The European Journal of Orthodontics - Advance Access

Stability of connected mini-implants and miniplates for skeletal anchorage in orthodontics

Leung, M. T. C., Rabie, A. B. M., Wong, R. W. K. — 2008-05-04

The aim of this study was to examine the primary stability of connected mini-implants and miniplates. Three different skeletal anchorage systems were investigated: (1) two 1.5 mm diameter cylindrical mini-implants connected with a 0.021 x 0.025 inch stainless steel (SS) wire, (2) two 1.6 mm diameter tapered mini-implants connected with a 0.021 x 0.025 inch SS wire, and (3) two 2.0 mm diameter cylindrical mini-implants connected by a titanium locking miniplate. Fifteen standardized bovine bone specimens were prepared, five specimens for each experimental group. The connected mini-implants were fixed on the bone specimens. The systems underwent uniaxial pull-out tests at the midpoint of the connecting wire or miniplate using a mechanical testing machine. One-way analysis of variance was used to determine the difference of the pull-out test results between the groups.

Both the titanium miniplate and SS wire connection systems showed severe deformation at the screw head, which broke before the mini-implants failed. The 2.0 mm miniplate system showed the highest pull-out force (529 N) compared with the other two wire connection systems (P < 0.001). The 2.0 mm system was also stiffer than the 1.6 and 1.5 mm systems (P < 0.001). The yield force of the 2.0 mm miniplate (153 N) was significantly higher than the 1.5 mm (88 N) and 1.6 mm (76 N) systems (P < 0.001).

This in vitro study demonstrated that the connection of two mini-implants with a miniplate resulted in higher pull-out force, stiffness, and yield force to resist pulling force and deformation. Such a set-up could thus provide a stable system for orthodontic skeletal anchorage.

Time-lapse observation of rat periodontal ligament during function and tooth movement, using microcomputed tomography

2008-03-26

The aim of this study was to observe the time-lapse changes in the rat periodontal ligament (PDL) during function and tooth movement. Under Nembutal anaesthesia, time-lapse changes in the thickness of the PDL of the first molars were investigated in five 12-week-old adolescent rats with microcomputed tomography. Three-dimensional (3D) images were reconstructed from the data. Histological observation was also performed, using undecalcified frozen sections of the maxillary first molar area.

The PDL appeared as a radiolucent furrow on the 3D images. A slight change in the thickness of the PDL was observed 1 hour after initiation of orthodontic force loading, which became significant after 6 hours, with the appearance of pressure–tension zones during the tooth movement. These changes were more significant 3 days after orthodontic loading.

Histological observation of the lingual cervical PDL (pressure zone) in nine 12- to 13-week-old rats demonstrated that the periodontal space had become narrow and the cellular elements appeared to be densely packed in the narrowed PDL 6 hours after orthodontic loading. Degeneration of tissues appeared 3 days after loading. Observation of the buccal cervical PDL (tension zone) demonstrated that the PDL was extended 6 hours after orthodontic force loading, and the extension continued for up to 3 days. Alkaline phosphatase activity was distributed in the PDL, except for the degenerating tissues in the pressure zone 3 days after loading.

The results suggest that the periodontal reaction was initiated within 6 hours after orthodontic force loading, which was related to the structural changes of the PDL. The changes probably induced an early response in individual cells of the PDL.

Does the degree of advancement during functional appliance therapy matter?

Rabie, A. B. M., Al-Kalaly, A. — 2008-03-14

The aim of this study was to assess the effect of varied degrees of mandibular advancement on condylar growth. Three hundred and thirty five 35-day-old female Sprague–Dawley rats were randomly divided into 10 experimental groups (n = 10) and five control groups (n = 5) for analysis of new bone formation and 10 experimental groups (n = 14) and five control groups (n = 14) for molecular analysis. The experimental animals were fitted with bite-jumping appliance to advance the mandible 2 and 4 mm. The rats were sacrificed on days 3, 7, 14, 21, and 30. A computer-assisted image analysing system was used to assess the quantity of new condylar bone formation. Molecular analysis utilizing real-time reverse transcription–polymerase chain reaction was used to assess the different levels of mRNA expression of different growth markers in the condyle.

