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A 32-year-old female with a repaired right unilateral cleft lip and palate underwent several surgical and orthodontic procedures during the rehabilitation process of her condition. Nine years after this extensive treatment she underwent transverse relapse of her maxilla and requested a consultation for its correction as she felt her speech and chewing were negatively affected. She presented with a transverse maxillary arch collapse on the cleft side with significant palatal scarring secondary to multiple palate procedures. A course of maxillary expansion and dental alignment with fixed orthodontic appliances was carried out. In addition, she had 2 triamcinolone injections 7 months apart while undergoing orthodontic treatment and one 10 months after completion to soften the scarred palatal tissues. The maxillary arch was successfully expanded and aligned. She was retained with a removable chrome cobalt palatal frame to be used full-time and assure stability of the correction. She has been followed for 4 years with no clinical evidence of relapse. Triamcinolone injection into significant palatal scarring in cleft palate patients with a decreased transverse maxillary dimension can be considered an adjunct procedure in conjunction with orthodontic treatment.

Introduction: Fixed orthodontic procedures such as separator placement, archwire placement andactivations, application of orthopaedic forces, and debonding of brackets produce pain in patients.This study was conducted to assess pain and oral health-related quality of life among patientsundergoing orthodontic treatment. Methods: This descriptive cross-sectional study was conducted among 152 orthodontic patients ofa teritary care center from January 2019 to October 2019 after receiving ethical approval from theInstitutional Review Committee (Ref. no. 2311201813). Convenience sampling method was done toselect the participants. Oral health-related quality of life using “Oral Health Impact Profile-14” andpain experienced during the first month of fixed orthodontic treatment were assessed. Data analysisfor calculation of frequency and proportion was done in Statistical Package of Social Sciences. Results: Mean pain score of the study participants was 5.05±2.07 and their mean oral health impactwas 12.71±7.27. Most of the study participants 86 (56.58%), had experienced moderate pain due toorthodontic treatment. Out of the reported impacts, 134 (88.2%) had painful aching in mouth and 127(83.6%) had difficulty during eating. Least impact was seen in alteration of taste 35 (23%). Conclusions: The pain intensity experienced by patients was variable. Most participants hadmoderate pain but few patients perceived no pain at all. The participants had at least one or otheroral health impacts due to fixed orthodontic treatment. Orthodontists should counsel the patientsregarding possible discomfort so that there is no discontinuation of treatment due to pain.

Aim: This study was conducted to clinically evaluate the effect of low-level laser therapy (LLLT) as a method of reducing pain reported by patients after placement of their first orthodontic archwires. Materials and methods: A sample of 10 patients with an age group of 12 to 26 years with moderate-to-severe anterior crowding was selected. Each patient was assigned to an experimental group (left quadrant with laser therapy) and a control group (right quadrant with no laser therapy). Low-level laser therapy was given immediately after the placement of initial archwire. All patients were instructed to fill up a survey form at home over the next 7 days. Results: The results revealed that the average onset of pain in the experimental group (16.10 hours) was significantly reduced when compared with the control group (3.10 hours). The most painful day was similar for both the groups. The pain ceased much sooner in the experimental group than in the control group. The intensity of pain was lesser in the experimental group when compared with the control group. Conclusion: Low-level laser therapy was an effective and noninvasive method for controlling pain in orthodontic patients after receiving their first archwires. The duration and intensity of pain reduced with the application of LLLT Clinical significance: Pain reduction during orthodontic procedures. Keywords: Low-level laser therapy, Nickel-titanium wires, Orthodontic pain.

This case report shows the combined use of piezosurgical and orthodontic procedures to successfully relocate two severely malpositioned implants in the anterior maxilla by moving them separately, with the objective of attaining functional prosthetic restoration and acceptable esthetics.

Background To investigate the skeletal development of HIV infected children through a morphological analysis of the cervical vertebrae (CV) in lateral cephalometric radiographs. Material and Methods The sample consisted of 86 lateral cephalometric radiographs of male and female children aged between 6 and 14 years old. The radiographs were equally distributed in groups 1 (HIV infected children) and 2 (non-infected children, paired by sex and age). Two examiners analyzed the CV according to the method of Hassel and Farman (1995). Spearman correlation coefficient was used to associate age and skeletal development within groups, while Mann-Whitney test compared the skeletal development between groups. Results The correlation of age and skeletal development in group 1 reached 0.17, 0.27 and 0.27 (p >0.05) for C2, C3 and C4, respectively, while in group 2 it reached 0.65, 0.54 and 0.60, respectively (p 0.05). Conclusions HIV infected and non-infected children showed a similar development of the CV. However, the weak correlation between age and CV development in HIV infected children highlights the need for careful decisions prior to therapeutic approaches – especially those founded on the prediction of skeletal development, such as maxillofacial surgeries, and orthopedic and orthodontic procedures. Key words:Cervical vertebrae, growth and development, HIV, radiology.

Unilateral palsy of the hypoglossal nerve is a rare complication of orthodontic procedures. The main reported causes of HNP are: orthopedic and otorhinolaryngology surgical interventions, and in particular maneuvers involving compression or overstretching of the hypoglossal nerve, dental procedures and traumas, and also infections, motoneuron disorders, tumors, vascular diseases. Diagnosis is usually performed by electrophysiology studies (EMG-VCN), and brain magnetic resonance imaging (MRI) is useful to exclude other causes. The prognosis depends on the location and extension of the damage. Currently there is not a standardized treatment approach except the speech therapy, although, in some cases, the high-dose steroid treatment could be useful. We describe the case of a ten-year-old female, who was admitted in our Unit after a deviation of the tongue associated with dysarthria and dysphagia, occurred after the application of a mobile orthodontic device.

OBJECTIVES: The aim was to find out if children who have gone through orthodontic and invasive treatment have less dental fear than children who have experienced only invasive treatment or no treatment at all. MATERIALS AND METHODS: The data consisted of 910 9- to 15-year-old children from Jyvaskyla and Kuopio, Finland. A questionnaire was used that contained 11 dental fear-related questions and family member’s dental fear and questions on oral health habits and family characteristics. Information on treatment procedures from three preceding years was collected from patient records. To study the association between dental fear and treatment experiences, analysis of variance, and multiple logistic regression analyses were performed. RESULTS: Dental fear was found more often in children who had experiences of orthodontic treatment experiences and invasive treatment than in children with invasive treatment only or no treatment experiences at all.LIMITATIONS: Different orthodontic treatment experiences were not analysed individually, and the study was retrospective. CONCLUSION: Familiarization to dental treatment via orthodontic procedures does not necessarily decrease dental fear among children.

