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Objective: To evaluate final posttreatment occlusion in patients with complete unilateral cleft lip and palate (cUCLP) by comparing (1) 3 treatment centers, (2) males and females, (3) cleft and noncleft sides, (4) right- and left-sided clefts, and (5) orthodontic treatment with/without orthognathic surgery (OS)., Design: Retrospective cohort study., Patients: Blinded posttreatment dental casts of 56 patients (19.4 ± 1.4 years) with cUCLP from 3 centers in Switzerland., Main Outcome Measure: Occlusal assessment using the modified Huddart/Bodenham (MHB) index., Results: Our sample comprised 35 males and 21 females, 46 with left- and 10 with right-sided clefts, of which 32 had undergone OS. The final posttreatment occlusion showed a median MHB score of 0 (interquartile range: -1.0 to 2.0) in the total sample and did not seem to depend on treatment center, sex, or OS. The MHB scores for the anterior buccal and the buccal segments were more negative on the cleft than on the noncleft side ( P = .002 and P = .006, respectively). When the cleft was on the left side, the MHB score tended to be more positive in the labial ( P = .046) and anterior buccal segments ( P = .034)., Conclusions: This study shows a very satisfactory final posttreatment occlusion in patients with cUCLP. The more constricted buccal occlusion on the cleft side emphasizes the attention that should be given in correcting the more medially positioned lesser maxillary segment. The influence of cleft-sidedness should be analyzed further on a sample including more patients with right-sided clefts.

Objectives: The aim of the study was to identify differences in the aesthetic evaluation of profile and frontal photographs of (1) patients treated for complete left-sided cleft lip and palate and (2) control patients by laypeople and professionals., Materials, Subjects, and Methods: Left-side profile and frontal photographs of 20 adult patients treated for complete left-sided cleft lip and palate (10 men, 10 women, mean age: 20.5 years) and of 10 control patients with a class I occlusion (five men, five women, mean age: 22.1 years) were included in the study. The post-treatment photographs were evaluated by 15 adult laypeople, 14 orthodontists, and 10 maxillofacial surgeons. Each photograph was judged on a modified visual analogue scale (VA S, 0-10; 0 'very unattractive' to 10 'very attractive'). A four-level mixed model was fitted in which the VA S score was the dependent variable; cases, profession, view, and rater were independent variables., Results: Compared with laypersons, orthodontists gave higher VA S scores (+0.69, 95% confidence interval (CI) [0.53, 0.84]; P < 0.001), followed by surgeons (+0.21, 95% CI [0.03, 0.38], P = 0.02). Controls were given significantly higher scores than patients with clefts for profile and frontal photographs (+1.97, 95% CI [1.60; 2.35], P < 0.001). No significant difference was found between the scores for the frontal and lateral views (P = 0.46)., Conclusions: All the different rater panels were less satisfied with the facial aesthetics of patients with clefts compared with that of control patients. Further research should evaluate whether these findings correlate with patients' self-perception and to what extent it affects the patients' psychosocial well-being.

Objectives: To investigate pharyngeal airway changes in patients with Pierre Robin sequence (PRS) longitudinally from childhood to adulthood., Setting and Sample Population: Cleft Lip and Palate Unit, Clinic of Orthodontics, University of Zurich. Twenty-four patients born between 1970 and 1990 with non-syndromic PRS., Materials and Methods: Lateral cephalograms at age 5 (T1), 10 (T2), 15 (T3) and 20 (T4) years were available. Variables describing pharyngeal airway dimensions, soft palate morphology, tongue and hyoid position, skeletal morphology and head posture were assessed., Results: A significant increase in nasopharyngeal depth was found over the entire observation period (T1 10.7 to T4 19.1 mm, p < 0.001), especially between T2 and T3 (change 3.8 mm, p < 0.001), and was mainly due to adenoid recession (r = -0.75, p < 0.001; variation explained by 56%). Increase in velopharyngeal depth mainly took place between T3 and T4 (change 2.3 mm, p < 0.01). It was due to more anterior tongue posture (r = 0.65, p < 0.001; 42.5% of variation explained), in turn allowing the soft palate to take a more vertical position (r = -0.52, p < 0.001). Increase in oropharyngeal depth was associated with head extension and anterior mandibular positioning (36% of variation explained). However, significance was not reached (T1 8.3 to T4 9.8 mm, p > 0.05)., Conclusions: Upper airway dimensions in children with PRS improve with time, except for the oropharyngeal airway. Despite large interindividual variation, the mean remained in the lower reaches of normality described in other studies. Thus, further research should investigate the prevalence of obstructive sleep apnoea in adults with PRS., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Objective: Our aim was to assess the association between mandibular asymmetry and sagittal and transverse occlusal asymmetry in young adult males with class III malocclusion. Our hypotheses were that (1) mandibular asymmetry increases with increasing mandibular length and (2) occlusal asymmetry is correlated with mandibular asymmetry., Material and Methods: On lateral cephalograms of 54 subjects, skeletal class and mandibular length were measured. Mandibular asymmetry was evaluated on orthopantomograms as right-left difference between condylar or ramus heights. Occlusal asymmetry was assessed on dental casts by differences between right and left canine and molar relationship, anterior and posterior crossbite as well as midline deviation., Results: Mandibular asymmetry was significantly correlated with sagittal and transverse occlusal asymmetry (p < 0.05), but not with mandibular length (p > 0.05). Condylar asymmetry due to a longer condyle on one side was correlated with asymmetric aggravation of canine and molar class III on the ipsilateral side (r = -0.53 and -0.62, respectively). In contrast, ramus asymmetry was related to contralateral aggravation of canine and molar class III relationships (r = 0.27 and 0.29, respectively). Correlations existed between asymmetry in total height of the condyle and ramus and asymmetric aggravation of anterior crossbite (r = -0.33), posterior crossbite (r = -0.30) and lower midline deviation (r = -0.27) to the contralateral side (p < 0.05)., Conclusions: Mandibular asymmetry is associated with occlusal asymmetry, especially in the sagittal plane. Condylar asymmetry had 28% and 38% of variance in common with sagittal canine and molar asymmetry, respectively. Asymmetry in total height of the condyle and ramus was related to transverse occlusal asymmetry.

