Potential Hazards of Orthodontic Treatment – What Your Patient Should Know

Orthodontic treatment carries with it the risks of tissue damage, treatment failure and an increased predisposition to dental disorders. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to proceed with orthodontic treatment. This paper outlines the potential hazards and suggests how they may be avoided or minimized

Does articulating study casts make a difference to treatment planning?

OBJECTIVE: To assess whether articulating casts in centric relation (CR) compared with intercuspal position (ICP) makes a difference to treatment planning. Design: Reliability analysis. Subjects: Ten orthodontists. METHODS: Twenty case vignettes were examined on three occasions: twice with the casts in ICP and once in CR. A series of dichotomous decisions were made relating to the treatment need and treatment mechanics. MAIN OUTCOME MEASURES: The changes in treatment decisions were examined. Intra-examiner agreement between the two hand-held cast assessments (H1 v. H2) and between the first set of hand-held casts compared with the articulated casts (H1 v. A1) were evaluated using the kappa statistic. The differences between the kappa statistics for H1 v. H2 and H1 v. A1 were then tested with the Wilcoxon matched pairs signed rank sum test. RESULTS: The only statistically significant change in the kappa score between H1 v. H2 and H1 v. A1 was for the extraction decision (P 0.007). No other statistically significant differences were found for the other treatment decisions, although trends were identified for orthognathic surgery and anchorage support decisions. CONCLUSION: Routine articulation of study models for all orthodontic patients is not supported by the results of this study. Articulation of the study models did not affect the treatment planning decisions in a meaningful manner. Further work with selected samples is required to determine if articulation is helpful for specific malocclusions

Molar band re-use and decontamination: a survey of specialists

Objective: To determine the pattern of use and re-use of orthodontic molar bands, and examine infection control measures in a sample of UK orthodontists. Design: Questionnaire survey. Subjects and methods: Questionnaires were sent to 204 individuals selected at random from the UK Specialist Orthodontist list. Follow-up questionnaires were sent to those that had not replied within 8 weeks. An overall response rate of 74.5% was achieved. Main outcome measures: Orthodontic band use and re-use and cross-infection control. Results: The reported rates of pre-sterilization cleaning and sterilization of orthodontic instruments were 92 and 100%, respectively. Of the respondents, 90% were using bands for molar teeth with the remainder routinely used bonded attachments. Most clinicians (95%) using bands routinely re-used them after being tried-in with 5% discarding them. Pre-sterilization cleaning of re-used molar bands was carried out by 92% of respondents who reclaimed bands. Sterilization of these bands was then carried out by most specialists apart from 2. Conclusions: The majority of UK specialist orthodontists who responded to the questionnaire are adhering to universal precautions for cross-infection control and are carrying out approved decontamination procedures. The majority are also reusing orthodontic bands that have been tried in the mouth, but found to be the wrong size. The great diversity of reported procedures for decontamination of instruments and bands suggest that more research is required to provide guidelines into the most effective method

Fluoridated elastomers: effect on disclosed plaque

OBJECTIVE: To investigate the effect of fluoridated elastomers on the quantity of disclosed dental plaque surrounding an orthodontic bracket in vivo. DESIGN: A randomized, prospective, longitudinal clinical trial, employing a split mouth, crossover design. Setting: The Orthodontic Departments of Liverpool and Sheffield Dental Hospitals. Subjects and methods: The subjects were 30 individuals about to start fixed orthodontic treatment. The study consisted of two experimental periods of 6 weeks with a washout period between. Fluoridated elastomers were randomly assigned at the first visit to be placed around brackets on 12, 11, 33 or 22, 21, 43. Non-fluoridated elastomers were placed on the contra-lateral teeth. After 6 weeks (visit 2) the elastomers were removed, the teeth disclosed and a photograph taken. Non-fluoridated elastomers were placed on all brackets for one visit to allow for a washout period. At visit 3, fluoridated elastomers were placed on the contra-lateral teeth to visit 1. At visit 4, the procedures at visit 2 were repeated. The photographs were scanned, then the area and proportion of the buccal surface covered with disclosed plaque was measured using computerized image analysis. A mixed-effects ANOVA was carried out with the dependent variable being the area or percentage area of disclosed plaque. RESULTS: There was no evidence of a systematic error and substantial agreement for the repeat readings of the same images. The only significant independent variable for the area of disclosed plaque was the subject (p<0.001). The significant independent variables for the proportion of disclosed plaque were the subject (p<0.001) and the tooth type (p=0.002). The independent variable describing the use of fluoridated or non-fluoridated elastomers was not significant for either the area or the proportion of disclosed plaque. CONCLUSION: Fluoridated elastomers do not affect the quantity of disclosed plaque around an orthodontic bracket

Fluoridated elastomers: in vivo versus in vitro fluoride release

OBJECTIVES: To compare (i) the in vivo release of fluoride from fluoridated elastomers to the in vitro release, and (ii) the residual fluoride content of the elastomers after 1 week in the mouth with and without fluoride toothpaste and mouthrinse. DESIGN: A prospective, longitudinal, cross-over study. Subjects and method: Six subjects were recruited by poster to take part in the study. Each subject had one premolar in each quadrant to which a bracket could be fixed and exemplary oral hygiene. Elastomers were then placed on these brackets. Intervention: The study was divided into two parts: (i) subjects used oral hygiene products with fluoride and (ii) oral hygiene products with fluoride were excluded. Both groups of elastomers were left in the mouth for 1 week. After collection the elastomers were stored in distilled water. MAIN OUTCOME MEASURES: The amount of residual fluoride in the ligatures after they have been placed in the mouth for 1 week was compared with the cumulative fluoride release in vitro over 1 week and 6 months. RESULTS: Only 13 per cent of the total amount of fluoride in fluoridated elastomers was released during the first week in vitro, compared with 90 per cent in vivo. There was a significantly greater amount (P = 0.001) of residual fluoride when the elastomers were in the mouth for 1 week in the presence of fluoride toothpaste and mouthrinse, than when fluoride supplements were excluded. CONCLUSIONS: (1) Higher levels of fluoride are lost from the fluoride elastomers in vivo than in vitro during the first week. (2) A significantly greater amount of residual fluoride was released from the elastomers placed in the mouth when fluoride toothpaste and mouthrinse were used

