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A case of acute bacterial endocarditis associated with orthodontic treatment is described and the problems associated with orthodontic treatment for 'at risk' patients are discussed. The American Heart Association recommendations for orthodontic patients are summarized, and the general recommendations of the Endocarditis Working Party of the British Society for Antimicrobial Chemotherapy are appended.
The lactic acid production in suspensions of plaque collected adjacent to orthodontic brackets retained with a glass ionomer cement (GIC), or a resin-based composite was investigated using a split-mouth technique. Forty-eight-hour-old plaque was collected at 3, 8, and 28 days, and 3 months after the onset of orthodontic treatment. Acid fermentation was induced by glucose and the L(+)-lactic acid concentrations were determined enzymatically after a 30-minute incubation period. Significantly (P < 0.05) lower levels of lactic acid were found in plaque from GIC-retained brackets compared with the composite controls at the 28 days and 3 months sampling occasions, respectively. The results suggest that the use of GIC as a bonding agent in orthodontics can be beneficial for patients assessed at risk of caries development.
Orthodontic therapy is best carried out in a normal skeletal and soft tissue environment. In patients requiring orthognathic surgery, it is suggested that there are advantages in correcting the skeletal and soft tissue elements as early as possible, and to orthodontically control the occlusion post-operatively. This results in a shorter overall treatment time due to more biologically favourable tooth movement, more predictable occlusal results and better management by the orthodontist. The clinical benefits of post-operative orthodontics are outlined.
The potential for iatrogenic damage following fixed orthodontic treatment has been well documented for many years. Enamel decalcification and gingival inflammation are preventable if good practice is followed. Patients with gingivitis or active caries should not be considered for fixed orthodontics until the disease is controlled. Diet advice, oral hygiene, and topical fluorides are the basic elements of any preventive regime, and while they need to be individually tailored for each patient, fluoride mouthrinses should be routinely used by all patients with fixed appliances. The susceptibility of enamel adjacent to an orthodontic attachment remains a problem which future improvements in adhesive materials may help to address.
The implementation of a Quality Assurance (QA) programme in orthodontic radiography is designed to improve the quality of the resultant radiographs and to reduce the number of repeat exposures. This is particularly desirable in orthodontic practice where the majority of patients are young and therefore more at risk from the detrimental effects of X-rays. A programme is described and QA tests are given that may be applied in the surgery. Particular emphasis is placed on QA measures for extraoral radiography, since this is frequently undertaken in the treatment of the orthodontic patient.
A questionnaire, relating to the use and acceptance of occlusal indices and in particular the Index of Orthodontic Treatment Need (IOTN), was sent to all UK hospital consultants in the orthodontics. Of the respondents 74.6 per cent routinely recorded the Dental Health Component of IOTN for their new patient referrals. The reasons for the increased acceptance of the IOTN amongst hospital orthodontic consultants are evaluated and some of the difficulties in usage, reported by respondents, are discussed.
This paper reports on two studies which investigated levels of discontinued orthodontic treatment amongst patients under 18 years, who had been treated in the General Dental Service (GDS) and Community Dental Service (CDS) of the National Health Service during June and July 1991. These complement the study of discontinued Hospital Dental Service treatment already reported. The studies indicated that, at the time, the levels were 13.1 per cent in the GDS and 12.5 per cent in the CDS. The figure for the GDS was much lower than that of 20 per cent reported in the Schanschieff Report. There was little difference in the levels of discontinued treatment between those working in the GDS with an orthodontic qualification (12.1 per cent) and those without (13.5 per cent). The results suggest that the levels for discontinued orthodontic treatment in those aged under 18 years of age may be lower than previously reported.
A study was undertaken to assess the views of recent graduates on the undergraduate orthodontic curriculum. The opinions of dental graduates qualified since 1968 from The Welsh National School of Medicine, the University of Birmingham and the University of London were acquired by postal questionnaire. The three samples were in close agreement in the majority of data supplied. A close relationship existed with Central Government figures, where these were available. General Dental Practitioners were found to treat a small and diminishing proportion of the orthodontic case load in the General Dental Services. The Advice Service has a limited application. Consultants acquire small numbers of patients from many sources, whilst practitioners limited to orthodontics receive larger numbers of patients from fewer sources. The undergraduate course was considered to be too short and lacking emphasis on complex therapy. Chairside, small group teaching on a greater variety of cases might improve diagnostic ability at the expense of a reduced individual case load.
