Changes in Orthodontic Treatment Modalities in the Past 20 Years: Exploring the Link between Technology and Scientific Evidence

Statement of the issue: Is there a link between the many perceived advances in orthodontic techniques/therapy and science in the past 20 years? The purpose of this paper is to take five topics and match the perceptions with the scientific evidence. The variety of appliances and the swings in treatment philosophy have been dramatic, including the swing from extraction to non-extraction therapy, the introduction of space-age wires, appliances that grow mandibles, the introduction and extraordinary growth of Invisalign, and reduced friction brackets to reduce treatment time, all with claims by manufacturers of better results than ever before. The focus is on faster treatment, reduced visits/appointments and superior results. Most of these ‘advancements’ represent what has been the ‘juggernaut of technology’. Materials and methods: Five questions are posed, and an evidencebased approach is used to critically examine the literature in these selected topics. Results: The evidence is lacking for some of the most commonly used systems and materials in orthodontic practice today. Conclusion: More randomised clinical trials are needed in orthodontic practice to evaluate treatment outcomes

Glass-ionomer Adhesives in Orthodontics: Clinical Implications and Future Research Directions

During the past ten years significant advances have been made in the development of glass-ionomer bonding adhesives. The beneficial effects of fluoride are well documented and an agent which reduces or prevents a white spot lesion that commonly occurs clinically, is desirable. There has been a notable lack of randomized clinical trials to determine the prevalence of white spot lesions after orthodontic treatment although it is often reported in the literature. White spot lesions pose health and esthetic problems and their proper clinical management has yet to be resolved. The objective of this paper Is to review the literature in this area and suggest a rationale for a clinical trial to assess the efficiency of glass-ionomer adhesives in facing the problem of decalcification and study the bond strength of these materials

Bond Strength of an Amorphous Calcium Phosphate–Containing Orthodontic Adhesive

Objective: To determine whether an amorphous calcium phosphate (ACP)-containing adhesive has an acceptable level of shear bond strength to be used as an orthodontic adhesive. Materials and Methods: Sixty extracted premolars were randomly divided into three groups for orthodontic bonding. Group 1 used a composite resin adhesive (Transbond XT), group 2 was bonded with an ACP-containing adhesive (Aegis Ortho), and group 3 used a resin-modified glass ionomer (Fuji Ortho LC). All bonded teeth were stored in distilled water at 37°C for 40 ± 2 hours prior to debonding. Shear bond strength and adhesive remnant index (ARI) were recorded for each specimen. Results: The mean shear bond strengths for the three test groups were: group 1 (15.2 ± 3.6 MPa), group 2 (6.6 ± 1.5 MPa), and group 3 (8.3 ± 2.8 MPa). A one-way analysis of variance showed a significant difference in bond strengths between the groups. A post hoc Tukey test showed group 1 to be significantly (P \u3c .001) greater than groups 2 and 3. A Kruskal-Wallis test and a Mann-Whitney U-test showed groups 1 and 3 exhibited lower ARI scores than group 2, but a majority of specimens in each group had greater than 50% of the cement removed along with the bracket during debonding. Conclusions: The ACP-containing adhesive demonstrated a low, but satisfactory bond strength needed to function as an orthodontic adhesive

Thermal Analysis of As-received and Clinically Retrieved Copper-Nickel-Titanium Orthodontic Archwires

Objective: To compare as-received copper-nickel-titanium (CuNiTi) archwires to those used in patients by means of differential scanning calorimetry (DSC). Also, the thermal or phase properties of 27°C, 35°C, and 40°C CuNiTi archwires were studied to ascertain if their properties match those indicated by the manufacturer. Materials and Methods: Six wires of 27°C, 35°C, and 40°C CuNiTi were tested as-received, and six each of the 27°C and 35°C wires were examined after use in patients for an average of approximately 9 and 7 weeks, respectively. Segments of archwire were investigated by DSC over the temperature range from −100°C to 150°C at 10°C per minute. Results: There were no significant differences between as-received and clinically used 27°C and 35°C wires for all parameters (heating onset, endset, and enthalpy and cooling onset, endset, and enthalpy), except the 27°C wires exhibited a significant decrease in the heating enthalpy associated with the martensite-to-austenite transition after clinical use. The heating endsets (austenite finish temperatures) of the 27°C and 35°C wires were within 2°C of those claimed by the manufacturer, but the 40°C wires were found to be nearer to 36°C than 40°C. Conclusions: Clinical use of CuNiTi wires resulted in few differences when compared with as-received wires analyzed by DSC. Two temperature varieties of CuNiTi are reasonably within the parameters of those identified by the manufacturer

