CBCT in orthodontics: a systematic review on justification of CBCT in a paediatric population prior to orthodontic treatment.

BACKGROUND: Taking into account radiation doses, safety, and protection, we highlighted the features in which cone-beam computed tomography (CBCT) can offer an advantage compared to the conventional two-dimensional imaging in paediatric dentistry before orthodontic treatment. OBJECTIVE: The aim of this article was to conduct a systematic review to assess the diagnostic efficacy of CBCT in the paediatric population at a pre-orthodontic phase. SEARCH METHODS: MEDLINE via PubMed was searched to identify all peer-reviewed articles potentially relevant to the review until 1 July 2018. Relevant publications were selected by two reviewers independently. SELECTION CRITERIA: The literature selection for this systematic review was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and was based on predetermined inclusion criteria. DATA COLLECTION AND ANALYSIS: Data were collected on overall study characteristics and examination characteristics of the selected studies. Methodological quality of the selected studies was evaluated. Original studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool. Thereafter, levels of evidence were obtained according to Grading of Recommendations Assessment, Development and Evaluation criteria. RESULTS: As a result of the QUADAS assessment, a total of 37 articles were included in the protocol. Following a proper protocol, CBCT was regarded as a reliable tool for assessment and management of impacted canine and root fracture. It provided a better evaluation of normal and pathological condylar shape and volume. CBCT was a superior choice for pre-surgical diagnostic applications in cleft lip and/or palate over a medical computed tomography based on its lower radiation exposure, shorter investigation time, and low purchase costs. CONCLUSIONS: CBCT is justified only in those cases where conventional radiography fails to provide a correct diagnosis of pathology. Therefore, it cannot be regarded as a standard method of diagnosis. CBCT imaging may also be justified when it positively affects treatment options or provides treatment optimization. REGISTRATION: None. CONFLICT OF INTEREST: None to declare.

The effect of various adhesives, enamel etching, and base treatment on the failure frequency of customized lingual brackets: a randomized clinical trial.

Objectives: The aim of this paper was to compare failure differences in precious metal customized lingual brackets bonded with three adhesive systems. Also, differences in failure of non-precious metal brackets with and without a silicatized base layer bonded with the same adhesive, as well as the influence of enamel etching prior to using a self-etching dual cure resin were explored. Materials/methods: Five different groups were defined in a semi-randomized approach. Group 1 (IME): Maxcem Elite with 378 Incognito brackets and etched teeth, Group 2 (IMNE): Maxcem Elite with 193 Incognito brackets on non-etched teeth, Group 3 (INE): Nexus+Excite with 385 Incognito brackets, Group 4 (IRE): Relyx with 162 Incognito brackets, Group 5 (HRME) and Group 6 (HNRME): Maxcem Elite with 182 Harmony brackets with silicatized and non-slicatized bases respectively. Bracket failures were recorded over a 12-month period. Results: The number of failures during the observation period was small in the various adhesives types of groups, as well as in HRME and HNRME groups, and the comparisons among those groups were non-significant (P > 0.05). A statistically significant difference (P < 0.05) was found between the IME and IMNE groups. Conclusions: 1. During the first year of treatment customized lingual brackets failure frequencies (rates) are not different for the three adhesive materials tested. 2. Eliminating the etching stage when using self-etch/self-adhesive adhesives, may lead to a dramatic increase in the failure rates. 3. Silicoating of stainless steel customized lingual brackets does not seem to influence the failure of the bonds.

Maxillary changes with bone-borne surgically assisted rapid palatal expansion: A prospective study.

INTRODUCTION: The aim of this prospective study was to analyze the postexpansion positional changes of the maxillary halves and their initial stability after transpalatal distraction with a bone-borne distractor and standard corticotomies of the anterior, lateral, and median bony supports of the maxilla without pterygomaxillary disjunction. METHODS: The sample consisted of 21 patients (15 female, 6 male; mean age, 26 years 5 months). Measurements on the maxillary study casts and the posteroanterior cephalograms were obtained before surgery, at the end of palatal expansion, and 10 weeks later. No orthodontic treatment was initiated during the examination period. RESULTS: After palatal expansion, significantly wider measurements were noted in the canine (35.5%), premolar (26.3%), and molar (17.8%) regions. Angulation changes in the premolar (-7°) and molar (-8°) segments were observed. No significant changes were seen between the end of palatal expansion and 10 weeks later. Arch perimeter increased by 9.16% between presurgery and 10 weeks after the end of expansion. CONCLUSIONS: The results indicated that more expansion was achieved anteriorly, and that there was buccal tipping of the split maxillary halves. Bone-borne surgically assisted rapid palatal expansion can provide significant expansion of the maxilla with an increase in arch perimeter, and it shows initial stability.