OBJECTIVE: The purpose of this study was to analyze the psychological aspects of adult patients who sought and underwent orthodontic treatment, evaluating their expectations and discomfort during treatment, as well as their satisfaction after completion of dental movement. RESULTS AND CONCLUSIONS: Data obtained from previous published papers, and also from questionnaires answered by 54 patients, showed that adult patients stood out for their attention to details and high interest in the esthetic improvements provided by treatment, and also for a greater perception of their initial malocclusion. On the other hand, the same data showed that adult patients, once informed about the limitations of their treatment and having confidence on the orthodontist, presented a high level of satisfaction with treatment results, revealing themselves as good patients for indication and execution of orthodontic procedures. OBJETIVO: o propósito desse trabalho foi analisar as características psicológicas dos pacientes adultos que procuraram e se submeteram a tratamentos ortodônticos, avaliando suas expectativas, desconforto durante o tratamento e satisfação final após a conclusão das movimentações dentárias propostas. RESULTADOS E CONCLUSÕES: os dados obtidos por meio de uma revisão bibliográfica e de questionários realizados com 54 pacientes demonstraram que os pacientes adultos se destacaram por serem mais detalhistas e exigentes em relação às melhoras estéticas proporcionadas pelo tratamento, e por apresentarem uma maior percepção de sua má oclusão antes do início do tratamento. Por outro lado, esses mesmos dados demonstraram que os pacientes adultos, uma vez bem esclarecidos sobre as limitações peculiares ao seu tratamento e sentindo-se bem amparados e orientados pelos profissionais responsáveis, apresentaram um alto índice de satisfação frente aos resultados finais do tratamento, sendo ótimos pacientes para a indicação e execução de procedimentos ortodônticos.

Introduction For over 50 years, the American Heart Association has made recommendations for the prevention of infective endocarditis. The first guidelines were published in 1955; since then, they have been updated 9 times, most recently in 2007. There is still confusion about which orthodontic procedures are most prone to generate bacteremias and lead to infective endocarditis in susceptible patients. The aim of this study was to conduct a survey to determine orthodontists' knowledge, attitudes, and in-office behaviors regarding the American Heart Association's guidelines. Methods A 4-page online survey consisting of 3 sections was sent to members of the American Association of Orthodontists by using a random number generator. The first section consisted of demographic information, the second consisted of questions about the respondents' practice characteristics, and the third included questions about the respondents' knowledge and management of the treatment of patients at risk for infective endocarditis. There were 78 responses. Results and Conclusions Orthodontists are screening for cardiac problems in the patient's medical history but to a lesser extent are requesting written medical clearance from the patient's physician before starting orthodontic treatment. Many of the orthodontists surveyed believed that their knowledge of the American Heart Association's guidelines and management of high-risk patients was in the good-to-excellent range. Orthodontists recommend antibiotic prophylaxis most frequently during band placement and removal. Patients at risk for infective endocarditis are somewhat likely to inquire about possible treatment sequelae associated with previous cardiac problems.

Orthodontic treatment induces various biological responses, including tooth movement and remodeling of alveolar bone. Although some studies have investigated the contribution of orthodontic procedures to changes in saliva conditions, little is known about the effects of different treatment durations on the saliva proteome. To identify the discriminating protein profiles in unstimulated whole saliva of orthodontic patients with different treatment durations, we used matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) combined with magnetic bead, and peptide mass fingerprints were created by scanning MS signals. Saliva samples from 40 patients (10 in each of four groups: the group without an appliance and groups under treatment for 2, 7, and 12 months) were analyzed. The results showed eight mass peaks with significant differences. Furthermore, mass peak intensities at proteins 1817.7, 2010.7, 2744 and 2710.2 Da represented a steady time-dependent increasing trend, whereas protein 4134 Da exhibited a decreasing tendency. Differential expression of the peptidome profile also occurred in the multiple comparisons, and we established a fitting model. Thus, the potential discriminating biomarkers investigated in this study reflected the complicated changes in periodontal tissues during orthodontic treatment and indicated dynamic interactions between orthodontic treatment and the saliva proteome. The results provide novel insights into alterations in salivary proteins due to different orthodontic treatment durations and may lead to the development of a therapeutic monitoring strategy for orthodontics.

Introduction Because of limited available reference data, this study described the vertical growth changes that occur in untreated adolescents 10 to 15 years of age and evaluated the validity of measurements commonly used to classify patients’ vertical growth tendencies. Methods The sample consisted of 228 subjects (119 boys, 109 girls) between 10 and 15 years of age with normal occlusions or malocclusions who had lateral cephalograms (n = 1303) taken annually. Based on 6 landmarks, 3 angles (PPA, MPA, PP/MPA) and 2 proportions (PFH:AFH and UFH:LFH) were calculated. To reduce errors, each subject’s growth curve was estimated by using multilevel modeling procedures, and the estimated values were analyzed. Results Growth changes between 10 and 15 years for each of the 5 measurements followed relatively simple (linear or quadratic) polynomial models. On average, PPA and PFH:AFH increased, and MPA and PP/MPA decreased. The UFH:LFH ratio increased during the first few years and then decreased. MPA, PP/MPA, and PFH:AFH showed moderately high intercorrelations; PPA displayed moderate to moderately low correlations with UFH:LFH; UFH:LFH showed a moderate correlation with PP/MPA. Approximately 75% to 86% of the subjects classified as hyperdivergent or hypodivergent at 10 years maintained their classification. Subjects classified as hyperdivergent at 15 years of age showed significantly greater growth changes than did those classified within normal limits, who, in turn, showed greater changes than did the hypodivergent subjects. Conclusions Measurements typically used to classify vertical growth tendencies changed significantly during adolescence, with boys generally showing greater changes than girls. Although MPA, PFH:AFH, and PP/MPA measured the same phenotypic attribute, PPA and UFH:LFH were relatively independent of the other 3 measurements. Most subjects maintained their vertical facial types, but some worsened, and others improved.

Crohn's disease is a chronic inflammation of the small intestine; it can involve other organs, such as the skin, eyes, lungs, and joints. Oral manifestations are common, especially ulcers and stomatitis, which macroscopically and histologically resemble those found in the gastrointestinal tract. However, orthodontic alterations are not yet known. This article reviews aspects related to the diagnosis of Crohn's disease and clinical considerations for an orthodontic patient.

