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Objectives To evaluate whether the amount of rapid maxillary expansion differentially affects the skeletal and dentoalveolar changes that occur. Materials and Methods This randomized controlled trial included 23 patients who had rapid maxillary expansion (RME). Subjects were randomly assigned to a conventional expansion control group (n = 12) or an overexpansion group (n = 11), who started treatment at 13.2 ± 1.5 and 13.8 ± 1 years of age, respectively. Cone beam computed tomography scans (11 cm) were obtained prior to rapid maxillary expander (RME) delivery and approximately 3.7 months later. Initial hand-wrist radiographs were used to determine the participants' skeletal maturity. Results The RME screws were activated 5.6 ± 1.2 mm and 10.1 ± 0.6 mm in the conventional and overexpansion groups, respectively. Overexpansion produced significantly greater expansion of the nasal cavity (2.1X–2.5X), maxillary base (2.3X), buccal alveolar crest (1.4X), and greater palatine foramina (1.9X). Significantly greater intermolar width increases (1.8X) and molar inclination (2.8X) changes were also produced. The nasal cavity and maxillary base expanded 23%–32% as much as the screws were activated. Skeletal expansion was positively correlated with RME screw activation (R = 0.61 to 0.70) and negatively correlated (R = −0.56 to −0.64) with the patients' skeletal maturation indicators (SMIs). Together, screw activation and the patients' SMI scores explained 48%–66% of the variation in skeletal expansion. Conclusions This pilot study shows that overexpansion produces greater changes than conventional expansion, with greater skeletal effects among less mature patients.

Objectives To quantify differences in the etch quality of enamel within and between human teeth, which has not previously been attempted. Materials and Methods The buccal right and left halves of 27 extracted human teeth were randomly allocated to scanning electron microscopy (SEM) or micro–computed tomography (μCT) for evaluation. The buccal surfaces were pumiced, etched with 37% phosphoric acid gel etchant for 15 seconds, rinsed, and air dried. Each tooth was divided into three regions (incisal, middle, and cervical) and viewed after etching at 1200× magnification with SEM. The μCT scans were taken before and after etching to calculate apparent and material mineral densities. Results SEM showed greater aprismatic enamel and poorer etch quality (ie, significantly less percentage enamel) for the posterior than anterior teeth and for the cervical region than for the incisal and middle regions of all teeth. Although there were no density differences prior to etching, μCT demonstrated that etching increased material density significantly more for the anterior than posterior teeth. Prior to etching, the enamel in the cervical regions was significantly less dense than the enamel in the middle or incisal regions. Etching significantly increased the material density of all three regions, which decreased initial regional differences. After etching, the apparent density of the cervical region remained significantly lower than the densities of the other two regions. Conclusions Based on SEM and μCT, there is greater aprismatic enamel and inferior etch quality in the cervical regions of all tooth types and is clinically significant in explaining the failure of sealant retention and the propensity for white spot lesions.

Introduction: Shorter miniscrew implants (MSIs) are needed to make orthodontics more effective and efficient. Objective: To evaluate the stability, insertion torque, removal torque and pain associated with 3 mm long MSIs placed in humans by a novice clinician. Methods: 82 MSIs were placed in the buccal maxillae of 26 adults. Pairs of adjacent implants were immediately loaded with 100g. Subjects were recalled after 1, 3, 5, and 8 weeks to verify stability and complete questionnaires pertaining to MSI-related pain and discomfort. Results: The overall failure rate was 32.9%. The anterior and posterior MSIs failed 35.7% and 30.0% of the time, respectively. Excluding the 10 MSIs (12.2%) that were traumatically dislodged, the failure rates in the anterior and posterior sites were 30.1% and 15.2%, respectively; the overall primary failure rate was 23.6%. Failures were significantly (p= 0.010) greater (46.3% vs 19.5%) among the first 41 MSIs than the last 41 MSIs that were placed. Excluding the traumatically lost MSIs, the failures occurred on or before day 42. Subjects experienced very low pain (2.2% of maximum) and discomfort (5.5% of maximum) during the first week only. Conclusions: Shorter 3 mm MSIs placed by a novice operator are highly likely to fail. However, failure rates can be substantially decreased over time with the placement of more MSIs. Pain and discomfort experienced after placing 3 mm MSIs is minimal and temporary.