Introduction: We aimed to investigate the skeletal morphology underlying Class III malocclusion in a random population of young white men., Methods: We randomly selected 3358 Swiss Army recruits and examined them clinically. Of 77 (2.3%) with Class III malocclusion, 57 agreed to have lateral cephalograms. Mandibular and maxillary relationships (ANB, Wits), positions (SNB, SNA), and relative sizes (GoPg and ANS-PNS related to SN) were determined. Comparison with normal values showed discrepancies., Results: In 75.4% of the subjects, the Class III malocclusion had a skeletal origin. The discrepancy was mainly (47.4%) due to mandibular prognathism or growth excess (10.5% prognathism, 15.8% macrognathia, or 21.1% both), whereas the maxilla alone accounted for 19.3% (10.5% retrognathism, 8.8% micrognathia), and there was a combination of mandibular and maxillary disharmony in 8.7%. Dental compensation was common, with proclined maxillary incisors in 42.1% and retroclined mandibular incisors in 26.3%., Conclusions: About 75% of the Class III malocclusion had skeletal origin in our subjects, mainly due to mandibular prognathism or macrognathia. The different skeletal types proposed in our study can give guidance in treatment planning and the evaluation of treatment effects in Class III malocclusion and in genetic studies.

Introduction: Because of the hereditary nature of Class III malocclusion, relatives of affected subjects often ask for a consultation. To estimate the degree of skeletal manifestation without exposing them to radiation, an alternative to lateral cephalograms would be valuable for preliminary diagnosis. Thus, we aimed to assess the validity of profile photographs to detect skeletal Class III discrepancy., Methods: Profile photographs and lateral cephalograms were available from 42 young white men, 29 with Class III malocclusion and 13 with Class I. A computer-based analysis was performed including hard-tissue variables on cephalograms and soft-tissue variables on photographs, Results: Soft-tissue facial characteristics showed strong correlations with several skeletal structures of skeletal Class III subjects (r > or = 0.7, P < 0.001). Thus, soft-tissue A'N'B', A'N'Pog', and N'A'/A'Pog' were highly related to skeletal ANB, ANPog, and NA/APog. Vertically, soft- and hard-tissue lower anterior face heights were strongly correlated. A soft-tissue A'N'B' angle of 6 degrees is the critical value below which skeletal Class III can be implied (sensitivity, 90.5%; specificity, 81.0%). This finding was validated among female subjects., Conclusions: A profile photograph can show with high probability a skeletal Class III discrepancy and might be useful for diagnosis during the initial consultation.

