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PubMed2004

Clinical suitability of titanium microscrews for orthodontic anchorage-preliminary experiences.

AIM: The future of orthodontic anchorage implants may well belong to micro-implants, developed in varying designs, lengths and diameters by different manufacturers. The aim of the present clinical study was to investigate whether titanium microscrews manufactured by Jeil Medical Corp. (South Korea) are suitable for orthodontic anchorage purposes. MATERIAL AND METHODS: At the Department of Orthodontics, University of Aachen, 36 micro-implants with diameters of 1.4, 1.6 and 2 mm and lengths of 6, 8 and 10 mm were inserted in 17 patients. The implants served predominantly as anchorage for premolar distalization, molar uprighting and molar mesialization. RESULTS: The mean age of the patients was 29 +/- 14 years. The implantation sites were evenly divided between the upper and lower jaw. The main insertion sites were buccal interradicular, retromolar, and palatal interradicular. Most implants used were 8 mm in length and 1.6 or 2 mm in diameter. The mean in situ time was 158 +/- 97 days. Eleven fixtures failed before the end of treatment, corresponding to a failure rate of 30%. CONCLUSIONS: The tested miniscrews with a diameter of 1.6-2 mm and a length of 8-10 mm proved suitable for orthodontic anchorage purposes. Whereas larger implants need a relatively extensive bone supply and the insertion sites are limited, microscrews offer a more flexible range of applications. They also offer crucial advantages such as simple, atraumatic insertion and removal, minimum patient stress, and a favorable cost-benefit ratio.

Bone Screws↗
PubMed1980

Reliability and stability of the orthodontic Patient Cooperation Scale.

Patient cooperation is recognized as an important factor in the outcome of orthodontic treatment. In order to predict patient cooperation, there have been numerous studies which have examined its correlates in orthodontic treatment. However, few, if any, of these studies have considered the reliability or stability of their patient cooperation measures. Hence, the correlates found or not found are suspect. The present article reports on the internal consistency and stability of the Orthodontic Patient Cooperation Scale (OPCS). Using the responses of practicing orthodontists, a list was generated of ten patient behaviors frequently considered in evaluating a patient's cooperation. Subjects were eighth- and ninth-grade students undergoing orthodontic treatment, who were rated by their own orthodontists after 2 months and 6 months of treatment. The internal consistency for the scale was estimated to be 0.71 (N = 44) at 2 months and 0.80 (N = 45) at 6 months. The correlation between scores at 2 months and at 6 months was 0.58 (N = 44), which may be considered to be a conservative estimate of the long-term stability of the scale. In summary, the OPCS has adequate internal consistency and reasonably stable scores over a 4-month period. As such, it should prove useful in studies looking for predictors of patient cooperation and in studies examining the relationship of patient cooperation and outcome of treatment.

Adolescent↗
PubMed1989

Mechanical properties and clinical applications of orthodontic wires.

This review article describes the mechanical properties and clinical applications of stainless steel, cobalt-chromium, nickel-titanium, beta-titanium, and multistranded wires. The consolidation of this literature will provide the clinician with the basic working knowledge on orthodontic wire characteristics and usage. Mechanical properties of these wires are generally assessed by tensile, bending, and torsional tests. Although wire characteristics determined by these tests do not necessarily reflect the behavior of the wires under clinical conditions, they provide a basis for comparison of these wires. The characteristics desirable in an orthodontic wire are a large springback, low stiffness, good formability, high stored energy, biocompatibility and environmental stability, low surface friction, and the capability to be welded or soldered to auxiliaries. Stainless steel wires have remained popular since their introduction to orthodontics because of their formability, biocompatibility and environmental stability, stiffness, resilience, and low cost. Cobalt-chromium (Co-Cr) wires can be manipulated in a softened state and then subjected to heat treatment. Heat treatment of Co-Cr wires results in a wire with properties similar to those of stainless steel. Nitinol wires have a good springback and low stiffness. This alloy, however, has poor formability and joinability. Beta-titanium wires provide a combination of adequate springback, average stiffness, good formability, and can be welded to auxiliaries. Multistranded wires have a high springback and low stiffness when compared with solid stainless steel wires. Optimal use of these orthodontic wires can be made by carefully selecting the appropriate wire type and size to meet the demands of a particular clinical situation.

