An orthodontic oral appliance: A randomized,controlled pilot study

Objective:This pilot study was performed to test the hypothesis that an orthodontic oral appliance (OA) that is designed to work against the backwardly directed forces on the upper incisors may counteract the reduction in overjet from these devices.Materials and Methods:Thirty patients with normal bites, good oral health, and milder sleep apnea were randomized to treatment with either OAs or orthodontic OAs. Bite changes were evaluated on plaster casts and radiographs and by questionnaires after a mean of 2.4 years in 19 frequent users.Results:Four of nine patients in the orthodontic OA group increased their overjet by ≥0.4 mm, while none of the 10 patients in the OA group experienced that effect.Conclusion:Only the orthodontic OA increases the overjet; this design may therefore be beneficial to patients at risk of negative effects on their bite during OA treatment.     

Effect of fixed orthodontic appliances on nonmicrobial salivary parameters

Objectives:To examine possible changes in the levels of salivary antioxidants, C-reactive protein (CRP), cortisol, pH, proteins, and blood in patients treated with fixed orthodontic appliances.Materials and Methods:Salivary samples from 21 orthodontic patients who met specific inclusion criteria were collected before the beginning of orthodontic treatment (T0; baseline), 1 hour after bonding (T1), and 4–6 weeks after bonding (T2). Oxidant-scavenging ability (OSA) was quantified using a luminol-dependent chemiluminescence assay. Cortisol and CRP levels were measured using immunoassay kits. pH levels and presence of proteins and blood in the samples were quantified using strip-based tests.Results:A significant decrease in salivary pH was observed after bonding (P = .013). An increase in oxidant-scavenging abilities during orthodontic treatment was detected, but the change was not statistically significant. Cortisol and CRP levels slightly increased after bonding, but the difference was small without statistical significance. Changes in the presence of proteins and blood were also insignificant.Conclusions:Exposure to fixed orthodontic appliances did not show a significant effect on salivary parameters related to inflammation or stress, with the exception of a significant but transient pH decrease after bonding.     

The effect of orthodontic bands or tubes upon periodontal status during the initial phase of orthodontic treatment

Introduction

Orthodontic bands cause periodontal inflammation. In theory, the use of a buccal tube (bond) instead of a band should prevent or minimize periodontal changes because the bonds are positioned away from the gingival margins.

Objective

The primary aim of this study was to investigate the periodontal status of orthodontic bands compared with bonds in the first three months of orthodontic treatment.

Materials and methods

Twenty-four orthodontic patients (mean age = 12.6 years) were enrolled in this Randomized Controlled Trial (RCT). Using the cross-mouth technique, bands and bonds were used in opposite quadrants. Periodontal parameters including the presence or absence of Bleeding On Probing (BOP) and Probing Depths (PDs) were taken at the start and three months into treatment.

Results

Bands caused a statistically significant change in the Bleeding On Probing (BOP) (P = 0.001 and 0.021) and bonds displayed a statistically insignificant change in the Bleeding On Probing (BOP) (P = 0.125 and 1.00) for the upper and lower arch. The difference in Probing Depths (PDs) between bands and bonds was also statistically significant (P = 0.001).

Conclusion

Molar bands are associated with greater periodontal inflammation compared with molar bonds in the first three months of fixed orthodontic treatment.     

正畸治疗中早期龋的防治

错畸形是仅次于龋病和牙周疾病的第三高发口腔疾病,随着文化和社会经济水平的不断提高,人们对正畸治疗的需求逐年增加。正畸固定矫治最常见的并发症——早期龋,已经严重挑战龋病预防和正畸治疗的美学效果,值得医患双方高度重视并采取有效的防治措施。     

Influence of exogenous pigmentation on the optical properties of orthodontic elastic ligatures

Objectives

The aim of this study was to assess the optical properties of orthodontic elastic ligatures under the influence of exogenous pigments contained in the daily diet.

