In recent years, a segmental approach to Class II correction has gained popularity among orthodontists. This concept is best represented by the Carrière Motion 3D™ Class II Appliance (CMA), which is an efficient and effe...In recent years, a segmental approach to Class II correction has gained popularity among orthodontists. This concept is best represented by the Carrière Motion 3D™ Class II Appliance (CMA), which is an efficient and effective appliance for the treatment of Class II malocclusions. Although it is original and innovative, it also has some inherent flaws that can potentially interfere with its daily use. A segmental approach is described, based on a section of 0.016 × 0.022-inch stainless steel archwire connected to a molar band distally and to a bracket on the mesial side. This simple alternative presents a 'do-it-yourself' and an easy-to-construct mechanism that employs the same principles and identical mechanics to achieve Class II correction yet overcomes most of the disadvantages of other modalities. In our clinic, we found that this optional, useful sectional appliance can correct Class II malocclusion effectively, predictively and on a regular basis.
AIM: To compare microleakage beneath ceramic and metal brackets prepared with either acid etching or laser conditioning. DESIGN: An in vitro study. SETTING: Department of Orthodontics, Faculty of Dentistry, Suez Canal Un...AIM: To compare microleakage beneath ceramic and metal brackets prepared with either acid etching or laser conditioning. DESIGN: An in vitro study. SETTING: Department of Orthodontics, Faculty of Dentistry, Suez Canal University, Ismailia, Egypt. METHODS: A total of 40 intact human premolars were selected and divided into four equal groups. The groups received the same adhesive-application procedures with different surface treatments and type of brackets: groups 1 (AM) and 3 (AC) underwent phosphoric acid etching; groups 2 (LM) and 4 (LC) underwent laser enamel conditioning using a Er,Cr:YSGG laser. Metal brackets were then bonded to the teeth in groups 1 (AM) and 2 (LM) and ceramic brackets in groups 3 (AC) and 4 (LC). Subsequently, they were placed in fuchsin dye solution. Each premolar was sectioned longitudinally in the occluso-gingival direction at right angles to the brackets. The dye penetration depth was calculated using a stereomicroscope. Microleakage was measured along the enamel-adhesive interface at each section's gingival and occlusal levels. For group comparisons, the Tukey test was utilised as a post hoc test to determine statistical significance between groups. The independent sample -test was utilised for comparing both subgroups. RESULTS: The results demonstrated significantly more microleakage under metal and ceramic brackets bonded to enamel prepared with laser conditioning than with acid etching at both the gingival and occlusal surfaces and in total. The AC group exhibited the lowest amount of microleakage, but the LC group demonstrated the highest amount of microleakage. CONCLUSION: The ceramic bracket group treated with acid etching exhibited the lowest level of microleakage. Microleakage values on the gingival and occlusal surfaces were higher in both bracket types for the laser etched groups.
OBJECTIVE: To assess the type, number and outcome of remote appointments in Orthodontics and Oral and Maxillofacial Surgery (OMFS) in one acute hospital trust and to establish whether remote appointments carried out duri...OBJECTIVE: To assess the type, number and outcome of remote appointments in Orthodontics and Oral and Maxillofacial Surgery (OMFS) in one acute hospital trust and to establish whether remote appointments carried out during the Covid-19 pandemic were successful in saving a face-to-face appointment. DESIGN: Service evaluation. SETTING: Orthodontic and OMFS departments at Buckinghamshire Healthcare NHS Trust. METHOD: A retrospective service evaluation was carried out, analysing the types, numbers and outcomes of remote appointments in Orthodontics and OMFS over a nine-month period (March-December 2020) during the Covid-19 pandemic in one hospital trust. Data were collected from the trust online booking system and departmental spreadsheets and recorded on Microsoft Excel. RESULTS: A total of 901 remote appointments were analysed, 42% (n = 387) of which were Orthodontic and 58% (n = 523) OMFS. Low failure to attend rates were seen in both specialties (3% (n = 18) OMFS; 6% (n = 21) Orthodontics). Retainer reviews accounted for 83% (n = 315) of all Orthodontic remote appointments and the most common outcome of remote appointments was discharge after attendance (49% n = 189). New patient consultations accounted for 41% (n = 212) of OMFS remote appointments and the most common outcomes were Oral Medicine review (31% n = 162) and discharge following attendance (20% n = 103). Remote platforms saved a follow-up face-to-face appointment in 92% (n = 352) of Orthodontic appointments, compared to 81% (n = 421) for OMFS remote appointments. CONCLUSION: When appropriately triaged, the majority of remote appointments do save a face-to-face visit, and there is a place for remote platforms in both specialties going forward. However further research is required in the post-pandemic era to ascertain the full long-term applicability of remote Orthodontic and OMFS appointments.