Objectives: To determine if posterior dental intrusion produces stable orthodontic and orthopedic corrections in growing retrognathic hyperdivergent patients. Materials and Methods: The sample included 14 subjects (five males and nine females), who were 13.4 ± 0.7 years pretreatment, treated for 3.5 years, and followed for 3.6 years posttreatment. During the initial orthopedic phase, 150 g NiTi coil springs were attached to two palatal miniscrew implants (MSIs) for maxillary intrusion; two buccal mandibular MSIs were used for posterior vertical control. Full orthodontic therapy was initiated to correct the malocclusions during the orthodontic phase. Patients were recalled a minimum of 1 year posttreatment (mean 3.6 ±1.6 years). Patients were compared to matched untreated controls. Results: Relative to the untreated controls, during treatment and retention, maxillary and mandibular molars underwent 2.8 mm and 3.7 mm of relative posterior intrusion, respectively. Maxillary incisors were extruded 1.3 mm and the mandibular incisors underwent 2.9 mm of relative intrusion. Overall orthopedic changes included a reduction in the mandibular plane angle (MPA; 3.3°), an increase in SN-Pg (2.4°), an increase in S-N-B (2.1°), and a 4.3 mm relative reduction in anterior facial height. The maxillary incisors, which showed 0.6 mm of intrusion (relative to controls), was the only dental or skeletal measure to show a statistically significant between-group posttreatment difference. Conclusions: Except for maxillary incisor position, the substantial dental intrusion and associated orthopedic corrections that were produced during treatment remained stable post-treatment.

Objectives: To determine the relative effects of Herbst appliance therapy in hypo- and hyperdivergent patients. Materials and Methods: The treated group included 45 growing Class II, division 1, patients treated with stainless steel crown Herbst appliances, followed by fixed edgewise appliances. The untreated control group consisted of 45 Class II, division 1, subjects, matched to the treated sample based on Angle classification, age, sex, and pretreatment mandibular plane angle (MPA). Subjects were categorized as hypo- or hyperdivergent based on their MPAs. Pre- and posttreatment cephalograms were traced and superimposed on cranial base and mandibular structures. Results: The primary effect of the Herbst in terms of maxillomandibular correction was in the maxilla. It significantly restricted maxillary growth, producing a “headgear effect.” Mandibular treatment changes depended on divergence. Hyperdivergent patients experienced a deleterious backward true mandibular rotation with Herbst treatment. Hypodivergent patients, as well as untreated hypo- and hyperdivergent controls, underwent forward true mandibular rotation. However, hypodivergent chins did not advance any more than expected for untreated hypodivergent Class II patients. Conclusions: Hypo- and hyperdivergent patients benefit from the Herbst's headgear effect. While the mandibular growth of hypodivergent patients overcomes the negative rotational effects, hyperdivergent patients undergo a deleterious backward mandibular rotation and increases in facial height.

Objective: To evaluate differences in discomfort levels between patients treated with aligners and traditional fixed orthodontic appliances. Materials and Methods: This blinded, prospective, randomized equivalence two-arm parallel trial allocated 41 adult Class I nonextraction patients to either traditional fixed appliance (6 males and 12 females) or aligner (11 males and 12 females) treatment. Patients completed daily discomfort diaries following their initial treatment appointment, after 1 month and after 2 months. They recorded their levels of discomfort at rest, while chewing, and while biting, as well as their analgesic consumption and sleep disturbances. Results: Both treatment modalities demonstrated similar levels of initial discomfort. There were no significant sex differences. Patients in the traditional fixed appliances group reported significantly (P < .05) greater discomfort than patients in the aligner group during the first week of active treatment. There was significantly more discomfort while chewing than when at rest. Traditional patients also reported significantly more discomfort than aligner patients after the first and second monthly adjustment appointments. Discomfort after the subsequent adjustments was consistently lower than after the initial bonding or aligner delivery appointments. A higher percentage of patients in the fixed-appliance group reported taking analgesics during the first week for dental pain, but only the difference on day 2 was statistically significant. Conclusions: Patients treated with traditional fixed appliances reported greater discomfort and consumed more analgesics than patients treated with aligners. This trial was not registered.

Objective:To determine whether apical base size is related to dental crowding.Materials and Methods:Digital scans of dental casts were taken of 75 untreated Class I adults to measure maxillary and mandibular tooth size, dental arch perimeters, intermolar widths, and intercanine widths. Cone beam computed tomography (CBCT) images were used to measure the apical base of the maxilla and mandible, including the total cross-sectional area, five basal arch perimeters and five basal arch widths. Principal components factor analyses were performed to evaluate the relationships between the apical base size and tooth-size-arch-length discrepancies (TSALD).Results:The dental arch and maxillary apical base measures were significantly larger in males than females. There were only limited sex differences in mandibular apical base size. The dental arch measurements were smaller in subjects with greater upper and lower TSALD. Maxillary and mandibular apical base dimensions were positively interrelated. Low-to-moderate correlations were found between the size of the maxillary apical base and TSALD. The size of the mandibular apical base was not related to upper or lower TSALD. Tooth size showed little to no relationship with TSALD.Conclusions:Although maxillary apical base size is related to maxillary and mandibular crowding in subjects with Class I malocclusion, mandibular apical base size is not.

