Residents' journal review

Abstract

A systematic review of vertical stability for surgical orthodontic treatmentsSolano-Hernández B, Antonarakis GS, Scolozzi P, Kiliaridis S. Combined orthodontic and orthognathic surgical treatment for the correction of skeletal anterior open-bite malocclusion: a systematic review on vertical stability. J Oral Maxillofac Surg 2013;71:98-109Anterior open-bite malocclusions, often treated with a combined orthodontic and surgical approach, are a great challenge for orthodontists during both treatment and retention. The aim of this review was to evaluate the vertical stability of combined orthodontic and surgical treatment of skeletal anterior open-bite malocclusions by using different surgical techniques and fixation. A literature search yielded 9 studies pertaining to vertical stability after combined orthodontic and surgical treatment; all were retrospective, and most were graded as having a low level of evidence. The data from these studies were evaluated based on the type of surgical procedure and the length of follow-up, with a 2-year cutoff to differentiate short-term from long-term follow-ups. There were wide variations in relapse after combined orthodontic and orthognathic surgical treatment for skeletal anterior open bite. Relapses of overbite (>2 mm bite opening) were seen in 16% of long-term follow-ups after LeFort I osteotomy and in 13% of short-term follow-ups after bilateral sagittal split osteotomy, yet no changes were greater than 2 mm after bimaxillary surgery. Increases of the mandibular plane angle (>2°) were evident during the short-term follow-ups after bimaxillary surgery, but only evident during long-term follow-ups after LeFort I osteotomies. Additionally, greater increases in the intermaxillary plane angle and anterior facial height tended to be seen in patients after bimaxillary surgery, compared with other surgical interventions. No conclusions could be drawn from the included studies about the influence of the type of fixation on vertical stability. Long-term skeletal relapse appears to be more prevalent after bimaxillary surgery for correction of anterior open-bite malocclusion, although there is a need for well-designed prospective studies with control groups investigating vertical relapse after various surgical interventions.Reviewed by Michael PayneRetention stability randomized controlled trialEdman Tynelius G, Bondemark L, Lilja-Karlander E. A randomized controlled trial of three orthodontic retention methods in Class I four premolar extraction cases—stability after 2 years in retention. Orthod Craniofac Res 2013 Jan 3 [Epub ahead of print]Maintaining the results of orthodontic treatment is a challenge despite all the advances in contemporary orthodontics. This randomized controlled trial compared 3 retention protocols: group V-CTC (2-mm vacuum-formed maxillary retainer, bonded mandibular canine-to-canine retainer), group V-S (vacuum-formed maxillary retainer with 0.22-0.34 mm stripping of 10 proximal mandibular anterior surfaces), and group P (prefabricated positioner covering all erupted teeth). The sample included 75 patients treated with 4 premolar extractions and fixed appliances. Their instructed wear time for the vacuum retainers was 22 to 24 hours per day for the first 2 days, followed by nighttime use for 12 months, and 30 minutes during the day and while sleeping for 12 months for the positioner. In the second year, all patients were on an every-other-night schedule. Mean age at the start of retention was 14.4 years. Study casts were obtained before treatment, at debond, and at 12 and 24 months into retention. Little's irregularity index, intercanine and intermolar widths of the maxilla and the mandible, arch length, overjet, overbite, and body height were measured. Values less than 3.5 mm for Little's irregularity index were defined as successful for retention. All 3 methods were successful in retaining the treatment results, although there was a significant difference among the protocols with Little's irregularity index for the groups: V-CTC (0.9) and V-S (1.2) vs P (2.0). The majority of relapse was in the mandibular anterior teeth during the first year of retention with minor changes during the second year. The authors suggested avoiding indiscriminate use of bonded lingual retainers and choosing retention appliances according to the initial diagnosis, cooperation, and oral hygiene.Reviewed by Manika PatwariSoft-tissue cephalometric norms for surgical approachShindoi JM, Matsumoto Y, Sato, Y, Ono T, Harada K. Soft tissue cephalometric norms for orthognathic and cosmetic surgery. J Oral Maxillofac Surg 2013;71:e24-30Ethnic and sex variations in soft-tissue thicknesses have great importance in diagnosis and treatment