A new yardstick for rating dental arch relationship in patients with complete bilateral cleft lip and palate

Objective: To develop yardsticks for assessment of dental arch relationship in young individuals with repaired complete bilateral cleft lip and palate appropriate to different stages of dental development. Participants: Eleven cleft team orthodontists from five countries worked on the projects for 4 days. A total of 776 sets of standardized plaster models from 411 patients with operated complete bilateral cleft lip and palate were available for the exercise. Statistics: The interexaminer reliability was calculated using weighted kappa statistics. Results: The interrater weighted kappa scores were between .74 and .92, which is in the "good" to "very good" categories. Conclusions: Three bilateral cleft lip and palate yardsticks for different developmental stages of the dentition were made: one for the deciduous dentition (6-year-olds' yardstick), one for early mixed dentition (9-year-olds' yardstick), and one for early permanent dentition (12-year-olds' yardstick).

Severe complication of a bonded mandibular lingual retainer

Bonding a flexible spiral wire retainer to the lingual surfaces of all 6 anterior mandibular teeth is a commonly used type of retention. Complications are rare but can be serious enough to produce biologic damage. This article presents a serious complication of a lingual flexible spiral wire retainer. Four years after the orthodontic treatment, a 20-year-old man sought treatment for a broken flexible spiral wire retainer. The clinical examination showed about 35° of buccal root torque of that tooth. A cone-beam computed tomography image showed that the root and the apex of the tooth were almost completely out of the bone on its buccal side. Surprisingly, the tooth's vitality was preserved. The tooth was moved back, nearly to its original position; clinically, only a gingival recession remained. Orthodontists and dentists should be aware of possible complications of bonded retainers. Patients should be clearly informed how to detect problems at an early stage.

A PRISMA assessment of the reporting quality of systematic reviews in orthodontics

Abstract Objectives: To assess the reporting quality of Cochrane and non-Cochrane systematic reviews (SR) in orthodontics and to compare the reporting quality (PRISMA score) with methodological quality (AMSTAR criteria). Materials and Methods: Systematic reviews (n  =  109) published between January 2000 and July 2011 in five leading orthodontic journals were identified and included. The quality of reporting of the included reviews was assessed by two authors in accordance with the PRISMA guidelines. Each article was assigned a cumulative grade based on fulfillment of the applicable criteria, and an overall percentage score was assigned. Descriptive statistics and simple and multiple linear regression analyses were undertaken. Results: The mean overall PRISMA score was 64.1% (95% confidence interval [CI], 62%-65%). The quality of reporting was considerably better in reviews published in the Cochrane Database of Systematic Reviews (P < .001) than in non-Cochrane reviews. Both multivariable and univariable analysis indicated that journal of publication and number of authors was significantly associated with the PRISMA score. The association between AMSTAR score and modified PRISMA score was also found to be highly statistically significant. Conclusion: Compliance of orthodontic SRs published in orthodontic journals with PRISMA guidelines was deficient in several areas. The quality of reporting assessed using PRISMA guidelines was significantly better in orthodontic SRs published in the Cochrane Database of Systematic Reviews.

Comparative assessment of clinical performance of esthetic bracket materials

To compare the alterations in esthetic appearance and slot morphology/integrity of two main types of esthetic brackets caused after clinical use.

Appreciation of cleft lip and palate treatment outcome by professionals and laypeople

The aim of the study was to analyse the aesthetic evaluation of head photographs of treated individuals with clefts by laypeople and professionals and to investigate how certain cephalometric variables could be related to their rating. A set of five standardized head photos (frontal, both laterals, three-quater right and left) of 12 Caucasian patients with treated unilateral cleft lip and palate were presented to 12 adult laypeople, 12 orthodontists, and 12 maxillofacial surgeons. For each set of photos the judges had to answer four questions on a visual analogue scale (VAS). The answers were analysed for intra- and inter-panel level of agreement and correlations of assessments with certain cephalometric parameters were determined. There was a high level of agreement for all assessments of each panel of raters. However, laypeople were less satisfied with lip and nose aesthetics compared to professionals. The three groups were similarly satisfied with the aesthetics of the jaws and the face. The anterior position of the maxilla (SNA) influenced positively professionals' ratings of facial aesthetics. Orthodontists were negatively influenced when the vertical dimension of the face or the distance of the lower lip to E-plane were relatively increased. The latter was the only cephalometric parameter correlated with lower aesthetic scores obtained from laypeople. Professionals report greater satisfaction from the treatment outcome and evaluate cleft consequences with less severity than laypeople. According to cephalometric findings, the relative positions of the lips seem to dominate facial aesthetics' appreciation by laypeople, while specialists appear to focus on different features of the face.