The purpose of this study was to evaluate the performance of a cyanoacrylate orthodontic adhesive with regard to tensile bond strength and bond failure location in comparison with a conventional no-mix orthodontic composite adhesive using stainless steel and ceramic brackets. One-hundred-and-twenty caries-free extracted premolar teeth were used in this study. There were 30 specimens for each tooth, adhesive, and bracket combination, and of these half were tested at 24 hours and half at 3 months. Hence, there were 15 samples in each test group. Bond strengths were assessed using an Instron Universal Testing Machine after storage for 24 hours and for 3 months at 37 degrees C in distilled water. Analysis of variance showed the mean bond strength of specimens bonded with cyanoacrylate was significantly lower than for those bonded with Right-on (P < 0.001). Weibull analysis showed that at a given stress the probability of failure significantly increased after 3 months for brackets bonded with cyanoacrylate. A Chi-square test of the ARI scores revealed no significant difference among the groups tested. This study showed that cyanoacrylate adhesives are unsuitable for use as a bonding agent in routine orthodontic practice.
OBJECTIVES: To evaluate possible apical root resorption following orthodontic retraction of the maxillary canine quantitatively and qualitatively. METHODS: Twenty maxillary canines in 12 patients were retracted using a prefabricated orthodontic spring. Twenty non-treated mandibular canines from the same patients served as controls. Standardized radiographs were taken of all upper and lower canines before (T0) and after (T2) retraction. Root length and tooth length were measured on the radiographs at T0 and T2, and the root length/tooth length ratio was calculated. Ten orthodontists assessed blind the root apex of the pairs of radiographs taken at T0 and T2 for resorption. Digital subtraction was performed between the pairs of radiographs taken at T0 and T2 and the mean density and the standard deviation of the grey shades of the root apex calculated. RESULTS: There were no significant differences between root length/tooth length ratio at T0 and T2 for either the maxillary (p = 0.45) or the mandibular canines (p = 0.79). There was considerable variation between observers judgements of root resorption: nine out of ten observers agreed that a resorption had taken place in only one tooth. There were no significant differences between the mean density values in the subtraction images of the upper and lower canines (p = 0.3). CONCLUSIONS: Quantitative assessment with conventional and subtraction radiography failed to demonstrate root resorption in the maxillary canines. Root resorption could be shown qualitatively in only one tooth. The standardized orthodontic force system used for canine retraction appeared to cause no resorption, or only a small degree of resorption of no clinical relevance.
This study was conducted to clarify the effects of surgical orthodontic treatment for malalignment caused by the prolonged retention of deciduous canines in young dogs. Fifty-five dogs with malocclusion or pre-malocclusion were divided into two groups. Group 1 received surgical orthodontic treatment (32 dogs) using modification of Ross and Yamane's method of treating for malalignment due to prolonged retention of deciduous canine teeth; Group 2 received no treatment (23 dogs). Occurrence of malocclusion 1-3 weeks after treatment of the group receiving surgery was only 3.8%. However, malocclusion was seen in 73.4% of the non-treatment group approximately 2 years after the first examination. Surgical orthodontic treatment was very useful in treating malalignment due to prolonged retention of deciduous canines in young dogs.
Currently two-thirds of European countries employ orthodontic auxiliaries and the UK is therefore unusual in not permitting their use. There is support from the orthodontic specialty for the concept of delegating routine intra-oral tasks to auxiliary personnel. The following describes a pilot project undertaken to determine the possible training structure for orthodontic auxiliaries. The modular course, which took place over a period of 4 weeks, is described and the results and implications are discussed.
BACKGROUND: The authors assessed the likelihood that interceptive orthodontic Medicaid programs would increase access to care for Washington children. METHODS: The authors surveyed 210 Washington state orthodontists, including questions on demographics, attitudes toward early treatment, use of innovations and perceptions of Medicaid. Respondents were either Medicaid participants or nonparticipants. RESULTS: Fifty of 159 respondents were Medicaid participants. Most respondents perceived early orthodontic treatment as beneficial. Medicaid participants were more willing to participate in Medicaid early-treatment programs, had slightly fewer patients in the "other insurance" category, provided more discounted fees, received more Medicaid inquiries, practiced in rural areas with lower household incomes, reported feeling overworked and experienced fewer Medicaid problems. The principal problem reported with the Medicaid system was low fee reimbursement. CONCLUSIONS: Programs offering early orthodontic treatment could increase access. Important barriers would be low fees and unfamiliarity with Medicaid. PRACTICE IMPLICATIONS: Medicaid should design programs aimed at early treatment with reasonable reimbursement and an educational component.