planning for orthodontic and orthognathic surgery patients, especially in the lower and middle thirds of the face. Japanese patients with normal occlusion are considered more dolichofacial with a retruded maxilla and a flatter profile. Variance of the soft-tissue envelope complicates the accurate assessment of these proportions. The purpose of this study was to identify sex differences and establish norms for young Japanese adults by using soft-tissue cephalometric analysis in the diagnosis and treatment planning of orthognathic and cosmetic surgery cases. Lateral cephalograms of 49 young subjects (19 men, 30 women; ages, 18-30 years) were retrospectively selected from the archival records of Tokyo Medical and Dental University Hospital. All subjects had a Class I molar relationship with minor crowding and a well-balanced facial profile with no previous orthodontic treatment or orthognathic surgery. The cephalometric norms, standard deviations, and significance values were calculated. The results showed significant differences in facial morphology between the sexes. Men had a flat occlusal plane, a more retruded orbital rim to the jaw, and an acute nasolabial angle. They had greater values for thickness of soft-tissue menton and the upper and lower lips. Men also had a longer vertical face, more so in the lower third. Women had a more projected midface and a convex profile. The authors believe that these differences should be kept in mind by orthodontists and surgeons during treatment planning.Reviewed by Syrah QuraishiNo pain, no gain? Effect of laser therapy on painDomínguez A, Velásquez SA. Effect of low-level laser therapy on pain following activation of orthodontic final archwires: a randomized controlled clinical trial. Photomed Laser Surg 2013;31:36-40The fourth highest reason for fear and apprehension for orthodontic patients is the pain associated with treatment. Many approaches have been used to ease the patient's pain experience, such as pain-reducing oral and topical medications, chewing gum, and acupuncture. Laser therapy has been indicated as a safe and efficient method to increase the rate of orthodontic tooth movement and for pain relief during the initial stages of treatment and canine retraction. The goal of this study was to investigate the pain relieving effects of GaAlAs lasers during the finishing stages of orthodontic treatment. Sixty patients were included in this split-mouth study. Thirty patients were treated with conventionally ligated straight-wire brackets, and 30 were treated with self-ligating brackets. The type of bracket system used and the arch to be irradiated were randomized. Upon placement of the final 0.019 × 0.025-in stainless steel archwire, the selected arch was irradiated with a GaAlAs laser at a wavelength of 830 nm for 22 seconds along the vestibular surface and 22 seconds along the palatal surface of the roots. The opposite arch was the placebo treated for the same amount of time. Patients scored their pain experience on a 100-mm scale after 2, 6, and 24 hours, and 2, 3, and 7 days. Each arch was scored separately. The maximum pain experienced for all treatment groups was at 24 hours after activation. The average pain experience between bracket types was not significantly different, whereas the pain reported for the irradiated arch was statically less than in the placebo group. Although the decrease in pain after laser irradiation has been shown to be statistically significant, it might not be clinically significant. Further cost-benefit analyses would likely be necessary before implementing this type of laser therapy into practice.Reviewed by Jake SpendloveDentoskeletal changes after Class II Division 1 Herbst treatmentBock NC, Ruf S. Dentoskeletal changes in adult Class II division 1 Herbst treatment—how much is left after the retention period? Eur J Orthod 2012;34:747-53Several articles have been published on the use of a Herbst appliance in adult Class II Division 1 patients as an alternative to orthognathic surgery or camouflage treatment. However, few authors have investigated the stability after Herbst treatment in adults. The purpose of this study was to analyze the dentoskeletal changes after treatment with a Herbst appliance in white Class II Division 1 adult patients. Fifteen patients (11 women, 4 men) with a Class II Division 1 malocclusion were treated with Herbst and fixed appliances at the University of Giessen in Germany. Their mean age was 25.6 years at the beginning of treatment; a hand-wrist radiograph was taken to ensure that growth had ceased. The patients were treated for an average of 22.9 months and monitored through retention for an average of 35.5 months. Skeletal and dental changes were observed in the lateral cephalometric