One-way analysis of variance (ANOVA), with a Bonferroni multiple comparison test, showed significantly more newly formed bone in the 4 mm group compared with the 2 mm and control groups on days 21 and 30 (P < 0.05). Most of the examined growth markers demonstrated a significant increase during the 4 mm advancement (P < 0.05). Indian hedgehog (Ihh) mRNA showed a 7- and 5-fold change, parathyroid hormone-related peptide (PTHrP) a 5.2- and 3-fold change and type II collagen a 9.6- and 3.7-fold change in the 4 and 2 mm advancement groups, respectively.

Varied degrees of mandibular advancement result in different quantities of new bone formation and levels of expression of growth members: Ihh, PTHrP, and type II collagen.

Perception of discomfort during initial orthodontic tooth alignment using a self-ligating or conventional bracket system: a randomized clinical trial

Scott, P., Sherriff, M., DiBiase, A. T., Cobourne, M. T. — 2008-03-13

The aim of this study was to compare the degree of discomfort experienced during the period of initial orthodontic tooth movement using Damon3^TM self-ligating and Synthesis^TM conventional ligating pre-adjusted bracket systems. Sixty-two subjects were recruited from two centres (32 males and 30 females; mean age 16 years, 3 months) with lower incisor irregularity between 5 and 12 mm and a prescribed extraction pattern, including lower first premolar teeth. These subjects were randomly allocated for treatment with either bracket system. Fully ligated Damon^TM 0.014-inch Cu NiTi archwires were used for initial alignment in both groups. Following archwire insertion, the subjects were given a prepared discomfort diary to complete over the first week, recording discomfort by means of a 100 mm visual analogue scale at 4 hours, 24 hours, 3 days, and 1 week. The subjects also noted any self-prescribed analgesics that were taken during the period of observation. Data were analysed using repeated measures analysis of variance.

There were no statistically significant differences in perceived discomfort levels between the two appliances; discomfort did not differ at the first time point and did not develop differently across subsequent measurement times. Overall, this investigation found no evidence to suggest that Damon3 self-ligating brackets are associated with less discomfort than conventional pre-adjusted brackets during initial tooth alignment, regardless of age or gender.

A preliminary evaluation of pre-treatment hypodontia patients using the Dental Aesthetic Index. How does it compare with other commonly used indices?

Shelton, A. T., Hobson, R. S., Slater, D. — 2008-02-27

There is currently no specific occlusal index related to hypodontia and there is a paucity of published literature on this subject. The aim of this study was to determine the relationship, if any, between the Peer Assessment Rating (PAR) Index, the Index of Complexity, Outcome and Need (ICON), and the Dental Aesthetic Index (DAI) score and the severity of hypodontia. All new patients attending the Newcastle Dental Hospital hypodontia clinic between February 2002 and March 2003 were included in the study. Of the 60 patients, two were excluded as the models were unavailable and one because they were predominantly in the primary dentition, making scoring impractical. The patient casts were scored with respect to PAR, ICON, and DAI. The mean patient age at presentation was 12 years, with a standard deviation of 1.89 and a range of 9–16 years, and a female to male ratio of 1.1:1.

A significant positive correlation, using Kendall tau b, was found between the number of missing teeth, excluding third molars, and the DAI score ( = 0.215, P = 0.027). There was no significant positive correlation between PAR ( = –0.186, P = 0.056) and ICON ( = 0.017, P = 0.861) score and the number of missing teeth. The results of this investigation indicate that further research is required in order to assess if the DAI could be used to determine whether or not to refer hypodontia patients for specialist advice.

Prediction of arch length based on intercanine width

Paulino, V., Paredes, V., Gandia, J. L., Cibrian, R. — 2008-02-08

Arch length (AL), intercanine width (ICW), and intermolar width (IMW) are essential for diagnosis and treatment planning and are closely related factors in orthodontics. The aim of the present study was to determine correlations between these measurements and to predict some of these measurements based on others.