Objective:To determine whether automated text messages sent daily to adolescent orthodontic patients improves oral hygiene more than weekly reminders.Materials and Methods:A blinded, prospective, randomized controlled trial was designed to evaluate the effects of automated messages on oral hygiene. Subjects were recruited from patients undergoing orthodontic treatment at the Texas A&M University College of Dentistry, Department of Orthodontics. They were being treated with a variety of fixed full appliances in both arches. Subjects were randomly assigned to either a once-a-week text message group or a daily text message group. There were 52 females and 27 males who were 12 to 17 years of age. Oral hygiene was measured at the beginning of the study and again 8.6 ± 0.9 weeks later.Results:The daily reminder group (N = 42) had significantly greater improvements in oral hygiene compliance than the weekly reminder group (N = 37). The daily score decreases were 48%, 21% and 19% for the bleeding index (BI), plaque index (PI), and gingival index (GI), respectively. The weekly score decreases were 27%, 14% and 13% for the BI, PI, and GI. There were no sex differences in hygiene changes during the study. The 42% of patients who completed the survey at the end of the study wanted more frequent messages and reported that messages related to decreasing treatment time were the most effective, while those related to oral hygiene were the least effective.Conclusions:Daily text messages are more effective at improving oral hygiene than weekly text messages.

Objectives:To test how long casein phosphopeptide–amorphous calcium phosphate (CPP-ACP) fluoride varnish prevents enamel demineralization in vitro.Materials and Methods:Human molars and premolars were sectioned buccolingually and randomly assigned to two groups. Standardized pretreatment images of enamel surfaces were obtained using FluoreCam. The control group received no treatment, and the experimental group received an application of CPP-ACP fluoride varnish. Over simulated periods of 2, 4, 8, and 12 weeks, specimens were placed in a toothbrushing simulator, thermocycled, subjected to 9 days of pH cycling, and imaged with FluoreCam. Samples were sectioned and polished for polarized light microscope (PLM) evaluation.Results:There were statistically significant time (P < .001) and varnish (P < .001) effects on area, intensity, and impact of enamel demineralization. The control group showed significant and progressive demineralization over the 12 weeks (P < .001). The experimental group revealed no significant demineralization during the first 4 weeks (P > .05) and significant (P < .001) increases thereafter. Experimental demineralization after 12 weeks was comparable to 2-week demineralization in the controls, with significant between-group differences (P < .001) in enamel demineralization at all time points. PLM of the control and experimental groups revealed lesion depths of 90 ± 34 μm and 37 ± 9 μm, respectively.Conclusions:Within the limitations of this in vitro study, CPP-ACP fluoride varnish prevents enamel demineralization for at least 4 weeks and limits demineralization up to 12 weeks.

Objective: To determine if 2-DeNT Oral Topical Powder is an effective treatment for traumatic oral ulcers. Materials and Methods: Of the 46 patients who were randomly allocated, 20 patients from the experimental group and 17 from the placebo control group completed the study. The patients, operators, and evaluators were all blinded. Patients applied the powder twice a day and completed a diary twice a day for 10 days. The diary was used to monitor the size of the lesions and pain levels (using a 10-cm visual analog scale). Results: By day 5, the ulcers in the experimental group had reduced in size by approximately 70%; and ulcers in the control group had reduced in size by 56%. The experimental-group ulcers were significantly (P < .05) smaller than the control-group ulcers from day 5 through day 9. Ulcers in the experimental group were completely resolved by day 8, whereas control-group ulcers were still present on day 10. Patients experienced a significant amount of stimulated pain until the night of day 2 in the experimental group and until the night of day 5 in the control group, but group differences in pain were not statistically significant. Conclusions: The 2DeNT Oral Topical powder was more effective than the placebo powder at accelerating the healing of oral traumatic ulcers.

