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Background: Cleft lip and palate (CLP) are among the most common congenital anomaly that affects up to 33,000 newborns in India every year. Nasoalveolar moulding (NAM) is a non-surgical treatment performed between 0 and 6 months of age to reduce the cleft and improve nasal aesthetics prior to lip surgery. The NAM treatment has been a controversial treatment option with 51% of the cleft teams in Europe, 37% of teams in the USA and 25 of cleft teams in India adopting this methodology. This treatment adds to the already existing high burden of care for these patients. Furthermore, the supporting evidence for this technique is limited with no high-quality long-term clinical trials available on the effectiveness of this treatment., Method: The NAMUC study is an investigator-initiated, multi-centre, single-blinded randomized controlled trial with a parallel group design. The study will compare the effectiveness of NAM treatment provided prior to lip surgery against the no-treatment control group in 274 patients with non-syndromic unilateral complete cleft lip and palate. The primary endpoint of the trial is the nasolabial aesthetics measured using the Asher McDade index at 5 years of age. The secondary outcomes include dentofacial development, speech, hearing, cost-effectiveness, quality of life, patient perception, feeding and intangible benefits. Randomization will be carried out via central online system and stratified based on cleft width, birth weight and clinical trial site., Discussion: We expect the results from this study on the effectiveness of treatment with NAM appliance in the long term along with the cost-effectiveness evaluation can eliminate the dilemma and differences in clinical care across the globe., Trial Registration: ClinicalTrials.gov CTRI/2022/11/047426 (Clinical Trials Registry India). Registered on 18 November 2022. The first patient was recruited on 11 December 2022. CTR India does not pick up on Google search with just the trial number. The following steps have to be carried out to pick up. How to search: ( https://ctri.nic.in/Clinicaltrials/advsearch.php -use the search boxes by entering the following details: Interventional trial > November 2022 > NAMUC)., (© 2024. The Author(s).)

Objectives: Dental antibiotic stewardship is crucial in low- and middle-income countries where the burden of antimicrobial resistance (AMR) is high and antibiotic misuse is common. Given that India is the most populous country, the largest antibiotic consumer and has a large dental prescriber population, this study investigated the extent to which current Indian policy and practice for dental antibiotic prescribing and stewardship aligns with the global policy and best practice., Methods: The READ approach was used to identify and extract data and synthesize the findings. Policy documents on dental antimicrobial stewardship were identified using a systematic search strategy involving nine medical and grey literature databases (Medline, Global Health, Web of Science, Cochrane, CINAHL, Eldis, Global Index Medicus, Proquest and Opengrey), targeted websites (government organizations and dental regulatory bodies) and contact with experts. Framework analysis was used to code extracted data into themes related to dental antimicrobial stewardship., Results: Of the 3039 records screened, 25 documents were included in the final analysis. The analysis showed a lack of guidelines or toolkits for appropriate antibiotic prescribing in dentistry in India. The treatment guidelines for antimicrobial use in common syndromes published by the Indian Council of Medical Research had no section or content for dental practitioners. Furthermore, the undergraduate dental curriculum developed by the Dental Council of India (DCI), included little content on appropriate antibiotic prescribing and no mention of AMR or stewardship. There were no educational resources either for dental practitioners or patients in the documents., Conclusion: This document analysis showed that there was little or no mention of dental antibiotic prescribing guidelines in key policy documents such as the National Action Plan on AMR. In addition, contradictory and subjective information provided in some policy documents could encourage dentists and other health professionals such as general practitioners to prescribe antibiotics for common dental conditions for which they are contra-indicated. There is an urgent need to develop relevant guidelines and include these in Indian policy documents on AMR particularly the National Action Plan on AMR., (© 2024 The Author(s). Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

The aim of this systematic review was to compare the effectiveness of pre-alveolar bonegraft (ABG) orthodontics with no orthodontic treatment for patients with non-syndromic unilateral cleft lip, alveolus and palate. All relevant studies from 1946 to October 30, 2022, were identified using several sources including The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), LILACS, Scopus, EMBASE, MEDLINE (Ovid) and EPUB ahead of publications and non-indexed citations. Randomized Controlled Trials (RCT) and Controlled Clinical Trials (CCT) were included., Population: Non-syndromic complete unilateral cleft lip, alveolus and palate patients who have had ABG surgery., Intervention: Orthodontics prior to ABG. Comparison: No orthodontic treatment prior to ABG., Primary Outcome: Successful eruption of permanent canines. All articles were screened for the title, abstract and full text independently and in duplicate by 2 reviewers. The quality assessment of RCT was performed using Cochrane's risk of bias tool and the CCT was assessed using ROBINS-I tool. Of the 904 studies retrieved in the search, one RCT and one CCT were included. Both studies were judged as high risk of bias. The results from one study showed a statistically significant increase in bone volume and decreased bone defect post-ABG in the orthodontic treatment group. However, there was no difference with respect to other variables. Both included studies were of low quality. There is not enough evidence to recommend orthodontic treatment pre-ABG for patients with complete unilateral cleft lip, alveolus and palate. Future high-quality studies are required to inform patients and clinicians about the effectiveness of pre-graft orthodontic treatment., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To assess the factors influencing the type and timing of Alveolar Bone Grafting (ABG) among cleft centers throughout India. To examine the decision-making criteria for orthodontic treatment and the timing of ABG., Design: Cross sectional survey., Method: This survey was based on a convenience-based sample selected from cleft teams across India. The survey was formulated using the SurveyMonkey platform and emailed to 40 cleft teams. The survey included questions on demographics, timing, surgical protocol, orthodontic protocol, radiograph prescription rate, assessment methods for the success of ABG and three scenarios for evaluating the timing of the bone graft. The Chi-squared test was performed to evaluate the difference in opinion between specialists. The inter-examiner reliability was assessed using Kappa statistics., Results: Thirty-five units completed the questionnaire. Most units operate with 1-2 surgeons, with 42.9% of them treating cleft patients for under 5 years. Only 11.4% of centres routinely advised oblique occlusal radiographs for post-surgery evaluation, and 31.4% prescribed CBCT. However, 40% of cleft teams did not perform audits to evaluate the success of ABG, and less than 50% advised radiographs six months post-surgery. Around 26% of centres do not routinely provide orthodontic treatment pre-ABG. The inter-examiner reliability for case scenarios showed poor agreement between the clinicians., Conclusion: The survey showed a serious lack of consensus in the ABG treatment among cleft teams in India and emphasises the need for standardised protocols for the treatment of children with cleft palate. There is an urgent need to develop core outcome set in cleft.

