Andrew T. DiBiase

Alignment efficiency of Damon3 self-ligating and conventional orthodontic bracket systems: a randomized clinical trial.

INTRODUCTION The aim of this study was to compare the efficiency of mandibular tooth alignment and the clinical effectiveness of a self-ligating and a conventional preadjusted edgewise orthodontic bracket system. METHODS A multicenter randomized clinical trial was conducted in 2 orthodontic clinics. Sixty-two subjects (32 male, 30 female; mean age, 16.27 years) with mandibular incisor irregularities of 5 to 12 mm and a prescribed extraction pattern including the mandibular first premolars were randomly allocated to treatment with Damon3 self-ligating (Ormco, Glendora, Calif) or Synthesis (Ormco) conventionally ligated brackets. Fully ligated 0.014-in nickel-titanium archwires were used first in both groups, followed by a sequence of 0.014 x 0.025-in and 0.018 x 0.025-in nickel-titanium, and 0.019 x 0.025-in stainless steel. Study casts were taken at the start of treatment (T1), the first archwire change (T2), and the placement of the final 0.019 x 0.025-in archwire (T3). Cephalometric lateral skull and long-cone periapical radiographs of the mandibular incisors were taken at T1 and T3. RESULTS No significant difference was noted (P >0.05) in initial rate of alignment for either bracket system. Initial irregularity influenced subsequent rate of movement, but sex, age, and appliance type were statistically insignificant. Alignment was associated with an increase in intercanine width, a reduction in arch length, and proclination of the mandibular incisors for both appliances, but the differences were not significant. Incisor root resorption was not clinically significant and did not differ between systems. CONCLUSIONS Damon3 self-ligating brackets are no more efficient than conventional ligated preadjusted brackets during tooth alignment.

Bullying in orthodontic patients and its relationship to malocclusion,self-esteem and oral health-related quality of life.

Objectives To measure the self-reported frequency and severity of bullying amongst patients referred for orthodontic treatment and to investigate whether there is a relationship between levels of self-reported bullying, malocclusion and need for orthodontic treatment and an individuals self-esteem and oral health-related quality of life (OHRQoL). Design and setting Cross-sectional study of an adolescent group referred for orthodontic assessment at three UK hospitals. Subjects and methods Three hundred and thirty-six participants aged between 10 and 14 years were recruited. Validated questionnaires were used to measure the self-reported frequency and severity of bullying, self-esteem and OHRQoL. Orthodontic treatment need was assessed using IOTN. Results The prevalence of bullying was 12·8%. Being bullied was significantly associated with Class II Division 1 incisor relationship (P = 0·041), increased overbite (P = 0·023), increased overjet (P = 0·001) and a high need for orthodontic treatment assessed using AC IOTN (P = 0·014). Bullied participants also reported lower levels of social competence (P<0·001), athletic competence (P<0·001), physical appearance related self-esteem (P<0·001) and general self-esteem (P<0·001). Higher levels of oral symptoms (P = 0·032), functional limitations (P<0·001), emotional (P<0·001) and social impact (P<0·001) from their oral condition, resulting in a negative impact on overall OHRQoL (P<0·001), were also reported. Conclusions Significant relationships exist between bullying and certain occlusal traits, self-esteem and OHRQoL.

Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: a randomized clinical trial

The aim of this study was to compare the degree of discomfort experienced during the period of initial orthodontic tooth movement using Damon3 self-ligating and Synthesis conventional ligating pre-adjusted bracket systems. Sixty-two subjects were recruited from two centres (32 males and 30 females; mean age 16 years, 3 months) with lower incisor irregularity between 5 and 12 mm and a prescribed extraction pattern, including lower first premolar teeth. These subjects were randomly allocated for treatment with either bracket system. Fully ligated Damon3 0.014-inch Cu NiTi archwires were used for initial alignment in both groups. Following archwire insertion, the subjects were given a prepared discomfort diary to complete over the first week, recording discomfort by means of a 100 mm visual analogue scale at 4 hours, 24 hours, 3 days, and 1 week. The subjects also noted any self-prescribed analgesics that were taken during the period of observation. Data were analysed using repeated measures analysis of variance. There were no statistically significant differences in perceived discomfort levels between the two appliances; discomfort did not differ at the first time point and did not develop differently across subsequent measurement times. Overall, this investigation found no evidence to suggest that Damon3 self-ligating brackets are associated with less discomfort than conventional pre-adjusted brackets during initial tooth alignment, regardless of age or gender.