Material and methods

For the analysis, colorless (clear) elastic segments (ORTHO Organizers, lot 660625A10) were used as received from the manufacturer, and were divided into 8 groups of 3 segments each. Each group was immersed in 200 mL of a solution containing a determined substance, as follows: distilled water (control group), Coca-Cola^®, Pomarola brand tomato sauce (Cica^®), açai, Jasmine^® brand green tea, Royal Blend^® black tea brand, Pilão^® brand coffee and Palmares^® wine brand. All test specimens were immersed in the solutions and kept in an appropriate receptacle for 7 days at 37ºC¹⁴. After the staining session, the test specimens were washed with distilled water in an ultrasonic vat for 5 min and dried with paper tissues⁶. The portable digital spectrophotometer Vita Easyshade Compact was used to assess if there was color variation of the test specimens. This variation was quantified and qualified at the initial time (T0) and after staining (T1).

Results

These results were analyzed statistically using the software SPSS version 18.0. The Shapiro-Wilk test of normality was applied followed by the one-way analysis of variance and the Tukey''s post hoc test. The level of significance adopted was 5%.

Conclusions

From the substances evaluated in this study, those with higher staining potential on esthetic elastic ligatures were black tea, coffee and wine, respectively. Knowing this information, the dentist may advise their patients to avoid certain foods because of elastic staining may occur thus decreasing the aesthetics of the material.     

国产无托槽隐形矫治技术的临床应用初探

目的 将我国自主研发的无托槽隐形矫治技术应用于口腔正畸临床,探讨该矫治器的临床应用情况、存在的问题以及应用前景.方法 选取41例较简单的错(牙合)畸形患者,主要包括牙列间隙、牙列拥挤以及牙周病止畸治疗,应用国产无托槽隐形矫治技术进行正畸治疗.通过层析扫描建立数字化三维牙颌模型,通过激光快速成形技术加工无托槽隐形矫治器,根据治疗方案,为每例患者设计10～40副矫治器.患者每2～3周更换一副矫治器,矫治后评估疗效.结果 所有病例均完成矫治并取得良好的矫治效果,矫治后牙列排齐、无间隙、前牙覆(牙合)覆盖正常,矫治疗程6～25个月,平均18个月.结论 目前,国产无托槽隐形矫治技术仅町矫治相对简单的错(牙合)畸形,并以其透明、美观、舒适、卫生等优点,而具有良好的临床应用前景.     

The use of a simple functional appliance as an adjunct to fixed appliance orthodontic treatment

Three clinical case studies are presented to demonstrate the use of a simple functional appliance in orthodontic situations not covered by traditionally-accepted dental and skeletal indications. In each case, the appliance was used to reduce the severity of the malocclusion, before a routine fixed-appliance detailing phase.     

Tip-Edge Plus直丝弓技术矫治Ⅱ类错(牙合)的临床应用初探

目的 通过观察Tip-Edge Plus直丝弓技术矫治的Ⅱ类错(牙合)患者颅面、牙(牙合)的特征性改变,探讨该技术的矫治要点.方法 应用Tip-Edge Plus直丝弓技术矫治12例(女性7例,男性5例,平均14.3岁)Ⅱ类错袷双颌或上颌前突患者.所有患者均拔除4颗第一前磨牙,按照Tip-Edge Plus 直丝弓技术矫治程序进行矫治,矫治前后行X线头影测量分析.结果 与矫治前相比,矫治后患者软组织侧貌改善明显,鼻唇角增大17.22°(P<0.01);上、下唇突距分别减少4.57 mm、3.72 mm(P<0.01);上、下切牙显著内收,突度分别减小4.73 mm、1.89mm(P<0.05).依靠口内支抗,矫治前后上颌支抗磨牙的移动仅为0.89 mm(P>0.05).结论 Tip-Edge Plus直丝弓技术利用口内支抗、细丝轻力,快速倾斜移动牙齿后简捷、准确转距并正轴的方法 ,可有效矫治Ⅱ类错(牙合)双颌或上颌前突患者.     

