Magnets and orthodontics

Magnetic extrusion technique for restoring severely compromised teeth: A case report

An orthodontic magnetic extrusion technique is described for the management of an extensively damaged maxillary premolar. A cylindrical neodymium-iron-boron (Nd₂Fe₁₄B) magnet was attached to the remaining tooth structure, and a second magnet was placed on a resin-bonded partial denture. A 4.5-mm extrusion was obtained after 3 adjustments, and the tooth was prepared with a 3-mm buccal and 2-mm lingual ferrule by following a biologically oriented preparation technique and restored with a monolithic zirconia crown. Eighteen months after completing the treatment, no evidence of soft tissue dehiscence, abnormal tooth mobility, endodontic failure, or root resorption was found.

The relationship between the force and separation of miniature magnets used in dentistry

OBJECTIVE

Miniature magnets are used in dentistry, principally for the retention of prosthetic devices. The relationship between force and separation of a magnet and its keeper, or, equivalently, two such magnets, has been neither defined theoretically nor described practically in any detail suitable for these applications. The present paper addresses this lacuna.

METHODS

A magnet is considered as a conglomeration of magnetic poles distributed over a surface or a solid in three-dimensional space, with the interaction of poles governed by the Coulomb law. This leads to a suite of mathematical models. These models are analysed for their description of the relationship between the force and the separation of two magnets.

RESULTS

It is shown that at a large distance of separation, an inverse power law must apply. The power is necessarily integer and at least two. All possibilities are exhausted. Complementarily, under reasonable assumptions, it is shown that at a small distance of separation, the force remains finite.

SIGNIFICANCE

The outcome is in accordance with practical experience, and at odds with the use of simple conceptual models. Consequences relevant to the usage of magnets in dentistry are discussed.

Cytotoxic effect of indigenously fabricated dental magnets for application in prosthodontics

Context

Dental magnets are used for retaining removable prostheses such as a removable partial denture, complete denture, and maxillofacial prosthesis. They provide good retention for the prostheses. However, the elements released from the magnets may be cytotoxic for the tissues. Therefore, it is necessary to evaluate their cytotoxic effect on cell lines.

Aim

The aim of the study is to check the cytotoxic effect of indigenously fabricated dental magnets on animal cell lines.

Materials and Methods

Neodymium-iron-boron (Nd-Fe-B) magnet was tested for cytotoxicity. The magnet was encased in a teflon cylinder. Magnets were placed in the well tissue-cultured plates together with a suspension containing NIH 3T3 mouse fibroblasts (5 × 10⁵ cells/ml). After 3 days of incubation at 37°C, cell viability was determined by mean transit time (MTT) assay. Cells were subsequently dissolved in 100 μl dimethyl sulfoxide with gentle shaking for 2 h at room temperature followed by measurement of absorbance at 570 nm. Eight replicate wells were used at each point in each of four separate measurements. Measured absorbance values were directly used for calculating percent of viable cells remaining after the respective treatment. Data were analyzed statistically with significance level set at P < 0.05.

Results

The control group had highest absorbance reading for the MTT assay followed by test group. The lowest values were found with bare Nd-Fe-B magnets. One-way ANOVA test was performed for the data obtained. There was a statistical significant difference seen in the positive control (bare magnets, 44.96) and the test (teflon cased magnets, 96.90) group.

Conclusion

More number of viable cells was visible in test group cells indicating that the indigenously fabricated dental magnet did not show any cytotoxicity.

Case Presentation of Two Maxillectomy Patients Restored with Two-piece Hollow Bulb Obturator Retained using Two Different Types of Magnets

Palatal defect can be repaired by reconstructive surgery and/or a dental prosthesis. We present prosthodontic rehabilitation of two partially edentulous patients, both with surgically induced palatal defect and explains how to achieve the goal for esthetics and phonetics. This also describes the fabrication of a hollow obturator by two piece method, which is simple and may be used as definitive obturator for maximum comfort of the patient. In both the above cases, since the mouth opening is restricted due to surgery, obturator prosthesis is given as two pieces retained with opposite poles of magnet, which facilitates the removal and insertion of the prosthesis.

Effects of a magnetic palatal expansion appliance with reactivation system: An animal experiment

INTRODUCTION

The purpose of this study was to evaluate the effects of a newly designed magnetic palatal expansion appliance with a reactivation system.