Is early class III protraction facemask treatment effective? A multicentre, randomized, controlled trial: 15‐month follow‐up

OBJECTIVE To investigate the effectiveness of early class III protraction facemask treatment in children under 10 years of age at 3-year follow-up. DESIGN Multicentre randomized controlled trial. SUBJECTS AND METHODS Seventy-three patients were randomly allocated, stratified for gender, into early class III protraction facemask group (PFG) (n = 35) and a control/no treatment group (CG) (n = 38). OUTCOMES Dentofacial changes were assessed from lateral cephalograms and occlusal changes using the peer assessment rating (PAR). Self-esteem was assessed using the Piers-Harris childrens self-concept scale, and the psychosocial impact of malocclusion with oral aesthetic subjective impact score (OASIS) questionnaire. Temporomandibular joint (TMJ) signs and symptoms were also recorded. The time points for data collection were at registration (DC1), 15 months later (DC2) and 3 years post-registration (DC3). RESULTS The following mean skeletal and occlusal changes occurred from the class III starting point to DC3 (3-year follow-up): SNA, PFG moved forwards +2·3° (CG forward +1·6°; P = 0·14); SNB, PFG moved forwards +0·8° (CG forward +1·5°, P = 0·26); ANB, PFG class III base improved +1·5° (CG stayed about the same at +0·1°; P = 0·001). This contributed to an overall difference in ANB between PFG and CG of +1·4° in favour of early protraction facemask treatment. The overjet was still improved by +3·6 mm in the PFG and changed a small amount +1·1 mm in the CG (P = 0·001). A 21% improvement in PAR was shown in the PFG and the CG worsened by 8·4% (P = 0·02). There was no increase in self-esteem (Piers-Harris score) for PFG compared with the CG (P = 0·56) and no statistically significant difference in the impact of malocclusion (OASIS) between groups in terms of the changes from DC1 to DC3 (P = 0·18). TMJ signs and symptoms were very low at DC1 and DC3. CONCLUSIONS The favourable effect of early class III protraction facemask treatment undertaken in patients under 10 years of age, is maintained at 3-year follow-up in terms of ANB, overjet and % PAR improvement. The direct protraction treatment effect at SNA is still favourable although not statistically significantly better than the CG. Seventy per cent of patients in PFG had maintained a positive overjet which we have defined as ongoing treatment success. Early protraction facemask treatment does not seem to influence self-esteem or reduce the patients personal impact of their malocclusion at 3-year follow-up.

Efficiency of mandibular arch alignment with 2 preadjusted edgewise appliances.

INTRODUCTION The aim of this study was to compare the efficiency of mandibular arch alignment in 3 dimensions with a self-ligating bracket system (SmartClip, 3M Unitek, Monrovia, Calif) and a conventional preadjusted edgewise twin bracket (Victory, 3M Unitek) in nonextraction patients. This was a prospective, randomized, controlled clinical trial at the Royal London Hospital, School of Dentistry, and Kent and Canterbury Hospital, United Kingdom. Sixty-six consecutive patients satisfying the inclusion criteria were enrolled in the study. They were randomly allocated with a computer-generated system to 1 of the 2 bracket systems. METHODS Pretreatment mandibular arch irregularity was measured by using a coordinate measuring machine (Merlin II, International Metrology Systems, Gloucester, United Kingdom). A 0.016-in round martensitic active nickel-titanium aligning archwire (3M Unitek) was placed in all subjects. Mandibular arch irregularity was remeasured 8 weeks later. RESULTS Sixty-five subjects completed the study. Bracket type had little influence on alignment efficiency overall (P = 0.08), or in the buccal (P = 0.173) or labial segments (P = 0.528) after adjustment for pretreatment differences by analysis of covariance (ANCOVA). Alignment efficiency was highly correlated to pretreatment irregularity overall (P <0.001), both in the buccal (P = 0.001) and labial (P <0.001) segments. Increasing age appeared to have a negative effect on alleviation of irregularity, although this effect did not reach statistical significance (P = 0.053). CONCLUSIONS The null hypothesis that efficiency of alignment in the mandibular arch in nonextraction patients is independent of bracket type was accepted. Alignment efficiency is largely influenced by initial irregularity.

