Ingalill Feldmann

Occlusal changes from adolescence to adulthood in untreated patients with Class II Division 1 deepbite malocclusion.

A sample of 47 untreated children (M 32:F 15) with Class II Division 1 (II/1) deep-overbite malocclusion was collected from a group of patients who declined orthodontic therapy. Longitudinal records consisted of plaster dental casts and lateral cephalograms at original diagnosis and plaster dental casts at a follow-up observation in adulthood, an average of 11.5 years later. To study retrospectively natural changes in dental occlusion during this interval, plaster-cast millimetric measurements were recorded of sagittal dental relationships (first molar and canine), overjet, overbite, and crowding/spacing at the two registrations. Results showed statistically significant improvements in untreated II/1 deepbite malocclusion from adolescence to adulthood for all measured occlusal variables except development of mild crowding. Therefore, assumptions that untreated II/1 distoclusion will worsen with age appear to be unfounded. The evidence indicates that the absence of orthodontic correction for adolescent patients with Class II Division 1 deepbite malocclusion will not usually lead to measurable occlusal deterioration in young adulthood.

Anchorage capacity of osseointegrated and conventional anchorage systems : a randomized controlled trial.

INTRODUCTION Our aim in this investigation was to evaluate and compare orthodontic anchorage capacity of 4 anchorage systems during leveling/aligning and space closure after maxillary premolar extractions. METHODS One hundred twenty patients (60 girls, 60 boys; mean age, 14.3 years; SD 1.73) were recruited and randomized into 4 anchorage systems: Onplant (Nobel Biocare, Gothenburg, Sweden), Orthosystem implant (Institut Straumann AG, Basel, Switzerland), headgear, and transpalatal bar. The main outcome measures were cephalometric analysis of maxillary first molar and incisor movement, sagittal growth changes of the maxilla, and treatment time. The results were also analyzed on an intention-to-treat basis. RESULTS The maxillary molars were stable during the leveling/aligning in the Onplant, Orthosystem implant, and headgear groups, but the transpalatal bar group had anchorage loss (mean, 1.0 mm; P <.001). During the space-closure phase, the molars were still stable in the Onplant and Orthosystem groups, whereas the headgear and transpalatal bar groups had anchorage loss (means, 1.6 and 1.0 mm, respectively; P <.001). Thus, the Onplant and the Orthosystem implant groups had significantly higher success rates for anchorage than did the headgear and transpalatal bar groups. Compared with the Orthosystem implant, there were more technical problems with the Onplant. CONCLUSIONS If maximum anchorage is required, the Orthosystem implant is the system of choice.

Pain intensity and discomfort following surgical placement of orthodontic anchoring units and premolar extraction : a randomized controlled trial

OBJECTIVE To evaluate and compare perceived pain intensity and discomfort between the placement of two different orthodontic anchoring units designed for osseointegration and premolar extraction in adolescent patients. MATERIALS AND METHODS A total of 120 adolescent patients (60 girls and 60 boys) were recruited and randomized into three groups. Group A underwent installation of an onplant, group B installation of an Orthosystem implant, and group C premolar extraction. Pain intensity and discomfort, analgesic consumption, limitations in daily activities, and functional jaw impairment were evaluated the first evening and one week after the intervention. RESULTS Pain intensity following surgical installation of an onplant was comparable to the pain intensity experienced after premolar extraction, but there was significantly less pain after surgical installation of an Orthosystem implant compared to installation of an onplant (P = .002) or premolar extraction (P = .007). The protective, vacuum-formed stent caused great discomfort, even more discomfort than the surgical sites following installation of the onplant or the Orthosystem implant. CONCLUSION The Orthosystem implant was better tolerated than the onplant in terms of pain intensity, discomfort, and analgesic consumption and was, therefore, the anchorage system of choice in a short-term perspective.