Porcelain Surface Roughness, Color and Gloss Changes after Orthodontic Bonding

The purpose of this study was to evaluate the alteration in surface characteristics after orthodontic debonding of two types of porcelain systems commonly used in prosthetic dentistry. For this purpose, porcelain specimens were fabricated from low-fusing (n = 20) and high-fusing (n = 20) porcelain. The baseline surface roughness, color, and gloss were evaluated using profilometry, color shade index, and gloss study. All specimens were bonded with brackets and debonded using a testing machine at a rate of 0.1 mm/minute crosshead speed. The porcelain surfaces were polished using a 12-fluted carbide composite removal bur (low-fusing, n = 20; high-fusing, n = 20). In addition, half of each porcelain group was further polished using a series of Sof-Lex discs (low-fusing, n = 10; high-fusing, n = 10). The postdebond porcelain surface characteristics roughness, color, and gloss were reevaluated and compared with baseline measurements. The results were analyzed with two-way analysis of variance and Tukey multiple comparisons test, with porcelain type (low-fusing or high-fusing) and polishing protocol (carbide bur or carbide bur and discs) serving as discriminate variables at α = 0.05 level of significance. Bonding and debonding increased all roughness parameters tested; however, no change was revealed between the two polishing protocols. Similarly, gloss and color index changes were significantly altered after resin grinding, regardless of the polishing method used. No difference was identified between the two porcelain types with respect to roughness, color index, or gloss. Orthodontic bonding alters the porcelain surfaces, and postdebond polishing does not restore the surface to the prebond state

Moving an incisor across the midline: A treatment alternative in an adolescent patient

A 13-year-old sought treatment for a severely compromised maxillary left central incisor and an impacted fully developed left canine. Extraction of both teeth became necessary. As the key component of the revised comprehensive treatment plan, the right maxillary central incisor was moved into the position of the left central incisor. All other maxillary teeth were moved mesially to close any gaps. Active orthodontic treatment was completed after 34 months. Frenectomy, minor periodontal surgeries, and bonded lingual retainers were used to improve aesthetics and stabilize the tooth positions. The patient was pleased with the treatment outcome. Cone-beam computed tomography provided evidence that the tooth movement was accompanied by a deviation of the most anterior portion of the median palatine suture. This observation may make relapse more likely if long-term retention cannot be ensured. Root resorption was not observed as a consequence of the major tooth movement. (Am J Orthod Dentofacial Orthop 2011;139:533-43

Differential Scanning Calorimetry (DSC) Analyses Of Superelastic And Nonsuperelastic Nickel-Titanium Orthodontic Wires

The purpose of this study was to determine the transformation temperatures for the austenitic, martensitic, and rhombohedral (R) structure phases in representative as-received commercial nitinol (NiTi) orthodontic wire alloys, to reconcile discrepancies among recent publications. Specimens were examined by differential scanning calorimetry (DSC) over a temperature range from approximately −170° C to 100° C, with a scanning rate of 10° C per minute. Two different pathways, with the intermediate R structure either absent or present, were observed for the transformation from martensitic to austenitic NiTi, whereas the reverse transformation from austenitic to martensitic NiTi always included the R structure. The enthalpy (ΔH) for the transformation from martensite to austenite ranged from 0.3 to 35 calories per gram. The lowest ΔH value for the nonsuperelastic Nitinol wire is consistent with a largely work-hardened, stable, martensitic microstructure in this product. The DSC results indicate that the transformation processes are broadly similar in superelastic, body-temperature shape-memory, and nonsuperelastic NiTi wires. Differences in bending properties for the NiTi orthodontic wires at room temperature and 37° C are due to the relative proportions of the metallurgical phases in the microstructures