Chromium Alloys↗
PubMed1991

Orthodontic therapy in the patient treated with cyclosporine.

Cyclosporine is an immunosuppressive drug that is gaining widespread use in the treatment of a variety of disorders. Gingival hyperplasia, a common side effect of cyclosporine therapy, has significant implications for orthodontic treatment, especially as the drug becomes more widely used to treat diseases prevalent in adolescents. A 5-year study of a group of patients with type 1 diabetes who were receiving cyclosporine treatment revealed a series of findings that are of importance to the orthodontist, including the potential for orthodontic appliances to increase the severity of the induced gingival enlargement and the potential of the gingival hyperplasia to complicate orthodontic therapy. Guidelines to minimize the degree of cyclosporine-induced gingival enlargement in the orthodontic patient are suggested.

Adolescent↗
PubMed1992

Craniomandibular disorders with special reference to orthodontic treatment: an evaluation from childhood to adulthood.

The purpose of the present study was to reexamine a group of children and adolescents with respect to signs and symptoms of craniomandibular disorders (CMD) and to evaluate whether any differences could be found between persons who had received orthodontic treatment earlier and those who had not. A total of 402 children in three age groups (7, 11, and 15 years) had participated in a cross-sectional study on the relationship between malocclusion and signs and symptoms of CMD. Ten years later they were asked to answer a questionnaire. In the youngest age groups (now 17 and 21 years old) 190 (76%) subjects answered the questionnaire. In the oldest age group (now 25 years old) completed questionnaires were received from 103 (84%) subjects, and 83 (62%) of those subjects appeared for a clinical examination. Subjects with a history of orthodontic treatment had a lower prevalence of subjective symptoms of CMD (TMJ sounds included) than those without any experience of orthodontics. Although the differences were small, it was more evident for the oldest age group. The clinical examination has shown that persons who had undergone orthodontic treatment had a significantly lower clinical dysfunction index than those who had not.

Adolescent↗
PubMed1993

Applications of the air-powder polisher in clinical orthodontics.

Air polishers are relatively new devices that have provided dentistry with an alternative method for cleansing the tooth surface. Many publications attest to the efficacy of the instrument in plaque and stain removal while advising the practitioner of potential health risks to the patient. In spite of the information available, little research has been published concerning air polishing procedures in the treatment of the tooth surface before placement of the orthodontic bracket. In light of the research supporting the efficacy of plaque and stain removal, the use of the air polisher has been shown to have no detrimental influence on the bonding of the resin bracket cement to the tooth surface. It would appear that the system may be ideal for use in conjunction with orthodontic treatment. The air-powder polisher has been found to be the most effective method of plaque removal for orthodontic patients without causing breakage of elastics or wires or loss of zinc phosphate or composite material. Another application for the air-powder polisher in the orthodontic practice is surface preparation of the tooth before bracket placement. The instrument should be held approximately 4 to 5 mm from the tooth surface, at a 60 degree angle for anterior smooth surfaces, at an 80 degree angle for posterior smooth surfaces, and at a 90 degree angle for occlusal surfaces. A constant circular motion should be used, with an exposure time of 30 to 60 seconds.

Air Pressure↗
PubMed2004

Influence of orthodontic derotation and extrusion on pulpal and periodontal condition of autotransplanted immature third molars.

The aim of this study was to determine the influence of orthodontic treatment on the pulpal and periodontal condition of 91 transplanted immature third molars. In patients with atrophy of the alveolar process or unfavorable root morphology, transplants had to be placed in extreme rotated or infraoccluded positions. After 3 to 6 months, these transplants were derotated (45 degrees to 90 degrees) to a correct position in the dental arch (derotation group; n = 28) or extruded to the occlusal plane (extrusion group; n = 21). Finally, approximal spaces were closed in both groups. A sample of 42 transplanted third molars with no orthodontic treatment need served as the control group. All transplants were followed clinically and radiologically for a mean period of 4.0 years. With respect to pulpal and periodontal conditions, no significant differences were observed between the control and the extrusion group. In contrast, compared with the control group, transplants in the derotation group had a significantly poorer pulpal and periodontal condition. In the derotated transplants, a significant correlation was detected between pulp necrosis and orthodontic treatment of multi-rooted transplants. This study indicates that orthodontic extrusion and minor lateral movements of autotransplanted immature third molars, as well as rotation of single-rooted third-molar transplants, represent no additional risk to transplant survival. In contrast, rotation of multi-rooted transplants seems to initiate later severance of the vascular and nerval supply to the pulp.