BAYRAK, SULE/0000-0001-7023-2358 WOS: 000288158100024 PubMed: 21392687 Introduction: The aim of this study was to compare dental development in a group of children with mild-to-moderate hypodontia with a matched group. Methods: A study group of 70 children (43 girls, 27 boys) with hypodontia, aged 5.3 to 12.5 years, was matched for race, age, and sex with 140 healthy, normal control subjects. The children's dental ages were calculated by using a modified dental-age estimation method. Differences between dental and chronologic ages were analyzed by t tests, and the correlations between differences in dental and chronologic ages and the numbers of missing teeth were analyzed with the Spearman correlation test. Results: Dental development in children with mild-to-moderate hypodontia was significantly delayed compared with the control group (P < 0.05); however, the mean difference did not exceed 0.3 years in either sex. No correlation was observed between the differences in dental and chronologic age and the severity of hypodontia. Conclusions: Children with mild-to-moderate hypodontia had delayed dental development of a few months; this was statistically significant. Because of individual variations, each patient should be carefully examined. (Am J Orthod Dentofacial Orthop 2011;139:334-8)

金沢大学医薬保健研究域医学系

Introduction The American Board of Orthodontics’ discrepancy index (DI) was designed to objectively quantify the complexity of a malocclusion before orthodontic treatment. In this study, we assessed the influence of age and sex on the DI distribution of a large mixed sample of patients. An additional objective was to ascertain the effectiveness of the DI for predicting the probability that 1 resident can complete the treatment of the malocclusion in a 24-month residency. Methods A group of 6 calibrated investigators independently determined the DI scores for 716 consecutive patients in the permanent dentition from the patient pool of Indiana University’s graduate orthodontics program over 7 years. The DI was scored and compared with the patient’s sex and age, and it was noted whether the patient was transferred to a second resident when the first one graduated. Results The DI is not significantly related to sex or age, but it was a significant predictor for patients who required transfer to a second resident for completion of treatment. Conclusions The DI was a relatively stable index for measuring malocclusion complexity. It is independent of sex or age but is a consistent indicator of the greater time and effort required to complete treatment, because of the significant correlation to the necessity to transfer patient care to a second resident.

Introduction The purpose of this descriptive study was to estimate retainer wear and compliance among orthodontic patients in the first 2 years after active orthodontic treatment. Methods A random sample of 1200 orthodontic patients was selected from 4 offices. Data were collected by a self-administered questionnaire that consisted of 6 items: type of retainer prescribed, age, sex, length of time since debond, and hours per day and nights per week that patients wore their retainers. Responses were solicited by mail or the Internet. Data were gathered on a categorical scale and analyzed. Results The overall response rate was 36% during a 6-week period. In the first 3 months after debond, 60% of patients were wearing their retainers more than 10 hours during a 24-hour cycle, and 69% were wearing the retainers every night. At 19 to 24 months after debond, 19% of the patients were not wearing their retainers, and 81% wore their retainers at least 1 night per week. Compliance rates during the periods of 0 to 3, 4 to 6, 7 to 9, 10 to 12, 13 to 18, and 19 to 24 months were 69%, 76%, 55%, 62%, 45%, and 45%, respectively. Age, sex, and type of retainer did not influence the levels of compliance. Conclusions Most continued to wear their retainers at least 1 night per week, with compliance rates, as defined, tending to decrease in our sample. It was encouraging that 81% of the patients in this sample largely maintained their orthodontic result.

Dentinogenesis imperfecta is an inherited dentinal dysplasia involving several risks for orthodontic treatment. This case report describes the multidisciplinary treatment of a 17-year-old girl whose Class II Division 1 malocclusion was complicated by dentinogenesis imperfecta type II and maxillary anterior trauma.

Introduction In this study, we aimed to evaluate the reasons for failure of orthodontic treatment for impacted maxillary canines and to recommend measures to overcome them. Methods Twenty-eight patients (ages, 17.4 ± 4.3 years) with 37 maxillary impacted canines were referred after a failed attempt to resolve the impaction. Reasons for failure were analyzed, and corrective measures undertaken. The success rate of the revised treatments and the durations of both treatments were recorded. Results The mean duration of the failed treatments was 26.2 ± 17.2 months. The failed treatments were mostly based on plane radiographs, intra-arch dental anchorage, and elastic traction directly to the labial archwire. The major reasons for failure were inadequate anchorage (48.6%), mistaken location and directional traction (40.5%), and ankylosis (32.4%). In several patients, there was more than 1 possible reason for failure. The success rate of the revised treatments was 71.4%, and the mean duration was 14.4 ± 7.2 months. Repeat surgery was needed for 62.9% of the canines in which corrective treatment was started, mostly to redirect the ligature wires. The corrective measures included the use of 3-dimensional imaging and a change in the direction of traction. Anchorage was reinforced by dental and skeletal means. Conclusions Inaccurate 3-dimensional diagnosis of location and orientation of impacted teeth and failure to appreciate anchorage demands were the major reasons for failure in the treatment of impacted canines.

Introduction The aims of this research were to establish norms for the sagittal and vertical occlusal cephalometric analyses of Pancherz for Chinese children and compare them with those of a matched white sample. Methods The material comprised lateral cephalograms of a random sample of 405 southern Chinese children (age, 12 years; 200 boys, 205 girls) and an additional sample of 86 British white children (age, 12 years; 43 boys, 43 girls) in Hong Kong. The radiographs were digitized twice. Results Statistically significant sex differences were found for 9 of 11 parameters in the sagittal occlusal analysis, and 6 of 10 in the vertical occlusal analysis in the Chinese sample, whereas there were no sex differences in the sagittal occlusal analysis and only 2 differences in the vertical occlusal analysis in the white sample. Statistically significant ethnic differences were found for 5 parameters in boys and 8 in girls of the 11 parameters in the sagittal analysis. For the vertical analysis, 7 of 10 parameters in both sexes differed significantly. Conclusions For the sagittal and vertical occlusal analyses of Pancherz, separate sex-specific standards are needed for Chinese and white children.

Introduction Our objective was to test the hypotheses that treatment with 2 fixed orthodontic appliances (SmartClip and Victory; 3M Unitek, Monrovia, Calif) would result in no difference in (1) the duration of orthodontic treatment or (2) the number of visits required. Methods Sixty-six consecutive patients were randomly allocated to treatment with a self-ligating bracket system (SmartClip) or a conventional appliance (Victory). The duration of treatment and the number of visits required in addition to the initial and final peer assessment rating (PAR) scores were recorded. The number of teeth extracted during treatment and the frequency of mechanical eruption of canines were also noted. Analyses of covariance were used to assess the influence of bracket type on treatment durations, visits required, and percentage PAR score reductions. Results Fifty-four (81.8%) participants completed the study. The duration of treatment was 3 months greater in the group treated with SmartClip. However, bracket type had no statistical influence on treatment duration ( P = 0.076), total visits required ( P = 0.184), or percentage PAR score reduction ( P = 0.255). Conclusions Neither hypothesis could be rejected. Bracket type did not influence the duration of treatment or the number of visits required. The percentages of PAR score reductions were also unaffected by the choice of appliance.

The objective of this study was to evaluate natural changes in maxillary posterior alveolar height (MPAH) and axial inclination of the maxillary first molars (AIMFM) in subjects with Class II malocclusion to determine the validity of predictive equations.Longitudinal records of 30 untreated white subjects (13 girls, 17 boys) with skeletal Class II malocclusion were collected at ages 9, 12, 14, and 16 years. They had participated in the Burlington Growth Centre study, and cephalograms were analyzed with Dentofacial Planner Plus software (version 2.0, Dentofacial Planner, Toronto, Ontario, Canada). Serial means were compared with the Bonferroni post-hoc test (P0.05). Predictive equations were obtained and studied with the analysis of agreement.Gradually, means of MPAH had statistical increments with sexual dimorphism from 14 to 16 years of age. A distal mean of AIMFM was found at 9 years of age that decreased significantly during growth, with sexual dimorphism between the ages of 9 and 12 years. Changes in AIMFM varied among subjects in distinct stages. Values of MPAH were predicted with high validity at intervals of 3 years or longer, whereas estimations for AIMFM were unreliable.In this study group, there was significant alveolar growth, with a natural tendency to upright the distal inclination at the maxillary first molars.

