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Presurgical infant orthopedics (PSIO) is done to reduce the size of the cleft defect along with improving the arch alignment and nasolabial aesthetics in patients with cleft lip and palate, leading to an improvement of nasolabial aesthetics allowing for a tidier and more aesthetic reparative procedure and postsurgical scar. Since the 2000s, clear aligners have slowly and steadily treaded their way as an acceptable orthodontic modality, with their usage and acceptability increasing considerably over the past decade. Thus, from the knowledge gathered in its 10 years working with 3-dimensional (3-D) diagnosis, treatment planning, and 3-D Printing services, Compass 3D (Belo Horizonte, Brazil) developed the OrthoAligner NAM system. This case series highlights one of the world’s first documented cases of PSIO treated with a series of clear aligners.

This case report introduces digital surgery-first approach orthognathic surgery assisted by three-dimensional virtual planning and combined with invisible orthodontic treatment for a 21-year-old female patient with a skeletal Class III high-angle gummy smile malocclusion. We explored the clinical significance of the widespread application of digital technology for rapid development of the orthodontic/orthognathic field. The regional acceleratory phenomenon and clear aligners were used to achieve fast and aesthetic tooth movement after surgery. The treatment lasted only 8 months, and the patient was satisfied with the aesthetic results. The results remained stable after 1 year of follow-up. This case report highlights the advantages of combining a digital design and a surgery-first approach to produce accurate, rapid, safe, stable, and fulfilling cosmetic results. The combination of the surgery-first approach and clear aligners can facilitate patient-oriented surgical orthodontic treatment.

In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned 103 individuals to oral-appliance or CPAP therapy. Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance (76.5%) and for 43 of 52 persons using CPAP (82.7%). For the difference in effectiveness, a 95% two-sided confidence interval was calculated. Non-inferiority of oral-appliance therapy was considered to be established when the lower boundary of this interval exceeded −25%. The lower boundary of the confidence interval was −21.7%, indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea. However, subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease (apnea-hypopnea index > 30). Since these people could be at particular cardiovascular risk, primary oral-appliance therapy appears to be supported only for those with non-severe apnea.

Previous studies of CAD/CAM-produced sacrificial patterns for removable partial denture frameworks have been documented but to date, no such restorations have been test-fitted to a patient. This paper provides details of the first trial fitting to a patient of an RPD framework, the sacrificial pattern of which was produced by CAD/CAM and RP technologies. A cast of the patient was scanned and the normal procedures of dental surveying and pattern build were undertaken with reference to the scanned model using computer-aided design. A sacrificial pattern of the design was produced by rapid prototyping technology. After spruing the pattern, investment-casting and finishing techniques were carried out according to conventional principles. The framework was successfully trial-fitted to the patient and clinically judged to be acceptable for the next stage of denture fabrication, that of adding acrylic bases and artificial teeth.

The pretreatment and post-treatment study casts and records of 156 completed fixed appliance and removable appliance cases were analysed, and the influence of various factors on the standard of result, as measured by the change in PAR score produced by treatment and the duration of treatment, was assessed. For the purpose of analysis the sample was divided into two groups; a two-arch fixed appliance group (n = 81) and a removable/mini fixed appliance group (n = 75). Multiple regression procedures were carried out separately for both groups, first, with all gathered data and, secondly, with only information which would be known at the start of treatment. For fixed appliances the initial PAR score was consistently an influential variable on change in PAR score and duration of treatment. Patient compliance, the need to extract a permanent first molar and the presence of an anterior crossbite were also important. The initial PAR score also explained much of the variation in change in PAR for removable/mini fixed appliances, but generally, regression models for this group were less well fitting.

The potential hazards and patient resistance to wearing extra-oral appliances are well documented. A method of distalizing molars without the need for head-gear is described.

The aim of the present long-term follow-up study of orthodontically-treated patients (mean: 15·7 years) was to analyse post-retention changes and to reveal factors which may play a role as predictors for long-term prognosis. Pretreatment, end-of-treatment, and post-retention models of 226 cases with all types of anomaly were used to measure intercanine and intermolar width, arch length, and sum of the mesiodistal dimension of the incisors, Irregularity Index, crowding, molar and canine relationship, overjet, and overbite. In order to assess the influence of sex, initial and end-of-treatment alignment, type of therapy, amount of tooth movement, and presence of third molars on the extent of postretention changes, the total sample was divided into subgroups. Findings indicated that post-retention crowding and incisor irregularity increased more frequently in the mandible than in the maxilla. Pretreatment variables such as increased mesiodistal incisor dimension, severe crowding and incisor irregularity, arch length deficiency, arch constriction, and increased overbite as well as post-treatment spacing, arch expansion, increased arch length, and residual Class II or III molar relationships were found to be associated factors in the process of post-retention increase of crowding and incisor irregularity. ‘Overexpansion’ was found to be a factor in mandibular incisor relapse.

