A randomised controlled trial of the Neuro Emotional Technique (NET) for childhood Attention Deficit Hyperactivity Disorder (ADHD): a protocol

<p>Abstract</p> <p>Background</p> <p>An abundance of literature is dedicated to research for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Most, is in the area of pharmacological therapies with less emphasis in psychotherapy and psychosocial interventions and even less in the area of complementary and alternative medicine (CAM).</p> <p>The use of CAM has increased over the years, especially for developmental and behavioral disorders, such as ADHD. 60–65% of parents with children with ADHD have used CAM. Medical evidence supports a multidisciplinary approach (i.e. pharmacological and psychosocial) for the best clinical outcomes. The Neuro Emotional Technique (NET), a branch of Chiropractic, was designed to address the biopsychosocial aspects of acute and chronic conditions including non-musculoskeletal conditions. Anecdotally, it has been suggested that ADHD may be managed effectively by NET.</p> <p>Design/methods</p> <p>A placebo controlled, double blind randomised clinical trial was designed to assess the effectiveness of NET on a cohort of children with medically diagnosed ADHD.</p> <p>Children aged 5–12 years who met the inclusion criteria were randomised to one of three groups. The control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months.</p> <p>The Conners' Parent and Teacher Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners' ADHD Index and Conners' Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners' Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity.</p> <p>Calculations for the sample size were set with a significance level of 0.05 and the power of 80%, yielding a sample size of 93.</p> <p>Discussion</p> <p>The present study should provide information as to whether the addition of NET to an existing medical regimen can improve outcomes for children with ADHD.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trial Registration Number: ANZCTRN 012606000332527</p

Bonded orthodontic retainers:Clinical survival, adhesion and material aspects

Orthodontic retainers are used at the end of an orthodontic treatment to retain the achieved tooth position. Without a phase of retention, there is a tendency for the teeth to relapse towards their initial position after treatment. The aetiology of relapse is not fully understood but relates to a number of factors that involves periodontal and occlusal aspects, possibly soft tissue pressures and physiological growth. Retention, which refers to the fixation of the achieved orthodontic result, can be accomplished using removable or fixed retainers. Due to the advances in adhesive technologies, the use of fixed retainers bonded to lingual or palatal surfaces of the incisors has been widely used. Debonding of these retainers is however one of the most frequently reported failure types in orthodontics and has a multifactorial cause. This thesis was conducted in an attempt to identify some of the possible debonding factors causing these failures. Therefore, failures were analyzed in clinical retrospect as well as bond strenght comparison of different retainer types and materials. Comparison of the fatigue resistance, debonding force, and failure type of different retainer materials in vitro was conducted as well as a prospective evaluation of the survival of multi-stranded stainless steel bonded retainers using different resin composite types. At last the evaluation of anterior tooth movement with and without bonded retainers under incremental loading conditions using 3D reconstruction was done. Debonding of these retainers remains unsolved and multicausal, yet aspects such as age, gender, operator, resin composite type could be disclosed

Displacement of teeth without and with bonded fixed orthodontic retainers: 3D analysis using triangular target frames and optoelectronic motion tracking device

PURPOSE The objective of this study was to evaluate the anterior tooth movement without and with bonded fixed orthodontic retainers under incremental loading conditions. MATERIALS AND METHODS Six extracted mandibular anterior human teeth were embedded in acrylic resin in True Form I Arch type and 3D reconstruction of Digital Volume Tomography (DVT) images (0.4 mm voxels) were obtained. The anatomy of each tooth was segmented and digitally reconstructed using 3D visualization software for medical images (AMIRA, FEI SVG). The digital models of the teeth were repositioned to form an arch with constant curvature using a CAD software (Rhinoceros) and a base holder was designed fitting the shape of the roots. The clearance between the roots and their slot in the holder was kept constant at 0.3 mm to replicate the periodontal ligament thickness. The holder and the teeth were then manufactured by 3D printing (Objet Eden 260VS, Stratasys) using a resin material for dental applications (E = 2-3 GPa). The 3D-printed teeth models were then positioned in the holder and the root compartments were filled with silicone. The procedure was repeated to obtain three identical arch models. Each model was tested for tooth mobility by applying force increasing from 5 to 30 N with 5 N increments applied perpendicular on the lingual tooth surface on the incisal one third (crosshead speed: 0.1 mm/s). The teeth on each model were first tested without retainer (control) and subsequently with the bonded retainers (braided bonded retainer wire; Multi-strand 1 × 3 high performance wire, 0.022″ × 0.016″). Tooth displacement was measured in terms of complicance (F/Δ movement) (N/mm) using custom-built optoelectronic motion tracking device (OPTIS) (accuracy: 5 µm; sampling rate: 200 Hz). The position of the object was detected through three LEDs positioned in a fixed triangular shape on a metal support (Triangular Target Frame). The measurements were repeated for three times for each tooth. Data were analyzed using mixed model with nesting (alpha = 0.05). RESULTS The use of retainer showed a significant effect on tooth mobility (0.008 ± 0.004) compared to non-bonded teeth (control) (0.014 ± 0.009) (p  0.05). CONCLUSION Mandibular anterior teeth showed less tooth mobility when bonded with stainless steel wire as opposed to non-bonded teeth but the tooth mobility varied depending on the tooth type. Intermittent increase in loading from 5 to 30 N did not increase tooth displacement

Fatigue resistance, debonding force, and failure type of fiber-reinforced composite, polyethylene ribbon-reinforced, and braided stainless steel wire lingual retainers in vitro

<p>Objective: To analyze the fatigue resistance, debonding force, and failure type of fiber-reinforced composite, polyethylene ribbon-reinforced, and braided stainless steel wire lingual retainers in vitro. Methods: Roots of human mandibular central incisors were covered with silicone, mimicking the periodontal ligament, and embedded in polymethylmethacrylate. The specimens (N = 50), with two teeth each, were randomly divided into five groups (n = 10/group) according to the retainer materials: (1) Interlig (E-glass), (2) everStick Ortho (E-glass), (3) DentaPreg Splint (S2-glass), (4) Ribbond (polyethylene), and (5) Quad Cat wire (stainless steel). After the recommended adhesive procedures, the retainers were bonded to the teeth by using flowable composite resin (Tetric Flow). The teeth were subjected to 10,00,000 cyclic loads (8 Hz, 3 - 100 N, 45 degrees angle, under 37 +/- 3 degrees C water) at their incisoproximal contact, and debonding forces were measured with a universal testing machine (1 mm/min crosshead speed). Failure sites were examined under a stereomicroscope (x40 magnification). Data were analyzed by one-way analysis of variance. Results: All the specimens survived the cyclic loading. Their mean debonding forces were not significantly different (p > 0.05). The DentaPreg Splint group (80%) showed the highest incidence of complete adhesive debonding, followed by the Interlig group (60%). The everStick Ortho group (80%) presented predominantly partial adhesive debonding. The Quad Cat wire group (50%) presented overlying composite detachment. Conclusions: Cyclic loading did not cause debonding. The retainers presented similar debonding forces but different failure types. Braided stainless steel wire retainers presented the most repairable failure type.</p>