White lesions after orthodontic treatment: does low fluoride make a difference?
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OBJECTIVE: To compare and measure the changes in size of post-orthodontic demineralized white lesion enamel lesions treated with a low fluoride (50 ppm) versus a non-fluoride mouthrinse/toothpaste regime. STUDY DESIGN: An experimental double-blind prospective randomized clinical controlled trial. SETTING: A university dental school orthodontic clinic (Sheffield, UK). PARTICIPANTS: Twenty-six patients identified as having post-orthodontic demineralized white lesions on removal of their fixed appliance. METHOD AND INTERVENTIONS: The participants were randomly and blindly assigned to either a low fluoride mouthrinse/toothpaste treatment regime or an inactive control. Computerized image analysis of calibrated photographic images taken under polarized light were used to measure the lesions. OUTCOME MEASURES: Lesion size and proportion (DWL%t) and percentage reduction (ADPR) at debond, and at 12 and 26 weeks later. RESULTS: Five participants dropped out of the study, 12 had the low fluoride regime and 9 did not. As a percentage of the total labial tooth area (DWL%t) the mean size of the lesions at debond was 8.1% (SD 3.7). After 12 weeks the mean size of lesion had reduced to 4.6% (SD 2.6), which was a significant reduction (p=0.03). After 26 weeks the mean size was 3.5% (SD 2.1), which was a very significant reduction (p<0.003). This confirmed statistically that post-orthodontic demineralized white lesions do reduce in size with time reflecting remineralization or other enamel surface changes. Intervention using a test low fluoride mouthrinse/toothpaste combination at 26 weeks showed an average difference percentage reduction (ADPR) of 54.3% (Upper 95% CI=62.08, Lower 95% CI=46.44%) compared with a non-active control combination, which showed an ADPR of 66.1% (Upper 95% CI=77.74, Lower 95% CI=54.51%). This failed to show any differences or therapeutic affect. CONCLUSIONS: Post-orthodontic demineralized white lesions reduced in size during the 6 months following treatment by approximately half the original size. There was no clinical advantage in using the low fluoride formulation of mouthrinse/toothpaste in this study. (+info)
How to effectively use a 2 x 4 appliance.
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A mixed dentition treatment can efficiently and effectively be provided using a 2 x 4 appliance. The indications for early treatment are discussed and advantages of fixed appliances over traditionally used removable appliances illustrated using four case reports. (+info)
A modified monobloc for the treatment of obstructive sleep apnoea in paediatric patients.
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The aims of this study were to determine the differences in craniofacial morphology between children with obstructive sleep apnoea (OSA) and control subjects, and to investigate the effects of modified monobloc (MM) appliance treatment in OSA children. The treatment group consisted of 20 OSA Caucasian subjects (10 boys and 10 girls) with ages ranging from 4 to 8 years (mean 5.91 years). The control group comprised 20 healthy Caucasian subjects without OSA (10 boys and 10 girls) with ages ranging from 5 to 7 years (mean 6 years). Polysomnography was used to establish the diagnosis of OSA and to evaluate the effects of MM treatment in the test group. Cephalometric radiographs and study models were obtained for all subjects. A number of statistically significant differences were detected in craniofacial morphology between the treatment group and controls. The treatment group demonstrated a skeletal Class II pattern (P= 0.04), with a reduced mandibular length (P= 0.03) and a corresponding increase in overbite. The hyoid bone was located superiorly in the OSA group (P = 0.04). Analysis of the dental arches demonstrated a significantly smaller distance between the first and second inter-molar primary mandibular regions (P = 0.03 and P = 0.04, respectively) in OSA patients. Repeat polysomnography, with the MM in situ, after 6 months of wear, revealed a significant reduction in the apnoea-hypopnoea index in children with OSA (P= 0.0003). The MM was found to reduce daytime sleepiness and to subjectively improve assessed sleep quality. The patients and their parents reported good compliance with MM treatment. (+info)
The effect of fixed orthodontic appliances on the oral carriage of Candida species and Enterobacteriaceae.
