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ZusammenfassungDer Wittenberger Arzt Konrad Victor Schneider (1614–1680) hat als Erster den Nachweis erbracht, dass Schleim nicht im Gehirn gebildet und auch nicht über das Siebbein in die Nasenhöhle sezerniert wird. Er hat erkannt, dass es keine offene anatomische Verbindung zwischen Gehirn und nasalem Luftraum gibt. Schneider hat die sinunasale Schleimhaut als Produktionsstätte des Schleims entdeckt und damit die Hypothese der zerebralen Schleimproduktion und -sekretion von Hippokrates, Galen und Vesal widerlegt. Zu Ehren von Schneider wurde die Schleimhaut „membrana Schneideria“ benannt.

ZusammenfassungDas Management von Patienten mit einer Molaren-Inzisiven-Hypomineralisation (MIH) gewinnt durch die steigende Prävalenz zunehmend an Bedeutung. Bei der Therapieplanung ist ein enger Austausch zwischen Zahnarzt und Kieferorthopäden von erheblicher Bedeutung, da neben dem Defektausmaß auch die gegebenen dentalen und skelettalen Faktoren zu berücksichtigen sind. Die Extraktion kann bei Molaren mit einer schlechten Prognose eine wertvolle Alternative zu aufwändigen Restaurationen darstellen. Der Zeitpunkt der Extraktion ist weiterhin essenziell, um einen größtmöglich spontanen Lückenschluss herbeizuführen und die kieferorthopädische Behandlungsdauer gering zu halten. Sofern jedoch keine Indikation für eine Extraktion der Molaren vorliegt, sollten die betroffenen hypomineralisierten Zähne mit den verfügbaren Mitteln solange wie möglich erhalten werden.Das Ziel dieses Artikels ist es eine Übersicht über das Management von MIH-Zähnen unter Berücksichtigung der kinderzahnärztlichen und kieferorthopädischen Expertise zu präsentieren. Die individuelle Entscheidung für oder gegen eine Extraktion wird anhand von zwei Fallbeispielen beleuchten.

During orthodontic treatment, enamel demineralization can occur. Its early detection is the basis for efficient preventive measures to arrest or remineralize lesions. In the present study, the application of a novel blue hemoglobin-based liquid (BlueCheck) was evaluated as proof of concept for detection of artificially demineralized smooth surfaces. 60 samples from extracted human posterior teeth were randomly assigned to four groups (15 per group). In 30 of these samples (groups A and B), superficial enamel was removed to create a ground surface. On the surface of other 30 samples (group C and D), orthodontic metal brackets were bonded. On each surface, BC liquid was applied and rinsed with water after 3 min (baseline). All surfaces were checked by two independent observers for presence of blue areas. On each sample, one side was covered by nail varnish to protect this enamel part from demineralization. The samples were demineralized with lactic acid (pH 4.6) for 7 days (group A and C) and 14 days (group B and D), respectively. Mineral loss was determined using quantitative light-induced fluorescence after demineralization. BlueCheck dye was again applied on the samples and evaluated for presence of stained areas. Histological sections were prepared from randomly selected samples and lesion depth was measured. Kruskal-Wallis test was used for group comparison (α = 0.05). After demineralization, median ΔF value for all samples was −8.25% indicating the presence of an initial demineralization. The difference of ΔF values was not statistically significant between samples at 7 or 14 days of demineralization, nor for samples with and without orthodontic brackets (p = 0.13). At baseline, none of the sample surfaces showed discoloration, whereas a distinctive blue color was visible after demineralization in all samples exposed to acid-exposed areas, corresponding to 100% sensitivity. The internal control surfaces (without demineralization) did not show any staining, corresponding to 100% specificity. Histologically measured lesion depths ranged between 200 and 254 μm. In this in vitro study, staining of demineralized enamel surface areas were shown to be reliable. Based on our results, this easily applicable product seems useful to be an adjuvant method to clinical examination to monitor oral health during an orthodontic treatment on tooth surfaces after removal of dental biofilm.

The Wittenberg physician Konrad Victor Schneider (1614-1680) was the first to prove that mucus is not formed in the brain, nor is it secreted into the nasal cavity via the ethmoid bone. He recognised that there is no open anatomical connection between the brain and the nasal air space. Schneider discovered the sinonasal mucosa as the production site of mucus and thus refuted the hypothesis of cerebral mucus production and secretion by Hippocrates, Galen and Vesal. The nasal mucosa was named "membrana Schneideria" in honour of Schneider.Der Wittenberger Arzt Konrad Victor Schneider (1614–1680) hat als Erster den Nachweis erbracht, dass Schleim nicht im Gehirn gebildet und auch nicht über das Siebbein in die Nasenhöhle sezerniert wird. Er hat erkannt, dass es keine offene anatomische Verbindung zwischen Gehirn und nasalem Luftraum gibt. Schneider hat die sinunasale Schleimhaut als Produktionsstätte des Schleims entdeckt und damit die Hypothese der zerebralen Schleimproduktion und -sekretion von Hippokrates, Galen und Vesal widerlegt. Zu Ehren von Schneider wurde die Schleimhaut „membrana Schneideria“ benannt.

Objective Rapid maxillary expansion (RME) is an established and frequently used procedure to overcome maxillary constriction. In-depth studies about morphological changes of the alveolar process and its immediate surroundings are missing. Therefore, the aim of the present study was to examine the treatment effects of a dentally anchored, rapid maxillary expander at different dentition stages upon palatal width, height and shape. Material and methods The dental casts of 114 patients—taken immediately before and after RME—were three-dimensionally analysed. Depending on the dentition stage, the patients were divided into two groups (each n = 57, group 1, early mixed dentition; group 2, late mixed or permanent dentition). Results The width increases were highly significant, both in the overall and in the individual groups (p p Conclusions Maxillary expansion occurs more parallel in early treatment compared to V-shaped opening in the later treatment approach. Clinical relevance RME is more advantageous in an early dentition.

Objective: To evaluate the effect of a 445-nm diode laser on the shear bond strength (SBS) of metallic brackets before debonding. Background: Due to the new blue laser technology, very few studies ...

The aim of this study was to assess the effects of tooth/bone-borne (hybrid) and tooth-borne (TB) surgically assisted rapid maxillary expansion (SARME) on the width of the nasal soft and hard tissue.Twenty skeletally mature patients (nine males and 11 females; mean age 19.4 years) with transverse maxillary hypoplasia were randomly assigned to hybrid or TB devices. The patients had undergone SARME operations, performed by the same surgical team using the same procedure (Le Fort I osteotomy with pterygomaxillary dysjunction, midline osteotomy, and no down-fracture). Nasal soft- and hard-tissue changes were analyzed using CBCT preoperatively (T0), at the end of the active expansion phase (T1), and after 6 months of retention (T2). The study was approved by the relevant ethics committee.The skeletal and soft-tissue nasal parameters increased significantly in the T0-T1 and T0-T2 periods in both groups (P 0.05). No statistically significant differences between the groups were observed. The mean piriform aperture width increased from 1.26 mm in T0-T1 to 0.97 mm in T1-T2 and 2.17 mm in T0-T2 (P 0.008). In the soft tissue, the alar base width increased to 2.78 mm and the alar width to 2.95 mm in T0-T2 (P = 0.001). There was a positive correlation (63.6%) between the changes in skeletal and soft-tissue values.The hybrid and TB devices led to similarly significant widening effects in nasal soft and hard tissues in both the short term and 6 months after SARME.

