Do fixed orthodontic appliances adversely affect the periodontium? A systematic review of systematic reviews

This overview aimed to summarize the available systematic reviews that assess the effects of treatment with fixed orthodontic appliances (FOAs) on the periodontium. Unrestricted electronic search of nine databases and additional manual searches were performed up to January 2019. Systematic reviews and meta analyses that assessed the effect of FOAs on the periodontal parameters were included. The methodological quality of the included reviews was evaluated using the A Measurement Tool to Assess Systematic Reviews2 (AMSTAR 2). The initial search yielded 2529 articles from which 19 were included in the current study. AMSTAR 2 scores ranged from critically low to high quality. The quality of evidence ranged from very low to low. The superiority of the periodontal outcomes of self-ligating brackets over conventional brackets could not be proven. The available evidence regarding the effects of FOAs on the periodontium is controversial and of very low quality. The short-term effects of FOAs were temporary worsening the periodontal parameters. Some conclusions regarding the periodontal outcomes of self-ligating brackets could be withdrawn. Future high-quality trials are required. The review was registered at the International prospective register of systematic reviews with registration number CRD42018106662.     

Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference?

van der Veen MH, Attin R, Schwestka‐Polly R, Wiechmann D. Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference? Eur J Oral Sci 2010; 118: 298–303.©2010 The Authors. Journal compilation © 2010 Eur J Oral Sci Orthodontic treatment with fixed appliances is considered a risk factor for the development of white spot caries lesions (WSL). Traditionally, brackets are bonded to the buccal surfaces. Lingual brackets are developing rapidly and have become more readily available. Buccal surfaces are considered to be more caries prone than lingual surfaces. Furthermore, lingual brackets are shaped to fit the morphology of the teeth and seal almost the entire surface. In the present study we tested the hypothesis that lingual brackets result in a lower caries incidence than buccal brackets. We tested this hypothesis using a split‐mouth design where subjects were allocated randomly to a group receiving either buccal or lingual brackets on the maxillary teeth and the alternative bracket type in the mandible. The results indicate that buccal surfaces are more prone to WSL development, especially when WSL existed before treatment. The number of WSL that developed or progressed on buccal surfaces was 4.8 times higher than the number of WSL that developed or progressed on lingual surfaces. When measured using quantitative light‐induced fluorescence (QLF), the increase in integrated fluorescence loss was 10.6 times higher buccally than lingually. We conclude that lingual brackets make a difference when caries lesion incidence is concerned.     

How to … manage the transition from functional to fixed appliances

Abstract

This paper presents the methods of transfer from functional to fixed appliances. The aim of transition should be maintenance of Class II correction in a time-efficient manner without compromising long-term patient co-operation.     

Effects of fixed appliances in correcting Angle Class?II on the depth of the posterior airway space

Objective

The objective of this retrospective study based on the metric evaluation of lateral cephalograms was to investigate the extent to which treatment with two different fixed appliances for the correction of Angle Class?II influenced the morphology of the extrathoracic airway space (the posterior airway space, PAS).

Patients and methods

A total of 43?patients with Angle Class?II malocclusion were classified into two groups according to the appliance used for treatment: the functional mandibular advancer (FMA; n?=?18) or the Herbst appliance (n?=?25). Lateral cephalograms were taken of each patient at the start of functional jaw orthopedic treatment (time point T1) and at its completion (time point T2). Specific distances and angles were measured and analyzed in a cephalometric analysis.

Results

We observed major differences among the 43?patients in the depth of the posterior airway space during treatment with fixed appliances for Angle Class?II correction. Regression analysis revealed that changes in sagittal and vertical positions had different effects on the depth of specific PAS sections: increases in anterior facial height are associated proportionately with increases in PAS width, particularly in the upper region. On the other hand, increases in posterior facial height and in the mandible??s forward displacement correlated inversely to the decreases in depth, particularly in the central and lower PAS regions. The two treatment appliances (FMA, Herbst appliance) had the same effects on extrathoracic airway depth.

Conclusions

Analyses of lateral cephalograms indicate that Angle Class?II treatment with fixed appliances does not prevent sleep apnea in patients at risk. Nevertheless, this study does not permit absolutely reliable conclusions about the dimensions of the pharyngeal airway space. As the lateral cephalogram provides good images of structures in the midsagittal plane but is incapable of imaging the transverse dimension, there is an automatic lack of information concerning the precise width and volume of the extrathoracic airway space.     

