James Noble

Nickel allergy and orthodontics, a review and report of two cases

Nickel is a common component in many orthodontic materials. An allergy to nickel is commonly seen in the population, more frequently in women. This allergy has increased with the more frequent use of nickel containing jewellery and intraoral piercings. As a result, this allergy can be expected to be more readily encountered in dental practice. Possible allergy to nickel should be a question in the initial patient health history questionnaire. The dental practitioner should be mindful of this allergy during the course of orthodontic treatment, and know how to diagnose a nickel allergy if it appears and subsequent action in treatment and referral if it is suspected. This paper provides a summary of nickel allergy, its epidemiology, diagnosis and recommendations and alternatives to treatment. A detailed description of two cases where it was discovered in orthodontic patients is also reported.

Treatment of dental anomalies in children with complete unilateral cleft lip and palate at SickKids hospital, Toronto.

Objective: To quantify dental anomalies in permanent dentition associated with complete unilateral cleft lip and palate and to survey treatment modalities used to address these problems. Method: Retrospective study of 116 children with complete unilateral cleft lip and palate treated at SickKids since birth. Presence and morphology of lateral incisors and second premolars were determined. Orthodontic, surgical, and/or prosthetic procedures were analyzed. Results: The cleft-side lateral incisor was absent in 93.1% of finished cases. The lateral incisor mesial to the cleft was present in 4.3%, absent due to agenesis in 75.9%, and extracted in 19.8% of cases. The lateral distal to the cleft was present in 2.6%, absent due to agenesis in 33.6%, and extracted in 63.8% of cases. Of 105 lateral incisors, only one had normal morphology. Noncleft-side lateral incisors were absent in 16% of finished cases. Absence was due to agenesis in 12.1% of cases and extraction in 4.3%. When the lateral incisor was missing, closure of the dental space occurred by orthodontic tooth movement after alveolar bone grafting (45%); surgical closure with simultaneous alveolar bone grafting (35%); prosthetic closure (17%); and 3% were failures. Agenesis of premolars occurred in 12.1% of cleft-side and 10.3% of noncleft-side maxillary second premolars. Conclusions: The cleft-side lateral incisor is rarely present at the conclusion of orthodontic and surgical treatment of complete unilateral cleft lip and palate. Often absent due to agenesis, when present it is typically abnormal in size and bone support and is commonly extracted in favor of canine substitution.

Future practice plans of orthodontic residents in the United States

INTRODUCTION The purpose of this study was to investigate the future clinical practice plans of orthodontic residents in the United States. METHODS All program chairs and directors of the 65 US orthodontic residency programs were contacted by e-mail and telephone and asked for permission to e-mail their residents and invite them to take part in an anonymous 57-item questionnaire online. A total of 335 e-mails from 37 programs were obtained, and the survey was sent in May 2007. Basic statistics including chi-square comparative analyses were performed by sex, age, and year of program. RESULTS A total of 63.04% of orthodontic residents plan to use self-ligating brackets; 84.06% plan to use Invisalign (Align Technology, Santa Clara, Calif); 92.03% plan to use temporary anchorage devices, and 72.26% plan on placing them themselves; 28.26% plan to use cone-beam computerized tomography; 92.75% plan to use a digital imaging program; 45.65% plan to use indirect bonding; and 10.87% plan to use lingual orthodontics. A total of 70.07% plan to use 2-phase treatment, and 61.59% said they will use functional appliances. A total of 81.16% plan to become certified by the American Board of Orthodontics, but only 18.12% thought certification should be mandatory for licensure; 36.50% indicated that a master of science degree should be required in their program, and 77.94% believe that a 24- to 30-month program adequately prepares them for future orthodontic practice. CONCLUSIONS Newer orthodontic technologies such as self-ligating brackets, temporary anchorage devices, and Invisalign as well as functional appliances are expected to grow in popularity in the United States because of projected future use by orthodontic residents. Two-phase orthodontic treatment with functional appliance mechanics will continue to be used. Most orthodontic residents will become certified by the American Board of Orthodontics but do not believe it should be necessary for licensure. Orthodontic residents in the United States believe that a 2-year program adequately prepares them for private practice.