A questionnaire sent to all U.K. hospital orthodontic consultants resulted in an 88 per cent response rate. The average waiting time for initial consultation was 31·6 weeks for routine cases and 3·6 weeks for urgent cases. The average waiting time for out patient treatment was 68·7 weeks for routine cases and 7·5 weeks for urgent cases. Nearly 33 per cent of hospitals used the Dental Health Component of the Index of Orthodontic Treatment need (IOTN) as a guide to placing patients on waiting lists. ‘Urgency’ and ‘Complexity’ were used more frequently than indices. Sixty-nine per cent of hospitals exclude some categories of malocclusion from treatment in their departments. A prospective survey reported on 2480 completed treatments over a six week period and there was an average discontinuation rate of 9·2 per cent of all cases finished during the period. Comparison of the completed and discontinued groups revealed few significant treatment-related factors. There was some evidence that the more senior and experienced the operator, the less the rate of discontinuation. A greater rate of discontinuation was seen in removable appliance cases when compared with fixed appliance cases.

Anterior tooth surface loss is a significant problem, ideally requiring early recognition, diagnosis and prevention of progression. However, when first noted it is often sufficiently advanced to warrant treatment. Management should be aimed at minimizing further tooth surface loss and frequently benefits from an integration of treatment procedures. The problems, aims of treatment, and relevant treatment modalities are discussed, and two illustrative cases presented.

The undergraduate orthodontic courses at Toronto and Liverpool are compared. Each course comprises more than 250 hours of teaching and within that, more than 100 hours involve clinical tuition. Both courses contain laboratory modules for the teaching of removable and fixed appliance technique. Undergraduates treat their own patients with both simple and complex appliances, within their clinical training period which extends over at least 2 years. Liverpool undergraduates treat more patients per student than their counterparts in Toronto (P

Roentgencephalometry was used for the assessment of the development of clinically important facial characteristics In complete unilateral cleft lip and palate during the prepubertal and pubertal period. Thirty-one patients aged 8 and 11 years and 30 patients aged 11 and 14 years were examined repeatedly. All of them were operated upon and orthodontically treated with the same methods. An unfavorable development of facial convexity, sagittal jaw relations, configuration of the soft profile, and of the prominence of the upper lip occurred during both periods. An improvement of overjet that was attained during the prepubertal period showed a renewed impairment during the period of puberty. The impairment was not caused by the higher facial growth rate, but was attributable to the exhaustion of the compensation and adaptation mechanisms of the dentoalveolar component of the upper Jaw produced by the preceding orthodontic therapy. The development of sagittal jaw relations and of facial rotation was not related to the Initial patterns of these characteristics, but the possibility of an improvement of the inclination of upper incisors and of overjet was influenced by their initial pattern. During the prepubertal period the development of overjet was not related to the development of sagittal jaw relations or of mandibular growth rotation, as was the case during puberty.

The aim of the study was to evaluate in a three-dimensional manner the dentoskeletàl changes after slow maxillary expansion. The sample consisted of 34 children with a unilateral, symmetrical posterior cross-bite. Half of the children were treated with a quad-helix and the rest with a removable appliance. Assessment of the changes was made with study casts, and frontal and lateral cephalograms, before treatment, at the end of the expansion, after a retention period of 3 months, and after a post-retention period of 3 months. The results showed that sufficient expansion of the dental arches took place in both groups. The expansion expressed in the molar region in the quad-helix group was mostly due to buccal translation of the teeth and in the removable appliance group due to buccal tipping. The quad-helix group showed somewhat greater basal expansion than the removable appliance group, though the basal expansion in both groups was rather small. A tendency towards an increase of the NL/ML angle characterized the removable appliance group, but the opposite pattern was present in the quad-helix group.

This paper presents the orthodontic banding model for vital teeth and the orthodontic in situ model for slabs of enamel, root surface, dentin, or other mineralized tissues such as shark enamel. The model for vital teeth is an in vivo model, since a crevice for plaque accumulation is created behind orthodontic bands on the buccal enamel surfaces of teeth in situ. Visible white-spot lesions are usually seen after a four-week banding period in the absence of fluoride. The microbiological flora developed behind the bands shows a similarity to that of natural caries. Microradiographic data show that the initial lesion is a softening of the enamel surface. Later, a subsurface lesion develops. A modification of the model has been developed for the use of slabs of mineralized tissues. In this model, slabs are mounted on a removable appliance. The slabs are covered with orthodontic banding material for plaque accumulation. Lesion development in enamel in the two model systems is almost identical. The benefit of the in vivo model is that caries development can be studied on vital teeth in young individuals. The model is independent of the patient's cooperation. No special diet is required, e.g., no sucrose rinsing. In the in situ model, slabs could be examined after one study period and then replaced for another period.