The modified “Wunderer” osteotomy for stabilization of the cleft-premaxilla – A new operative technique

The operative closure of bilateral cleft lip and palate is a difficult procedure that requires in most cases secondary corrections. Besides aesthetic improvements of lip and nose also the rehabilitation of the teeth, in particular of the maxillary arch is important for the improvement of the chewing function and also for the well being of the patient. One of the most disturbing factors for the construction of any type of prosthetic devices, like removable denture, fixed bridge or dental implants is the mobility and often also malposition of the premaxilla. This problem can only be solved by the insertion of bone grafts into the bilateral gaps of the anterior maxillary arch. This procedure however, is difficult due to the narrowness and poor overview that complicates the closure of the nasal mucosa, which is the precondition for the success. For facilitating the operation the premaxilla is osteotomized and reflected anteriorly according to the method of Wunderer (1962). Then, after the much easier closure of the nasal mucosa the bony defects can be filled with autogenous cancellous bone and finally the oral mucosa can be closed. A preoperatively prepared palatal acrylic plate helps to protect the palatal tissue and also stabilizes the position of the premaxilla. The blood supply to the osteotomized premaxilla is secured by a sound soft tissue pedicle of the buccal muco-periosteum. The effectiveness of the blood supply of the premaxilla was examined in experimental studies by several authors. Also investigations of the growth impediments of the premaxilla and the midface revealed that early osteotomies will interfere with the development of this region. Therefore it is advisable to carry out this procedure not before the patient has reached the age of 12–14 years, which is also depending on the race and the gender of the patient.     

Class II malocclusion treatment using combined Twin Block and fixed orthodontic appliances – A case report

The effect of the Twin Block functional orthodontic appliances is mostly dento-alveolar with small skeletal effect. There are certain clinical indications where functional appliances can be used successfully in class II malocclusion e.g. in a growing patient. The use of these appliances is greatly dependent on the patient’s compliance and they simplify the fixed appliance phase. In this case, a 13-year old adolescent was treated with Twin Block appliance followed by fixed appliance to detail the occlusion. The design and treatment effects were demonstrated in this case report.     

Molar bands for ‘precision’ bonding of lingual retainers

Abstract

Bonded retainers have been used principally for long-term retention of treated cases. Various methods of bonding lingual retainers have been described in the literature over the past two decades. However, accurate and passive placement of retainers has always been a matter of concern. This report presents a simple and economical method for accurate and passive placement of bonded lingual retainers that enables the operator to save considerable chair time.     

Is lingual nerve protection necessary for lower third molar germectomy? A prospective study of 300 procedures

Lingual nerve damage is one of the most common complications of lower third molar removal. However evaluation of the factor involved in these lesions is difficult since most previous series are heterogeneous. The purpose of this prospective randomized study was to ascertain the impact of lingual nerve protection in a homogeneous series including only patients undergoing third molar germectomy (i.e. removal of the developmental bud prior to anchoring of the roots in the jaw). Data from a total of 300 germectomy procedures were included in this study. All procedures were performed by the same experienced surgeon randomly with or without lingual nerve protection. No lingual nerve injury was observed after third molar germectomy regardless of whether or not lingual nerve protection was used. Lingual nerve protection is unnecessary for lower third molar germectomy.     

Pendulum and modified pendulum appliances for maxillary molar distalization in Class II malocclusion – a systematic review

Objective: The main purpose of the present systematic review was to evaluate the quantitative effects of the pendulum appliance and modified pendulum appliances for maxillary molar distalization in Class II malocclusion.

Materials and methods: Our systematic search included MEDLINE, EMBASE, CINAHL, PsychINFO, Scopus and key journals and review articles; the date of the last search was 30 January 2017. We graded the methodological quality of the studies by means of the Quality Assessment Tool for Quantitative Studies, developed for the Effective Public Health Practice Project (EPHPP).

Results: In total, 203 studies were identified for screening, and 25 studies were eligible. The quality assessment rated four (16%) of the study as being of strong quality and 21 (84%) of these studies as being of moderate quality. The pendulum appliances showed mean molar distalization of 2–6.4?mm, distal tipping of molars from 6.67° to 14.50° and anchorage loss with mean premolar and incisor mesial movement of 1.63–3.6?mm and 0.9–6.5?mm, respectively. The bone anchored pendulum appliances (BAPAs) showed mean molar distalization of 4.8–6.4?mm, distal tipping of molars from 9° to 11.3° and mean premolar distalization of 2.7–5.4?mm.

Conclusions: Pendulum and modified pendulum appliances are effective in molar distalization. Pendulum appliance with K-loop modification, implant supported pendulum appliance and BAPA significantly reduced anchorage loss of the anterior teeth and distal tipping of the molar teeth.     

Clinical Applications of the TMJ Scale™

The clinical use of the TMJ Scale? with individual patients having TM disorders is described using several case examples. Areas of predicted physical and psychosocial dysfunction using this test agree well with history and clinical examination results in these patients. The case examples demonstrate the capability of the TMJ Scale to detect and describe the multidimensional symptom state found in individual patients having complex TM disorders.     

Efficacy of fluoride varnish for preventing white spot lesions and gingivitis during orthodontic treatment with fixed appliances—a prospective randomized controlled trial

Objectives

The development of white spot lesions around orthodontic brackets and gingivitis is a common problem during orthodontic treatment with fixed appliances. This prospective randomized double-blind controlled clinical trial investigated the preventive efficacy of a one-time application of two commonly used fluoride varnishes in patients with low to moderate caries risk.