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The aim of this investigation was to evaluate the prevalence of Candida and Enterobacteriaceae in a group of adolescents during fixed orthodontic appliance (FOA) therapy. The experimental group was recruited from a larger sample of orthodontic patients who were clinically examined once to obtain baseline data before active treatment. The group comprised 27 subjects; 13 males, 14 females (mean age 15.5 +/- 2.3 years). Thereafter, the experimental group was examined three times during a 3 month follow-up period after insertion of the FOA. The whole mouth plaque score was obtained, and the oral cavity was then sampled for Candida species and Enterobacteriaceae using three different microbiological culture techniques, namely the oral rinse, pooled plaque and the imprint culture.A significant increase in candidal numbers was observed after FOA insertion when the imprint technique was used (P < 0.001), although the overall candidal prevalence rates obtained using the oral rinse and pooled plaque techniques did not demonstrate such a change. The predominant Candida species isolated was C. albicans and the number of coliform carriers significantly increased after the insertion of a FOA, as detected by the oral rinse (P < 0.05) and the pooled plaque (P < 0.05) techniques. In total, eight coliform species were isolated following FOA therapy compared with the three species isolated before insertion of the appliance. The results also revealed a significant increase in plaque index due to the introduction of a FOA. Taken together, these data imply that insertion of a FOA is likely to promote oral carriage of Candida and coliform species. Furthermore, it appears that routine oral hygiene instruction and information on appliance hygiene given to these patients may not necessarily reduce plaque accumulation and possible attendant effects. Further work with a larger cohort is required to confirm these findings. (+info)
Lingual orthodontics: history, misconceptions and clarification.
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Many frank misconceptions still exist surrounding the efficacy and clinical nature of lingual orthodontics, which were first introduced over 25 years ago in Japan and the United States. Despite early difficulties in the development of the technique, it has become a valid clinical option for patients in many parts of the world. Specific problems, for example concerning patient comfort and biomechanics, have been systematically solved over time. Continuing modification of clinical methods significantly increases options for clinicians and patients, especially adults who may be reluctant to accept traditional labial orthodontic appliances. (+info)
Three-dimensional numerical simulation of dental implants as orthodontic anchorage.
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Endosseous oral implants have been used as orthodontic anchorage in subjects with multiple tooth agenesis, and their application under orthodontic loading has been demonstrated clinically and experimentally. The aim of this investigation was to examine three-dimensional (3D) bone and implant finite element (FE) models. The first model assumed that there was no osseointegration and the second that full osseointegration had occurred. These models were used to determine the pattern and distribution of stresses within the ITI-Bonefit endosseous implant and its supporting tissues when used as an orthodontic anchorage unit. The study examined a threaded implant placed in an edentulous segment of a human mandible with cortical and cancellous bone. The results, using both models, indicated that the maximum stresses were always located around the neck of the implant, in the marginal bone. Thus, this area should be preserved clinically in order to maintain the bone-implant interface structurally and functionally. (+info)
Approach to obstructive sleep apnea syndrome at Tokyo Dental College, Ichikawa General Hospital.
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In this communication, we report the current status of OSAS (Obstructive Sleep Apnea Syndrome) in the southern region of Higashikatsushika around Ichikawa City, our effort to improve patient QOL as well as to establish diagnostic and therapeutic methods, and the results of a comparison of therapeutic options with the focus on improvement of compliance by using nCPAP (nasal continuous positive airway pressure). We examined 112 patients who visited the Otolaryngology Department at Tokyo Dental College, Ichikawa General Hospital, with the chief complaint of nocturnal snoring or sleep apnea from January 2001 to April 2003 and underwent all-night PSG (polysomnography). Based upon the results of these all-night PSGs, 89 and 23 patients were diagnosed as having OSAS and simple snoring, respectively. Using the AHI classification of severity, 58 and 31 patients were assessed as having severe OSAS and mild OSAS, respectively. (1) nCPAP was tried in 61 patients, and 39 patients (63%) were able to continue it. After the introduction of nCPAP, surgery was performed in 18 patients (30%). As a result, weaning from nCPAP was successfully achieved in 10 cases, compliance with nCPAP was improved in six cases, alleviation of symptoms (decreased pressure) was seen in one case, and aggravation was noted in one case. In addition, four patients (7%) unilaterally discontinued nCPAP. (2) Surgery was performed in 34 patients, and 18 of them had surgery after nCPAP was tried. (3) We asked the dental department to make OAs (oral appliances) for 31 patients but seven of them did not attend the department, so a total of 24 patients used OAs. Fourteen patients (58%) were able to tolerate an OA for 3 months or more. Based on these results, we are hoping to achieve a better control of OSAS by combining nCPAP and other modalities. (+info)
Combined cephalometric and stent planning for palatal implants.
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Several aspects of palatal implant usage are technique sensitive. In particular, problems during the insertion stage may compromise implant osseo-integration, or its subsequent ease of handling and effectiveness. This paper describes a systematic approach to combined cephalometric and model planning, and subsequent stent fabrication for Orthosystem palatal implants. The authors recommend this protocol in order to optimize three-dimensional control of implant positioning, and to both simplify and standardize the insertion stage. (+info)