Objective To use an alumni-centered, practice-based research network to evaluate white spot lesions (WSLs) among treated orthodontic patients.Materials and Methods: An initial survey was conducted to ascertain whether orthodontic alumni from Texas A&M University Baylor College of Dentistry were willing to participate. Twenty randomly selected alumni participated, providing 158 treated cases. Each alumnus (1) obtained internal review board consent; (2) submitted pre- and posttreatment photographs of 10 consecutively finished cases; (3) completed a treatment survey; and (4) had the patient/parent complete the American Dental Association (ADA) Caries Risk Assessment.Results: Almost 90% of the alumni surveyed were willing to participate in the practice-based research, primarily because a fellow alumnus asked them to. Approximately 28% of the patients developed WSLs. The average patient developed 2.4 white spots, affecting 12.7% of the teeth examined. WSLs were significantly (P < .001) more (2.3−3.2 times) likely for patients who were identified on the ADA Caries Risk Assessment. The risk of developing WSLs during treatment was also increased for those with fair (2.7 times) or poor (3.5 times) oral hygiene, poor gingival health (2.3 times), and extended treatment times (2.1 times).Conclusions: There is a substantial risk of developing WSLs among private practice patients, depending partially on the length of treatment. Patients at greatest risk can be identified prior to treatment based on the ADA Caries Risk Assessment, oral hygiene, and gingival health.

Purpose The purpose of this study was to determine how micro-osteoperforations (MOPs) affect tooth movements, bone turnover, bone density, and bone volume. Methods A split-mouth experimental design with 7 beagle dogs was used to evaluate bone surrounding maxillary second premolars that had been retracted for 7 weeks. One month after the maxillary third premolars were extracted, 8 MOPs (1.5 mm wide and 7 mm deep) were created without flaps with the use of the Propel device (6 were placed 3 mm distal to the second premolar and 2 were placed in the premolar furcation) on one randomly chosen side. The maxillary second premolars were retracted bilaterally with the use of 200 g nickel-titanium closed coil springs. Tooth movements were measured intraorally and radiographically. Microscopic computed tomography was used to evaluate the material density and volume fraction of bone distal to the premolars. Hematoxylin and eosin–stained and fluorescent sections were used to examine the bone remodeling. Results Neither the intraoral (P = 0.866) nor radiographic (P = 0.528) measures showed statistically significant side differences in tooth movements. There also were no statistically significant differences in the density (P = 0.237) or volume fraction (P = 0.398) of bone through which the premolars were being moved. Fluorescent and histologic evaluations showed no apparent differences in osteoblasts, osteoclasts, or mineralization of bone near the teeth being moved. Bone healing was evident in and near the MOP sites, which had nearly but not completely healed after 7 weeks. Regions of acellular bone were evident extending ∼0.8 mm from the MOP sites. Conclusions MOPs placed 3 mm away from teeth do not increase tooth movements and have limited and transitory effect on bone.

OBJECTIVE: To evaluate the biological response of alveolar bone surrounding maxillary second premolars to flapless alveolar decortication and moderate, continuous forces in a buccal direction. MATERIALS AND METHODS: Using a randomized split-mouth experimental design, unilateral alveolar decortication was performed with a piezosurgery unit around the maxillary second premolars of six female dogs. The contralateral side received a sham surgery. The maxillary second premolars were moved buccally with archwires (initial 163.9 cN expansive force) for 9 weeks, followed by 2 weeks of consolidation. Intraoral, radiographic, and model measurements were performed to evaluate tooth movements; the amount and quality of surrounding bone were quantified using micro-CT; bone formation was evaluated histologically. RESULTS: The experimental premolars were expanded and tipped significantly ( P < 0.05) more than the control premolars (1.35 times and 2.05 times as much, respectively). Peak rates of tooth movement occurred around 5 weeks. Dehiscenses were observed on both the experimental and control sides, with no statistically significant side differences in buccal bone height (BBH). Micro-CT analyses showed less mature bone in the apico-buccal and cervico-lingual regions around the experimental teeth. Hematoxylin and eosin sections demonstrated fenestrations on the cervico-buccal bone on both sides. The experimental side showed substantially more new bone formation and modeling of apico-buccal, cervico-lingual, and buccal bone than the control side. CONCLUSIONS: Archwire expansion resulted in reductions in BBH. Piezosurgical flapless alveolar decortication, in combination with archwire expansion, increased tooth movements and tipping and produced less bone, less dense bone, and less mature bone.

