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PubMed1992

Cariostatic effect and fluoride release from a visible light-curing adhesive for bonding of orthodontic brackets.

This study was designed to investigate the cariostatic potential in vivo of a visible light-curing adhesive for the bonding of orthodontic brackets. The fluoride release of the adhesive in water and saliva was also measured. Ten orthodontic patients with premolars to be extracted participated. One bracket with Heliosit-Orthodontic (no fluoride) was positioned on the buccal surface of one premolar (control), and another bracket with Orthodontic cement VP 862 (containing fluoride) was positioned on the experimental contralateral premolar. The adhesives were cured with a Heliolux II lamp, and the teeth were extracted after 4 weeks. The patients used a fluoride toothpaste during the experiment. The mineral content of the enamel adjacent to the brackets was determined by quantitative microradiography. The fluoride release from disk-shaped plates of the fluoride adhesive was measured in water for a 6-month period and in human saliva for 24 hours. The fluoride adhesive reduced lesion depths by about 48% than the nonfluoride adhesive (P less than 0.05, t test). The largest release of fluoride from the plates in water was observable within the first week. However, a significant amount of fluoride was still released after 6 months. The fluoride release in saliva was significantly lower in human saliva at pH 7 than in water (P less than 0.01, t test). When salivary pH was lowered to 4, to mimic a cariogenic challenge, the amount of fluoride released increased up to the value measured in water. It was concluded that the regular use of fluoride toothpastes is insufficient to inhibit lesion development around orthodontic brackets.(ABSTRACT TRUNCATED AT 250 WORDS)

Adhesives↗
PubMed1991

Orthodontic treatment and temporomandibular joint sounds--a longitudinal study.

Temporomandibular joint sounds are often recognized as a clinical sign of temporomandibular disorders. The purpose of this study was to examine changes in the occurrence and resolution of these sounds in patients before and after orthodontic treatment with full fixed appliances. From a pool of 324 patients who came to a university postgraduate orthodontic clinic specifically for treatment of a malocclusion, 160 were examined before and after orthodontic treatment. When joint sounds were either reported or detected clinically, the patients underwent an audiovisual examination to more precisely and objectively record the occurrence and timing of the sound during mandibular opening and closing. No statistically significant difference could be found in the change in occurrence of joint sounds among patients treated with extraction and nonextraction treatment strategies. Overall, fewer patients had joint sounds at the end of the active stage of orthodontic treatment than before treatment. Also, fewer patients demonstrated reciprocal clicking after treatment than before treatment. Therefore it appeared that orthodontic treatment did not pose an increased risk for developing temporomandibular joint sounds irrespective of whether extraction or nonextraction treatment strategies were used. A progression of signs or symptoms to more serious problems was not apparent over the time period studied.

Adolescent↗
PubMed1990

Effects of etchant concentration and duration on the retention of orthodontic brackets: an in vivo study.

Etching of enamel before the bonding of orthodontic attachments is usually done with a solution of 37% H3PO4 for 60 seconds. The purpose of this study was to evaluate the effects of etchant concentration and duration on the clinical retention of bonded orthodontic attachments. Two randomly selected groups of orthodontic patients participated in the study. In both groups, teeth in contralateral quadrants, excluding the molar teeth, were bonded. In the first group, 158 teeth were etched with a solution of 37% H3PO4 for 60 seconds, and 155 teeth were etched with 37% H3PO4 for 15 seconds. In the second group, 196 teeth were etched with 37% H3PO4 and 196 teeth with 15% H3PO4, both for 60 seconds. Conventional edgewise mechanotherapy was used in both groups of patients. After 24 months of treatment, in the first group, 8 brackets were dislodged when etched with 37% H3PO4 for 60 seconds and 9 when etched with 37% H3PO4 for 15 seconds. In the second group, 6 brackets were dislodged when etched with 37% H3PO4 for 60 seconds and 13 were dislodged when etched with 15% H3PO4 for 60 seconds. Reducing the etching time of 37% H3PO4 from 60 seconds to 15 seconds or reducing the acid concentration from 37% to 15% H3PO4 applied for 60 seconds had no significantly different effect on the retention of bonded orthodontic attachments. The results suggest that the reduction of etchant concentration and the duration of etching in orthodontic bonding should be considered.

