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Journal: European journal of orthodontics


The aim of this longitudinal study was to assess whether correction of unilateral posterior crossbite in the primary dentition results in improvement of facial symmetry and increase of palatal surface area and palatal volume. A group of 60 Caucasian children in the primary dentition, aged 5.3 ± 0.7 years, were collected at baseline. The group consisted of 30 children with a unilateral posterior crossbite with midline deviation of at least 2 mm (CB) and 30 without malocclusion (NCB). The CB group was treated using an acrylic plate expander. The children’s faces and dental casts were scanned using a three-dimensional laser scanning device. Non-parametric tests were used for data analysis to assess differences over the 30 months period of follow-up. The CB children had statistically significantly greater facial asymmetry in the lower part of the face (P < 0.05) and a significantly smaller palatal volume (P < 0.05) than the NCB children at baseline. There were no statistically significant differences between the two groups at 6, 12, 18, and 30 months follow-ups. Treatment of unilateral posterior crossbite in the primary dentition period resulted in an improvement of facial symmetry in the lower part of the face (P < 0.05) and increase of the palatal surface area and palatal volume (P < 0.001). At 30 months, relapse was observed in eight children (26.7 per cent). Treatment of unilateral posterior crossbite in the primary dentition improves facial symmetry and increases the palatal surface area and the palatal volume, though it creates normal conditions for normal occlusal development and skeletal growth.

Concepts: Facial symmetry, Group theory, Sociology, Statistical significance, Area, Asymmetry


The aim was to determine if bracket prescription has any effect on the subjective outcome of pre-adjusted edgewise treatment as judged by professionals. This retrospective observational assessment study was undertaken in the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield, UK. Forty sets of post-treatment study models from patients treated using a pre-adjusted edgewise appliance (20 Roth and 20 MBT) were selected. The models were masked and shown in a random order to nine experienced orthodontic clinicians, who were asked to assess the quality of the outcome, using a pre-piloted questionnaire. The principal outcome measure was the Incisor and Canine Aesthetic Torque and Tip (ICATT) score for each of the 40 post-treatment models carried out by the nine judges. A two-way analysis of variance was undertaken with the dependent variable, total ICATT score and independent variables, Bracket prescription (Roth or MBT) and Assessor. There were statistically significant differences between the subjective assessments of the nine judges (P<0.001), but there was no statistically significant difference between the two bracket prescriptions (P = 0.900). The best agreement between a clinician's judgment of prescription used and the actual prescription was fair (kappa statistic 0.25; CI -0.05 to 0.55). The ability to determine which bracket prescription was used was no better than chance for the majority of clinicians. Bracket prescription had no effect on the subjective aesthetic judgments of post-treatment study models made by nine experienced orthodontists.

Concepts: Dentistry, Hospital, Evaluation, Assessment, Analysis of variance, Judgment, Statistics, Statistical significance


The aim of the study was to test the hypothesis that the gene defect causing congenital absence of maxillary lateral incisors also causes narrowing of the dentition. A total of 81 patients with one or two congenitally missing lateral incisors were retrieved; 52 (64.2 per cent) patients presented bilateral agenesis, whereas 29 (35.8 per cent) had unilateral agenesis. The control group consisted of 90 consecutively treated patients. The largest mesiodistal crown dimension for all teeth, except for the maxillary second and third molars, was measured on plaster casts using a digital caliper to the nearest 10th of a millimetre. Statistical testing was performed using the analysis of variance model (P < 0.05) to test for differences in the mesiodistal dimension between the sample and the control group. Significance has been assessed using a P-value threshold level of 5 per cent. Agenesis of maxillary lateral incisors was found to be a significant predictor of tooth size. Patients who were missing maxillary lateral incisors had smaller teeth compared to control subjects, except for the maxillary right and left first molars. This finding was true for both unilateral and bilateral lateral incisor agenesis. Interaction between maxillary lateral incisor agenesis and gender was not significant. Patients with congenitally missing lateral incisors have narrower teeth than patients without any dental anomalies, except for maxillary first molars. A higher prevalence of microdontic contralateral incisors was found in patients with unilateral agenesis with respect to the control group.