Aim: To evaluate the impact of COVID-19 on clinical orthodontic services, orthodontic education, and the emotional well-being of orthodontists and orthodontic trainees in India., Materials and Methods: The survey was designed using Survey Monkey™ and distributed to members of the Indian Orthodontic Society via their registered email address and also via social media platforms (WhatsApp and LinkedIn)., Results: A total of 610 responses to the survey were received. The majority of respondents agreed on the negative impact of COVID-19 on clinical activity and the associated income of orthodontists. Respondents reported that this was mainly due to national restrictions (70.1%), increased cross infection measures (59.6%), state restrictions (55.9%), and social distancing (39.4%). Ninety one percent of respondents agreed that orthodontic staff should have evidence of vaccination before providing care.COVID-19 was found to have a negative impact on the trainees' perceptions of their clinical dexterity (72.4%), their confidence with respect to academic knowledge (66.5%), their mental health (80.7%), and their stress levels during the pandemic (93.2%)., Conclusion: The COVID-19 pandemic has had a negative impact on orthodontic specialists and post-graduate trainees in India. The impact on trainees' mental health was significantly higher compared to trainees from other countries. Decreased clinical activity has reduced the opportunities for learning, and trainers must rise to the challenge of providing additional support to this cohort of trainees who will progress to become the future orthodontic workforce., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Thiruvenkatachari, Sivakumar, Ananth, Sabbagh, Lewis, Chadwick, Kaliyaperumal and Batra.)

A national survey of cleft teams was undertaken to evaluate the current standard of care for patients with cleft lip and palate (CLP) in India as a part of Cleft Care India study., This was a cross-sectional questionnaire-based study., Cleft teams across India attending the 19th Annual Conference of the Indian Society of Cleft Lip and Palate were invited to complete the questionnaire. The questionnaire consisted of 18 questions that included demographics, institutional details, patient protocols, surgical technique, rehabilitation facilities, and accessibility. The data are descriptively reported., A total of 112 centers completed the survey. Nongovernment organizations funded 87% of the cleft centers and 8% did not receive any funding. Only 39% of the centers had centralized cleft services providing multidisciplinary care. Speech therapy was provided either onsite or through referral at 90% of the centers, whereas audiology was provided only at 4% of centers. Feeding advice was routinely provided in 52% of centers. Millard technique was the most preferred technique for unilateral cleft lip repair (66%). The 2-flap technique (37%) and pharyngeal flap (48%) were the most common surgeries for cleft palate and pharyngoplasty, respectively. Although 54% of centers reported their patients to be interested in comprehensive care, 43% reported that their patients only wanted surgical correction., There is wide diversity in access to cleft care and clinical practices across centers in India. Further work is needed to evaluate the quality of care by assessing outcomes of centers treating patients with CLP.

Introduction: The Twin-block (TB) and the van Beek Headgear-Activator (vBHGA) are indicated for patients with Class II malocclusion with a retrognathic mandible. Although the former is commonly prescribed for horizontally growing patients, the latter is often recommended for those growing vertically. This study aimed to compare the skeletal, dentoalveolar, and soft-tissue short-term effects of TB and vBHGA, taking growth patterns into account., Methods: Immediate prefunctional (T1) and postfunctional appliance (T2) lateral cephalometric radiographs were retrospectively obtained for vBHGA (n = 46), TB (n = 45), and untreated control (n = 45) groups. The interaction of several variables at T1, T2, and T2 - T1, as well as the resultant treatment effect, were analyzed using the analysis of covariance regression models at the 5% significance level., Results: Except for a greater reduction in Wits measurement (3.0 mm; P <0.0001) in the TB group, no anteroposterior (AP) skeletal difference was observed between the 2 appliances (ANB, 0.530; P = 0.07) (Harvold, 0.13 mm; P = 0.81). Both improved the AP skeletal relationship (ANB and Harvold) compared with the control (P <0.05). Although this mostly occurred because of the forward positioning of the mandible with the TB (SNB, 0.960; P = 0.01), the maxillary restriction was the main mechanism with the vBHGA (SNA, 1.590; P <0.01). Dentoalveolar compensations were more pronounced with the TB (IMPA, 1.92; P = 0.02), leading to greater overbite and overjet correction. Only the inclination of the maxillary incisors showed interaction with the growth pattern, with the TB horizontal growers experiencing more retroclination (U1-NA°. 3.620; P = 0.0067)., Conclusions: Both appliances produced similar modest AP skeletal changes that, together with dentoalveolar compensations, were able to correct the Class II malocclusion regardless of growth pattern., (Copyright © 2023 American Association of Orthodontists. All rights reserved.)

Background/objectives: The aim of this systematic review was to compare the different force delivery systems for orthodontic space closure by sliding mechanics., Search Methods: Multiple sources including Cochrane Central, Ovid Medline, Embase etc. were used to identify all relevant studies., Selection Criteria: Randomized controlled trials (RCT) of parallel-group and split-mouth designs were included., Participants: Orthodontic patients of any age treated with fixed orthodontic appliances and requiring space closure., Data Collection and Analysis: Search result screening, data extraction and quality assessment were performed independently and in duplicate by 2 reviewers. The included studies were grouped into parallel-arm and split-mouth studies and subgroup analysis was then performed for the type of retraction subsets; en-masse and individual canine retraction. A traditional meta-analysis, and network meta-analysis (NMA) for direct and indirect comparisons for the rate of space closure were performed., Results: Thirteen studies, six parallel-arm and seven split-mouth were included. The traditional meta-analysis comparing Nickel-titanium (NiTi) closed coil springs and elastomeric power chain for the rate of tooth movement showed statistically significant difference favouring NiTi springs (MD: 0.24; 95% CI, 0.03-0.45; I2 0%, P = 0.02) and the comparison between NiTi springs and active ligatures also showed statistically significant result favouring NiTi springs (MD: 0.53; 95% CI, 0.44-0.63; I2 0%, P ˂ 0.00001) for the rate of tooth movement. NMA for the rate of space closure showed fairly confident evidence for NiTi coil springs when compared with elastomeric chain and active ligatures. The NiTi coil spring ranked best between all methods of space closure., Conclusions: There is moderate quality evidence in favour of NiTi coil springs for the rate of space closure when compared with active ligature and low quality of evidence favouring NiTi springs when compared with elastomeric chain. The ranking from NMA showed NiTi coil springs to be the best method for space closure with 99% chance. An urgent need for standardization of study designs and the need for development of an agreed core outcome sets and core outcome instrument measurement sets is evident., Registration: PROSPERO CRD42020157811., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The aim of this article is to outline the potential risks in orthodontic treatment and the general dental practitioner's role in reducing and managing such risks. The success of orthodontic treatment largely depends on patient understanding of the risk/benefit implications of the orthodontic treatment and all of the potential consequences involved in such treatment. A perfect blend of good case selection, sound clinical judgement and, more importantly, a patient's clear understanding of the potential risks involved and the treatment implications help minimise and manage potential hazards that occur during the course of the treatment., (© 2021. The Author(s), under exclusive licence to the British Dental Association.)

