Lam L. Cheng

Predisposing factors to dental caries in children with cleft lip and palate: A review and strategies for early prevention

Objective: To review predisposing factors contributing to dental caries in patients with cleft lip, cleft palate, or both (CL/P). Design: Patients with CL/P have a higher susceptibility to caries compared with the population group without clefts. A review of the literature was undertaken to determine factors that could account for the compromised oral hygiene and the high caries prevalence in patients with CL/P. Results: After a literature review, modern strategies for the prevention of early childhood caries were developed and should be considered for integration into the overall management protocol of patients with CL/P. Conclusions: Preventive dental care is ever more so important in patients with CL/P compared with patients without clefts.

Physical properties of root cementum: Part 23. Effects of 2 or 3 weekly reactivated continuous or intermittent orthodontic forces on root resorption and tooth movement: A microcomputed tomography study

INTRODUCTION The force application period is a modifiable factor in root resorption. There is still ambiguity if the continuity of force application is advantageous in terms of root resorption and tooth movement. In this prospective randomized clinical trial, we compared the effects of 2 reactivation periods of controlled-intermittent and continuous forces on root resorption and tooth movement. METHODS Thirty-two patients were randomly divided into 2 groups: 2 weekly and 3 weekly reactivations. A split-mouth setup was used for the intermittent and continuous force comparisons. The intermittent force was designed with a pause of 3 days before each reactivation of the springs. A buccally directed tipping force (150 g) was generated with 0.017 × 0.025-in Beta III Titanium cantilever springs (3M Unitek, Monrovia, Calif). After the extractions, surface analysis was performed with microcomputed tomography (model 1172; SkyScan, Aartselaar, Belgium) and specially designed software (CHull2D) for direct volumetric analysis. Buccal premolar movement was also measured on the images of the study casts. RESULTS Continuous forces produced more resorption than intermittent forces on the total volumes in both groups. A significant difference was found for the 3-weekly group only (P <0.01) on the cervical-mesial (P <0.01) and cervical-buccal (P <0.05) compression regions. In the 2-weekly group, differences were evident in the middle-distal (P <0.05) and middle-lingual (P <0.05) tension regions. Continuous forces produced significantly more tooth movement than did the intermittent forces for both the 2-weekly (P <0.01) and the 3-weekly (P <0.001) regimens. Significant differences were not observed between the 2 intermittent force regimens regarding root resorption and tooth movement. CONCLUSIONS Intermittent force causes less root resorption and tooth movement than continuous force. Root resorption decreases irrespective of the timing of reactivation, when a pause is given. On the other hand, timing of reactivation might have critical importance on continuous force applications, since 2 weekly reactivations produced faster tooth movement with similar root resorption when compared with intermittent force.

Physical properties of root cementum: Part 16. Comparisons of root resorption and resorption craters after the application of light and heavy continuous and controlled orthodontic forces for 4, 8, and 12 weeks

INTRODUCTION Orthodontic force duration can affect the severity of root resorption. The aim of this clinical study was to investigate the amounts of root resorption volumetrically after the application of controlled light and heavy forces in the buccal direction for 4, 8, and 12 weeks. METHODS The sample consisted of 54 maxillary first premolars in 36 patients (mean age, 14.9 years; 21 girls, 15 boys) who required first premolar extractions as part of their orthodontic treatment. The teeth were allocated into 3 groups that varied in the duration of force application: 4, 8, or 12 weeks. The right or left first premolars were randomly selected to receive 2 levels of forces. A light buccally directed orthodontic force of 25 g was applied to the experimental tooth on 1 side, while a heavy orthodontic force of 225 g was applied on the contralateral premolar. At the end of the experimental period, the teeth were extracted and scanned with the microcomputed-tomography x-ray system. Resorption crater analysis was performed with specially designed software for direct volumetric measurements. RESULTS Significant differences in the extent of root resorption were found between 4, 8, and 12 weeks of force application (P <0.001), with substantially more severe resorption in the longer force duration groups. The light force produced significantly less root resorption than did the heavy force. CONCLUSIONS After 4, 8, or 12 weeks of buccally directed orthodontic forces applied on the maxillary first premolars, the volumes of root resorption craters were found to be related to the duration and the magnitude of the forces.