Randomized clinical trial of orthodontic treatment efficiency with self-ligating and conventional fixed orthodontic appliances

INTRODUCTION Our objective was to test the hypotheses that treatment with 2 fixed orthodontic appliances (SmartClip and Victory; 3M Unitek, Monrovia, Calif) would result in no difference in (1) the duration of orthodontic treatment or (2) the number of visits required. METHODS Sixty-six consecutive patients were randomly allocated to treatment with a self-ligating bracket system (SmartClip) or a conventional appliance (Victory). The duration of treatment and the number of visits required in addition to the initial and final peer assessment rating (PAR) scores were recorded. The number of teeth extracted during treatment and the frequency of mechanical eruption of canines were also noted. Analyses of covariance were used to assess the influence of bracket type on treatment durations, visits required, and percentage PAR score reductions. RESULTS Fifty-four (81.8%) participants completed the study. The duration of treatment was 3 months greater in the group treated with SmartClip. However, bracket type had no statistical influence on treatment duration (P = 0.076), total visits required (P = 0.184), or percentage PAR score reduction (P = 0.255). CONCLUSIONS Neither hypothesis could be rejected. Bracket type did not influence the duration of treatment or the number of visits required. The percentages of PAR score reductions were also unaffected by the choice of appliance.

Influence of radiographic position of ectopic canines on the duration of orthodontic treatment.

OBJECTIVE To investigate the influence of radiographic position of palatally impacted canines on the length of treatment for orthodontic alignment. MATERIALS AND METHODS Treatment records of 45 consecutive successfully treated patients (36 unilateral, 9 bilateral) with ectopic palatal canines treated with surgical exposure and orthodontic traction were analyzed. The sample was based on orthodontic referrals over a 3-year period in Kent and Canterbury Hospital, UK. The duration of treatment was related to radiographic parameters including the height of the impacted canine, angulation of the long axis to the upper midline, mesiodistal position of the canine tip relative to the midline and adjacent incisors, and the anteroposterior position of the canine root apex. RESULTS Using multiple stepwise regression analysis, the horizontal position of the canine crown relative to adjacent teeth and maxillary dental midline showed a statistically significant correlation with the duration of treatment (P =.042), explaining 7.7% of the overall variance. However, treatment duration was found to be independent of the initial canine angulation (P = .915), vertical height (P =.065), and position of the canine apex (P = .937). CONCLUSIONS Accurate prediction of treatment duration for orthodontic alignment of palatally impacted maxillary canines is difficult. However, the mesiodistal position of the canine may be a useful predictor of treatment duration.

Duration of treatment and occlusal outcome using Damon3 self-ligated and conventional orthodontic bracket systems in extraction patients: A prospective randomized clinical trial

INTRODUCTION This was a prospective randomized clinical trial comparing the effect of bracket type on the duration of orthodontic treatment and the occlusal outcome as measured by the peer assessment rating (PAR). METHODS A multi-center randomized clinical trial was carried out in 2 orthodontic clinics. Sixty-two subjects (32 male, 30 female; mean age, 16.27 years) with a mean pretreatment PAR score of 39.40, mandibular irregularity from 5 to 12 mm, and prescribed extractions including mandibular first premolars were randomly allocated to treatment with either the Damon3 self-ligated or the Synthesis conventional ligated preadjusted bracket systems (both, Ormco, Glendora, Calif). An identical archwire sequence was used in both groups excluding the finishing archwires: 0.014-in, 0.014 × 0.025-in, and 0.018 × 0.025-in copper-nickel-titanium aligning archwires, followed by 0.019 × 0.025-in stainless steel working archwires. Data collected at the start of treatment and after appliance removal included dental study casts, total duration of treatment, number of visits, number of emergency visits and breakages during treatment, and number of failed appointments. RESULTS Sixty-two patients were recruited at the start of treatment, and the records of 48 patients were analyzed after appliance removal. Accounting for pretreatment and in-treatment covariates, bracket type had no effect on overall treatment duration, number of visits, or overall percentage of reduction in PAR scores. Time spent in space closure had an effect on treatment duration, and the pretreatment PAR score influenced only the reduction in PAR as a result of treatment. CONCLUSIONS Use of the Damon3 bracket does not reduce overall treatment time or total number of visits, or result in a better occlusal outcome when compared with conventional ligated brackets in the treatment of extraction patients with crowding.