Background: An alveolar cleft commonly affects 75% of cleft lip and palate patients. While it is common practice to provide a course of orthodontic treatment before alveolar bone grafting, there are no previous high-quality studies reporting on the benefits of this type of treatment., Aim: The aim of the study is to evaluate the effectiveness of pre-alveolar bone graft orthodontics for unilateral non-syndromic cleft palate patients., Method: The PABO trial is a multicentric, parallel, two-arm, single-blinded randomised controlled trial. The inclusion criteria include unilateral cleft alveolus patients requiring bone graft and between the age group of 8 and 13 years with erupted upper central incisors. Participants will be recruited at three centres across India. Participants will be randomised to orthodontic treatment or no orthodontic treatment group. Both groups of participants will have alveolar bone graft surgery and will be followed up for 6 months after surgery. The primary outcome will be the success of the alveolar bone graft measured by anterior oblique radiograph and secondary outcomes include quality of life, cost analysis and quality of the dento-occlusal outcome. Data analysis will be carried out by an independent statistician at the end of the study., Discussion: This study is the first to evaluate the effect of orthodontics on alveolar bone graft success. The increased burden of care for these patients with multiple treatments required from multiple specialists from birth to adult life highlights the need for reducing unnecessary treatment provision., Trial Registration: Clinical Trials Registry - India, CTRI/2020/10/028756 . Trial prospectively registered on 29 October 2020. ., (© 2021. The Author(s).)

Background and Objectives: Class II malocclusion is one of the most common orthodontic problems. The Twin Block appliance has proven to be the most popular appliance for the correction of these malocclusions. Although randomized controlled trials (RCTs) on the Twin Block appliance have reported the changes to be mainly dentoalveolar, several nonrandomized studies have reported a significant skeletal improvement in these patients. Hence, the aim of this study was to compare the effectiveness of Twin Block appliance evaluated using an RCT or retrospectively selected cases (RSC) for the treatment of Class II Division 1 malocclusion in an adolescent population., Methods: This was a retrospective study. The results for an RCT were selected from a UK Class II multicenter study. Sixty-three patients from the trial were included. This group was matched with retrospectively selected Class II cases treated with a Twin Block functional appliance and their results submitted for Membership in Orthodontics examination in the United Kingdom, from four centers. The primary outcome was skeletal measurement ANB (A point, nasion, B point). Secondary outcomes included final peer assessment rating (PAR) scores and final overjet. Intrarater reliability of measurements was assessed. Independent samples t-test was carried out to look at the difference between the groups., Results: The reliability assessment showed excellent agreement for all measurements. The data were normally distributed. There was a statistically significant difference favoring the RSC group for final overjet (mean difference [MD] = 1.068, 95% confidence interval [CI] -0.67 to 1.47, P = 0.000) and final PAR (MD = 4.0, 95% CI -0.79 to 5.5, P = 0.000). There was no significant difference in the scores for final ANB (MD = 0.34, 95% CI -0.39 to 1.07, P = 0.33)., Conclusion: The RSCs show significantly improved overjet and PAR scores at the end of treatment and no statistically significant difference for skeletal change. The study raises the question of a potential role of observational studies in evaluating the effect of an intervention in orthodontics., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Dens invaginatus (DI) is a developmental anomaly resulting in a deepening or invagination of the enamel organ into the dental papilla prior to calcification of the dental tissues. Presence of DI is considered to increase the risk of caries and pulpal pathology, but they are often missed in the initial orthodontic assessment as they present with no clinical signs of an anomaly. In absence of adequate oral hygiene and maintenance, bacterial contamination of these malformations can lead to the development of early caries and consequent pulpal death. Early diagnosis of these lesions is critical as they can negatively impact any planned orthodontic treatment and assessment of the prognosis of these lesions is therefore necessary prior to the commencement of orthodontic treatment. In this article, we aim to illustrate the need for appropriate diagnosis and multidisciplinary approach in the management of DI in patients undergoing orthodontic treatment.

