-titanium wire. Both archwires produced a moment-to-force ratio adequate for translation.

Aparelho de protração mandibular Forsus no tratamento das más oclusões do Padrão II: relato de caso clínico / Pattern II malocclusions treatment with Forsus mandibular protraction appliance: case report

O presente artigo tem o objetivo de descrever, por meio de um caso clínico, a aplicação do aparelho ortopédico fixo híbrido Forsus (3M Unitek, Monrovia) no tratamento de um paciente Padrão II, com deficiência mandibular e relação oclusal de Classe II, 1ª divisão, destacando os cuidados mecânicos, as vantagens e desvantagens dessa abordagem terapêutica. O resultado do tratamento evidenciou a correção da relação sagital de Classe II e do trespasse horizontal, decorrente de compensações dentárias, especialmente na arcada inferior, sem a necessidade de exodontias e dispensando a cooperação do paciente com o uso do aparelho.

Incidence and impact of previous orthodontic treatment in patients attending orthognathic combined clinics: a survey.

This prospective questionnaire-based study was designed to determine the incidence of patients attending orthognathic combined clinics who have previously had orthodontic treatment, and to assess the impact, if any, this has had on their proposed surgical treatment. Contemporaneous and historical data from consecutive patients at different stages of treatment who were attending clinics at two London hospitals during a three-month period were included. In total 22/56 patients (39%) had previously had orthodontic treatment, and of those, it had had an undesirable effect on the current management of 10 (45%). The effects included a reduced range of dental movements available to orthodontists (8/23, 35%), undesirable extractions (5/23, 22%), and a prolonging of preoperative orthodontics (5/23, 22%). The median age at which previous orthodontic treatment had been started was 13.5 (range 11-26). Nearly a third of patients reported that they had not been advised by their referring practitioner that a combined orthodontic and surgical approach might be required. The study suggests that preliminary assessment should be improved. Patients should be informed about and prevented from undergoing orthodontic treatment that may limit future surgical management, otherwise they may have to face repeated and prolonged orthodontic treatment, unexpected operations, and potential limitations to the outcome of surgical treatment. This could be achieved through the training and education of all practitioners and the development of referral guidelines.

Transposição dentária: opções de tratamento: relato de casos

As transposições dentárias ainda são consideradas um desafio na prática clínica ortodôntica. Essas anomalias não possuem etiologia definida, causam danos estéticos e funcionais e os ortodontistas possuem dificuldade na escolha do tratamento, visto que as implicações variam de danos déntários, periodontais e perda dentária...