Patient compliance with Hawley retainers fitted with the SMART® sensor: A prospective clinical pilot study

Objective:To evaluate the compliance of patients while wearing maxillary Hawley retainers embedded with SMART microsensors.Methods:The sample population consisted of 22 patients who were divided into an experimental (group A) and a control group (group B). Group A was informed that they would be monitored through the use of SMART microsensors, while group B was not informed that they would be monitored. After the delivery of the retainers (T0), the patients were evaluated at T1 and T2, represented by 6- and 12-week follow-up visits, respectively. At T1, group B was informed of our ability to monitor their compliance. Both groups continued wearing their retainers during T1 to T2.Results:During T0–T1, Group A wore their retainers for an average of 16.3 hours (SD 4.39), while group B wore their appliances for an average of 10.6 hours (SD 5.36, t  =  2.426, P  =  .027). Although group B increased their retainer wear by 0.5 hours/day from T1 to T2, this increase was not statistically significant.Conclusions:Despite significant differences being noted between the two groups at T1, group B did not show significant mean changes in their wear time before and after becoming aware of the use of the SMART microsensor.     

Impact of wearing fixed orthodontic appliances on quality of life among adolescents: Case-control study

Objective:To investigate the impact of wearing a fixed orthodontic appliance on oral health-related quality of life (OHRQoL) among adolescents.Materials and Methods:A case-control study (1∶2) was carried out with a population-based randomized sample of 327 adolescents aged 11 to 14 years enrolled at public and private schools in the City of Brumadinho, southeast of Brazil. The case group (n  =  109) was made up of adolescents with a high negative impact on OHRQoL, and the control group (n  =  218) was made up of adolescents with a low negative impact. The outcome variable was the impact on OHRQoL measured by the Brazilian version of the Child Perceptions Questionnaire (CPQ_11–14) – Impact Short Form (ISF:16). The main independent variable was wearing fixed orthodontic appliances. Malocclusion and the type of school were identified as possible confounding variables. Bivariate and multiple conditional logistic regressions were employed in the statistical analysis.Results:A multiple conditional logistic regression model demonstrated that adolescents wearing fixed orthodontic appliances had a 4.88-fold greater chance of presenting high negative impact on OHRQoL (95% CI: 2.93–8.13; P < .001) than those who did not wear fixed orthodontic appliances. A bivariate conditional logistic regression demonstrated that malocclusion was significantly associated with OHRQoL (P  =  .017), whereas no statistically significant association was found between the type of school and OHRQoL (P  =  .108).Conclusions:Adolescents who wore fixed orthodontic appliances had a greater chance of reporting a negative impact on OHRQoL than those who did not wear such appliances.     

Analysis of the effect of CPP-ACP tooth mousse on enamel remineralization by circularly polarized images

Objective:To evaluate the effect of casein phosphopeptide–amorphous calcium phosphate tooth mousse on the remineralization of bovine incisor by circularly polarized images.Methods:Eighty bovine incisors, each with a 4 × 4 mm artificially demineralized area, were used. The samples were divided into four groups: Group A, casein phosphopeptide–amorphous calcium phosphate tooth mousse; Group B, fluoride toothpaste; Group C, casein phosphopeptide–amorphous calcium phosphate tooth mousse and fluoride toothpaste; and Group D, no treatment. Circularly polarized images were taken after the specimens were treated for 3, 6, 9, or 12 weeks, and the size of the demineralized area and the mean grey level were measured. Data analysis was done using repeated measures variance analysis. Pearson correlation coefficients were computed to evaluate the correlation between the size of the demineralized area and the mean grey level.Results:In all four groups, the size of the demineralized area and the mean grey level declined with time. The size of the demineralized area of Group C was significantly smaller than that of Group A at the end of the third and sixth weeks (P  =  .039, P  =  .000, respectively), and the mean grey level of Group C was lower than that of Group A at the end of the 6th and 12th weeks (P  =  .037, P  =  .004, respectively). At the end of the 6th, 9th, and 12th weeks, the size of the demineralized area of Group C was smaller (P  =  .000, P  =  .005, P  =  .005, respectively) and the mean grey level was lower (P  =  .000) than those of Group B. No statistically significant correlations were detected between the size of the demineralized area and the mean grey level.Conclusion:Casein phosphopeptide–amorphous calcium phosphate tooth mousse can reduce the size and mean grey level of demineralized areas and promote the remineralization of bovine enamel. Combined application with fluoride toothpaste strengthens the effect.     