Introduction Our objective was to determine whether the elevation of a full-thickness mucoperiosteal flap alone, without cortical cuts, decreases the amount of bone around teeth and accelerates mesial tooth movements. Methods The mandibular second premolars of 7 beagle dogs were extracted, and on a randomly selected side, a full-thickness mucoperiosteal buccal flap extending from the distal aspect of the third premolar to the mesial aspect of the first premolar was elevated. The other side did not receive flap surgery. The mandibular third premolars were protracted with orthodontic appliances. Tooth movements were analyzed biweekly over an 8-week period with calipers and radiographs. The amount and density of bone were analyzed using microcomputed tomography; bone remodeling was evaluated with histologic sections. Results Experimental tooth movements measured intraorally between cusp tips were significantly greater (25.3%) than control tooth movements. The approximate center of resistance measured radiographically also moved significantly more (about 31%) on the experimental than on the control side. The experimental premolar tipped more than the control premolar (10.5° vs 8.7°), but the difference was not statistically significant. The medullary bone volume fraction mesial to the third premolar was significantly less (9.1%) and the bone was significantly less dense (9%) on the experimental side than on the control side. Histology showed no apparent side differences in the numbers of osteoclasts and osteoblasts evident in the medullary bone. Conclusions Elevation of a full-thickness mucoperiosteal flap alone (ie, without injury to bone) decreases the amount and density of medullary bone surrounding the tooth and accelerates tooth movement. Due to its limited effects, elevation of a flap alone to increase tooth movements may not be justified.

The aim of this split-mouth experimental study was to determine (1) whether corticotomy procedures increase tooth movement and (2) the effects of a second corticotomy procedure after 4 weeks on the rate of tooth movement. The mandibular third and maxillary second premolars of five skeletally mature male foxhounds, approximately 2 years of age, were extracted. One randomly selected mandibular quadrant had buccal and lingual flaps and corticotomies performed around the second premolar; the other quadrant served as the control. Both maxillary quadrants had initial buccal flaps and corticotomies; one randomly selected quadrant had a second buccal flap surgery and corticotomy after 28 days. Coil springs (200 g force), along with a 0.045 mm diameter tube on a 0.040 mm diameter guiding wire, were used to move the mandibular second and maxillary third premolars. Records, including digital calliper measurements and radiographs, were taken on days 0, 10, 14, 28, 42, and 56. Multilevel statistical procedures were used to model longitudinal tooth movements. The radiographic measurements initially showed increasing mandibular tooth movement rates, peaking between 22 and 25 days, and then decelerating. Total mandibular tooth movements were significantly (P < 0.05) greater on the experimental (2.4 mm) than on the control (1.3 mm) side. The rates of maxillary tooth movement slowed over time, with significantly (P < 0.05) more overall tooth movement on the side that had two (2.3 mm) than one (2.0 mm) corticotomy procedure. Alveolar corticotomy significantly increases orthodontic tooth movement. Performing a second corticotomy procedure after 4 weeks maintained higher rates of tooth movement over a longer duration and produced greater overall tooth movement than performing just one initial corticotomy, but the difference was small.

Objective: A pilot investigation was performed to test the null hypothesis that highly filled (58%) resin sealants do not prevent white spot lesions in patients undergoing active orthodontic treatment. Materials and Methods: A split-mouth design was applied to 60 healthy patients, with the sealant randomly allocated to either the right or the left side of each jaw. The sealant was applied to the incisors and canines from the gingival surface of the bracket to the free gingival margin. The contralateral teeth had the same type of bracket with no sealant. Sealants were placed on the experimental teeth 2 weeks to 3 months after initial bonding and were removed after 15 to 18 months. Intraoral photographs, visual assessments, and DIAGNOdent (KaVo Dental Corporation, Lake Zurich, Ill) measurements were used to assess white spot lesions after sealant removal. Results: Six lesions on the teeth with sealants were identified visually, compared with 22 lesions on the teeth without sealants. The teeth without sealants had 3.8 times the number of white spot lesions than were noted on the sealed teeth. These sealants showed no visible signs of discoloration. The DIAGNOdent measured statistically significant differences between sealed and unsealed teeth in the maxilla (P < .001) and in the mandible (P = .010). DIAGNOdent measurements also showed a difference between sealed and unsealed teeth after the 28 teeth with visible lesions were excluded. Conclusion: The hypothesis was rejected. Ultraseal XT Plus clear sealant (Ultradent Products, South Jordon, Utah) produced a significant reduction in enamel demineralization during fixed orthodontic treatment and should be considered for use by clinicians to minimize white spot lesions.