Introduction: Currently, there is limited evidence on the effects of malocclusion on oral health and whether the correction of malocclusion results in an improvement in oral health. In this review, we examined the evidence from randomized controlled trials and prospective cohort studies to provide information on any association between malocclusion and oral health and the effects of orthodontic treatment., Methods: We conducted this review in 2 parts: (1) we looked at the impact of malocclusion on oral health, and (2) we reviewed the evidence on the effect of orthodontic treatment on oral health. We searched for randomized controlled trials and prospective cohort studies. The searches were completed for articles published between January 1, 1990 and October 8, 2018 and covered Medline via Ovid, Embase, and the Cochrane Database of Systematic Reviews. References of included articles and previous systematic reviews were hand-searched. No language restrictions were applied. Two members of the study team assessed the quality of the studies using the Appraisal Tool for Cross-Sectional Studies to appraise the quality of studies in part 1. The assessment was performed at the study level. Two authors assessed each study independently, with a third author consulted when a disagreement occurred. For studies in part 2, we used the Newcastle-Ottawa scale to assess the risk of bias. When studies were included in a Cochrane review, we incorporated the risk of bias assessment. We developed data extraction forms for each area of oral health under investigation (trauma, quality of life, caries, and periodontal disease). Each author piloted the form, and we held discussions to inform any necessary refinements. We extracted data from studies into 2 × 2 tables, which provided a binary analysis of malocclusion vs the outcome of interest. If these data were not available from the published paper, then studies were not included in the meta-analysis. The authors were contacted when possible to request data in this format., Results: For part 1 of the study, we identified 87 studies. The overall quality was low. We could not include any of the data into an analysis because of a large variation in the nature of the studies, data collected, and outcome measures that were selected. For part 2 of the study, we found 7 studies; however, there were similar deficiencies in the data as in part 1, and thus, we could not reach any strong conclusions., Conclusions: Overall, there is an absence of published evidence regarding the effects of malocclusion on oral health and the impact of orthodontic treatment on oral health., (Copyright © 2020 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: The objective of this study was to assess the characteristics and level of evidence (LOE) of clinical studies recently published in leading orthodontic journals and to explore the association between the LOE and potentially related factors., Methods: The official online archives of 5 leading orthodontic journals were hand-searched to identify clinical research articles published during the period 2015-2017. The LOE of all included studies was assessed using a modified LOE classification system developed based on the Oxford LOE and Grading of Recommendations Assessment, Development and Evaluation (GRADE). Univariable and multivariable logistic regression analyses were performed to identify the association between the LOE of each article (high LOE vs. low LOE) and 7 factors., Results: A total of 637 studies were included and assessed. Of these, 8 (1.3%) were of level 1, 160 (25.1%) level 2, 326 (51.2%) level 3, and 143 (22.4%) level 4. According to multivariable logistic regression analyses, journal of publication (P < .001), funding status (P = .003), and the geographic origin of the first author (P = .006) were significantly associated with the LOE., Conclusions: The number of studies with high LOE in leading orthodontic journals was limited. There is still need for further improvement in the overall LOE of clinical studies in orthodontics., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: Intention-to-treat (ITT) analysis is an approach to managing dropouts and missing data in randomized controlled trials (RCTs). In this study, we systematically reviewed orthodontic RCTs to assess the frequency that an ITT analysis was carried out, to compare the number of trials that reported using ITT analyses with those that had truly used it, and to evaluate how dropouts and missing data were managed., Methods: Systematic searches were conducted in electronic databases including Cochrane Oral Health's Trials Register (searched on November 30, 2016) and Cochrane Central Register of Controlled Trials (2016) in the Cochrane Library (searched on November 30, 2016), with no restrictions on language, publication year, or publication status. RCTs comparing orthodontic or orthopedic treatments, or comparing orthodontic or orthopedic treatment with a control group without intervention were included. A customized data collection form was created, piloted, and used to gather information from the selected studies. The data extraction was performed by 2 authors independently and in duplicate, with disagreements resolved by discussion with the third author. The studies were assessed for attrition bias. The data were grouped and classified according to 2 categorical variables: sample analyzed and missing data strategy. The results were reported in percentages and descriptively., Results: From the 55 RCTs identified, 6 reported using an ITT approach. From these, only 1 study carried out a true ITT analysis (2%). From the 49 RCTs that did not report using an ITT analysis, 12 had used it (22%). The most used method of analyzing missing data was "completer sample" with 19 studies using this method (28%). "Full random sample" and "sufficient dose" were similar, with 13 and 11 studies, respectively (16% and 14%). The most frequently used missing data strategy for studies that did not conduct a true ITT analysis was "sample followed" with 30 studies (81%). For the studies that conducted a true ITT analysis, the most observed missing data strategy was "no dropouts" with 11 studies (79%)., Conclusions: Less than a third of the RCTs in orthodontics used an ITT analysis. There is a potential lack of understanding on dropouts and missing data management in research on orthodontic treatment., (Copyright © 2018 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: Prominent upper front teeth are a common problem affecting about a quarter of 12-year-old children in the UK. The condition develops when permanent teeth erupt. These teeth are more likely to be injured and their appearance can cause significant distress. Children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of their teeth. If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait and provide treatment in adolescence., Objectives: To assess the effects of orthodontic treatment for prominent upper front teeth initiated when children are seven to 11 years old ('early treatment' in two phases) compared to in adolescence at around 12 to 16 years old ('late treatment' in one phase); to assess the effects of late treatment compared to no treatment; and to assess the effects of different types of orthodontic braces., Search Methods: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 27 September 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2017, Issue 8), MEDLINE Ovid (1946 to 27 September 2017), and Embase Ovid (1980 to 27 September 2017). The US National Institutes of Health Ongoing Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases., Selection Criteria: Randomised controlled trials of orthodontic treatments to correct prominent upper front teeth (Class II malocclusion) in children and adolescents. We included trials that compared early treatment in children (two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces versus late treatment in adolescents (one-phase) with any type of orthodontic braces or head-braces, and trials that compared any type of orthodontic braces or head-braces versus no treatment or another type of orthodontic brace or appliance (where treatment started at a similar age in the intervention groups).We excluded trials involving participants with a cleft lip or palate, or other craniofacial deformity/syndrome, and trials that recruited patients who had previously received surgical treatment for their Class II malocclusion., Data Collection and Analysis: Review authors screened the search results, extracted data and assessed risk of bias independently. We used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, and mean differences (MDs) and 95% CIs for continuous outcomes. We used the fixed-effect model for meta-analyses including two or three studies and the random-effects model for more than three studies., Main Results: We included 27 RCTs based on data from 1251 participants.Three trials compared early treatment with a functional appliance versus late treatment for overjet, ANB and incisal trauma. After phase one of early treatment (i.e. before the other group had received any intervention), there was a reduction in overjet and ANB reduction favouring treatment with a functional appliance; however, when both groups had completed treatment, there was no difference between groups in final overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18; 343 participants) (low-quality evidence) or ANB (MD -0.02, 95% CI -0.47 to 0.43; 347 participants) (moderate-quality evidence). Early treatment with functional appliances reduced the incidence of incisal trauma compared to late treatment (OR 0.56, 95% CI 0.33 to 0.95; 332 participants) (moderate-quality evidence). The difference in the incidence of incisal trauma was clinically important with 30% (51/171) of participants reporting new trauma in the late treatment group compared to only 19% (31/161) of participants who had received early treatment.Two trials compared early treatment using headgear versus late treatment. After phase one of early treatment, headgear had reduced overjet and ANB; however, when both groups had completed treatment, there was no evidence of a difference between groups in overjet (MD -0.22, 95% CI -0.56 to 0.12; 238 participants) (low-quality evidence) or ANB (MD -0.27, 95% CI -0.80 to 0.26; 231 participants) (low-quality evidence). Early (two-phase) treatment with headgear reduced the incidence of incisal trauma (OR 0.45, 95% CI 0.25 to 0.80; 237 participants) (low-quality evidence), with almost half the incidence of new incisal trauma (24/117) compared to the late treatment group (44/120).Seven trials compared late treatment with functional appliances versus no treatment. There was a reduction in final overjet with both fixed functional appliances (MD -5.46 mm, 95% CI -6.63 to -4.28; 2 trials, 61 participants) and removable functional appliances (MD -4.62, 95% CI -5.33 to -3.92; 3 trials, 122 participants) (low-quality evidence). There was no evidence of a difference in final ANB between fixed functional appliances and no treatment (MD -0.53°, 95% CI -1.27 to -0.22; 3 trials, 89 participants) (low-quality evidence), but removable functional appliances seemed to reduce ANB compared to no treatment (MD -2.37°, 95% CI -3.01 to -1.74; 2 trials, 99 participants) (low-quality evidence).Six trials compared orthodontic treatment for adolescents with Twin Block versus other appliances and found no difference in overjet (0.08 mm, 95% CI -0.60 to 0.76; 4 trials, 259 participants) (low-quality evidence). The reduction in ANB favoured treatment with a Twin Block (-0.56°, 95% CI -0.96 to -0.16; 6 trials, 320 participants) (low-quality evidence).Three trials compared orthodontic treatment for adolescents with removable functional appliances versus fixed functional appliances and found a reduction in overjet in favour of fixed appliances (0.74, 95% CI 0.15 to 1.33; two trials, 154 participants) (low-quality evidence), and a reduction in ANB in favour of removable appliances (-1.04°, 95% CI -1.60 to -0.49; 3 trials, 185 participants) (low-quality evidence)., Authors' Conclusions: Evidence of low to moderate quality suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective for reducing the incidence of incisal trauma than providing one course of orthodontic treatment in adolescence. There appear to be no other advantages of providing early treatment when compared to late treatment. Low-quality evidence suggests that, compared to no treatment, late treatment in adolescence with functional appliances, is effective for reducing the prominence of upper front teeth.

