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Objectives To compare the efficacy of casein phosphopeptide (CPP)-amorphous calcium phosphate (ACP) MI Varnish (GC America, Inc, Alsip, IL) and ProSeal (Reliance Orthodontic Products, Itasca, IL) sealant in preventing the development of white spot lesions (WSLs) in orthodontic patients. Materials and Methods This prospective randomized clinical trial included 40 orthodontic patients 12–17 years of age. One group had sealants placed on their anterior maxillary teeth, with reapplications every 3 months. The other group had MI Varnish applied every 4–6 weeks. WSL formation and oral hygiene were evaluated at the initial appointment before bonding (T1) and 12 months later (T2). Standardized digital photographs were analyzed using the enamel decalcification index (EDI). Statistical comparisons were made using independent and paired-sample t-tests as well as chi-square tests. Results In this trial, 43% of patients and 15% of teeth developed new WSLs. Lateral incisors showed the highest incidence of decalcification and WSL formation. WSL formation and EDI score increases during treatment were significantly greater in the gingival region than in the mesial, distal, or incisal regions. Of the EDI scores at T2, 93.8% were 0 and 5.5% were 1. Poor oral hygiene at T2 showed a high positive predictive value (76%) for the development of WSLs. There were no statistically significant between-group differences for the development of WSLs. Conclusions MI Varnish and ProSeal sealant provided similar levels of protection during the first 12 months of fixed orthodontic treatment. The severity of the WSLs that developed was minimal. WSLs were most likely to develop on lateral incisors and in the gingival regions of teeth, especially among patients with poorer oral hygiene.

Objectives To compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances. Materials and Methods This randomized controlled trial included 66 patients, 32 aligners, and 34 fixed-appliance patients. The median ages of the aligner and braces patients were 26.7 (interquartile range [IQR]: 9.8) and 25.9 (IQR: 16.6) years, respectively. Pretreatment occlusion was assessed using the ABO Discrepancy Index. Posttreatment (T1) and 6-month retention (T2) occlusions were quantified using the ABO Objective Grading System (OGS) scores. Results The braces group finished treatment significantly (P < .001) earlier (0.4 years) than the aligner group. The median DI scores for the aligner and braces groups were 4.5 and 7.0, respectively, which was a statistically significant (P = .015), but clinically insignificant, difference. There were no statistically significant between-group differences for the total OGS scores or any of the individual component scores at debond (T1) or after 6 months of retention (T2). During the posttreatment period, alignment and overjet worsened significantly in the aligner group, while buccolingual inclinations and occlusal relations improved. Over the same period, alignment worsened in the braces group and buccolingual inclinations improved. There was no statistically significant between-group difference in posttreatment changes of the total OGS scores. Conclusions While patients with simple malocclusions require 4.8 months longer treatment times with aligners than traditional braces, the treatment and 6-month posttreatment occlusal outcomes are similar.

Objectives To evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur. Materials and Methods This randomized controlled trial included 23 patients who had rapid maxillary expansion (RME). Subjects were randomly assigned to a conventional expansion control group (n = 12) or an overexpansion group (n = 11), who started treatment at 13.2 ± 1.5 and 13.8 ± 1 years of age, respectively. Cone beam computed tomography scans (11 cm) were obtained prior to rapid maxillary expander (RME) delivery and approximately 3.7 months later. Initial hand-wrist radiographs were used to determine the participants' skeletal maturity. Results The RME screws were activated 5.6 ± 1.2 mm and 10.1 ± 0.6 mm in the conventional and overexpansion groups, respectively. Overexpansion produced significantly greater expansion of the nasal cavity (2.1X–2.5X), maxillary base (2.3X), buccal alveolar crest (1.4X), and greater palatine foramina (1.9X). Significantly greater intermolar width increases (1.8X) and molar inclination (2.8X) changes were also produced. The nasal cavity and maxillary base expanded 23%–32% as much as the screws were activated. Skeletal expansion was positively correlated with RME screw activation (R = 0.61 to 0.70) and negatively correlated (R = −0.56 to −0.64) with the patients' skeletal maturation indicators (SMIs). Together, screw activation and the patients' SMI scores explained 48%–66% of the variation in skeletal expansion. Conclusions This pilot study shows that overexpansion produces greater changes than conventional expansion, with greater skeletal effects among less mature patients.

Objectives To validate the use of the sagittal distance between ANS and Pg (ANSPg) as a measure of favorable and unfavorable anteroposterior skeletal relations and to identify multivariate cephalometric measures that could be used to predict favorable and unfavorable relations at 15 years of age. Materials and Methods This longitudinal study included 226 untreated adolescents evaluated at 10 and 15 years of age. Patients were grouped as “favorable” or “unfavorable” based on the ANSPg (measured parallel to S-N -7°) at 15 years of age (ANSPg15). ANSPg15 was validated based on its correlation with changes in ANSPg between 10 and 15 years of age, as well as its relationships with established measures of growth potential. Multiple regression and discriminant analyses were performed to predict ANSPg15 from measures at 10 years of age. Results ANSPg15 and the change in ANSPg between 10 and 15 years of age were significantly correlated (R= –0.661; P ≤ .001), with 77% of patients in whom relationships improved (ie, distance decreased) exhibiting favorable relationships at 15 years of age. Established measures of growth potential were significantly (P < .001) correlated with ANSPg15 and showed significant differences between patients with favorable and unfavorable relations. Multiple regression showed that the Y-axis, ANS-N-Pg, and symphyseal angle measured at 10 years explained approximately 60% (R = 0.78) of the variation in ANSPg15. Based on these three variables, discriminant function correctly predicted favorable or unfavorable relations of ANSPg15 77% of the time. Conclusions ANSPg15 was a valid measure for determining favorable and unfavorable anteroposterior skeletal relationships that could be predicted with moderately high levels of accuracy.