Adolescent↗
PubMed1994

Orthodontic treatment demand and need in third and fourth grade schoolchildren.

There have been few reports worldwide addressing orthodontic need and demand in children and no recent reports in the United States. The purpose of this study was to examine the orthodontic need and demand in third and fourth grade children (n = 3696). Data including age, sex, race, orthodontic status, socioeconomic status, availability of specialist treatment services, as well as thorough occlusal data, were collected. Orthodontic demand was significantly higher in girls (9.5%) than boys (6.8%), whereas need had the inverse relationship (41.8%, 44.2%, respectively). There were no meaningful differences in age among the demand, need, and no need groups. Demand was greater in white than in black children (11.8% versus 1.2%); however, need was observed to be less in black (35.3%) than in white children (47.2%). Demand was greater in the urban schools (8.9%) than in the rural schools (6.3%), whereas need was found to be similar. There was more demand in the higher socioeconomic groups (11.7%) than in the lower groups (1.8%), whereas need was similar in all the groups. The demand group had a significantly greater number of orthodontists within a radius of up to 5 miles of the school than the need and no need groups. Logistic regression models to examine factors that distinguish the groups show that when demand versus need/no need groups are compared, those students with an increased "risk" of previous treatment are more likely to have more orthodontists nearby, to be in higher socioeconomic groups, and to be female students.

Black or African American↗
PubMed1994

A radiographic study of posterior apical root resorption in orthodontic patients.

The purpose of this study was to determine the extent of apical root resorption, after fixed appliance therapy, in the posterior part of the dentition, and to evaluate if predisposing factors can be pointed out retrospectively. Tooth length in the posterior part of the dentition was measured on pretreatment and posttreatment orthopantomograms of 153 patients who were treated with standard edgewise appliances. Pretreatment and posttreatment tooth lengths were determined, and an attempt was made to explain the differences by sex, age, stage of root formation at onset of orthodontic treatment, extraction versus nonextraction therapy and treatment duration. Patients were divided into two groups according to their root formation. Group A consisted of patients with incompleted root formation at onset of orthodontic treatment except for the first molars. Group B consisted of patients where root formation was completed with the exception of second and third molars. Posttreatment tooth lengths of groups A and B were compared with pretreatment tooth lengths of group B with a paired t test, and correlations with the variables were calculated with multiple regression analysis only in group B. Posttreatment group A showed no significant differences with the mean root lengths of pretreatment group B. Differences between the mean pretreatment and posttreatment root lengths in group B were significant. Posterior teeth showed root shortening during active orthodontic treatment independent of sex, age, extraction versus nonextraction therapy, and duration of active treatment. Teeth with incompleted root formation at onset of orthodontic treatment showed root lengthening during active treatment, yet did not reach their "normal" tooth length.

Adolescent↗
PubMed1997

Effects of orthodontic treatment on nutrient intake.

Orthodontists often advise their patients to eat soft foods after treatment to avoid pressure sensitivity. Yet there is little research as to how this affects nutrient intake. This study compared nutrient intake before and after orthodontic adjustment to see whether any changes occurred. Ten patients between the ages of 12 and 16 years were selected from the University of Buffalo School of Orthodontics. These patients recorded the foods they ate for 3 days before and 3 days after treatment. Treatment types studied were those that cause a significant level of pressure sensitivity such as an arch wire change. The recorded diets were analyzed with a paired two sample t test, with alpha = 0.05 as the significance level. The results of this study show a decrease in intake of copper and manganese after orthodontic adjustment. Also trends toward a greater percentage of calories from total and saturated fat at the expense of carbohydrates, a decrease in fiber intake, and an improvement in the calcium to phosphorus ratio were seen. Bone metabolism, and therefore tooth movement may be affected by copper and manganese levels. Thus, to optimize patient physiologic response to orthodontic treatment, it may be beneficial to provide nutritional guidance to patients in choosing soft food diets.