Polymerization Efficiency of Glass-Ionomer and Resin Adhesives under Molar Bands

Objective: To determine the degree of cure of a light-cured resin-modified glass ionomer (RMGI) under molar bands compared with a light-cured resin and a dual-cured resin. Materials and Methods: The 3 cements used were Fuji Ortho LC, Eagle Spectrum resin, and Variolink II dual-cure. Each sample was indirectly light cured for 20 seconds (10 seconds occlusally, 10 seconds cervically) under sections of molar bands, and the degree of cure was evaluated with micro-MIR FTIR spectroscopy. Results: The RMGI exhibited a significantly higher mean degree of cure (55.31%) than both of the resins (Eagle 19.23%; Variolink II, 25.42%), which did not differ significantly at α = .05 level of significance. Conclusion: Higher degree of conversion can be obtained from RMGIs under molar bands compared with composite resin adhesives provided the proper curing technique is used

Force to Debond Brackets from High-fusing and Low-fusing Porcelain Systems

The purpose of this study was to test the hypothesis that porcelain surface finishing, ie, low- and high-fusing porcelain, has an effect on the amount of force required to debond orthodontic brackets. A total of 20 high-fusing and 20 low-fusing porcelain specimens were prepared, polished, and bonded with standard edgewise brackets using a suggested porcelain bonding protocol. The brackets were debonded with a universal testing machine at shear mode. Resin removal was performed using two methods: a multifluted carbide bur with and without the use of Sof-Lex polishing discs. Representative specimens were studied under a scanning electron microscope before and after debonding to assess the surface morphology and potential surface damage. Statistical analysis with a t-test revealed that there was no difference between the two porcelain treatments on the force to debond values and no qualitative differences were observed on the porcelain surface between the two resin clean-up methods. From a clinical perspective, the practitioner can bond ceramic restorations without previous knowledge of the porcelain type used

Do the Mechanical and Chemical Properties of Invisalign\u3csup\u3eTM\u3c/sup\u3e Appliances Change After Use? A Retrieval Analysis

Aim: To investigate the mechanical and chemical alterations of Invisalign appliances after intraoral aging. Materials and methods: Samples of Invisalign appliances (Align Technology, San Jose, California, USA) were collected following routine treatment for a mean period of 44±15 days (group INV), whereas unused aligners of the same brand were used as reference (group REF). A small sample from the central incisors region was cut from each appliance and the buccal surface was analysed by attenuated total reflectance-Fourier transform infrared (ATR-FTIR) spectroscopy (n = 5). Then the appliances were cut (n = 25) and embedded in acrylic resin, ground/polished in a grinding polishing machine, and the prepared surfaces were subjected to Instrumented Indentation Testing under 4.9 N load. Force-indentation depth curves were recorded for each group and the following parameters were calculated according to ISO 14577-1; 2002 specification: indentation modulus (E IT), elastic to total work ratio also known as elastic index (ηIT), Martens Hardness (HM), and indentation creep (C IT) The mean values of the mechanical properties were statistically analysed by unpaired t-test (a = 0.05). Results: ATR-FTIR analysis confirmed the urethane based structure of the appliances, without important chemical differences attributed to the aging process. INV group showed significantly lower E IT (REF: 2466±20, INV: 2216±168MPa), HM (REF: 119±1, INV: 110±6 N mm−2) and higher ηIT (REF: 40.0±0.3, INV: 41.5±1.2%), and C IT (REF: 3.7±0.2 INV: 4.0±0.1%). The increase in ηIT indicates that INV is a more brittle than REF, whereas the increase in C IT, a decrease in creep resistance. Conclusion: Despite the lack of detectable chemical changes, intraoral aging adversely affected the mechanical properties of the Invisalign appliance