Enamel demineralization can occur as a side effect during orthodontic treatment with fixed appliances and should be detected as early as possible. A new approach to assess demineralization is a system consisting of a photosensitive protein that binds to free calcium ions at the enamel surface. A camera is then used to visualize the bioluminescence spots. This in vitro study aimed to evaluate the ability of the bioluminescence technology to assess artificially demineralized enamel adjacent to various orthodontic brackets.In all, 108 human enamel samples were allocated randomly to groups with different orthodontic bracket material: stainless steel, titanium, ceramic. Initial lesions were created adjacent to the brackets. The samples were assessed by bioluminescence before and after demineralization. Images were assessed for presence of bioluminescence spots (yes/no). To quantify the bioluminescence measurements, the images' pixel values (P) were calculated within a defined area (F) adjacent to each bracket before and after demineralization. Quantitative light-induced fluorescence measurements (ΔF, ΔQ) were performed as the reference standard for demineralization.After demineralization, bioluminescence spots were visible (yes/no decision) in 87% of the samples. The pixel analysis of the bioluminescence spots showed significantly higher pixel values after demineralization compared to baseline (p 0.0001). The bracket material had no influence on the bioluminescence measurements. All samples showed fluorescence loss with a median ΔF of -9.52% (±3.15) and a median ΔQ of -1.01% × mmThe bioluminescence technology is a promising tool to demonstrate demineralization adjacent to different orthodontic brackets in vitro.ZIELSETZUNG: Schmelzdemineralisationen können während einer kieferorthopädischer Behandlung mit festsitzenden Apparaturen auftreten und sollten so früh wie möglich erkannt werden. Ein neuer Ansatz ist ein System basierend auf einem lichtsensitiven Protein, das freie Kalziumionen an der Schmelzoberfläche bindet und Biolumineszenzfelder visualisiert. Das Ziel dieser In-vitro-Studie war es, die Eignung der Biolumineszenztechnologie zur Detektion von artifiziell erzeugten Demineralisationen im Schmelz in der Zirkumferenz von verschiedenen kieferorthopädischen Brackets zu untersuchen.Insgesamt 108 humane Zähne wurden randomisiert in Gruppen mit unterschiedlichem kieferorthopädischem Bracketmaterial eingeteilt: Edelstahl, Titan, Keramik. Am Rand der Brackets wurden Initialläsionen erzeugt. Die Proben wurden vor und nach der Demineralisation mittels Biolumineszenz untersucht. Die Bilder wurden auf das Vorhandensein von Biolumineszenzfeldern (ja/nein) bewertet. Zur Quantifizierung der Biolumineszenzmessungen wurden die Pixelwerte (P) der Bilder innerhalb eines definierten Bereichs (F) am Rand der Brackets vor und nach der Demineralisation berechnet. Quantitative lichtinduzierte Fluoreszenzmessungen (ΔF, ΔQ) wurden als Referenzstandard für die Demineralisation herangezogen.Nach der Demineralisation waren bei 87 % der Proben Biolumineszenzfelder sichtbar (Ja/nein-Entscheidung). Die Analyse der Biolumineszenzfelder zeigte signifikant höhere Pixelwerte nach der Demineralisation im Vergleich zu den Werten vor der Demineralisation (p 0,0001). Das Bracketmaterial hatte keinen Einfluss auf die Biolumineszenzmessungen. Alle Proben zeigten einen Fluoreszenzverlust mit einem ΔF-Medianwert von −9,52 % (± 3,15) sowie einem ΔQ-Medianwert von −1,01 % × mmDie Biolumineszenztechnologie hat sich in vitro als ein vielversprechendes Verfahren zur Visualisierung von Demineralisationen in der Bracketzirkumferenz erwiesen.

The objective of this split-mouth trial was to investigate the influence of photobiomodulation therapy (PBMT) on adjuvant treatment of gingivitis induced by multi-bracket appliances, after bracket debonding and professional tooth cleaning.Thirteen patients (mean age 16.15 years; standard deviation ±2.12 years) who had completed active orthodontic treatment with fixed orthodontic appliances in an orthodontic clinic were included on a randomized basis. At time point T0, after bracket debonding and professional tooth cleaning, the papilla bleeding index (PBI) and bleeding on probing (BOP) were assessed in the upper jaw by the blinded investigator (M.S.), who was not aware at any time of which quadrant received PBMT. The study was based on a patient-blinded split-mouth design. In each patient, PBMT was administered by a practitioner (S.S.) in one upper quadrant (wavelength: 660 nm; Power: 100 mW; Power density: 100 mW/cmNo statistical differences were observed between the sides with regard to PBI and BOP values at T0 (p 0.05). The PBI and BOP values decreased significantly between T0 and T1 on both sides (p 0.05). At T1, the PBI and BOP values were significantly lower in the laser side in comparison with the control side (p 0.05).On the basis of these results and study parameters, adjuvant PBMT is able to accelerate the healing process in patients with gingivitis induced by multi-bracket appliances.

Craniofacial sutures are important growth sites for skull development and are sensitive to mechanical stress. In order to determine the role of bone resorption in stress-mediated sutural bone growth, midpalatal suture expansion was performed in mice receiving alendronate, an anti-resorptive bisphosphonate. The midpalatal sutures of 8-week-old C57BL/6 mice were expanded by orthodontic wires over the period of 2 weeks. Mice with maxillary expansion without drug treatment as well as untreated animals served as controls. Skulls were analyzed with micro-computed tomography (micro-CT), immunohistochemistry and histology. Maxillary expansion in mice without drug treatment resulted in an increase of TRAP-positive osteoclasts. In contrast, no increase in osteoclasts was observed in expanded sutures of mice with bisphosphonate treatment. Double calcein labeling demonstrated rapid bone formation on the oral edges of the expanded sutures in mice without bisphosphonate treatment. Less bone formation was observed in bisphosphonate-treated mice after expansion. Histology revealed that the sutural architecture was reestablished in expanded sutures of mice without bisphosphonate treatment. In contrast, the sutural architecture was disorganized and the cartilage had an irregular form, following expansion in bisphosphonate-treated mice. Finally, micro-CT imaging demonstrated that the total amount of maxillary expansion was significantly lower in mice with bisphosphonate treatment as compared to those of mice without drug treatment. In conclusion, our results indicate that osteoclast-mediated bone resorption is needed for maxillary suture expansion and reorganization of sutural architecture. Orthodontic palatal expansion can be complicated in patients with inherited or drug-induced diseases of osteoclast dysfunction.