BACKGROUND: Centric relation (CR) has been a controversial subject in dentistry for more than a century. For at least the past four decades, issues involving CR have been of interest to orthodontists. The definition of CR has changed over the past half-century from a retruded, posterior and, for the most part, superior condyle position to an anterior-superior condyle position. TYPE OF STUDIES REVIEWED: The authors addressed the historical and contemporary orthodontic perspective of CR. The source material for this review came mainly from literature and searches the lead author accumulated over the last 30 years. As there is no evidence-based (EB) model level 3 (systemic) review on the topic of CR, the best evidence on this subject was gleaned only from a thorough examination and evaluation at EB model level 2 (experience plus best available sample studies). There was, however, enough high-quality EB model level 2 information on the topic of CR for the authors to draw conclusions on the basis of a scientific appraisal of relevant research. RESULTS: Although the reliability of CR records has been substantiated, the records' validity has little to no evidentiary support. In addition, population-based sample studies and consensus statements from national conferences support the view that the positions of the temporomandibular joint (TMJ) condyles in relation to the glenoid fossa or CR position are not diagnostic of temporomandiblar disorders. There appears to be little to no benefit of using gnathologic records and articulator-mounted dental casts to discern discrepancies in maximum intercuspation of the teeth coincident with TMJ condyles in an anterior-superior CR position in orthodontic patients. CLINICAL IMPLICATIONS: The benefit of using gnathologic CR records and articulators in orthodontics has not been substantiated by scientific evidence.
The present study is part of a research project that includes different components for the simulation of orthodontic tooth movement and comparing experimental results. This concept includes the development of a bone remodelling algorithm, as well as experimental studies on tooth movement. After the acquisition and evaluation of specific experimental data of the patient's situation, the individual components have to be integrated to verify and forecast tooth movement. The aim is to design individual treatment devices as well as to shorten treatment while making it more effective. The geometry of the teeth and that of the surrounding alveolar bone both influence the orthodontic tooth movement. For this reason, an exact morphological tooth model for the valid simulation of the tooth movement is needed, and can be constructed from computed tomography data. Simulation of tooth movement can then be compared with "in vivo" measurements of the orthodontic tooth movement. In this study, a specially developed hybrid retraction spring is employed. This spring enables the application of a defined, almost constant force system. The "in vivo" determined tooth movement is simulated with the aid of special positioning and measuring devices. Meanwhile, the active force system can be determined by 6-component force/moment sensors. The experimentally measured force system, "in vivo" measurements of tooth movement and the CT model are now available for numerical simulation for the first time.
This report presents a case of a completely intrusive luxation of an immature permanent central incisor in a 7 years 9 months-old girl. Because there are severe intrusive trauma and cortical alveolar bone fracture, it was impossible to reposition with orthodontic or surgical method alone. The intruded tooth was repositioned to healthy alveolar bone level by using surgical extrusion and stabilization with sutures and periodontal pack. After healing of adjacent bone, the intruded maxillary central incisor erupted orthodontically by removable orthodontic appliance. It was moved from a high position to level of adjacent tooth in about 7 months. A radiograph was taken 6 months after ceasing forced eruption, which demonstrated minor root resorption, but the alveolar bone height had increased.
In an orthodontic practice, it is common to deal with impacted teeth, which are one of the most difficult situations dealt with by dentists. This case report describes the surgical and orthodontic management of the impacted teeth in a large dentigerous cyst. In the initial stage of treatment, the cyst was marsupialized over 7 months. After decompression of the cyst, spontaneous eruptions of the impacted tooth were noticed. Then, they were orthodontically brought into the proper occlusion.
1. Periodontosis occurs in the same age group in which orthodontic therapy is most often done. It is a periodontal disease which in the early stages may show little or no gingival inflammation and is easily overlooked unless one is aware of the existence of this condition and looks for it. 2. Since malocclusions are common in adolescents, it is reasonable to expect that some adolescents with malocclusions will also develop periodontosis. 3. Periodontosis may have its onset during active orthodontic treatment. 4. Orthodontists, should routinely examine all of their patients, using adequate roentgenograms and a periodontal probe before initiating therapy and at periodic (yearly) intervals during active treatment. 5. Where malocclusions are present in patients who already have periodontosis, orthodontic treatment may be a necessary and beneficial part of the total treatment plan.