Introduction: Maxillary canines are generally considered important both cosmetically and functionally. Most claims on the importance of maxillary canines, however, have been based on expert opinions and clinician-based studies. There are no scientific studies in the literature reporting on their cosmetic importance or how laypeople perceive a smile treated by maxillary canine extractions. Our objective was to investigate whether there is any difference in the perceptions of patients' smiles treated by extracting either maxillary canines or first premolars, as judged by orthodontists, dentists, and laypeople., Methods: This retrospective study included 24 participants who had unilateral or bilateral extraction of maxillary permanent canines and fixed appliances in the maxillary and mandibular arches to comprehensively correct the malocclusion, selected from orthodontic patients treated at Chesterfield Royal Hospital NHS trust in the United Kingdom over the last 20 years. The control group of patients had extraction of maxillary first premolars followed by fixed appliances and finished to an extremely high standard judged by the requirement that they had been submitted for the Membership in Orthodontics examination. The finished Peer Assessment Rating scores for this group were less than 5. The end-of-treatment frontal extraoral smiling and frontal intraoral views were presented for both groups. The photographs were blinded for extraction choice and standardized for size and brightness using computer software (Adobe Photoshop CC version 14.0; Adobe Systems, San Jose, Calif). The work file was converted to an editable pdf file and e-mailed to the assessors. The assessor panel consisted of 30 members (10 orthodontists, 10 dentists, and 10 laypeople), who were purposely selected. The measures were rated on a 10-point Likert scale., Results: The attractiveness ratings were not statistically significantly different between the canine extraction and premolar extraction groups, with a mean difference of 0.33 (SD, 0.29) points. A 1-way repeated-measures analysis of variance to test the difference in scores among the laypeople, orthodontists, and dentists (n = 30) showed no statistically significant difference (Wilks lambda = 0.835; P = 0.138), and the Bonferroni test indicated that no pair-wise difference was statistically significant., Conclusions: No statistically significant difference was found in the smile attractiveness between canine extraction and premolar extraction patients as assessed by general dentists, laypeople, and orthodontists. Further high-quality studies are required to evaluate the effect of canine extraction and premolar substitution on functional occlusion., (Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.)

Introduction: Class III malocclusion affects between 5% and 15% of our population. The 2 most common dilemmas surrounding Class III treatment are the timing of treatment and the type of appliance. A number of appliances have been used to correct a Class III skeletal discrepancy, but there is little evidence available on their effectiveness in the long term. Similarly, early treatment of Class III malocclusion has been practiced with increasing interest. However, there has been no solid evidence on the benefits in the long term. The aim of this systematic review was to evaluate the effectiveness of orthodontic/orthopedic methods used in the early treatment of Class III malocclusion in the short and long terms., Methods: Several sources were used to identify all relevant studies independently of language. The Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Embase (Ovid), and MEDLINE (Ovid) were searched to June 2016. The selection criteria included randomized controlled trials (RCTs) and prospective controlled clinical trials (CCTs) of children between the ages of 7 and 12 years on early treatment with any type of orthodontic/orthopedic appliance compared with another appliance to correct Class III malocclusion or with an untreated control group. The primary outcome measure was correction of reverse overjet, and the secondary outcomes included skeletal changes, soft tissue changes, quality of life, patient compliance, adverse effect, Peer Assessment Rating score, and treatment time. The search results were screened for inclusion, and the data extracted by 2 independent authors. The data were analyzed using software (version 5.1, Review Manager; The Nordic Cochrane Centre, The Cochrane Collaboration; Copenhagen, Denmark). The mean differences with 95% confidence intervals were expressed for the continuous data. Random effects were carried out with high levels of clinical or statistical heterogeneity and fixed affects when the heterogeneity was low., Results: Fifteen studies, 9 RCTs and 6 CCTs, were included in this review. In the RCT group, only 3 of 9 studies were assessed at low risk of bias, and the others were at high or unclear risk of bias. All 6 CCT studies were classified as high risk of bias. Three RCTs involving 141 participants looked at the comparison between protraction facemask and untreated control. The results for reverse overjet (mean difference, 2.5 mm; 95% CI, 1.21-3.79; P = 0.0001) and ANB angle (mean difference, 3.90°; 95% CI, 3.54-4.25; P <0.0001) were statistically significant favoring the facemask group. All CCTs demonstrated a statistically significant benefit in favor of the use of each appliance. However, the studies had high risk of bias., Conclusions: There is a moderate amount of evidence to show that early treatment with a facemask results in positive improvement for both skeletal and dental effects in the short term. However, there was lack of evidence on long-term benefits. There is some evidence with regard to the chincup, tandem traction bow appliance, and removable mandibular retractor, but the studies had a high risk of bias. Further high-quality, long-term studies are required to evaluate the early treatment effects for Class III malocclusion patients., Trial Registration Number: PROSPERO CRD42015024252., (Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: The aim of this study was to develop a low-dose protocol suitable for cone beam CT (CBCT) examination of an impacted maxillary canine in children by using a combination of dosimetry with subjective and objective image quality assessment., Methods: Radiation dose and image quality measurements were made using a dental CBCT machine. An image quality phantom was used to investigate the relationship between objective image quality and dose-area product (DAP) for a broad range of exposure settings. Subjective image quality assessment was achieved using a paediatric skull phantom submerged in a water bath for the same range of exposure settings. Eight clinicians assessed each CBCT data set for nine aspects of image quality using a five-point rating scale of agreement., Results: Acceptable image quality, defined using subjective judgements by the clinicians of the skull phantom images, was achievable with DAP values of 127 mGy cm(2) or greater and a polytetrafluoroethylene (PTFE) contrast-to-noise ratio (CNR) of 4.8 or greater. A cautious choice was made to recommend a low-dose protocol of 80 kV and 3 mA for implementation into clinical practice, corresponding to a DAP value of 146 mGy cm(2) and a PTFE CNR of 5.0., Conclusion: A low-dose protocol for this particular CBCT machine was established which represents as much as a 50% reduction compared with manufacturer's recommendations., Advances in Knowledge: To the authors' best knowledge, this is the first study that addresses dose optimization in paediatric clinical protocols in dental CBCT. Furthermore, this study explores the relationship between radiation dose, objective and subjective image quality.

