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PubMed1987

The role of the general practitioner and the orthodontist in the provision of orthodontic care.

Orthodontics is a small branch of dentistry but one of the oldest and most widespread of dental specialties. It is characterized by long-term treatment objectives which are related to dentofacial morphology and function, growth, facial balance and maturation. Owing to the lack of baseline data it has not been included in the recommendations of the FDI for a stepwise procedure towards 'Health for All by the Year 2000'. Serious efforts should be made to allow inclusion of orthodontics by overcoming this data problem. It is strongly recommended that an internationally acceptable index for orthodontic purposes at the community level be developed. Problems of integration of orthodontic services within oral health care programmes are most significant at medium resource levels when priorities have to be established among many highly desirable dental services. In upper resource levels with less caries and periodontal disease than before the general practitioner should be aware of the rapidly increasing needs for service among elderly people due to improved oral health in adults. For the sake of efficiency, control and quality orthodontic treatment should preferably be carried out by appropriately educated orthodontists, even if the case appears simple in the beginning. Simple cases treated by specialists consume fewer resources than are needed for a system of effective communication and delegation to the general practitioner. Continuing education of all practitioners and other members of the dental team should be carried out in personnel categories and across the boundaries between them.

General Practice, Dental↗
PubMed1987

Undergraduate and continuing education in orthodontics: a view into the 1990s.

It has been projected that up to 40 per cent of clinical practice undertaken by general dentists in major cities in Canada may involve some type of orthodontic therapy by the mid-1990s. This major shift has already started and the University of British Columbia has begun to update its curriculum accordingly. Concomitant with a decrease in demand for two year postgraduate education courses and a reduced need for the control of decay, academic programmes across Canada are experiencing an increased demand for more extensive orthodontic education by both undergraduate dental students and general practitioners. Current practice trends indicate that more orthodontics is undertaken by general practitioners and that fewer orthodontists are being trained. The Department of Orthodontics at the University of British Columbia utilizes the Dental Performance Simulation System (J. Morita Corp., Japan) for preclinical training in straight-wire edgewise techniques. In their second year, students fit and cement bands, bond brackets, ligate archwires and fit and adjust headgears on the Simulation System. Two years of clinical sessions (3 hours/week) follow this preclinical training. By carefully selecting only Class I non-extraction cases that can be completed ideally in eight months or less of active edgewise therapy, a realistic generalist/specialist division of labour has been developed. To fully meet the anticipated general practice orthodontic demands in the 1990s, undergraduate academic programmes must be prepared to significantly alter current overall curriculum objectives.

Canada↗
PubMed1981

Clinical applications of direct orthodontic bonding systems.

Utilization of direct bonding of attachments to tooth surfaces has greatly facilitated traditional full-banding procedures for patients undergoing complete orthodontic therapy. The bonding of plastic brackets best relegated to maxillary anterior teeth is supplemented with metal bracket bonding for posterior teeth. Buccal tubes attached to metal mesh pads may also be bonded, although conventional orthodontic bands and buccal tubes are ideal for posterior teeth. Bonded metal brackets can accommodate resilient arch wires, torque sectionals, and root paralleling springs. Direct bonding to recently exposed impacted cuspids facilitates elastic traction procedures--once difficult to do before at least partial eruption of these teeth. In addition to the treatment of full orthodontic cases, direct orthodontic bonding is also an adjunct in the correction of single tooth malpositions. The continual improvement of composite resin systems has truly provided a renaissance in orthodontic techniques and has greatly benefited treatment methods.

Acid Etching, Dental↗
PubMed1995

Occlusion, Orthodontic treatment, and temporomandibular disorders: a review.

A review of the current literature regarding the interaction of morphologic and functional occlusal factors relative to TMD indicates that there is a relatively low association of occlusal factors in characterizing TMD. Skeletal anterior open bite, overjets greater than 6 to 7 mm, retruded cuspal position/intercuspal position slides greater than 4 mm, unilateral lingual crossbite, and five or more missing posterior teeth are the five occlusal features that have been associated with specific diagnostic groups of TMD conditions. The first three factors often are associated with TMJ arthropathies and may be the result of osseous or ligamentous changes within the temporomandibular articulation. With regard to the relationship of orthodontic treatment to TMD, the current literature indicates that orthodontic treatment performed during adolescence generally does not increase or decrease the odds of developing TMD later in life. There is no elevated risk of TMD associated with any particular type of orthodontic mechanics or with extraction protocols. Although a stable occlusion is a reasonable orthodontic treatment goal, not achieving a specific gnathologically ideal occlusion does not result in TMD signs and symptoms. Thus, according to the existing literature, the relationship of TMD to occlusion and orthodontic treatment is minor. Signs and symptoms of TMD occur in healthy individuals and increase with age, particularly during adolescence; thus, TM disorders that originate during various types of dental treatment may not be related to the treatment but may be a naturally occurring phenomenon.