METHODS

A magnetic palatal expansion appliance was designed based on the repulsion forces of neodymium-iron-boron magnets combined with a reactivation system. Eighteen prepubertal male beagle dogs were assigned randomly to the magnetic expansion (ME) group, the mechanical screw expansion (SE) group, or the control group. Two pairs of nonmagnetic metal bone marker implants were inserted into palatal bone bilaterally 3 mm lateral to the midpalatal suture and in line with the first and fourth premolars, respectively, in each dog. The 6 animals in each group received (1) newly designed magnetic expanders, (2) jackscrew expanders, or (3) no expansion appliance. Expansion was stopped after 4 weeks when 6 mm of activation was achieved in the 2 treated groups. Three-dimensional evaluations of dental and skeletal effects were performed with cone-beam computed tomography. Histologic examinations were conducted using light microscopy to observe morphologic changes in the midpalatal suture after hematoxylin and eosin staining.

RESULTS

The absolute transversal changes of both treated groups before and after expansion were significantly greater than those in the control group in all parameters (P <0.001). The differences of the distances of bilateral canines in the ME group were significantly greater than in the SE group (1.04 ± 0.16 mm; P <0.001); the differences of the distances between implants adjacent to the first premolars (0.77 ± 0.06 mm; P <0.001) and the distances between implants adjacent to the fourth premolars (0.37 ± 0.06 mm; P <0.001) in the SE group were significantly greater than in the ME group. Histologic observations of the palatal sutures in the ME and SE groups, when compared with the control group, showed widening of the sutures and many fibroblasts in an active, proliferative state. Counts of osteoblasts were increased in both expansion groups. Counts of osteoclasts were increased in the SE group.

CONCLUSIONS

Both appliances expanded the maxilla effectively and induced processes of bone remodeling of the midpalatal sutures during expansion. The new magnetic palatal expansion appliances produced a smaller skeletal effect and a greater dental effect than did the mechanical screw palatal expansion appliances.

Application of orthodontic forces prior to autotransplantation - case reports

AIM

This case report describes the successful autotransplantation of mandibular molars after application of orthodontic forces and discusses the advantages of this technique, that is, pre-application of an orthodontic force for autotransplantation.

SUMMARY

After clinical and radiographic examination, autotransplantation was planned with the patient's written informed consent. An orthodontic force was applied, and the surgical procedure was performed after tooth mobility had increased. Root canal treatment was performed within 2 weeks of autotransplantation. At the 1-year follow-up, the transplanted teeth revealed asymptomatic and healthy periodontal conditions.

KEY LEARNING POINTS

Autotransplantation is the surgical movement of a tooth from its original location to another site. The pre-application of orthodontic force technique was recently introduced for autogenous tooth transplantation. Pre-application of an orthodontic force may be a useful treatment option for autotransplantation.

Magnetic fields of 10mT and 120mT change cell shape and structure of F-actins of periodontal ligament cells

Dental magnetic attachments, usually applied locally to oral cavities, produce stray fields (flux leakage) spreading in adjacent tissues. It has been found that human periodontal ligament (PDL) cells change their geometry and the structure of their cytoskeleton F-actins when the cell cultures are exposed to B-field strengths of B = 10mT and 120mT, respectively, which are similar to those generated by dental magnetic attachments. Analytically, after long-time exposures to B-fields for 12h, 36 h and 60 h, respectively, cytoskeleton F-actins are labeled with a fluorescent dye and observed under a laser scanning confocal microscope. The geometrical cell parameters of cell length and cell width and the fluorescence emission of labeled F-actins, respectively, were determined and subjected to an automatic image analysis using a special software. The results on cell shrinkage and filament reorganizations were statistically analyzed by the program ANOVA (P < 0.05). It was found that only long-time (hours) exposure to high fields in the order of 0.1T may produce tissue irritations during long-time medical treatments using open- and closed-field dental magnetic attachments.

Magnetic strength and corrosion of rare earth magnets

INTRODUCTION

Rare earth magnets have been used in orthodontics, but their corrosion tendency in the oral cavity limits long-term clinical application. The aim of this project was to evaluate several; magnet coatings and their effects on magnetic flux density.

METHODS

A total of 60 neodymium-iron-boron magnets divided into 6 equal groups--polytetrafluoroethylene-coated (PTFE), parylene-coated, and noncoated--were subjected to 4 weeks of aging in saline solution, ball milling, and corrosion testing.