radiographs acquired before treatment, after Herbst and fixed appliance treatment, and after retention. The amount of skeletal change was drastically less in adults compared with previously reported amounts of skeletal change in adolescents. Significant changes in molar relationship, overjet, overbite, incisor angulation, and profile convexity were observed after treatment, and the minimal relapse after the retention period was considered clinically irrelevant. Whereas only minor skeletal changes were maintained after the retention period, Herbst and fixed appliance treatment provided a stable result in correcting Class II Division 1 malocclusions in borderline adult patients.Reviewed by Nicholas Valeri A systematic review of vertical stability for surgical orthodontic treatmentsSolano-Hernández B, Antonarakis GS, Scolozzi P, Kiliaridis S. Combined orthodontic and orthognathic surgical treatment for the correction of skeletal anterior open-bite malocclusion: a systematic review on vertical stability. J Oral Maxillofac Surg 2013;71:98-109Anterior open-bite malocclusions, often treated with a combined orthodontic and surgical approach, are a great challenge for orthodontists during both treatment and retention. The aim of this review was to evaluate the vertical stability of combined orthodontic and surgical treatment of skeletal anterior open-bite malocclusions by using different surgical techniques and fixation. A literature search yielded 9 studies pertaining to vertical stability after combined orthodontic and surgical treatment; all were retrospective, and most were graded as having a low level of evidence. The data from these studies were evaluated based on the type of surgical procedure and the length of follow-up, with a 2-year cutoff to differentiate short-term from long-term follow-ups. There were wide variations in relapse after combined orthodontic and orthognathic surgical treatment for skeletal anterior open bite. Relapses of overbite (>2 mm bite opening) were seen in 16% of long-term follow-ups after LeFort I osteotomy and in 13% of short-term follow-ups after bilateral sagittal split osteotomy, yet no changes were greater than 2 mm after bimaxillary surgery. Increases of the mandibular plane angle (>2°) were evident during the short-term follow-ups after bimaxillary surgery, but only evident during long-term follow-ups after LeFort I osteotomies. Additionally, greater increases in the intermaxillary plane angle and anterior facial height tended to be seen in patients after bimaxillary surgery, compared with other surgical interventions. No conclusions could be drawn from the included studies about the influence of the type of fixation on vertical stability. Long-term skeletal relapse appears to be more prevalent after bimaxillary surgery for correction of anterior open-bite malocclusion, although there is a need for well-designed prospective studies with control groups investigating vertical relapse after various surgical interventions.Reviewed by Michael Payne Solano-Hernández B, Antonarakis GS, Scolozzi P, Kiliaridis S. Combined orthodontic and orthognathic surgical treatment for the correction of skeletal anterior open-bite malocclusion: a systematic review on vertical stability. J Oral Maxillofac Surg 2013;71:98-109Anterior open-bite malocclusions, often treated with a combined orthodontic and surgical approach, are a great challenge for orthodontists during both treatment and retention. The aim of this review was to evaluate the vertical stability of combined orthodontic and surgical treatment of skeletal anterior open-bite malocclusions by using different surgical techniques and fixation. A literature search yielded 9 studies pertaining to vertical stability after combined orthodontic and surgical treatment; all were retrospective, and most were graded as having a low level of evidence. The data from these studies were evaluated based on the type of surgical procedure and the length of follow-up, with a 2-year cutoff to differentiate short-term from long-term follow-ups. There were wide variations in relapse after combined orthodontic and orthognathic surgical treatment for skeletal anterior open bite. Relapses of overbite (>2 mm bite opening) were seen in 16% of long-term follow-ups after LeFort I osteotomy and in 13% of short-term follow-ups after bilateral sagittal split osteotomy, yet no changes were greater than 2 mm after bimaxillary surgery. Increases of the mandibular plane angle (>2°) were evident during the short-term follow-ups after bimaxillary surgery, but only evident during long-term follow-ups after LeFort I osteotomies. Additionally, greater increases in the intermaxillary plane angle and anterior facial height tended to be seen in patients after bimaxillary