OBJECTIVES: To assess clinician perceptions of and satisfaction with remote appointments in orthodontics and oral and maxillofacial surgery (OMFS). DESIGN: Cross-sectional questionnaire-based study. SETTING: Orthodontic...OBJECTIVES: To assess clinician perceptions of and satisfaction with remote appointments in orthodontics and oral and maxillofacial surgery (OMFS). DESIGN: Cross-sectional questionnaire-based study. SETTING: Orthodontic and OMFS departments in six acute NHS hospital Trusts in the UK. PARTICIPANTS: A total of 36 (a mixture of consultants, specialty doctors, registrars and therapists in both orthodontics and OMFS) completed responses were received. METHOD: Once piloted, questionnaires were disseminated across six hospital Trusts to orthodontic and OMFS clinicians. A combination of face-to-face (F2F) and online dissemination was used. RESULTS: A total of 28 of 36 (77.8%) questionnaires were completed, 75% (n = 21) by orthodontic clinicians and 25% (n = 7) by OMFS clinicians. A 100% (n = 21) response rate was achieved for orthodontic clinicians, compared to a 47% (n = 7/15) response rate for OMFS clinicians. High levels of clinician satisfaction were found for clinician confidentiality; however, concerns remained around patient confidentiality and the inability to conduct a clinical examination. The majority (n = 21, 75%) of clinicians felt that remote appointments had their place in the post-pandemic era, particularly for retainer reviews in orthodontics and biopsy results in OMFS. CONCLUSION: When appropriately triaged, the majority of remote appointments do save a face-to-face visit, and there is a place for remote platforms in both specialties going forward. However further research is required in the post-pandemic era to ascertain the full long-term applicability of remote orthodontic and OMFS consultations.
This case report describes the orthodontic management of a case of chronic non-bacterial osteomyelitis (CNO) of the mandible, a rare non-infective variant of osteomyelitis that exhibits a marked predilection in children...This case report describes the orthodontic management of a case of chronic non-bacterial osteomyelitis (CNO) of the mandible, a rare non-infective variant of osteomyelitis that exhibits a marked predilection in children and adolescents. The patient presented with a unilateral facial swelling associated with fluctuating pain. Radiographic examination, along with tissue biopsy and culture, as well as multispecialty input, led to confirmation of the diagnosis. There was no clear aetiological factor and pharmacological, symptomatic management was indicated. CNO requires multidisciplinary input, with good interspecialty communication and discussion, for an accurate diagnosis. Orthodontic management should be considered on a case-by-case basis, with tailored aims appropriate for each patient.
OBJECTIVE: To compare the space closure, root resorption and canine angulation during en-masse retraction of the labial segment after extraction of first premolars with or without interseptal bone reduction distal to the...OBJECTIVE: To compare the space closure, root resorption and canine angulation during en-masse retraction of the labial segment after extraction of first premolars with or without interseptal bone reduction distal to the maxillary canines. DESIGN: A single-centre, parallel randomised control trial included 16 participants with a mean age of 21.5 years. Participants were allocated into treatment groups using blocked randomisation, and blinding was employed for outcome assessors and data analysts. INTERVENTIONS: The control group consisted of eight participants who underwent extraction of maxillary first premolars only, while the experimental group included eight participants who underwent interseptal bone reduction immediately after premolar extraction. En-masse retraction was performed using conventional friction mechanics with anchorage reinforcement in both groups. OUTCOMES: Measurements of space closure were conducted over 3 consecutive months during retraction. The time taken for total space closure was recorded. Cone-beam computed tomography scans were taken before and 3 months after retraction to assess root resorption and canine angulation. RESULTS: The experimental group demonstrated a significant increase in the rate of en-masse retraction compared to the control group over 3 months (mean difference [MD] = 1.09 mm, 95% confidence interval [CI] = 0.78-1.40), with an overall space closure rate of MD 0.26 mm/month (95% CI = 0.17-0.34). However, these changes were of minimal clinical significance. The change in canine angulation (MD = 4.50°, 95% CI = -1.61-10.61) did not exhibit statistical significance. Substantial root resorption was observed in six maxillary anterior teeth, with no difference between the groups. CONCLUSION: Interseptal bone reduction is a minimally invasive surgical technique, resulting in an accelerated rate of en-masse retraction in the experimental group over 3 months. However, despite the statistical significance, the clinical impact on overall space closure was minimal, with a difference of only 0.26 mm/month observed between the groups. Interseptal bone reduction did not affect the change in canine angulation and root resorption.
