The second molar dilemma in orthodontics: to bond or not to bond?

OBJECTIVES

To compare orthodontic treatment (OT) outcome in adolescents undergoing nonextraction fixed OT with or without bonding of second molars using the score of the American Board of Orthodontics Cast Radiograph Evaluation (C-R-Eval).

MATERIALS AND METHODS

This study included healthy adolescents with skeletal Class I or mild Class II/Class III malocclusion, normal or deep overbite (OB), and mild-to-moderate dental crowding (<5 mm) who underwent nonextraction fixed OT with ("bonded" group) or without ("not-bonded" group) bonding of second molars. Patient treatment records, pre- and posttreatment digital models, lateral cephalograms, and orthopantomograms were assessed. The evaluated outcomes included leveling of the curve of Spee (COS), OB, control of incisor mandibular plane angle (IMPA), number of emergency visits (related to poking wires and/or bracket failure of the terminal molar tubes), treatment duration, and C-R-Eval. Treatment variables were compared across time points and among groups.

RESULTS

The sample included 30 patients (mean age 16.07 ± 1.80 years) in the bonded group and 32 patients (mean age 15.69 ± 1.86 years) in the not-bonded group. The mean overall C-R-Eval score was significantly higher (P < .001) in the not-bonded group (25.25 ± 3.98) than in the bonded group (17.70 ± 2.97). There were no significant differences in mean changes of COS, OB, IMPA, or treatment duration among groups. The mean number of emergency visits was significantly higher in the bonded (3.3 ± 0.6) than the not-bonded group (1.9 ± 0.4) (P < .001).

CONCLUSIONS

Bonding of second molars enhances the outcome of nonextraction fixed OT as demonstrated by the C-R-Eval without increasing treatment duration, irrespective of more emergency visits.

Cleansing efficacy of an oral irrigator with microburst technology in orthodontic patients-a randomized-controlled crossover study

OBJECTIVES

Orthodontic patients struggle with interdental cleaning calling for simpler mechanical devices to reduce the high plaque levels. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in patients with fixed braces after 4 weeks of home-use.

MATERIALS AND METHODS

The study design is a randomized and single-blinded cross-over study. After 28 days using the products at home, hygiene indices (Rustogi Modified Navy Plaque Index (RMNPI); gingival bleeding index (GBI)) were compared between test (oral irrigator) and control product (dental floss).

RESULTS

Seventeen adult individuals finalized the study. After 28 days of cleaning with the oral irrigator, RMNPI was 54.96% (46.91-66.05) compared to 52.98% (42.75-65.60) with dental floss (p = 0.029). Subgroup analysis revealed that the higher cleansing efficacy of the dental floss is attributable to buccal and marginal areas. GBI after the test phase with the oral irrigator was 12.96% (7.14-24.31) and statistically significantly higher compared to 8.33% (5.84-15.33) with dental floss (p = 0.030) which could be seen in all subgroups.

CONCLUSIONS

Oral irrigators do not remove plaque and reduce gingival bleeding as efficiently as dental floss in easily accessible regions. However, in posterior regions, where the patients struggled with the application of dental floss, the oral irrigator showed similar results.

CLINICAL RELEVANCE

Oral irrigators should only be recommended to orthodontic patients who cannot use interdental brushes and are not compliant with dental flossing.

Effect of nanomicelle curcumin-based photodynamic therapy on the dynamics of white spot lesions and virulence of Streptococcus mutans in patients undergoing fixed orthodontic treatment: A randomized double-blind clinical trial

BACKGROUND/PURPOSE

The formation of white spot lesions (WSLs) around fixed orthodontic appliances is a major complication during treatment. The current double-blind, randomized clinical trial (RCT) study aims to investigate the varying effects of nanomicelle curcumin-based photodynamic therapy (NMCur-aPDT) on microbial count and virulence of Streptococcus mutans as well as the number and dynamics of WSLs.