Objective: To produce buccal translation and determine whether buccal bone forms on the cortical surfaces. Materials and Methods: Eleven patients requiring maxillary first premolar extractions participated in this prospective, randomized, split-mouth study. Pre- and posttreatment records included models, photographs, and small field of view CBCT images. One randomly chosen maxillary first premolar was moved buccally with 50 g of force applied approximately at the tooth’s center of resistance. The other premolar served as the control. Forces were re-activated every 3 weeks for approximately 9 weeks, after which the teeth were held in place for 3 weeks. Pre- and posttreatment records were analyzed and superimposed to evaluate changes in the dental-alveolar complex. Results: There was significant (P < .05) movement of the experimental premolar with minimal buccal tipping (2.2°). Changes in maximum bone height were bimodal, with 6 patients showing 0.42 mm and 5 patients showing 8.3 mm of vertical bone loss. Buccal bone thickness 3 mm apical to the CEJ decreased 0.63 mm. Direct measurements and CBCT superimpositions showed that buccal bone over the roots grew 0.46 mm and 0.51 mm, respectively. Conclusions: It is possible to produce buccal bodily tooth movement with only limited amounts of tipping. Such movements are capable of producing buccal bone apposition, but there are potential limitations.

Objective: To evaluate the treatment effect of an antioxidant–essential oil gel on orthodontic patients with generalized gingivitis. The gel contains the essential oils menthol and thymol and the antioxidants ferulic acid and phloretin. Materials and Methods: Thirty patients from the university’s orthodontic clinic were screened for gingivitis and randomly allocated into treatment and placebo-control groups. Each patient was evaluated at three orthodontic treatment visits (T1, T2, and T3). A periodontal examination, including probing depth (PD), bleeding on probing (BOP), gingival index (GI), and plaque index (PI) was performed at each visit. Between T1 and T2, patients were instructed to apply a topical gel (active or placebo) to their gingiva twice daily after brushing. From T2 to T3, patients were instructed to discontinue use of the gel. Results: The treatment group showed statistically significant (P < .05) reductions of BOP (−13.6 percentage points) and GI (−0.14) between T1 and T2, and significant increases in BOP (13.3 percentage points) and GI (0.14) between T2 and T3. Except for an increase in the GI between T2 and T3, the control group showed no significant changes in BOP or GI over time. The only other significant changes that occurred pertained to the treatment group, which showed significant increases in PD (0.08 mm) and PI (0.18) between T2 and T3. Conclusion: Application of a topical antioxidant-essential oil gel is an effective means of reducing inflammation in orthodontic patients with gingivitis.

Objective: To test the retention of smooth-surface sealants bonded with different etching protocols against toothbrushing and, secondarily, to characterize the type and location of sealant loss. Materials and Methods: Eighty-nine extracted human teeth were randomly assigned one of two etching protocols: 37% phosphoric acid etch (ETCH) or self-etching primer (SEP). Six specimens at a time were placed in a toothbrushing machine to simulate 4, 8, 12, and 24 months of toothbrush abrasion. Using black-light photographs of each specimen taken before and after brushing, four blinded coinvestigators determined new sealant loss, loss along the edge of an initial defect, and the location of sealant loss. Results: Overall, there were significantly (P < .05) more teeth with sealant loss in the SEP group (38.6%) than in the ETCH group (15.5%). New loss of sealant was significantly (P < .05) more likely in the SEP group (27.2%) than in the ETCH group (2.2%). Of the teeth with new loss of sealant, all (100%) had loss at the edge, and 23% had progressive loss. There was no significant group difference in sealant loss from initial defects. Of the teeth that showed enlargement of initial defects, 91% had loss at the edge and 91% had progressive loss. Conclusions: Using SEP to apply facial sealants results in lower retention rates than using ETCH. The vast majority of sealant loss occurs at the edges. Loss of sealant due to enlargement of an initial defect is highly progressive over time.

Objective: To compare the time efficiency of aligner therapy (ALT) and conventional edgewise braces (CEB) based on large samples of patients treated by the same highly experienced orthodontist, with the same treatment goals for both groups of patients. Materials and Methods: The retrospective portion of the study evaluated 150 CEB patients who were matched, based on mandibular crowding and number of rotated teeth, to 150 ALT patients. All records were obtained at one orthodontist's office. All of the patients had mild-to-moderate Class I malocclusions (≤5 mm incisor crowding) and were treated nonextraction. Age, gender, total treatment time, total number of appointments, types of appointments, materials used, mandibular crowding, and number of rotated teeth were recorded from the patients' records. The prospective portion of the study timed the various types of appointments for both treatments with a stopwatch. Results: Compared to ALT, CEB required significantly (P < .01) more visits (approximately 4.0), a longer treatment duration (5.5 months), more emergency visits (1.0), greater emergency chair time (7.0 minutes), and greater total chair time (93.4 minutes). However, ALT showed significantly (P < .01) greater total material costs and required significantly more total doctor time than CEB (P < .01). Conclusions: Whether the greater time efficiency of ALT offsets the greater material costs and doctor time required depends on the experience of the orthodontist and the number of ALT case starts.