Displaced premolars in panoramic radiography: fact or fallacy?

OBJECTIVE: To test the null hypothesis that there is no difference between premolar position visualized on panoramic radiographs (PRs) and lateral headfilms (LHs). MATERIALS AND METHODS: The prevalence of differences in the direction of crown angulation between PR and LH was assessed. Furthermore, brass wire markers with different sagittal and transverse angulations were placed in a dry skull. With the markers in place, LHs and PRs were taken. RESULTS: A difference in the direction of crown angulation of unerupted second premolars between PR and LH occurred in 19.5% of patients. The reason for the angulation differences is a buccolingual orientation of the tooth, which appears as a mesiodistal angulation on the PR. CONCLUSION: The null hypothesis was rejected since in one-fifth of the patients premolar projection differs between the panoramic radiograph and the lateral headfilm.

Preventive effect of ozone on the development of white spot lesions during multibracket appliance therapy

OBJECTIVE: To test the null hypotheses: (1) there is no difference in the caries protective effect of ozone and Cervitec/Fluor Protector during multibracket (MB) appliance therapy, and (2) DIAGNOdent and quantitative light-induced fluorescence (QLF) are not superior to a visual evaluation of initial caries lesions. MATERIALS AND METHODS: Twenty right-handed patients with a very poor oral hygiene who required full MB appliance therapy were analyzed during 26 months. In a split-mouth-design, the four quadrants of each patient were either treated with ozone, a combination of Cervitec and Fluor Protector, or served as untreated controls. The visible plaque index (VPI) and white spot formation were analyzed clinically. DIAGNOdent and QLF were used for a quantitative assessment of white spot formation. RESULTS: The average VPI in all four dental arch quadrants amounted to 55.6% and was independent of the preventive measure undertaken. In the quadrants treated with Cervitec/Fluor Protector, only 0.7% of the areas developed new, clinically visible white spots. This was significantly (P < .05) less than in the quadrants treated with ozone (3.2%). The lesions detected with QLF only partially corresponded to the clinically detected white spots, while DIAGNOdent proved to be unable to detect any changes at all. CONCLUSIONS: The caries protective effect of Cervitec/Fluor Protector during MB therapy was superior to ozone, and a visual evaluation of initial caries lesions was superior to both DIAGNOdent and QLF.

Facts and myths regarding the maxillary midline frenum and its treatment: a systematic review of the literature

OBJECTIVE To systematically review the current literature on the maxillary midline frenum and associated conditions and complications, as well as the recommended treatment options. METHOD AND MATERIALS A detailed MEDLINE database search was carried out to provide evidence about the epidemiology, associated pathologies, and treatment options regarding the maxillary frenum. Of the 206 initially identified articles, 48 met the inclusion criteria. RESULTS The maxillary frenum is highly associated with a number of syndromes and developmental abnormalities. A hypertrophic frenum may be involved in the etiology of the midline diastema. There is also a tendency by orthodontists to suggest posttreatment removal of the frenum (frenectomy). Studies on the cause of gingival recession due to the maxillary frenum are inconclusive. An injured frenum in combination with other traumas and doubtful history might point to child abuse. The involvement of hyperplastic frena in the pathogenesis of peri-implant diseases remains uncertain. There seems to be a clinical interest regarding lasers for surgery for treatment of maxillary frena. The superiority of laser treatment in relation to conventional surgical methods has not yet been demonstrated in the literature. CONCLUSION A maxillary frenum is a clinical symptom in numerous syndromic conditions and plays a role in the development of the median midline diastema. Nevertheless, the contribution to gingival recession and peri-implant diseases in the region of the maxillary incisors is rather controversial. Laser techniques are reported as the method of choice for the surgical removal of frena; however, this needs to be substantiated by appropriate prospective controlled studies.

