Editor's Choice

Abstract

With the burgeoning of prescription and over-the-counter drug use, this systematic review from Nijmegen, The Netherlands, is essential information for all dental practitioners. Do you react differently when planning treatment for a person who has been taking bisphosphonates compared with someone taking NSAIDS, raloxifene, or estrogens? A newer treatment for osteoporosis, raloxifene, will probably be in the same category as estrogen for decreased tooth movement. So far, only bisphosphonates have been linked in the literature to severe dental adverse effects, including slower tooth movement and bone healing and, possibly, the end-stage pathology of necrosis. According to these authors, most published articles have been related to general bone physiology in terms of density, mineralization, turnover rate, and osteoclast differentiation. In addition, clinical side effects, including gingival hyperplasia, xerostomia, and external root resorption, can be induced by medications. However, most reviews have not reported on the effects of medications on the rate of orthodontic tooth movement itself. This systematic review focuses mainly on orthodontic tooth movement, based primarily on well-controlled animal studies. With the average American receiving more than 10 prescriptions every year, the orthodontist must try to identify their effects by carefully questioning each patient about medication history and consumption of food supplements. These researchers also recommend “that such an inquiry be a part of every orthodontic diagnosis.” This prospective clinical trial was conducted to determine the efficiency of tooth movement with removable aligners (Invisalign, Align Technology, Santa Clara, Calif). The authors used software to compare predicted and actual tooth movements. Throughout the article, they identify this as the “accuracy of tooth movement”; in other words, “how efficient is the appliance?” The purpose of this study was clear. A better understanding of how teeth respond to Invisalign treatment might help the clinician select more suitable patients for treatment. A total of 38 consecutively treated patients were enrolled in this clinical study. The mean accuracy of Invisalign for all tooth movements was 41%. The highest accuracy was achieved during lingual constriction (47.1%), and the lowest during extrusion (29.6%). The least accurate tooth movements were related to extrusion of the maxillary (18.3%) and mandibular (24.5%) central incisors. Despite the relatively low mean accuracy for some movements, over one-quarter of tooth movements in the study were at least 70% accurate. Although improvement of anterior overbite has been reported in the literature, significant correction of a deep overbite with Invisalign treatment appears to be unlikely. Overall, the results of this prospective study indicate that we still have much to learn about the efficacy of the Invisalign system. How much of your working life have you spent trying to bond mandibular premolar brackets correctly? If they are positioned too high, it is often impossible to achieve ideal occlusal interdigitation during finishing; if the teeth are not fully erupted, it is often impossible to bond the brackets low enough. The purpose of this randomized controlled clinical trial was to compare the clinical bond failure rate of gingivally offset mandibular premolar brackets with that of standard premolar brackets in an everyday clinical setting. Do gingivally offset brackets work any better in clinical practice? Even moderate reductions in bond failure have significant benefits for patients and orthodontists. Using a crossover bracket design in 80 subjects, these authors found that the gingivally offset premolar brackets had a lower failure rate, and the difference was both statistically and clinically significant.