How orthodontic records can influence torque choice decisions?

INTRODUCTION: The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. METHODS: Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. RESULTS: The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. CONCLUSIONS: This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.

Assessment of interproximal enamel reduction planned by the digital set-up of a customized lingual orthodontic appliance: A comparison cohort study.

Objectives: Interproximal enamel reduction (IER), commonly known as stripping, is a frequently used technique in orthodontic treatment to address issues related to arch length discrepancies and tooth size discrepancies (TSD). The use of digital set-up allows for precise prediction of the amount of IER required. TSD occurs when the sizes of maxillary and mandibular teeth are not in proportion to each other. This study aims to evaluate and compare the suggested IER values generated by the digital set-up of a customized lingual orthodontic appliance in both upper and lower arches, across sextants, and among different teeth concerning TSD. Materials and methods: We analyzed suggested IER values from 809 cases. The statistical analysis was divided into two parts: part 1 focused on the number of stripped surfaces, and part 2 assessed the quantity of enamel removed. Comparisons were made between upper and lower arches, sextants, and teeth using the Friedman test, followed by pairwise Wilcoxon tests with Bonferroni correction. Results: The study found that mandibular and frontal stripping were more frequently suggested than maxillary and posterior stripping. Lower canines were the teeth most commonly recommended for stripping, followed by upper incisors. Conclusion: Within the scope and limits of this cohort study, we conclude that, in general, more IER is required in the mandible as compared to the maxilla. Particularly in the anterior sextants, IER might be necessary to achieve optimal alignment and occlusion.

Microhardness and Chemical Composition of Different Metallic Brackets: An In Vitro Study.

The purpose of the study is to compare the hardness of different metallic brackets to enamel and to determine their chemical composition and microstructure. Five metallic brackets (0.022″ × 0.028″ inch) from seven orthodontic firms produced in different alloys (Discovery® Smart/Empower®/Genius®2 Metal/VictoryTM series/Equilibrium®/Damon Q) were chosen (n = 35). The hardness of the brackets and enamel was measured using a microhardness tester. The study of the chemical composition of brackets was carried out on a single bracket per series. A scanning electron microscope (SEM) equipped with an energy dispersive spectroscopy (EDS) detector was used. Analysis of the chemical composition of metallic brackets was obtained with Oxford Instruments Ultim Max Aztec software. Metallic brackets' hardness varied from 203 to 439 HV. A significant difference exists between Ti Equilibrium® brackets, the rest of the brackets and the enamel (p-value = 0.003). No significant difference was found between SSa(stainless-steel alloy), Co-Cra(Cobalt-Chrome) brackets and the enamel. The chemical study confirms that the alloys used to produce metallic brackets validate all the data of the manufacturers except for Genius®2 Metal; according to this study, they are considered to be Co-Cra alloys. The study of the composition of brackets made it possible to confirm manufacturers' data. Genius®2 Metal brackets, Empower®2 and VictoryTM series brackets filled the properties needed for orthodontic treatment. The hardness of metallic brackets is influenced by the alloy used and manufacturing method. Co-Cra brackets with hardness comparable to enamel can be considered as an alternative to SSa brackets in patients allergic to nickel.

Comparison of shear bond strength and ARI of four different adhesive systems used to bond molar tubes: An in vitro study.