Objective: The aim of this study was to measure the effect of irradiation with a novel 445-nm diode laser on the shear bond strength (SBS) of ceramic brackets before debonding. Materials and methods: Thirty ceramic brackets (In-Ovation® C, GAC) were bonded in standard manner to the planed and polished buccal enamel surfaces of 30 caries-free human third molars. Each tooth was randomly allocated to the laser or control group, with 15 samples per group. The brackets in the laser group were irradiated with the diode laser (SIROLaser Blue®; Sirona) on three sides of the bracket bases for 5 sec each (lateral–coronal–lateral, a total of 15 sec) immediately before debonding. SBS values were measured for the laser group and control group. To assess the adhesive remnant index (ARI) and the degree of enamel fractures, micrographs of the enamel surface were taken with 10-fold magnification after debonding. Results: The SBS values were significantly lower statistically in the laser group in comparison with t...

During orthodontic treatment with fixed appliances, demineralization around brackets often occurs. The aim of this in vitro study was to investigate the effect of the caries-protective self-assembling peptide P11‑4 (SAP P11-4) on the shear bond strength of metal brackets.In all, 45 extracted human wisdom teeth were available for the study. The teeth were randomly divided into 3 groups (each n = 15) and pretreated as follows: test group 1: application of SAP P11‑4 (Curodont Repair, Windisch, Switzerland) and storage for 24 h in artificial saliva; test group 2: application of SAP P11‑4; control group: no pretreatment with SAP P11‑4. A conventional metal maxillary incisor bracket (Discovery, Dentaurum, Ispringen) was adhesively bonded to each buccal surface. The shear bond strength was tested according to DIN 13990. After shearing, the Adhesive Remnant Index (ARI) was determined microscopically (10 × magnification). Analysis of variance (ANOVA) was used to check the groups for significant differences (α = 0.05). The distribution of the ARI scores was determined with the χThere was no significant difference in shear forces between the groups (p = 0.121): test group 1 = 17.0 ± 4.51 MPa, test group 2 = 14.01 ± 2.51 MPa, control group 15.54 ± 4.34 MPa. The distribution of the ARI scores between the groups did not vary (p-values = 0.052-0.819).The application of the caries protective SAP P11‑4 before bonding of brackets did not affect the shear bond strength. Therefore, pretreatment of the enamel surface with SAP P11‑4 shortly before bracket insertion can be considered.ZIEL: Während einer kieferorthopädischen Behandlung mit festsitzenden Apparaturen können in der Bracketzirkumferenz Demineralisationen entstehen. Im Rahmen dieser In-vitro-Studie sollte der Einfluss des kariesprotektiven Peptids P11‑4 auf das Haftverhalten zwischen Metallbrackets und Zahnoberfläche untersucht werden.Fünfundvierzig extrahierte humane Weisheitszähne standen für die Studie zur Verfügung. Die Zähne wurden randomisiert auf 3 Gruppen verteilt (je n = 15) und unterschiedlich vorbehandelt: Testgruppe 1: Applikation von P11‑4 (Curodont Repair, Windisch, Schweiz) und Lagerung für 24 h in künstlichem Speichel; Testgruppe 2: Applikation von P11‑4; C = Kontrollgruppe: keine Vorbehandlung. Auf jede Bukkalfläche wurde ein konventionelles, metallisches Twinbracket (Discovery, Dentaurum, Ispringen) adhäsiv befestigt. Die Scherhaftfestigkeit wurde nach DIN 13990 mit einer Universalprüfmaschine untersucht. Nach dem Abscheren wurde der ARI (Adhesive Remnant Index) mikroskopisch bestimmt (Vergr. 10:1). Mittels ANOVA (Analysis of Variance) wurden die Gruppen auf signifikante Unterschiede überprüft (α = 0,05). Die Verteilung der ARI-Scores wurde mit dem χEs bestand kein statistisch signifikanter Unterschied in Bezug auf den Haftverbund zwischen den Untersuchungsgruppen (p = 0,121): Testgruppe 1 = 17,0 MPa (Standardabweichung [SD] 4,51), Testgruppe 2 = 14,01 MPa (SD 2,51), Kontrollgruppe 15,54 MPa (SD 4,34). Die Verteilung der ARI-Scores zwischen den Gruppen war statistisch nicht signifikant unterschiedlich (p-Werte 0,052–0,819).Die Anwendung des kariesprotektiven Peptids P11‑4 vor der regulären Schmelzätztechnik zeigte weder sofort nach der Applikation noch nach 24 h Lagerung in künstlichem Speichel einen signifikanten Einfluss auf den Haftverbund von Brackets. Somit kann eine Vorbehandlung der Schmelzoberfläche mit P11‑4 unmittelbar vor Bracketinsertion in Betracht gezogen werden.

Purpose Enamel demineralization can occur as a side effect during orthodontic treatment with fixed appliances. This study aimed to evaluate the efficacy of the self-assembling peptide P11-4 for remineralization combined with fluorides, compared to application of fluoride varnish alone. De- and remineralization was assessed using a novel bioluminescence technology measuring free calcium ions in initial lesions. Methods Orthodontic brackets were bonded on human enamel samples and white spot lesions were created. 117 samples were allocated randomly into 3 groups: Group I = no treatment, group II = single application of fluoride varnish (22,600 ppm), group III = treatment with P11-4 following a single application of fluoride varnish. Bioluminescence and Quantitative light-induced fluorescence (QLF) measurements were performed at baseline, after demineralization and after storage in artificial saliva for 7, 30 and 90 days. Results After demineralization, all areas showed loss of fluorescence (median F -9.44 %). The median F differed significantly between all groups at all investigation times (p < 0.000001). The proportion of samples without luminescence spots were 25.0 % in group I, 21.4 % in group II and 30.8 % in group III after 90 days. Conclusions Application of P11-4 combined with fluoride varnish was superior to the use of fluorides alone for remineralization of enamel adjacent to brackets. The bioluminescence system was shown to be a promising tool for digital demonstration of de- and remineralization.

To evaluate the progression of demineralization during orthodontic treatment, the assessment of lesion activity is important in addition to the detection of lesion extent. This study aimed to evaluate the ability of laser fluorescence measurements to differentiate between active and inactive initial lesions in vitro. In all, 63 extracted, permanent human teeth were available for the study. On each occlusal investigation site, surface extent and activity of caries lesions were classified visually using ICDAS/ICCMS (International Caries Detection and Assessment System/International Caries Classification and Management System) criteria, following laser fluorescence measurements. Teeth were hemisected and assessed for lesion depth. Methyl red dye was applied to validate lesion activity on the sections. A Mann–Whitney U-test was performed to evaluate differences between laser fluorescence measurements for active and inactive lesions. For visual and laser fluorescence findings, diagnostic accuracy (Az, sensitivity and specificity) were calculated. A total of 19 sound surfaces and 44 surfaces with ICDAS codes 1/2 were classified visually. The differences in laser fluorescence measurements between active and inactive lesions were not significant for the initial lesions (p > 0.05). Sensitivity/specificity for lesion depth was 90.5/92.3% (Az = 0.894), respectively, for visual assessment and 69.1/76.9% (Az = 0.745), respectively, for laser fluorescence. Sensitivity/specificity for activity assessment was 68.6/85.0% (Az = 0.768) for the visual method. For laser fluorescence measurements, no diagnostic accuracy values could be calculated for caries activity assessment. The visual detection and activity assessment of initial lesions was more suitable than the laser fluorescence method. Based on the results of this in vitro study, use of laser fluorescence cannot be recommended for distinguishing between active and inactive initial caries lesions on occlusal surfaces.