Unlabelled: In this article, we summarize the most clinically relevant findings of our recently updated Cochrane systematic review into the treatment of Class II Division 1 malocclusion., Methods: A systematic review of the databases was performed to identify all randomized controlled trials evaluating early treatment with functional appliances to correct Class II Division 1 malocclusion., Results: Three early treatment studies with data from 353 participants were included in this review. The results showed no significant difference for any outcomes, except new incidence of incisor trauma, which was significantly less for the early treatment group. The risk ratio analysis for new incisor trauma showed that providing early treatment reduced the risk of trauma by 33% and 41% in the functional and headgear groups, respectively. However, when the numbers needed to treat were calculated, early treatment with functional appliances prevents 1 incidence of incisal trauma for every 10 patients (95% CI, 5-174), and headgear treatment prevents 1 incidence of incisal trauma for every 6 patients (95% CI, 3-23)., Conclusions: Orthodontic treatment for young children, followed by a later phase of treatment when the child is in early adolescence, appears to reduce the incidence of new incisal trauma significantly compared with treatment that is provided in 1 phase when the child is in early adolescence. However, these data should be interpreted with caution because of the high degree of uncertainty. There are no other advantages in providing 2-phase treatment compared with 1 phase in early adolescence., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To investigate if there are any significant differences in the final inclination of the upper and lower anterior teeth of patients treated with a Roth or an MBT bracket prescription., Materials and Methods: Forty sets of posttreatment study models from patients treated using a preadjusted edgewise appliance (20 Roth and 20 MBT) were selected using predetermined inclusion and exclusion criteria. The models were masked and laser-scanned, and the final crown inclinations of UL1, UR3, and LR1 were assessed from the digital images. A two-way analysis of variance was undertaken with the dependent variable of final crown inclination and independent variables of bracket prescription (Roth or MBT) and tooth type., Results: There were no statistically significant differences in terms of the final inclination of the anterior teeth between the two bracket prescriptions (P  =  .132). Statistically significant differences were found between the final inclinations of different tooth types investigated (P < .001)., Conclusion: In this group of selected patient records, the differences in torque values between the two bracket prescriptions did not lead to any real clinically detectable differences in the final inclination of teeth.

Introduction: The objective of this 3-arm parallel randomized clinical trial was to compare the effectiveness of temporary anchorage devices (TADs), Nance button palatal arches, and headgear for anchorage supplementation in the treatment of patients with malocclusions that required maximum anchorage. This trial was conducted between August 2008 and February 2013 in 2 orthodontic departments in the United Kingdom., Methods: The study included 78 patients (ages, 12-18 years; mean age, 14.2 years) who needed maximum anchorage. Eligibility criteria included no active caries, exemplary oral hygiene, and maximum anchorage required., Outcome: The primary outcome was mesial molar movement during the period in which anchorage supplementation was required. The secondary outcomes were duration of anchorage reinforcement, number of treatment visits, number of casual and failed appointments, total treatment time, dento-occlusal change, and patients' perceptions of the method of anchorage supplementation., Randomization: Treatment allocation was implemented by contacting via the Internet the randomization center at the University of Nottingham, Clinical Trials Unit. The randomization was based on a computer-generated pseudo-random code with random permuted blocks of randomly varying size., Blinding: A research assistant who was blinded to the group allocation recorded all data., Intervention: The patients were randomly allocated to receive anchorage supplementation with TADs, a Nance button on a palatal arch, or headgear. They were all treated with maxillary and mandibular preadjusted edgewise fixed appliances with 0.022-in slot prescription brackets. They were followed until orthodontic treatment was complete., Results: Seventy-eight patients were randomized in a 1:1:1 ratio among the 3 groups. The baseline characteristics were similar in the groups, and they were treated for an average of 27.4 months (SD, 7.1 months); 71 completed orthodontic treatment. The data were analyzed on a per-protocol basis and showed no differences in the effectiveness of anchorage supplementation between TADs, Nance button palatal arches, and headgear. Compared with headgear, the average mesial movements of the maxillary right molar were 0.62 mm (-0.32 to 1.55 mm) with the Nance and -0.58 mm (-1.53 to 0.36 mm) with TADs; the maxillary left molar was moved -0.09 mm (-1.00 to 0.83 mm) with the Nance and -0.96 mm (-1.89 to -0.04 mm) with the TADs. Peer assessment rating scores were significantly better with the TADs than in the headgear and Nance groups. The patient questionnaires showed that comfort levels on placement of the TADs and the Nance were similar. Headgear was more troublesome and less popular with the patients., Conclusions: There was no difference in the effectiveness between the 3 groups in terms of anchorage support. There were more problems with the headgear and Nance buttons than with the TADs. The quality of treatment was better with TADs. As a result, TADS might be the preferred method for reinforcing orthodontic anchorage in patients who need maximum anchorage., Trial Registration: ClinicalTrials.gov Identifier: NCT00995436., Protocol: The protocol was published on the above site before the trial commencement., Funding: The British Orthodontic Society Foundation funded the study and American Orthodontics provided all the TADs and associated equipment., (Copyright © 2014 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Background: Prominent upper front teeth are a common problem affecting about a quarter of 12-year old children in the UK. The correction of this condition is one of the most common treatments performed by orthodontists. This condition develops when the child's permanent teeth erupt and children are often referred to an orthodontist for treatment with dental braces to reduce the prominence of the teeth. These teeth are more likely to be injured and their appearance can cause significant distress.If a child is referred at a young age, the orthodontist is faced with the dilemma of whether to treat the patient early or to wait until the child is older and provide treatment in early adolescence., Objectives: To assess the effects of orthodontic treatment for prominent upper front teeth when this treatment is initiated when the child is seven to 11 years old compared to when they are in early adolescence, or when treatment uses different types of orthodontic braces., Search Methods: We searched the following databases: Cochrane Oral Health Group's Trials Register (to 17 April 2013), CENTRAL (The Cochrane Library 2013, Issue 3), MEDLINE (OVID) (1946 to 17 April 2013) and EMBASE (OVID) (1980 to 17 April 2013). There were no restrictions regarding language or publication date., Selection Criteria: Randomised controlled trials of children and/or adolescents (age < 16 years) on early treatment (either one or two-phase) with any type of orthodontic braces (removable, fixed, functional) or head-braces compared with late treatment with any type of orthodontic braces or head-braces; or, on any type of orthodontic braces or head-braces compared with no treatment or another type of orthodontic brace or appliance (with treatment starting in children of similar ages in both groups) to correct prominent upper front teeth., Data Collection and Analysis: Review authors screened the search results, extracted data and assessed risk of bias independently, used odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous outcomes, mean differences (MDs) and 95% CIs for continuous outcomes and a fixed-effect model for meta-analyses as there were fewer than four studies., Main Results: We included 17 studies based on data from 721 participants.Three trials (n = 343) compared early (two-phase) treatment (7-11 years of age) with a functional appliance, with adolescent (one-phase) treatment. Statistically significant differences in overjet, ANB and PAR scores were found in favour of functional appliance when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.21, 95% CI -0.10 to 0.51, P = 0.18) (low quality evidence), final ANB (MD -0.02, 95% CI -0.47 to 0.43, P = 0.92), PAR score (MD 0.62, 95% CI -0.66 to 1.91, P = 0.34) or self concept score (MD 0.83, CI -2.31 to 3.97, P = 0.60). However, two-phase treatment with functional appliance showed a statistically significant reduction in the incidence of incisal trauma (OR 0.59, 95% CI 0.35 to 0.99, P = 0.04) (moderate quality evidence). The incidence of incisal trauma was clinically significant with 29% (54/185) of patients reporting new trauma incidence in the adolescent (one-phase) treatment group compared to only 20% (34/172) of patients receiving early (two-phase) treatment.Two trials (n = 285), compared early (two-phase) treatment using headgear, with adolescent (one-phase) treatment. Statistically significant differences in overjet and ANB were found in favour of headgear when the first phase of early treatment was compared with observation in the children due to receive treatment in adolescence. However, at the end of treatment in both groups, there was no evidence of a difference in the overjet (MD 0.22, 95% CI -0.56 to 0.12, P = 0.20) (low quality evidence), final ANB (MD -0.27, 95% CI -0.80 to 0.26, P = 0.32) or PAR score (MD -1.55, 95% CI -3.70 to 0.60, P = 0.16). The incidence of incisal trauma was, however, statistically significantly reduced in the two-phase treatment group (OR 0.47, 95% CI 0.27 to 0.83, P = 0.009) (low quality evidence). The adolescent treatment group showed twice the incidence of incisal trauma (47/120) compared to the young children group (27/117).Two trials (n = 282) compared different types of appliances (headgear and functional appliance) for early (two-phase) treatment. At the end of the first phase of treatment statistically significant differences, in favour of functional appliances, were shown with respect to final overjet only. At the end of phase two, there was no evidence of a difference between appliances with regard to overjet (MD -0.21, 95% CI -0.57 to 0.15, P = 0.26), final ANB (MD -0.17, 95% CI -0.67 to 0.34, P= 0.52), PAR score (MD -0.81, 95% CI -2.21 to 0.58, P = 0.25) or the incidence of incisal trauma (OR 0.79, 95% CI 0.43 to 1.44, P = 0.44).Late orthodontic treatment for adolescents with functional appliances showed a statistically significant reduction in overjet of -5.22 mm (95% CI -6.51 to -3.93, P < 0.00001) and ANB of -2.37° (95% CI -3.01 to -1.74, P < 0.00001) when compared to no treatment (very low quality evidence).There was no evidence of a difference in overjet when Twin Block was compared to other appliances (MD 0.01, 95% CI -0.45 to 0.48, P = 0.95). However, a statistically significant reduction in ANB (-0.63°, 95% CI -1.17 to -0.08, P = 0.02) was shown in favour of Twin Block. There was no evidence of a difference in any reported outcome when Twin Block was compared with modifications of Twin Block.There was insufficient evidence to determine the effects of Activator, FORSUS FRD EZ appliances, R-appliance or AIBP., Authors' Conclusions: The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is more effective in reducing the incidence of incisal trauma than providing one course of orthodontic treatment when the child is in early adolescence. There appears to be no other advantages for providing treatment early when compared to treatment in adolescence.