MATERIALS AND METHODS

Double-blind prospective RCT, comprised of 48 patients with fixed orthodontic appliances, were recruited for the current study. The patients were divided into four groups according to the type of the treatment (NMCur, LED, NMCur-aPDT or VITIS® anti-caries mouthwash), using block randomization. Antimicrobial and anti-virulence activities of the treatments against isolated S. mutans were assessed via colony counting and quantitative real-time polymerase chain reaction (qRT-PCR), respectively. The visual inspection using the International Caries Detection and Assessment System (ICDAS II) score and laser fluorescence (LF) detection using a DIAGNOdent device were used for the detection and assessment of the dynamics of WSLs, respectively, on the labial surface in four areas (i.e., gingival, incisal, mesial, and distal) of the upper and lower anterior teeth at 30-, 60-, 90-, and 120-days follow-up after bonding of the lower and upper arches.

RESULTS

The antimicrobial properties of NMCur, VITIS®, and NMCur-aPDT were time-dependent so the highest reduction in S. mutans population was observed following NMCur-aPDT (99.98%) on day 120 of the study. The gtfB gene expression levels in S. mutans isolates from the NMCur-aPDT group on days 60, 90, and 120 decreased by 2.07-, 2.32-, and 3.01-fold more than in S. mutans isolates from the VITIS® group, respectively (all P < 0.05), while NMCur and LED treatments could not significantly reduce gtfB gene expression up to 120 days of follow-up (P > 0.05). In patients who were treated with LED, an increase in the mean number of WSLs per patient (mean increase, 1.8; P < 0.05) was found, while in NMCur-aPDT and VITIS® groups, not only no increases were observed, but the mean number of WSLs per patient decreased (mean reductions, 0.5 and 0.9, respectively; not significant). LED treatment caused significant increases (P < 0.05) in the mean LF values at 90-and 120-days of follow-up in comparison with the baseline (mean increases, 5.1 and 6.5, respectively) while, in NMCur-aPDT, VITIS®, and NMCur groups 11.8-, 7.1-, and 4.4-reductions in the mean LF values were observed, respectively (all, P < 0.05).

CONCLUSIONS

The antimicrobial and anti-virulence activities of NMCur-aPDT against S. mutans were higher than the other treatment groups. In patients who were treated with NMCur-aPDT, the mean number and LF values of WSLs per patient were significantly lower than the other groups in 90-and 120-days of follow-up.

Evaluating the effects of orthodontic treatment with clear aligners and conventional brackets on mandibular condyle bone quality using fractal dimension analysis of panoramic radiographs

OBJECTIVE

Orthodontic treatment carried out with clear aligners has become a method that is preferred by patients. In this study, the effect following orthodontic treatment with clear aligners and with conventional brackets, on the mandibular condyle trabecular bone formation is aimed to be examined.

MATERIALS AND METHODS

Thirty two individuals (16 females and 16 males) with a mean age of 16.80 ± 3,10 years who received orthodontic treatment with clear aligners and conventional brackets were included in the study. Individuals included in the study from the archive data were divided into two groups according to treatment types. The mandibular condyle bone quality in the panoramic images taken from the patients before orthodontic treatment (T0) and after orthodontic treatment (T1) has been compared retrospectively. This examination is carried out via the fractal analysis method.

RESULT

The mandibular condyle bone density in individuals that have undergone orthodontic treatment with clear aligners, has been reduced following orthodontic treatment. In individuals that have undergone orthodontic treatment with conventional brackets however the mandibular condyle bone density has increased following treatment (T0) in comparison to before being treated (T1). The mandibular condyle bone density change according to different treatment groups has been found to be statistically different.

CONCLUSION

Orthodontic treatment with clear aligners provides several advantages to patients. However, besides determining the effectiveness of the treatment, complications must also be examined. Application of clear aligners in orthodontic treatment may cause a decrease in bone density in the mandibular condyle. When evaluating orthodontic treatments carried out with clear aligners, the change of the mandibular condyle head bone should be taken into consideration.

A Novel Technique for Accuracy in Horizontal, Vertical, and Axial Bracket Placement in Orthodontic Bonding

AIM

The aim of the study was to develop a method which can help us achieve precise and accurate direct bonding (DB).

BACKGROUND

Proper and accurate bracket position during orthodontic bonding is one of the main concerns for the clinician. Proper bonding reduces the effort to achieve good finishing by minimizing the wire bending. Unwanted tooth movements like unplanned tip, torque, and rotation are minimized, so the treatment time is shortened. Commonly used techniques for bonding brackets to teeth are DB and indirect bonding (IDB).