Objectives To quantify differences in the etch quality of enamel within and between human teeth, which has not previously been attempted. Materials and Methods The buccal right and left halves of 27 extracted human teeth were randomly allocated to scanning electron microscopy (SEM) or micro–computed tomography (μCT) for evaluation. The buccal surfaces were pumiced, etched with 37% phosphoric acid gel etchant for 15 seconds, rinsed, and air dried. Each tooth was divided into three regions (incisal, middle, and cervical) and viewed after etching at 1200× magnification with SEM. The μCT scans were taken before and after etching to calculate apparent and material mineral densities. Results SEM showed greater aprismatic enamel and poorer etch quality (ie, significantly less percentage enamel) for the posterior than anterior teeth and for the cervical region than for the incisal and middle regions of all teeth. Although there were no density differences prior to etching, μCT demonstrated that etching increased material density significantly more for the anterior than posterior teeth. Prior to etching, the enamel in the cervical regions was significantly less dense than the enamel in the middle or incisal regions. Etching significantly increased the material density of all three regions, which decreased initial regional differences. After etching, the apparent density of the cervical region remained significantly lower than the densities of the other two regions. Conclusions Based on SEM and μCT, there is greater aprismatic enamel and inferior etch quality in the cervical regions of all tooth types and is clinically significant in explaining the failure of sealant retention and the propensity for white spot lesions.

The purpose of this study was to evaluate the effects of 2 extraction patterns on incisor and molar movements in patients with growing Class II Division 1.The sample included 54 patients 10-17 years of age treated by 2 private practice orthodontists using Tweed directional force mechanics, 4 premolar extractions, J-hook headgears, and Class II elastics or Saif springs. The sample was divided on the basis of having maxillary and mandibular first premolars (4/4) or maxillary first and mandibular second premolars (4/5) extracted. Each group included 27 patients. Treatment lasted 2.8 ± 0.60 years and 2.6 ± 0.54 years for the 4/4 and 4/5 groups, respectively. Pretreatment (T1) and posttreatment lateral cephalograms and dental casts were evaluated. Cranial base, mandibular, and maxillary superimpositions were performed to quantify tooth movements and displacements.There were no statistically significant T1 between-group differences in crowding or in the SNA, SNB, ANB, and MPA angles. Analyses of covariance, controlling for statistically significant (P 0.05) differences in T1 mandibular incisor position, showed that mandibular first premolars extractions produced greater (1.6 mm) mandibular incisor retraction than second premolar extractions. The mandibular first molars were protracted significantly more (0.7 mm) after the second premolar than the first premolar extractions. Within-group changes of the MPA, between-group differences in the changes in MPA, and the amount of vertical eruption of the maxillary and mandibular molars were not significantly different between the 2 extraction patterns.Extraction of mandibular second premolars enhances Class II molar correction, with greater mesial first molar movement and less distal incisor movement. Neither extraction pattern has an effect on the MPA or the vertical dimension (ie, there was no "wedge effect").

ZusammenfassungEin großer Teil der Klasse-II-Fälle ist retrognath und hyperdivergent. Viele zeigen ein ungünstiges Wachstumsmuster, durch das sich die anteroposterioren, die vertikalen und die transversalen skelettalen Beziehungen immer weiter verschlechtern. Mit den bisherigen Behandlungsstrategien ließen sich zwar die dentalen Beziehungen korrigieren, bei den skelettalen Problemen waren sie jedoch wenig effektiv. Bei der Behandlung der dentalen und der skelettalen Probleme ist es daher wichtig, den Unterkiefer nach vorne zu rotieren, anstatt ihn nach vorne zu überstellen. Eine echte Rotationsbewegung der Mandibula nach vorne, durch die bei wachsenden Kindern hauptsächlich die Projektion des Kinns bestimmt wird, lässt sich am besten durch absolute oder relative Intrusion der Zähne durchführen. Dies führt bei Kindern im Wachstum zu einer stärkeren Kinnprojektion, zu einem verbesserten Skelettprofil, zur Verkleinerung von Grund- und Kieferwinkeln und zur Verringerung der vorderen unteren Gesichtshöhe. Die mit diesem Verfahren erreichten orthopädischen Veränderungen sind vergleichbar mit oder sogar besser als die Ergebnisse, die kieferorthopädisch mit skelettaler Verankerung oder chirurgisch bei Erwachsenen erreicht werden. Das Verfahren scheint außerdem zu stabileren Ergebnissen zu führen als die Behandlung erwachsener Patienten, da hier mit und nicht gegen das Wachstum gearbeitet wird.

Over the past two decades, artificial intelligence (AI) and machine learning (ML) have undergone considerable development. There have been various applications in medicine and dentistry. Their application in orthodontics has progressed slowly, despite promising results. The available literature pertaining to the orthodontic applications of AI and ML has not been adequately synthesized and reviewed. This review article provides orthodontists with an overview of AI and ML, along with their applications. It describes state-of-the-art applications in the areas of orthodontic diagnosis, treatment planning, growth evaluations, and in the prediction of treatment outcomes. AI and ML are powerful tools that can be utilized to overcome some of the clinical problems that orthodontists face daily. With the availability of more data, better AI and ML systems should be expected to be developed that will help orthodontists practice more efficiently and improve the quality of care.

The objective of this paper is to evaluate past and present research efforts, and provide directions for future orthodontic research initiatives. Bibliometric indices show that the highest quality and most impactful research is currently being conducted in the United States, United Kingdom, Germany, Brazil and Italy. While the quality of orthodontic research has improved substantially over time, more and higher quality randomized controlled trials need to be conducted. Research efforts must be devoted toward developing evidence-based standards of care, which are necessary to protect the orthodontic profession from incursions by charlatans and outside entities. Future research in the areas of genetics, technology, artificial intelligence and craniofacial orthopedics offer great opportunities to advance the profession, individualize treatments and make them more effective and efficient.