Acid Etching, Dental↗
PubMed1994

Shear bond strengths of a glass ionomer for direct bonding in orthodontics.

This study was undertaken to compare the shear bond strengths of mesh-backed orthodontic buttons bonded to human enamel using a glass ionomer marketed for direct bonding in orthodontics, both in conjunction with, as well as without, enamel etching and to compare the results with a no-mix composite bonding resin. Freshly extracted noncarious human premolar crowns were used, to which mesh-backed metal orthodontic buttons were bonded to the lingual surfaces with one of three methods: group 1, glass ionomer without enamel etching; group 2, glass ionomer with enamel etching; and group 3, with a no-mix orthodontic bonding resin with enamel etching. After being stored in water for 48 hours at 37 degrees C, the samples were tested to failure in an Instron with the Bencor testing system. The data were statistically analyzed with the Mann-Whitney U test. The debonded specimens were visually inspected in respect of failure mode. The no-mix bonding resin had a significantly higher shear bond strength than the glass ionomer cement. Enamel etching with 37% orthophosphoric acid increased the mean shear bond strength of the glass ionomer, however, not significantly. Less cement remained on enamel after debonding when the glass ionomer was used when compared with residual resin when the no-mix bonding resin was used. Clinical research by several investigators is advised to determine the bond failure rate of glass ionomers when used in conjunction with orthodontic bracket bonding.

Acid Etching, Dental↗
PubMed1996

Prevention of enamel demineralization during orthodontic treatment: an in vitro study using pit and fissure sealants.

Enamel demineralization during active orthodontic treatment remains a significant problem. The purpose of this in vitro study was to evaluate the efficacy of applying a light-cured unfilled resin, a conventional pit and fissure sealant, to the labial surface of teeth with previously placed orthodontic appliances to prevent demineralization. Orthodontic brackets were bonded to 40 extracted human teeth with a commercially available orthodontic adhesive. The exposed labial surfaces of 30 teeth (experimental group) were sealed with a clear, light-cured, unfilled resin. The remaining 10 teeth (control group) were left unsealed. Both groups were placed in a demineralization environment, and then all teeth were sectioned and examined under polarized light microscopy for the presence or absence of enamel demineralization. Every member of the control group exhibited demineralization of the entire exposed labial surface, whereas 80% of the sealed teeth exhibited no demineralization. Small, isolated areas of enamel loss were seen in six of the sealed teeth representing "breaks" in the sealant layer. The results of this study indicate that light-cured sealant treatment after orthodontic appliance placement significantly reduces enamel demineralization.

Bisphenol A-Glycidyl Methacrylate↗
PubMed1997

Alveolar bone turnover and tooth movement in male rats after removal of orthodontic appliances.

The purpose of this study was to acquire tooth movement, histomorphometric and biochemical data on oral tissues that had previously been loaded with calibrated orthodontic forces. One hundred and forty-four male Sprague-Dawley rats were randomly divided into two groups: Group I, orthodontic appliances placed for 16 days to mesially move maxillary first molars with an initial force of 40 gm, and group II, sham orthodontic treatment. Seven to twelve rats were killed at each of six times after removal of appliance. Tooth movement was measured cephalometrically, alveolar bone turnover by histomorphometry, and tissue phosphatase levels biochemically. Treated molars moved distally more rapidly than the shams (13.9 vs 5.0 microns/day). The appliance removal group had a persistent 10-fold elevation in root resorption on the mesial (p < 0.0001), as well as early elevations in osteoclasts on the mesial and osteoblasts on the distal (p < 0.001) that returned to control by 3 to 5 days. Acid, alkaline phosphatase, and tartrate-resistant acid phosphatase (TRAP) remained elevated in the tissues until 10 days (p < 0.0001). Changes in the dynamic measures of bone formation were characterized by low rates at days 1 and 3 (p < 0.01), elevating thereafter on the mesial and the converse on the distal. Orthodontic tooth movement relapses, and bone remodeling continues for several days after removal of appliance consistent with the direction of loading, orthodontic treatment stimulates root resorption at sites that were loaded in pressure without detectable recovery, and root resorption does not increase at the tension sites.