A Correction to this paper has been published: 10.1007/s00056-020-00247-1

Objectives: This study determined the influence of irradiation on aesthetic ceramic brackets with a novel 445-nm diode laser prior to debonding on the bracket failure mode. Materials and methods: Thirty ceramic brackets (In-Ovation® C, GAC) were standard-bonded to the oral and buccal planed and polished enamel surfaces of 15 caries-free human 3rd molars. Prior to study-blinded debonding, the brackets in the laser group were irradiated with the diode laser (SIROLaser Blue®, Sirona), while the irradiation was simulated within the conventional group. To determine the degree of enamel fractures and the adhesive remnant index (ARI) before debonding (T0), after debonding (T1) and after removal of the remaining composite using a rotating fraise (red ring, Comet) (T2), micrographs of the enamel surface at 10-fold and 20-fold magnifications were taken. Additionally, the enamel surface was investigated using seven randomly chosen samples from each group at every time point by SEM at 200-fold and 500-fold magnifications. Results: In the laser group, the ARI-score was statistically significantly reduced (p Conclusion: Irradiation with the novel diode laser prior to debonding of ceramic brackets significantly changes bonding failure in terms of less remaining adhesive. This is of clinical importance as the risk of enamel fractures and chair time can be reduced.

Eine kieferorthopadische (KFO-)Therapie beim erwachsenen Patienten ist mittlerweile keine Ausnahme mehr, sondern klinischer Alltag. Innerhalb der letzten zehn Jahre hat dieser Behandlungsansatz in der Kieferorthopadie wie kein anderer an Bedeutung gewonnen. Auch, wenn viele Patienten eine KFO-Therapie im Erwachsenenalter zur Optimierung der dentofazialen Asthetik wunschen, sind die Hauptziele dieses Ansatzes in der parodontalen Regeneration, der okklusalen Harmonisierung sowie der Pravention und der Prognoseverbesserung der verbleibenden Dentition zu sehen. Aufgrund altersinvolutiver Veranderungen ist nach einer KFO-Intervention die lebenslange biologische und mechanische Retention indiziert. Der synoptisch integrative Therapieansatz eines umfassenden interdisziplinaren KFO-Versorgungskonzeptes mit Schnittstellen zu Parodontologie, Prothetik, Chirurgie und konservierender Zahnheilkunde stellt damit eine Conditio sine qua non dar.

Background The aim of this study was to use three-dimensional datasets to identify associations between treatment for adult crowding, using Invisalign aligner and interproximal enamel reduction (IER), and changes in the volume of interradicular bone. Methods A total of 60 cone-beam computed tomography (CBCT) scans from 30 adult patients (28 women, two men; 30 CBCTs pre-treatment, 30 post-treatment) were examined retrospectively in order to measure bone volume three-dimensionally. The patients’ average age was 36.03 ± 9.7 years. The interradicular bone volume was measured with OsiriX at four levels in the anterior tooth areas of the maxilla and mandible. Differences in bone between T0 and T1 were analyzed with IBM SPSS 21.0 using the Wilcoxon test for paired samples. Results Overall, a slight increase in the quantity of bone was found (0.12 ± 0.73 mm). There was a highly significant increase in bone in the mandible (0.40 ± 0.62 mm; P

This study investigated temperature increases in dental pulp resulting from laser-assisted debonding of ceramic brackets using a 445-nm diode laser.Eighteen ceramic brackets were bonded in standardized manner to 18 caries-free human third molars. Pulpal fluid circulation was simulated by pumping distilled water at 37°C through the pulp chamber. The brackets were irradiated with a 445-nm diode laser. Temperatures were measured using a thermal camera at points P1 (center of the pulp) and P2 (in the hard dental tissue) at the baseline (T0), at the start and end of laser application (T1 and T2), and the maximum during the sequence (TSignificant differences in the temperatures measured at P1 and P2 were observed among T0, T1, T2, and TOn the basis of the laser settings used, there is no risk to the vitality of dental pulp during laser-assisted debonding of ceramic brackets with a 445-nm diode laser.

Der Uberwachung des Zahnwechsels bei Kindern kommt erhebliche praventive Bedeutung zu. Dafur ist es notwendig, den regelrechten Zahnwechsel zu kennen. Unterschieden werden drei Phasen der postnatalen Entwicklung: Milchgebiss, fruhes und spates Wechselgebiss sowie das permanente Gebiss. Im Beitrag werden die physiologischen Veranderungen wahrend der unterschiedlichen Entwicklungsstadien beleuchtet sowie Informationen gegeben uber notwendige Masnahmen zur Vermeidung von Komplikationen beim Zahnwechsel.

Introduction The aim of this study was to analyze the time-dependent in-vitro behavior of the periodontal ligament (PDL) by determining the material parameters using specimens of porcine jawbone. Time-dependent material parameters to be determined were expected to complement the results from earlier biomechanical studies. Methods Five mandibular deciduous porcine premolars were analyzed in a combined experimental-numeric study. After selecting suitable specimens (excluding root resorption) and preparing the measurement system, the specimens were deflected by a distance of 0.2 mm at loading times of 0.2, 0.5, 1, 2, 5, 10, and 60 seconds. The deflection of the teeth was determined via a laser optical system, and the resulting forces and torques were measured. To create the finite element models, a microcomputed tomography scanner was used to create 3-dimensional x-ray images of the samples. The individual structures (tooth, PDL, bone) of the jaw segments were reconstructed using a self-developed reconstruction program. A comparison between experiment and simulation was conducted using the results from finite element simulations. Via iterative parameter adjustments, the material parameters (Young's modulus and Poisson's ratio) of the PDL were assessed at different loading velocities. Results The clinically observed effect of a distinct increase in force during very short periods of loading was confirmed. Thus, a force of 2.6 N (±1.5 N) was measured at the shortest stress duration of 0.2 seconds, and a force of 1.0 N (±0.5 N) was measured at the longest stress duration of 60 seconds. The numeric determination of the material parameters showed bilinear behavior with a median value of the first Young's modulus between 0.06 MPa (2 seconds) and 0.04 MPa (60 seconds), and the second Young's modulus between 0.30 MPa (10 seconds) and 0.20 MPa (60 seconds). The ultimate strain marking the transition from the first to the second Young's modulus remained almost unchanged with a median value of 6.0% for all loading times. Conclusion A combined experimental-numeric analysis is suitable for determining the material properties of the PDL. Microcomputed tomography allows high-precision recordings with only minimum effort. This study confirms the assumption of time dependency and nonlinearity of previous studies.