Evaluation of White Spot Lesions on Teeth with Orthodontic Brackets

Accurate evaluation of demineralized white spot lesions during orthodontic treatment is important to both clinicians, so they might implement early prevention and/or treatment, and researchers who wish to study the effectiveness of those methods. Assessment will depend on accurate detection and measurement of a lesion, using procedures that demonstrate good validity and reproducibility. A range of evaluative techniques are outlined and the advantages and disadvantages of each are discussed. Some methods can be applied by the busy clinician, whereas others are more suitable for the researcher undertaking a clinical trial. Regardless of who is using the technique, it should be relatively straightforward to apply in the clinical situation, and whatever technique is undertaken, researchers and clinicians must appreciate the need for proper research designs to produce reliable information regarding the effectiveness of any intervention

Orthodontic palatal implants: clinical technique

The aim of this paper is to familiarize the readers with some of the clinical considerations necessary to ensure successful use of mid-palatal implants. Both surgical and technical aspects will be discussed along with a description of impression techniques used

How to design and set up a clinical trial part 1 : the research question

Data from clinical trials involving human participants are essential in establishing an evidence base about the safety and effectiveness of our treatments. This first article describes the steps involved in designing and setting up a clinical trial, from establishing the research question(s) to searching the literature. Acquiring some knowledge about how to set up a clinical trial will allow the conscientious clinician to use the most relevant information to provide the highest possible standards of clinical care for his/her patients. CPD/Clinical Relevance: Even if a clinician is not, has never been, nor is ever planning to be involved in research, he/she should understand and be able to interpret the data from clinical trials

Midpalatal implants vs headgear for orthodontic anchorage - a randomized clinical trial: Cephalometric results

OBJECTIVE: To compare the clinical effectiveness of the mid-palatal implant as a method of reinforcing anchorage during orthodontic treatment with that of conventional extra-oral anchorage. DESIGN: A prospective, randomized, clinical trial Setting: Chesterfield and North Derbyshire Royal Hospital NHS Trust and the Charles Clifford Dental Hospital, Sheffield. SUBJECTS AND METHODS: 51 orthodontic patients between the ages of 12 and 39, with a class II division 1 malocclusion and ‘absolute anchorage’ requirements were randomly allocated to either receive a mid-palatal implant or headgear to reinforce orthodontic anchorage. The main outcome of the trial was to compare the mesial movement of the molars and incisors of the two treatment groups between T1 (start) and T2 (end of anchorage reinforcement) as measured from cephalometric radiographs. RESULTS: The reproducibility of the measuring technique was acceptable. There were significant differences between the T1 and T2 measurements within the implant group for the position of the maxillary central incisor (p<0.001), position of the maxillary molar (p=0.009) and position of the mandibular molar (p<0.001). There were significant differences within the headgear group for the position of the mandibular central incisor (p<0.045), position of the maxillary molar (p=<0.001) and position of the mandibular molar (p<0.001). All the skeletal and dental points moved mesially more in the headgear group during treatment than in the implant group. These ranged from an average of 0.5mm more mesial for the mandibular permanent molar to 1.5mm more mesial for the maxillary molar and mandibular base. None of the treatment changes between the implant and headgear groups were statistically significant. CONCLUSIONS: Mid-palatal implants are an acceptable technique for reinforcing anchorage in the orthodontic patient

Midpalatal implants vs headgear for orthodontic anchorage - a randomized clinical trial: Cephalometric results

OBJECTIVE: To compare the clinical effectiveness of the mid-palatal implant as a method of reinforcing anchorage during orthodontic treatment with that of conventional extra-oral anchorage. DESIGN: A prospective, randomized, clinical trial Setting: Chesterfield and North Derbyshire Royal Hospital NHS Trust and the Charles Clifford Dental Hospital, Sheffield. SUBJECTS AND METHODS: 51 orthodontic patients between the ages of 12 and 39, with a class II division 1 malocclusion and ‘absolute anchorage’ requirements were randomly allocated to either receive a mid-palatal implant or headgear to reinforce orthodontic anchorage. The main outcome of the trial was to compare the mesial movement of the molars and incisors of the two treatment groups between T1 (start) and T2 (end of anchorage reinforcement) as measured from cephalometric radiographs. RESULTS: The reproducibility of the measuring technique was acceptable. There were significant differences between the T1 and T2 measurements within the implant group for the position of the maxillary central incisor (p<0.001), position of the maxillary molar (p=0.009) and position of the mandibular molar (p<0.001). There were significant differences within the headgear group for the position of the mandibular central incisor (p<0.045), position of the maxillary molar (p=<0.001) and position of the mandibular molar (p<0.001). All the skeletal and dental points moved mesially more in the headgear group during treatment than in the implant group. These ranged from an average of 0.5mm more mesial for the mandibular permanent molar to 1.5mm more mesial for the maxillary molar and mandibular base. None of the treatment changes between the implant and headgear groups were statistically significant. CONCLUSIONS: Mid-palatal implants are an acceptable technique for reinforcing anchorage in the orthodontic patient