Evaluación de la falla del bracket en relación con diferentes factores en pacientes que reciben tratamiento ortodóntico integral: Un estudio de cohorte retrospectivo.

Objective: The aim of this study was to investigate loose brackets in relation to various related factors in orthodontic patients who had completed orthodontic treatment. Material and Methods: In this retrospective study, 738 medical records of patients who had undergone comprehensive orthodontic treatment and matched specific inclusion criteria were selected. Paired t-tests and ANOVA, along with the Mann-Whitney test and Kruskal–Wallis analyses were performed to compare the means of variables between selected subgroups. Results: Loose brackets were found most frequently on premolars, followed by incisors and then canines (p<0.01). Male and young patients were found to have a higher incidence of loose brackets compared to female and adult patients (p=0.044 and p<0.01, respectively). The highest correlation coefficient value was found between treatment duration and total number of loose brackets (0.393), which was statistically significant. Conclusions: The frequency of total number of loose brackets increased with younger age group. Premolar teeth were found to be the most commonly affected teeth, followed by incisors and canines. Mandibular teeth presented more loose brackets than maxillary.Objetivo: Fue investigar brackets sueltos en relación con varios factores relacionados en pacientes ortodónticos que habían completado el tratamiento de ortodoncia. Material y Métodos: En este estudio retrospectivo, se seleccionaron 738 registros médicos de pacientes que se habían sometido a un tratamiento ortodóntico integral y criterios de inclusión específicos coincidentes. Se realizaron pruebas t pareadas y ANOVA, junto con la prueba de Mann-Whitney y los análisis de Kruskal-Wallis para comparar las medias de las variables entre los subgrupos seleccionados. Resultados: Se encontraron corchetes sueltos con mayor frecuencia en los premolares, seguidos de incisivos y luego caninos (p<0.01). Se encontró que los pacientes masculinos y jóvenes tenían una mayor incidencia de corchetes sueltos en comparación con los pacientes femeninos y adultos (p=0.044 y p<0.01, respectivamente). El valor del coeficiente de correlación más alto se encontró entre la duración del tratamiento y el número total de corchetes sueltos (0.393), que fue estadísticamente significativo. Conclusiones: La frecuencia del número total de corchetes sueltos aumentó con el grupo de edad más joven. Los dientes premolares fueron los dientes más afectados, seguidos de los incisivos y los caninos. Los dientes mandibulares presentan más brackets sueltos que los maxilares

Caries assessment in orthodontic patients

Background and aims: White spot lesions (WSLs) are the most common adverse effect related to orthodontic treatment that may develop into manifest caries lesions if preventive measures are not strictly followed. Caries prevalence has historically been high in the Kingdom of Saudi Arabia (KSA) and the Middle East. Dental caries has previously been evaluated by different techniques. The aims of this thesis were to study: 1) Caries-related factors in orthodontic patients at de-bonding, and compare caries risk profiles between the governmental (G) and private (P) orthodontic patients, 2) The prevalence of buccal caries lesions including WSLs at de-bonding in the G and P orthodontic patients, using the international caries detection and assessment system (ICDAS-II) and the DIAGNOdent Pen, 3) The severity of buccal caries lesions according to ICDAS-II via digital photographs and compare this method with clinical examinations, and 4) Caries-related factors and evaluate caries risks for the G and P orthodontic patients at de-bonding and after four years (longitudinal study). Methodology: A cross-sectional evaluation was carried out on 89 patients at de-bonding; 45 patients in the G-group and 44 patients in the P-group (Studies I and II). Thirteen postgraduate orthodontic students examined 245 close-up digital photographs (Study III). A longitudinal evaluation was performed on 40 out of the 89 baseline patients; (G=20) (P=20). Investigations included a questionnaire, oral clinical examinations, plaque scoring, saliva sampling, bitewing radiographs, and using the computerized caries risk program “Cariogram” to illustrate the caries risk profiles (Studies I and IV). Assessment of the severity of buccal caries lesions was evaluated by using ICDAS-II, DIAGNOdent Pen (Study II), and digital photographs (Study III). Results and conclusions: Study I, the findings revealed that “the chance of avoiding new cavities”, according to the Cariogram model, was higher in the P-group compared to the G-group (61% and 28%, respectively) (P < .001). Decayed, missing, and filled surfaces (DMFS), plaque index, mutans streptococci and lactobacilli counts were significantly higher in the G-group compared to the P-group (P < .05). Study II, the G-group showed statistically significantly higher prevalence of buccal caries lesions including WSLs compared to the P-group evaluated by ICDAS-II, DIAGNOdent Pen (P < .0001). ICDAS-II showed that 43% of the patients in the P-group and 9% in the G-group were free from any WSLs. In the G-group, 22% of the patients versus none in the P-group had 16 lesions or more. The Spearman’s correlation coefficient between the two methods was 0.71, which revealed that the clinical index (ICDAS-II) showed a good correlation with the DIAGNOdent Pen. Study III, intra-examiner reliability and the reliability between each examiner and the clinical examination showed moderate to excellent agreement, with kappa values of 0.52-0.83. The Spearman’s correlation coefficient, between scoring buccal caries lesions via clinical examinations and scoring via photographs, was 0.76, which revealed that scoring buccal caries lesions on digital photographs according to ICDAS-II criteria is a reliable and valid method for assessing the severity of buccal caries lesions. Study IV, the chances to avoid new cavities after four years from de-bonding improved from 31% to 52%, and from 58% to 77% in the G-group and the P-group, respectively. This improvement was also observed for all patients (G+P) from 44% to 64% (P < .001). Caries risks according to the Cariogram at de-bonding and after four years is greater in the patients treated at the governmental clinics compared to the private clinics