RESULTS

A significant decrease in magnet flux density was recorded after applying a protective layer of parylene, whereas a slight decrease was found after applying a protective layer of PTFE. After 4 weeks of aging, the coated magnets were superior to the noncoated magnets in retaining magnetism. The corrosion-behavior test showed no significant difference between the 2 types of coated magnets, and considerable amounts of iron-leached ions were seen in all groups.

CONCLUSIONS

Throughout the processes of coating, soaking, ball milling, and corrosion testing, PTFE was a better coating material than parylene for preserving magnet flux density. However, corrosion testing showed significant metal leaching in all groups.

Intrusion of overerupted molars by corticotomy and magnets

Although posterior tooth intrusion in an adult patient is a difficult procedure, it can be achieved without extruding the adjacent teeth by performing a corticotomy and using magnets. In carrying out this procedure on 2 adult patients whose molars had overerupted due to the early loss of antagonists, tooth movement was rapidly achieved without discomfort or side effects.

The ectopic maxillary canine: a review

This article reviews the aetiology and management of the ectopic maxillary canine. Much controversy surrounds the causes of canine palatal ectopia. The recent evidence surrounding the genetic and guidance theories are examined. The management options are detailed and the indications for each treatment modality based on the available scientific evidence are presented. Finally, the untoward sequelae of canine ectopia are discussed.

Attractive magnets for orthodontic extrusion of crown-root fractured teeth

A subgingival crown-root fracture presents the clinician with a difficult restorative problem, including reaching the fracture line, and is complicated by the need to maintain the periodontal tissues in good health. The treatment options up to now have usually been limited to extrusion of the remaining root with a conventional orthodontic appliance, surgical intraalveolar transplantation of the root or extraction with bridge replacement. In this report, a new method of orthodontic extrusion with attractive magnets is presented. One or two neodymium-iron-boron magnets were attached to the remaining root and a second, larger neodymium-iron-boron magnet was incorporated in a removable appliance. The roots were extruded 2 to 3 mm with a force range from 50 to 240 cN during a treatment period of 9 to 11 weeks. Good force control at short distances, no friction, and no material fatigue of permanent rare earth magnets resulted in successful rapid extrusion. No evidence of soft tissue dehiscences, aberrant tooth mobility, or root resorption was found.

Corrosion of the intra-oral magnets by multi-species biofilms in the presence and absence of sucrose

The purpose of this study was to determine the corrosive effects of multi-species biofilms on intra-oral magnets in the presence and absence of sucrose. Using pooled human saliva as an inoculum, biofilms were grown on the surfaces of 90 neodymium-iron-boron (Nd2Fe14B) magnets in a constant depth film fermentor under aerobic conditions at 37 degrees C. The fluid phase was a mucin-containing artificial saliva (delivered at a rate of 0.72/litres day-1), and, after 15 days, 100 ml of 10% (w/v) sucrose was added (as three pulses of 33.3 ml) each day for a further 15 days. Six magnets with attached biofilms were removed periodically. On each sampling occasion the numbers of aerobes, anaerobes, streptococci, veillonellae and actinomyces in each biofilm, the pH of the fermentor effluent and the dry mass of the magnets were determined. Addition of sucrose to the fermentor resulted in a fall in pH (from a mean of 6.94 to a mean of 4.96), an increase in the proportion of streptococci and a decrease in the proportion of veillonellae comprising the biofilms. The decrease in mass of the magnets was 28-fold greater in the presence of sucrose than in its absence. The results of this study have shown that the presence of sucrose affects the microbial composition of multi-species biofilms growing on Nd2Fe14B magnets and results in a marked increase in corrosion of the magnets.

Effects of orthodontic magnets on cutaneous epithelial thickness and tibial bone growth in rats

The use of permanent magnets in orthodontic treatment has increased significantly over the past years, triggered by the introduction of rare earth magnetic alloys. Concerns about possible side effects have been expressed relating to their use in orthodontic treatment. In previous experimental studies evidence of a reduction in bone formation and epithelial turnover close to rare earth magnets has been presented. The aim of the present study was twofold: to confirm earlier results and to study whether the observed changes are reversible. One hind leg in each of 45 rats was fitted with aluminum rings with Co5Sm magnets, whereas the other hind leg was fitted with sham rings. After 8 weeks 25 rats were killed, and the rings in the remaining rats were removed. The latter group was killed after another 11 weeks. The epithelial and bone reactions were evaluated histomorphometrically. Previous results showing thinner epithelium and retarded rate of bone formation close to Co5Sm magnets were confirmed. These effects were also shown to be largely reversible. It was concluded on the basis of this and the magnitude of the effects that any local side effects from orthodontic rare earth magnets appear negligible when extrapolated to the clinical situation.