TECHNIQUE

A new technique involving the innovative use of tooth-shaped stickers was suggested to combine the advantages of both the methods.

CONCLUSION

There was an accuracy in horizontal, vertical, and axial positioning of the brackets using this method.

CLINICAL SIGNIFICANCE

We found this as an effective method to achieve ideal bracket position by eliminating subjective bias and standardizing the bonding procedure, thus achieving better results in a shorter time by eliminating bonding errors.

Multidisciplinary Approach for the Management of Dilacerated Permanent Maxillary Incisor: A Case Report

Dilaceration is an abrupt deviation along the long axis of the tooth, which may be observed between the crown, root, or both. Management of such teeth poses a unique challenge to the clinician due to its position within the esthetic zone. This case report describes the management of impacted maxillary central incisor with severe root dilacerations (90° angulation and crown directed toward the anterior nasal spine). Surgical extraction of tooth was done after the elevation of the flap and fixed orthodontic treatment was planned to regain the required amount of space followed by prosthetic rehabilitation using the same extracted tooth as pontic.

Cone beam computed tomographic evaluation of the changes in condylar position in growing patients with unilateral posterior crossbite undergoing rapid maxillary expansion followed by fixed orthodontic therapy

PURPOSE

This study aimed at assessing changes in condylar position (CP) in growing patients with unilateral posterior crossbite (UPC) undergoing rapid maxillary expansion (RME) followed by fixed orthodontic treatment (FOT) (experimental-group); and growing patients without posterior crossbite (PC) treated with FOT alone (control-group).

METHODS

Cone beam computed tomography (CBCT) images were obtained before treatment (T0), 6 months after RME (T1) and after FOT (T2) for the experimental-group (n = 19); and at T0 and T2 for the control-group (n = 22). Condylar position-related measurements including the anterior joint space (AJS), superior joint space (SJS), posterior joint space (PJS), lateral position of condyle (LC) and condylar angle (CA) were measured. Non-parametric tests were used.

RESULTS

On the crossbite side, significant increases were found in LC (P = 0.039) and CA (P = 0.007), and on the non-crossbite side significant increases were observed in SJS (P = 0.027) and LC (P = 0.001) between T0, T1 and T2 in patients with UPC. On the right and left sides in the control-group, significant increases were identified in LC (P < 0.001 and P = 0.012, respectively) between T0 and T2.

CONCLUSIONS

In growing patients with UPC, RME followed by FOT is associated with significant changes in CP-related measurements.

Effect of high concentration nano-hydroxyapatite serum on shear bond strength of metal brackets following three different enamel surface preparation methods: An in vitro study

OBJECTIVE

White spot lesion (WSL) is one of the most important complications of fixed orthodontic treatment. Many methods have been studied to prevent this problem. This study is aimed to investigate the effect of high concentration nano-hydroxyapatite (nHAP) on shear bond strength (SBS) of metal brackets and Adhesive Remnant Index (ARI) score in different preparation methods.

MATERIAL AND METHODS

Sixty human premolars, which were extracted for orthodontic reasons were included in this in vitro study. The teeth were randomly divided into 4 groups of 15 each: one control group and three nHAP groups. After applying nHAP for 2 to 3 minutes daily for 10 days, the groups 2 to 4 underwent sandblasting using 50μm aluminium oxide and 30 seconds etching, 60 and 30 seconds etching, respectively, and the brackets were then bonded to the teeth. After debonding, SBS and ARI scores were recorded. Data were analysed using the ANOVA test and posthoc test for pairwise comparisons.

RESULTS

No significant difference was observed in SBS between the control group and the nHAP groups. The sandblasted teeth showed significantly higher SBS than the 30 seconds etching after nHAP application (P=0.02). The teeth etched for 60 seconds showed a significantly higher ARI score than the 30 seconds etched teeth with (P=0.003) or without (P<0.001) nHAP application.

CONCLUSIONS

The use of nHAP before bracket bonding can be considered as a caries preventive method since it did not compromise the SBS. Sixty seconds etching is recommended for less likely damage to the enamel after debonding.

