Nicola Parkin

Fluorides, orthodontics and demineralization: a systematic review

Objectives To evaluate the effectiveness of fluoride in preventing white spot lesion (WSL) demineralization during orthodontic treatment and compare all modes of fluoride delivery. Data sources The search strategy for the review was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for RCTs or CCTs: Cochrane Clinical Trials Register, Cochrane Oral Health Group Specialized Trials Register, MEDLINE and EMBASE. Inclusion and exclusion criteria were applied when considering studies to be included. Authors of trials were contacted for further data. Data selection The primary outcome of the review was the presence or absence of WSL by patient at the end of treatment. Secondary outcomes included any quantitative assessment of enamel mineral loss or lesion depth. Data extraction Six reviewers independently, in duplicate, extracted data, including an assessment of the methodological quality of each trial. Data synthesis Fifteen trials provided data for this review, although none fulfilled all the methodological quality assessment criteria. One study found that a daily NaF mouthrinse reduced the severity of demineralization surrounding an orthodontic appliance (lesion depth difference −70.0 μm; 95% CI −118.2 to −21.8 μm). One study found that use of a glass ionomer cement (GIC) for bracket bonding reduced the prevalence of WSL (Peto OR 0.35; 95% CI 0.15–0.84) compared with a composite resin. None of the studies fulfilled all of the methodological quality assessment criteria. Conclusions There is some evidence that the use of a daily NaF mouthrinse or a GIC for bonding brackets might reduce the occurrence and severity of WSL during orthodontic treatment. More high quality, clinical research is required into the different modes of delivering fluoride to the orthodontic patient.

No Difference in Surgical Outcomes Between Open and Closed Exposure of Palatally Displaced Maxillary Canines

PURPOSE To investigate differences in surgical outcomes between open and closed exposure for palatally displaced maxillary canines. MATERIALS AND METHODS This multicenter randomized controlled trial involved 2 parallel groups. The settings were 1 dental teaching hospital in and 2 hospital units near Sheffield, UK. Participants were younger than 20 years, had a unilateral palatally displaced maxillary canine, and provided informed consent. They were randomly allocated to receive the open or the closed surgical procedure. The outcomes were time spent in the operating room and 10-day postoperative patient questionnaire findings. Statistical differences between the 2 techniques were tested using independent t tests for continuous variables and χ(2) tests for frequencies. RESULTS The final study sample was composed of 71 participants (64% female). There were no differences in the gender ratios (open: 27 female, 13 male; closed; 25 female, 16 male) or mean ages (open: 14.3 yrs; standard deviation [SD], 1.3 yrs; closed: 14.1 yrs; SD, 1.6 yrs) of the 2 groups at the start. The mean operating times for the open and closed techniques were 34.3 minutes (SD, 11.2 min) and 34.3 minutes (SD, 11.9 min), respectively (P = .986). There were no statistically significant differences between the 2 treatment groups for any patient-assessed outcome (P > .05). CONCLUSIONS There were no differences in the surgical outcomes investigated in this study between open and closed exposure for palatally displaced maxillary canines.

Esthetic judgments of palatally displaced canines 3 months postdebond after surgical exposure with either a closed or an open technique.

INTRODUCTION The aim of this study was to compare the esthetic judgments of orthodontists and laypeople regarding the appearance of palatally displaced canines 3 months after treatment with either a closed or an open surgical exposure and orthodontic alignment. METHODS A multicenter randomized controlled trial was undertaken in 3 hospitals in the United Kingdom. Patients with unilateral palatally displaced canines were randomly allocated to receive either a closed or an open surgical exposure. The teeth were aligned with fixed appliances, and 3 months after debond, intraoral photographs were taken. The photographs were projected in random order to 2 panels of judges (orthodontists and laypeople), who completed a questionnaire. RESULTS The images of 67 participants (closed, 33; open, 34) were included. The laypeople were able to identify the operated tooth only 49.7% of the time (95% CI, 45.3%-54.0%); this was no better than chance (P = 0.880). The orthodontists were more successful but still identified the treated canine with certainty only 60.7% of the time (95% CI, 53.7%-67.8%; P = 0.003). Both panels more frequently assessed the unoperated canine to have a better appearance than the contralateral operated canine; however, there were no differences between the closed and open groups (proportion preferring unoperated canine-laypeople: closed, 58.7%; open, 57.0%; P = 0.43; and orthodontists: closed, 60.9%; open, 60.6%; P = 0.27). CONCLUSIONS There is an esthetic impact to aligning a palatally displaced canine, but it is mostly minor and unlikely to be detectable by laypeople. The esthetic impact was the same, whether the canine was exposed with a closed or an open surgical technique.

Space closing versus space opening for bilateral missing upper laterals – aesthetic judgments of laypeople: a web-based survey

Objective To investigate the opinions of laypeople regarding the aesthetic outcome of treating patients with developmental absence of both maxillary lateral incisors using either orthodontic space closure (OSC) or space opening and prosthetic replacement (PR). Design Cross sectional, web-based survey. Methods A panel of five orthodontists and five restorative dentists examined post-treatment intra-oral images of 21 patients with developmental absence of both upper lateral incisors. A consensus view was obtained about the 10 most attractive images (5 OSC; 5 PR). The 10 selected images were used in a web-based survey involving staff and students at the University of Sheffield. In the first section, the participants were asked to evaluate the attractiveness of the 10 randomly arranged single images using a 5-point Likert scale. In the second section, an image of OSC was paired with an image of PR according to their attractiveness ranking by the clinician panel, and the participants were asked to indicate which of the two images they preferred. Results The survey received 959 completed responses with 9590 judgements. The images of OSC were perceived to be more attractive (mean rating 3·34 out of 5; SD 0·56) compared with the images of PR (mean rating 3·14 out of 5; SD 0·58) (mean diff 0·21; P <; 0·001). Female and staff judges tended to give higher attractiveness ratings. Both females and males preferred the OSC images closing in 3 out of 4 paired images. Conclusion Space closing was perceived to be more attractive than space opening by lay people. The findings have implications for advising patients about the best aesthetic outcome when both maxillary lateral incisors are missing.

Early Management of the Palatally Displaced Maxillary Permanent Canine

This chapter describes the current evidence concerning the early management of the palatally displaced canine (PDC).

Interventions for promoting the eruption of palatally displaced permanent canine teeth, without the need for surgical exposure, in children aged 9 to 14 years

Interventions for promoting the eruption of palatally displaced permanent canine teeth, without the need for surgical exposure, in children aged 9 to 14 years

Current ideas on the management of palatally displaced canines

An adolescent presenting with a palatally displaced canine (PDC) is a fairly common occurrence. The condition is expensive to treat as it involves surgical exposure (usually under general anaesthesia) followed by lengthy fixed orthodontic treatment at an average of two to three years. In the majority of cases alignment is successful. However if orthodontic alignment is unsuccessful and the tooth has to be surgically removed this can leave a large bony defect, which will be difficult to restore with a bridge or implant (see Figure 1). This article aims to give an overview of current principles and problems in the management of PDC.