Acid Phosphatase↗
PubMed1998

Effectiveness and duration of orthodontic treatment in adults and adolescents.

The purpose of this investigation was to compare the effectiveness and duration of orthodontic treatment in adults and adolescents with a valid and reliable occlusal index. Another aim was to evaluate variables that may influence the effectiveness and duration of orthodontic treatment in general. Pretreatment and posttreatment study models were scored using the Peer Assessment Rating Index. The difference in scores between pretreatment and posttreatment stages reflects the degree of improvement and therefore the effectiveness of treatment. Variables that reflect patient compliance were recorded from written treatment records from three private orthodontic practices. The sample consisted of 32 adults (mean age, 31.3 years) and 40 adolescents (mean age, 12.9 years), all of whom had four premolars extracted as part of the treatment strategy. The results indicated that there were no statistically significant differences (P > .05) between adults and adolescents regarding treatment effectiveness (occlusal improvement) and treatment duration. Multiple regression techniques revealed that the number of broken appointments and appliance repairs explained 46% of the variability in orthodontic treatment duration and 24% of the variability in treatment effectiveness. Furthermore, orthodontic treatment of the buccal occlusion and overjet explained 46% of the variability in treatment duration.

Adolescent↗
PubMed1999

Patient-centered evaluation of orthodontic care: a longitudinal cohort study of children's and parents' attitudes.

As health services are adapted to meet consumers' needs, patient-centered evaluation of quality of care as well as informed consent to treatment decisions become increasingly important concepts in orthodontics. In an attempt to assess the orthodontic service in a region, this study focused on attitudes among children and their parents. The attitudes were recorded both before and after the period in which orthodontic treatment is usually carried out. Changes in children's and parents' attitudes were applied to measure outcome of care, and to evaluate the relevance of informed consent in decisions about treatment. Seventy-nine family units were interviewed with the use of questionnaires when the child was 11 years of age and again at 16 years. Both orthodontically treated and untreated subjects were included. Responses to questions about satisfaction with dental appearance and desire for treatment were transformed to a score for orthodontic concern. A significant decrease in the concern score was observed over the 5-year period among the treated subjects, and the care system apparently identified and provided treatment to the majority of those children concerned at 11 years. Intra-unit disagreement in concern was observed among 25% of the child/parent units at the 11-year stage, whereas at 16 years nearly all units agreed. Informed consent as a tool to ensure patients' autonomy when decisions about treatment are made did not appear to be negatively affected by conflicting attitudes between children and their parents.

Adolescent↗
PubMed2001

Bicortical titanium screws for critical orthodontic anchorage in the mandible: a preliminary report on clinical applications.

Critical anchorage during orthodontic treatment in the mandible needs both time and effort and patient compliance. In 8 patients, 12 bicortical titanium screws (BIS) were used as anchorage units for orthodontic molar protraction. The criteria for patient selection were: critical anchorage in the lower jaw (i.e. retraction of anterior teeth undesirable) and molar extraction sites. After insertion of the screws in local anesthesia, orthodontic forces were applied immediately. One screw worked loose and had to be removed before the end of treatment. Problems encountered included impingement of the screw head and slight inflammatory reactions of the surrounding mobile mucosa, which necessitated premature removal of two screws. After healing, a new insertion site was chosen. Further treatment was uneventful. Anchorage for orthodontic forces as described offers several advantages. The total treatment time is reduced as the screws can be loaded immediately. The line of action of the orthodontic force coincides with the level of the center of resistance of the molar resulting in a favorable translatory tooth movement. Treatment does not depend on patient cooperation.

Adolescent↗
PubMed2000

Orthodontic extractions: a comparative study of inhalation sedation and general anaesthesia.

