Adult patients' adjustability to orthodontic appliances. Part I: a comparison between Labial, Lingual, and Invisalign™.

This prospective study examined the adult patient's perception of recovery after insertion of three types of orthodontic appliances: Buccal, Lingual and Invisalign. The sample consisted of sixty-eight adult patients (45 females and 23 males) who comprised three groups: 28 Buccal, 19 Lingual, and 21 Invisalign patients. After appliance insertion, patients completed a Health-Related Quality of Life questionnaire daily for the first week and again on day 14, in order to assess patients' perception of pain and analgesic consumption. In addition, four areas of dysfunction were assessed: oral dysfunction, eating disturbances, general activity parameters, and oral symptoms. Lingual appliance was associated with more severe pain and analgesic consumption, the greatest oral and general dysfunction, and the most difficult and longest recovery. The Invisalign patients complained of relatively high levels of pain in the first days after insertion; however this group was characterized by the lowest level of oral symptoms and by a similar level of general activity disturbances and oral dysfunction compared to the Buccal appliance. Many Lingual and some Buccal patients did not reach a full recovery from their eating difficulties by the end of the study period. The present study provides information to adult patients and clinicians assisting them in choosing the most appropriate treatment modality in relation to Health-Related Quality of Life parameters.

Psychosocial reward of orthodontic treatment in adult patients.

SUMMARY: The purpose of this study was to assess the short-term psychosocial impact of dental aesthetic improvement in adult subjects. Sixty-nine adult patients (61 females and 8 males, aged 21-59 years) requesting aesthetic dental improvement were prospectively and randomly recruited for the study in a private orthodontic office. A general interview included patient motivation and expectations from treatment. After clinical examination, discussion of the mode of treatment and the expected outcome, the patients were requested to complete the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) with several additions. The duration of their treatment was 6-14 months, and the main goals were tooth alignment, crowding alleviation, or space closure. After removal of the appliances, they completed an identical PIDAQ. Each patient served as his/her own control. Assessment of the impact of aesthetic improvement was based on the responses to the same questions relating to the patients' perceived dental aesthetics before and after treatment, their self-esteem, and changes in their social behaviour resulting from the treatment. The data were analysed using Cohen's and Pearson's correlation analyses and chi-square and Student's t-tests. A statistically significant improvement (P < 0.001) was found for all four factors: dental self-confidence (DSC), social impact (SI), psychological impact (PI), and aesthetic concern (AC). The reliability of the questionnaire, using Cronbach's alpha, was between 0.709 and 0.947. The degree of significance was not related to age, marital status, education, or gender. Dental aesthetics generated a significant improvement in adult patients' quality of life for the period examined (up to 6 months post-treatment).

Malposition of unerupted mandibular second premolar in children with palatally displaced canines.

OBJECTIVE: To test the hypotheses that (1) the distal angulation of unerupted mandibular premolar (MnP2) is significantly greater in children with palatally displaced canines (PDC) than in those in a control sample; and (2) delayed tooth formation is significantly more frequent in children with both malposed MnP2 and PDC than in children with PDC only. MATERIALS AND METHODS: We examined retrospectively panoramic radiographs from 43 patients with PDC who had no previous orthodontics. A control sample consisted of age- and sex-matched patients. The distal angle formed between the long axis of MnP2 and the tangent to the inferior border was measured. Dental age was evaluated using the Koch classification. RESULTS: A significant difference was observed between the mean inclination of the right side MnP2 in the PDC group (75.4 degrees) and that of the control group (85.8 degrees). This difference was highly statistically significant (P < .0001). The same evaluation was carried out for the left side, with similar results. The average dental age was found to be delayed in patients who showed both abnormalities (malposed MnP2 and PDC) compared with patients who showed the PDC anomaly only. CONCLUSION: Both hypotheses are retained. Statistically, PDC and MnP2 malposition are significantly associated suggesting a common genetic etiology, despite taking place on opposite jaws. While the presence of PDC or MnP2 anomaly has been associated with a delay in tooth formation, we find the presence of both anomalies to show a more profound delay. Our findings suggest a delay in tooth formation as a possible common genetic mechanism for these 2 malposition anomalies.