CBCT of skeletal changes following rapid maxillary expansion to increase arch-length with a development-dependent bonded or banded appliance

Objective:To assess the three-dimensional (3D) skeletal response to a standardized 5 mm of rapid maxillary expansion (RME) in growing children (6–15 years) with maxillary width deficiency and crowding.Materials and Methods:A bonded appliance was used prior to the eruption of the maxillary first premolars (Mx4s), and a banded appliance was used thereafter. A consecutive sample of 89 patients (29 boys and 60 girls) from a large pediatric dentistry and orthodontics practice was divided into four groups: 1) 6–8 years old (n  =  26), 2) 9–11 years old with unerupted Mx4s (n  =  21), 3) 9–11 years with erupted Mx4s (n  =  23), and 4) 12–15 years (n  =  19). For all patients, the 3D evaluation of dental and skeletal effects was performed with cone-beam computed tomography (CBCT).Results:For both appliances in all patients, CBCT confirmed a triangular pattern of expansion in both the frontal and sagittal planes. Overall, both appliances produced significant maxillary expansion (>80% of the 5-mm activation), but older children showed a progressively more dental (less skeletal) response. Comparison of the two types of expanders in the crossover sample, children aged 9–11 years, showed that the bonded RME produced the most efficient skeletal expansion in the preadolescent sample. Increased maxillary width at the level of the zygomaticomaxillary suture was the best indicator for development of maxillary arch circumference.Conclusion:Development-dependent appliances (bonded RPE before Mx4s erupt, and a banded device thereafter) provided optimal RME treatment for all children from age 6–15 years.     

Assessing anteroposterior basal bone discrepancy with the Dental Aesthetic Index

Objective:To investigate dental appearance and cephalometric features, using a sample of orthognathic and/or orthodontic patients. A special interest was to identify the relationship of the Dental Aesthetic Index (DAI) with anteroposterior basal bone discrepancy (APBBD) and cephalometric indicators.Materials and Methods:A full sample of 159 patients in two Japanese hospitals was used. Each patient was assessed with a preorthodontic dental cast and cephalometric radiography.Results:Malocclusion with APBBD was more prevalent among high DAI subjects (P  =  .034, OR  =  1.04, 95% CI: 1.00–1.08), Class III malocclusion patients (P  =  .048, OR  =  2.32, 95% CI: 1.01–5.34) and male patients (P  =  .008, OR  =  2.96, 95% CI: 1.33–6.61). Participants scoring 88 points (the highest score in this sample) of the DAI had 16.84 times the risk of APBBD of those who scored 17 points (the lowest score in this sample). Patients with APBBD presented with a greater adjusted ANB angle (t  =  −8.10, P < .001) and a larger adjusted A-B/NF appraisal (t  =  −9.65, P < .001). The SNA angle (P < .001), the SNB angle (P  =  .002), the adjusted ANB angle (P  =  .001), and the adjusted A-B/NF appraisal (P  =  .035) were associated with DAI scores in cubic regression models.Conclusion:This study has demonstrated a relationship between the DAI and APBBD. Feasibility of using the adjusted ANB angle and the adjusted A-B/NF appraisal to assess severity of APBBD has been confirmed. The DAI may provide a supportive method to evaluate orthognathic needs. Future investigations are indicated.     