Impacted maxillary canines and root resorptions of neighbouring teeth: a radiographic analysis using cone-beam computed tomography

The study analyses the location of impacted maxillary canines and factors influencing root resorptions of adjacent teeth using cone-beam computed tomography (CBCT). In addition, the interrater reliability between observers of two different dental specialties for radiographic parameters will be evaluated. CBCT images of patients who were referred for radiographic localization of impacted maxillary canines and/or suspicion of root resorptions of adjacent teeth were included. The study analysed the exact three-dimensional location of the impacted canines in the anterior maxilla, frequency and extent of root resorptions, and potential influencing factors. To assess interrater agreement, Cohen's correlation parameters were calculated. This study comprises 113 patients with CBCT scans, and 134 impacted canines were analysed retrospectively. In the patients evaluated, 69 impacted canines were located palatally (51.49 per cent), 41 labially (30.60 per cent), and 24 (17.91 per cent) in the middle of the alveolar process. Root resorptions were found in 34 lateral incisors (25.37 per cent), 7 central incisors (5.22 per cent), 6 first premolars (4.48 per cent), and 1 second premolar (0.75 per cent). There was a significant correlation between root resorptions on adjacent teeth and localization of the impacted canine in relation to the bone, as well as vertical localization of the canine. Interrater agreement showed values of 0.546-0.877. CBCT provides accurate information about location of the impacted canine and prevalence and degree of root resorption of neighbouring teeth with high interrater correlation. This information is of great importance for surgeons and orthodontists for accurate diagnostics and interdisciplinary treatment planning.

Maxillary canine impaction in orthodontic patients with and without agenesis: A cross-sectional radiographic study

ABSTRACT Objective: To assess potential associations between maxillary canine impaction (MCI) and agenesis status as well as between MCI and gender. Materials and Methods: The records of 182 orthodontic patients with agenesis (excluding the third molars) and 630 orthodontic patients without agenesis were examined. Diagnosis of MCI was based on pretreatment panoramic radiographs. Maxillary canines that had not erupted as a result of physical barrier or deflection in the eruption path at the dental age of at least 12 years were considered impacted. Logistic regression analysis was used to test for the associations of interest. Results: MCI was detected in 5.6% (n  =  35) of the nonagenesis group (28 female and 7 male participants) and in 18.1% (n  =  33) of the agenesis group (20 female and 13 male participants). Bilateral impaction was detected in 12 patients (34.3%) of the nonagenesis group and in 11 patients (33.3%) of the agenesis group. There was evidence that maxillary lateral incisor agenesis (odds ratio  =  5.1, 95% confidence interval [CI] 2.5-10.5, P < .001) and second premolar agenesis (odds ratio  =  2.6, 95% CI 1.0-6.6, P  =  .042) were significant MCI predictors after adjusting for gender. The odds of MCI were 69% higher in female versus male subjects after adjusting for agenesis status (95% CI 0.97-2.92, P  =  .063). Conclusions: This study indicates that there is evidence that agenesis status is a strong predictor of MCI, whereas gender is a weak predictor of MCI. Caution should be exercised in interpreting the results because of the observational nature of the present study.

Quality evaluation of the available Internet information regarding pain during orthodontic treatment

OBJECTIVE To investigate the quality of the data disseminated via the Internet regarding pain experienced by orthodontic patients. MATERIALS AND METHODS A systematic online search was performed for 'orthodontic pain' and 'braces pain' separately using five search engines. The first 25 results from each search term-engine combination were pooled for analysis. After excluding advertising sites, discussion groups, video feeds, and links to scientific articles, 25 Web pages were evaluated in terms of accuracy, readability, accessibility, usability, and reliability using recommended research methodology; reference textbook material, the Flesch Reading Ease Score; and the LIDA instrument. Author and information details were also recorded. RESULTS Overall, the results indicated a variable quality of the available informational material. Although the readability of the Web sites was generally acceptable, the individual LIDA categories were rated of medium or low quality, with average scores ranging from 16.9% to 86.2%. The orthodontic relevance of the Web sites was not accompanied by the highest assessment results, and vice versa. CONCLUSIONS The quality of the orthodontic pain information cited by Web sources appears to be highly variable. Further structural development of health information technology along with public referral to reliable sources by specialists are recommended.