Materials and methods

Ninety adolescent orthodontic patients with a low to moderate caries risk were prospectively randomized to three groups of 30 patients each: (1) standardized dental hygiene with fluoride toothpaste and one-time application of placebo varnish (control) or (2) of elmex® fluid or (3) of Fluor Protector S on all dental surfaces at the start of fixed therapy. The extent of enamel demineralization and gingivitis was determined with the ICDAS and the gingivitis index (GI) at baseline and after 4, 12, and 20 weeks.

Results

Each treatment group showed a significant increase of the ICDAS index, but not of the GI over the course of time with no significant intergroup differences detectable.

Conclusions

A one-time application of fluoride varnish at the start of orthodontic treatment did not provide any additional preventive advantage over sufficient dental hygiene with fluoride toothpaste with regard to formation of white spots and gingivitis in patients with a low to moderate caries risk.

Clinical relevance

In dental practice, patients often receive an application of fluoride varnish at the start of orthodontic treatment with fixed appliances. However, the efficacy of this procedure is still unclear.

     

FTIR characterization of the setting reaction of biodentine™

Objective

To provide insight of the setting reactions of Biodentine?, a hydraulic calcium silicate cement, based upon observations using Fourier Transform Infra-Red (FTIR) spectroscopy.

Simple hemoglobin–gold nanoparticles modified electrode for the amperometric detection of acrylamide

In this work we propose the design of an electrochemical setup (hemoglobin–gold-nanoparticles–ITO glass), used for the determination of a hemoglobin adduct (acrylamide). Acrylamide is neurotoxin and potential carcinogen, formed mainly in high temperatures processed food that contains large quantity of starch (French fries, baked bread). Acrylamide forms hemoglobin adducts, and our sensing device is based on this property, by passivating the hemoglobin-modified electrode by the addition of low concentrations of acrylamide. The sensitivity to acrylamide better as 0.1 μM makes this electrochemical cell configuration suitable for the detection of acrylamide in food products.     

Clinical Application and Effects of the Forsus™ Spring A Study of a New Herbst Hybrid

BACKGROUND: The best known of the fixed functional appliances are the Herbst appliance and the Jasper Jumper. The Forsus spring is a new development which has been tested in a clinical study to establish when it can be used and to compare it with its predecessors. PATIENTS AND METHOD: The Forsus spring was used over a period of 4 months to treat 13 patients with an average age of 14.2 years with Class II malocclusion. RESULTS: Evaluation of the lateral cephalograms showed that dental effects accounted for 66% of the sagittal correction. The sagittal occlusal relations were improved by approximately 3/4 of a cusp width to the mesial on both the right and left side as a result of distal movement of the upper molars and mesial movement of the lower molars. Retrusion of the upper and protrusion of the lower incisors reduced the overjet by 4.6 mm. Intrusion and protrusion of the lower incisors reduced the overbite by 1.2 mm. The occlusal plane was rotated by 4.2 degrees in clockwise direction as a result of intruding the lower incisors and the upper molars. The maxillary and mandibular arches were expanded at the front and rear during treatment.--Evaluation of a questionnaire filled in by the patients after 2 months of treatment showed that approximately half of them had experienced difficulties in brushing their teeth. The main problem, however, was the restriction experienced in the ability to yawn. Overall, two thirds of the adolescents found the Forsus spring better than the appliance previously used to correct their Class II malocclusion, such as headgear, activator or Class II elastics. CONCLUSION: The Forsus spring has stood the test in clinical application. It is a good supplement to the Class II appliance systems already available.     

Precision of indirect bonding of lingual brackets using the Quick Modul System (QMS)®

Objectives

Almost all common laboratory procedures for lingual orthodontic appliances use indirect bonding of brackets via transfer trays. Ensuring precise transfer of these bracket positions to the oral cavity is especially important, as subsequent manual adjustments are challenging in lingual orthodontics and even minor errors of bracket placement may result in considerably deviating tooth positions. The purpose of this study was to evaluate in vivo the precision of indirect bonding of lingual brackets using the “Quick Modul System” (QMS®; Halbich Lingualtechnik, Berlin, Germany).

Materials and methods

The study included eight consecutive patients treated with lingual brackets. After placing the brackets on a setup cast, the resultant positions were digitized with an optical scanner (OraScanner®; OraMetrix, Richardson, TX, USA). Individual transfer copings (QMS®) were used to transfer the brackets to the mouth, followed by intraoral scanning and virtual superimposition to analyze how much the intraoral bracket positions deviated from the positions on the cast.

Results

Translational deviations added up to a mean transfer error of 0.12 mm in the mesiodistal, 0.13 mm in the orovestibular, and 0.10 mm in the vertical planes. Mean deviations in rotational directions amounted to 2.20° of inclination, 3.21° of angulation, and 2.29° of rotation.

Conclusion

The transfer system investigated in this study is capable of transferring bracket positions with good clinical precision. No differences between the bracket types and both modifications of the transfer copings were noted.