Objective.The aim of this in vitro study was to determine the shear bond strength (SBS) and adhesive remnant index (ARI) score of two self-etching no-mix adhesives (iBond™and Scotchbond™) on different prosthetic surfaces and enamel, in comparison with the commonly used total etch system Transbond XT™.Materials and Methods. A total of 270 surfaces (1 enamel and 8 restorative surfaces,n=30) were randomly divided into three adhesive groups. In group 1 (control) brackets were bonded with Transbond XT primer. In the experimental groups iBond adhesive (group 2) and Scotchbond Universal adhesive (group 3) were used. The SBS was measured using a Zwicki 1120™testing machine. The ARI and SBS were compared statistically using the Kruskal–Wallis test (P≤0.05).Results. Significant differences in SBS and ARI were found between the control group and experimental groups.Conclusions. Transbond XT showed the highest SBS on human enamel. Scotchbond Universal on average provides the best bonding on all other types of surface (metal, composite, and porcelain), with no need for additional primers. It might therefore be helpful for simplifying bonding in orthodontic procedures on restorative materials in patients. If metal brackets have to be bonded to a metal surface, the use of a dual-curing resin is recommended.

The success of rapid maxillary expansion is hard to predict in patients from the age of 20. There are as yet no reliable parameters enabling us to define success or failure a priori. The aim of this study was thus to use micro-CT techniques to quantify suture morphology three-dimensionally, and investigate its relation to age. The morphology of the midpalatal suture was evaluated by documenting 28 human-palate specimens from individuals aged 14–71 using computed tomography. The software AMIRA 3.00 was used for 3D (three-dimensional) reconstruction of the datasets. Sutural morphology was quantified and examined for age-dependent morphological characteristics with the software Image Tool 3.00. To that end, the specimens were assigned to three age groups (< 25 years, 25 years to < 30 years, ≥ 30 years) and the following parameters were considered: obliteration index in the frontal plane, and suture length, linear sutural distance, and interdigitation index in the horizontal plane, as well as bone density (BV/TV [%]) in the sagittal plane. Significant differences between age groups were only found for bone density in sagittal dimension. The middle-aged group exhibited the highest bone density (53.2%). In comparison to that group, bone density was significantly lower in the youngest and the oldest age groups. The mean obliteration index exhibited substantial inter-individual variation, was generally low, and did not correlate with chronological age. The extent of interdigitation was independent of age. The necessity for surgical weakening can neither be explained by sutural interdigitation increasing with age nor by a higher obliteration index. Sutural bone density (hence the fracture resistance increasing with age) seems to be the parameter limiting conservative RME.

There is a growing market of biomaterials for orthopedic applications. As soon as these materials are surgically introduced into the constantly remodeling bone of the patient, they start to interact with the local cells: osteoblasts and osteoclasts. At the first glance, the bone building osteoblasts seem to be the more important cells for osseointegration of implants. However, it is mainly the bone resorbing action of osteclasts that determines the longevity of the implant. In this paper, we give a short overview over the current understanding of osteoclast biology; we review the interaction between biomaterials, biomaterial particles and osteoclasts, and the effects of treatment with antiosteoclastic agents like bisphosphonates on biomaterial implant healing.

Rapid maxillary expansion (RME) is a therapeutic orthodontic option with a long history, and there are many reports in the literature reporting widely divergent results concerning the appliance efficacy and many different treatment protocols. We aimed to evaluate the treatment protocols and clinical experiences with RME via a national inquiry of orthodontists to identify the status quo of RME in clinical daily routine. Within the framework of an anonymous questionnaire, 2003 orthodontists and members of the German Orthodontic Society (DGKFO) were asked to report on their clinical experiences with RME. The standardized questionnaire covered clinical indications, dentition period at the time of insertion, mode of activation, retention time, observed side effects, and the reasons for requiring surgical assistance. The data from 487 questionnaires could be evaluated. The only indication for RME named by a large majority of responders was transversal maxillary deficiency. The average extent of the transversal deficiency amounted to 5.29 ± 2.25 mm (median 5 mm). Most orthodontists (87.7%) employed RME in the permanent dentition of adolescents; it was significantly less frequently applied in the primary dentition or adults. Answers regarding the mode of activation varied greatly. The most frequent mode of activation was “1–2 activations a day” independent of the dentition period. 64.5% of the orthodontists reported buccal tipping of the anchorage teeth. No correlation was detected between mode of activation, time of insertion and observed side effects. 60% of the orthodontists reported a retention period of between 3 and 6 months (median 4.5 months). With an average age of 19.28 years, 79.3% assessed chronological age as a limiting factor for conventional RME. It was not possible to identify a homogeneous diagnostic procedure for the indication of surgical assistance. Although RME has a long clinical history, no standardized treatment protocols exist. Randomized clinical trials are necessary to make clear-cut clinical recommendations on the use of RME, as required by the tenets of evidence-based medicine and quality assurance.

Proteus syndrome is a rare condition that involves atypical growth of the bones, skin and head and a variety of other symptoms. Only a few authors have reported on the craniofacial manifestations so far. The authors present a case of a 7-year-old girl with Proteus syndrome in which the facial skeleton showed unilateral overgrowth. The analysis of the radiological evaluation revealed a bialveolar prognathism, a skeletal class III, a dolicocephalic growth pattern and a left convex face scoliosis. On the left side, the lesser wing of the sphenoid was elevated and the ethmoidal cell complex was hypertrophic. The left ramus and body of the mandible were enlarged. The asymmetric dental development with a precocious dental age on the affected side was the most striking feature on the panoramic view. Early diagnosis and therapy depend on clinical evaluation and imaging. Therefore, further evaluations on the craniofacial features of patients with Proteus syndrome are necessary in order to establish a list of characteristic symptoms.

This prospective study was designed to evaluate a new concept of myofunctional therapy in comparison with conventional myofunctional therapy. 45 children aged three to sixteen years in need of myofunctional therapy were randomly divided into two groups: 19 children were referred to myofunctional therapy in private practices in Hamburg and served as controls. The remaining 26 children were treated with face former therapy at the Department of Orthodontics by a medical assistant specializing in myofunctional therapy. The overall observation time was six months. Every three months an overall clinical assessment was performed at the Department of Orthodontics by a speech pathologist and an orthodontist, who documented the clinical situation. The clinical examination included measurement of lip strength, palatography to document the swallowing pattern, logopedic diagnosis, and an orthodontic examination with reference to a standardized diagnostic sheet. In all children’s orofacial function could be improved. Children treated with the Face Former showed a statistically significantly improvement in palatal tongue position during swallowing. They achieved stronger lip pressure within a shorter time than children who did not use the Face Former. However, at the end of the observation time there was no statistically significant difference in lip strength between the two groups. Habitual mouth closure was also achieved within a shorter time for children treated with the FaceFormer than children with myofunctional therapy. Face Former therapy seems to offer a good alternative to conventional myofunctional therapy. Longitudinal studies will follow to judge whether the established orofacial balance could be stabilized, i.e. the established physiological orofacial function becomes automatic.