Adolescent↗
PubMed2006

Special features of planning and application of orthodontic miniscrews in cleft patients.

Patients with clefts of lip, alveolus and palate or some facial syndromes need complex and long-lasting orthodontic therapy. The possibility of orthodontic anchorage is often limited by congenital absence of teeth, disturbed skeletal growth or failing compliance with extraoral sources of force. Correct positioning and insertion provided, miniscrews can serve as anchorages and shorten the period of active treatment in patients with clefts. With the help of a case presentation, an outline of using orthodontic miniscrews (like: Titan, Forestadent) for anchorage in patients with clefts of lip, alveolus and palate is given along with a discussion of advantages and disadvantages. Thus miniscrews are suited for use in cleft patients. However, they require careful orthodontic and surgical planning.

Bone Screws↗
PubMed2002

Clinical bond failure of pre-coated and operator-coated orthodontic brackets.

OBJECTIVES: To test the hypothesis that there is no significant difference in clinical bracket failure between the 3M APC Mini Twin bracket system and the Transbond XT adhesive during orthodontic treatment. DESIGN: A randomized, split mouth, prospective clinical trial. SETTING AND SAMPLE POPULATION: The Department of Orthodontics and Dentofacial Orthopedics at University of Missouri, Kansas City. Twenty-nine subjects who were treatment planned to receive comprehensive orthodontics using 0.018 slot appliances. EXPERIMENTAL VARIABLE: The adhesive pre-coated brackets (APC) system was randomly assigned to one side of the mouth and the Transbond XT was assigned to the opposite side. OUTCOME MEASURE: The absence of any of the brackets at the time of a regular or emergency orthodontic appointment. RESULTS: There was no significant difference (P > 0.05) in bracket failure between the 3M APC Mini Twin bracket system and the Transbond XT adhesive at any time period (90, 180, or 365 days). The failure rate of brackets on premolars was higher than on incisors or canines. CONCLUSION: APC Mini Twin bracket system and Transbond XT adhesive are equally effective in maintaining brackets clinically. Inexperienced operators had an overall 7.5% bond failure 12 months following bracket placement.

Acrylic Resins↗
PubMed2001

Orthodontics and occlusion.

The discipline of orthodontics is directed towards alteration of the occlusion of the teeth and the relationships of the jaws. It is therefore somewhat surprising to find that there is little scientific evidence to support any of the concepts that suggest occlusal goals for orthodontic treatment. Most of the current concepts of orthodontic treatment are based upon personal opinion and retrospective studies. Nevertheless, an attempt is made here to provide a guide to the relationship of orthodontics and the occlusion that is evidence based. Where the evidence is weak, these areas have been highlighted.

Centric Relation↗
PubMed1990

The specialist orthodontic practitioner. The 1989 survey.

In 1989, a survey of specialist orthodontic practitioners was carried out, with the cooperation of the British Association of Orthodontists. Questionnaires were sent to all BAO members in full-time specialist orthodontic practice; a 72% response was achieved. The results revealed that the specialist orthodontic practitioner service was well equipped and adequately qualified to accept a role as providers of the majority of UK orthodontic treatment. When new patient treatments were analysed, it was found that fixed appliance treatment was proposed for 60% of patients. However, the majority of the respondents felt that the system of remuneration in the GDS encouraged quantity as opposed to quality of treatment.

Adult↗
PubMed1993

The first 100 cases: a personal audit of orthodontic treatment assessed by the PAR (peer assessment rating) index.