Three-dimensional analysis of effects of rapid maxillary expansion on facial sutures and bones: A systematic review

OBJECTIVE To evaluate the evidence on three-dimensional immediate effects of rapid maxillary expansion (RME) treatment on growing patients as assessed by computed tomography/cone beam computed tomography (CT/CBCT) imaging. MATERIALS AND METHODS The published literature was searched through the PubMed, Embase, and Cochrane Library electronic databases from January 1966 to December 2012. The inclusion criteria consisted of randomized controlled trials, prospective controlled studies, and prospective case-series. Two reviewers extracted the data independently and assessed the quality of the studies. RESULTS The search strategy resulted in 73 abstracts or full-text articles, of which 10 met the inclusion criteria. When treating posterior crossbites with a RME device, the existing evidence points out that the midpalatal suture opening is around 20%-50% of the total screw expansion. There seems to be no consistent evidence on whether the midpalatal sutural opening is parallel or triangular. The effect on the nasal cavity dimensions after RME seems to be apparent and indicates an enlargement between 17% and 33% of the total screw expansion. Circummaxillary sutures, particularly the zygomaticomaxillary and frontomaxillary sutures and also spheno-occipital synchondrosis, appear to be affected by the maxillary expansion. Overall, however, the changes were small and the evidence not conclusive. CONCLUSIONS CT imaging proved to be a useful tool for assessment of treatment effects in all three dimensions. The majority of the articles were judged to be of low quality, and therefore, no evidence-based conclusions could to be drawn from these studies.

Reliability of a questionnaire assessing experiences of adolescents in orthodontic treatment

OBJECTIVE To evaluate the reliability of a questionnaire that assessed the expectations and experiences of adolescent patients about orthodontic treatment. MATERIALS AND METHODS The study included two groups of patients: 30 consecutive patients (19 girls and 11 boys, mean age 14.6 years, SD 2.3 years) naïve to orthodontic treatment, and 30 consecutive adolescent patients (17 girls and 13 boys, mean age 15.1 years, SD 2.0 years) in active orthodontic treatment with fixed appliances in both jaws. A questionnaire comprising 46 items was developed, based upon focus group interviews and previous established questionnaires. The questionnaire covered the following domains: Treatment motivation; treatment expectations; pain and discomfort from teeth, jaws, and face; functional jaw impairment; and questionnaire validity. Internal consistency as well as temporal stability with the test-retest method was investigated. RESULTS A majority of the questions exhibited acceptable test-retest reliability, and composite scores yielded excellent reliability for all domains. Internal consistency was acceptable and good face validity was found for all domains. CONCLUSION The questionnaire can be recommended for use in the assessment of expectations and experiences of orthodontic treatment.

A novel method for superimposition and measurements on maxillary digital 3D models-studies on validity and reliability.

Background Serial 3D models can be used to analyze changes, but correct superimposition is crucial before measurements can be assessed. Earlier studies show that every palatal structure changes due to growth or treatment. Here, we describe a new method that uses an algorithm-based analysis to perform superimpositions and measurements in maxillary 3D models. This method can be used to identify deformations. In a second step, only unchanged areas are used for superimposition. Objectives This study investigates the validity and reliability of this novel method. Methods Digital 3D models from 16 cases were modified by an independent 3D engineer to simulate space closure and growth. True values for tooth movements were available as reference. Measurements and repeated measurements were performed by four observers. Results The total tooth movement had an absolute mean error of 0.0225 mm (SD 0.03). The intraclass correlation coefficient (ICC) was 0.9996. Rotational measurements had an absolute mean error of 0.0291 degrees (SD 0.04 degrees) and an ICC of 0.9999. Limitations Serial models need to be taken with a moderate interval (1 to 2 years). Obvious changed areas in the palate need to be cropped before processing the models. Conclusion The tested method is valid and reliable with excellent accuracy and precision even when changes through growth or orthodontic treatment occur.

Pain and discomfort following insertion of miniscrews and premolar extractions: A randomized controlled trial

OBJECTIVE To investigate and compare the experience of pain and discomfort between insertion of miniscrews and premolar extractions in adolescent patients. MATERIALS AND METHODS A total of 80 adolescents were recruited and randomized into groups A and B. Both groups were treated with extraction of the upper first premolars and fixed appliance. Beyond the fixed appliance, patients in group A received anchorage reinforcement with miniscrews. Miniscrews were inserted buccally between the second premolar and first molar when space closure started. Space closure was performed as en masse retraction with immediate loading by 150-g coil springs. Pain, discomfort, impact on daily activities, and functional jaw impairment were assessed with patient-reported questionnaires. Questionnaires were filled in at baseline, the evening after tooth extraction, 1 week after tooth extraction, the evening after screw placement, and 1 week after screw placement. RESULTS Patients reported significantly lower levels of pain (P < .001) and discomfort (P = .012) after screw placement compared with premolar extractions. The ability to drink (P = .035) and the ability to take a big bite (P < .001) were also significantly less disturbed in the evening after screw placement. During the first week after screw placement, the impact on leisure time activities was significantly lower (P = .015) compared with premolar extractions. CONCLUSION The use of miniscrews in adolescents can be recommended from a pain and discomfort perspective.