OBJECTIVE: To compare directly inhalation sedation and general anaesthesia in terms of treatment success rate, various aspects of morbidity and time taken, when used for patients having orthodontic extractions. DESIGN: Patients requiring orthodontic extractions were treated with either inhalation sedation or general anaesthesia. The two groups were matched for age, sex, number of teeth extracted and pre-operative anxiety. Data were collected by questionnaires. SETTING: Unit of Paediatric Dentistry at the University Dental Hospital of Manchester. SUBJECTS: All patients referred for orthodontic extractions between November 1994 and May 1996 were invited to take part in the study. Total number of patients = 101. INTERVENTIONS: Sixty-six patients commenced treatment with inhalation sedation and 35 with general anaesthesia. Routine orthodontic extractions were carried out. OUTCOME MEASURES: Treatment success rate, various aspects of morbidity and total time taken were measured and compared for the two groups. RESULTS: Treatment success rates were high for both groups. Significantly less morbidity was found to be associated with inhalation sedation and the total time taken was significantly shorter with inhalation sedation than with general anaesthesia. CONCLUSIONS: Inhalation sedation is a successful alternative to general anaesthesia for orthodontic extractions with patients experiencing less morbidity and the time taken being shorter.

Anesthesia, Dental↗
PubMed1991

An analysis of the effects of place of childhood, undergraduate and postgraduate education upon the regional distribution of specialist orthodontic practitioners.

In 1989, a survey of specialist orthodontic practitioners was carried out. Questionnaires were sent to all members of the British Association of Orthodontists who were engaged in full-time specialist practice. This yielded a response rate of 72%. One part of the questionnaire was directed towards details concerned with the practitioner's place of childhood, undergraduate and postgraduate education. The regions in the UK were grouped into two large areas of the 'north' and the 'south'. It was evident that most of the practitioners had received their orthodontic training in the 'south' of England and were employed within the same region. Detailed data analysis was carried out using the Mantel-Haenszel chi-squared test. This revealed that there was a strong association between the place of postgraduate orthodontic training and place of employment of the specialist practitioner (chi 2 = 48.6, P less than 0.00001). The data suggest that one method of reducing the present unequal distribution of the specialist orthodontic practitioner would be to increase the number of postgraduate training places in those regions with low levels of orthodontic manpower.

Adult↗
PubMed2006

Undergraduate orthodontic assessment and examination in UK dental schools.

AIMS AND OBJECTIVES: This paper assesses the current internal assessment and BDS examination of undergraduate orthodontics in UK dental schools, the changes which have occurred in the last three years, and future changes proposed. METHOD: Questionnaires were emailed to the undergraduate orthodontic course leaders in each of the UK dental schools. Twelve dental schools agreed to participate in the survey. Responses were checked for completeness, summarised and sent back to individual course leaders to verify. These verified responses were then analysed. RESULTS: There was a wide variation in the form and content of the in-course assessment and the BDS examination in the 12 UK dental schools. The in-course assessment varied from minimal to extensive, and in its percentage contribution to BDS. The use of written, clinical, and particularly patient treatment and laboratory assessments varied considerably from school to school. The format of the BDS examination varied in the number, type and timing of written examinations, in the number of students examined clinically, and in the use of additional examinations of viva, case presentation, or OSCE. CONCLUSIONS: Comparison of undergraduate orthodontic courses in UK dental schools revealed a wide variation in student assessment and examination. Current orthodontic internal assessments are inconsistent with no common pattern across the courses, and inconsistencies also exist in the BDS examination. Guidelines for orthodontic assessment and examination are needed to ensure standards and consistency in UK dental schools in the future.

Curriculum↗
PubMed2000

Benchmarking the clinical orthodontic evidence on Medline.