OBJECTIVE: To determine if re-establishment of occlusal contact was achieved within 6 months after insertion of a fixed anterior bite plane in individuals with Class II division 2 incisor relationship, and to evaluate th...OBJECTIVE: To determine if re-establishment of occlusal contact was achieved within 6 months after insertion of a fixed anterior bite plane in individuals with Class II division 2 incisor relationship, and to evaluate the occlusal and vertical skeletal changes and acceptance of the intra-oral scanner and bite plane. DESIGN: Single-centre two-arm parallel group randomised controlled trial with 1:1 allocation to intervention and control groups. SETTING: Dundee Dental Hospital and Research School, UK. PARTICIPANTS: A total of 38 participants aged 9-16 years (11 males, 27 females) with Class II division 2 incisor relationship and increased overbite (greater than one-third incisor overlap). METHODS: Participants were randomised to intervention (n = 19) and control (n = 19) groups using block randomisation. The intervention group had a fixed anterior bite plane, and the occlusion and vertical facial dimensions were monitored with intra-oral scans, lateral cephalograms and photographs. The control group received no treatment and occlusal and vertical facial dimensions were monitored with scans and photographs. Questionnaires were completed by participants and parents/carers. An intention-to-treat analysis was planned. RESULTS: The overbite reduced in all participants in the intervention group (mean initial overbite: 5.07 mm, 95% confidence interval [CI] = 4.15-6.00; mean overbite after 6 months: 2.45 mm, 95% CI = 1.93-2.96). There was a mean incisor intrusion of 0.29 mm (95% CI = 0.17-0.42) and mean eruption of the first molars of 0.23 mm (95% CI = 0.09-0.37). There was no significant change in incisor inclination or vertical skeletal change. Feedback from participants and their parents/carers were generally positive. CONCLUSION: Fixed anterior bite planes effectively reduce an increased overbite in adolescents with a Class II division 2 incisor relationship, due to a combination of incisor intrusion and molar eruption with no change in incisor inclination or vertical skeletal change. Intra-oral scanning and fixed anterior bite planes are acceptable in adolescents.
OBJECTIVE: To obtain an overview of current practice for pre-alveolar bone graft (pre-ABG) orthodontics at cleft centres across the United Kingdom. DESIGN: Cross-sectional survey. SETTING: Web-based. METHODS: The survey...OBJECTIVE: To obtain an overview of current practice for pre-alveolar bone graft (pre-ABG) orthodontics at cleft centres across the United Kingdom. DESIGN: Cross-sectional survey. SETTING: Web-based. METHODS: The survey was distributed online to UK orthodontic consultants undertaking cleft care and was piloted before use. The domains explored included level of experience, perceived benefits and concerns with undertaking pre-ABG orthodontics, types of appliances used and ABG outcomes. RESULTS: A total of 38 consultant orthodontists responded, with a response rate of 56%. Pre-ABG orthodontics was performed most commonly (81.6%) in patients with a bilateral cleft lip and palate; however, 21.1% never performed it in any cleft phenotypes. The most common types of appliances used were fixed slow expanders and fixed appliances. No respondents reported poor ABG outcomes. CONCLUSION: There was no clear protocol for providing pre-ABG orthodontic treatment, with wide variation across the UK. A variety of orthodontic treatment approaches are being undertaken, and the outcomes of ABGs remain successful. Multidisciplinary teams should have a holistic approach to patient care when deciding to perform pre-ABG orthodontics and involve patients in decision making. Future UK research should focus on additional secondary outcomes and determining a standardised approach to ensure best possible care is delivered.