OBJECTIVE: The purpose of this in vitro study was to determine and compare the shear bond strength and ARI score of one traditional etch-and-rinse adhesive system serving as control, with those of two other all-in-one adhesives but with enamel acid etching preceding their application, and of one new 8th generation all-in-one bonding agent combined with a traditional adhesive used to bond stainless steel buccal tubes to molar teeth. MATERIAL AND METHODS: Four groups of teeth were formulated according to the adhesive system used to bond the tubes on the molars. Shear bond strength was measured using a universal testing machine (Hounsfield, UK). After debonding, each enamel surface was imaged using Inspex HD l080p Vesa camera (Ash Technologies Ltd., Ireland) to determine the ARI score. RESULTS: The mean SBSs in MPa for the four groups were respectively: A: 9.640 (±3.69), B: 10.261 (±3.03), C: 9.689 (±2.48), D: 8.412 (±3.02). No statistically significant differences were neither found through one-way ANOVA to exist between the group means (P: 0.715), nor for the ARI score frequence through Chi2 (P: 0.534). Maxcem Elite showed four and G-Premio Bond zero instances of enamel fracture. CONCLUSIONS: 1. SBSs of all adhesives and ARI score distributions did not present any significant differences when used to bond stainless steel molar tubes. 2. All adhesives presented with acceptable shear bond strengths for clinical use. 3. Maxcem Elite under the tested conditions presented the greatest and G-Premio the least number of enamel fractures.

Cytotoxicity of two bonding adhesives assessed by three-dimensional cell culture.

OBJECTIVE: To determine the toxicity of orthodontic adhesives assessed on in vitro three-dimensional reconstructed human oral epithelium (RHOE). MATERIALS AND METHODS: Two adhesive primers, Transbond XT (3M, Monrovia, Calif) and Excite (Vivadent, Schaan, Liechtenstein), were tested. After topical exposure, the cell cultures were fixed, cut, and stained for light microscopy (LM) and transmission electron microscopy (TEM). Detection of cytotoxicity by measuring lactate dehydrogenase (LDH) activity was performed. Toxicity was assessed by evaluating the morphological changes with LM and TEM. Copper wires and Triton X-100 served as positive controls, and native cell cultures as negative control. RESULTS: Morphological evaluation of the native cell cultures revealed no toxic reactions. The LDH assay revealed the following mean values for viability: native cell line (negative control), 1.51; Triton X-100 (positive control), 3.06; Transbond XT polymerized, 1.15; Excite polymerized, 1.11; Transbond XT primer, 2.67; and Excite primer, 0.04. Acute toxicity was observed for Triton X-100 and Transbond XT primer (P < .001). Histological evaluation of the RHOE showed toxicity for both primers and mild changes after topical application of polymerized adhesives. The biocompatibility ranking of the adhesive primers was the same after histological analysis and LDH assay except for Excite noncured. CONCLUSIONS: RHOE proved to be a valuable model for topical exposure. The toxicity of both uncured primers was demonstrated.

Updated secondary implant stability data of two dental implant systems. A retrospective cohort study.

BACKGROUND: At present, updated secondary implant stability data generated by actual versions of resonance frequency analysis (RFA) and mobility measurement (MM) electronic devices of 2 different implant systems with actual manufactured surfaces seem to lack and/or are incomplete. MATERIAL AND METHODS: Secondary implant stability data based on both RFA and MM measurements were collected and analyzed from 44 formerly treated patients (24 f, 20 m) that received either Ankylos Cellplus (Ø3.5mm) (A) (n=36) or Straumann regular neck SLA tissue level (Ø4.1mm) (S) (n=37) implants in posterior positions of both jawbones (total number= 72). These results were interpretated in view of formerly published data. RESULTS: Estimated RFA outcomes (mean±SD) for A implants were of 81.23 (±0.65) (LP) - 76.15 (±1.57) (UP) isq; for S implants 76.15 (±1.48) (LP) - 73.88 (±2.34) (UP) isq. Estimated MM outcomes for A implants were (-4.0) (±0.23) (LP) - (-3.2) (±0.33) (UP) ptv; for S implants (-5.15) (±0.39) (LP) - (-4.4) (±0.84) (UP) ptv. According to GEE statistical modelling, implant type and - position seems to influence the outcome variables (p<0.05), gender and implant length did not (p >0.05). CONCLUSIONS: Secondary implant stability values, recorded with current RFA and MM devices, of A Cellplus implants are provided for the first time. A difference of 14.7-9.7 isq values was noted for CellPlus versus TPS S implants recorded with a cabled RFA device. This study supports the assumption that RFA outcomes generated with first generation RFA devices are different from those obtained with current RFA devices, meaning that its use in reviews need caution and correction. Key words:Secondary implant stability, resonance frequency analysis, Periotest, Osstell Mentor, Straumann, Ankylos, CellPlus, SLA.