Background: When orthodontic treatment is provided with fixed appliances, it is sometimes necessary to move the upper molar teeth backwards (distalise) to create space or help to overcome anchorage requirements. This can be achieved with the use of extraoral or intraoral appliances. The most common appliance is extraoral headgear, which requires considerable patient co-operation. Further, reports of serious injuries have been published. Intraoral appliances have been developed to overcome such shortcomings. The comparative effects of extraoral and intraoral appliances have not been fully evaluated., Objectives: To assess the effects of orthodontic treatment for distalising upper first molars in children and adolescents., Search Methods: We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 10 December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 11), MEDLINE via OVID (1946 to 10 December 2012) and EMBASE via OVID (1980 to 10 December 2012). No restrictions were placed on the language or date of publication when searching the electronic databases., Selection Criteria: Randomised clinical trials involving the use of removable or fixed orthodontic appliances intended to distalise upper first molars in children and adolescents., Data Collection and Analysis: We used the standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of the risk of bias independently and in duplicate. We contacted authors to clarify the inclusion criteria of the studies., Main Results: Ten studies, reporting data from 354 participants, were included in this review, the majority of which were carried out in a university dental hospital setting. The studies were published between 2005 and 2011 and were conducted in Europe and in Brazil. The age range of participants was from nine to 15 years, with an even distribution of males and females in seven of the studies, and a slight predominance of female patients in three of the studies. The quality of the studies was generally poor; seven studies were at an overall high risk of bias, three studies were at an unclear risk of bias, and we judged no study to be at low risk of bias.We carried out random-effects meta-analyses as appropriate for the primary clinical outcomes of movement of upper first molars (mm), and loss of anterior anchorage, where there were sufficient data reported in the primary studies. Four studies, involving 159 participants, compared a distalising appliance to an untreated control. Meta-analyses were not undertaken for all primary outcomes due to incomplete reporting of all summary statistics, expected outcomes, and differences between the types of appliances. The degree and direction of molar movement and loss of anterior anchorage varied with the type of appliance. Four studies, involving 150 participants, compared a distalising appliance versus headgear. The mean molar movement for intraoral distalising appliances was -2.20 mm and -1.04 mm for headgear. There was a statistically significant difference in mean distal molar movement (mean difference (MD) -1.45 mm; 95% confidence interval (CI) -2.74 to -0.15) favouring intraoral appliances compared to headgear (four studies, high or unclear risk of bias, 150 participants analysed). However, a statistically significant difference in mean mesial upper incisor movement (MD 1.82 mm; 95% CI 1.39 to 2.24) and overjet (fixed-effect: MD 1.64 mm; 95% CI 1.26 to 2.02; two studies, unclear risk of bias, 70 participants analysed) favoured headgear, i.e. there was less loss of anterior anchorage with headgear. We reported direct comparisons of intraoral appliances narratively due to the variation in interventions (three studies, high or unclear risk of bias, 93 participants randomised). All appliances were reported to provide some degree of distal movement, and loss of anterior anchorage varied with the type of appliance.No included studies reported on the incidence of adverse effects (harm, injury), number of attendances or rate of non-compliance., Authors' Conclusions: It is suggested that intraoral appliances are more effective than headgear in distalising upper first molars. However, this effect is counteracted by loss of anterior anchorage, which was not found to occur with headgear when compared with intraoral distalising appliance in a small number of studies. The number of trials assessing the effects of orthodontic treatment for distilisation is low, and the current evidence is of low or very low quality.

Introduction: The aim of this study was to evaluate the effectiveness of orthodontic/orthognathic surgical care provided in the North West region of England. It was an observational, prospective cohort study at 13 maxillofacial clinics in the United Kingdom., Methods: The 131 patients comprised 47 males (35.9%) and 84 females (64.1%), with an average age of 22.6 years. They received orthodontic/orthognathic treatment according to the normal protocols of the operators. They were then followed until all orthodontic treatment was completed. Final skeletal pattern, final peer assessment rating score, number of attendances, and duration of treatment were recorded., Results: At the end of the 5-year study, 94 patients had completed treatment, and 71 had complete data. Data analysis showed that, overall, the treatments provided were effective in terms of skeletal and dental occlusal outcomes; the final mean peer assessment rating score was 10.58. However, treatment duration was longer than commonly expected, with a mean length of 32.8 months (SD,11.3). The outcome of treatment was influenced by only pretreatment skeletal discrepancy., Conclusions: This prospective investigation showed that orthodontic/orthognathic surgical care was effective. The outcome of treatment was influenced only by the severity of the pretreatment skeletal discrepancy.