Physical properties of root cementum: Part 13. Repair of root resorption 4 and 8 weeks after the application of continuous light and heavy forces for 4 weeks: A microcomputed-tomography study

INTRODUCTION The reparative process of root absorption begins in the periodontium when orthodontic force is discontinued or reduced below a certain level. Our aim was to evaluate cementum repair at 4 and 8 weeks of retention after 4 weeks of continuous light and heavy orthodontic forces. The effects of age, tooth movement, and fluoride exposure were also investigated. METHODS Forty patients were recruited and divided into 4 groups of 10. The maxillary first premolars were loaded with either light (25 g) or heavy (225 g) orthodontic force. After 4 weeks of loading, the maxillary left first premolars were extracted as the positive control group, and the maxillary right first premolars were placed in retention for 4 or 8 more weeks before extraction; these were the experimental groups. The extracted teeth were studied with microcomputed tomography. To assess cementum repair, volumetric changes of the resorption craters were measured with specially designed computer software. Tooth movement was also measured on study casts taken before and after the extractions. RESULTS Root resorption continued for 4 weeks after orthodontic force ceased. The resorptive activity was more pronounced from heavy forces. Passive retention after 4 weeks of light force had the least root resorption crater volume (cube root scale). The total amount of the cementum repaired did not depend on magnitude of orthodontic force or retention time within our parameters (P >0.05). This might indicate concurrence of resorption and repair during passive retention. Most repair seemed to occur after 4 weeks of passive retention following the 4 weeks of heavy forces. The volume of root resorption craters positively depended on tooth movement (P = 0.02) and negatively correlated with chronologic age (P <0.01). CONCLUSIONS Although there was no significant difference in the amounts of repair between groups, root resorption continued for 4 weeks after orthodontic force stopped. Resorptive activity was more pronounced after the heavy forces. The reparative processes were different between the light and heavy forces, with marked individual variations. Repair seemed to become steady after 4 weeks of passive retention following 4 weeks of light force application, whereas most repair occurred after 4 weeks of passive retention following 4 weeks of heavy force application. Root resorption crater volume positively depended on tooth movement and negatively correlated with chronologic age.

Repair of root resorption 4 and 8 weeks after application of continuous light and heavy forces on premolars for 4 weeks: a histology study.

INTRODUCTION Repair of root resorption cavities has been studied under light microscopy, scanning electron microscopy, and transmission electron microscopy. The aim of this investigation was to demonstrate the use of microcomputed tomography (micro-CT) to assist in the identification of the region of interest for light microscopy preparation. This study also qualitatively illustrated the root resorption craters with 4 or 8 weeks of retention after 4 weeks of continuous light or heavy orthodontic force application. METHODS Four patients who required bilateral extractions of maxillary first premolars as part of their orthodontic treatment were divided into 2 groups (groups I and II) of 2. The maxillary left and right first premolars were loaded with light (25 g) or heavy (225 g) orthodontic force for 4 weeks. After 4 or 8 weeks of retention, the maxillary first premolars were extracted. The extracted teeth were investigated with micro-CT. By using 3-dimensional images created by the micro-CT, the largest resorption craters on the buccal and lingual sides were identified. Parasagittal sections of these resorption craters were studied histologically under hematoxylin and eosin staining. RESULTS The use of micro-CT improved the efficiency and accuracy of histologic techniques. Comparatively, less root resorption was repaired by new cementum after heavy orthodontic force application and short retention time. The reparative processes seemed to depend on time, with longer retention time yielding the most amount of repair. Reparative cementum was a mixture of acellular and cellular cementum. Reparative processes seemed to commence at the central part of the resorption cavity and expand to the periphery. CONCLUSIONS Root resorption cavities have the potential to repair regardless of the orthodontic force magnitude. Correlative microscopy with micro-CT and conventional light microscopy adds a new dimension to current root resorption investigation techniques.