A removable appliance design has been described which is useful in the traction of ectopic canine teeth and is capable of exerting forces in all planes of space, thus optimizing the potential to achieve a stable and aesthetically pleasing result. It does not substitute for the finesse of a fixed appliance, but is a useful tool for when a fixed appliance is not acceptable to the patient. The appliance is cheap to construct, easy to adjust and keep clean, and is well tolerated by patients.

The aim of the present investigation was to determine the reasons for lack of patient co-operation and premature termination of orthodontic treatment. Over a period of 10 years files at the School of Dentistry, Huddinge, Sweden, showed that 80 patients (4 per cent) terminated treatment prematurely. These patients were interviewed regarding their reasons for not completing treatment. Lack of motivation was the most common reason given. Insufficient information about orthodontic treatment and lack of communication between the orthodontist and patient were the basis for the reasons given. Orthodontists require more knowledge of psychology and should have some training in information communication in order to further reduce the level of discontinued treatments.

This study describes the predominant cultivable microflora of three-week-old plaque samples obtained from human enamel sites, on the basis of microbial identification of over 9000 fresh isolates. Lower removable appliances, on which were mounted enamel sections and slabs, were worn by five young adult subjects under three experimental protocols. These were (1) 'normal' plaque conditions, (2) extra-oral sucrose applications nine times daily, and (3) inoculation of each subject's own mutans streptococci onto the enamel test sites and sucrose applications, as described above. With the exception of slightly higher proportions of Gram-negative bacilli associated with slab plaque following sucrose application, no significant differences in percentage or absolute counts of organisms were found between normal and sucrose plaques. The inoculation of mutans streptococci, combined with extra-oral sucrose applications, was associated with significantly higher percentages and absolute mean counts of both mutans streptococci and lactobacilli, and lower proportions of S. sanguis and S. oralis. Although the isolation frequency of mutans streptococci increased in all subjects and the overall mean proportion rose following inoculation, considerable inter-subject variation was seen in mean percentage counts of these organisms isolated from the three-week plaque samples.

An intra-oral appliance model was used to investigate the composition of the plaque microflora associated with early enamel demineralization. Enamel sections, with exposed windows, were mounted on lower removable appliances, and the devices were worn by volunteers for three-week periods under three experimental conditions. These were: (1) "normal" plaque conditions, (2) extra-oral sucrose applications nine times daily, and (3) inoculation of each volunteer's own mutans streptococci onto the test sites and sucrose applications as described for (2). After 21 days, the plaque overlying each window was removed, and the bacterial composition was determined. Changes in mineral content of the associated enamel were measured by microradiography and microdensitometry, and the total mineral loss (Az) that had occurred at each site was calculated. The 144 sites studied were divided into four demineralization groups by Az value, with an increase in mineral loss from group 1 to group 4. A progressive and significant increase in the isolation frequency of mutans streptococci occurred from Az group 1 to group 4 sites. These organisms were isolated from the plaque of every location with enamel mineral loss of over 1000 Az units, but were not detected in 27% of the group 3 sites. Lactobacilli comprised 2% to 3% of the total cultivable microflora in groups 1-3 sites, but were found in significantly higher proportions (18%) at those enamel sites experiencing the most extensive mineral loss (group 4). No significant relationship was found between demineralization and the levels of Actinomyces species or Veillonella. This model allows plaque bacterial composition to be related to the very early stages of enamel demineralization, and the results support the view that lactobacilli are associated with the more established lesions.

Absolute distal movement of upper first molars together with distal tipping, but no significant extrusion, occurred with cervical traction. Distal movement of the maxillary first molars was more stable in the group where maxillary 2nd molars had been extracted. With Andresen treatment a restraining effect took place on the upper molars, while mesial movement of the lower first molars contributed to correction of the molar relationship.

The serial occlusal changes for a consecutively referred sample of malocclusion from a Welsh town are presented. The patients were assigned to one of four treatment regimes (meant to represent those commonly used in the U.K.) and treated to a rigid protocol. Twenty-five per cent of the cases were reviewed by an eight clinician panel. No bias in the original assignments was found although there was considerable interobserver variation. At defined pretreatment, post-treatment, and post-retention stages, records were collected and the study casts quantitatively measured using a reflex metrograph and an occlusal analysis programme. The results found for the overjet, overbite, crown inclination, and crown angulation are presented and discussed.

The Characteristics of three types of buccal canine retraction springs are investigated. In general, these springs are unduly stiff and so excessive forces can be applied by even small activations. Additionally, they can be unstable vertically. By careful attention to geometry, it is possible to design a spring with acceptable clinical properties.