Secondary implant stability outcome of immediate versus late placed variable-thread implants in the maxilla. A retrospective cohort study.

BACKGROUND: The healing of xenograft augmentated intra-alveolar gaps following immediate implant placement (IMIP) after tooth extraction is likely to differ in time and density compared to the native bone part that directly contacts the implant. MATERIAL AND METHODS: Secondary implant stability (SIS) data recorded 2-3 months following a late implant placement protocol (LIP) (n= 43) and 6-8 months following an immediate implant placement protocol (IMIP) (n=33) of variable-thread implants (Nobel Active™) in the maxilla were retrospectively collected from files of 63 patients (42 females, 21 males). Statistical analysis was performed using a generalized estimating equation model (GEE). Data split-up according to implant diameter (RP, Ø= 4.3mm) , narrow platform (NP, Ø= 3.5mm) was adopted. RESULTS: For NP implants, the mean ISQ (±SD) values were 70.84 (±4.86) in LIP group and 72.41 (±3.89) in the IMIP group. For RP implants, mean ISQ (±SD) values were 73.45 (±8.77) in the LIP group and 75.93 (±5.73) in the IMIP group. Significant effect of treatment modus in favour of the IMIP and gender in favour of males and implant position was noted (p<0.05). CONCLUSIONS: SIS following a IMIP protocol after 6-8 months is comparable to LIP protocol after 2-3 months. A minor ISQ outcome difference in favour of the IMIP protocol can be attributed to a difference in hard tissue alteration during healing of the xenograft part. Key words:Secondary implant stability, RFA, Osstell Mentor, variable thread implants, Nobel Active, Bio-Oss, immediate implant placement, late implant placement, non-submerged healing, gap.

[Concepts, evaluation methods, diagnostic and prognostic values of implant stability]. / Concepts, moyens d'evaluation, valeurs diagnostique et pronostique de la stabilite implantaire.

The outcome of oral implant treatment is in part focused on the obtained implant stability as outlined in the success criteria as propose by Albrektsson T. & Albrektsson B. (1987) and by Buser et al. (1997). In those criteria, clinical diagnostic testing of implant stability is a rather crude and subjective procedure. Quantitative measurement technology, such as the Periotest and the Osstell Mentor devices do provide more refined and objective tools to diagnose and monitor the state of osseointegration. On the other hand, their power to predict treatment outcome is rather low.

The use of three-dimensional oral mucosa cell cultures to assess the toxicity of soldered and welded wires.

The aim of the present study was to determine whether there is a difference in toxicity and loss of viability of three-dimensional (3D) reconstructed human oral epithelium (RHOE) cell cultures induced by point-welded (PW), laser-welded (LW), and silver-soldered (SiS) orthodontic wires. Three types of soldered stainless steel (SS) wires: PW, LW, and SiS were prepared (n = 3) and subjected to multiple end-point analysis (MEA). Six pieces were cut from each wire. Each piece was placed on the triplicate cell cultures (RHOE model based on TR 146 cells). After 24 hours of topical exposure, the cell cultures were cut and stained with haematoxylin/eosin. Toxicity was assessed by evaluating the morphological changes and classifying these as mild, moderate, or severe. The in vitro cell cultures were subjected to a 3-(4,5-dimethylthiazol-2-yl)2,5-diphenyl tetrazolium bromide (MTT) assay in order to quantify viability. Copper wires served as the control to determine severe toxicity and native cell cultures were used as a baseline. Untreated SS wire (0.9 mm) was included for comparison with the welded wires. Histological evaluation with respect to toxicity and measurement of viability in the 3D cell cultures showed no severe toxicity or loss of viability for any of the wires. The morphological ranking of the tested wires from mild to severe toxicity was: SS = PW = LW < SiS. MTT tests revealed the following mean viability values: native cell line (negative control) 98.1 per cent, SS 96.8 per cent, PW 95.5 per cent, LW 95.5 per cent, SiS 85.7 per cent, and copper wires (positive control) 51.2 per cent. Relative comparison between the different welding techniques tested on RHOE revealed, however, that LW and PW wires induced less toxicity/loss of viability compared with SiS wires.