OBJECTIVE The primary purpose of this study was to statistically evaluate age, ethnic and sex differences in the prevalence of clinically meaningful malocclusions among adults. SETTING AND SAMPLE POPULATION A random sample of 8804 untreated US adults between 17 and 46 years of age was selected from the Third National Health and Nutrition Examination Survey data. MATERIALS & METHODS Three ethnic (non-Hispanic White, non-Hispanic Black and Mexican Americans) and three age (17-26, 27-36 and 37-46 years) groups were evaluated. Subjects with and without clinically meaningful malocclusions were categorized based on the established cut-off values. Chi-square analyses were performed to determine differences in prevalence. RESULTS The prevalence of clinically meaningful mandibular incisor irregularity, overjet and overbite increased significantly (P

The aim of this work was to determine how far the effects of micro-osteoperforations (MOPs) extend within bone by quantifying the damage caused and the short-term bony adaptations that occur in and around the injury site.With the use of a split-mouth design, 34 MOPs (Propel) were randomly placed in the mandibular furcal bone of 13 beagle dogs either 2 or 4 weeks before killing them. The control side received no treatment. Vickers hardness microindentation, microscopic computed tomography, and histologic analyses were performed to evaluate the bone surrounding the MOPs.Microfractures produced during insertion extended ∼0.6 mm from the MOP sites. Cortical and trabecular bone were significantly less dense on the experimental than on the control side up to 4.2 mm from the edge of the MOP, but side differences were small (5%) beyond 1.5 mm from the MOP. Experimental cortical bone was significantly softer than the control bone up to 0.8 mm from the MOP after 2 weeks of healing, and up to 0.5 mm from the MOP after 4 weeks of healing. Hematoxylin and eosin stained sections of cortical and trabecular bone showed small areas of woven bone within the MOP sites after 2 weeks, and acellular areas of bone extending ∼0.5 mm from the MOP. After 4 weeks of healing, there were greater amounts of woven bone, as well as early signs of lamellar bone, in and around the MOP sites. Markedly increased TRAP activity extending up to 2.5 mm from the MOP was evident after 2 weeks, but not after 4 weeks. Vital fluorescence staining showed diffuse bone deposition on the experimental side up to 1.5 mm from the MOP margin.When MOPs are performed in beagle dogs, demineralization is transient and healing of the injured area, as well as remineralization of bone affected by MOP placement, begins during the first 2 weeks. Although the transient effects extend farther, the principal effects extend only ∼1.5 mm from the MOP site.

Objective: To evaluate the association between adolescents’ orthodontic quality of life before initiating orthodontic treatment and their objective case complexity as measured by the American Board of Orthodontics’ Discrepancy Index (DI). Design and setting: A single-centre, cross-sectional survey study. Methods: The Orthodontic Quality of Life Assessment Survey (OQoLAS) was administered to 240 adolescents (aged 11–14 years) during their record-gathering appointment. After completion of the survey, a DI score was calculated for each patient based on pretreatment measurements. Pearson correlation coefficients, r, were used to assess the association of DI scores with OQoLAS total and subdomain scores. A multiple linear regression of OQoLAS total scores adjusting for age, gender and DI scores was conducted. Results: The study did not find a strong correlation between OQoLAS and DI scores (r = 0.10; P = 0.6497). On average, the OQoLAS scores (functional, emotional and social subdomains of OQoLAS) were slightly higher among girls than among boys but there was no statistical difference for total OQoLAS score between boys and girls (42.4 vs. 45.4, P = 0.2005). However, there was a significant difference in oral health perception rating between boys and girls, with girls being more likely to rate their oral health positively (adjusted P = 0.0226). The total DI scores of boys with respect to girls were not statistically different ( P = 0.4256). The components of the DI that showed highest score were for cephalometric measures, followed by overjet; and the lowest scores were for lateral open bite and buccal posterior crossbite. The measure of association analysis did not show any strong correlation between the OQoLAS (total score and subdomain scores), and DI score or any of its components. Conclusion: Malocclusion severity was not found to be correlated with orthodontic quality of life in adolescents aged 11–14 years seeking orthodontic treatment.

Introduction: Shorter miniscrew implants (MSIs) are needed to make orthodontics more effective and efficient. Objective: To evaluate the stability, insertion torque, removal torque and pain associated with 3 mm long MSIs placed in humans by a novice clinician. Methods: 82 MSIs were placed in the buccal maxillae of 26 adults. Pairs of adjacent implants were immediately loaded with 100g. Subjects were recalled after 1, 3, 5, and 8 weeks to verify stability and complete questionnaires pertaining to MSI-related pain and discomfort. Results: The overall failure rate was 32.9%. The anterior and posterior MSIs failed 35.7% and 30.0% of the time, respectively. Excluding the 10 MSIs (12.2%) that were traumatically dislodged, the failure rates in the anterior and posterior sites were 30.1% and 15.2%, respectively; the overall primary failure rate was 23.6%. Failures were significantly (p= 0.010) greater (46.3% vs 19.5%) among the first 41 MSIs than the last 41 MSIs that were placed. Excluding the traumatically lost MSIs, the failures occurred on or before day 42. Subjects experienced very low pain (2.2% of maximum) and discomfort (5.5% of maximum) during the first week only. Conclusions: Shorter 3 mm MSIs placed by a novice operator are highly likely to fail. However, failure rates can be substantially decreased over time with the placement of more MSIs. Pain and discomfort experienced after placing 3 mm MSIs is minimal and temporary.

To evaluate the preventive effects of different time intervals between repeated applications of the CPP-ACP fluoride varnish on enamel demineralization.Human teeth were sectioned and randomly allocated to three groups: 4-week, 6-week, and 12-week (N = 22/group). Baseline images of the enamel surfaces were obtained using the FluoreCam recording the area, intensity, and impact of baseline enamel demineralization. All groups received fluoride varnish applications at the beginning of the experiment. The varnish was reapplied every 4 or 6 weeks in the 4-week and 6-week groups, respectively. Following each application, the groups underwent thermo-cycling, tooth brushing and pH cycling to simulate the time effect. After 12 weeks, the enamel surfaces were reimaged using the FluoreCam. Within and between-group differences in the area, intensity and impact of demineralization were evaluated.At baseline, there were no significant between-group differences for area, intensity, or impact. Statistically significant (p0.001) enamel demineralization occurred over time within each group. There were significant between-group differences in the changes that occurred in area (P = 0.004), impact (P = 0.022), but not intensity. The 12-week had significantly larger areas of demineralization than the 6-week (P = 0.041) and 4-week (P = 0.001) groups. Changes in impact was significantly (P = 0.007) greater in the 12-week group than 4-week group, but not greater than the 6-week group. There were no statistically significant differences between 4- and 6-week groups in the changes of area, intensity, or impact.Reapplication of the CPP-ACP fluoride varnish every 4-6 weeks, is more effective in reducing enamel demineralization compared to every 12 weeks.