The dental casts of 197 Spanish patients (119 females and 78 males) with a mean age of 18 years (11–26 years) in the permanent dentition attending the Orthodontic Department of the University of Valencia, Spain, were selected. ICW, IMW, and AL on each dental cast were measured using a previously tested digital method. Correlation between variables was determined using Pearson's correlation coefficient. Linear regression analysis was applied and the 95 per cent confidence intervals (CIs) for slope and intercept were determined.

The data showed very high correlations between ICW and AL, both for the upper and lower arches and for males and females, r = 0.925. This coefficient was very close to 1, indicating a linear relationship. The regression equation for AL and ICW was AL = 1.36 ICW + 29.39 for both arches. There was very high correlations between AL and ICW for the upper and lower arches and a regression equation between both magnitudes was established indicating that the size of one factor can be predicted by knowing the other. For an increase of 1 mm in ICW, the AL increases approximately 1.36 mm with a 95 per cent CI (1.30–1.42).

Relationship between dental arch width and vertical facial morphology in untreated adults

Matthew Forster, C., Sunga, E., Chung, C.-H. — 2008-02-08

The objectives of this study were to investigate if a relationship exists between dental arch width and the vertical facial pattern determined by the steepness of the mandibular plane, and to examine the differences in dental arch widths between male and female untreated adults. Lateral cephalograms and dental casts were obtained from 185 untreated Caucasians (92 males, 93 females) between 18 and 68 years of age with no crossbite, minimal crowding, and spacing. The angle of the mandibular plane (MP) to the anterior cranial base (SN) was measured on cephalograms of each patient. Dental casts were used to obtain comprehensive dental measurements including maxillary and mandibular intercanine, interpremolar, and intermolar widths, as well as the amount of crowding or spacing. The arch widths of males and females were analysed and the differences between them were tested for significance using a Student's t-test. Regression analysis was used to determine the statistical significance of the relationships between MP–SN angle and dental arch width and crowding or spacing.

The results showed that male arch widths were significantly larger than those of females (P < 0.05). For both males and females, there was a trend that as MP–SN angle increased, arch width decreased. It was concluded that dental arch width is associated with gender and facial vertical morphology. Thus, using individualized archwires according to each patient's pre-treatment arch form and width is suggested during orthodontic treatment.

Assessment of vertical facial and dentoalveolar changes using panoramic radiography

Nohadani, N., Ruf, S. — 2008-01-21

The purpose of the study was to analyse longitudinal vertical facial and dentoalveolar changes using panoramic radiographs (PRs) and to compare the results with measurements on lateral cephalometric radiographs (LCRs) in order to determine whether, under certain circumstances, the radiation dose for a patient may be reduced by taking only a PR instead of a PR and a LCR. Pre- and post-treatment PRs and LCRs of 30 (15 females and 15 males) orthodontically treated adolescents (mean age pre-treatment 10.9 years, post-treatment 13.4 years) were analysed using Pearson's correlation coefficients and gender differences using Fisher's z-transformation.

The results revealed that most variables exhibited larger absolute values on PRs than on LCRs. Comparison of dentoskeletal morphology between the LCRs and the PRs revealed moderate to high, mostly statistically significant, interrelations both before and after orthodontic treatment. The lowest correlations were found for the maxillary jaw base angle (NL/H; r = 0.35***) and the highest for the gonial angle (ML/RL; r = 0.90***). However, when assessing the combined growth and treatment changes from before to after treatment, only weak to moderate, not statistically significant, interrelations were found between LCRs and PRs. Anterior face height (AFH; r = 0.43***), the mandibular plane angle (ML/H; r = 0.06*), and the distance of the incisal tip of the most extruded mandibular incisor to the ML-line (ii-ML; r = –0.21*) were the only statistically significant parameters. The average group differences for growth and treatment changes, however, were small for most parameters.

Analysis of vertical facial and dentoalveolar parameters on PRs delivers a moderate approximation to the situation depicted on LCRs. However, PRs cannot be recommended for the analysis of individual longitudinal changes in vertical facial and dentoalveolar parameters.