In Vivo Bonding of Orthodontic Brackets to Fluorosed Enamel using an Adhesion Promotor

OBJECTIVES To determine the success of bracket retention using an adhesion promoter with and without the additional microabrasion of enamel. MATERIALS AND METHODS Fifty-two teeth with severe dental fluorosis were bonded in vivo using a split-mouth design where the enamel surfaces of 26 teeth were microabraded with 50 microm of aluminum silicate for 5 seconds under rubber dam and high volume suction. Thirty-seven percent phosphoric acid was then applied to the enamel, washed and dried, and followed by placement of Scotchbond Multipurpose Plus Bonding Adhesive. Finally, precoated 3M Unitek Victory brackets were placed and light cured. The remaining teeth were bonded using the same protocol but without microabrasion. RESULTS After 9 months of intraoral service, only one bond failure occurred in the control group where microabrasion was used. Chi-square analysis revealed P = .31, indicating no statistical significance between the two groups. CONCLUSIONS Bonding orthodontic attachments to fluorosed enamel using an adhesion promoter is a viable clinical procedure that does not require the additional micro-mechanical abrasion step.

Location and Presence of Permanent Teeth in a Complete Bilateral Cleft Lip and Palate Population

OBJECTIVE To describe the location and presence of permanent teeth in nonsyndromic complete bilateral cleft lip and palate patients from the Manitoba Centre for Craniofacial Difference. MATERIALS AND METHODS Records of 1570 patients dating back to 1958 were assessed in this retrospective chart review. RESULTS Thirty-eight patients met the inclusion criteria, providing 76 cleft site teeth: A tooth on each side of the cleft was considered to have developed from a single lateral incisor tooth bud. The pattern M was assigned when a tooth was found mesial to the cleft, D when distal, MD when mesial and distal and AB if none was found. Pattern M was noted 9.2% of the time; D, 47.4%; MD, 5.3%; and AB, 38.2%. Teeth outside the cleft site: In the maxilla, agenesis occurred in 11.9% of second premolars and 10.5% of central incisors. In the mandible, agenesis occurred in 4.0% of second premolars, 2.6% of lateral incisors, 2.6% of central incisors, and 2.6% of second molars. CONCLUSIONS The lateral incisor was most commonly found distal to the cleft. Agenesis of the lateral incisor and teeth outside the cleft were more common than in noncleft populations.

Diagnosis and management of the infraerupted primary molar

An infraerupted tooth is a tooth that has failed to erupt to be in line with adjacent teeth in the vertical plane of occlusion. The general dentist may be faced with this predicament which requires careful attention and thoughtful consideration in terms of long-term patient goals. It is important to diagnose infraerupted teeth and treat them in a timely fashion to help prevent unwelcome sequelae. Important interdisciplinary communication is vital between the dentist and the orthodontist to ensure that precious space and time are not lost. Here we present a review article of complications and considerations that must be taken into account when faced with a patient who has an infraerupted tooth.

Motivations of Orthodontic Residents in Canada and the United States to Treat Patients With Craniofacial Anomalies, Cleft Lip/Palate, and Special Needs

Objectives To determine the motivation of orthodontic residents in Canada and the United States to treat patients with cleft lip/palate (CLP), craniofacial anomalies (CFA), and special needs (SN). Methods In March 2009, an e-mail with a link to a 41-item survey was sent to all orthodontic residents in Canada and the United States (n = 944). Results Of 944 residents contacted, 339 viewed and 208 completed the survey (22.03%). Using a seven-point Likert scale, residents recognized the importance of treating patients with CLP/CFA/SN. When asked if they plan to treat patients with CLP/CFA/SN, 54.48% responded yes, 13.46% no, and 36.06% were unsure. A total of 38.05% said they would charge the same fee as a typical multiarch case, while 58.05% would charge more, and 60% of fourth-year residents would charge twice the fee. Of the respondents, 43.00% were aware of the established fellowship programs in CLP/CFA/SN. Canadian residents (67.9%) were more enthusiastic about completing a fellowship than Americans were. Of the respondents, 29.33% would complete a 1-year fellowship, while 70.67% would not. A total of 78.4% of male respondents and 77.4% of American residents indicated they would not pursue a fellowship. Conclusions Residents supported the importance of treating patients with CLP/CFA/SN, and more than 54% indicated they plan to treat these patients. Residents who indicated that they would not treat these patients sited limited experience and inadequate expertise as the reasons. Less than 30% indicated a willingness to pursue a fellowship program.