Incidence of orthodontic brackets detachment during orthodontic treatment : A systematic review

Objectives: To evaluate the incidence of orthodontic brackets detachment during orthodontic treatment. Methods: Using electronic databases; eligible studies up to January 2018 were retrieved, independently reviewed, and screened. The Coleman Methodology Scoring System (CMS) and Cochrane Collaboration's tool were used to assess quality and risk of bias in the included studies. Results: Of the seventeen studies included in the final synthesis, thirteen were categorized as randomized clinical trials (RCTs), one prospective cohort and retrospective survey each, whereas two studies could not be categorized. The number of patients in the selected studies ranged between 19 and 153; the mean age was between 10.5 to 38.7 years, and male to female ratio was 353:495. Almost all studies had a high risk of bias, and more than half of the studies had CMS score of 70 or above. The numbers of brackets examined in the studies ranged between 361 and 3336. The incidence of brackets detachment ranged from 0.6 to 28.3%. Conclusions: The incidence of brackets detachment during orthodontic treatment is high

Prevalence of work-related musculoskeletal disorders among dental students of King Saud University, Riyadh, Kingdom of Saudi Arabia

Aim: To evaluate the presence of work-related musculoskeletal disorders (WRMSDs) among undergraduate dental students of the College of Dentistry, King Saud University (KSU), Riyadh, Saudi Arabia. Materials and methods: A questionnaire-based cross-sectional survey was conducted in 2017 and distributed to150 undergraduate female, and male dental students of KSU who had started to work with patients in the clinic or with manikins. Data were collected related to WRMSDs. Results: Nearly, 142 (95%) students returned the completed questionnaire, 88 (62%) were females and 54 (38%) were males. The results of this study indicate that musculoskeletal symptoms among dental students of KSU are high. Females generally reported more WRMSDs. Seventy-two percent of females and 41% of males reported frequent headaches. Fourteen percent of females and 6% of males had some musculoskeletal pain disorders before joining the dental profession, whereas 68% of females and 43% of males reported pain attributed to their clinical dental work. In the majority of females (67%) and males (61%), the onset of pain was gradual. Commonly reported pain sites in both females and males were the neck, shoulder, upper and lower back. The most common pain sites, among females were shoulder and neck, and upper- and lower-back among males. Conclusion: The WRMSDs can affect the dental professionals from the early stages of their clinical carrier, even as dental students. Concrete steps are required to prevent the occurrence of WRMSDs among dental students by providing them the detailed knowledge about theoretical and practical aspects of dental ergonomics. Higher prevalence of WRMSDs among female dental students indicate that female dental professionals need to be extra vigilant to adhere to the principles of dental ergonomics from the very beginning of their clinical career. Clinical significance: The awareness to implement the principles of dental ergonomics among dental students can help to prevent early development of WRMSDs among them. The inclusion of dental ergonomics as a detailed stand-alone subject in the dental curriculum before the start of clinical training can contribute minimize the risk of WRMSDs throughout the professional life of the dentists

Assessment of knowledge about dental ergonomics among dental students of King Saud University, Riyadh, Kingdom of Saudi Arabia

