Nicky Mandall

Effectiveness of early orthodontic treatment with the Twin-block appliance: a multicenter, randomized, controlled trial. Part 1: Dental and skeletal effects.

This study evaluated the effectiveness of early orthodontic treatment with the Twin-block appliance for the developing Class II Division 1 malocclusion. This multicenter trial was carried out in the United Kingdom. A total of 174 children, aged 8 to 10 years old, with Class II Division 1 malocclusion were randomly allocated to receive treatment with a Twin-block appliance or to an untreated, control group. Data were collected at the start of the study and 15 months later. Results showed that early treatment with Twin-block appliances resulted in reduction of overjet, correction of molar relationships, and reduction in severity of malocclusion. Most of this correction was due to dentoalveolar change, but some was due to favorable skeletal change. Early treatment with the Twin-block appliance is effective in reducing overjet and severity of malocclusion. The small change in the skeletal relationship might not be considered clinically significant.

Effectiveness of treatment for Class II malocclusion with the Herbst or twin-block appliances: a randomized, controlled trial.

The aim of this study was to evaluate the effectiveness of Herbst and Twin-block appliances for established Class II Division I malocclusion. The study was a multicenter, randomized clinical trial carried out in orthodontic departments in the United Kingdom. A total of 215 patients (aged 11-14 years) were randomized to receive treatment with either the Herbst or the Twin-block appliance. Treatment with the Herbst appliance resulted in a lower failure-to-complete rate for the functional appliance phase of treatment (12.9%) than did treatment with Twin-block (33.6%). There were no differences in treatment time between appliances, but significantly more appointments (3) were needed for repair of the Herbst appliance than for the Twin-block. There were no differences in skeletal and dental changes between the appliances; however, the final occlusal result and skeletal discrepancy were better for girls than for boys. Because of the high cooperation rates of patients using it, the Herbst appliance could be the appliance of choice for treating adolescents with Class II Division 1 malocclusion. The trade-off for use of the Herbst is more appointments for appliance repair.

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.

Juvenile idiopathic arthritis (JIA): a screening study to measure class II skeletal pattern, TMJ PDS and use of systemic corticosteroids

Objective To screen patients with oligoarticular and polyarticular forms of Juvenile Idiopathic Arthritis (JIA) to determine (i) the severity of their class II skeletal pattern; (ii) temporomandibular joint signs and symptoms and (iii) use of systemic corticosteroids. Design Cross‐sectional screening. Subjects and setting Sixty‐eight children with JIA aged between 9 and 16 years old who were screened at four regional treatment centres in the UK. Method Patients were screened clinically and radiographically for the presence of class II skeletal pattern and temporomandibular (TMJ) pain dysfunction syndrome. In addition, the JIA sub‐type and history of disease activity and medication were recorded. Main outcome measures Class II skeletal pattern, TMJ signs and symptoms, use of systemic corticosteroids. Results The mean ANB values were 4·2 degrees (SD = 2·9 degrees) in the oligoarticular group and 5·1 degrees (SD = 3·8 degrees) in the polyarticular group. Just under one‐third of children had a moderate or severe class II skeletal pattern and a further quarter of children had a mild class II skeletal pattern. Clinical signs and symptoms of temporomandibular joint pain dysfunction syndrome were low (<20%), except for crepitus and click which affected between 24 and 40% of JIA children. Radiographically, 57% of oligoarticular and 77% of polyarticular cases exhibited condylar erosion. Use of systemic corticosteroids varied between centres, but overall, was prescribed more in polyarticular cases (P = 0·001). Conclusions Just under one‐third of oligoarticular and polyarticular JIA patients exhibited a moderate or severe class II skeletal pattern. It is, therefore, likely that any future clinical trial to investigate the effect of functional appliance treatment in JIA patients, will need multicentre co‐operation to fulfil potential sample size requirements. Clinical signs and symptoms of temporomandibular joint pain dysfunction syndrome were low except for crepitus and click. However, radiographic evidence of condylar erosion was high particularly in the polyarticular group. Use of systemic corticosteroids was prescribed more in polyarticular cases and this is likely to reflect the severity of the disease.