Bone- and dentoalveolar-anchored dentofacial orthopedics for Class III malocclusion: New approaches,similar objectives?: A systematic review

Objectives:To analyze the scientific literature and compare in the results of conventional orthopedic appliances with those obtained from recent bone-anchored orthopedics for Class III malocclusion.Materials and Methods:The literature was systematically reviewed using PubMed/Medline, Scopus, and Scirus databases up to January 2012. Articles were selected by two different researchers (kappa index  =  0.83), based on established inclusion/exclusion criteria. Methodologic quality was classified as high, medium, or low quality.Results:The search strategy identified 1020 titles. Thirty studies were selected after applying the criteria (high quality  =  9, medium quality  =  21). Protraction rates differed within a range of one- to twofold between bone-anchored and dentoalveolar therapies (P < .001). All studies noted the effect of clockwise rotation on the mandible and an increase in inferior-anterior and total facial height; this was more obvious in dentoalveolar therapy than in bone-anchored orthopedics (P < .001).Conclusions:Dental parameters like overjet increased significantly with both sets of groups, ranging from 1.7 to 7.9 mm with dentoalveolar therapy and from 2.7 to 7.6 mm with bone-anchored orthopedics.     

Comparisons of soft tissue chin thickness in adult patients with various mandibular divergence patterns

Objective:To evaluate the association between soft tissue at the chin (STC) thickness and mandibular divergence.Materials and Methods:Nongrowing patients seeking orthodontic treatment (n  =  190; 113 women and 77 men), who had an average age of 26.94 years (range  =  18.10–53.50 years), were stratified in four subgroups based on cephalometric mandibular plane inclination to anterior cranial base (MP/SN): low  =  MP/SN ≤ 27° (n  =  48); medium-low  =  27° < MP/SN ≤ 32° (n  =  60); medium-high  =  32° < MP/SN < 37° (n  =  37); and high  =  MP/SN ≥ 37° (n  =  45). The STC thicknesses were measured at pogonion (Pog), gnathion (Gn), and menton (Me). Group differences were evaluated with two-way analysis of variance and Student''s t-test. The Pearson product moment correlation gauged associations between parameters.Results:The STC values were greater in men than women (P < .02) and were smaller in the high group (7.47 ± 2.42 mm) than in all other groups at Gn (mean values  =  9.00 mm < STC < 9.58 mm; P < .001) and at Me (high group  =  6.30 ± 1.89 mm; other groups  =  7.15 mm < STC< 7.57 mm; P  =  .011).Conclusion:The STC is thinner at Gn and Me in hyperdivergent facial patterns, apparently in contrast to Pog. This differential thickness warrants focused research as it implies that it is possible (1) to vertically grow hard tissues impinging on the inferior soft tissue envelope in patients with severe hyperdivergence and (2) to plan for genioplasty in such patients when more advancement of the chin might be needed to compensate for the increased vertical height.     

A prospective randomized split-mouth study on pain experience during chairside archwire manipulation in self-ligating and conventional brackets

Objective:To investigate patient discomfort during archwire engagement and disengagement in patients treated with self-ligating and conventional brackets using a split-mouth design.Materials and Methods:Eighteen consecutive patients (15 female, 3 male; age: 22.2 ± 6.4 years) who requested treatment with fixed orthodontic appliances were randomly assigned for bonding with SmartClip self-ligating brackets on one side of the dentition and conventional standard edgewise brackets on the other. During the course of treatment, patients rated the discomfort experienced during every archwire engagement and disengagement using a numeric rating scale. Results were evaluated for round and rectangular nickel titanium and rectangular stainless steel, titanium molybdenum, and Elgiloy archwires. Patients also rated their overall experience retrospectively for both bracket systems.Results:Regardless of archwire type, disengagement was rated as being significantly more painful on the SmartClip side (P  =  .027). For rigid, rectangular archwires, engagement and disengagement were rated as being significantly more painful on the SmartClip side (P  =  .031; P  =  .004). Retrospective ratings favored conventional brackets beyond ratings recorded during treatment.Conclusion:Engagement and disengagement of rigid rectangular archwires caused more pain with SmartClip self-ligating brackets than with conventional ones. Careful archwire manipulation and patience during full alignment are essential for limiting chairside pain. Low pain levels will help ensure treatment satisfaction and compliance.     