Concepts: Molar, Maxillary central incisor, Mandibular lateral incisor, Canine tooth, Analysis of variance, Incisor, Maxillary lateral incisor, Teeth


The aim of this longitudinal study was to compare the prevalence of malocclusion at ages 3 and 7 years in a sample of children, exploring the hypothesis that prevalence of malocclusion is higher at 3 than at 7 years of age and may be influenced by sucking habits. The study sample comprised 386 children (199 girls and 187 boys), aged 3 years at study start, sourced from three Public Dental Service clinics in Sweden. Malocclusion was diagnosed by clinical examination, using a specific protocol. Data on allergy, traumatic injuries, sucking habits, and breathing pattern including nocturnal breathing disturbances were obtained by means of a questionnaire answered by child and parent in conjunction with the initial and final clinical examination. The overall prevalence of malocclusion decreased significantly, from 70 to 58% (P < 0.0001): predominantly anterior open bite, excessive overjet, and Class III malocclusion. Although high rates of spontaneous correction were also noted for deep bite, Class II malocclusion and posterior and anterior crossbites, new cases developed at almost the same rate; thus, the prevalence was unchanged at the end of the observation period. Anterior open bite and posterior crossbite were the only conditions showing significant associations with sucking habits. The results confirm the hypothesis of higher prevalence of malocclusion at 3 years of age and clearly support the strategy of deferring orthodontic correction of malocclusion until the mixed dentition stage.

Concepts: Sociology, Cohort study, Epidemiology, Prognathism, Dental braces, Age, Orthodontics, Malocclusion


SUMMARYTo quantitatively evaluate on lateral cephalograms horizontal, vertical, and angular changes in the position of the maxillary first molar based on the presence and absence of erupted maxillary second molars when it is distalized with the XBow appliance.In this retrospective study, a total of 102 consecutively treated cases were assessed. Lateral cephalograms were obtained at the start and after completion of active treatment with the XBow appliance. In one group of patients, distal movement of the maxillary first molars was performed before the eruption of maxillary second molars; in the other group of patients, both first and second maxillary molars were simultaneously moved distally. All cephalograms were superimposed on palatal plane using the method of best-fit. In order to compare the mean horizontal, vertical, and angular changes in molar position between the treatment groups and gender, a multivariate analysis of covariance (MANCOVA) was performed with the pre-treatment class II severity used as a covariate. Regression analysis was also performed to further explore any possible relationships between the predictor variables and the quantity and quality of distalization.A MANCOVA revealed that the eruption stage of the maxillary second molar did not have a significant effect on the change in position of the maxillary first molar after treatment with a XBow appliance.When distalizing maxillary first molars with a XBow appliance, there is no difference in the amount of distalization in patients with erupted and unerupted maxillary second molars.

Concepts: Molar, Teeth, Posterior superior alveolar artery


The aim of this study was to analyze stress distribution and displacement of the maxilla and teeth according to different designs of bone-borne palatal expanders using micro-implants. A three-dimensional (3D) finite-element (FE) model of the craniofacial bones and maxillary teeth was obtained. Four designs of rapid maxillary expanders: one with micro-implants placed lateral to mid-palatal suture (type 1), the second at the palatal slope (type 2), the third as in type 1 with additional conventional Hyrax arms (type 3), and the fourth surgically assisted tooth-borne expander (type 4) were added to the FE models. Expanders were activated transversely for 0.25mm. Geometric nonlinear theory was applied to evaluate Von-Mises Stress distribution and displacement. All types exhibited downward displacement and demonstrated more horizontal movement in the posterior area. Type 3 showed the most transverse displacement. The rotational movement of dentoalveolar unit was larger in types 1 and 3, whereas it was relatively parallel in types 2 and 4. The stresses were concentrated around the micro-implants in types 1 and 3 only. Type 2 had the least stress concentrations around the anchorage and showed alveolar expansion without buccal inclination. It is recommended to apply temporary anchorage devices to the palatal slopes to support expanders for efficient treatment of maxillary transverse deficiency.