Subjective and objective perception of orthodontic treatment need: a systematic review

The aim of this work was to investigate the published evidence on the comparison of self-perception and diagnosis of orthodontic treatment need. A search of Cochrane Library, MEDLINE, Scopus databases, and archives of two orthodontic journals was carried out from January 1966 to August 2011 by the two authors using Medical Subject Heading terms. Studies that investigated solely either self-perception of orthodontic need by laypersons or assessment of orthodontic need by professionals were excluded from the data analysis. The methodological soundness of each study and the aggregate level of evidence were evaluated according to predetermined criteria. Moderate level of evidence, the relatively highest grade, was assigned to 9.1 per cent of the 22 studies, finally included in the data analysis. The overall evidence level provided by the evaluated publications was rated as limited. However, the existing body of evidence indicated a highly variable association between self-perception of orthodontic treatment need and orthodontist's assessment. Future controlled studies with well-defined samples and common assessment methodology will clarify further the relationship between perception of treatment need by laypersons and orthodontists and enhance international comparison and development of health care strategies.

Orthodontic retention procedures in Switzerland.

OBJECTIVE To survey retention procedures used in orthodontic practices in Switzerland. MATERIAL AND METHODS A questionnaire previously developed by Renkema et al. (2009) was sent to 223 Swiss orthodontists. The questionnaire comprised six parts, mainly containing multiple-choice questions. Information as to background education of the individual orthodontist, retention in general, frequency of different types of removable or bonded retainers that were used, retention pro- tocol, and the type and size of the wire used for bonded retainers was assessed. RESULTS The overall response rate was 65 percent. Most orthodontists placed a bonded retainer in the upper and lower arch, except when the upper arch was expanded during treatment or when extractions were performed in the upper arch, in which case they placed a combination of fixed and removable retainers. Opinions varied with regard to how many hours the removable retainers should be worn and the duration of the retention phase. As far as bonded retainers were concerned, 87 percent of the orthodontists preferred life-long retention. Ninety-three percent of the orthodontists considered that the development of a guide- line on retention procedures would be useful. CONCLUSIONS The choice of retention procedures is mostly based on orthodontists personal preference. A further research into the long-term effectiveness of individual retention protocols is needed.

Complication sévère d’une contention collée linguale mandibulaire

Le collage d’un fil torsadé souple sur les faces linguales des six dents antérieures mandibulaires est une modalité de contention couramment utilisée. Les complications sont rares mais peuvent être assez sérieuses pour provoquer des dégâts biologiques. Cet article présente une complication sérieuse d’un fil de contention torsadé souple, collé en lingual. Quatre ans après son traitement orthodontique, un homme de 20 ans a consulté pour la rupture d’un fil de contention torsadé souple. L’examen clinique a montré un torque radiculo-vestibulaire d’environ 35° d’une dent. Une image en tomographie volumique à faisceau conique (Cone-Beam Computed Tomography ou CBCT) a montré que la racine et l’apex de la dent étaient presque totalement hors de l’os du côté vestibulaire. Étonnamment, la vitalité de la dent était préservée. La dent a été ramenée presque jusqu’à sa position initiale; cliniquement, seule une récession gingivale a persisté. Les orthodontistes et les dentistes devraient être conscients des complications possibles des contentions collées. Les patients devraient être clairement informés de la manière dont les problèmes peuvent être détectés à un stade précoce.

Objective assessment of patient compliance with removable orthodontic appliances: a cross-sectional cohort study.

OBJECTIVE To assess objectively patient compliance with removable orthodontic appliances and the effect of possible influential factors. MATERIALS AND METHODS Wearing times of 45 White patients were recorded with the aid of the TheraMon microsensor. Patient compliance was assessed relative to wear prescription and other parameters, such as age and sex. RESULTS There was high individual variation in most measured variables and in all groups/subgroups. During a median observation period of 186 days (range, 55-318 days) the actual wear time was 9.0 h/d (range, 0.0-16.0 h/d) and did not differ between distinct prescriptions (P = .49). Eight patients wore their appliances less than 2 h/d, and six of them did not wear their appliances at all. Overall, the median wear per day relative to prescription was 62.5% (range, 0.0-89.3%) for the 14 h/d and 112.5% (range, 0.0-200.0%) for the 8 h/d prescription wear (P = .01) groups. There was a strong negative correlation of age (median: 12.5 years) with the daily percentage of actual wear time per day relative to wear prescription (14 h/d prescription: n = 21, rho = -0.61, P = .00; 8 h/d prescription: n = 24, rho = -0.73, P = .00), while sex did not exert a significant influence on compliance (P = .58). CONCLUSIONS Despite the fact that patients and parents were informed about wear time recording, compliance was insufficient with regard to functional treatment (14 h/d prescription), while it was sufficient for retention purposes (8 h/d prescription). Objective measures are necessary to assess compliance with removable orthodontic appliances since patient compliance is a highly variable issue.