Editor's Summary and Q&A: Rate of tooth movement under heavy and light continuous orthodontic forces

INTRODUCTION The aim of this study was to measure the rate and the amount of orthodontically induced tooth movement under heavy (300 g) and light (50 g) continuous forces with superelastic nickel-titanium closing coils over a defined time (12 weeks). METHODS Fourteen patients who required maxillary canine retraction into first premolar extraction sites as part of their orthodontic treatment completed this study. In a split-mouth design, precalibrated nickel-titanium closing coil springs delivering a force of 300 g or 50 g were used to distalize the canines after an alignment and stabilization period. Intraoral and maxillary cast measurements were made at the beginning of canine retraction (T0) and every 28 days for 84 days (T1, T2, T3) to assess total space closure, canine retraction rate, canine retraction and molar anchorage loss, and canine rotation. RESULTS Statistical analysis showed that the amount of initial tooth movement (T0-T1) was not related to force magnitude; however, during the T1-T2 and T2-T3 periods, increased amounts and higher rates of tooth movement were found with heavy forces. These significantly increased the rate and the amount of canine retraction, but the adverse effects of loss of canine rotation control and anchorage were concomitantly increased. Light forces provided a greater percentage of canine retraction than heavy forces, with less strain on anchorage. CONCLUSIONS Initial tooth movement would benefit from light forces. Heavier forces tend to increase the rate and the amount of canine retraction but lose their advantage because of unwanted clinical side effects.

Physical properties of root cementum: part 15. Analysis of elemental composition by using proton-induced x-ray and gamma-ray emissions in orthodontically induced root resorption craters of rat molar cementum after exposure to systemic fluoride.

INTRODUCTION Root resorption resulting from orthodontic treatment is an unpredictable adverse effect. Literature examining the potential protective influence of tooth cementum minerals against orthodontically induced inflammatory root resorption has been sparse. Fluorine could have a role in minimizing the extent and severity of resorptive lesions. The purpose of this study was to examine the elemental content of tooth cementum in orthodontically induced inflammatory root resorption lesions and the effect of systemic fluoride. METHODS Twenty 7-week-old Wistar rats were divided into 2 groups of 10 and exposed to systemic fluoride (100 ppm) or nonfluoridated drinking water for 2 weeks. Orthodontic tooth movement was implemented with a nickel-titanitum closing coil with a force of 100 g. The molars were then extracted, dissected, and prepared for cross-sectioning through the largest mesial midroot crater. The samples were mounted and scanned by using the Commonwealth Scientific and Industrial Research Organisation and the Australian Research Councils National Key for Geochemical Evolution and Metallogeny of Continents Nuclear Microprobe (Melbourne, Victoria, Australia). Analysis of variance (ANOVA) was used for statistical comparison of the elements and to determine the effect of fluoride, and unaffected tooth structure compared with root resorption craters. The Student t test was used to compare root crater lengths and depths of the fluoride vs no-fluoride groups. RESULTS Root resorption lesions of the group exposed to fluoride were significantly reduced in length and depth (P <0.01). The mineral content of the root resorption craters of the fluoride group had higher concentrations of fluorine and zinc (P <0.01). There was less calcium in the craters of the no-fluoride group compared with the fluoride group (P <0.05). CONCLUSIONS Cementum quality (influenced by systemic fluoride exposure) might impact the extent of orthodontically induced resorptive defects.

Effect of continuous versus intermittent orthodontic forces on root resorption: A microcomputed tomography study

OBJECTIVES: To compare the extent of root resorption and the amount of tooth movement between continuous orthodontic force and intermittent orthodontic force that was activated in a similar way to a 4-week orthodontic adjustment period. MATERIALS AND METHODS: Twenty-five patients who required the extraction of upper first premolars were recruited in this study. A buccally directed continuous force of 150 g was applied to the upper first premolar on one side for 15 weeks. A buccally directed intermittent force (28 days on, 7 days off) of the same magnitude was applied to the contralateral first premolar. The teeth were extracted at the end of the experimental period and processed for volumetric evaluations of resorption craters. The degree of tooth movement and rotation were measured on the study models. RESULTS: Continuous force application displayed significantly higher root resorption volume than the intermittent force application ( P < .05), particularly on the buccal and lingual surfaces (P < .05) and the middle third of the root ( P < .01). There was more tipping and rotational movement in the continuous force group. CONCLUSIONS: In a 4-week orthodontic adjustment period, intermittent force significantly reduced the amount of root resorption compared with continuous force. Although there was less degree of tooth movement with intermittent force, unwanted rotational movement was avoided. This is crucial in patients who are predisposed to orthodontically induced inflammatory root resorption, and the use of this intermittent regimen should be considered.