Dental crowding: The role of genetics and tooth wear

Objective:To evaluate the role of genetics and tooth wear in the etiology of dental crowding through the analysis of a split indigenous Amazon population.Materials and Methods:Dental crowding prevalence (n  =  117), tooth wear (n  =  117), and inbreeding coefficient (n  =  288) were compared for both villages. A biometric investigation was performed by dental cast analysis of 55 individuals with no tooth loss. Mann-Whitney statistics, independent t-tests, and Fisher exact tests were used at P < .05.Results:A high coefficient of inbreeding was confirmed in the resultant village (F  =  0.25, P < .001). Tooth wear was not significantly different (P  =  .99), while a significantly higher prevalence of dental crowding was confirmed in the original village (PR  =  6.67, P  =  0.02). Forty dental arches (n  =  20) were examined in the new group, and only one (2.5%) had a dental crowding ≥5 mm. In the original villages, we found 20 arches (28.6%) with dental crowding. No difference was observed for tooth size, while larger dental arch dimensions explained a lower level of dental crowding in the resultant village.Conclusions:Our findings downplay the widespread influence of tooth wear, a direct evidence of what an individual ate in the past, on dental crowding and emphasize the role of heredity, exacerbated through inbreeding, in the etiology of this malocclusion.     

Short-Term Influence of Lingual Orthodontic Therapy on Microbial Parameters and Periodontal Status: A Preliminary Study

Objective:To perform a preliminary study of the short-term effect of fixed, customized lingual orthodontic appliances on periodontal and microbial parameters.Materials and Methods:The sample comprised 20 subjects (6 males and 14 females) with a mean age of 22.3 years ± 8.6 years. Before (T₀) and 4 weeks after placement (T₁) of custom-made lingual appliances on the lower teeth only, plaque index (PI), probing pocket depth (PPD), and bleeding on probing (BOP) were measured. A 16S rRNA-based polymerase chain reaction (PCR) method was used to detect Aggregatibacter actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) in the crevicular fluid. To compare periodontal parameters on bonded lingual (testing) and unbonded palatal (control) and labial (control) sites between T₀ and T₁, the Wilcoxon test was applied.Results:On the lingual aspects of bonded teeth, a significant increase of BOP (T₀: 23.4 ± 22.5%; T₁: 46.2 ± 23.5%; P  = .001) and PI (T₀: 0.3 ± 0.3; T₁: 1.0 ± 0.7; P  =  .001) was observed, but no significant changes for PPD (T₀: 2.1 ± 0.4 mm; T₁: 2.2 ± 0.3 mm; P  =  .286) were found. On control sites, no significant changes were recorded for any periodontal parameter. Aa was found in 25% of the patients at baseline (5 subjects) and in 35% of the patients at T₁ (2 additional positive subjects), whereas Pg was found in 5% of the cohort at T₀ and at T₁ (same patient).Conclusions:Even in the short term, insertion of fixed lingual appliances induced a worsening of periodontal parameters restricted to bonded lingual sites.     