Purpose: To quantify the prevalence of white spot lesions (WSLs) on the anterior teeth and, secondarily, to evaluate risk factors and predictors. Materials and Methods: Digital photographs and records of 885 randomly chosen patients were evaluated before and after treatment. Chart information included gender, age, as well as banding and debanding dates. Fluorosis and oral hygiene before and after treatment were also evaluated. Preexisting and posttreatment WSLs were recorded and compared for all 12 anterior teeth. Risk ratios (RR) and absolute risk (AR) were calculated to determine the likelihood and risk of WSL formation. Results: Overall, 23.4% of the patients developed at least one WSL during their course of treatment. Maxillary anterior teeth were affected more than mandibular teeth. The maxillary laterals and canines and the mandibular canines were the most susceptible. There was no significant difference in WSLs between genders. Fluorosis, treatment time in excess of 36 months, poor pretreatment hygiene, hygiene changes during treatment, and preexisting WSLs were all significantly (P < .05) related to the development of WSLs. The highest risk of developing WSLs was associated with preexisting WSLs (RR = 3.40), followed by declines in oral hygiene during treatment (RR = 3.12) and poor pretreatment oral hygiene (RR = 2.83). Conclusions: Nearly 25% of the patients developed WSLs while in treatment, depending on fluorosis, treatment time, preexisting WSLs, and oral hygiene. Orthodontists need to be mindful of these risk factors when making treatment decisions.

Objective: To determine the relative effects that phosphoric acid etching, metal brackets, composite resin adhesives, and filled resin sealants have on enamel decalcification. Materials and Methods: One hundred and fifty teeth were randomly divided into six groups to test the effects of acid etching, brackets, and a composite resin adhesive. The right side of each tooth was sealed. The teeth were submitted to a simulated carious challenge by Streptococcus mutans in a nutritive media for 42 days. Scanning electron photomicrographs (SEMs) were used to qualitatively evaluate the tooth surfaces. DIAGNOdent laser fluorescence was used to quantify the decalcification changes that occurred. Results: SEMs showed normal enamel on the control teeth, etching patterns on the acid-etched teeth, surface degradation on the teeth that had resin, and sealant tags on the sealed side. The untreated control group showed significantly less decalcification (P ≤ .05) than did all groups except the no etch+bracket group. The no etch+bracket group showed significantly less decalcification than did the etch+bracket, no etch+resin, and the etch+resin groups. Acid-etched teeth demonstrated significantly more decalcification (34%) than did those that were not etched. The teeth with resin showed significantly more decalcification (24%) than did those without resin. There was no significant difference between teeth that did and did not have brackets. The unsealed side of the teeth showed small amounts of—but significantly more—decalcification (5%) compared to the sealed side. Conclusions: Acid etching and composite resin adhesives increase enamel decalcification in vitro, while brackets do not. Filled resin sealants protect the teeth from decalcification.

OBJECTIVES: To determine the validity of five profile planes commonly used to describe the horizontal changes of the lower lip during orthodontic treatment. MATERIALS AND METHODS: Pretreatment and posttreatment cephalograms of 79 patients (12.4 ± 2.8 years of age) were evaluated. Lower lip (labrale inferiorus) changes over time were measured relative to the Rickett's E-line, Steiner's S1-line, Burstone's B-line, Sushner's S2-line, and Holdaway's H-line. As an independent measure of actual horizontal lip changes, the labrale inferiorus was measured relative to a stable reference plane registered on the sella and oriented on the SN-7°. RESULTS: The lower lip actually moved anteriorly 2.35 ± 3.35 mm during orthodontic treatment; the five profile planes indicated that the lower lip moved to a more retrusive, posterior position. The five profile planes also showed no statistically significant sex differences in terms of the treatment changes that occurred, while the actual lip changes showed that males exhibited significantly greater changes than females. Actual treatment changes showed that the lower lip moved to a more protrusive position with nonextraction than with extraction treatments, changes that were not evident based on the five profile lines. While lip changes based on the five profile planes demonstrated moderately high to high intercorrelations ranging from 0.81 to 0.97, they showed only weak correlations (r < .35) with the actual horizontal changes of the labrale inferiorus. CONCLUSIONS: While all five planes measured similar aspects of positional change, none of them closely reflected the actual lower lip changes that occurred. These planes should not be used to measure changes in lip position that occur during treatment.