Objectives: To determine if posterior dental intrusion produces stable orthodontic and orthopedic corrections in growing retrognathic hyperdivergent patients. Materials and Methods: The sample included 14 subjects (five males and nine females), who were 13.4 ± 0.7 years pretreatment, treated for 3.5 years, and followed for 3.6 years posttreatment. During the initial orthopedic phase, 150 g NiTi coil springs were attached to two palatal miniscrew implants (MSIs) for maxillary intrusion; two buccal mandibular MSIs were used for posterior vertical control. Full orthodontic therapy was initiated to correct the malocclusions during the orthodontic phase. Patients were recalled a minimum of 1 year posttreatment (mean 3.6 ±1.6 years). Patients were compared to matched untreated controls. Results: Relative to the untreated controls, during treatment and retention, maxillary and mandibular molars underwent 2.8 mm and 3.7 mm of relative posterior intrusion, respectively. Maxillary incisors were extruded 1.3 mm and the mandibular incisors underwent 2.9 mm of relative intrusion. Overall orthopedic changes included a reduction in the mandibular plane angle (MPA; 3.3°), an increase in SN-Pg (2.4°), an increase in S-N-B (2.1°), and a 4.3 mm relative reduction in anterior facial height. The maxillary incisors, which showed 0.6 mm of intrusion (relative to controls), was the only dental or skeletal measure to show a statistically significant between-group posttreatment difference. Conclusions: Except for maxillary incisor position, the substantial dental intrusion and associated orthopedic corrections that were produced during treatment remained stable post-treatment.

Objectives: To compare the incidence of white spot lesions (WSLs) among patients treated with aligners and those treated with traditional braces. Materials and Methods: A group of 244 aligner patients (30.4 ± 14 years) was compared to a group of 206 patients (29.2 ± 11.5 years) treated with traditional fixed braces. Consecutive cases in the late mixed or permanent dentitions who had high-quality pre- and posttreatment digital photographs available were included in the study. Each set of photographs was independently evaluated by two investigators to determine pretreatment oral hygiene (OH), fluorosis, and WSLs, as well as changes in OH and WSLs during treatment. Results: Approximately 1.2% of the aligner patients developed WSLs, compared to 26% of the traditionally treated patients. The numbers of WSLs that developed were also significantly (P < .001) less among the aligner patients. The aligner patients developed three new WSLs, while the traditionally treated patients developed 174 WSLs. The incidence of WSLs was greater for the maxillary than for the mandibular teeth, and it was greater for the canines than for the incisors. For the patients treated with traditional braces, fair or poor pretreatment OH, worsening of OH during treatment, preexisting WSLs, and longer treatment duration significantly (P < .05) increased the risk of developing WSLs during treatment. Conclusions: Patients treated with aligners have less risk of developing WSLs than do patients treated with traditional braces, which could be partially due to shorter treatment duration, or better pretreatment OH.

Made available in DSpace on 2018-12-11T17:21:25Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-07-12 The objective of this research was to compare the effect single low-level laser therapy (LLLT) irradiation on pain perception in patients having fixed appliance treatment in the clinic of orthodontics. Sixty-two patients were recruited to participate in this randomized, double-blinded, placebo-controlled study. The patients were assigned to four groups: group I—laser on the right side; group II—placebo on the right side; group III—laser on the left side; group IV—placebo on the left. The laser or placebo was applied before separation, 24 and 48 h after separation of their first permanent molars in the lower arch. Just after the separation, the average of the pain for the placebo group was 1.6, significantly greater than the average of 1.1 registered for the laser group (p = 0.013). After 24 h and before the new irradiation, the values registered among the different groups did not show any differences. In relation to the gender, only after the first irradiation in placebo group, the female had a level of pain (0.1) significantly higher (p = 0.04) compared to male, and after 48 h, the group where the laser was applied had a difference (p = 0.04) among the gender with a value of lower pain for men (0.6) than for women (1.6). The laser irradiation to minimize the pain was only effective when applied immediately after treatment and separation. In general way, there were no differences between the genders, except after the first placebo group irradiation in which the female had a significantly higher level of pain compared to male and after 48 h. The pain cycle observed in this study had its peak in 24 h, both for laser’s and placebo’s group. Department of Orthodontics Araraquara School of Dentistry UNESP–Univ Estadual Paulista Department of Dentistry Department of Orthodontics Baylor College of Dentistry Department of Restorative Dentistry Araraquara School of Dentistry UNESP–Univ Estadual Paulista Department of Restorative Dentistry Araraquara School of Dentistry São Paulo State University–UNESP, Rua Humaitá, 1680 Department of Orthodontics Araraquara School of Dentistry UNESP–Univ Estadual Paulista Department of Restorative Dentistry Araraquara School of Dentistry UNESP–Univ Estadual Paulista Department of Restorative Dentistry Araraquara School of Dentistry São Paulo State University–UNESP, Rua Humaitá, 1680

Importance Retention is an integral part of orthodontic treatment. Various biomedical agents, methods, and techniques have been introduced over the past 2 decades that could be useful in orthodontic retention. This review focuses on the underlying mechanisms and uses of these biomedical agents, lasers, vibrational therapies, and the most recent types of mechanical retainers. This review is also intended to serve as a resource for orthodontic researchers and clinicians. For researchers, it should facilitate further investigations into the clinical applications of the various agents and methods. For clinicians, it provides an up-to-date summary of new approaches that might be used in the future. Observations Several biomedical agents, including osteoprotegerin, bisphosphonates, bone morphogenic proteins, and relaxin, were reviewed. The applicability of low-level laser therapy (LLLT) and mechanical vibration also were evaluated, along with the modifications that have been introduced in conventional retention appliances. Conclusion and Relevance Among biomedical agents evaluated in this review, RANKL inhibitor agents, particularly denosumab, hold the greatest potential for future applications in orthodontic retention. In addition, LLLT has been associated with faster periodontal ligament maturation, especially if it is used with conventional retention methods, which might shorten the time required for retention after orthodontic treatment. Mechanical vibration has shown osteogenic effect on bone, even though it failed experimentally to inhibit relapse. Importantly, these new biomedical agents and techniques were mainly investigated experimentally, and further studies are required to confirm or refute their clinical applicability for orthodontic retention.