Adolescent↗
PubMed1995

The duration and sequencing of surgical-orthodontic treatment.

A review of surgical-orthodontic patients treated through the University of North Carolina Dentofacial Program indicated that the duration of surgical treatment was roughly comparable to that of nonsurgical orthodontics for most patients; there was a greater chance of very long treatment when surgery was involved. Treatment times differed significantly among patients whose orthodontic treatment was done in the faculty practice, university clinic, or outside the university. Median treatment times were 18, 24, and 28 months, respectively, for the three practice settings, but some patients in each group underwent more than 48 months of treatment. After 1 year of presurgical treatment, two thirds of the faculty practice patients, but only one third of the clinic and private practice patients, were ready for surgery. Postsurgical orthodontic treatment of patients attending the faculty practice also was completed more quickly: appliances were removed within 9 months from 83% of faculty practice patients, 71% of clinic patients, and 53% of private patients. Guidelines for efficient management of surgical-orthodontic patients are presented.

Academic Medical Centers↗
PubMed1997

Orthodontic appliances in relation to nickel hypersensitivity. A review.

Nickel hypersensitivity is an increasing problem in adolescents, especially in girls, with a prevalence of up to 30%. The presence of nickel in orthodontic appliances and the possibility of causing nickel hypersensitivity has been discussed in case reports. A review of the literature concerning nickel hypersensitivity in relation to orthodontic appliances has shown that the risk is very low for patients who are not nickel hypersensitive at the start of the treatment. A patient who is already nickel hypersensitive at the start of orthodontic treatment may in rare cases show adverse reactions induced by the appliance. The slow long-term release of nickel from orthodontic appliances may induce tolerance to nickel in individuals who are not hypersensitive at the start of orthodontic treatment.

Adolescent↗
PubMed1995

Root resorption related to orthodontics and other factors: a review of the literature.

Each patient (and parents or guardian) should be clearly informed that there is a real possibility of one or more teeth undergoing root resorption during orthodontic procedures. They should sign an Information and Consent Form arranged by the dentist that they understand these risks before treatment is begun. Open bite cases possess significantly great degrees of resorption. Since trauma is closely associated with root resorption, the patient (and parents or guardian) should be questioned concerning previous traumatic occurrences that involved blows or accidents involving the teeth. Periapical radiographs are an important part of orthodontic records. They are useful to compare pretreatment and posttreatment root resorption. Maxillary incisors are affected more frequently and to a greater degree than the rest of the teeth during active treatment. Also, root resorption of the upper incisors during the initial 6-9 months of treatment with fixed appliances gives a high risk for continued resorption during the subsequent treatment. Therefore, it would be prudent to take periapical radiographs periodically during treatment. When root resorption is detected during active treatment, a decision must be made as to whether to continue, modify or discontinue the treatment. Extremely heavy forces should be avoided, since they have been shown to produce greater resorption activity. The ectopic eruption of canines causes a significant number of resorptions in lateral incisors. Habits adversely affect root resorption and should be eliminated if possible. Pathological lesions increase the risk of resorption. Periodontal disease increases the risk of resorption. The practitioner contemplating doing orthodontics should be cognizant of the above factors in evaluating the risk of root resorption. Patients (and parents or guardians) should be made clearly aware that any type of orthodontic treatment carries with it the risk of root tip blunting or resorption during orthodontic therapy.

Child↗
PubMed1997

Adjunctive orthodontic therapy in adults over 50 years of age. Clinical management of compensated, partially edentulous malocclusion.