Malocclusion impacts adolescents' oral health–related quality of life

Objective:To test the hypothesis that malocclusion does not have an independent and negative effect on quality of life of adolescents.Materials and Methods:The cross-sectional design study comprised a sample of 519 children, aged 11 to 14 years, attending public schools in Osorio, a city in southern Brazil. One calibrated examiner carried out clinical examinations and recorded dental caries (decayed/missing/filled teeth), malocclusion (Dental Aesthetic Index), and dental trauma. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ_11–14), Impact Short Form, and their parents or guardians answered questions about socioeconomic status. Simple and multivariate linear regressions were performed to assess covariates for the overall CPQ_11–14 scores.Results:Greater impacts on oral health–related quality of life were observed for girls (P  =  .007), children with a lower household income (P  =  .016), those living in nonnuclear families (P < .001), and those with more decayed/missing/filled teeth (P  =  .001). Malocclusion was also associated with oral health–related quality of life: the severity of malocclusion was significantly related to higher scores of CPQ_11–14 even after scores were adjusted for control variables. CPQ_11–14 increased by approximately 1 point for each increase in the severity of malocclusion.Conclusions:Malocclusion has a negative effect on adolescents'' quality of life, independent of dental caries or traumatic dental injuries. Socioeconomic inequalities and clinical conditions are important features in adolescents'' quality of life.     

Changes in temporomandibular joint disc position and form following Herbst and fixed orthodontic treatment

Objective:To determine the changes in the position and form of the temporomandibular joint articular disc in adolescents with Class II division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliance (phase II).Materials and Methods:Thirty-two consecutive adolescents went through phase I of treatment and 23 completed phase II. The temporomandibular joints were evaluated qualitatively by means of magnetic resonance images at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3), and at the end of phase II (T4).Results:Significant changes in disc position were not observed with the mouth closed between T1 × T3 (P  =  .317), T3 × T4 (P  =  .287), or T1 × T4 (P  =  .261). At T2, on average, the disc was positioned regressively. With the mouth open, no difference was observed between T1 × T3 (P  =  .223) or T1 × T4 (P  =  .082). We did observe a significant difference between T3 × T4 (P < .05). Significant changes in the disc form were found with the mouth closed between T1 × T2 (P < .001) and T2 × T3 (P < .001).Conclusions:At the end of the two-phase treatment, in general terms, the position and form of the initial articular discs were maintained; however, in some temporomandibular joints some seemingly adverse effects were observed at T4.     

Shear bond strength of brackets bonded with hydrophilic and hydrophobic bond systems under contamination

Objective:To compare, in vitro, the shear bond strength (SBS) of two bond systems: Transbond XT/XT primer (TXT/XT) and Transbond Plus Color Change/Transbond Self Etching Primer (TPCC/TSEP).Materials and Methods:Each system was examined under four enamel surface conditions (dry, water, saliva, and blood), and 160 bovine teeth were divided into eight groups of 20 according to enamel surface condition. Group 1 used TPCC/TSEP and Group 2 used TXT/XT under dry conditions; Group 3 used TPCC/TSEP and Group 4 used TXT/XT with water; Group 5 used TPCC/TSEP and Group 6 used TXT/XT under saliva; and Group 7 used TPCC/TSEP and Group 8 used TXT/XT with blood. Brackets were bonded, and the samples were thermocycled 500 times between 5°C and 55°C; they were then submitted to a shear bond test with a universal testing machine with a 50 kgf load cell at 5 mm/min.Results:Although water and saliva affected TXT/XT more than they affected TPCC/TSEP, there were no significant differences among the groups (Groups 3 and 4: P  =  .940; Groups 3 and 5 and Groups 4 and 6: P  =  1.000; Groups 3 and 6: P  =  .988; Groups 4 and 5: P  =  .690; and Groups 5 and 6: P  =  .861).Conclusions:The presence of blood resulted in the lowest SBS from both bond systems, but especially from TXT/XT. TPCC/TSEP resulted in a higher SBS than TXT/XT under all conditions except the dry enamel surface.     