口腔正畸固定矫治中牙釉质脱矿的临床调查

目的：调查口腔正畸治疗后牙釉质脱矿的发病情况,并探讨对牙釉质脱矿的预防。方法：对90例使用固定矫治器正畸治疗患者治疗前后牙釉质脱矿情况进行观察,并对牙釉质脱矿牙的发病率和好发牙及好发部位进行统计。结果：58例固定矫治患者发生不同程度牙釉质脱矿,发病率为64．4％;牙釉质脱矿好发牙位为上前牙;好发部位是托槽龈方釉质和牙颈部。结论：固定矫治对牙釉质的脱矿损害应引起重视。矫治前应对其可能的危害因素进行充分估计,并采取措施减少固定矫治引起牙釉质脱矿的发生率。     

氟涂料用于固定矫治后釉质脱矿再矿化治疗的效果

目的评价氟浓度为2.26 mg/mL的氟涂料应用于正畸固定矫治后釉质脱矿再矿化治疗的临床效果。方法对正畸固定矫治结束并拆除托槽的患者进行牙釉质脱矿状况检查,选择符合纳入标准的110例受试者,随机分为2组,试验组在脱矿牙面上涂布氟涂料,对照组在脱矿牙面上涂布蒸馏水,每个月1次,持续6个月,在拆除托槽当天（基线）和拆除托槽3个月、6个月分别对唇颊面釉质脱矿区域进行临床视诊检查,使用临床视诊指数进行评分。结果基线、3个月、6个月时试验组的视诊指数分别为（2.22±0.42）分、（2.18±0.43）分、（2.15±0.41）分;对照组的视诊指数分别为（2.15±0.36）分、（2.14±0.38）分、（2.14±0.38）分。基线（t=2.470,P=0.228）、拆除托槽3个月（t=0.651,P=0.516）及6个月（t=0.149,P=0.882）试验组与对照组的差异均没有统计学意义。试验组的临床视诊指数在拆除托槽3个月、6个月与基线比较差异均有统计学意义（P＆lt;0.05）,但第3个月与第6个月的差异没有统计学意义（t=1.860,P=0.083）。结论应用2.26 mg/mL的氟涂料对固定矫治后出现的釉质脱矿进行再矿化治疗后,牙釉质脱矿程度有所降低,但再矿化效果不够显著。     

Meta-analysis on the mandibular dimensions effects of the MARA appliance in patients with Class II malocclusions

Objectives:To evaluate the short- and long-term effects of the mandibular anterior repositioning appliance (MARA) on mandibular dimensions in patients with Class II malocclusion and to assess the stability of the MARA results.Materials and Methods:Multiple electronic databases were searched for articles published in any language until March 2014. A manual search was also performed of reference lists of retrieved articles. The primary outcomes were the short-and long-term effects of the MARA appliance on mandible dimensions. The secondary outcome was postretention stability. Outcome measures were total mandibular unit length, corpus length, and ramus height. Two reviewers examined all articles independently and assessed their methodologic quality. Meta-analyses were conducted using random-effects models. The Cochrane test and the I² statistic were used to assess heterogeneity. Sensitivity analyses were performed and publication bias was evaluated.Results:Seven retrospective clinical controlled studies that compared MARA with controls were included. Three of the studies were medium quality; the rest were low quality. Meta-analysis of the short-term effects revealed a significant increase in total mandibular unit length (1.16 mm/y) and ramus height (1.58 mm/y) with MARA and a nonsignificant increase in corpus length (0.21 mm/y). Analyses of the long-term effects showed a statistically significant advantage of MARA over controls for all three variables, but the effect sizes were small. More high-quality studies are warranted.Conclusions:The MARA appliance produced statistically significant mandibular growth enhancement in the short- and long-term. These findings, however, may not be clinically significant.     