This paper provides guidelines for determining treatment objectives and evaluating posttreatment outcomes. More specifically, it reviews our current understanding of growth and maturation, focusing on the most salient aspects that apply to individual patients. Pretreatment diagnostics and treatment objectives will be addressed first, focusing initially on adjustments necessary based on the patient's somatic growth and maturity. Estimates of craniofacial growth that can be applied to individual patients when developing treatment objectives are then provided, along with the approach used to apply them. It will be shown how the estimates are adjusted, depending on the patient's sex, age, and growth patterns. These adjusted growth estimates are also used to evaluate posttreatment changes. Orthodontists must be able to separate the treatment changes from the growth changes that occur. The application of these guidelines will be demonstrated on three patients.

Objectives: To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients. Materials and Methods: The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo- or hyperdivergent based on their MPAs. Pre- and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures. Results: The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a “headgear effect.” Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo- and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients. Conclusions: Hypo- and hyperdivergent patients benefit from the Herbst's headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.

Objective: To evaluate differences in discomfort levels between patients treated with aligners and traditional fixed orthodontic appliances. Materials and Methods: This blinded, prospective, randomized equivalence two-arm parallel trial allocated 41 adult Class I nonextraction patients to either traditional fixed appliance (6 males and 12 females) or aligner (11 males and 12 females) treatment. Patients completed daily discomfort diaries following their initial treatment appointment, after 1 month and after 2 months. They recorded their levels of discomfort at rest, while chewing, and while biting, as well as their analgesic consumption and sleep disturbances. Results: Both treatment modalities demonstrated similar levels of initial discomfort. There were no significant sex differences. Patients in the traditional fixed appliances group reported significantly (P < .05) greater discomfort than patients in the aligner group during the first week of active treatment. There was significantly more discomfort while chewing than when at rest. Traditional patients also reported significantly more discomfort than aligner patients after the first and second monthly adjustment appointments. Discomfort after the subsequent adjustments was consistently lower than after the initial bonding or aligner delivery appointments. A higher percentage of patients in the fixed-appliance group reported taking analgesics during the first week for dental pain, but only the difference on day 2 was statistically significant. Conclusions: Patients treated with traditional fixed appliances reported greater discomfort and consumed more analgesics than patients treated with aligners. This trial was not registered.

Introduction A randomized split-mouth experiment was performed in dogs to determine the effects of bone grafting, together with corticotomies and buccal tooth movements, on dehiscence formation. Methods Bilateral full-thickness mucoperiosteal buccal flaps were raised, and corticotomies were performed with a piezosurgery unit adjacent to the maxillary second premolars in 7 dogs. The experimental (graft+) side received a demineralized freeze-dried allograph and a resorbable collagen membrane. The second premolars were expanded with archwires for 9 weeks, followed by 3 weeks of consolidation. Soft tissue measurements included probing depths, attachment loss, and recession. Tooth movements were monitored using intraoral, radiographic, and model measurements. Bone surrounding the second premolars was evaluated with microcomputed tomography. New bone formation was analyzed histologically using calcein and alizarin fluorescent labels, and hematoxylin and eosin stains. Results Postsurgical healing progressed normally with no signs of infection. The graft+ and control (graft−) second premolars underwent similar amounts of expansion (about 2.5 mm intraorally; about 1.7 mm radiographically) and tipping, with no statistically significant side differences. The soft tissue periodontium was not affected on either side. There were bony dehiscences on both the graft+ and graft− sides, with slightly but significantly ( P = 0.038) more bone loss over the mesial root on the graft− side. Bone material density was significantly ( P = 0.028) greater on the graft+ side. Buccal bone apposition was evident surrounding graft particles, and mineralized particulate graft material was present at the apical aspect of the roots on the graft+ side. Conclusions Bone grafting does not prevent dehiscence formation because only a limited amount of new bone is formed, primarily at the more apical aspects of the tooth's roots.

A prospective study to evaluate short-term changes in occlusal force and contact surface area associated with retainer wear. Total 32 subjects, randomly assigned to two experimental groups, a clear overlay group and a wrap-around retainer group, were followed to assess occlusal changes. Assessments were made utilizing the T-Scan II (Tekscan, Inc., 307 West First St., South Boston, MA 02127) method of occlusal analysis at 3 time periods; T0, at debond all subjects received lower fixed canine to canine retainer and upper clear overlay retainers; T1, 2 weeks later 14 subjects received wrap-around retainers and the clear overlay retainer group was checked (18 subjects); T2, occlusal contact assessment 2 months later for both groups. During T0–T1, the occlusion with clear overlay retainers showed a significant decrease in posterior surface area contact (p 0.05). An independent sample (15 subjects) showed high intraclass correlations (r > 0.90) between replicate measurements of relative force, indicating low technical errors when multiple measurements are used. In conclusion, there were no significant net changes in occlusal forces or areas after 6 weeks of comparison between the wrap-around and clear overlay retainers following orthodontic therapy. In addition, it was shown that the T-Scan is a reliable apparatus for analysis of relative force.