A visual evaluation of oral plaque removal utilizing an adjunct enzyme pre-rinse in orthodontic subjects

OBJECTIVE

To determine if an adjunct proteolytic pre-rinse along with contemporary methods of dental cleaning may more effectively remove visual plaque in subjects with fixed orthodontic appliances.

MATERIALS AND METHODS

Forty-three orthodontic subjects, ages 10 to 25, completed this single site, double-blind, crossover clinical trial. Subjects randomly received bromelain enzyme or a powdered-sugar placebo pre-rinse, followed by manual tooth brushing and use of a Waterpik. Subjects received the alternate pre-rinse during the subsequent visit. Baseline and residual plaque accumulation were recorded via disclosing tablet and digital photography. A single, blinded examiner scored visual plaque scores from randomized photographs. Treatment effects on composite plaque score were evaluated using repeated-measures analysis of variance. A 5% significance level was used for all tests.

RESULTS

No significant differences in plaque scores were noted at baseline or post-rinse between the enzyme and placebo. The changes from baseline to post-rinse (P = .190), post-brushing (P = .764), and post-Waterpik (P = .882) were not significantly different between interventions. Significant reduction in plaque scores were observed in both arms of the study after brushing (P < .01) and waterjet use (P < .01). Neither age (P = .220) nor gender (P = .449) impacted plaque scores.

CONCLUSIONS

Use of a bromelain enzyme pre-rinse alone did not significantly enhance plaque removal. A significant reduction in retained plaque was observed with the application of brushing and or Waterpik.

Application of photodynamic therapy against periodontal bacteria in established gingivitis lesions in adolescent patients undergoing fixed orthodontic treatment

BACKGROUND

The aim of this 4 week follow up randomized controlled clinical trial is to evaluate the effectiveness of photodynamic therapy (PDT) as an adjunct to ultrasonic scaling (US) in the reduction of gingival inflammatory parameters and periodontal pathogens in established gingival inflammation in adolescent patients undergoing fixed orthodontic treatment.

MATERIALS AND METHODS

A total of 22 adolescent patients (mean age: 17.5 years) undergoing fixed orthodontic treatment and presenting with persistent local gingival inflammation were randomized into two groups: Group-US: patients receiving ultrasonic scaling (US) with usual oral hygiene instructions and Group-PDT: in which patients received adjunctive PDT with US. Dichotomous recording for plaque scores (PS) and bleeding on probing (BOP) was used to assess the clinical inflammatory status. The total bacterial counts of P. gingivalis and T. forsythia were estimated and were expressed as log CFU/mL. All assessments were performed at baseline, 1 week and 4 weeks. For intergroup comparisons, student's t-test was computed along with Bonferroni correction for post hoc multiple comparisons. To identify differences between repeated follow-ups, ANOVA multiple rank test was used.

RESULTS

Both treatment modalities reported statistically significant reduction in PS and BOP in patients undergoing fixed orthodontic treatment (p < 0.05). However, there was no significant difference in PS and BOP when US was compared with PDT (p > 0.05). Group-US showed statistically significant reduction in T. forsythia at 1 week only (p < 0.05). Group-PDT showed statistically significant reduction in P. gingivalis and T. forsythia from baseline to 1 week and 4 weeks (p < 0.05). This was also significant when compared with US on both the time points (p < 0.05).

CONCLUSION

PDT was effective in significantly reducing periodontal pathogens in established gingivitis lesions in adolescent patients undergoing fixed orthodontic treatment in short term.

External apical root resorption after nonextraction orthodontic treatment with labial vs. lingual fixed appliances

OBJECTIVES

The aim of this retrospective study is to compare external apical root resorption (EARR) after labial and lingual fixed orthodontic treatment, as detected with panoramic radiographs.

MATERIALS AND METHODS

Sixty subjects were divided into two groups according to the treatment type: lingual (30 patients) and labial (30 patients) fixed orthodontic treatment. Panoramic radiographs which were obtained at the beginning of treatment (T0) and at the end of the treatment (T1) were evaluated. The maxillary and mandibular central and lateral incisors, as well as canine crown and root lengths were measured for T0 and T1. Crown to root ratios were used to determine EARR. Data were evaluated using analysis of variance and χ² analysis.