Influence of second-order bracket-archwire misalignments on loads generated during third-order archwire rotation in orthodontic treatment

Objective:To investigate the influence of a rotational second-order bracket-archwire misalignment on the loads generated during third-order torque procedures. Specifically, torque in the second- and third-order directions was considered.Materials and Methods:An orthodontic torque simulator (OTS) was used to simulate the third-order torque between Damon Q brackets and 0.019 × 0.025-inch stainless steel archwires. Second-order misalignments were introduced in 0.5° increments from a neutral position, 0.0°, up to 3.0° of misalignment. A sample size of 30 brackets was used for each misalignment. The archwire was then rotated in the OTS from its neutral position up to 30° in 3° increments and then unloaded in the same increments. At each position, all forces and torques were recorded. Repeated-measures analysis of variance was used to determine if the second-order misalignments significantly affected torque values in the second- and third-order directions.Results:From statistical analysis of the experimental data, it was found that the only statistically significant differences in third-order torque between a misaligned state and the neutral position occurred for 2.5° and 3.0° of misalignment, with mean differences of 2.54 Nmm and 2.33 Nmm, respectively. In addition, in pairwise comparisons of second-order torque for each misalignment increment, statistical differences were observed in all comparisons except for 0.0° vs 0.5° and 1.5° vs 2.0°.Conclusion:The introduction of a second-order misalignment during third-order torque simulation resulted in statistically significant differences in both second- and third-order torque response; however, the former is arguably clinically insignificant.     

Interventions for pain during fixed orthodontic appliance therapy: A systematic review

Objective:To compare the different methods of pain control intervention during fixed orthodontic appliance therapy.Materials and Methods:A computerized literature search was performed in MEDLINE (1966–2009), The Cochrane Library (Issue 4, 2009), EMBASE (1984–2009), and CNKI (1994–2009) to collect randomized controlled trials (RCTs) for pain reduction during orthodontic treatment. Data were independently extracted by two reviewers and a quality assessment was carried out. The Cochrane Collaboration''s RevMan5 software was used for data analysis. The Cochrane Oral Health Group''s statistical guidelines were followed.Results:Twenty-six RCTs were identified and six trials including 388 subjects were included. Meta-analysis showed that ibuprofen had a pain control effect at 6 hours and at 24 hours after archwire placement compared with the placebo group. The standard mean difference was −0.47 and −0.48, respectively. There was no difference in pain control between ibuprofen, acetaminophen, and aspirin. Other analgesics such as tenoxicam and valdecoxib had relatively lower visual analog scale (VAS) scores in pain perception. Low-level laser therapy (LLLT) was also an effective approach for pain relief with VAS scores of 3.30 in the LLLT group and 7.25 in the control group.Conclusions:Analgesics are still the main treatment modality to reduce orthodontic pain despite their side effects. Some long-acting nonsteroidal anti-inflammatory drugs (NSAIDs) and cyclo-oxygenase enzyme (COX-2) inhibitors are recommended for their comparatively lesser side effects. Their preemptive use is promising. Other approaches such as LLLT have aroused researchers'' attention.     

Influence of chewing time on salivary stress markers

PurposeWe investigated the influence of chewing time on salivary stress markers.MethodsParticipants performed arithmetic calculations for 30 min as stress loading, followed by chewing for 0, 5, 10, or 15 min. All experiments finished at 25 min after stress loading. With 0-min chewing, saliva was collected before stress loading (BS), immediately after stress loading (R0), and at 5, 10, 15, and 25 min after stress loading (R5, 10, 15 and 25). With 5, 10, or 15 min chewing, saliva was collected at BS and R0, immediately after chewing (Ch5, 10 and 15, respectively), and 25 min after stress loading (Ch5R25, Ch10R25 and Ch15R25, respectively). Salivary alpha-amylase activity and cortisol levels were measured to evaluate stress. Change in stress markers between R0 and Ch5, 10 and 15 or R25, Ch5R25, Ch10R25 and Ch15R25 were calculated.ResultsNo significant differences were observed in rate of change in alpha-amylase activity among the chewing conditions. Rate of decrease in cortisol levels was significantly greater at 15-min chewing than at 5-min chewing. Rate of decrease in cortisol levels was significantly greater at 10 and 15-min chewing than at 0-min chewing.ConclusionThe present results indicate that chewing time affects the reaction of the endocrine system to mental stress, and that continuous chewing for more than 10 min is effective in reducing stress.     