This study was conducted to evaluate the short-term post-retention stability of the transverse dimension in patients with Class I malocclusion treated with the Damon System. Nine females and seven males with average pre-treatment crowding, −1.9 ± 2.1mm in the maxilla and −2.2 ± 1.6mm in the mandible were evaluated. Subjects were 12.4 ± 1.5 years at pre-treatment, 15.3 ± 0.9 years at post-treatment, and 19.7 ± 1.2 years at post-retention. They were retained for an average of 2.1 ± 0.9 years, followed by no retention for an average of 2.3 ± 0.9 years. Models and cephalograms of all three stages were measured and the data were analyzed in SPSS. Treatment produced statistically significant increases in transverse arch dimensions (maxillary arch 2.0–5.6mm and mandibular arch 2.4–4.6mm), all of which were greater than expected for untreated controls. There were significant post-retention decreases in arch width, often less than expected for untreated controls. Relapse was less than 35.4% and 26% in the maxillary and mandibular arch, respectively. In conclusion, Damon treatment produced significant net gains in arch width, especially in the mandibular arch. Occlusal settling occurred following active treatment causing significant improvement in post-treatment outcomes.

Our objective was to evaluate the craniofacial growth of subjects with untreated Class II Division 2 malocclusion.A mixed longitudinal sample of 39 white Class II Division 2 subjects was analyzed at 5 time points: T1 (6 or 7 years), T2 (9 or 10 years), T3 (12 or 13 years), T4 (15 or 16 years), and T5 (18 or 19 years). They were compared with an age- and sex- matched sample of Class I controls. Seventeen measurements (12 angular, 5 proportional) were computed. Multilevel modeling procedures were used to statistically describe the growth changes and to evaluate group differences.There were no group differences in the relative sizes and anteroposterior positions of the jaws during childhood, adolescence, or early adulthood. Subjects with Class II Division 2 malocclusion demonstrated significantly (P 0.05) smaller mandibular plane angles, smaller palatal-to-mandibular plane angles, larger posterior-to-anterior facial height ratios, smaller gonial angles, smaller cranial base angles, larger interincisal angles, and more retroclined maxillary incisors than did the Class I subjects. The hypodivergent patterns were established early and became more pronounced over time. Group differences in the mandibular plane angle, palatal-to-mandibular plane angle, gonial angle, interincisal angle, and maxillary incisor-to-cranial base angle, as well as the posterior-to-anterior facial height ratio all increased over time; the difference in the cranial base angle remained unchanged over time. Retroclination of the maxillary incisors occurred primarily during the early mixed dentition.Subjects with Class II Division 2 malocclusion are more hypodivergent and have more upright maxillary incisors than do subjects with Class I occlusion. Hypodivergence establishes itself early and increases progressively through early adulthood; maxillary incisor retroclination occurs early.

Objective:To determine whether apical base size is related to dental crowding.Materials and Methods:Digital scans of dental casts were taken of 75 untreated Class I adults to measure maxillary and mandibular tooth size, dental arch perimeters, intermolar widths, and intercanine widths. Cone beam computed tomography (CBCT) images were used to measure the apical base of the maxilla and mandible, including the total cross-sectional area, five basal arch perimeters and five basal arch widths. Principal components factor analyses were performed to evaluate the relationships between the apical base size and tooth-size-arch-length discrepancies (TSALD).Results:The dental arch and maxillary apical base measures were significantly larger in males than females. There were only limited sex differences in mandibular apical base size. The dental arch measurements were smaller in subjects with greater upper and lower TSALD. Maxillary and mandibular apical base dimensions were positively interrelated. Low-to-moderate correlations were found between the size of the maxillary apical base and TSALD. The size of the mandibular apical base was not related to upper or lower TSALD. Tooth size showed little to no relationship with TSALD.Conclusions:Although maxillary apical base size is related to maxillary and mandibular crowding in subjects with Class I malocclusion, mandibular apical base size is not.

Aim To determine whether caries risk factors, including cariogenic bacterial levels and salivary function, can be used to identify orthodontic patients who develop white spot lesions (WSL). Methods This prospective case-control study comprised 50 patients 11-17 years of age, including 25 controls and 25 cases who developed new WSL during treatment. WSL, oral hygiene and fluorosis were evaluated from intraoral photographs. The biofilm was assessed with bacterial cultures and adenosine triphosphate (ATP) bioluminescence. Salivary analyses were performed to determine the pH of saliva and flow rates. A survey was used to assess snacking frequency, oral hygiene and fluoride utilization. Results There were no between-group pretreatment differences in WSL. Cases reported eating sugary foods significantly more often than the controls. There was a significant decline in oral hygiene during treatment, with no significant between-group difference. There also were no statistically significant between-group differences in the amount of saliva, buffer, ATP bioluminescence and bacterial levels. Both groups showed lower than normal buffer capacity and high bacterial levels. Conclusion Cases had greater sugar intake between meals than controls. ATP bioluminescence, Streptococcus mutans levels with Saliva Check Mutans, and salivary factors do not identify patients who develop WSL.

Introduction The purpose of this study was to evaluate the effects of longitudinal flutes on miniscrew implant (MSI) stability and bone healing. Methods Using 11 skeletally mature New Zealand white rabbits, we placed 31 longitudinally fluted and 31 nonfluted, 3-mm-long MSIs in standardized positions in their calvaria and immediately loaded them with 100 g using nickel-titanium coil springs. Insertion torque values were obtained for each MSI placed; removal torque values were obtained for 28 MSIs that had been in place for 6 weeks and 20 MSIs that had been in place for 2 weeks. The bone volume fractions at 6 to 24, 24 to 42, and 42 to 60 μm from the MSI surfaces were evaluated using microcomputed tomography with an isotropic resolution of 6 μm. Results The success rate was 97% for both the fluted and nonfluted MSIs. The difference in insertion torque between the fluted and nonfluted MSIs was not statistically significant ( P = 0.930). After 2 weeks, there was no statistically significant ( P = 0.702) difference in removal torque between the fluted and nonfluted MSIs. After 6 weeks, removal torque values were significantly ( P = 0.008) higher for the fluted (3.42 ± 0.26 N.cm) than the nonfluted (2.49 ± 0.20 N.cm) MSIs. Bone volume fractions of the 6-to-24–, 24-to-42–, and 42-to-60–μm layers were significantly ( P Conclusions Loaded 3-mm-long MSIs with and without flutes have high success rates. Longitudinal flutes placed in 3-mm MSIs increased their removal torque by 37% and decreased the amount of bone immediately surrounding them.