From anatomic and functional aspects the stomatognathic system and the upper cervical spine are closely interlinked. Together with complex neuromuscular relationships, this gives rise to an important field of cooperation between orthodontics and orthopedics. The literature appeals for close interdisciplinary cooperation for patients with syndromes and for those with torticollis and scoliosis. Since orthopedic points of contact are obvious in these special cases, orthopedic aspects are now being taken increasingly into account in farther-reaching studies. With the rising popularity of manual medicine, these aspects are being recognized from the orthopedic point of view too in terms of functional correlations and are being increasingly debated at international congresses and in the literature. Although relevant publications were initially confined to studies of moderate scientific interest or case reports, potential correlations have undergone scientific investigation in recent interdisciplinary studies. Despite the many clinical studies, no unequivocal recommendation can be given for basic conditions under which an orthopedist is bound to be consulted on patients with orthodontic findings. This literature review is aimed at providing an introduction to this still hotly debated issue.

Orofacial regulation therapy for children with Down’s syndrome was introduced to Europe in Munich in 1978. Since then, many clinical studies have provided scientific evidence that this therapeutic approach enhances the orofacial function and facial appearance of children with trisomy 21. Only few long-term results have been published to date. In the present study, 20 children with trisomy 21 were examined more than 12 years after starting treatment in infancy with a Castillo Morales stimulating plate. The follow-up examination showed that the improved orofacial appearance resulting from the early treatment had remained stable in most cases. Although the mechanical stimulus of the stimulating plate was absent during the follow-up period, some patients revealed a lip and tongue posture superior to that recorded at baseline. According to the results of the present study, the orofacial status in early childhood is decisive for the subsequent development of the orofacial region and the long-term stability of the achieved improvements: Children with a pronounced orofacial dysfunction showed a greater stimulation-plate-induced improvement than those with initially moderate orofacial findings. This observation was confirmed by the findings of the 12-year follow-up: Children with Down’s syndrome and initially slight orofacial impairment displayed only slight improvements or unchanged findings.

Background The objective of this study was to determine whether the addition of microsilver or nanosilver particles to an orthodontic primer affects shear bond strength (SBS) and bracket/adhesive failure. Methods Bovine incisors were randomly divided into six groups with 16 specimens in each: In group 1 (control), brackets were bonded with Transbond™ XT primer. In the experimental groups, microsilver (groups 2 and 3) and nanosilver (groups 4–6) particles of different sizes were added to Transbond XT primer and light cured for 15 seconds [group 2: 0.1% (w/w) microsilver particle size 3.5–18 μm; group 3: 0.3% (w/w) microsilver particle size 3.5–18 μm; group 4: 0.11% (w/w) nanosilver particle size 12.6–18.5 nm; group 5: 0.18% (w/w) nanosilver particle size 12.6–18.5 nm; group 6: 0.33% (w/w) nanosilver particle size 12.6–18.5 nm]. Thereafter, brackets were bonded by light curing the adhesive for 20 seconds. After 24 hours of storage in distilled water at 37°C, SBS was measured with a Zwicki 1120 testing machine. The adhesive remnant index and the prevalence of silver spots on the specimen surface were determined under 10× magnification. Statistical two-way analysis of variance was performed to compare SBS, and a chi-square test was used to compare ARI scores and the prevalence of silver spots. Results No significant differences in SBS (control: 16.59 ± 6.82 MPa; group 2: 20.6 ± 4.19 MPa; group 3: 16.98 ± 4.84 MPa; group 4: 17.15 ± 5.92 MPa; group 5: 20.09 ± 3.35 MPa; group 6: 16.44 ± 4.51 MPa; p > 0.665) and ARI scores (p = 0.901) were found between the control group and any experimental group. Only experimental groups with nanosilver particles revealed statistically more silver spots on the remaining adhesive. Conclusions Addition of small concentrations of microsilver or nanosilver particles affects neither SBS nor ARI scores. Addition of nanosilver particles results in silver spots in the remaining primer visible under 10× magnification. Further studies are needed to investigate the anti-caries potential and clinical performance of conventional orthodontic primer with incorporated nanosilver or microsilver particles.

Permanent retention is currently the method of choice to stabilize orthodontic treatment results. Frequently, permanent retention schemes are adopted to prevent posttreatment changes in the esthetic zone of the anterior teeth. With increasingly prolonged times of intraoral device use, and retention to be provided in the maxilla despite limited space, the demands placed on well-planned and precise retainer positioning are becoming more exacting. The aim of the present study was to analyze the intraoral precision of lingual retainers made using computer-aided design and machining (CAD/CAM).A custom manufacturer (Retaintechnology; Cologne, Germany) employing innovative CAD/CAM technology was commissioned to fabricate 16 lingual retainers. Following intraoral insertion using the manufacturer's recommended transfer system, impressions of the intraoral situations were taken and scanned for digitization. On this basis, the intraoral retainer positions were compared to the preceding virtual setups by superimposition with the manufacturer's datasets. Three-dimensional processing software (Geomagic Qualify 2012; Geomagic) was used to analyze the retainers, based on a total of 80 interproximal sites, for deviations from their planned positions along the horizontal (x-), sagittal (y-), and vertical (z-) axes. These deviations of the achieved from the intended positions were considered clinically relevant if ≥ 0.5 mm and, based on this premise, were subjected to a t-test with statistical software (Prism; GraphPad).The intraoral retainer positions were found to correlate closely with the preceding virtual setups (i.e., the positions as they had been planned by the custom manufacturer). Positional deviations were significantly less than 0.5 mm. They were very small in the horizontal and sagittal planes and moderately larger in the vertical plane.Highly precise intraoral results may be achieved by transferring three-dimensional virtual setups for lingual retainers to the actual patients. This CAD/CAM strategy of making retainers can offer high predictability even in anatomically demanding regions and in the presence of limited space.

Objectives: To analyse if Hybrid-RME has different effects on skeletal, dental and periodontal aspects when compared with those of Hyrax-RME or Hyrax-SARME. Methods: In this retrospective multicentre-study 28 patients with a severe nasomaxillary constriction were treated either with a Hyrax-type RME (6 patients, 13.92 ± 0.36 years), with a Hybrid-RME (7 patients, 17.20 ± 2.80 years) or with a surgical assisted Hyrax-SARME (15 patients, 30.58 ± 9.26). This study was performed in analogy to the method published by Garib, et al. using the freeware OsiriX 4.0. All measurements were performed twice with an interval of two weeks and the calculated mean value of both measurements was used for statistical evaluation, which was performed using SPSS 21 for Mac. Results: The age differences between all groups were significant (p

Xenon plasma arc lights were introduced recently for light-cured orthodontic bonding. Compared with a conventional tungsten-quartz-halogen light source, these high-intensity lights promise a dramatic reduction in curing time. The purpose of this in vitro investigation was to evaluate bond strength with 2 commercially available plasma arc lights and reduced curing intervals. Brackets were bonded to 150 extracted human teeth (75 premolars, 75 incisors) with a composite adhesive. Intervals of 2 and 6 seconds were used for curing with the plasma arc lights; a control group was bonded with a halogen light source and 20 seconds of light exposure per bracket. Bond strength testing was performed with a universal testing machine. A substantial reduction in curing time was possible with both plasma arc units. Significantly lower bond strength values were found for premolar brackets bonded with plasma arc curing lights and the shortest curing interval of 2 seconds compared with the longer curing time of 6 seconds or the standard curing time with the halogen light. Although 2 seconds of curing might be adequate to achieve acceptable bond strength values for the incisors, the Weibull analysis indicated a higher probability of bond failure for premolar brackets in particular. Six seconds of curing time is recommended for bonding stainless steel brackets with xenon plasma arc light sources.