The effects of samarium-cobalt magnets and pulsed electromagnetic fields on tooth movement

The purpose of this study was to determine whether the application of either samarium cobalt magnets or pulsed electromagnetic fields could increase the rate and amount of orthodontic tooth movement observed in guinea pigs. In addition, the objective was to evaluate the effect of a magnetic field on bony physiology and metabolism and to monitor for possible systemic side effects. Fifteen grams of laterally directed orthodontic force were applied to move the maxillary central incisors of a sample of 18 young male Hartley guinea pigs divided into three groups: group 1, an orthodontic coil spring was used to move the incisors; group 2, a pair of samarium-cobalt magnets provided the tooth moving force; and group 3, a coil spring was used in combination with a pulsed electromagnetic field. The results showed that both the static magnetic field produced by the samarium-cobalt magnets and the pulsed electromagnetic field used in combination with the coil spring were successful in increasing the rate of tooth movement over that produced by the coil springs alone. The mechanism producing this effect appears to have involved a reduction in the "lag" phase often seen in orthodontic tooth movement. Both magnetically stimulated groups also showed increases in both the organization and amount of new bone deposited in the area of tension between the orthodontically moved maxillary incisors.

Extent and flux density of static magnetic fields generated by orthodontic samarium-cobalt magnets

The aim of this study was to measure and to analyze the extent and flux density of static magnetic fields generated by commercially available samarium-cobalt magnets used in orthodontics. The flux density was measured with a gaussmeter and a Hall probe with the magnets mounted in clinically relevant positions, i.e., in attractive and in repelling positions and also in the single position. Furthermore, the flux density between new and clinically used and recycled magnets was compared. It was found that the maximum flux density was generated at the pole faces and that magnets in attractive positions produced the highest flux density (2.2 kG), followed by the single magnet (2.0 kG) and the repelling magnets (1.7 kG). The flux density decreased rapidly (exponentially) with increased distance from the magnets. The flux density was approximately the same or less than the flux density of the earth magnetism (0.3 to 0.7 G) 60 mm from the attractive magnets, 50 mm from the single magnets, and 35 mm from the repelling magnets. The difference in flux density between new and clinically used and recycled samarium-cobalt magnets was negligible. Thus, the static magnetic field exposure of surrounding tissues can be assumed to be low, and the conceivable risk of harmful biologic effects must be regarded as small and limited when the tested orthodontic magnets are used clinically.

In vitro cytotoxicity testing of neodymium-iron-boron magnets

Neodymium-iron-boron magnets are being increasingly used in orthodontic and orthopedic appliances. The purpose of this study was to investigate the in vitro cytotoxicity of these new "super" magnets. A modified agar overlay technique was performed using both L929 mouse fibroblasts and adult human oral mucosal fibroblasts. The neodyium-iron-boron magnets were tested in the following forms: uncoated magnetized, uncoated demagnetized, parylene coated demagnetized, and parylene coated magnetized. Results revealed that uncoated magnetized, uncoated demagnetized, and parylene coated magnetized were cytotoxic to both L929 mouse fibroblasts and human oral mucosal fibroblasts. However the parylene coated demagnetized neodymium magnets were only cytotoxic to the human mucosal fibroblasts. This study supports the hypothesis that these are cytotoxic effects of possibly corrosion products and of magnetism. The specific toxic effects of parylene were not examined in this present study. Statistical analysis (Mann-Whitney U-test, p = 0.014) suggested that, in this experiment, the human oral mucosal fibroblasts were more sensitive to the effects of these rare earth magnets. With the evidence of a biological effect, the use of implanted magnets must at present be limited until the safety can be assured.