RESULTS

In all, 5 patients (16.7%) in the lingual group and 7 patients (23.3%) in the labial group had a minimum of one tooth with severe EARR, while 9 patients (30%) in the lingual group and 14 patients (46.7%) in the labial group had no EARR. A total of 26 teeth (7.2%) in the lingual group and 34 teeth (9.4%) in the labial group developed severe EARR; however, 184 teeth (51.1%) in the lingual group and 202 teeth (56.1%) in the labial group did not reveal any EARR. No statistically significant difference was found for the resorption rates between the treatment groups (p > 0.05). Although not statistically significant, there was a higher percentage of severe EARR in the mandible within the labial group.

CONCLUSIONS

Both lingual and labial orthodontic techniques showed statistically similar root resorption rates. EARR is a multifactorial issue and individual predispositions must also be taken into consideration.

Role of taste perception in white spot lesion formation during orthodontic treatment

OBJECTIVES

To investigate the role of individual's taste sensitivity using 6-n-propylthiouracil (PROP) in the development of white spot lesions (WSLs) in adolescent orthodontic patients.

MATERIALS AND METHODS

44 healthy adolescents, aged 12 to 16 years old, who were in fixed-appliance orthodontic treatment for at least 6 months, consented to participate in this cross-sectional study. Data regarding participants' demographic information, oral hygiene practices, and dietary habits were obtained by a questionnaire. An oral clinical examination was performed to determine the oral hygiene status, the presence of WSLs and dental caries experience. The taste phenotype of the participants was evaluated through PROP test and they were accordingly divided into PROP nontasters and PROP tasters.

RESULTS

The sample consisted of 24 subjects in the WSL group and 20 subjects in the WSL-free group. The WSL group demonstrated higher mean plaque score (48.2), mean decayed, missing, and filled surfaces (2.38), and mean decayed, missing, and filled teeth (1.96) scores compared to the WSL-free group (38.7, 0.85, and 0.55, respectively), but no significant differences were found. Most subjects in the WSL group were PROP nontasters (66.6%) whereas most subjects in the WSL-free group were PROP tasters (75%); a significant difference was observed between the groups (P = .006).

CONCLUSIONS

The prevalence of white spot lesions was significantly higher in adolescent orthodontic patients who were PROP nontasters compared to PROP tasters. A PROP taste perception could be a potential risk factor for the formation of WSLs during fixed orthodontic treatment that warrants further attention.

[Influences on periodontal health and conditions of patients with periodontitis by clear aligner treatment]

No matter what kind of therapies you choose, clear aligner treatment (CAT) or fixed orthodontic treatment (FOT), the therapy must be performed on the basis of periodontal health and follow the rule that the treatment cannot be harmful to the periodontal tissues. Doctors and patients prefer the clear aligner treatment because of its features, such as aesthetic, removable and comfortable. There are many studies which consider the influences of CAT on the periodontal health, and the conclusions are relatively consistent. The CAT is more beneficial for the plaque-control and maintaining the periodontal health. However, there are a few articles which are talking about applying the CAT to the patients with severe periodontitis. This article mainly reviews the effect of CAT towards the patients with periodontitis, and provides some reference when the patients with severe periodontitis need to choose a proper treatment.

Efficacy of Three Types of Plaque Control Methods During Fixed Orthodontic Treatment: A Randomized Controlled Trial

Aim:

The aim of this study was to evaluate and compare the efficacy of three types of plaque control methods among 13- to 35-year-old subjects receiving fixed orthodontic treatment in Coorg Institute of Dental Sciences, Virajpet, Coorg district, Karnataka, India.

Materials and Methods:

A total of 111 subjects who fulfilled the inclusion and exclusion criteria were randomly included in the study. The subjects were recalled after 1 month of the commencement of fixed orthodontic treatment for the recording of baseline data including plaque index (PI), gingival index (GI), and modified papillary bleeding index (MPBI). After recording of the baseline data, the subjects were randomly allocated into each of the intervention groups, i.e., group A (manual tooth brush), group B (powered tooth brush), and group C (manual tooth brush combined with mouthwash) by lottery method. Further, all the subjects were recalled after 1 and 2 months for recording the data.