Conventional dental-borne rapid maxillary expansion (RME) leads to a widening of the airways, followed by improved nasal breathing. Although combined skeletal-dental appliances are nowadays being inserted increasingly often and provide a force at the center of resistance in the nasomaxillary complex, no study exists so far that shows whether this treatment may improve the expansionary effect on the airways. In this study, low-dose computed tomography (CT) images from 31 patients (average age 14.63 ± 0.38 years) were examined retrospectively. Both records (T0 = before expansion and T1 = immediately after maximum expansion) were taken in a time interval of 25 days to avoid growth influence. Five patients were treated with Hyrax RME, 6 patients with Hybrid RME, and 20 patients with acrylic cap RME. The total airway volume increased highly significantly (mean +7272.6 mm(3); P0.001, power = 0.998), representing an average airway expansion of +11.54 % (2.35 %/mm activation). While the nasopharynx and oropharynx showed highly significant expansion (P0.000, power = 0.999), the airway at the laryngopharynx did not change significantly (P0.779, power = 0.05). Although the patients were significantly older in the Hybrid RME group (P = 0.006), the positive rhinological effects were comparable within all groups of different appliances (P0.316). Hybrid RME may, therefore, be an advisable procedure in patients with nasomaxillary impairment and pronounced patient's age.

Introduction Rapid maxillary expansion (RME) is a common technique to improve the dental and skeletal transverse width in cases of constricted maxillary arches. Although retention after RME has been widely examined, there is still no clear statement about the minimal retention time in postpubertal patients and many practitioners have retention concepts varying between three and six months. Methods This retrospective study consisted of 14 patients who were either treated with a Haas-type RME (6 patients) or a Hybrid-RME (8 patients). The average age was 15.8 years (min. 13.5 years, max. 23.0 years). Low-dose CT scans were taken initially before placement of the RME (T0), directly after maximal activation (T1) and (in six cases) also in retention after 6 months (T2). Using a 3D-software (“OnDemand3D”/Cybermed Inc.) in analogy to the method published by Franchi et al. (AJODO Volume 137/ Number 4) all values were measured twice at an interval of 1 month to assess the method error and the intraoperator reliability. Statistical analysis was performed using SPSS 21 for Mac. Possible influences of the RME-type were assessed using the univariate ANOVA. Changes in the sutural density between the different points of time were examined using paired t-tests. Results The density of the suture decreased significantly after expansion (T0-T1) with both types of RME (p = 0.000). In the retention period there was a significant increase of the sutural density (p = 0.007) although it did not achieve the initial level (p = 0.002). Conclusions 1. The midpalatal suture was opened in all analysed patients. 2. In postpubertal patients a retention time of six months does not allow sufficient reorganization of the suture. 3. Therefore, a retention period longer than six months seems to be beneficial to prevent relapses in postpubertal patients.

The aim of this in vitro study was to investigate the demineralization rate in human enamel after interproximal polishing (IPP) and to detect possible correlations with the IPP method used, with special emphasis on the surface characteristics of the enamel being treated. This in vitro study tested five IPP systems (Profin Directional System®, Intensiv ProxoStrip®, OS discs®, ARS Safe-Tipped Bur Kit® and Ortho-Strips Set®) that are currently available on the market. Each of the five examination groups comprised 12 randomly selected teeth, while the control group consisted of six teeth. The teeth were placed in an artificial model for each group. The proximal contacts were then resolved by IPP. To allow detection of any surface characteristics, one surface was not further processed after IPP, while the other side was additionally polished. After IPP, the teeth were exposed to a pH-cycling model with alternating phases of demineralization and remineralization. Substance loss was analyzed using optical emission spectrometry. Data were subjected to simple analysis of variance (ANOVA) performed with Tukey’s test. Comparison between the groups with and without polishing was conducted using the t test for independent samples. The significance level was set at p

Background: The quality of interdisciplinary cooperation is one of the most important factors in the success and long-term stability of treatment of patients suffering from orofacial dysfunctions. However, speech pathologists have criticized the poor communication and diagnosis at the time of referral and have requested a standardized diagnostic referral sheet with the aim of improving interdisciplinary cooperation. Diagnostic Referral Sheet: The diagnostic referral sheet presented here is based on the demands of speech pathologists focusing on myofunctional therapy and helps in initial assessment of the individual situation and necessary treatment. It is subject to continuous updating and coordinates the many medical disciplines involved on account of the complex pathology. Conclusion: The multidisciplinary diagnostic referral sheet, which is independent of treatment methods and compressed into one page, is aimed at contributing to quality assurance and to the improved documentation of orofacial dysfunctions.

Since its introduction in dental radiology in 1998, cone-beam computed tomography (CBCT) has found increasing acceptance in clinical routine. The aim of this study was thus to evaluate this imaging modality from an orthodontic point of view. Two systems formed the basis of this investigation: the NewTom 9000 (NewTom Germany AG, Marburg, Germany), in use at the University Medical Center Hamburg-Eppendorf since October 2002, and the mobile Arcadis Orbic 3D system (Siemens Medical Solutions, Erlangen, Germany), which was introduced in February 2005. Two independent examiners evaluated a total of 68 NewTom and 15 Arcadis Orbic 3D images involving orthodontic indications. The images were categorized according to their indications and diagnostic value assessed according to a predefined and quantifiable protocol. Information obtained from the CBCT was also compared to that gleaned from conventional radiographs. The indication for the NewTom images in cleft patients as well as for all Arcadis Orbic 3D images was considered justified. The osseous morphology of the cleft and position of osteosynthetic screws and plates were particularly well visualized. CBCT implementation in cases of tooth impaction or for assessing third molars was considered justified, although its value was judged differently by the two examiners. CBCT did not provide more information than conventional imaging regarding cartilaginous joint structures. In complex orthodontic cases in which 3D imaging is mandatory, CBCT is the method of choice. Furthermore, in cleft patients and those undergoing combined orthodontic and maxillofacial therapy, CBCT proved advantageous, providing more information than conventional images.

