Philip E. Benson

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.

Polarized versus nonpolarized digital images for the measurement of demineralization surrounding orthodontic brackets.

OBJECTIVE To compare the assessment of demineralized white lesions surrounding orthodontic brackets using images produced with and without polarizing filters to reduce incidental flash reflection. MATERIALS AND METHODS Thirty teeth with orthodontic brackets and a systematic arrangement of artificially induced demineralization were used. Standardized digital images of the teeth were taken with and without a cross-polarizing filter. These were repeated after 1 week. All the images were randomly numbered and assessed by an investigator, unaware as to the nature of the study. The presence or absence of demineralization was recorded and compared with the actual demineralization pattern. The lesion area and degree of whiteness (LI%) were measured using computerized image analysis. Twenty images from each group were randomly chosen and duplicated for an assessment of measurement error. RESULTS The positive and negative predictive values were better from the polarized images (0.97 and 0.84, respectively) than from the nonpolarized images (0.90 and 0.74, respectively). The percentage agreements for the repeat assessments of the same slide were better for the polarized images (96%) than for the nonpolarized images (89%). The limits of agreement and intraclass correlation coefficients between measurements of repeated images were lower for lesion area from cross-polarized images, suggesting better reproducibility, but not for LI%. CONCLUSION A cross-polarization filter enhances the subjective assessment of demineralized lesions surrounding an orthodontic bracket and improves the reproducibility of measuring the lesion area. The filter did not improve the assessment of changes in enamel gray levels with demineralization.

Orthodontic palatal implants: clinical technique

The aim of this paper is to familiarize the readers with some of the clinical considerations necessary to ensure successful use of mid-palatal implants. Both surgical and technical aspects will be discussed along with a description of impression techniques used.

Is the short‐form Child Perceptions Questionnaire meaningful and relevant to children with malocclusion in the UK?

Objective To explore the face and content validity of the 16‐item short‐form of CPQ11–14 (CPQ ISF‐16), an oral health‐related quality of life measure (OHRQoL) measure, with young people with malocclusion in the UK. Design Qualitative study. Setting Interviews about CPQ ISF‐16 were conducted in participants’ homes. Subjects and methods The sample included 10 participants aged 12–14 years attending an orthodontic clinic of a dental hospital in the UK. All participants were judged to be in definite need of orthodontic treatment. Interventions The interviews covered the impact of malocclusion on young peoples daily lives and participants were then asked to complete CPQ ISF‐16 and describe their interpretation of the meaning of questions, any ambiguities of wording and comment on the layout of the questionnaire and response format. Results Having a malocclusion ‘bothered’ young people to varying degrees. For those participants for whom having a malocclusion impacted on their lives, concerns were about self‐consciousness with dental appearance. On analysis of the content validity some items were felt to be relevant to the impact of malocclusion, particularly questions from the emotional and social well‐being subscales; however, other questions were felt not to be relevant. Concerns about face validity were expressed about several facets of the measure including the response format, the use of ‘double’ questions and interpretation of certain words. Conclusion Concerns were expressed by young people with malocclusions about the face and content validity of CPQ ISF‐16. Further consideration should be given to the need for a child‐centred malocclusion‐specific OHRQoL measure.

Physical Properties of Conventional and Super Slick Elastomeric Ligatures after Intraoral Use

OBJECTIVE To investigate the change in the physical properties of conventional and Super Slick elastomeric ligatures after they have been in the mouth. MATERIALS AND METHODS Nine healthy volunteers took part. One orthodontic bracket was bonded to a premolar tooth in each of the four quadrants of the mouth. Two conventional and two Super Slick elastomeric ligatures were placed at random locations on either side of the mouth. The ligatures were collected after various time intervals and tested using an Instron Universal testing machine. The two outcome measures were failure load and the static frictional resistance. RESULTS The failure load for conventional ligatures was reduced to 67% of the original value after 6 weeks in situ. Super Slick elastomeric ligatures showed a comparable reduction after 6 weeks in situ (63% of original value). There were no statistical differences in the static friction between conventional and Super Slick elastomerics that had been in situ for either 24 hours (P = .686) or 6 weeks (P = .416). There was a good correlation between failure load and static friction (r = .49). CONCLUSIONS There were statistically significant differences in the failure loads of elastomerics that had not be placed in the mouth and those that had been in the mouth for 6 weeks. There were no differences in the static frictional forces produced by conventional and Super Slick ligatures either before or after they had been placed in the mouth. There appears to be a direct proportional relationship between failure load and static friction of elastomeric ligatures.

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.

Treatment and stability of class II division 2 malocclusion in children and adolescents: a systematic review.