Cone-beam computed tomography (CBCT) has become popular, and its many inherent advantages are indisputable. Nevertheless, CBCT is prescribed cautiously because the radiation dosage is higher than that of conventional radiography. When and to what extent should CBCT be prescribed for orthodontic patients? The purpose of this article is to present 4 curious cases in which a considerable discrepancy was found between the conventional panoramic radiograph and the CBCT view. Is it time to spare patients an unnecessary conventional panoramic radiograph and shift to CBCT for all patients?

This article describes a patient whose permanent canines and premolars had not erupted at age 14 years, although their root formation was complete, with closed apices. Surgical and orthodontic treatment was planned to correct the multiple impactions. The orthodontic traction used 5 strategic teeth and allowed for the eruption of all 12 impacted teeth. The surgical-orthodontic treatment of many impacted teeth yielded good esthetic and periodontal results, as shown by the patient's satisfaction and the periodontal probing 2 years after the treatment. Multiple impacted teeth are a rare eruption disturbance that requires early detection: no signs of a genetic syndrome or an endocrine disorder had been found, or failure to move along the eruption path, which is a characteristic of another syndrome, primary failure of eruption.

Introduction Pain is a major concern of patients before orthodontic treatment. Currently, the most frequently recommended treatments for pain after archwire placement or appliance adjustment are over-the-counter (OTC) analgesics. Although the overuse of OTC medications and their potential side effects are concerns, particularly for children, no study to date has investigated a nonpharmacologic option for pain management as an alternative for these analgesics. Methods A parallel 2-group stratified block randomized clinical trial was designed to assess the pain response of adolescents during the first week after initial archwire placement. The subjects were randomly assigned to 1 of 2 pain management groups: bite wafer (BW) or OTC analgesics. Pain levels were reported on a numerical rating scale. The intensity and unpleasantness of the pain were also assessed. Data were collected at 8 times over a 7-day period. A general linear mixed model with heterogeneous compound symmetry covariance matrix was fitted separately for each outcome. Estimates from the mixed model were used to test a noninferiority hypothesis that the BW group, on average, was not inferior with respect to pain management to the OTC group. Results The patterns of pain level, intensity, and unpleasantness over time were similar for the 2 groups (P >0.33). Pain management for the BW group as indicated by pain level, intensity, and unpleasantness was not inferior to that of the OTC group (P >0.39). Conclusions In adolescents, the BW is a nonpharmacologic option for pain management after orthodontic procedures that is at least as effective as OTC analgesics.

Introduction Correct tooth position in the 3 planes of space is a major objective of orthodontic treatment. The aim of this study was to determine whether a panoramic radiograph (OPT) provides a true assessment of the mesiodistal root relationship of adjacent teeth. Methods OPTs of 22 patients near the end of treatment with fixed appliances in both arches were taken before debonding. When the roots of adjacent teeth were touching on the OPT, cone-beam computed tomography (CBCT) was used to show the true root relationships. Results We evaluated 235 interdental sites by OPT and CBCT; 47 areas showed contact between adjacent roots in the OPT images. However, the CBCT images showed true contact in only 5 of these areas; ie, 11% of the diagnoses based on OPT images were true positive, whereas the rest (89%) was false positive. One hundred eighty-eight sites showed no contact in the OPT images; this was confirmed by CBCT. Conclusions OPT has high sensitivity and relatively high specificity to detect adjacent roots touching each other. Root contacts are overestimated when evaluated by OPT.

Introduction The aims of this study were to assess the peer assessment rating (PAR) index in relation to perceived treatment needs for maxillary protrusion in Japanese subjects and to investigate how perceived orthodontic treatment needs change with increased experience in dentistry and orthodontics. Methods The subjects were 155 persons (73 men, 82 women; mean age, 24.2 years; SD, 4.7 years) including dental students, residents, and orthodontists. We showed them casts from 10 patients with untreated maxillary protrusion and gave them a questionnaire with a 100-point visual analog scale (VAS), concerning their perceptions of orthodontic treatment needs. The PAR index was used for cast evaluation. Results The PAR index showed significant correlations with the VAS scores. On the casts evaluated with a PAR index below 17, there was no difference in VAS scores between the 3 groups; however, orthodontists perceived significantly greater treatment needs than did students and residents on casts with a PAR index of 18 or 19. The VAS scores were significantly increased when casts with a PAR index of more than 20 and overjet above 5.0 mm were evaluated. Orthodontists and residents perceived greater treatment needs than students on assessing occlusions with severe maxillary protrusion. Conclusions The PAR index is clinically useful to evaluate malocclusion, and the perception of treatment needs was significantly greater when the maxillary protrusion cast had a PAR index of more than 20 and overjet above 5.0 mm. Perceived needs for orthodontic treatment for maxillary protrusion changed with increasing experience and skills in dentistry and orthodontics.

Introduction It is not known whether the design of the expander has an effect on initial adaptation, comfort level, speech, chewing, and swallowing, or whether age is a crucial aspect when dealing with speech adaptations. The objectives of this study were to assess whether patients of different age groups undergoing palatal expansion with various types of expanders experienced discomfort, speech impairment, chewing difficulty, and swallowing disturbances. Methods A questionnaire was developed and distributed to patients who had received palatal expanders in the preceding 3 to 12 months. Results Regardless of the type of expander, most patients initially felt oral discomfort, and had problems with speech and mastication. However, these disturbances were confined to the first week after cementation of the device. Remarkable adaptation to the device in all aspects studied was observed by the end of the first week. In addition, age did not influence the variables; younger patients and older teenagers responded similarly to the survey. In addition, the questionnaire responses did not appear to be related to the respondents' sex. Conclusions Discomfort might not be a deciding variable when choosing an appliance. Instead, clinicians should base their decision on factors such as its biomechanics.

Introduction Mini-implants are placed in restricted sites, requiring an accurate surgical technique. However, no systematic study has quantified technique accuracy to reliably predict the surgical risks. Therefore, a graduated 3-dimensional radiographic-surgical guide (G-RSG) was proposed, and its inaccuracy and risk index (RI) were estimated. Methods The sample consisted of 6 subjects (4 male, 2 female), who used mini-implant anchorage. Ten drill-free screws (DFS) were placed by using the G-RSG. The central point of the mesiodistal septum width (SW) was the selected implant site on the presurgical radiograph. The distances between DFS and the adjacent teeth (5-DFS and 6-DFS) were measured to evaluate screw centralization and inaccuracy degree (ID). These distances were statistically compared by independent t tests, and inaccuracy was determined by the expression ID = (5-DFS – 6-DFS)/2, which represents deviation of the mini-implant's final position regarding the central point initially selected. Then SW, ID, and screw diameter (SO) were combined to estimate the surgical risk with RI expressed by RI = SO/SW – ID. Results The 5-DFS and 6-DFS distances were not significantly different. The ID of the G-RSG was 0.17 mm. The low ID ensured a safe RI ( Conclusions The G-RSG accuracy allowed fine prediction of the final DFS position in the interradicular septum, with a low RI, which is a helpful tool to estimate surgical risks.