Malposition of unerupted mandibular second premolar in children with cleft lip and palate.

OBJECTIVE: To determine whether distoangular malposition of the unerupted mandibular second premolar (MnP2) is more frequent in children with unilateral clefts of the lip and palate. MATERIALS AND METHODS: This retrospective study examined panoramic radiographs from 45 patients with unilateral clefts of the lip and/or palate who had no previous orthodontics. A control sample consisted of age- and sex-matched patients. The distal angle formed between the long axis of MnP2 and the tangent to the inferior border was measured. The mean, standard deviation, and range were calculated for the angles measured in the cleft and the control groups. The significance of the differences between the means was evaluated by the paired t-test. The angles of the cleft and noncleft sides were also measured and compared. RESULTS: The mean inclination of the MnP2 on the cleft side was 73.6 degrees , compared with 84.6 degrees in the control group. This difference was highly significant statistically (P < .0001). The difference in angles from the cleft and noncleft sides was 0.7 degrees , not statistically significant. A significant association was found between clefting and distoangular malposition of the developing MnP2, suggesting a shared genetic etiology. This association is independent of the clefting side, ruling out possible local mechanical effects. CONCLUSION: Clinicians should be aware of the potential for anomalous development of MnP2 in children with clefts.

Angular changes and their rates in concurrence to developmental stages of the mandibular second premolar.

In the early developmental stage of the mandibular second premolar (MnP2), it is not unusual to find the tooth extremely angulated to the lower border of the mandible, as seen in the panoramic roentgenogram. On eruption, the tooth, in most cases, is close to being upright. However, impaction or other types of malocclusions due to its ectopic eruption are not rare. This study follows the angular changes of the MnP2 during development. Two hundred two panoramic roentgenograms of 101 patients were retrospectively analyzed. All patients had two sequential films with a minimal time interval of nine months. Each MnP2 was traced, and its developmental stage as well as its angulation to the lower border of the mandible was registered. We found that normally more MnP2 are distally (56.5%) than mesially (25%) inclined. There is a statistically significant difference in the inclination of the teeth during their development from stage D to stage F (D = 75.17 degrees +/- 15.25 degrees, E = 79.35 degrees +/- 12.18 degrees, F = 83.38 degrees +/- 10.79 degrees). The average amount of total angular change rate of the MnP2s from stage D to stage G is 0.09 +/- 0.25 degrees/mo, and the absolute angular change rate is 0.19 +/- 0.25 degrees/mo.

The oxidant-scavenging abilities in the oral cavity may be regulated by a collaboration among antioxidants in saliva, microorganisms, blood cells and polyphenols: a chemiluminescence-based study.

Saliva has become a central research issue in oral physiology and pathology. Over the evolution, the oral cavity has evolved the antioxidants uric acid, ascorbate reduced glutathione, plasma-derived albumin and antioxidants polyphenols from nutrients that are delivered to the oral cavity. However, blood cells extravasated from injured capillaries in gingival pathologies, or following tooth brushing and use of tooth picks, may attenuate the toxic activities of H2O2 generated by oral streptococci and by oxidants generated by activated phagocytes. Employing a highly sensitive luminol-dependent chemiluminescence, the DPPH radical and XTT assays to quantify oxidant-scavenging abilities (OSA), we show that saliva can strongly decompose both oxygen and nitrogen species. However, lipophilic antioxidant polyphenols in plants, which are poorly soluble in water and therefore not fully available as effective antioxidants, can nevertheless be solubilized either by small amounts of ethanol, whole saliva or also by salivary albumin and mucin. Plant-derived polyphenols can also act in collaboration with whole saliva, human red blood cells, platelets, and also with catalase-positive microorganisms to decompose reactive oxygen species (ROS). Furthermore, polyphenols from nutrient can avidly adhere to mucosal surfaces, are retained there for long periods and may function as a "slow-release devises" capable of affecting the redox status in the oral cavity. The OSA of saliva is due to the sum result of low molecular weight antioxidants, albumin, polyphenols from nutrients, blood elements and microbial antioxidants. Taken together, saliva and its antioxidants are considered regulators of the redox status in the oral cavity under physiological and pathological conditions.