Comparison of mandibular arch changes during alignment and leveling with 2 preadjusted edgewise appliances

INTRODUCTION Our objective was to compare the effects of 2 preadjusted appliances on angular and linear changes of the mandibular incisors, and transverse mandibular arch dimensional changes over a minimum of 30 weeks. This was a prospective, randomized, controlled, clinical trial a the Royal London Hospital, School of Dentistry, in London and the Kent and Canterbury Hospital in Canterbury, United Kingdom. METHODS Sixty- six consecutive patients satisfying the inclusion criteria were enrolled and randomly allocated to treatment with a self-ligating bracket system (SmartClip, 3M Unitek, Monrovia, Calif) and conventional preadjusted edgewise brackets (Victory, 3M Unitek). Initial study models and cephalograms were obtained within a month of starting the trial. All subjects received treatment with the following archwire sequence: 0.016-in round, 0.017 x 0.025-in rectangular, 0.019 x 0.025-in rectangular martensitic active nickel-titanium archwires, and 0.019 x 0.025-in stainless steel archwires. Final records, including study models and a lateral cephalogram, were collected a minimum of 30 weeks after initial appliance placement. Lateral cephalograms were assessed for treatment-related changes in mandibular incisor inclination and position. Transverse dimensional changes in intercanine, interpremolar, and intermolar dimensions, and the amount of crowding alleviated during the study period were assessed by comparison of pretreatment and posttreatment models. All measurements were made with a digital caliper (150 mm ISO 9001 electronic caliper, Tesa Technology, Renens, Switzerland). RESULTS Sixty patients completed the study. After adjustment for pretreatment values, duration of treatment, and amount of crowding alleviated during the study period, bracket type had little effect on incisor inclination (P = 0.437) and positional changes (P = 0.35), and intercanine (P = 0.967), inter-first premolar (P = 0.495), and inter-second premolar (P = 0.905) dimensions. However, the self-ligating appliance produced slightly more expansion in the molar region, a difference that was statistically significant (P = 0.009). Pretreatment values for incisor inclination (P = 0.044) and transverse dimensions (P = 0.000) affected inclination and transverse changes, respectively, with proclination less likely when the labial segment was proclined at the outset and expansion unlikely during leveling and alignment in wider arches. Greater alleviation of crowding during the study period resulted in more incisor proclination (P = 0.000) and advancement (P = 0.000). CONCLUSIONS There was little difference overall in the pattern of arch alignment and leveling related to the 2 preadjusted appliances. However, there was a statistically greater increase in intermolar width in the group treated with the self-ligating appliance, although the difference was only 0.91 mm.

Revisiting the supernumerary: the epidemiological and molecular basis of extra teeth

Supernumerary teeth are a common clinical and radiographic finding and may produce occlusal and dental problems. The aetiological basis of extra teeth is poorly understood in human populations; however, the mouse provides a useful model system to investigate the complex genetics of tooth development. This article describes recent advances in our understanding of the genetic basis of supernumerary teeth. We have reviewed biological evidence that provides insight into why supernumerary tooth formation may occur. Indeed, many of the molecular signalling pathways known to be involved in normal development of the tooth germ can also give rise to additional teeth if inappropriately regulated. These include components of the Hedgehog, FGF, Wnt, TNF and BMP families, which provide a useful resource of candidate genes that may potentially play a role in human supernumerary tooth formation.