Introduction Our purposes were to investigate factors influencing career choice and to identify future plans of Canadian orthodontic residents. Methods All orthodontic residents in the 5 Canadian residency training programs were invited to complete an anonymous online survey in November 2006. Data were categorized by demographic variables, and basic statistics including chi-square comparative analyses were performed. Results Forty-four of the 54 residents in Canada (81.48%) completed the survey. “Intellectual stimulation/challenge” emerged as the most important factor (40%) influencing the decision to pursue specialty training in orthodontics, followed by a “passion for orthodontics” (29%). The decision to become an orthodontist was made by 42% of respondents while they were in dental school; 33% had decided after completing dental school, and 24% had already decided before starting their dental school studies. Most residents (82%) planned to work in a private practice environment. Only 2 (4.5%) indicated that they will most likely practice primarily in an academic setting. Eighty percent said that they will use self-ligating brackets in private practice, and almost 80% said they will use Invisalign (Align Technology, Santa Clara, Calif). A total of 55% indicated that orthodontic residents should be required to undertake research leading to a masters of science degree as part of their orthodontic program. A total of 77% thought that a 24- to 30-month program was too short to adequately prepare them for private practice. Conclusions Intellectual stimulation was the major attraction of most applicants to orthodontic programs, and the decision to become an orthodontist was normally made during dental school or even earlier. Most residents intended to enter an urban or suburban private practice after graduation, with few considering academic career choices. Modern techniques such as self-ligating brackets and Invisalign are expected to be popular among future orthodontists in Canada.

This case report describes the management of a partially edentulous adult with a severe deepbite malocclusion and a collapsed buccal segment because of supraeruption of the maxillary second and third molars. The treatment involved placement of an endosseous dental implant to achieve absolute intermaxillary and intramaxillary anchorage. Rare-earth magnets embedded in acrylic bite-blocks were used to intrude the supraerupted maxillary molars on the right side. After use as an anchorage device, the implant was restored and brought into occlusion. Good occlusal and esthetic results were achieved with this cost-effective treatment.

Introduction Our purpose was to study the in-vitro cytotoxic and estrogenic properties of Invisalign appliances (Align Technology, Santa Clara, Calif). Methods Three sets, each consisting of a maxillary and a mandibular appliance, of as-received aligners were immersed in normal saline solution for 2 months. Samples of eluents were diluted to 3 concentrations (5%, 10%, and 20% vol/vol) and tested for cytotoxicity on human gingival fibroblasts and estrogenicity by measuring their effect on the proliferation of the estrogen-responsive MCF-7 breast cancer cells. All assays were repeated 4 times for each maxillary and mandibular set, and the results were analyzed with 2-way analysis of variance (ANOVA) with appliance and concentration serving as predictors at the .05 level of significance; differences among groups were investigated with the Tukey test. Results There was no evidence of cytotoxicity on human gingival fibroblasts and no stimulation of proliferation of the MCF-7 cell line at any concentration, indicating no estrogenicity of aligner eluents. Conclusions The use of Invisalign appliances did not seem to induce estrogenic effects under the conditions of this experiment.

Introduction Cortical bone thickness and overall bone depth are important factors to consider when placing an orthodontic mini-implant. The purpose of this study was to investigate both variables in the palate quantitatively to aid clinicians in planning successful mini-implant placements. Methods Thirty dry skulls were imaged with cone-beam computed tomography technology. Coronal slices were generated on which overall bone depth and cortical bone thickness were measured at 4 levels and 34 palatal placement sites. One-way analysis of variance (ANOVA) was used for data analysis. Results Overall bone depth decreased with increasing distance from the midsagittal plane and from the anterior to the posterior palatal regions. Cortical bone thickness decreased from anterior to posterior, but no differences were detectable within measurement levels. Conclusions Bone depth and cortical bone thickness of the palate were most favorable for temporary anchorage device placement at the level of the first and second premolars. This information could aid clinicians in choosing suitable palatal placement sites for orthodontic mini-implants.

This study continues our assessment of agreement and disagreement among 25 Chinese and 20 US orthodontists in the ranking for facial attractiveness of end-of-treatment photographs of randomly sampled growing Chinese and white orthodontic patients. The main aims of this article were to (1) measure the overall pattern of agreement between the mean rankings of US and Chinese orthodontists, and (2) measure the strength of agreement between the rankings of the US and Chinese orthodontists for each patient.Each judge independently ranked standard clinical sets of profile, frontal, and frontal-smiling photographs of 43 US patients and 48 Chinese patients. For each patient, a separate mean rank was computed from the responses of each group of judges. Pearson correlations between the mean ranks of the 2 groups of judges were used to measure their overall agreement. Paired and unpaired t tests were used to measure the agreement between the judges of the 2 groups for each patient.The overall agreement between the mean rankings of the US and Chinese judges was very high. For the US patients, the correlation between the Chinese and US judges means was r = 0.92, P0.0001. For the Chinese patients, the analogous value was r = 0.86, P0.0001. Agreement between the 2 groups of judges concerning each patient was also generally strong. For two thirds of the patients, the mean ranks of the US and Chinese judges differed by less than 1 unit in a scale of 12. However, for 6 patients considered individually (5 Chinese and 1 US), the assessment of the 2 groups of judges was statistically significantly different at P values ranging from 0.02 to less than 0.0001, even after the Bonferroni correction.These findings demonstrate that orthodontic clinicians can reliably identify and rank subtle differences between patients, and that differences between judges and between patients can be distinguished at a high level of statistical significance, given appropriate study designs. However, the reasons clinicians give for the differences in their judgments are more difficult to investigate and will require further study.