SummaryBackgroundAlthough post-treatment mandibular alignment has been extensively investigated, the findings remain controversial.ObjectivesThe objective was to assess mandibular alignment changes, as measured by the irregularity index, of patients who underwent full-fixed orthodontic treatment and were followed up at least 1 year after retention.Search methodsMEDLINE, EMBASE, and Cochrane library, in addition, the reference lists of included studies, were screened. The search was conducted up to April 2018.Selection criteriaThe study designs included both interventional and observational studies of orthodontic patients who received either extraction or non-extraction treatment.Data collection and analysisThe interventional studies were assessed using the Cochrane Collaboration’s risk of bias assessment tool. The quality of the observational studies was evaluated using National Institution of Health quality assessment tools. The first two authors independently applied the eligibility criteria, extracted the data, and assessed the risk of bias. Any conflicts were resolved with consensus discussion with the third author.ResultsThe search retrieved 11 326 articles, 170 of which were assessed for eligibility. There were 44 studies included in the qualitative assessments and 30 in the meta-analyses. The studies included 1 randomized control trial (RCT) and 43 observational studies. The RCT was judged to have a high risk of bias and all of the observational studies had either fair or poor quality. The meta-analysis was based on studies judged to be of fair quality, including a total of 1859 patients. All meta-analyses were performed using random-effect models. The standardized mean difference between post-treatment and post-retention irregularity was 1.22 (95% CI, 1.04–1.40) and 0.85 (95% CI, 0.63–1.07) after extraction and non-extraction treatments, respectively. There was a substantial heterogeneity for the extraction (I2 = 75.2%) and non-extraction (I2 = 70.1%) studies. The follow-up duration (1–10 versus 10–20 years) explained 33% of the heterogeneity, with longer follow-up studies showing more irregularity.LimitationsThe quality of evidence provided by the studies was low. There was a risk of publication bias, and the search was limited to English language.Conclusions and implicationsPost-treatment mandibular irregularity increases are limited. Irregularity increases are slightly greater in patients treated with mandibular premolars extractions, and in patients followed up over longer periods of time.RegistrationThe study protocol was not registered.

Objective:To determine whether automated text messages sent daily to adolescent orthodontic patients improves oral hygiene more than weekly reminders.Materials and Methods:A blinded, prospective, randomized controlled trial was designed to evaluate the effects of automated messages on oral hygiene. Subjects were recruited from patients undergoing orthodontic treatment at the Texas A&M University College of Dentistry, Department of Orthodontics. They were being treated with a variety of fixed full appliances in both arches. Subjects were randomly assigned to either a once-a-week text message group or a daily text message group. There were 52 females and 27 males who were 12 to 17 years of age. Oral hygiene was measured at the beginning of the study and again 8.6 ± 0.9 weeks later.Results:The daily reminder group (N = 42) had significantly greater improvements in oral hygiene compliance than the weekly reminder group (N = 37). The daily score decreases were 48%, 21% and 19% for the bleeding index (BI), plaque index (PI), and gingival index (GI), respectively. The weekly score decreases were 27%, 14% and 13% for the BI, PI, and GI. There were no sex differences in hygiene changes during the study. The 42% of patients who completed the survey at the end of the study wanted more frequent messages and reported that messages related to decreasing treatment time were the most effective, while those related to oral hygiene were the least effective.Conclusions:Daily text messages are more effective at improving oral hygiene than weekly text messages.

Objectives:To test how long casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) fluoride varnish prevents enamel demineralization in vitro.Materials and Methods:Human molars and premolars were sectioned buccolingually and randomly assigned to two groups. Standardized pretreatment images of enamel surfaces were obtained using FluoreCam. The control group received no treatment, and the experimental group received an application of CPP-ACP fluoride varnish. Over simulated periods of 2, 4, 8, and 12 weeks, specimens were placed in a toothbrushing simulator, thermocycled, subjected to 9 days of pH cycling, and imaged with FluoreCam. Samples were sectioned and polished for polarized light microscope (PLM) evaluation.Results:There were statistically significant time (P < .001) and varnish (P < .001) effects on area, intensity, and impact of enamel demineralization. The control group showed significant and progressive demineralization over the 12 weeks (P < .001). The experimental group revealed no significant demineralization during the first 4 weeks (P > .05) and significant (P < .001) increases thereafter. Experimental demineralization after 12 weeks was comparable to 2-week demineralization in the controls, with significant between-group differences (P < .001) in enamel demineralization at all time points. PLM of the control and experimental groups revealed lesion depths of 90 ± 34 μm and 37 ± 9 μm, respectively.Conclusions:Within the limitations of this in vitro study, CPP-ACP fluoride varnish prevents enamel demineralization for at least 4 weeks and limits demineralization up to 12 weeks.

AIM The aim of the present study was to compare the effects of carbon dioxide (CO2 ) laser and casein phosphopeptide amorphous calcium phosphate (CPP-ACP)fluoride varnish on enamel demineralization. METHODS Human teeth were randomly assigned to three groups. The enamel was treated with fluoride varnish, 10.6 μm CO2 laser, or no treatment (control), followed by 9 days of pH cycling. Baseline and final FluoreCam images were used to quantify the area, intensity, and impact of demineralization; cross-sectional microhardness was used to measure the mechanical properties of the enamel. RESULTS There were statistically-significant changes in the area, intensity and impact of demineralization in the control and laser groups (P