Effect of corrosion products (neodymium iron boron) on oral fibroblast proliferation

The biological effects of the corrosion products of neodymium iron boron (Nd2Fe14B) magnets are largely unknown. The aim of this study was to identify the types of corrosion product and to evaluate the effect of the corrosion products (CP) of Nd2Fe14B magnets on the proliferation of human oral mucosal fibroblasts. Uncoated Nd2Fe14B magnets were stored in saline at 37 degrees C for 6 months and the corrosion products collected. 100 microL of a cell suspension (human oral mucosal fibroblasts [14 x 10(4) cells/mL]) was aliquoted into 72 wells of a 96-well plate, the remaining plates receiving culture medium only. After 12 h incubation at 37 degrees C, each well then received 100 microL of either (A) culture medium, (B) 100% CP, (C) 50% CP, or (D) 0% CP. The plates were reincubated at 37 degrees C for a further 48, 96, or 144 h. Fibroblast proliferation was assessed using the methylene blue uptake/elution technique. The compounds in the corrosion product were examined using quantitative X-ray analysis. Statistical analysis (ANOVA, Bonferroni's test 0.05, SAS v 6.04), showed that at each time point, the cell numbers in groups B, C, and D were significantly lower than group A. Within groups B, C, and D no significant differences were found, despite the suggestion of a dose response effect. Fibroblast proliferation in the presence of corrosion products was significantly lower than with culture medium. Fibroblast proliferation did occur in the presence of 0, 50, and 100% CP. The actual corrosion products appeared to be salts of iron but 3.2% (+/- 0.6) of neodymium chloride (NdCl3) was found.

Orthodontic rare earth magnets--in vitro assessment of cytotoxicity

The aim of this study was to assess and compare in vitro the cytotoxic effects of uncoated and parylene-coated rare earth magnets, used in orthodontics. Cytotoxicity of samarium-cobalt magnets (SmCo5 and Sm2Co17) and neodymium-iron-boron magnets (Nd2Fe14B) was assessed by two in vitro methods, the millipore filter method and an extraction method. Orthodontic stainless steel brackets served as controls. Uncoated SmCo5-magnets showed high cytotoxicity while uncoated Sm2Co17-magnets demonstrated moderate cytotoxicity. Uncoated neodymium-iron-boron magnets, as well as parylene coated Sm2Co17-magnets and parylene-coated neodymium-iron-boron magnets, showed negligible cytotoxicity. Short-term exposure to a static magnetic field did not cause any cytotoxic effect on the cells.

Biocompatibility of new, clinically used, and recycled orthodontic samarium-cobalt magnets

The aim of this study was to compare the cytotoxic effect of new, clinically used, and recycled samarium-cobalt magnets (SmCO5). Cytotoxicity was assessed by two in vitro methods, the millipore filter method and an extraction method. In the filter method, the test material and the target cells are separated by a thin, permeable membrane. The test assesses the cytotoxicity of both water soluble and nonwater soluble components of the test material. The extraction test, which has a higher sensitivity, assesses the cytotoxicity of water soluble components only. According to the filter method, one magnet (new) showed a mild cytotoxic effect; all other tested magnets showed no cytotoxicity. Judged by the extraction test, new as well as clinically used magnets demonstrated a weak cytotoxic effect, suggesting the presence of a small amount of leachable cytotoxic components. The level of exerted cytotoxicity of such components was significantly lower for clinically used than for new magnets. When recycled magnets were tested, the cytotoxicity had significantly decreased, (p < 0.001), and the cytotoxicity could be considered negligible. The results thus revealed that SmCO5 magnets can be recycled with maintained good biocompatibility. Because a small amount of water soluble cytotoxic agents seem to leach out from new partially stainless steel-coated samarium-cobalt magnets, it is recommended that they be stored in water for 24 hours before clinical use, thereby conceivably decreasing the oral exposure of water soluble cytotoxic agents.

[The effect of static magnetic fields on prostaglandin synthesis in L-929 and 3T3 mouse fibroblasts. An in-vitro study]

The aim of this study was to examine the influence of static, inhomogeneous magnetic fields on prostaglandin synthesis in L-929 and 3T3 mouse fibroblasts. Two pairs of magnets, one CoSm and the other NdFeB, were attached 10 mm apart under the culture chamber. One pair was in the attracting position and the other in the repelling position. The maximum magnetic induction measured was 85 respectively 120 mT and the incubation time was 72 hours. Control groups consisted of untreated cells and cells under the influence of demagnetized magnets. The following measurements were taken: prostaglandin synthesis (PGE2), protein content (GP), and the number (Z) of cells (only L-929 mouse fibroblasts). The data were analyzed statistically using the Tukey test and the significance niveau was set at alpha = 0.05. The results using this method demonstrated that the measurable effects of in vitro treatment of mouse fibroblasts with static magnetic fields of varying induction did not significantly differ from the control groups. The sensitivity of our method was verified beforehand with a recombinant, human TNF alpha stimulated reference group.