In the age of evidence-based dentistry, an interesting question is whether dentists' subjective or general assessments of preadolescent orthodontic treatment need are correlated with objectively determined need. In addition, because children from socioeconomically disadvantaged and underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment, it is worthwhile to investigate whether unmet orthodontic treatment need is correlated with preadolescent smile assessments and desire for braces. Our objectives were to explore (1) whether pediatric residents' objective and subjective assessments of preadolescent orthodontic treatment need are correlated and also correlate with the treatment recommendations made, (2) whether preadolescent responses concerning their smile-related quality of life and desire for braces are correlate, and (3) whether dentist and patient assessments are related.Data were collected from 1566 preadolescents (age range, 8-11 years; 47.3% boys, 52.7% girls; 55.7% black, 39.7% white, 2.9% Hispanic) in oral examinations and face-to-face interviews. Malocclusion was determined with the index of orthodontic treatment need.Objective and subjective orthodontic treatment need indicators were correlated (r = .719, P0.001). Pediatric residents' recommendations for orthodontic treatment were correlated with both the objective assessment of treatment need (r = .547, P0.001) and the subjective assessment of treatment need (r = .522, P0.001). Both sets of malocclusion indicators correlated with the patients' self-perceptions (r = -.145, P0.001; r = -.177, P0.001) and their desire for braces (r = .106, P = 0.001; r = .141, P0.001). Patient desire for braces was significantly correlated with smile-related quality-of-life scores (r = .665, P0.001).Although subjective and objective assessments of preadolescent orthodontic treatment need are rather consistent, the percentage of actual treatment recommendations exceeded both the subjective and objective assessments of treatment need. Preadolescent self-assessments and desire for braces were significantly correlated, and also correlated with the treatment recommendations and the objective and subjective components of the index of orthodontic treatment need score.

Introduction In this study, we evaluated the effects of orthodontic appliances and an extracted maxillary first premolar on the esthetic evaluation of a smiling face according to the perceptions of orthodontists and laypeople. Methods Standardized oblique photographs of a young woman with a pleasing smile were taken. The photos were edited by using digital imaging software to produce 10 combinations of presence or absence of orthodontic appliances with either esthetic or metal brackets, rubber bands of different colors, and presence or absence of the maxillary first premolar. Two groups of 50 observers each, 1 of laypeople and the other of orthodontists, evaluated the images and assigned esthetic scores to the smiles according to a visual analog scale. Results The presence of orthodontic appliances and metal brackets, regardless of rubber band color, had no negative effect on the esthetic evaluation of the smile by either group. Appliances with esthetic brackets were significantly less pleasing for laypeople, whereas for orthodontists they did not affect the esthetic evaluation of the smile. The extraction space had a significantly negative effect on the evaluation of the smile, and only orthodontists thought that the appliance minimized its effect. Conclusions The type of bracket used with the orthodontic appliances and a maxillary first premolar extraction space produced different esthetic perceptions in laypeople and orthodontists.

Introduction This study was designed to compare the reliability of the Q-sort and visual analog scale (VAS) methods for the assessment of smile esthetics. Furthermore, agreement between orthodontists and parents of orthodontic patients, and between male and female raters, was assessed in terms of subjective evaluation of the smile. Methods Clinical photographs and digital video captures of 48 orthodontically treated patients were rated by 2 panels: 25 experienced orthodontists (15 men, 10 women) and 20 parents of the patients (8 men, 12 women). Interrater reliability of the Q-sort and VAS methods was evaluated by using single-measure and average-measure intraclass correlation (ICC). Kappa agreement and the McNemar test were used to evaluate agreement between orthodontists and parents, and between men and women, for “attractive” and “unattractive” images of smiles captured with clinical photography. Results The single-measure ICC coefficients showed fair to good reliability of the Q-sort and poor reliability of the VAS for measuring esthetic preferences of an individual orthodontist or parent. Both rating groups agreed significantly (P >0.05) on the total percentage of “attractive” images of smiles captured with clinical photography. Men and women, however, significantly disagreed on the total percentages of “attractive” and “unattractive” smiles. Women rated higher percentages of both image groups as “attractive” than did their male counterparts. Conclusions The Q-sort was more reliable than the VAS for measuring smile esthetics. Orthodontists and parents of orthodontic patients agreed with respect to “attractive” and “unattractive” smiles. Men and women agreed poorly with respect to “attractive” and “unattractive” smiles.

In the past few decades, more patients have been treated orthodontically, but no longitudinal study has compared orthodontic bands and brackets microbiologically and clinically.This longitudinal trial (split-mouth design) included 24 patients. Microbiology (sub- and supragingival), probing depth (PD), bleeding on probing (BOP), and gingival crevicular fluid flow (GCF) were assessed at baseline (band placement) and at weeks 18 (bracket bonding) 20, 24, and 36. A statistical comparison was made over time and among the banded, bonded, and control sites.The aerobe/anaerobe ratio of sub- and supragingival colony forming units decreased significantly (relatively more anaerobes) over the study period for the banded and bonded sites (P0.001). This decrease was accompanied by significant elevations in PD, BOP, and GCF. These changes occurred faster after bonding compared to banding. No significant changes were observed 18 weeks after banding with the exception of increased PD (P0.001). At week 36, all microbial and clinical variables at the bonded site had changed significantly in the negative direction (P0.001) compared to week 18. The control sites did not show any significant changes over time, indicating that the effects were localized.The placement of fixed orthodontic appliances had a significant impact on microbial and clinical variables. The changes occurred faster at the bonded sites compared to the banded sites, probably because wire insertion caused difficulties in approximal cleaning. Over the long term, banding did not lead to more adverse microbial and periodontal effects than bonding.

Management of orthodontic treatment requires specific attention when patients develop medical problems that affect their general health or require treatments that might not be compatible with orthodontic care. This article describes the interface of orthodontic and medical care in a patient who was diagnosed with acute myeloid leukemia midway through her orthodontic treatment.

Introduction: The aim of this study was to answer this question: to what extent do facial proportions change in comparison with the divine values during growth? Methods: The changes of the facial proportions in ordinary subjects were analyzed with full-face photos from 20 female and 20 male subjects. In each photo, 5 transverse and 7 vertical reference distances were considered. The facial photos from childhood (age, 6.5 years), adolescence (17 years), and adulthood (30 years) of each subject were compared. For all photos in both planes (transverse and vertical), the ideal reference distances were calculated with a base value (1) and the divine proportion. These ideal distances were compared with the actual distances. Two facial disproportion indexes in the transverse and vertical planes, respectively, were determined and defined as the average absolute deviations of all measured distances from their ideal values. Results: The facial proportions changed, on average, only a small amount during the growth period from childhood to adulthood, but large interindividual variations were seen. The disproportion indexes in the transverse and vertical planes varied between 10.5% and 18.1% in the female subjects and 12.0% and 18.3% in the male subjects. Conclusions: In comparison with the divine values, facial proportions in both sexes remain rather constant during growth.

Our aim was to test the hypothesis that relapse of incisor alignment is associated with skeletal maturity at the end of treatment, as assessed with the cervical vertebral maturation (CVM) method.This was a case-control study with information from the postretention database at the University of Washington. Mandibular incisor irregularity (II) at least 10 years out of retention (T3) was used to define the subjects (II6 mm, relapse group) and the controls (II3.5 mm, stable group). The following model measurements were made: II at pretreatment (T1), II at posttreatment (T2), and intercanine width at T1 and T2. On cephalograms taken T2, the CVM status was determined. Logistic regression analyses were used to determine the association between relapse and CVM status after treatment. The models were adjusted for potentially confounding variables (II at pretreatment and posttreatment, intercanine width change during treatment, sex, age at T2, and treatment alternatives).No association between CVM stage at T2 and relapse was found (P = 0.89). Both groups had similar distributions of the CVM stages (P0.05). Pretreatment II and postretention time were found to be correlated with long-term incisor stability (P = 0.007 and 0.034, respectively). Sex was not related to relapse (P = 0.33).Maturity of craniofacial structures at the end of treatment evaluated with the CVM method is not associated with long-term stability of incisor alignment.

