David Bearn

Bonded orthodontic retainers: A review

Recent reports have suggested that long-term retention may be required to prevent posttreatment changes. The bonded orthodontic retainer constructed from composite and multistrand orthodontic wire provides an esthetic and efficient system for maintained retention. The development, indications for use, and clinical techniques are described. The range of materials reported for clinical use in construction of bonded orthodontic retainers are reviewed. Recommmendations based on the literature are made. This review implicates placement of insufficient resin or use of a resin with inadequate abrasion resistance in the failure of bonded fixed retainers.

Cleft lip and palate care in the United Kingdom - The Clinical Standards Advisory Group (CSAG) study. Part 2: Dentofacial outcomes and patient satisfaction

OBJECTIVE To describe facial development and appearance, quality of bone grafts, oral health, and patient/parent satisfaction, with clinical outcome, for children in two age cohorts born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. DESIGN Cross-sectional outcome study. SETTING Fifty National Health Service cleft centers. PARTICIPANTS Children born with complete UCLP between April 1, 1982, and March 31, 1984, (12-year-olds) and April 1, 1989, and March 31, 1991 (5-year-olds). Data were collected for 239 5-year-olds and 218 12-year-olds. The parents of these children were also interviewed to determine levels of satisfaction with care received. MAIN OUTCOME MEASURES Skeletal pattern, dental arch relationship, success of alveolar bone grafting, facial appearance, oral health status, and patient/parent satisfaction. RESULTS Nearly 40% of 5- and 12-year-olds had poor dental arch relations, and 70% of 12-year-olds had midface retrusion. Fifteen percent of 12-year-olds had not received an alveolar bone graft, and only 58% of bone grafts that had been undertaken were successful. Twenty percent of 12-year-olds and 40% of 5-year-olds had untreated dental caries. Less than one-third of subjects had a good facial appearance as judged by a panel of experts. Levels of patient and parent satisfaction were generally high. CONCLUSION A rigorous evaluation of cleft care in the United Kingdom reveals disappointing outcomes.

Cleft lip and palate care in the United Kingdom: The clinical standards advisory group (CSAG) study. Part 4 : Outcome comparisons, training, and conclusions

OBJECTIVE A critical appraisal of cleft care in the United Kingdom. DESIGN Retrospective comparative study. SETTING All National Health Service cleft centers in the United Kingdom. PATIENTS/PARTICIPANTS Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. MAIN OUTCOME MEASURES Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. CONCLUSIONS This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.

Ex vivo surface and mechanical properties of coated orthodontic archwires

This study examined the mechanical and physical properties of retrieved coated nickel-titanium (NiTi) archwires compared with unused samples. Ultraesthetic 0.016 inch coated archwires (G&H(R) Wire Company) were investigated. Ten as-received wires were subjected to a three-point bending test using conventional and self-ligating bracket systems. Surface roughness of the coating was measured with a contact stylus profilometer. Optical and scanning electron microscopes were used to assess surface topography. Ten archwires were used in vivo for a period of between 4 and 6 weeks. Retrieved archwires were subjected to the same tests. The percentage of the remaining coating was calculated using digital photography. Coated archwires were used in vivo for a mean period of 33 days. Differences between the mean values of the as-received and retrieved archwires were determined using t-tests. In the three-point bending test, with conventional elastomeric ligation, retrieved wires produced a lower unloading force (P < 0.001). Both retrieved and as-received coated archwires produced zero values of unloading force when deflected for 4 mm. When tested using a self-ligating bracket system, retrieved and as-received coated archwires produced the same amount of force (P > 0.05). With surface profilometry, all measured roughness parameters (except R(sm)) had greater surface roughness for the retrieved coated archwires (P < 0.05). Under microscopy, retrieved coated archwires showed discolouration, ditching, and delamination. Only 75 per cent of the coating was present in retrieved coated archwires. Retrieved coated archwires produced lower unloading force values than as-received coated archwires with conventional ligation. Surface roughness of coated archwires increased after use. Coated archwires have a low aesthetic value, with 25 per cent of the coating lost within 33 days in vivo.

Mechanical properties of coated superelastic archwires in conventional and self-ligating orthodontic brackets

INTRODUCTION Coated archwires have been introduced to improve esthetics during orthodontic treatment. Our aim was to investigate the mechanical properties of coated superelastic archwires compared with conventional superelastic archwires with conventional and self-ligating brackets. METHODS Four types of orthodontic archwires were investigated, 2 superelastic nickel-titanium and 2 coated Ultraesthetic archwires in 0.016-in and 0.018 x 0.025-in dimensions (all from G&H Wire, Greenwood, Ind). To achieve the same nominal size, the coated archwire is constructed from a smaller archwire that, when coated, reaches the nominal dimensions stated for the archwire. Conventional edgewise Orthos and Damon 2 self-ligating brackets (both from Ormco, Orange, Calif) were used with each wire. All specimens were tested in a universal testing machine in a 3-point bending test at a speed of 1 mm per minute and deflected for 2 mm. Loading and unloading forces were recorded and load-deflection curves plotted. RESULTS Coated superelastic wires produced statistically significantly lower forces in loading and unloading when compared with the superelastic nickel-titanium wires at most archwire deflections (P <0.01). For nickel-titanium wires, loading values ranged from 189 to 1202 g, whereas the respective values for coated wires were 124 to 772 g. For all wires, an increase in size resulted in an increase in force. Interactions between wire type (coated or uncoated) and bracket type were observed. CONCLUSIONS Ultraesthetic coated archwires produced lower force values in loading and unloading compared with uncoated wires of same nominal size. The Damon 2 self-ligating bracket system produced lower force values in loading and unloading. The lowest forces were generated by the combination of Ultraesthetic coated archwires and Damon 2 self-ligating brackets.