Increasing numbers of adults, with a wide range of compensated partially edentulous (CPE) malocclusions, could benefit from adjunctive orthodontic therapy. Because loss of teeth is a risk factor for osteoporosis (OP) and restoration of occlusion depends on a positive bone response, all subjects in a prospective clinical trial were screened for OP risk factors and other bone-related metabolic problems. The sample consisted of 16 potential orthodontic patients (3 males, 13 females) over the age of 50. Based on risk factor analysis, six (44%, 1 male and 6 females) were referred for medical evaluation including bone mineral density (BMD) measurement. Ultimately, five osteopenic/osteoporotic patients, along with four patients reporting no significant osteoporotic risk factors, completed multidisciplinary treatment including adjunctive orthodontics. All were successfully treated to what was considered to be optimal esthetics and function with no substantial complications. It was concluded that patients over 50 years of age of both sexes can be effectively treated orthodontically if they have a healthy periodontium, retain an adequate residual dentition, can be controlled medically, and are compliant with treatment recommendations. Overall, orthodontics was a readily accepted, cost-effective aspect of treatment that substantially improved the esthetics and function of patients with moderate to severe CPE malocclusion.

Aged↗
PubMed1998

Orthodontic treatment priority: a comparison of two indices.

Approval for state sponsored funding of orthodontic treatment is often decided using an index of malocclusion. The purpose of this study was to determine whether two indices used for prioritizing patients would identify different groups of individuals qualifying for orthodontic treatment funding approval. In addition, the characteristics of patients approved using different indices were compared. The records of 40 patients previously submitted for state medicaid funding approval were evaluated by three study examiners using two orthodontic treatment priority indices, the Salzmann Handicapping Malocclusion Assessment (Salzmann) and the Index of Orthodontic Treatment Need (IOTN). Comparisons were made between state medicaid and study examiner Salzmann scores, rankings, and funding decisions, and between study examiner Salzmann rankings, IOTN rankings, and funding decisions. Correlation and rank correlation coefficients between the state and study examiners' Salzman scores were high (r = 0.74; p < 0.001, and R = 0.77; p < 0.001). Rank correlation analysis of the study examiners' Salzmann and IOTN values demonstrated a weaker relationship (R = 0.40; p < 0.02). Agreement on funding decisions, evaluated by the Kappa statistic, was greater between the two Salzmann evaluations (K = 0.57) than between the study examiners' Salzmann and IOTN evaluations (K = 0.14). As expected, depending on the method used to determine orthodontic treatment funding priority, different patients were likely to be identified for treatment approval. The characteristics of patients whose treatment was approved was closely related to the criteria defined by the method employed.

Health Care Rationing↗
PubMed1992

[The deactivation behavior and effectiveness of different orthodontic leveling arches--a dynamic analysis of the force systems].

Using the orthodontic measuring and simulation system (OMSS), the deactivation behaviour of diverse orthodontic levelling arches was investigated. The vertical forces and uprighting moments, as also the levelling effectiveness for initial malalignments of tooth 21 (1 mm and 2 mm infraocclusion, 20 degrees angulation) were measured, with the influence of various ligatures used in clinical practice being taken into account. The results may be summarized as follows: In the case of a large vertical offset (infraocclusion) the vertical forces can attain values of up to 3.8 N, depending on the type of levelling arch used. On deactivation, we can observe a sharp decrease in force caused by the frictional resistance between bracket and arch wire, which has to be overcome by the wire. The loss of desired force caused by friction may be as much as 50%, and is determined by the arch wire, bracket and mode of ligation. A smaller vertical offset (infraocclusion) (1 mm) is associated with extrusive forces of 0.2 N--0.8 N. Using looped levelling arches made of 0.016" standard steel wire, there is no frictional loss of orthodontic force, so that the highest vertical forces (more than 3.0 N) are observed with these arch wires. With an initial angulation of the tooth of about 20 degrees, uprighting moments of between 3.0 Nmm and 33.0 Nmm are measured, the looped arches again generating the highest moments. To ensure adequate uprighting moments in a combination of vertical offset (infraocclusion) and angulation, very high extrusive forces must be accepted. As a dynamic analysis of the tooth movement with the OMSS shows, the use of a specific arch wire results in a typical levelling defect. There is no general correlation between extrusive force or uprighting moment and the levelling effectiveness of an orthodontic arch. It is not possible to recommend a particular levelling arch.

Biomechanical Phenomena↗
PubMed2005

Comparison of the initial orthodontic force systems produced by a new lingual bracket system and a straight-wire appliance.