Introduction: In this study, we assessed agreement and disagreement among pairs of Chinese and US orthodontists in the ranking for “facial attractiveness” of end-of-treatment photographs of growing Chinese and white orthodontic patients. Methods: Two groups of orthodontist-judges participated: from the University of the Pacific, School of Dentistry, in California and from Peking University School and Hospital of Stomatology in China. Each judge independently ranked standard clinical sets of profile, frontal, and frontal-smiling photographs of 43 white patients and 48 Chinese patients. Pearson correlations were generated for a total of 1980 rankings by pairs of judges. Results: The resulting correlations ranged from +0.004 to +0.96 with a median of +0.54. Of these, 18.7% were lower than 0.4; 41.0% were lower than 0.5; 68.8% were lower than 0.6; 91.6% were lower than 0.7; and only 8.4% were greater than 0.7. As had been anticipated, correlations between judges were higher when they ranked patients of their own ethnicity than when they ranked patients of different ethnicity, but the differences were smaller than had been expected. The rankings of no pair of judges correlated negatively. This is to say that no pair of judges, whether of the same or different ethnicity, ranked the patients so that those 1 judge tended to find attractive were consistently found unattractive by the other. Conclusions: The distribution of levels of agreement between pairs of orthodontists did not differ substantially whether the pairs included 2 US orthodontists, 2 Chinese orthodontists, or 1 US and 1 Chinese orthodontist. As might be expected, the pairs of Chinese orthodontists agreed with each other slightly better on average when ranking Chinese patients, and the pairs of US orthodontists agreed with each other slightly better on average when ranking white American patients, but the overall differences were small. These findings appear consistent with the inference that, on average, judgments of “facial attractiveness” by orthodontists at the 2 venues are more similar than had been expected for patients of Chinese and white ethnicity.

Introduction: Onplants serve as subperiosteal anchorage in the maxilla to facilitate tooth movement. We determined the applicability of onplants and the process of osseointegration in the mandible of minipigs. Methods: Thirty-six onplants (OnPlants, Nobel Biocare USA, Yorba Linda, Calif) were positioned in 9 adult animals, 2 on each side. At 3, 6, and 12 weeks after surgery, 3 minipigs were killed. Undecalcified ground sections were evaluated histologically and histomorphometrically. Results: Nineteen onplants were lost during the observation period. Newly formed bone per tissue volume was 7% ± 5% (n = 4), 21% ± 9% (n = 5), and 22% ± 13% (n = 8) at the 3 observation times. The corresponding percentages of bone-to-implant contact were 15% ± 22%, 30% ± 27%, and 44% ± 35%. The number of bone-to-implant contacts remained stable over time at 1.0 ± 0.9 contacts per millimeter. The average lengths of bone-to-implant contacts were 0.2 ± 0.1 mm, 0.3 ± 0.2 mm, and 0.5 ± 0.3 mm. Conclusions: These results showed a low survival rate of onplants in the mandible and that the early stage of healing is central to the process of osseointegration. Stable placement is a prerequisite for onplant survival in the mandible.

Introduction: The esthetic impact of the soft-tissue profile might play a major role in deciding on premolar extraction or nonextraction treatment, particularly in borderline patients. The purpose of this study was to compare the esthetic impact of extraction and nonextraction therapy on Korean patients. Methods: Panels of 50 dentists and 50 laypersons evaluated randomly presented pretreatment and posttreatment soft-tissue profiles of 50 extraction and 50 nonextraction patients. As subjects in this study, borderline patients were selected based on their initial diagnostic records. Two panels were asked to compare the pretreatment and posttreatment profile tracings and to quantify their perceptions of the esthetic impact of treatment change using a visual analog scale. Results: Premolar extraction patients showed greater improvement in facial profile compared with nonextraction patients, regardless of the panel. Based on the results of regression analysis to determine the degree of lip protrusion at which the retraction that commonly follows premolar extraction would be needed, the intersection was about 3.0 mm behind the Ricketts’ E-line; this is far behind the Korean norm. Conclusions: The results indicate that premolar extraction is more beneficial than nonextraction treatment in terms of facial profile improvement in Korean borderline patients.

Introduction Even with advances in materials and techniques, demineralization around brackets during orthodontic treatment continues to be a problem. The purpose of this in-vivo study was to evaluate the effect of a fluoride varnish on enamel demineralization adjacent to bonded brackets. Methods Fifteen patients who needed at least 2 premolars extracted for orthodontic reasons were selected. In each patient, 1 premolar was considered the test tooth, and the other was the control. Brackets were bonded, and T-loops were engaged on all premolars, but only the test teeth received fluoride varnish. The premolars were extracted after 85 to 95 days, and buccolingual sections 50 to 70 μm in thickness were evaluated with polarized light microscopy. The mean depth of demineralization in each lesion was measured 3 times on photographs by an operator blinded to the groups (intraclass correlation of the 3 measurements was 0.988). Results The mean lesion depths were 57.0 ± 5.5 μm in the test group and 94.3 ± 6.7 μm in the control group. There was significant reduction (approximately 40%) in depth of demineralization in the test group (P Conclusions Fluoride varnish can be beneficial as a preventive adjunct in reducing demineralization adjacent to brackets.

Orthodontists typically make judgments of facial attractiveness by examining groupings of profile, full-face, and smiling photographs considered together as a "triplet." The primary objective of this study was to determine the relative contributions of the 3 photographs-each considered separately-to the overall judgment a clinician forms by examining the combination of the 3.End-of-treatment triplet orthodontic photographs of 45 randomly selected orthodontic patients were duplicated. Copies of the profile, full-face, and smiling images were generated, and the images were separated and then pooled by image type for all subjects. Ten judges ranked the 45 photographs of each image type for facial attractiveness in groups of 9 to 12, from "most attractive" to "least attractive." Each judge also ranked the triplet groupings for the same 45 subjects. The mean attractiveness rankings for each type of photograph were then correlated with the mean rankings of each other and the triplets.The rankings of the 3 image types correlated highly with each other and the rankings of the triplets (P.0001). The rankings of the smiling photographs were most predictive of the rankings of the triplets (r = 0.93); those of the profile photographs were the least predictive (r = 0.76). The difference between these correlations was highly statistically significant (P = .0003). It was also possible to test the extent to which the judges' rankings were influenced by sex, original Angle classification, and extraction status of each patient. No statistically significant preferences were found for sex or Angle classification, and only 1 marginally significant preference was found for extraction pattern.Clinician judges demonstrated a high level of agreement in ranking the facial attractiveness of profile, full-face, and smiling photographs of a group of orthodontically treated patients whose actual differences in physical dimensions were relatively small. The judges' rankings of the smiling photographs were significantly better predictors of their rankings of the triplet of each patient than were their rankings of the profile photographs.