与正畸治疗有关的牙根尖吸收的影响因素研究

目的 对正畸治疗中牙根尖吸收的影响因素进行研究,为矫治前根尖吸收预测提供临床参考。方法 选取北京口腔医院正畸科临床病例60例,进行性别、疗程、ANB、下颌平面角、矫治前后的上中切牙根尖移动的距离和牙轴倾斜度变化等因素与矫治后上颌中切牙根尖吸收程度的相关性分析。结果疗程、上中切牙倾斜度的变化、上中切牙根尖在垂直向上的移动距离与根尖吸收有显著相关,可以解释48％的根尖吸收量的变异。结论治疗因素能为矫治前预测根尖吸收的严重程度提供参考,但根尖吸收还有许多不确定的个体因素存在。     

Effect of fixed orthodontic appliances on salivary microbial parameters at 6 months: a controlled observational study

Objective

The aim of this study was to assess the microbial changes in children with fixed orthodontic appliances compared with a control group of children without orthodontic treatment.

Material and Methods

Ninety-five children, aged between 12 and 16 years, participated in this study. Forty-eight subjects were fitted with fixed orthodontic appliances and forty-seven were free of any such appliances. The follow-up was 6 months for all children. The association between orthodontic appliances and high levels of Streptococcus mutans and Lactobacillus spp was assessed with logistic regression models, taking age, sex, pH and buffer capacity into account.

Results

Differences at baseline between the two groups were not statistically significant. We found that wearing a fixed orthodontic appliance was associated with high levels of Streptococcus mutans and Lactobacillus spp (adjusted OR: 6.65, 95% CI [1.98-22.37]; 9.49, 95% CI [2.57-35.07], respectively), independently of other variables.

Conclusion

The originality of the present epidemiological study was to evaluate the evolution of salivary microbial parameters in a population of children with fixed orthodontic appliances. Our results show an increase of Streptococcus mutans and Lactobacillus spp values during the follow-up. The whole dental workforce should be aware that preventive measures are of paramount importance during orthodontic treatment.     

电话回访对青少年患者正畸治疗保持阶段依从性的影响

目的：探讨提高青少年患者正畸治疗保持阶段依从性的有效方法。方法将80例正畸固定矫治结束后配戴活动保持器的青少年患者随机平均分为对照组和干预组,分别进行椅旁健康教育和电话回访,比较两组患者在保持阶段的依从性。结果保持初期（1～6个月）,两组患者的依从性均较高,除复诊率外,各项差异均无统计学意义（P＞0.05）。保持中后期（7～18个月）,两组患者的依从性均逐步降低,对照组明显低于干预组;保持器的损坏/丢失率以及畸形复发率却呈上升趋势,对照组明显高于干预组,差异有统计学意义（P＜0.05）。结论保持阶段是青少年正畸矫治的重要环节,电话回访有助于提高正畸青少年患者保持阶段的依从性,是青少年患者正畸治疗保持成功的关键。     

多乐氟在正畸治疗中对牙釉质脱矿的影响

目的：评价多乐氟在正畸固定矫治中对釉质脱矿的预防作用。方法选择接受正畸固定矫治的患者56例,采用自身对照,粘接托槽后,将患者牙齿以中线为界,左侧牙设为试验组（包括21、22、23、24、31、32、33、34）,右侧牙设为对照组（包括11、12、13、14、41、42、43、44）,共观察896颗牙（每组448颗牙）,试验组每3个月在托槽和带环周围牙面涂布多乐氟,对照组不做处理。分别在治疗开始后第6、12个月时对受试牙进行检查,观察牙面釉质脱矿的发生率及脱矿指数。结果正畸开始前试验组和对照组的脱矿率和脱矿程度比较差异均无统计学意义（P＞0.05）;在固定矫治6个月后对照组脱矿率较试验组高,两组间差异无统计学意义（P＞0.05）,但脱矿程度对照组高于试验组;矫治12个月后,对照组的脱矿率和脱矿程度均高于试验组程度（P＜0.05）。结论多乐氟对固定正畸过程中釉质脱矿具有预防作用。