The first 100 consecutively started cases treated by a specialist registrar in orthodontics were examined and pre- and post-study models were scored using the peer assessment rating (PAR) index. The PAR index proved both simple and reproducible to use: 92 cases had post-treatment records available, 91 patients registered a drop in PAR score, and one patient registered an increase. Of these 92 patients, 38 (41%) were greatly improved, 43 (47%) were improved, and 11 (12%) were made worse or no different (ie they failed to achieve a 30% drop in PAR score). Of the factors examined, only the appliance type used was significantly related to PAR score change. Of the 11 cases apparently made worse, individual examination revealed that four of these represented beneficial occlusal changes but due to limited treatment goals they did not register as improved using the PAR index according to previously agreed criteria. The PAR index measures 'good tooth position' which, although very important, is not the only factor in orthodontic treatment. The use of the PAR index to detect 'good' and 'bad' orthodontic treatment is not without problems. Its use in mixed dentition and adjunctive orthodontic treatments may not always be appropriate.

Adolescent↗
PubMed2006

The role of orthodontics in implant dentistry.

Orthodontic treatment of partially edentulous patients is difficult, especially if a significant number of teeth are missing. With loss of teeth, adjacent or opposing teeth usually tip, drift or over-erupt leaving spaces that are not optimal for replacement of missing teeth. Orthodontic correction of these spatial relationships will aid prosthetic replacement of the missing teeth, function, hygiene and aesthetics. Orthodontists rely on teeth to provide the anchorage to correct malocclusions. With patients with an intact dentition dental anchorage is usually adequate to facilitate tooth movement. In some partially edentulous patients however, insufficient anchorage may present to correct the malocclusion. In these patients implants can provide additional anchorage. At times, osseointegrated implants can also be used to support restorations after completion of orthodontic therapy if treatment planning is precise. The use of implants for orthodontic anchorage requires an interdisciplinary approach and precise planning to achieve optimal results.

Alveolar Bone Loss↗
PubMed2005

Early orthodontic treatment and long-term observation in a patient with Morquio syndrome.

Early orthodontic treatment and long-term observation in a patient with Morquio syndrome were demonstrated. To date, there are no case reports describing orthodontic treatment in such a patient. The patient showed spaced maxillary and mandibular arches with a tongue thrust habit at age seven years eight months. She also showed a protruded upper lip, labial inclination of the upper and lower anterior teeth, and thin enamel. The tongue thrust habit disappeared after the application of a removable orthodontic appliance. The spaced dentition in the upper and lower arches improved after treatment with a fixed appliance with closing loop arch wire (0.017 x 0.025") and bands on the upper and lower molars. We did not use an edgewise appliance because of the thin enamel. The protruded upper lip and labial inclination of the upper and lower anterior teeth were also improved after treatment, but optimal intercuspation of the teeth was not achieved. However, optimal intercuspation of the teeth was achieved after long-term observation and the masticatory function was improved. It was suggested that early orthodontic treatment could improve the malocclusion in a patient with Morquio syndrome and that improvement of masticatory function could be achieved during a long-term retention period.

Age Factors↗
PubMed2006

Implant vs screw loading protocols in orthodontics.

OBJECTIVE: This systematic review presents the loading protocols applied when using implants and/or screws in orthodontic treatments. MATERIALS AND METHODS: Clinical trials which assessed the use of implants and/or screws for orthodontic anchorage and studies involving treatment on syndromic patients, surgery, other simultaneous treatments, or appliances (ie mini-plates) were considered. Electronic databases (Medline, Medline In-Process & Other Non-Indexed Citations, Lilacs, Pubmed, Embase, Web of Science, and All Evidence Based Medicine Reviews) were searched with the help of a senior Health Sciences librarian. Abstracts which appeared to fulfill the selection criteria were selected by consensus. The original articles were then retrieved and evaluated with a methodological checklist. References were also hand searched for possible missing articles. RESULTS: Eleven articles fulfilled the selection criteria established. Five studies involved the use of implants while six involved the use of screws for orthodontic purposes. An individual methodological analysis for each article was made. CONCLUSIONS: Loading protocols for implants involve a minimum waiting period of 2 months before applying orthodontic forces while loading protocols for screws involve immediate loading or a waiting period of 2 weeks to apply forces. Success rates for implants were on average higher than for screws.

Bone Screws↗