Introduction: Smile evaluation and designing are important; recent emphasis on the soft tissues has been on par with that on the hard tissues in orthodontic diagnosis and treatment planning. This importance has not yet gained proper attention, and smile analysis is often ignored in clinical examinations. We attempted a comprehensive evaluation of smile characteristics with the following aims: (1) evaluation of perception differences, if any, between dental specialists and laypersons; and (2) quantification of smile characteristics with the smile arc, buccal corridor measurements, and a modified smile index (MSI). Methods: The sixty subjects included in the study had an age range of 18 to 25 years (mean, 21 years) with equal numbers of men and women. Frontal posed smile photographs were taken of all subjects. The study had 2 parts. Analysis of perception differences between dental specialists and laypersons was performed with a visual analog scale. Quantification of smile characteristics was done with smile-arc evaluation for consonance or nonconsonance, buccal corridor measurements, the MSI, and comparisons of the MSI with the facial index and the mandibular width-facial height index. Results: There was no perception difference between the specialists and the laypersons on overall smile evaluation. Women had more consonant smile arcs than men, and there was high correlation between the right and left buccal corridor spaces in men and women. The MSI showed no correlation to the facial index, but there was a negative correlation of the MSI with the mandibular width-facial height index. Conclusions: Smile analysis should be an important aspect of orthodontic diagnosis and treatment planning. Orthodontists should not disturb consonant smiles but create them with proper bracket positioning. The MSI, with negative correlation with the mandibular width-facial height index, warrants further evaluation with a larger sample to validate its clinical use and to develop a predictive approach of its relationship.

Introduction: The purpose of this pilot study was to investigate the effects of facemask treatment with a rigid skeletal anchor. Methods: Miniplates were placed on the lateral nasal wall of the maxilla in 6 subjects (mean age, 11.8 ± 1.1 years). No dental tissue was incorporated into the anchorage system. Lateral cephalograms of each patient were evaluated at the beginning of treatment (T1), at the end of active treatment (T2), and at the end of follow-up (T3). Results: In the horizontal plane, mean A-point movement was 4.8 ± 2.0 mm in a mean of 10.8 ± 2.4 months. The infraorbital region showed significant anterior movement (mean, 3.3 ± 1.1 mm) at T2. At T3, advancement of the maxilla and the infraorbital region was well maintained (mean follow-up time, 15.2 ± 0.9 months). Miniplate stability was excellent in all patients throughout treatment. Conclusions: Remarkable advancement in the middle face and consequent fullness in the soft-tissue profile can be achieved by using skeletal anchorage in conjunction with facemask therapy in the late mixed-dentition period.

The common protocol of a week-long duration of elastomeric separators to facilitate band placement usually causes discomfort. In this study, we examined the minimum separation time required to create an interproximal space0.16 mm (band thickness), the interproximal changes over 24 hours after separator removal, and the mechanical characteristics of various separators.Thirty subjects, ages 28.1 +/- 2.8 years, had an elastomeric separator placed between the mandibular second premolar and first molar (CP5-6) for 1, 4, 12, and 24 hours. After separator removal, CP5-6 was measured for space and tightness of dental contact point (TDCP) changes up to 24 hours after separator removal. The mechanical behaviors of 6 manufacturers' separators were compared.After 12 and 24 hours of separation, all patients demonstrated space0.16 mm (P.001). A significant negative correlation (R = -0.59 to -0.63; P = .001) was found between baseline TDCP and the space measured at separator removal. A biphasic viscoelastic recovery (82%-95%) to baseline tightness level occurred within 24 hours. Variation between manufacturers was low (9%).Separators should be placed a day before banding. The patient should arrive 3 to 4 hours before the appointment for separator replacement if the separator is lost. Rapid recovery after separation removal implies the biological soundness of elastomeric separation regardless of the manufacturer used.

Objective: To determine patients' expectations, acceptance, and experience of pain with microimplant surgery compared to other orthodontic procedures.Materials and Methods: Seventy-eight microimplants were placed in 37 patients as an anchorage unit for orthodontic treatment. Patients were asked to rate anticipated pain and pain experienced with various orthodontic procedures (tooth extraction, insertion of separators, initial tooth alignment, and microimplant surgery) on a visual analog scale (VAS) over a 7-day period. One month after insertion of microimplants, patients were asked to rate their acceptance of the procedure using a structured questionnaire.Results: Unlike other orthodontic procedures, patients expected to experience a significantly higher level of pain with microimplant surgery than they experienced (P < .001). The postoperative pain experienced decreased continuously from day 1 to day 7 for all orthodontic procedures (P < .05). The total area under the curve (AUC) of pain experienced over the 7-day period was significantly larger for initial tooth alignment than for microimplant surgery (P < .05). Most patients were satisfied with the microimplant surgery (76%) and would recommend it to a friend or family member (78%).Conclusions: Patients tended to overestimate the pain anticipated with microimplant surgery. Patients were accepting of the surgery and would recommend it to others.

Introduction: A predrilled miniscrew, when used as a temporary anchorage device in the infrazygomatic crest of the maxilla, can be displaced under orthodontic loading. The purpose of this retrospective cephalometric study was to compare the loading behavior of predrilled and self-drilling miniscrews placed in the infrazygomatic crest of the maxilla. Methods: The subjects were 32 women who had miniscrews in the infrazygomatic crest of the maxilla as skeletal anchorage for en-masse anterior retraction and intrusion; 16 had predrilled miniscrews, and 16 had the self-drilling type. The miniscrews were all 2 mm in diameter and 10 to 17 mm long. They were loaded with nickel-titanium closed-coil springs 2 weeks after placement. All the miniscrews remained stable, without detectable mobility or loosening, throughout the treatment period. Cephalometric radiographs were taken immediately before force application (T1) and at least 5 months later (T2). The T1 and T2 cephalometric tracings were superimposed to determine whether any displacement of the miniscrews had occurred. Results: The predrilled and self-drilling miniscrews were all significantly displaced in accordance with the force direction of the nickel-titanium coil springs. The amounts of miniscrew displacement were similar between the predrilled and self-drilling miniscrews, and were correlated to the length of the loading period. The displacements were 0.0 to 1.6 mm with extrusion, 1.5 mm with forward or backward tipping at the screw tail, and 1.5 mm with forward tipping at the screw head. Conclusions: The loading behaviors of predrilled and self-drilling miniscrews were similar in the infrazygomatic crest of the maxilla. These miniscrews were all subject to displacement under orthodontic loading, and the amount of the displacement was correlated to the length of the loading period, although they remained stable without detectable mobility or loosening.