Comparison of pharyngeal airway volume among different vertical skeletal patterns: A cone-beam computed tomography study

Objective:To test the null hypothesis that there are no significant differences in pharyngeal airway volumes among adult patients with different vertical skeletal patterns and a clinically normal sagittal skeletal pattern using cone-beam computed tomography (CBCT).Material and Methods:The study sample consisted of 100 adult patients (45 men and 55 women; mean age  =  24.0 ± 5.3 years) with a normal sagittal skeletal pattern divided into three groups according to the vertical skeletal patterns: high angle (32 patients: 15 women and 17 men), low angle (34 patients: 14 women and 20 men), and normal angle (34 patients: 16 women and 18 men) groups. Nasopharyngeal, oropharyngeal, and total airway volumes of patients in all vertical groups were calculated. Group differences were analyzed using one-way analysis of variance and post hoc Tukey tests.Results:Nasopharyngeal airway volume in the high-angle group (mean  =  6067.9 ± 1693.9 mm³) was significantly lower than that of the low- and normal-angle groups (P < .01). Oropharyngeal airway volume was highest in the low-angle group (mean  =  15,957.6 ± 6817.2 mm³) and significantly decreased in the control (mean  =  11,826.1 ± 4831.9 mm³; P  =  .008) and high angle (mean  =  10,869.1 ± 4084.1 mm³; P  =  .001) groups. Total airway volume was highest in the low-angle group (mean  =  24,261.6 ± 8470.1 mm³) and lowest in the high-angle group (mean  =  16,937.0 ± 5027.4 mm³; P < .001).Conclusion:The null hypothesis was rejected. Significant differences were found in pharyngeal airway volumes among different skeletal vertical patterns.     

Response of the maxillary dentition to a statically determinate one-couple system with tip-back mechanics: A prospective clinical trial

Objective:To quantify the effects of tip-back mechanics on the maxillary first molars and incisors.Materials and Methods:Sixteen subjects with Class II end-on malocclusion were treated with an intrusion arch to achieve distalization of the maxillary molar through tip-back mechanics. Lateral cephalograms were taken prior to molar tip-back (T1), after molar tip-back (T2), and after molar root uprighting (T3). Data were analyzed using the Friedman’s and Wilcoxon signed rank tests to evaluate differences in time points (P ≤ .016).Results:The maxillary first molar distalized 1.53 mm (P = .001) with 6.65° (P = .001) of distal tipping and 0.86 mm (P = .001) of extrusion at T2. Minor relapse of the first molar (mesial direction) was seen at T3. The maxillary incisors flared labially 0.4 mm, and the incisor root apex moved palatally 1.19 mm (P = .005) at T2. At T3, the incisor root apex moved palatally 1.5 mm (P = .003) from T1. An angular change from T1 of 3.31° (P = .008) and 3.53° (P = .014) was seen at T2 and T3, respectively, as a result of palatal root movement of the maxillary incisors.Conclusions:A significant amount of distalization of maxillary molars was attained at the crown level with tip-back mechanics. Palatal root angulation change was significant in the incisors with minimal anteroposterior movement of the incisal edge.     

In vitro and in vivo mechanical stability of orthodontic mini-implants: Effect of sandblasted,large-grit,and anodic-oxidation vs sandblasted,large-grit,and acid-etching

Objective:To compare in vivo and in vitro mechanical stability of orthodontic mini-implants (OMIs) treated with a sandblasted, large-grit, and anodic-oxidation (SLAO) method vs those treated with a sandblasted, large-grit, and acid-etching (SLA) method.Materials and Methods:Fifty-four titanium OMIs (cylindrical shape, drill-free type; diameter  =  1.45 mm, length  =  8 mm, Biomaterials Korea Inc, Seoul, Korea) were allocated into control, SLA, and SLAO groups (N  =  12 for in vivo and N  =  6 for in vitro studies per group). In vitro study was carried out on a polyurethane foam bone block (Sawbones, Pacific Research Laboratories Inc, Vashon, Wash). In vivo study was performed in the tibias of Beagles (6 males, age  =  1 year, weight  =  10 to 13 kg; OMIs were removed at 8 weeks after installation). For insertion and removal of OMIs, the speed and maximum torque of the surgical engine were set to 30 rpm and 40 Ncm, respectively. Maximum torque (MT), total energy (TE), and near peak energy (NPE) during the insertion and removal procedures were statistically analyzed.Results:In the in vitro study, although the control group had a higher insertion MT value than the SLA and SLAO groups (P < .01), no differences in insertion TE and NPE or in any of the removal variables were noted among the three groups. In the in vivo study, the control group exhibited higher values for all insertion variables compared with the SLA and SLAO groups (MT, P < .001; TE, P < .01; NPE, P < .001). Although no difference in removal TE and removal NPE was noted among the three groups, the SLAO group presented with a higher removal MT than the SLA and control groups (P < .001).Conclusions:SLAO treatment may be an effective tool in reducing insertion damage to surrounding tissue and improving the mechanical stability of OMIs.     