Osseointegration of miniscrews: a histomorphometric evaluation.

Mini-implants and miniscrews are commonly used in orthodontics to provide additional temporary intraoral anchorage. Partial osseointegration represents a distinct advantage in orthodontic applications, allowing effective anchorage to be combined with easy insertion and removal. This article reports the histomorphometric findings of the osseointegration of bracket screw bone anchors (BSBAs). In an experimental animal study, four BSBAs were inserted in the alveolar process of the lower jaw in each of five male beagle dogs, aged 6.5 months from the same mother. Eleven screws were lost during the study, nine of them due to lack of primary stability. One screw was removed at the end of the examination period for evaluation of ease of removal. After 6 months, histological evaluation of the eight remaining screws was performed to evaluate the extent of osseointegration. All eight screws showed partial osseointegration (mean 74.48 per cent, standard deviation +/- 15.33 per cent). The amount of osseointegration was independent of loading time and location (anterior or posterior), as tested with an independent samples t-test (P > 0.05). Analysis of the data indicated that small titanium screws were able to function as rigid osseous anchors against an orthodontic load of 200 cN for 6, 12, 18, or 24 weeks after a minimal healing period or no healing period. These findings show that miniscrews, used for temporary anchorage in orthodontics, partially osseointegrate.

Toxicity of used orthodontic archwires assessed by three-dimensional cell culture.

The aim of the present study was to determine whether used orthodontic wires made of different materials cause toxicity and loss of viability on three-dimensional (3D) cell cultures. Three types of orthodontic wires, stainless steel, Nitinol, and TMA (n = 9) which had been used clinically in fixed appliances for a period of 1 month, were retrieved at random from five patients. Both upper and lower archwires were collected and subjected to two different protocols: to assess toxicity, two pieces of each wire were placed on 3D cell cultures (reconstituted human epithelium); to investigate the possibility of cell damage, the 3-(4,5-dimethylthiazol-2-yl)2,5-diphenyl tetrazolium bromide (MTT) assay was used and haematoxylin and eosin staining was performed to evaluate morphological changes. Copper wire served as the control to determine the morphology of severe toxicity, and native cell cultures and silk were used as the negative controls. Morphological evaluation of the native cell cultures revealed no toxic reactions. The ranking, from mild to severe toxicity was as follows: stainless steel < Nitinol = TMA. There were no significant differences between TMA and Nitinol. The MTT assay revealed the following mean percentage values for viability: native cell line (negative control), 100; stainless steel, 102.25; TMA, 87.4; Nitinol, 85.3; and copper wire (positive control) 57.2. Histological evaluation of the 3D cell cultures showed no severe toxicity or loss of viability for any of the wires. However, relative comparison between the different wires revealed that stainless steel induced less toxicity/loss of viability compared with TMA and Nitinol wire.

[Low viscosity composites as materials for orthodontic bonding]. / Les composites à basse viscosité comme matériaux de contention en orthodontie.

A new type of composite materials, referred to as low viscosity composites, has been introduced onto the dental market. Little has been published yet concerning the biological and mechanical properties of these new materials, and the practitioner has to rely on the information, provided by the manufacturer. The low viscosity composites are hybrid composites, with a decreased amount of filler particles. This results in a lower viscosity, which makes these materials more appropriate in certain situations. Since the filler loading of these materials is decreased, one could expect inferior mechanical properties, compared to the conventional and hybrid composites. Therefore, the indications for using low viscosity composites are limited. In this article we propose to use low viscosity composites for the bonding of lingual retainers and implant-borne transpalatal arches. The explicit feature of flow, is very attractive for these indications, because a minimum of finishing is needed, when a low viscosity composite is used in these situations. Since there is no direct occlusal bite force put on the composite, the fact that the mechanical properties of a low viscosity composite could be inferior to those of a conventional composite, can be disregarded. A protocol for fixing lingual retainers and implant-borne transpalatal arches is proposed in the article, with other tips, concerning the fabrication of the retainers themselves.