OBJECTIVE: To determine how filler content and an acidic environment affect the retention of sealants placed on smooth enamel surfaces. MATERIALS AND METHODS: A sample of 120 teeth was randomly divided into six subsamples. Three experimental sealants with identical formulas, with the exception of the amount of filler content (18%, 30%, 50%), were applied according to manufacturers' recommendations. Half of the subsamples were exposed to an acid environment (pH of 2.5) for 96 hours. With the use of a tooth-brushing simulator, each tooth was exposed to 15,000 brushing strokes, while a slurry of 1∶3 toothpaste/neutral sodium bicarbonate cycled through the machine. Initial and final photographs were analyzed subjectively and objectively. Scanning electron microscope photomicrographs were used to evaluate the tooth surface. RESULTS: Subjective analyses showed significant (P < .05) filler effects, with the 18% filled sealant showing the least change, followed by the 30% sealant, then the 50% filled sealant, which showed the greatest loss. Objective analyses showed the same pattern of loss, but the differences between sealants were not statistically significant. Exposure to an acidic environment had no significant effect on sealant retention. SEMS showed a layer of sealant remaining on all of the sealed teeth evaluated. CONCLUSIONS: Filler content of resin sealant material affects the retention of sealants on smooth enamel surfaces; exposure to an acid environment has no effect on sealant retention. Within the limits of this study, highly filled resin sealants once saturated have the ability to endure the oral environment and remain on a smooth enamel surface, regardless of the amount of filler content.

Objective: To develop models for predicting changes in lip position of Class I extraction patients. Materials and Methods: Pretreatment and posttreatment lateral cephalograms of 46 white female adults and 109 white female adolescents were examined. Mean pretreatment ages for the adolescent and adult groups were 12.2 ± 1.2 years and 23.0 ± 8.5 years, respectively. Subjects were treated with conventional edgewise mechanics. Multivariate prediction models were derived from a randomly selected sample of 119 subjects and validated on the remaining 36 subjects. Results: Adolescents demonstrated significant vertical and horizontal skeletal growth and treatment changes, while adults showed only small increases in anterior face height. While significant retraction of the upper and lower incisors occurred in both groups, the amounts were greater in adults than in adolescents. Ratios for horizontal hard tissue to soft tissue movements ranged from 1.4:1 to 1.1:1 and 1.3:1 to 1:1 for the upper (Ls) and lower (Li) lips, respectively. There were moderate relationships between horizontal lip and underlying hard tissue movements (correlations ranged from .57 to .78 for Ls and from .58 to .86 for Li). Multiple regressions to predict lip movements showed moderately strong relationships for the upper lip (R = .79 to .81) and strong relationships for the lower lip (R = .89 to .90). Two to three variables were necessary to predict vertical lip movements (R = .82 to .87). The validation sample showed no systematic biases and similar levels of accuracy. Conclusions: Upper and lower lip retraction in four first premolar extraction cases can be predicted with moderately high levels of accuracy in white female adolescents and adults.

A pilot investigation was performed to test the null hypothesis that highly filled (58%) resin sealants do not prevent white spot lesions in patients undergoing active orthodontic treatment.A split-mouth design was applied to 60 healthy patients, with the sealant randomly allocated to either the right or the left side of each jaw. The sealant was applied to the incisors and canines from the gingival surface of the bracket to the free gingival margin. The contralateral teeth had the same type of bracket with no sealant. Sealants were placed on the experimental teeth 2 weeks to 3 months after initial bonding and were removed after 15 to 18 months. Intraoral photographs, visual assessments, and DIAGNOdent (KaVo Dental Corporation, Lake Zurich, Ill) measurements were used to assess white spot lesions after sealant removal.Six lesions on the teeth with sealants were identified visually, compared with 22 lesions on the teeth without sealants. The teeth without sealants had 3.8 times the number of white spot lesions than were noted on the sealed teeth. These sealants showed no visible signs of discoloration. The DIAGNOdent measured statistically significant differences between sealed and unsealed teeth in the maxilla (P.001) and in the mandible (P = .010). DIAGNOdent measurements also showed a difference between sealed and unsealed teeth after the 28 teeth with visible lesions were excluded.The hypothesis was rejected. Ultraseal XT Plus clear sealant (Ultradent Products, South Jordon, Utah) produced a significant reduction in enamel demineralization during fixed orthodontic treatment and should be considered for use by clinicians to minimize white spot lesions.