Results:

Regarding plaque levels, it was seen that there was a highly statistically significant difference between the three groups (P = 0.001), with the manual tooth brush combined with chlorhexidine mouthwash group recording the lowest mean PI score of 0.5 ± 0.39. A comparison of the mean GI scores among the groups at the end of 2 months shows a highly statistically significant difference (P = 0.001). The mean MPBI scores at the end of 2 months were highly statistically significant among the three groups (P = 0.001), with the group C recording the lowest mean MPBI score of 0.3 ± 0.3.

Conclusion:

The powered tooth brush group subjects exhibited significantly lesser PI, GI, and MPBI scores than the manual tooth brush group at the end of 2 months, whereas the manual tooth brush combined with chlorhexidine mouth wash group subjects showed maximum improvement, having significantly lesser PI and GI scores than the powered tooth brush group.

Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients

Introduction: Maintenance of good oral hygiene is important for patients undergoing fixed orthodontic treatment.

Aim: The aim of this study was to evaluate the effectiveness of a manual orthodontic toothbrush, powered toothbrush with oscillating head and sonic toothbrush in controlling plaque, gingivitis and interdental bleeding in patients undergoing fixed orthodontic treatment, and to compare their relative efficacy.

Materials and methods: Sixty subjects, who were to receive orthodontic treatment with both upper and lower fixed appliances, were randomly divided into three study groups, with 20 patients in each group. Groups I to III were given manual orthodontic, powered and sonic toothbrushes, respectively. Plaque index (PI), gingival index (GI) and interdental bleeding index were scored to assess the level of plaque accumulation, gingival health and interdental bleeding at baseline; 4 and 8 weeks recall visits after fixed appliance bonding. Paired t-tests and one-way analysis of variance (ANOVA) tests were used for intragroup and intergroup comparisons. The level of statistical significance was set at p < 0.05.

Results: This study showed that a significant reduction in all the three indices scores was found from baseline to 4 and 8 weeks in group III. On intergroup comparison, no statistically significant differences were detected between the three groups for any of the parameters assessed.

Conclusion: On intragroup comparison, sonic brushes performed superiorly in reducing gingivitis, plaque and interdental bleeding as compared to the manual orthodontic and powered brushes. On intergroup comparison, the relative comparative effectiveness was found to be similar for all the three brushes.

How to cite this article: Sharma R, Trehan M, Sharma S, Jharwal V, Rathore N. Comparison of Effectiveness of Manual Orthodontic, Powered and Sonic Toothbrushes on Oral Hygiene of Fixed Orthodontic Patients. Int J Clin Pediatr Dent 2015;8(3):181-189.

Risk factors and management of white spot lesions in orthodontics

The formation of white spot lesions or enamel demineralization around fixed orthodontic attachments is a common complication during and following fixed orthodontic treatment, which mars the result of a successfully completed case. This article is a contemporary review of the risk factors, preventive methods and fate of these orthodontics scars. The importance of excellent oral hygiene practice during fixed orthodontic treatment must be explained. Preventive programs must be emphasized to all orthodontic patients. Suggestions are offered in the literature for ways to prevent this condition from manifesting itself.

Prevalence of white spot lesion in a section of Indian population undergoing fixed orthodontic treatment: An in vivo assessment using the visual International Caries Detection and Assessment System II criteria

Background:

Enamel demineralization resulting in White Spot Lesion (WSL) is one of the most common disease outcome associated with fixed orthodontic therapy with high prevalence rates in western countries. However, no such studies have been done on Indian population.

Aim:

The aim of this study was to evaluate the prevalence of WSLs in a section of urban Indian population between the age group of 12-20 years undergoing fixed orthodontic therapy for a period of 12-15 months.

Materials and Methods:

180 patients who qualified for this study were examined and evaluated for WSLs: Group I (test group) comprised of 90 subjects who were undergoing orthodontic treatment for a period of 12-15 months; Group II (control group) comprised of 90 subjects who were in need of orthodontic treatment.

Results:

The result showed a high prevalence rate of 75.6% in Group I compared to 15.6% in Group II.

Conclusions:

The study elicited significantly higher prevalence rate of WSLs in Indian patients undergoing fixed orthodontic treatment.