Force-distance relation and properties of repelling Sm-Co5 magnets in orthodontic clinical use: an experimental model

In recent years, magnets and magnetic forces have been suggested as an alternative to traditional orthodontic devices such as elastics, springs and wires. The purpose of this study was to analyze the reliability and the output of forces for prefabricated orthodontic repelling Sm-Co5 magnets and the force conditions for the magnets after 5 months of maximal loading. The test-machine consisted of a jig where the tested pair of repelling magnets was mounted close to the clinical situation. With a cylindrical strain gauge transducer, a micrometer screw, a bridge-amplifier, and a Mingograph jet recorder, force-distance diagrams were constructed. The force-distance diagrams showed that the force-distance curve was hyperbolic and that the mean force when the magnetic pole faces were almost in contact with each other was 214.9 g, SD 13.42 g. The variation of magnetic force between different Sm-Co5 magnets was 6-9%. The difference in force before and after 5 months of maximal loading of the magnets was not significant. The test results indicate that with proper handling of the forces according to the new force diagrams, the system is reliable for orthodontic use.

Rare earth magnets and impaction

Aberration in the eruption process was found to be a prime etiologic factor in inducing impaction. Thus an ideal treatment approach should attempt to mimic the normal eruption modus. However, conventional traction methods have been found to be associated with gingiva inflammation, bone recession, reduced attached gingiva, periodontal pockets, exposed cementoenamel junction, and root resorption of the impacted and adjacent teeth. These side effects are the result of premature exposure of the impacted tooth to the oral cavity through a nonself-cleansing pathway and an uncontrolled force system. The present study introduces a new, magnetic attraction system, with a magnetic bracket bonded to an impacted tooth and an intraoral magnet linked to a Hawley type retainer. Vertical and horizontal magnetic brackets were designed, with the magnetic axis magnetized parallel and perpendicular to the base of the bracket, respectively. The vertical type is used for impacted incisors and canines, and the horizontal magnetic bracket is applied for impacted premolars and molars. A three-dimensional analysis of the magnetic force system, by means of the OMSS apparatus, found the small magnetic bracket combined with a large pole surface area of the intraoral magnet to exhibit the most efficient convergent guidance. For this report the magnetic eruption device was examined on one animal subject and four patients. The Nd2Fe14B magnets were coated with parylene and/or encapsulated in stainless steel housings. In deep impaction, the magnetic bracket was cold-sterilized before surgery, and the surgical mucoperiosteal flap was then sutured over the bonded magnetic bracket. Attraction was initiated 1 to 2 weeks after healing. Thus tooth emergence into the oral cavity replicated normal eruption conditioning. The system operated at an attractive force level of 0.2 to 0.5 N. Adjustment was accomplished by temporarily interposing a magnetic spacer between the two magnetic units. No side effects were observed in this restricted number of treated cases, and treatment time was reduced. The study recommends the application of magnets in the treatment of impaction on the grounds of less invasive surgical procedure, effective attractive forces at short distances, and controlled spatial guidance.

An attractive solution to unerupted teeth

A user- and patient-friendly method of treating unerupted teeth is described. A neodymium iron boron magnet is attached to the unerupted tooth, and a second, larger magnet is incorporated in a removable appliance. The resulting forces provide a friction-free system, requiring little or no adjustment, which rapidly encourages the unerupted tooth into a position in which it may be bonded and thereby aligned by more conventional methods.

Unerupted premolars--an alternative approach

These two cases illustrate variations of an alternative technique for moving unerupted teeth into the mouth. Previously described techniques may damage the tooth or the periodontium and the regular adjustments required can be uncomfortable and are unpleasant for the patient and the operator. The method described provides a stress free alternative which is readily acceptable to patients. Adjustments are rarely needed, but if required they usually involve repositioning a magnet in the removable appliance, a procedure carried out simply by the operator or technician using cold cure acrylic.

Micro-magnetic retainers: an attractive solution to fixed retention

The use of neodymium-iron-boron micro-magnets as a fixed retainer which does not hinder oral hygiene, is reported. A patient with persistent midline spacing treated using this method is described.