BACKGROUND AND AIM: Over the last few years, lingual appliances have become an established orthodontic treatment technique. Many studies have concentrated on various esthetic aspects, on laboratory and clinical procedures, and on patient comfort and compliance. The orthodontic force systems of these appliances, however, have not yet been investigated. The aim of this study was thus to determine the forces and moments produced by a new lingual bracket system during the leveling phase of orthodontic treatment and to compare those with the corresponding force system of a labial straight-wire appliance. MATERIAL AND METHOD: The intra-oral situation of ten patients undergoing orthodontic treatment was replicated in measurement casts fitted with lingual and labial brackets. Special care was taken to precisely reproduce each patient's interbracket geometry. We measured each tooth's force systems as generated by a leveling arch inserted into the lingual and labial brackets. RESULTS: The resulting force systems of both appliances were found to be quite similar with regard to the magnitude of most force and moment components. Only the first molars were subjected to considerably greater single forces with the lingual appliance. Tipping moments were found to be significantly smaller with the lingual technique, whereas the rotational moments were significantly smaller with the labial appliance. All in all we noted significant differences between the two techniques only in certain areas which upon closer examination were distributed over only a few tooth types. CONCLUSIONS: The initial force systems produced by the new lingual bracket system proved to be comparable with those delivered by a conventional straight-wire appliance. The actual levels of forces and moments, however, were found in certain cases to be too heavy with both techniques. We therefore recommend the development of leveling wires producing considerably lighter forces and moments.

Bite Force↗
PubMed2006

Force systems in the initial phase of orthodontic treatment -- a comparison of different leveling arch wires.

BACKGROUND AND AIM: The determination of orthodontically-effective forces and moments places great demands on the technical equipment. Many patients report severe pain after fixed appliance insertion. Since it is assumed that pain from orthodontic appliances is associated with the force and moment levels applied to the teeth and since the occurrence of root resorption is a common therapeutic side effect, it would seem important to know the actual magnitudes of the components of the active orthodontic force systems. The aim of the present study was therefore to measure initial force systems produced by different leveling arch-wires in a complete multi-bracket appliance and to assess whether force and moment levels can be regarded as biologically acceptable or not. MATERIAL AND METHODS: The actual bracket position in 42 patients was transferred onto a measurement model. Forces and moments produced by a super-elastic nickel-titanium (NiTi) archwire, a 6-strand stainless steel archwire, and a 7-strand super-elastic NiTi archwire were determined experimentally on different teeth. RESULTS: Average forces and moments produced by the super-elastic NiTi arch wires were found to be the highest. In spite if their larger diameter, the stranded arch wires' average force and moment levels were lower, especially that of the stranded super-elastic archwire. Nevertheless, maximum force levels sometimes exceeded recommended values in the literature and must be considered as too high. CONCLUSIONS: The measured arch wires' initial force systems differed significantly depending on the type of archwire and its material structure. Stranded arch wires produced lower force and moment levels, and we recommend their use in the initial phase of orthodontic treatment.

Bite Force↗
PubMed2003

Nickel allergy and orthodontics.

Nickel is the most common metal to cause contact dermatitis in orthodontics. Nickel-containing metal alloys, such as nickel-titanium and stainless steel, are widely used in orthodontic appliances. Nickel-titanium alloys may have nickel content in excess of 50 per cent and can thus potentially release enough nickel in the oral environment to elicit manifestations of an allergic reaction. Stainless steel has a lower nickel content (8 per cent). However, because the nickel is bound in a crystal lattice it is not available to react. Stainless steel orthodontic components are therefore very unlikely to cause nickel hypersensitivity. This article discusses the diagnosis of nickel allergy in orthodontics and describes alternative products that are nickel free or have a very low nickel content, which would be appropriate to use in patients diagnosed with a nickel allergy.

Contraindications↗
PubMed1997

Extent and provision of orthodontic services for children and adolescents in Finland.

Orthodontic services for Finnish children and adolescents up to the age of 18 in 1992 were monitored by a questionnaire sent to all municipal health centres responsible for children's dental care in Finland, and 96% responded. All health centres provided some orthodontic treatment, but the percentage of 0 18-year-old children receiving treatment ranged from 1% to 19%. One-quarter of all dental visits of the 0 18-year-olds were in connection with orthodontics. The timing of treatment was early, the average age for starting was 9.5 years. In statistical analyses, the number of children receiving treatment was associated with the timing of treatment. At the age of 7, the most frequently used appliances were quad helix, removable appliance and orthopaedic headgear and, at the age of 13, fixed appliance and activator. Most treatments were provided by nonspecialists. The specialist expertise needed was usually purchased from an outside orthodontist by means of consultation contracts. Every fifth health centre, usually the largest, had employed one or more specialist orthodontists. The regional distribution of orthodontists was uneven, emphasizing regional variation in the delivery of orthodontic services.