Influence of unilateral maxillary first molar extraction treatment on second and third molar inclination in Class II subdivision patients

Objective:To assess the maxillary second molar (M2) and third molar (M3) inclination following orthodontic treatment of Class II subdivision malocclusion with unilateral maxillary first molar (M1) extraction.Materials and Methods:Panoramic radiographs of 21 Class II subdivision adolescents (eight boys, 13 girls; mean age, 12.8 years; standard deviation, 1.7 years) before treatment, after treatment with extraction of one maxillary first molar and Begg appliances and after at least 1.8 years in retention were retrospectively collected from a private practice. M2 and M3 inclination angles (M2/ITP, M2/IOP, M3/ITP, M3/IOP), constructed by intertuberosity (ITP) and interorbital planes (IOP), were calculated for the extracted and nonextracted segments. Random effects regression analysis was performed to evaluate the effect on the molar angulation of extraction, time, and gender after adjusting for baseline measurements.Results:Time and extraction status were significant predictors for M2 angulation. M2/ITP and M2/IOP decreased by 4.04 (95% confidence interval [CI]: −6.93, 1.16; P  =  .001) and 3.67 (95% CI: −6.76, −0.58; P  =  .020) in the extraction group compared to the nonextraction group after adjusting for time and gender. The adjusted analysis showed that extraction was the only predictor for M3 angulation that reached statistical significance. M3 mesial inclination increased by 7.38° (95% CI: −11.2, −3.54; P < .001) and 7.33° (95% CI: −11.48, −3.19; P  =  .001).Conclusions:M2 and M3 uprighting significantly improved in the extraction side after orthodontic treatment with unilateral maxillary M1 extraction. There was a significant increase in mesial tipping of maxillary second molar crowns over time.     

Skeletal and dental effects of molar distalization using a modified palatal anchorage plate in adolescents

Objective:To evaluate and compare skeletal effects and the amount of molar distalization in maxilla using modified palatal anchorage plate (MPAP) vs headgear appliances in adolescent patients.Materials and Methods:Pre- and posttreatment lateral cephalograms of 45 Class II malocclusion patients were analyzed; 24 were treated with MPAP appliances (age, 12.4 years) and 21 with headgear (age, 12.1 years). Fixed orthodontic treatment started with the distalization process in both groups. Thirty-two variables were measured and compared between both groups using multivariate analysis of covariates.Results:There was no significant main effect of the appliance type on the treatment results (P  =  .063). Also, there was no significant main effect of the appliance type on both pre- and posttreatment comparisons (P  =  .0198 and .135, respectively). The MPAP and headgear groups showed significant distalization of maxillary first molars (3.06 ± 0.54 mm and 1.8 ± 0.58 mm, respectively; P < .001). Sagittal skeletal maxillomandibular differences were improved after treatment (P < .001), with no significant differences between the two groups. No significant difference in treatment duration was found between the groups.Conclusions:The MPAP showed a significant skeletal effect on the maxilla. Both MPAP and headgear resulted in distalization of maxillary first molars. Therefore, it is recommended that clinicians consider the application of MPAP, especially in noncompliant Class II patients.