Orthodontics: The role of removable appliances in contemporary orthodontics

The contemporary uses of removable appliances are considerably more limited than in the past. This article discusses possible reasons for their declining use, including recognition of their limitations. It is possible to achieve adequate occlusal improvement with these appliances providing that suitable cases are chosen. Specific indications for their appropriate use on their own in the mixed dentition are presented. Removables can also be used as an adjunct to more complex treatments, to enhance the effect of fixed appliances, headgear or in preparation for functional appliances. Further research is required to confirm whether their use in conjunction with more complex treatments enhances the quality and efficiency of treatment or not.

Banding versus bonding of first permanent molars: a multi-centre randomized controlled trial

Objective To assess the effectiveness of banding versus bonding of first permanent molars during fixed appliance treatment; in terms of attachment failure, patient discomfort and post-treatment enamel demineralization. Design Multi-centre randomized clinical trial. Setting One District General Hospital Orthodontic Department and two Specialist Orthodontic Practices. Participants Orthodontic patients aged between 10 and 18 years old, randomly allocated to either receive molar bands (n = 40) or molar bonds (n = 40). Method Bands were cemented with a conventional glass ionomer cement and tubes were bonded with light-cured composite to all four first permanent molar teeth for each subject. Attachments were reviewed at each recall appointment to assess loosening or loss. The clinical end point of the trial was the day of appliance debond. Enamel demineralization at debond was assessed using the modified International Caries Assessment and Detection System (ICDAS). Results The first time failure rate for molar bonds was 18·4% and 2·6% for molar bands (P = 0·0002). Survival analysis demonstrated molar bonds were more likely to fail compared with molar bands. First permanent molars with bonded tubes experienced more demineralization than those with cemented bands (P = 0·027). There was no statistically significant difference in discomfort experienced by patients after banding or bonding first permanent molars (P>0·05). Conclusion This study shows that as part of fixed appliance therapy, American Orthodontics photoetched first permanent molar bands cemented with 3M ESPE Ketac-Cem perform better than American Orthodontics low profile photo-etched and mesh-based first permanent molar tubes bonded with 3M Unitek Transbond XT in terms of failure behaviour and molar enamel demineralization.

The Oral Yeast Flora: Effect of Upper Removable Orthodontic Appliances

The aim of this study was to test the hypothesis that the oral biology of yeasts in children alters in response to presence of an upper removable appliance (URA). Thirty-four normal controls and 34 patients, undergoing removable orthodontic appliance treatment were studied. Saliva samples were obtained from all subjects along with a foam imprint from the fitting surface of the URA in the case of patients. Samples were cultured on CHROMagar Candida. Colonies that were green-blue in colour were confirmed as Candida albicans by the germ-tube test. Other yeasts were identified by means of commercial identification kits. Oral yeast species were isolated from 32.3% of healthy controls compared with 76.5% of children with a URA ( p < 0.01). C. albicans was the most prevalent species isolated from saliva and appliance in the same individual (13) and from saliva alone in both patient (six) and control (ten) individuals. In eight of 34 patients, but in only one of 34 controls, more than one yeast species was present. The prevalence of oral colonization by Candida spp. is significantly higher amongst wearers of removable orthodontic appliances. Furthermore, the oral biology of yeasts is affected by URA wear so that colonization is more important, and by a wider variety of Candida species, and multispecies are seen.

Orthodontics: Are specialist outreach clinics for orthodontic consultation effective? A randomised controlled trial

Objective To develop outreach clinics for orthodontic consultation and evaluate their costs and effectiveness.Design Single centre randomised controlled trial with random allocation of referred patients to outreach or main base consultation appointments.Setting One hospital orthodontic department and three community health centre clinics in Greater Manchester.Subjects 324 patients who were referred for orthodontic treatment.Main outcome measures The outcome of consultation, the cost and duration of the visit and the consumers perceptions of the visit.Results There were no differences in outcome of the consultation. While consumer travel costs and the duration of appointments were significantly higher for the main base clinics, these differences were not great. However, consumers preferred to attend an appointment in an outreach clinic.Conclusions There do not appear to be marked advantages or disadvantages in providing consultation appointments for orthodontics in outreach clinics