Adolescent↗
PubMed1990

An analysis of retrospective data concerning the provision of orthodontic treatment by the community dental services.

The distribution of both community orthodontic and dental officer manpower has been reviewed, and both exhibit an unequal regional variation. The amount of orthodontic treatment provided was calculated, and expressed as a treatment rate and percentage of fixed: removable appliances fitted. There was a marked regional variation in the form of appliance utilized, and there was a significant relationship between community orthodontic manpower and the relative use of fixed appliances. However, the treatment rate was not related to the manpower distribution. The data collected, by the Department of Health, on the provision of orthodontic treatment was found to have some limitations in its usefulness for epidemiological purposes.

Adolescent↗
PubMedDate not supplied

Second molar replacement applied to dentofacial orthopedics and orthodontics much more than a technique.

There is seldom a consensus on any dental subject. The literature contains conflicting points of view and results of studies vary considerably. I have endeavored to present my paradigm of second molar replacement in dentofacial orthopedics and orthodontics. I have presented a summation of information known to date regarding this subject. I based this article on my extensive clinical experience and observations over many years. I participate in continuing education, and know many of the traditional and functional post-doctoral educators. I read the literature. For your benefit, I have presented this information and shared a paradigm that has positively changed my life, and perhaps will change the way you practice. Second molar replacement technique has revolutionized orthodontic treatment. The technique offers distinct benefits considering the patient's face, the jaw joints, and the teeth. The reader is strongly encouraged to read bibliography references for a mature understanding of second molar replacement in modern orthodontics and TMD therapy. When extraction of teeth is needed for orthodontic purposes Broadbent considers second molar replacement, second bicuspid removal, first bicuspid removal, lower incisor removal, and then other extraction possibilities to resolve the malocclusion. When extraction guidelines are followed and treatment mechanics are properly designed the extraction of second molars have predicable good results in a high percentage of cases. However, second molar removal may be contraindicated for numerous reasons. Diagnosis and case selection is paramount! The doctor must diagnosis and determine if and when second molar replacement would be in each patient's best interest. The bottom line for each individual patient is the best possible facial esthetics, functional occlusion, and health of jaw joints.

Adolescent↗
PubMed2001

[Orthodontic treatment in children and adults].

Orthodontics is concerned with the study of dental-maxillofacial development, and the analysis and treatment of anomalies in this development. The orthodontic approach commences with the monitoring of oro-facial functions as of the early stages of childhood (3 to 4 years). This first stage is chiefly preventative. Interceptive orthopaedic treatment is performed, if necessary, on young patients who have reached the mixed dentition stage. This treatment involves the use of fixed or removable braces to correct any irregularity in the maxillofacial development and dental malposition. The treatment for most dental malpositions commences as of the setting in of the secondary dentition (11 to 13 years). The movements of the teeth in the three precise spatial directions are defined with the use of fixed braces. Residual maxillary deformities (prognathism, retrognathism, laterognathism, etc.) are corrected at the end of the growth process or in adulthood through fixed orthodontic treatment combined with maxillofacial osteotomies. Adult patients are treated with the same fixed orthodontic techniques and according to a therapeutic protocol adapted to their specific dental or periodontal mutilations.

Adolescent↗
PubMed2000

Space for missing maxillary lateral incisors--orthodontic perceptions.

Historically there has been a long-standing debate regarding the orthodontic management of dentitions with missing maxillary lateral incisors. Whether to provide space for prosthetic replacements or to close space utilizing the canines as substitute lateral incisors are the options of treatment planning for an individual. This presentation is directed at the orthodontic management of those patients who were orthodontically treated in the past by providing space for replacement lateral incisors and now at dental maturity or even later, seek a prosthetic replacement in the form of an osseointegrated fixture. In many instances there will be inadequate interradicular bone space and yet at the time of debanding adequate space often was present and now some years hence the patient is faced with orthodontic re-treatment to provide that space again. Whilst that is a challenge in itself, there is a further apparent problem to be met for those younger patients requiring space opening mechanics in deciding upon and implementing at the debanding phase, the form of retention that will hold the teeth and the roots firmly in position until the time is right for an osseointegrated fixture to be placed and treatment finalized.

Adolescent↗