Bonded orthodontic retainers: The wire-composite interface ☆ ☆☆ ★ ★★ ♢ ♢♢ ♦

The bonded orthodontic retainer constructed from multistrand wire and composite is an efficient esthetic retainer, which can be maintained long-term. Clinical failures of bonded orthodontic retainers, most commonly at the wire/composite interface, have been reported. This in vitro investigation aimed to evaluate selected multistrand wires and composite materials that are available for use in the construction of bonded fixed retainers. An in vitro model was developed to simulate the forces encountered at the wire/composite interface. No significant difference was detected between different multistrand wire types and diameters with regard to retention in composite. Wires were placed in one of three groups according to surface characteristics identified with scanning electron microscopy. Increasing the thickness of composite overlying the wire increased the force required to detach the wire from the composite. Thickness of composite greater than 1.0 mm overlying the wire may give little clinical advantage. Greater force was required to detach the wire from Concise Orthodontic (3M Unitek) than any other composite tested. In vitro abrasion resistance testing found Heliosit Orthodontic (Vivadent) and Right On (TP Orthodontics, Inc.) to have poor abrasion resistance, whereas Concise Orthodontic and Transbond (3M Unitek) had abrasion resistance comparable with restorative composites. Clinical recommendations are made based on these findings.

Cleft Lip and Palate Care in the United Kingdom—The Clinical Standards Advisory Group (CSAG) Study. Part 1: Background and Methodology

OBJECTIVE To review the history of cleft care in the United Kingdom and the rationale and methodology of a national study. DESIGN Descriptive overview to introduce this series of papers. SETTING Fifty National Health Service cleft teams. PATIENTS/PARTICIPANTS Two age cohorts, 5-year-olds and 12-year-olds, with nonsyndromic complete unilateral cleft lip and palate and their parents. MAIN OUTCOME MEASURES Facial development and appearance, quality of bone grafts, speech, oral health and patient/parent satisfaction. CONCLUSIONS The case for a national assessment of cleft care is made. The methodology of the cross-sectional outcome study is described, together with a survey of training for recently appointed clinicians.

Prospective, multi-center study of the effectiveness of orthodontic/orthognathic surgery care in the United Kingdom

INTRODUCTION The aim of this study was to evaluate the effectiveness of orthodontic/orthognathic surgical care provided in the North West region of England. It was an observational, prospective cohort study at 13 maxillofacial clinics in the United Kingdom. METHODS The 131 patients comprised 47 males (35.9%) and 84 females (64.1%), with an average age of 22.6 years. They received orthodontic/orthognathic treatment according to the normal protocols of the operators. They were then followed until all orthodontic treatment was completed. Final skeletal pattern, final peer assessment rating score, number of attendances, and duration of treatment were recorded. RESULTS At the end of the 5-year study, 94 patients had completed treatment, and 71 had complete data. Data analysis showed that, overall, the treatments provided were effective in terms of skeletal and dental occlusal outcomes; the final mean peer assessment rating score was 10.58. However, treatment duration was longer than commonly expected, with a mean length of 32.8 months (SD,11.3). The outcome of treatment was influenced by only pretreatment skeletal discrepancy. CONCLUSIONS This prospective investigation showed that orthodontic/orthognathic surgical care was effective. The outcome of treatment was influenced only by the severity of the pretreatment skeletal discrepancy.

Photogrammetric Assessment of the Soft Tissue Profile in Unilateral Cleft Lip and Palate

OBJECTIVE To describe the soft tissue profile of children with unilateral cleft lip and palate from profile photographs and assess the reliability of this method. DESIGN Retrospective analysis of prospectively collected data. SETTING A national study in the United Kingdom. SUBJECTS Caucasian children born in the United Kingdom between April 1, 1982, and March 31, 1984, and aged between 12 and 14 years at data collection. A cleft side and noncleft side profile photograph was available for each of 175 children. METHOD Seven angular measurements were made using Dentofacial Planner Plus software, and the profile appearance was rated by an expert panel. RESULTS Reliability for repeated measurement of the same photograph was acceptable for all but li-sm(s)-pg(s) (labiomental fold). Similar levels of reliability were found when comparing measurements from the cleft side and non-cleft side photograph. Logistic regression showed that the variables nst-sn-ls (nasolabial angle), ss(s)-n(s)-pg(s) (maxillary prominence), and g(s)-prn-pg(s) (facial convexity) were associated with the profile score. CONCLUSIONS Soft tissue profile analysis from photographs is reliable and robust under a range of conditions. Soft tissue profile measurements are associated with panel ratings of profile.

Ex vivo Bond Strength of Adhesive Precoated Metallic and Ceramic Brackets

Compared with conventional adhesive systems, adhesive precoated (APC) brackets are reported to have advantages in clinical use. The ex vivo bond strength to human premolar teeth of metallic and ceramic APC brackets was compared wi1h that of identical brackets bonded with Transbond® (3M Unitek) light cured orthodontic adhesive, and patterns of failure were examined. There was no significant difference (P>0·05) in mean bond strength between metallic brackets bonded with the two systems. Ceramic brackets bonded with Transbond® had significantly higher (P<0·05) mean bond strength and failure more normally occurred at the composite/enamel interface when compared with APC ceramic brackets and metallic brackets. Following debonding no enamel damage was observed with either APC or conventionally bonded ceramic brackets.