Saliva increases the availability of lipophilic polyphenols as antioxidants and enhances their retention in the oral cavity.

OBJECTIVE: Lipophilic polyphenols in fruit beverages can avidly bind to surfaces of microorganisms and to blood cells and to impart upon them enhanced oxidant scavenging abilities (OSA). However, since many of the polyphenols are actually not fully soluble in water, they are therefore not available to act as effective antioxidant agents. We hypothesized that whole saliva, proteins such as albumin and mucin, human red blood cells and platelets, may all increase the "solubility" and availability of lipophilic antioxidant polyphenols thus increasing the OSA of whole saliva. DESIGN: The OSA of whole un-stimulated human saliva, obtained from healthy donors and of combinations among saliva, mucin, blood cells, fruit beverages and reagent polyphenols were quantified by chemiluminescence, DPPH radical and tetrazolium reduction assays. Kinetics of the clearance of polyphenols from saliva after holding in the mouth for 30s of an extract from beverages cinnamon was assayed by the Folin Ciocalteu's and the luminescence assays. RESULTS: OSA of fruit beverages and of reagent polyphenols were markedly increased by whole saliva, mucin and by red blood cells. Polyphenols associated with a cinnamon extract were retained in the oral cavity for several hours as measured by luminescence and Folin reagent techniques. CONCLUSIONS: A new approach to explain the additional role of saliva and salivary proteins and of blood cells as enhancers of OSA of lipophilic polyphenols is presented. This might have a significant importance to assess complex interactions among polyphenols from nutrients, salivary antioxidants, salivary proteins and blood cells extravasated from injure capillaries during infection and inflammation.

Adequacy of mandibular premolar position despite early loss of its deciduous molar.

The mandibular second premolar (MnP2) tooth is one of the most commonly impacted teeth. Early loss of its deciduous predecessor has long been suggested to be a factor in the etiology of the MnP2 impaction. In this study, panoramic roentgenograms were used to measure the angular position of the unerupted MnP2 in 85 children. The study was carried out to test whether early loss of the lower second primary molar (dM2) correlates with MnP2 malpositions that are measurably greater than those from a control sample. The results show a small and statistically insignificant difference between the mean angles in cases with (79.6 degrees) and without (83.2 degrees) dM2. To eliminate individual factors, e.g., genetics, 2 sides of the same patient, with and without dM2, were compared. The group with the missing dM2 on one side showed higher angle differences, compared with the control group. However, the differences were still small (approximately 4 degrees) and statistically insignificant. Our findings do not show a significant influence of early loss of dM2 on the inclination of the unerupted MnP2, suggesting that environmental factors may be of less significance, compared with genetic ones.

Malposition of unerupted mandibular second premolar associated with agenesis of its antimere.

Aberrant tooth positions--such as infraocclusion, mesially ectopic maxillary first molar, palatally displaced canine, tooth transposition, and tooth rotation--are gaining attention as variables in a putative, genetically related pattern of dental anomalies. This study, using panoramic roentgenograms, was undertaken to measure the angular position of the unerupted mandibular second premolar (MnP2) in children. The experimental subjects were 17 children with an unerupted MnP2 and agenesis of the other MnP2, a likely indicator of site-specific genetic disturbance. An age/sex-matched control-reference group was similarly measured for comparison. The hypothesis tested was that the unerupted, developing MnP2 teeth in the experimental subjects would show measurably greater malpositions than those of the control sample. The results indicated a 10 degrees increase in distoangular inclination for the unerupted MnP2 in the agenesis sample; this was a highly significant difference statistically (P = .003), compared with the MnP2 inclinations in the control sample. These findings, associating exaggerated distoangular malposition of the unerupted MnP2 in children with agenesis of the contralateral MnP2, identify a new phenotype of dental developmental disturbance to add to the accumulated evidence supporting shared genetic mechanisms for dental anomaly patterns.