Introduction: The divergence in prevalence of a specific malocclusion is often striking. In addition to differences in ethnic background, sex, and age, inconsistency in diagnostic criteria might be important. Our aim was to investigate the prevalence of mesiocclusion in the same group by modifying the diagnostic criteria., Methods: We examined clinically 3358 young white men. The prevalence of mesiocclusion was determined by applying diagnostic criteria based on the sagittal relationship of the anterior teeth. Correlations to the molar sagittal relationship were calculated., Results: When the diagnosis was based on anterior crossbite, the prevalences were 9.0% for 1 incisor, 4.7% for 2 incisors, and 1.3% for 4 incisors involved. The prevalence decreased when teeth in edge-to-edge positions were excluded (5.2%, 1.9%, and 0.5%, respectively). When canine relationship was used, the prevalences varied from 5.2% to 0.2%, with mesiocclusion increasing from a quarter to 1 cusp width on average. When incisors and canines were combined, prevalences ranged from 0.2% to 3.0 %. The sagittal relationship of the anterior teeth was moderately correlated to the molars., Conclusions: Subtle differences in diagnostic criteria lead to varying prevalence values for mesiocclusion. The diagnostic criteria of at least 2 incisors in crossbite or edge-to-edge and a mean canine mesiocclusion of at least a half cusp width are recommended for future epidemiologic studies as the anterior tooth relationship that correlates relatively highly to the sagittal molar relationship.

Introduction: Recent technologic advances make it possible to increase the light power density to reduce the necessary exposure duration. The kinetics of polymerization are complex. The special case of indirectly curing the thin layler of composite below the metallic bracket base further increases this complexity. It was hypothesized that the concept of "total energy,"--the reciprocity between power density and exposure duration--does not hold for orthodontic light-cure bracket bonding., Methods: Stainless steel brackets were bonded on deciduous bovine incisors with a standard light-cured composite. A calibrated, powerful halogen lamp allowed for modification of power density from 300 to 3000 mW/cm2. Metallic brackets were bonded in 8 groups of 20 incisors each with various combinations of power densities and exposure durations to obtain 3 levels of energy density (6000, 12000, and 24000 mJ/cm2). Another group of 20 incisors served as the positive control with a conventional powerful halogen lamp (1000 mW/cm2) for 40 seconds. After storage for 24 hours at 37 degrees C in water, the bracket shear bond strength (SBS) and the adhesive remnant index (ARI) were measured., Results: It was confirmed that bracket SBS mainly depends on the energy density of the light cure. All groups with an energy density of 6000 mJ/cm2 had significantly lower SBS than the groups with higher energy densities (P <0.01). The dependence of SBS on exposure duration for the same energy density followed an exponential model of nonlinear regression (r2 = 0.98)., Conclusions: The concept of "total energy" does not hold for orthodontic light-cure bracket bonding. An exposure time of less than 4 seconds, irrespective of the power density, cannot guarantee sufficient bracket bond strength. There seems to be an advantage of power density over exposure duration in the context of metallic bracket bonding. These results show that, for an efficient light-cure bracket bonding, there is an absolute lower limit of exposure duration (4 seconds) and an upper limit of useful power density (3000 mW/cm2).

Objectives: In order to reduce curing time for bracket bonding with light-cured composites, manufacturers increase the power density (PD) of light sources. The present study aims at investigating the relationship between PD and shear bond strength (SBS) at short exposure time., Methods: Stainless steel brackets were bonded to bovine incisors using light-cured adhesive. Six groups of 20 incisors each were exposed to 4s of halogen light with different PD increasing from 500 to 3000 mW/cm(2) in steps of 500 mW/cm(2). Two more groups were exposed to a PD of 3000 mW/cm(2) for 6s (n=15) and 8s (n=19), thus simulating non-available PD of 4500 and 6000 mW/cm(2) for 4s. A halogen lamp with a PD of 1000 mW/cm(2) was used for 40s in the control group (n=15). After storage for 24h at 37 degrees C in water, SBS and adhesive remnant index (ARI) were recorded., Results: SBS was significantly different among groups (ANOVA, p<0.001). SBS comparable to the control group could only be achieved with a PD of at least 3000 mW/cm(2). An exponential model described the relationship between SBS and PD. The best-fit curve based on this model reached 85% of the highest possible SBS at approximately 4000 mW/cm(2). ARI scores showed that higher PD was associated with better adhesion at the bracket/adhesive interface., Conclusions: Our findings show the SBS dependence on PD, and thus provide a valuable tool for the development of light-curing systems. An exponential model suggests that SBS enters a region of saturation and cannot be improved significantly by further increasing PD.