Aim: To assess the knowledge about dental ergonomics and work-related musculoskeletal disorders (WRMSDs) among dental students of King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia, undergoing practical clinical training. Materials and methods: A self-designed questionnaire after pre-testing was distributed to 150 dental students of KSU undergoing clinical training, to collect data related to (a) basic knowledge about dental ergonomics; (b) any course/workshop about dental ergonomics attended; (c) basic knowledge about WRMSDs; (d) familiarity about preventive measures to decrease the risk of WRMSDs; and (e) knowledge about treatment options for WRMSDs. Results: One hundred forty-two students (95%) returned the completed questionnaires, of them 54 (38%) were males and 88 (62%) were females. The main findings of the study are that only 30% of the students knew about dental ergonomics; 93% of students have not attended any course/workshop about dental ergonomics; about half the students knew about WRMSDs; 62% of the students did not know about preventive measures to decrease the risk of WRMSDs, and 80% of students did not have knowledge about treatment options for WRMSDs. In general, female students had a better understanding of dental ergonomics and WRMSDs than male students. Conclusion: The basic knowledge of the dental ergonomics among dental students at King Saud University, Riyadh, Kingdom of Saudi Arabia is not adequate. Clinical significance: There is a need for introducing dedicated theoretical and practical courses covering all aspects of dental ergonomics in the undergraduate curriculum of dental education

Assessment of Knowledge about Dental Ergonomics among Dental Students of King Saud University, Riyadh, Kingdom of Saudi Arabia

Aim: To assess the knowledge about dental ergonomics and work-related musculoskeletal disorders (WRMSDs) among dental students of King Saud University (KSU), Riyadh, Kingdom of Saudi Arabia, undergoing practical clinical training. Materials and methods: A self-designed questionnaire after pre-testing was distributed to 150 dental students of KSU undergoing clinical training, to collect data related to (a) basic knowledge about dental ergonomics; (b) any course/workshop about dental ergonomics attended; (c) basic knowledge about WRMSDs; (d) familiarity about preventive measures to decrease the risk of WRMSDs; and (e) knowledge about treatment options for WRMSDs. Results: One hundred forty-two students (95%) returned the completed questionnaires, of them 54 (38%) were males and 88 (62%) were females. The main findings of the study are that only 30% of the students knew about dental ergonomics; 93% of students have not attended any course/workshop about dental ergonomics; about half the students knew about WRMSDs; 62% of the students did not know about preventive measures to decrease the risk of WRMSDs, and 80% of students did not have knowledge about treatment options for WRMSDs. In general, female students had a better understanding of dental ergonomics and WRMSDs than male students. Conclusion: The basic knowledge of the dental ergonomics among dental students at King Saud University, Riyadh, Kingdom of Saudi Arabia is not adequate. Clinical significance: There is a need for introducing dedicated theoretical and practical courses covering all aspects of dental ergonomics in the undergraduate curriculum of dental education

Assessment of enamel surface roughness and hardness with metal and ceramic orthodontic brackets using different etching and adhesive systems: An in vitro study

Background: This study aimed to evaluate enamel surface roughness and microhardness following the use of different bracket materials (metal or ceramic), etchants (total- and self-etchants), and adhesive systems (precoated or flash-free). Method: A total of 99 extracted human premolars were selected for the analysis. The surface roughness was first assessed (roughness control). One specimen from each subgroup was examined using a scanning electron microscope to illustrate the surface topography. Eighty-eight teeth were prepared using total- or self-etchants and bonded to precoated or flash-free adhesive metal or ceramic brackets. The remaining 11 specimens were not bonded to brackets (microhardness controls). The brackets were debonded after immersion in distilled water for 24 h. The specimens were again scanned for surface roughness and topography imaging. Finally, the microhardness was assessed using a micro-Vickers hardness test at a force of 200 g for 10 s. Result: An overall statistically significant increase in surface roughness and reduced surface microhardness were observed in all experimental groups when compared with those in the control groups. The etchant type was the only variable found to contribute to the measured surface properties, with increased roughness and reduced microhardness introduced by total-etching compared to those by self-etching. Conclusion: Orthodontic brackets introduced a significant increase in enamel surface roughness and reduce microhardness compared with untreated enamel, regardless of the bracket material, etchant type, and adhesive system. The etchant type was the only variable contributing to these changes, with total etching having a more pronounced effect

Nonsyndromic Generalized Radiculomegaly of Permanent Dentition: A Rare Case Report