A new removable appliance design is presented which offers the possibility of significant palatal movement of the maxillary incisor roots and which is capable of producing marked changes in the position of the root apices. Heavy extra-oral forces may be applied through the appliance to the entire maxilla to orthopaedically change the facial growth pattern and ameliorate the Skeletal II problem, with the torquing movements being carried out concurrently. A second phase of Edgewise treatment, often with directly bonded transparent plastic brackets, is then carried out to complete the correction. This stage is much reduced in complexity and may be confined to alignments and detailing of the occlusion over a relatively short period of time.

In the first part of this short series of articles the author viewed the history of the edgewise mechanism through the eyes of a European trained orthodontist. He brought the story of the edgewise mechanism up-to-date with a description of the progressive light wire edgewise (bio-progressive) technique of Ricketts, which he has adopted and adapted to his own practice. In Part II he continues to compare and contrast the modern edgewise technique he is using with the advanages and disadvantages of other techniques more commonly used in Britain today. The treatment of three cases is described with photographic and line illustrations. These show the basic principles upon which the Progressive light edgewise technique of Ricketts is based.

Analysis of 20 cases of Class III malocclusion treated with the FR.III showed that correction of the anterior crossbite was effected by adjustment of incisor inclinations and backward rotation or repositioning the mandible accompanied by an increase in face height. Subjects which responded most favourably to the FR.III were those with severe Class III malocclusion and a deep incisor overbite.

A follow-up study of the effect of activator treatment on the incisors is presented. Much of the effect of activator treatment is due to movement of the incisors. It has been claimed that the upper incisors become retroclined, however, a proclination of the lower incisors may also occur and this has been regarded by many as a contra-indication, This aspect has been studied in a material consisting of 40 Angle Class II:1 cases treated with the activator. Mean age at the start of treatment was 11 years and at the end of treatment 12.5 years. Incisor position and inclination were recorded on radiographs taken before and after treatment. The results indicate a significant improvement regarding upper incisor position and inclination whereas the lower incisors had moved forward 2.6 mm and proclined 16° on average. A regression analysis suggested, however, that cases with proclined lower incisors prior to treatment underwent retroclination during treatment (p

A removable appliance to extrude exposed palatally impacted canines and subsequently to move them into the arch, is described and its use illustrated.

A removable/fixed appliance technique is described for treatment of Class III malocclusion by inter-maxillary traction. A variation is described for correction of lateral crossbite.

The progression of proximal caries on canines, premolars and molars has been studied among 129 children treated with removable orthodontic appliances. The registration of carious lesions was performed on posterior bitewing radiographs taken before and after the orthodontic treatment. The children in this investigation showed a higher proximal caries progression than children treated with fixed orthodontic appliances where bands had been used. However, in comparison with caries data from epidemiological investigations in children of similar ages from the same area no difference was noted.

A study was carried out of Class II, Division 1 cases treated by the Andresen appliance. Results were determined in terms of overjet reduction and the reasons for failure were recorded for those cases who did not complete their treatment. Growth and treatment changes were assessed cephalometrically. It was found that those cases showing the more complete overjet reduction also tended to show more growth in facial height and a faster rate of growth in facial height when compared with the less successfully treated cases.

Three groups of Class II/I patients were compared where treatment was carried out using Begg, Andresen and removable appliance techniques. Skeletal growth, as assessed by the dimensions S-Me, N-Me, ALFH and Me-Ar did not show any difference between the groups. All three groups showed an apparent improvement in skeletal pattern during treatment.

A longitudinal and transverse study has been carried out on 22 orthodontic patients during their first year of treatment to assess levels of plaque control and gingival inflammation. The scores were of full data and the patients randomly arranged on a split mouth cross-over design to study the effects of patient oral care and selective tooth cleaning on levels of oral health. The results are analysed in respect of upper fixed, lower fixed and upper removable appliances, comparing and contrasting quadrants that have been treated differently. Plaque levels appear constant, whereas levels of gingival inflammation are consistently worse during treatment but only in certain areas of the mouth. Levels of plaque and gingivitis are well controlled. There appears to be no hygiene disadvantage to an upper removable appliance when compared with an upper fixed appliance though the effect differs in relation to the tooth aspect considered. The significance of the findings is discussed.

The force-displacement characteristics of three types of buccal-canine retraction spring to both horizontal (normal) and vertical displacements is derived from simple beam theory. The analyses are used to examine theoretically the effect of variations in the geometry of a given type of spring and also to compare the merits of three designs in terms of the force applied on activation, and their stability to vertical displacement. Experimental measurements on enlarged models of the force—displacement behaviour were in good agreement with the values predicted by the derived equations.