Introduction: The aim of this study was to evaluate the effectiveness of early orthodontic treatment with the Twin-block appliance for the treatment of Class II Division 1 malocclusion. This was a multi-center, randomized, controlled trial with subjects from 14 orthodontic clinics in the United Kingdom., Methods: The study included 174 children aged 8 to 10 years with Class II Division 1 malocclusion; they were randomly allocated to receive treatment with a Twin-block appliance or to an initially untreated control group. The subjects were then followed until all orthodontic treatment was completed. Final skeletal pattern, number of attendances, duration of orthodontic treatment, extraction rate, cost of treatment, and the child's self-concept were considered., Results: At the end of the 10-year study, 141 patients either completed treatment or accepted their occlusion. Data analysis showed that there was no differences between those who received early Twin-block treatment and those who had 1 course of treatment in adolescence with respect to skeletal pattern, extraction rate, and self-esteem. Those who had early treatment had more attendances, received treatment for longer times, and incurred more costs than the adolescent treatment group. They also had significantly poorer final dental occlusion., Conclusions: Twin-block treatment when a child is 8 to 9 years old has no advantages over treatment started at an average age of 12.4 years. However, the cost of early treatment to the patient in terms of attendances and length of appliance wear is increased.

Introduction: Our aims in this study were to (1) develop a method of measuring 3-dimensional (3D) tooth movement using a 3D surface laser scanner, (2) test the accuracy of this method, and (3) compare the measurements with those from cephalometric radiographs., Methods: A method of superimposing pretreatment and posttreatment models on the palatal rugae was developed, and an experimental model was prepared to evaluate the accuracy and reliability of the laser scanner. Records were obtained from a prospective longitudinal randomized clinical trial evaluating anchorage loss with headgears and midpalatal osseointegrated implants as a source of anchorage in Chesterfield, United Kingdom. The pretreatment and posttreatment study models were analyzed by using a 3D laser scanner to measure the 3D tooth movement., Results: The laser scanner was accurate to 0.0235 mm for anteroposterior measurements and 0.0071 mm for buccolingual movements for every 0.5 mm of movement. The study model analysis showed that mesial molar movements were 1.38 mm on the right side and 1.11 mm on the left side for the implant group, and 2.24 mm on right side and 1.63 mm on left side for the headgear group, with no statistically significant difference between the groups. The results for vertical movement of molars showed extrusion on both sides in both groups but no statistically significant difference between the groups. In the transverse plane, the results were not statistically significantly different between the groups. The results from superimposition of lateral cephalograms were similar to those obtained from the scanner., Conclusions: The 3D laser scanner provides accurate and reliable measurements of tooth displacement and can be considered an alternative to cephalometric radiographs.

Introduction: Various anchorage techniques have been designed for canine retraction. Intraoral techniques have not always been successful, and now implants are widely used for this purpose. A new type of titanium microimplant, with a small diameter and a button-like head, was shown to be an effective source of anchorage for distal movement of the canines. The purposes of this study were to measure and compare the rates of canine retraction with titanium microimplant anchorage and conventional molar anchorage., Methods: The sample comprised 12 patients (8 female, 4 male; mean age, 19.7 years; range, 16-22 years) who were scheduled for extraction of all first premolars. After leveling and aligning, titanium microimplants 1.2 mm in diameter and 9 mm in length were placed between the roots of the second premolar and the first molars. The implants were placed in the maxillary and mandibular arches on the same side in 10 patients and in the maxilla only in 2 patients. A brass wire guide and a periapical radiograph were used to determine the implant position. After 15 days, the implants and the molars were loaded with closed coil springs with a force of 100 g for canine retraction. Preretraction and postretraction lateral cephalograms were taken and superimposed for measuring the amount of retraction. The amount of canine retraction was measured from pterygoid vertical in the maxilla and SN perpendicular in the mandible., Results: Mean canine retraction amounts were 4.29 mm in the maxilla and 4.10 mm in the mandible on the implant-anchorage side, and 3.79 mm in the maxilla and 3.75 mm in the mandible on the molar-anchorage side. The rates of canine retraction were 0.93 mm per month in the maxilla and 0.83 mm per month in the mandible on the implant-anchored side, and 0.81 mm per month in the maxilla and 0.76 mm per month in the mandible on the molar-anchored side., Conclusions: Canine retraction proceeds at a faster rate when titanium microimplants are used for anchorage.

Introduction: The objective of this study was to compare the effectiveness of midpalatal implants with that of headgear as methods of supplementing anchorage during orthodontic treatment. This was a randomized, clinical trial at the Chesterfield and North Derbyshire Royal Hospital NHS Trust and the Charles Clifford Dental Hospital, Sheffield, United Kingdom., Methods: Fifty-one orthodontic patients between the ages of 12 and 39 with absolute anchorage requirements were randomly allocated to receive either a midpalatal implant or headgear to reinforce orthodontic anchorage. The outcome measures of the trial were the surgical and orthodontic success rates of the implants, the number of visits, and the length of treatment time, and the success of treatment as judged by the peer assessment rating (PAR) score reductions and the patients' attitudes to implant placement., Results: The surgical success rate of the implants was 75%, and the orthodontic success rate was more than 90%. Both implants and headgear proved to be effective methods of reinforcing anchorage. The total number of visits was greater in the implant group, but the overall treatment times were almost identical. There were no statistically significant differences between the 2 groups in PAR scores either at the start or the end of treatment, and the percentages of PAR score reductions were almost identical. The patients had no problems accepting midpalatal implants as a method of reinforcing anchorage., Conclusions: Midpalatal implants are an acceptable technique for reinforcing anchorage in orthodontic patients and a good alternative for patients who do not wish to wear headgear.

Objective: A long-term comparison of the failure rates of orthodontic brackets bonded with either a self-etching primer (SEP) or conventional etch and primer (AE)., Design: Prospective randomized controlled clinical trial., Setting: UK district general hospital with one operator, 2003-6., Participants: Hospital waiting list patients needing fixed appliances (n=60)., Method: Experimental (SEP) group patients (n=30) received pre-adjusted edgewise brackets (n=438) bonded with Transbond Plus following manufacturer's instructions. Control (AE) group patients (n=30, brackets n=433) were bonded using a 15-second conventional etch and primer (Transbond XT). In both groups brackets were light-cured for 20 seconds. First-time bond failures were recorded with the time of failure. Bracket bonding time was recorded. All patients were followed to the end or discontinuation of treatment., Results: Bracket failure rates: SEP=4.8%, AE=3.5%, P=0.793. Mean placement time per bracket (seconds): SEP=75.5 (+/-6.7; 95% CI=72.9, 78.0), AE=97.7 (+/-9.1; 95% CI=94.3, 101.2) P=0.000., Conclusion: There was no difference in the failure rates of brackets bonded with either Transbond Plus SEP or conventional AE using Transbond XT paste. Bonding with SEP was significantly faster than using conventional AE.