The purpose of this study was to identify and quantify the availability of orthodontic literature for evidence-based clinical decision-making (ie, sound clinical studies of etiology, diagnosis, treatment, or prognosis meeting basic methodologic criteria for direct clinical use). This is a first step toward developing online decision analysis systems. A search strategy based on Medical Subject Headings (MeSH) for orthodontics was developed to examine MEDLINE using the Ovid Web Gateway search engine. Sensitive and specific methodologic search filters were then employed to identify the 4 categories of information. The results were then subdivided by year to identify trends and sorted to identify source of publications. In the period 1990 to 1998, the MEDLINE searches identified 6938 English-language articles about orthodontics. The mean number of articles (+/-SD) per year ranged from 42+/-25 for specific searches to 314+/-214 for sensitive searches. The number of articles identified by the specific or sensitive searches increased 14% to 21% annually. When subdivided by clinical category, the mean numbers of articles per year for specific and sensitive searches were respectively: etiology 19+/-15 and 91+/-37, diagnosis 11+/-5 and 80+/-35, therapy 3+/-1 and 50+/-23, and prognosis 10+/-7 and 93+/-33. Five dental journals accounted for nearly half of these publications. These results provide several key findings: (1) there is a substantial literature of clinically relevant information in orthodontics upon which to base clinical decisions; (2) the information appears to be balanced between etiology, diagnosis, treatment, and prognosis; (3) approximately 45% of the articles reside in 5 journals, whereas the remainder reside in approximately 66 other journals, making it difficult to stay current; (4) the number of articles is increasing significantly each year; (5) to stay current, one would need to read between 1 and 6 articles per week, 52 weeks per year; (6) these trends suggest the need for computer-based clinical knowledge systems; and (7) the methods used here can be immediately employed to identify the best and most current clinical orthodontic evidence.

Analysis of Variance↗
PubMed2002

Orthodontic treatment outcomes in the long term: findings from a longitudinal study of New Zealanders.

The aim of this study was to use a health services research (HSR) approach to examine the longer-term outcomes of orthodontic treatment. Participants in a longstanding population-based New Zealand cohort study (the Dunedin Multidisciplinary Health and Development Study) were allocated to one of four malocclusion severity categories on the basis of orthodontic data collected at age 12. The outcome of that care by age 26 was evaluated using the key indicators of equity (was it fair?); efficacy (did it work?); effectiveness (did it work in the longer term?); and safety (was it associated with a greater subsequent experience of caries, periodontal disease, or tooth loss?). Data were available for 452 Study members, of whom 56.2% were in the minor/none category, 29.0% were in the definite category, 10.2% were in the severe category, and 4.6% were in the handicapping treatment-need category. No clear differences in treatment uptake by socioeconomic status were apparent, and the proportion treated increased across the malocclusion severity categories, as did the proportion that showed an improvement following treatment. By age 26 a difference between those who had and those who had not been treated was evident, with the percentage of those rating their dental appearance as above average increasing with increasing severity of the age-12 orthodontic treatment need. This was also true for the percentage that considered their orthodontic treatment to have been successful. There were no significant differences in caries experience, periodontal disease occurrence, or tooth loss between those who had and had not been treated by age 26. This study has found the equity, efficacy, effectiveness, and safety of orthodontic treatment in the Dunedin cohort to be acceptable.

Adolescent↗
PubMed2004

Are the flowable composites suitable for orthodontic bracket bonding?

The study aims to determine the shear bond strength (SBS) values of different flowable composites (Pulpdent Flows-Rite, 3M Filtek Flow, and Heraeus Kulzer Flow Line) in comparison with a conventional orthodontic adhesive and the bond failure sites of these composites. Eighty extracted human premolars were divided into four groups of 20 teeth each. Brackets were bonded to the teeth in each test group with different composites, according to the manufacturer's instructions. SBS values of these brackets were recorded (in MPa) using a universal testing machine. Adhesive remnant index (ARI) scores were determined after the failure of brackets. Data were analyzed using analysis of variance (ANOVA), Tukey honestly significant difference, and chi-square tests. SBS values of groups 1 (Transbond XT), 2 (Flows-Rite), 3 (Flow), and 4 (Flow Line) were found to be 17.10 +/- 2.48 MPa, 6.60 +/- 3.2 MPa, 7.75 +/- 2.9 MPa, and 8.53 +/- 3.50 MPa, respectively. The results of this study demonstrate that the orthodontic adhesive (Transbond XT) had higher SBS values than the flowable composites. Results of ANOVA revealed statistically significant differences among the groups (P < .05). The SBS values were significantly lower in all flowable composite groups than the orthodontic adhesive. ARI scores were significantly different between the orthodontic adhesive and all the flowable groups investigated. The use of flowable composites is not advocated for orthodontic bracket bonding because of significantly lower SBS values achieved.