OBJECTIVE: To evaluate the effect of 10% papain as an enamel deproteinising agent on the shear bond strength (SBS) of three orthodontic adhesives: Transbond XT, resin-modified glass ionomer cement (RMGIC) and Biofix. DES...OBJECTIVE: To evaluate the effect of 10% papain as an enamel deproteinising agent on the shear bond strength (SBS) of three orthodontic adhesives: Transbond XT, resin-modified glass ionomer cement (RMGIC) and Biofix. DESIGN: Single-centre, double-blinded, split-mouth randomised controlled trial. SETTING: Department of Orthodontics and Dentofacial Orthopaedics, Nair Hospital Dental College, Mumbai, India. PARTICIPANTS: A total of 20 participants, requiring bilateral premolar extraction for fixed orthodontic treatment in both the maxillary and mandibular arches, were included in this study. METHODS: In total, 80 premolars from the above-mentioned participants were divided into four groups as follows: group A: Transbond XT deproteinised with 10% papain gel; group B: Biofix deproteinised with 10% papain gel; group C: RMGIC deproteinised with 10% papain gel; and group D: Transbond XT without enamel deproteinisation as a control group-bonded as instructed by the manufacturer. After deproteinisation, brackets were bonded and after a follow-up period of 28 days, the teeth were extracted. The SBS was then measured using the Universal Testing Machine. The force needed to shear the bracket was documented, and bond strengths were subsequently calculated in megapascals (MPa). The obtained results were subjected to statistical analysis and one-way ANOVA was performed to compare the mean SBS between the groups. Subsequently, pairwise comparisons were conducted using Tukey's post hoc test. RESULTS: There was a statistically significant difference in SBS among all groups ( = 0.002). The SBS of TransXT with deproteinisation increased significantly compared with TransXT without deproteinisation ( = 0.03). There was no statistically significant difference between the SBS of TransXT without deproteinisation and RMGIC ( = 0.47) and Biofix ( = 0.39), both with deproteinisation. CONCLUSION: The use of 10% papain for deproteinising enamel improved the SBS of all materials. Deproteinising improved the SBS of RMGIC and Biofix to the level of TransXT without deproteinisation.
INTRODUCTION: Temporomandibular joint (TMJ) ankylosis is a debilitating condition characterised by the fusion of bony or fibrous tissues in the TMJ, resulting in restricted mouth opening, functional challenges and facial...INTRODUCTION: Temporomandibular joint (TMJ) ankylosis is a debilitating condition characterised by the fusion of bony or fibrous tissues in the TMJ, resulting in restricted mouth opening, functional challenges and facial deformities. This report highlights the complexity and multifaceted nature of TMJ ankylosis and emphasises the significance of early intervention and a multidisciplinary approach. Distraction osteogenesis has emerged as a successful method for managing TMJ ankylosis and associated facial asymmetry. Post-distraction orthodontic management is essential to address occlusal changes, including posterior open bite and crossbite.Diagnosis and treatment plan:A 17-year-old boy with unilateral right-sided TMJ ankylosis presented with restricted mouth opening, facial asymmetry and functional difficulties. Multidisciplinary treatment planning involved distraction osteogenesis, condylectomy, coronoidectomy and orthodontic correction to improve the occlusion and facial aesthetics. RESULTS: The treatment significantly improved facial aesthetics, mouth opening, occlusion and the patient's confidence and self-esteem. CONCLUSION: This case report underscores the complexity of TMJ ankylosis and the need for a comprehensive approach, including surgical and orthodontic interventions. Collaboration among healthcare professionals and ongoing research is vital to refine treatment approaches and improve the quality of life for patients with TMJ ankylosis.