INTRODUCTION Our objectives were to evaluate the evidence with regard to the effectiveness and stability of orthodontic treatment interventions for Class II Division 2 malocclusion in children and adolescents. This is a systematic review conducted according to the PRISMA statement. METHODS The Cochrane Oral Health Trials Register, the Cochrane Central Register of Controlled Trials, MEDLINE, and EMBASE were searched to November 2011. Relevant conference abstracts were also screened. No language restrictions were applied. Inclusion criteria were clinical studies with at least 20 subjects with Class II Division 2 malocclusion in which comparisons were made with an untreated Class II Division 2 malocclusion group, another treated Class II Division 2 malocclusion group, or neither. For included studies ranked best on the hierarchy of evidence, assessments of methodologic quality and risk of bias were undertaken. Abstracts and, when appropriate, full articles were examined independently by 2 investigators. Disagreements were resolved through discussion. Treatment changes and stability with or without retainers were measured with the following: skeletal, soft tissue, dental, and occlusal changes; gingival health; temporomandibular joint status and related muscular activity; and quality of life. RESULTS Of the 322 studies identified in the search, 20 met the final inclusion criteria. All had a high risk of bias. CONCLUSIONS Highly biased evidence exists with regard to management and stability of Class II Division 2 malocclusion. Guidelines are proposed based on current evidence.

Measurement of White Lesions Surrounding Orthodontic Brackets: Captured Slides Vs Digital Camera Images

Digital images provide an efficient means of processing and storing clinical images and are increasingly being used in orthodontic practice. However, for research purposes it must be shown that measurements from digital images are as reliable as those from captured slides, particularly in the area of postorthodontic demineralization. The aim of this in vitro study was to compare the assessment of demineralized white lesions surrounding orthodontic brackets using images produced from captured slides with those from a digital camera. Thirty teeth with orthodontic brackets and a systematic arrangement of artificially induced demineralization were used. Standardized images of the teeth were taken in 35-mm slide format and using a digital camera. The slides were scanned and saved as digital images. All the images were numbered, recoded in a random order, and assessed by a second investigator. The image was examined for the presence or absence of demineralization. This was compared with the actual demineralization pattern, and the positive and negative predictive values were calculated. Twenty images from each group were randomly chosen and duplicated for an assessment of measurement error. The positive and negative predictive values were better from the digital images (0.92 and 0.81) than from the captured slides (0.88 and 0.74). The percentage agreements for the repeat assessments of the same slide were similar (96% for the captured slides and 93% for the digital images). Measurements of enamel demineralization using images from a digital camera are as accurate and reproducible as images captured from a photographic slide.

Roth versus MBT: does bracket prescription have an effect on the subjective outcome of pre-adjusted edgewise treatment?

The aim was to determine if bracket prescription has any effect on the subjective outcome of pre-adjusted edgewise treatment as judged by professionals. This retrospective observational assessment study was undertaken in the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield, UK. Forty sets of post-treatment study models from patients treated using a pre-adjusted edgewise appliance (20 Roth and 20 MBT) were selected. The models were masked and shown in a random order to nine experienced orthodontic clinicians, who were asked to assess the quality of the outcome, using a pre-piloted questionnaire. The principal outcome measure was the Incisor and Canine Aesthetic Torque and Tip (ICATT) score for each of the 40 post-treatment models carried out by the nine judges. A two-way analysis of variance was undertaken with the dependent variable, total ICATT score and independent variables, Bracket prescription (Roth or MBT) and Assessor. There were statistically significant differences between the subjective assessments of the nine judges (P<0.001), but there was no statistically significant difference between the two bracket prescriptions (P = 0.900). The best agreement between a clinicians judgment of prescription used and the actual prescription was fair (kappa statistic 0.25; CI -0.05 to 0.55). The ability to determine which bracket prescription was used was no better than chance for the majority of clinicians. Bracket prescription had no effect on the subjective aesthetic judgments of post-treatment study models made by nine experienced orthodontists.

Seen and heard: towards child participation in dental research

BACKGROUND There has been an increasing emphasis in many countries worldwide to capture the views of children on health services and research. A previous systematic review found that most oral health research from 2000 to 2005 was conducted on children and highlighted the need for greater research with children. AIM To describe the extent to which oral health research between 2006 and 2014 has been conducted with or on children. DESIGN Systematic review. Electronic databases were searched for the literature on child dental health. Each identified paper was examined by two researchers and categorised based on the extent to which children were involved in the research, the type of study (evaluative or otherwise), the country of origin, and the clinical discipline. RESULTS The search included 2950 papers after application of the exclusion criteria. Of these, 17.4% were with children, 18.3% involved the use of proxies (parents or clinician), and 64.2% were on children. CONCLUSIONS The proportion of studies from 2006 to 2014 involving research with children has increased from 7.3% in 2000-2005. This systematic review provides evidence for movement towards childrens involvement in dental research over the last 10 years. Future dental research must focus on incorporating childrens perspectives into the evaluation of dental treatments to improve outcomes for children.