Adhesiveness↗
PubMed2006

Orthodontic treatment need in Peruvian young adults evaluated through dental aesthetic index.

The objectives of this study were to evaluate the frequency and severity of the malocclusion and treatment needs in Peruvian young adults. The second aim was to compare the orthodontic treatment needs according to sex and socio-economic status (SES). This cross-sectional study was conducted at the University Dental Clinic of a private university in Lima, Peru. A total of 267 freshmen (from 16 to 25 years old) were randomly selected from a pool of 780 students. Students wearing an orthodontic appliance or reporting a history of orthodontic treatment were excluded from the study. Clinical examinations were conducted using the Dental Aesthetic Index (DAI). Mann-Whitney and Kruskal-Wallis tests were used to compare the DAI scores according to sex and SES, respectively. The mean DAI score was 28.87 points (IC(95%) 27.77; 29.97, where IC indicates interval of confidence). Around one-third of the sample presented severe or very severe malocclusion, which implies a highly desirable or mandatory orthodontic treatment need. No statistically significant difference was found between the DAI scores according to sex (P = .592) and SES (P = .397). Approximately one-third of the evaluated Peruvian young adults would need orthodontic treatment according to the DAI. In this population, malocclusion was characterized by a relatively high frequency of missing teeth, appreciable dental crowding, and inadequate anteroposterior relationships.

Adolescent↗
PubMed2003

The relationship between normative orthodontic treatment need and oral health-related quality of life.

OBJECTIVES: The first objective was to assess whether having had orthodontic treatment affected the levels of oral health-related quality of life impacts in Brazilian adolescents. A second objective was to assess the relationship between a normative clinical measure of orthodontic treatment need and two measures of oral health-related quality of life. METHODS: A cross-sectional study was conducted in Bauru, SP, Brazil, on 1675 randomly selected adolescents aged between 15 and 16 years. Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess the adolescents' oral health-related impacts. Multiple logistic regression was used in the data analysis. RESULTS: Adolescents who had completed orthodontic treatment reported less oral health impacts on their daily life activities than those currently under treatment or those who never had any treatment. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study provided more information about the adolescents' perceived satisfaction with their appearance than the IOTN on its own. CONCLUSION: Current methods of assessing orthodontic need should be complemented by oral health-related quality of life measures with valid psychometric properties, and measures of perceived need.

Activities of Daily Living↗
PubMed2002

Efficacy of a wax containing benzocaine in the relief of oral mucosal pain caused by orthodontic appliances.

During orthodontic treatment, pain and discomfort of the oral mucosa can be experienced as a result of trauma from the appliances caused by increased friction between mucosal tissue and the surface of the brackets. Currently, orthodontists have few remedies to prevent or relieve this mucosal irritation. The orthodontist can give the patient wax to cover the brackets as a prophylactic measure or to use as needed on specific irritating appliances. Orthodontic wax contains no analgesic components. The purpose of this study was to determine the efficacy of an orthodontic wax containing benzocaine that is released over time in a controlled manner. This randomized, prospective, double-blind, clinical trial compared patients' responses to the wax with benzocaine and the currently used unmedicated orthodontic wax. Seventy patients, 35 in each treatment group, were instructed to apply the wax in a specific manner, and their pain levels were recorded at 6 different time points. The pain levels were analyzed with a repeated-measure analysis of variance (ANOVA) model with factors of treatment (medicated wax vs unmedicated wax) and times (6 levels). Post-hoc pair-wise comparisons were made on the basis of the Fisher least significant difference procedure. The results of this study clearly indicated that the pain profile over time of the group that received the wax containing benzocaine was significantly different from that of the subjects who received the unmedicated wax. The medicated group had significantly lower pain levels at every time point after the first hour (P <.0003 in each case) compared with the unmedicated group. The medicated wax was effective immediately and continued to reduce pain in greater magnitude than did the unmedicated wax. A wax applied to orthodontic brackets that slowly and continuously releases benzocaine is significantly more effective at reducing the pain associated with mucosal irritation than is the current option used by most orthodontists.

Adult↗