Pain and discomfort during the first week of rapid maxillary expansion (RME) using two different RME appliances: A randomized controlled trial

OBJECTIVES To evaluate and compare perceived pain intensity, discomfort, and jaw function impairment during the first week with tooth-borne or tooth-bone-borne rapid maxillary expansion (RME) appliances. MATERIALS AND METHODS Fifty-four patients (28 girls and 26 boys) with a mean age of 9.8 years (SD 1.28 years) were randomized into two groups. Group A received a conventional hyrax appliance and group B a hybrid hyrax appliance anchored on mini-implants in the anterior palate. Questionnaires were used to assess pain intensity, discomfort, analgesic consumption, and jaw function impairment on the first and fourth days after RME appliance insertion. RESULTS Fifty patients answered both questionnaires. Overall median pain on the first day in treatment was 13.0 (range 0-82) and 3.5 (0-78) for groups A and B, respectively, with no significant differences in pain, discomfort, analgesic consumption, or functional jaw impairment between groups. Overall median pain on the fourth day was 9.0 (0-90) and 2.0 (0-71) for groups A and B, respectively, with no significant differences between groups. There were also no significant differences in pain levels within group A, while group B scored significantly lower concerning pain from molars and incisors and tensions from the jaw on day 4 than on the first day in treatment. There was a significant positive correlation between age and pain and discomfort on the fourth day in treatment. No correlations were found between sex and pain and discomfort, analgesic consumption, and jaw function impairment. CONCLUSIONS Both tooth-borne and tooth-bone-borne RME were generally well tolerated by the patients during the first week of treatment.

A cost-effectiveness analysis of anchorage reinforcement with miniscrews and molar blocks in adolescents: a randomized controlled trial

OBJECTIVE To analyse cost-effectiveness of anchorage reinforcement with buccal miniscrews and with molar blocks. We hypothesized that anchorage with miniscrews is more cost-effective than anchorage with molar blocks. TRIAL DESIGN A single-centre, two-arm parallel-group randomized controlled trial. METHODS Adolescents (age 11-19 years) in need of treatment with fixed appliance, premolar extractions, and en masse retraction were recruited from one Public Dental Health specialist centre. The intervention arm received anchorage reinforcement with buccal miniscrews during space closure. The active comparator received anchorage reinforcement with molar blocks during levelling/alignment and space closure. The primary outcome measure was societal costs defined as the sum of direct and indirect costs. Randomization was conducted as simple randomization stratified on gender. The patients, caregivers, and outcome assessors were not blinded. RESULTS Eighty patients were randomized into two groups. The trial is completed. All patients were included in the intention-to-treat analysis. The median societal costs for the miniscrew group were €4681 and for the molar block group were €3609. The median of the difference was €825 (95% confidence interval (CI) 431-1267). This difference was mainly caused by significantly higher direct costs consisting of material and chair time costs. Differences in chair time costs were related to longer treatment duration. No serious harms were detected, one screw fractured during insertion and three screws were lost during treatment. GENERALIZABILITY AND LIMITATIONS The monetary variables are calculated based on a number of local factors and assumptions and cannot necessarily be transferred to other countries. Variables such as chair time, number of appointments, and treatment duration are generalizable. Owing to the study protocol, the benefit of miniscrews as a stable anchorage has not been fully utilized. CONCLUSIONS When only moderate anchorage reinforcement is needed, miniscrews are less cost-effective than molar blocks. The initial hypothesis was rejected. Miniscrews provide better anchorage reinforcement at a higher price. They should be used in cases where anchorage loss cannot be accepted. TRIAL REGISTRATION NCT02644811.

Letters From Our Readers

Letters From Our Readers : Re: Response to: Pain and discomfort following insertion of miniscrews and premolar extractions: A randomized controlled trial. The Angle Orthodontist; 2016; 86: 891-899.