OBJECTIVE: To investigate the prevalence of, and relationship between, bullying and malocclusion in schoolchildren aged 10-14 years in the South East of the UK. DESIGN: Cross-sectional cohort study. SETTING: Sixteen prim...OBJECTIVE: To investigate the prevalence of, and relationship between, bullying and malocclusion in schoolchildren aged 10-14 years in the South East of the UK. DESIGN: Cross-sectional cohort study. SETTING: Sixteen primary and secondary schools in South East of the UK. PARTICIPANTS: Schoolchildren aged 10-14 years who were consented to participate. METHODS: The prevalence and nature of bullying were measured using a questionnaire. Traits of malocclusion and the need for orthodontic treatment were assessed by clinical examination and determined by the Index of Orthodontic Treatment Need (IOTN) Dental Health (DHC) and Aesthetic components (AC). RESULTS: Complete data were collected for 698 participants. The number defined as being bullied was 68 (9.7%). There was no difference in the prevalence of bullying between gender, ethnicity or age. Higher rates of bullying were reported in mixed sex schools ( = 0.03). Participants with an increased overjet ( = 0.02) and/or a greater need for treatment, as measured by IOTN DHC ( = 0.01) and AC ( = 0.01), reported higher rates of bullying. While there was no difference in the overall prevalence of bullying between genders, boys were more likely than girls to experience physical bullying ( <0.001) and being called names ( = 0.03). CONCLUSION: A significant relationship was evident between being bullied and certain traits of malocclusion.
OBJECTIVE: To apply the Peer Assessment Rating (PAR) to cases that have been assessed by the NHS Business Service Authority (NHSBSA) using the orthodontic treatment protocol (OTO), then compare the NHSBSA outcome assessm...OBJECTIVE: To apply the Peer Assessment Rating (PAR) to cases that have been assessed by the NHS Business Service Authority (NHSBSA) using the orthodontic treatment protocol (OTO), then compare the NHSBSA outcome assessment with weighted (W) and unweighted (U) PAR scores. DESIGN: Cross-sectional study. SETTING: UK. CASES: Anonymised orthodontic cases submitted to the NHSBSA. METHODS: A sample of 30 reports from 2021/2022 were randomly selected to include different standard of treatment grades. The records were de-identified and the pre- and post-treatment study models were PAR scored by a calibrated assessor. RESULTS: The mean percentage change in PAR was higher in cases from green reports (W: 78%; U: 79%) than amber (W: 68%; U: 67%) and red reports (W: 65%; U: 65%). Alignment and poor buccal segment interdigitation were the most reported concerns for cases included in the red and amber graded reports. A residual increased overjet was the most common occlusal feature leading to PAR scores not being more than 70% improved. Only slight agreement was shown between OTP and PAR using the kappa statistic, and the chi-square statistical test found that outcome measures are statistically significantly different. CONCLUSION: There are fundamental differences between OTP and PAR, and general agreement between them has not been demonstrated. The NHSBSA Report provides a more critical outcome assessment than PAR, identifying elements that are not assessed or measured by the PAR index.
OBJECTIVE: To investigate the accuracy of full arch scans taken using the iTero Element 2 under clinical settings. DESIGN: Prospective clinical study. METHODS: A customised upper removable appliance (URA) with four spher...OBJECTIVE: To investigate the accuracy of full arch scans taken using the iTero Element 2 under clinical settings. DESIGN: Prospective clinical study. METHODS: A customised upper removable appliance (URA) with four spheres (A-D) was fabricated from a maxillary arch iTero scan for a 24-year-old patient. Six linear values were measured on the URA using a high-accuracy coordinate measuring machine. A total of 60 intra-oral iTero scans were taken by two operators (HA and AS) with the test URA inserted to the participant's maxillary dentition at T1 and T2. Geomagic Control X software was used to measure the six linear distances between the reference spheres (1-4) in all scans. Comparisons between distances on full arch scans to true distances on the URA were made to evaluate accuracy. RESULTS: The median distance to the prepared bench top URA mean was significantly away from zero for each operator and timepoint across all measurements except AD versus 14 and BD versus 24. Statistically significant, although clinically non-significant, differences in median linear distances in relation to the prepared benchtop URA were observed between evaluators in segments AB versus 12 (operator 1 -0.021 mm vs. operator 2 -0.06 mm) and AC vs. 13 (operator 1 -0.044 mm vs. operator 2 -0.167 mm) at T1. CONCLUSION: The accuracy of scanners is defined as the trueness and precision of the captured scans to the dental arches. The accuracy of iTero Element 2 is acceptable for diagnosis and treatment planning in orthodontics. Length and location of the scanned segment and scanning sequence 'protocol' affect accuracy.