Introduction: Orthodontic brackets are routinely bonded with light-cured adhesives. Conventional halogen lights used in bonding have the disadvantage of a long curing time, and the available alternatives (laser and plasma lights) are expensive. Our aim was to investigate the minimum time necessary to bond brackets with a new, relatively low-priced, high-power halogen light., Methods: Five groups of 15 deciduous bovine incisors were bonded with stainless steel brackets (Mini Diamond Twin, Ormco, Orange, Calif) by using different lamps and curing times. Three of the groups were bonded by using a high-power halogen light (Swiss Master Light, Electro Medical Systems, Nyon, Switzerland) for 2, 3, and 6 seconds, respectively. The fourth group, bonded with a fast halogen light (Optilux 501, Sybron Dental Specialties, Danbury, Conn) for 40 seconds, served as the positive control group. The fifth group, the comparison group, was bonded with a plasma light (Remecure, Remedent, Deurle, Belgium) for 4 seconds. After storage for 24 hours in the dark at 37 degrees C in water, shear bond strength was measured with a universal testing machine., Results: A curing time of 2 seconds with the high-power halogen light negatively affected the bond strength and the probability of bond survival. The adhesive remnant index scores were not significantly different among the groups. Most failures (> 60%) occurred at the bracket base/adhesive interface., Conclusions: The high-power halogen light seems to be a cost-effective solution to reducing curing time. The recommended curing times to bond stainless steel brackets are 6 seconds and, with caution, even 3 seconds.

The aim of the present in vitro study was to establish the minimum necessary curing time to bond stainless steel brackets (Mini Diamond Twin) using new, intensive, light-emitting diode (LED) curing units. Seventy-five bovine primary incisors were divided into five equal groups. A standard light curing adhesive (Transbond XT) was used to bond the stainless steel brackets using different lamps and curing times. Two groups were bonded using an intensive LED curing lamp (Ortholux LED) for 5 and 10 seconds. Two more groups were bonded using another intensive LED curing device (Ultra-Lume LED 5) also for 5 and 10 seconds. Finally, a high-output halogen lamp (Optilux 501) was used for 40 seconds to bond the final group, which served as a positive control. All teeth were fixed in hard acrylic and stored for 24 hours in water at 37 degrees C. Shear bond strength (SBS) was measured using an Instron testing machine. Weibull distribution and analysis of variance were used to test for significant differences. The SBS values obtained were significantly different between groups (P < 0.001). When used for 10 seconds, the intensive LED curing units achieved sufficient SBS, comparable with the control. In contrast, 5 seconds resulted in significantly lower SBS. The adhesive remnant index (ARI) was not significantly affected.A curing time of 10 seconds was found to be sufficient to bond metallic brackets to incisors using intensive LED curing units. These new, comparatively inexpensive, curing lamps seem to be an advantageous alternative to conventional halogen lamps for bonding orthodontic brackets.

Demineralization around orthodontic brackets is one of the side-effects of orthodontic treatment. However, simple methods for its early detection, quantification and monitoring are lacking. Therefore, the aim of this investigation was to evaluate red laser-light induced fluorescence for measurement of demineralization around brackets in vitro, and whether an interference by the brackets should be expected. The site of measurement was standardized on 30 extracted human molars with natural demineralization on smooth surfaces. Fluorescence was measured (Diagnodent) on prebonded, etched, bonded with stainless steel brackets, and debonded enamel. We found no statistically significant difference in fluorescence after etching. After bonding, the fluorescence decreased by a median value of 0.5 compared to the prebonded and etched enamel. After debonding, the fluorescence increased by a median value of 0.5 and 1 compared with the prebonded and bonded conditions, respectively. The lack of agreement between prebonded and bonded enamel values (limits +12.4/-12.6) was possibly due to the difficulty in finding the same spot without the bracket (coefficient of repeatability = 9.1-10.8). In vitro, demineralization around brackets can be measured by laser fluorescence, but clinical studies are necessary.

Background: (I) Introducing an intraoral camera system with a special positioner to allow computer-based analysis of reproducible images on lingual tooth surfaces and (II) comparing plaque removal by three manual toothbrushes with different brushhead designs (convex, multilevel and flat trimmed) on lingual mandibular tooth surfaces., Method: In a clinical single-blind, crossover, 24-h plaque-regrowth study on 25 subjects, a computer-based index (PPI) was used to evaluate pre- and postbrushing plaque on lingual surfaces of mandibular premolars and molars. Subjects brushed their teeth under standardized conditions at three visits, each time with a different, randomly assigned toothbrush., Results: The intraoral camera system allowed a reproducible and relatively convenient access to the lingual surfaces of the mandibular teeth and provided an increase in objectivity. Overall, each brush achieved statistically significant plaque removal, however, none reached clinical relevance. The multilevel brush was superior at specific sites, but failed to show statistically significant superiority in terms of overall plaque reduction. Without regard of the toothbrush used, the right handed subjects were less efficient in removing plaque from the right side compared to the left., Conclusions: The method is able to detect even small differences in plaque reduction. None of the different brushhead designs was able to compensate an insufficient brushing techniques.