This experimental study was designed to (1) produce buccal translation of maxillary premolars and (2) evaluate the effects on the buccal alveolar bone.A randomized split-mouth study was designed based on 7 adult male beagle dogs. The experimental side received a custom cantilever appliance fabricated to produce a translatory force through the maxillary second premolar's center of resistance. The contralateral second premolar received no appliance and served as the control. The premolars underwent 6-7 weeks of buccal translation, followed by 3 weeks of fixed retention. Biweekly tooth movements were evaluated using intraoral and radiographic measurements. Pretreatment and posttreatment models were measured to assess tipping. Three-dimensional microscopic tomography was used to quantify the amount and density of buccal bone. Bone formation and turnover were assessed using fluorescent labeling, hematoxylin and eosin staining, tartrate-resistant acid phosphatase staining, and bone sialoprotein immunostaining.The applied force (100 g of force) translated (1.4 mm) and minimally tipped (4°) the experimental teeth. Lateral translation produced dehiscences at the mesial and distal roots, with 2.0 mm and 2.2 mm loss of vertical bone height, respectively. Bone thickness decreased significantly (P 0.05) at the apical (∼0.4 mm), midroot (∼0.4 mm), and coronal (∼0.2 mm) levels. Fluorescent imaging, hematoxylin and eosin staining, and immunostaining for bone sialoprotein all showed new bone formation extending along the entire periosteal surface of the second premolar's buccal plate. Tartrate-resistant acid phosphatase staining demonstrated greater osteoclastic activity on the experimental than that of control sections.New buccal bone forms on the periosteal surface during and after tooth translation, but the amount of bone that forms is less than the amount of bone loss, resulting in a net decrease in buccal bone thickness and a loss of crestal bone.

Introduction Our objectives were to evaluate marginal alveolar bone height in the anterior mandible after orthodontic treatment and to assess any correlations between morphologic and treatment changes. Methods We used 57 pretreatment and posttreatment cone-beam computed tomography images (17 male and 40 female subjects; 22 Class I, 35 Class II; average age, 18.7 ± 10.8 years; average treatment time, 22.7 ± 7.3 months) to measure cortical bone thickness, ridge thickness, distance from the apex to the labial cortical bone, and the distance from the cementoenamel junction to the marginal bone crest. Changes in the cementoenamel junction to the marginal bone crest distance were correlated with pretreatment measurements and treatment changes. Results Although there were great variations, the average facial and lingual vertical bone losses were 1.16 ± 2.26 and 1.33 ± 2.50 mm, respectively. The incisor-mandibular plane angle changes were also highly variable, averaging 2.4°. Conclusions Orthodontic treatment causes changes in alveolar bone height and cortical bone thickness around the mandibular incisors. Although pretreatment cortical bone thickness, ridge width thickness, and specific tooth movements all play roles in what happens to the bone during treatment, incisor inclination was not correlated with alveolar bone height changes.

Aims: To evaluate whether a biobehavioral intervention would be more effective than a self-care intervention or no intervention in reducing psychosocial distress, reducing pain, and improving functioning in patients with an acute myofascial temporomandibular disorder (m-TMD). Methods: Participants (n = 435) were from community dental clinics in the Dallas-Fort Worth Metroplex who were seeking treatment for their acute TMD symptoms and were recruited between 2008 and 2013. The participants were diagnosed using the Research Diagnostic Criteria for TMD (RDC/TMD) and assigned to a biobehavioral intervention, self-care intervention, or no intervention. Three outcomes were assessed: psychosocial distress, pain, and functioning; and treatment effectiveness was assessed according to TMD diagnosis. Outcome evaluations were conducted immediately postintervention as well as at 1 and 2 years postintervention. Analyses were conducted using two-level hierarchical multilevel linear models (MLMs). Results: Contrary to expectations, patients did not respond differently to the intervention based on their TMD diagnosis. Acute m-TMD patients, especially those with other comorbid TMD diagnoses, reported the highest levels of pain and pain-related symptoms and disability. They also exhibited poorer jaw functioning, especially if they were at high risk for chronic TMD. Conclusion: This study indicates that acute m-TMD tends to result in more severe symptom presentations, particularly if diagnosed in combination with other TMD comorbidities. Additionally, patients do not appear to respond better to biobehavioral or self-care intervention on the basis of their TMD diagnosis.

Objective: To determine if 2-DeNT Oral Topical Powder is an effective treatment for traumatic oral ulcers. Materials and Methods: Of the 46 patients who were randomly allocated, 20 patients from the experimental group and 17 from the placebo control group completed the study. The patients, operators, and evaluators were all blinded. Patients applied the powder twice a day and completed a diary twice a day for 10 days. The diary was used to monitor the size of the lesions and pain levels (using a 10-cm visual analog scale). Results: By day 5, the ulcers in the experimental group had reduced in size by approximately 70%; and ulcers in the control group had reduced in size by 56%. The experimental-group ulcers were significantly (P < .05) smaller than the control-group ulcers from day 5 through day 9. Ulcers in the experimental group were completely resolved by day 8, whereas control-group ulcers were still present on day 10. Patients experienced a significant amount of stimulated pain until the night of day 2 in the experimental group and until the night of day 5 in the control group, but group differences in pain were not statistically significant. Conclusions: The 2DeNT Oral Topical powder was more effective than the placebo powder at accelerating the healing of oral traumatic ulcers.

Objective: To determine the effects of occlusion on maximum bite force of growing subjects.Materials and Methods: Incisor and first molar bite force of children and adolescents was evaluated. Four cohorts were measured annually for 3 years, starting at approximately 7, 9, 12, and 15 years of age, respectively. The initial sample included 182 females and 198 males; there were 130 subjects with normal occlusion, 111 with Class I malocclusion, and 139 with Class II malocclusion. Multilevel analyses were performed to model the growth changes and compare groups.Results: Maximum bite force increased significantly (P < .05) over time. Incisal forces peaked at 14.3 and 15.3 years of age for females and males, respectively. Maximum molar bite force peaked at 16 years for both males and females. Subjects with normal occlusion had significantly higher bite force than subjects with malocclusion. Maximum molar bite force exhibited a significant testing effect, with forces increasing 2.6 kg each year that the tests were repeated.Conclusions: Malocclusion has a detrimental effect on bite force. Changes in maximum bite force are also due to age, sex, and repeated testing.