Introduction. Radiculomegaly (marked elongation of dental roots) is a distinct dental abnormality with a major clinical significance that is closely related to oculofaciocardiodental syndrome (OFCD). Since OFCD syndrome was first identified in 1996, only a few cases of nonsyndromic/nonfamilial radiculomegaly have been reported. We report a new nonsyndromic/nonfamilial radiculomegaly case and the association of OFCD syndrome with the dental challenges. Case Presentation. 18-year-old medically free male presented to the screening dental clinics complaining of teeth malposition. Panoramic radiograph incidentally revealed extremely long and wide roots of almost all dentition. Apical radiographs and cone-beam computed tomography (CBCT) were taken to confirm this anomaly and to rule out any artifact. The images confirmed the excessive length of the roots. A cephalometric X-ray was performed on the patient to rule out any dentofacial deformity. History and physical examinations were negative for ocular or cardiac anomalies. Due to lack of evidence of physical signs and symptoms consistent with OFCD syndrome, genetic testing was not performed. Conclusion. Dentists need to be informed of the clinical and radiographic features of different dental anomalies, especially radiculomegaly, as it is considered one of the significant features of OFCD syndrome. Challenges related to radiculomegaly face dentists while the current literature has not yet provided a solid baseline for managing such patients. The challenges include repairing the root canals, extracting and/or moving the teeth orthodontically. Early diagnosis of the syndrome is crucial to prevent dental challenges and provide the best dental care services

Shear bond strength of new and rebonded orthodontic brackets to the enamel surfaces

OBJECTIVES: The objective of this study was to compare the shear bond strength (SBS) of new and rebounded orthodontic brackets bonded to the buccal sound and cleaned enamel surfaces using two orthodontic adhesives: resin-modified glass-ionomer (RMGI) and resin-composite. MATERIALS AND METHODS: Forty premolars were randomly allocated into four groups, 10 teeth/group. New and rebonded brackets were bonded to sound and cleaned enamel surface, and then were subjected to thermocycling. The bond strength was determined using a universal testing machine at a crosshead speed of 1 mm/min. Remaining adhesives on enamel after bracket debonding was scored independently by two investigators who were not aware of the four different groups, using adhesive remnant index (ARI). RESULTS: There was a statistical significant difference in SBS of the four groups (P = 0.005). SBS values were significantly higher with cleaned enamel surfaces after adhesive removal compared to sound enamel. SBS was significantly higher for rebonded brackets, when compared with the new brackets. No significant difference was found between the two adhesives types. The level of agreement between the two raters was higher toward the classification of higher categories of ARI (scores 5 and 6) with agreement percentage 91.7% and 100%, respectively. There was more adhesive remained among resin-composite groups. CONCLUSIONS: The bond strength of debonded sandblasted stainless-steel brackets was higher than new brackets. Resin-composite and RMGI orthodontic adhesives used in this study exhibited sufficient SBS values for bonding brackets to sound and cleaned enamel and comparable to each other

Caries risk profiles in orthodontic patients: A 4-year follow-up study using the Cariogram model in governmental vs. private clinics

Objectives: To (1) analyze caries-related factors and (2) evaluate caries risk using the Cariogram model for governmental and private orthodontic patients at de-bonding and 4 years after de-bonding. Materials and methods: Forty orthodontic patients with mean age of 26.4 years were recruited from a governmental (G) group (n = 20) and private (P) group (n = 20) and were examined at de-bonding (T1) and 4 years after de-bonding (T2). The examination included a questionnaire, plaque scoring, caries examination, bitewing radiographs, and assessment of salivary secretion rate, buffering capacity and cariogenic microorganisms. The data were entered into the Cariogram program to illustrate the caries risk profiles. Results: The chance to avoid new cavities was higher in P-group compared to G-group at T1 (58% and 31%, respectively) (P < 0.01) and T2 (77% and 52%, respectively) (P < 0.001). Plaque index was significantly higher in G-group, and fluoride was used significantly more in P-group at T1 and T2 (P < 0.05). The chance to avoid new cavities was higher at T2 compared to T1 (64% and 44%, respectively) (P < 0.001). Saliva secretion rate and buffer capacity were significantly increased, and the plaque index was significantly decreased at T2 compared to T1 (P < 0.01). Conclusion: According to the Cariogram, orthodontic patients were less likely to avoid new cavities at de-bonding and 4 years after de-bonding in government clinics compared to private clinics, and the caries risk significantly decreased 4 years after orthodontic treatment for all patients, regardless of the location of treatment. Keywords: Risk assessment, Cariogram, Orthodontics, Saudi Arabi