Concepts: Analytic geometry, Teeth, Spanish language, Palatal expander


ObjectivesLoosening and loss rates of monocortical mini-implants are relatively high, therefore the following null hypothesis was tested: ‘The local bone stress in mono and bicortically-anchored mini-implants is identical’.Material and MethodsAnisotropic Finite Element Method (FEM) models of the mandibular bone, including teeth, periodontal ligaments, orthodontic braces, and mini-implants of varying length, were created. The morphology was based on the Computed Tomography data of an anatomical preparation. All mini-implants with varying insertion depths (monocortical short, monocortical long, bicortical) were typically loaded, and the induced effective stress was calculated in the cervical area of the cortical bone. The obtained values were subsequently analysed descriptively and exploratively using the SPSS 19.0 software.ResultsThe null hypothesis was rejected, since the stress values of each anchorage type differed significantly (Kruskal-Wallis Test, P < 0.001). Therefore, the lowest effective stress values were induced in bicortical anchorage (mean = 0.65MPa, SD = 0.06MPa) and the highest were induced in monocortical (short) anchorage of the mini-implants (mean = 1.79MPa, SD = 0.29MPa). The Spearman rank correlation was 0.821 (P < 0.001).ConclusionsThe deeper the mini-implant was anchored, the lower were the effective stress values in the cervical region of the cortical bone. Bicortical implant anchorage is biomechanically more favourable than monocortical anchorage; therefore, bicortical anchorage should be especially considered in challenging clinical situations requiring heavy anchorage.

Concepts: Finite element method in structural mechanics, Orthodontics, Statistical tests, Null hypothesis, Spearman's rank correlation coefficient, Non-parametric statistics, Finite element method


This study aimed to investigate the differences in the force loss during simulated archwire-guided canine retraction between various conventional and self-ligating brackets. Three types of orthodontic brackets have been investigated experimentally using a biomechanical set-up: 1. conventional ligating brackets (Victory Series and Mini-Taurus), 2. self-ligating brackets (SmartClip: passive self-ligating bracket, and Time3 and SPEED: active self-ligating brackets), and 3. a conventional low-friction bracket (Synergy). All brackets had a nominal 0.022″ slot size. The brackets were combined with three rectangular 0.019×0.025″ archwires: 1. Remanium (stainless steel), 2. Nitinol SE (nickel-titanium alloy, NiTi), and 3. Beta III Titanium (titanium-molybdenum alloy). Stainless steel ligatures were used with the conventional brackets. Archwire-guided tooth movement was simulated over a retraction path of up to 4mm using a superelastic NiTi coil spring (force: 1 N). Force loss was lowest for the Victory Series and SmartClip brackets in combination with the steel guiding archwire (35 and 37.6 per cent, respectively) and highest for the SPEED and Mini-Taurus brackets in combination with the titanium wire (73.7 and 64.4 per cent, respectively). Force loss gradually increased by 10 per cent for each bracket type in combination with the different wires in the following sequence: stainless steel, Nitinol, and beta-titanium. Self-ligating brackets did not show improved performance compared with conventional brackets. There was no consistent pattern of force loss when comparing conventional and self-ligating brackets or passive and active self-ligating brackets.

Concepts: Metallurgy, Passivation, International Phonetic Alphabet, Titanium, Corrosion, Bracket, Steel, Stainless steel


Summary OBJECTIVE: To evaluate the stability and bone availability of the most distal (third) palatal ruga, as an anatomical region for safe insertion of orthodontic mini-implants (OMIs) in the anterior palate.

Concepts: Place of articulation, Anatomy


White spot lesions (WSL) frequently occur as side-effect of multibracket appliance treatment. The clinical effects of local fluoridation on post-orthodontic WSL and oral health development are however inconclusive.

Concepts: Water fluoridation,, Evaluation methods, Effectiveness, Health care, Placebo, Clinical trial, Clinical data acquisition