The aim of this investigation was to evaluate the long-term orofacial development of Down children who received plate therapy according to Castillo Morales in their early childhood. The orofacial development of 27 Down children was documented before and after plate therapy and at a follow-up examination 13 years ± 6 months after initiation of therapy. The orofacial appearance significantly improved during therapy (p=0.00). During the follow-up, mouth posture remained stable (p=0.259), whereas tongue position further improved (p=0.034). A better long-term development was documented in children with initial severe orofacial dysfunctions.

SUMMARY The enhanced risk of dental caries is one negative side-effect of fi xed appliances. A new antimicrobial and fl uoride-releasing self-etching bonding system (Clearfi l Protect Bond ™ ) has been introduced in restorative dentistry and clinical studies have already shown the potential for this primer to be used clinically with effective antiplaque properties. Therefore, this in vitro study was conducted in order to evaluate the new primer in comparison with a conventional bonding preparation. One hundred and twenty extracted human teeth were randomly divided into three groups of 40 specimens each (20 incisors, 20 premolars). In group 1 a conventional bonding procedure was used (etching, Transbond XT), in group 2 the new primer was used according to the manufacturer’s recommendations when bonding to intact enamel, while in group 3 the new primer was used without prior etching. Shear bond strength (SBS) was measured with a universal testing machine and the adhesive remaining after debonding was determined using an optical microscope at ×10 magnifi cation. The adhesive remnant index was used in order to assess the mode of failure. No enamel fractures were detected in any of the specimens. In all groups acceptable bond strengths were observed. The only statistically signifi cant difference ( P = 0.004) was found for the incisors in group 2, which showed the highest mean SBS (17.46 MPa). Considering the acceptable bond strength and the mode of failure, use of the new primer without prior etching is recommended in patients with fi xed appliances. Further in vivo studies will be carried out in order to evaluate clinical performance.

352 children radiologically identified with asymmetry in the occipito-cervical region were assessed on a number of myofunctional measures. In all children an orthopedic examination was conducted including a functional test of the upper cervical spine and the iliac joint, the postural test by Matthiass, as well as gait analysis. During a second examination the orofacial myofunctional status was recorded. In general, about 70% of the children revealed orofacial myofunctional disorders. Correlational analysis was conducted in order to determine whether specific myofunctional variables were associated with postural and orthopedic alterations. A weak body posture correlated statistically significantly with all assessed myofunctional variables. On the other hand, all orthopedic items correlated significantly with a reclined head position. A blockade of the iliac spine correlated significantly with persistent habits, articulation disorders and tongue dysfunction, whereas functional asymmetry of the upper cervical spine correlated significantly with incompetent lips. A finding of at least five statistically significant correlations within each orofacial variable underlined the complex symptomatology of myofunctional disorders, so that consideration needs to be given to adequate treatment approaches. The data generated by the present study stress the importance of early interdisciplinary screening in children to ensure a physiological development of the orofacial region and the still growing vertebral column. To help understand the complexity of symptoms influencing orofacial development, an explanatory model of the “interactive functional box system” is given.

Conventional therapeutic approaches to correct ankylosed anterior teeth in infraposition require compromises involving esthetics and function. The combined approach of distraction and early orthodontic fine adjustment, not yet established as a routine, promises better results concerning the bone conditions and gingival development. Both female patients had suffered a trauma to the front teeth during early mixed dentition resulting in ankylosed central incisors in infraposition. At the ages of 14 years and 2 months and 15 years and 2 months, respectively, we carried out segment distraction by means of a bone-supported internal distractor followed by orthodontic fine adjustment after having shortened the consolidation phase. Both ankylosed front teeth could be successfully aligned, leading to an increase in bone and harmonization of the gingival margin in the dental arch. At ten and 14 months after the conclusion of treatment, we observed only few deviations in the dental situation compared to posttherapeutic findings. From a functional and esthetic point of view, therapy involving combined orthodontics and surgery is superior to conventional therapy. Orthodontic fine adjustment should be considered as a continuation of the distraction procedure.

The aim of stimulating plate therapy in patients with trisomy 21 is to correct orofacial dysfunctions and prevent the establishment of subsequent morphological characteristics such as protrusion of the incisors and pseudoprognathia. This study investigated the effectiveness of this type of therapy in improving skeletal traits of patients with Down syndrome. The lateral cephalograms of 22 consecutive juveniles with Down syndrome, whose orofacial dysfunctions had been successfully treated with a stimulating plate according to Castillo Morales in infancy (17 months +/- 24 months), were examined 136 months on average (minimum of 78 months, maximum of 231 months) after initiation of treatment. In 16 of the 22 patients, the anomaly-typical bialveolar protrusion of the anterior teeth was diagnosed. The cephalometric results indicated larger values of cephalometric parameters concerning cranial base and maxilla, and markedly larger mandibular cephalometric values when compared to untreated children with Down syndrome. These results show that a stimulating plate may not always be indicated in patients with Down syndrome with a skeletal Class III pattern and minor orofacial findings.

From anatomic and functional aspects the stomatognathic system and the upper cervical spine are closely interlinked. Together with complex neuromuscular relationships, this gives rise to an important field of cooperation between orthodontics and orthopedics. The literature appeals for close interdisciplinary cooperation for patients with syndromes and for those with torticollis and scoliosis. Since orthopedic points of contact are obvious in these special cases, orthopedic aspects are now being taken increasingly into account in farther-reaching studies. With the rising popularity of manual medicine, these aspects are being recognized from the orthopedic point of view too in terms of functional correlations and are being increasingly debated at international congresses and in the literature. Although relevant publications were initially confined to studies of moderate scientific interest or case reports, potential correlations have undergone scientific investigation in recent interdisciplinary studies. Despite the many clinical studies, no unequivocal recommendation can be given for basic conditions under which an orthopedist is bound to be consulted on patients with orthodontic findings. This literature review is aimed at providing an introduction to this still hotly debated issue.

Aim: In-vitro evaluation of an alternative method to the conventional acid etch technique. Material and Method: 240 human anterior and posterior teeth were divided into 16 groups of 15 teeth each. Group variables were: tooth type, enamel conditioning technique (Prompt L-Pop®: 3M Espe, Seefeld, Germany, or 37% phosphoric acid and bonding), adhesive (Transbond™ XT: 3M Unitek, Monrovia, CA, USA and ENlight®: Ormco, Orange, CA, USA), and testing procedure (shear and tensile bond strength). Upper lateral incisors and premolar brackets (Mini-Diamond®: Ormco, Orange, CA, USA) were used. Intergroup differences were analyzed by an analysis of variance. The enamel surface and the failure mode of debonded specimens were investigated with light and scanning electron microscopy. Results: Despite a tendency towards a higher bond strength after phosphoric acid conditioning, no statistically significant differences were found between the enamel conditioning methods. Statistically significant differences were recorded for the different adhesives: bond strength with Transbond™ XT was higher than with Enlight®. Conclusion: The single-step bonding agent sems to provide an acceptable bond strength between adhesive and enamel. No enamel fractures were detected. In vivo studies will be conducted to investigate the clinical performance of the new material.