surgery, compared with other surgical interventions. No conclusions could be drawn from the included studies about the influence of the type of fixation on vertical stability. Long-term skeletal relapse appears to be more prevalent after bimaxillary surgery for correction of anterior open-bite malocclusion, although there is a need for well-designed prospective studies with control groups investigating vertical relapse after various surgical interventions.Reviewed by Michael Payne Anterior open-bite malocclusions, often treated with a combined orthodontic and surgical approach, are a great challenge for orthodontists during both treatment and retention. The aim of this review was to evaluate the vertical stability of combined orthodontic and surgical treatment of skeletal anterior open-bite malocclusions by using different surgical techniques and fixation. A literature search yielded 9 studies pertaining to vertical stability after combined orthodontic and surgical treatment; all were retrospective, and most were graded as having a low level of evidence. The data from these studies were evaluated based on the type of surgical procedure and the length of follow-up, with a 2-year cutoff to differentiate short-term from long-term follow-ups. There were wide variations in relapse after combined orthodontic and orthognathic surgical treatment for skeletal anterior open bite. Relapses of overbite (>2 mm bite opening) were seen in 16% of long-term follow-ups after LeFort I osteotomy and in 13% of short-term follow-ups after bilateral sagittal split osteotomy, yet no changes were greater than 2 mm after bimaxillary surgery. Increases of the mandibular plane angle (>2°) were evident during the short-term follow-ups after bimaxillary surgery, but only evident during long-term follow-ups after LeFort I osteotomies. Additionally, greater increases in the intermaxillary plane angle and anterior facial height tended to be seen in patients after bimaxillary surgery, compared with other surgical interventions. No conclusions could be drawn from the included studies about the influence of the type of fixation on vertical stability. Long-term skeletal relapse appears to be more prevalent after bimaxillary surgery for correction of anterior open-bite malocclusion, although there is a need for well-designed prospective studies with control groups investigating vertical relapse after various surgical interventions. Reviewed by Michael Payne Retention stability randomized controlled trialEdman Tynelius G, Bondemark L, Lilja-Karlander E. A randomized controlled trial of three orthodontic retention methods in Class I four premolar extraction cases—stability after 2 years in retention. Orthod Craniofac Res 2013 Jan 3 [Epub ahead of print]Maintaining the results of orthodontic treatment is a challenge despite all the advances in contemporary orthodontics. This randomized controlled trial compared 3 retention protocols: group V-CTC (2-mm vacuum-formed maxillary retainer, bonded mandibular canine-to-canine retainer), group V-S (vacuum-formed maxillary retainer with 0.22-0.34 mm stripping of 10 proximal mandibular anterior surfaces), and group P (prefabricated positioner covering all erupted teeth). The sample included 75 patients treated with 4 premolar extractions and fixed appliances. Their instructed wear time for the vacuum retainers was 22 to 24 hours per day for the first 2 days, followed by nighttime use for 12 months, and 30 minutes during the day and while sleeping for 12 months for the positioner. In the second year, all patients were on an every-other-night schedule. Mean age at the start of retention was 14.4 years. Study casts were obtained before treatment, at debond, and at 12 and 24 months into retention. Little's irregularity index, intercanine and intermolar widths of the maxilla and the mandible, arch length, overjet, overbite, and body height were measured. Values less than 3.5 mm for Little's irregularity index were defined as successful for retention. All 3 methods were successful in retaining the treatment results, although there was a significant difference among the protocols with Little's irregularity index for the groups: V-CTC (0.9) and V-S (1.2) vs P (2.0). The majority of relapse was in the mandibular anterior teeth during the first year of retention with minor changes during the second year. The authors suggested avoiding indiscriminate use of bonded lingual retainers and choosing retention appliances according to the initial diagnosis, cooperation, and oral hygiene.Reviewed by Manika Patwari Edman Tynelius G, Bondemark L, Lilja-Karlander E. A randomized controlled trial of three orthodontic retention methods in Class I four premolar extraction cases—stability after 2 years in retention. Orthod Craniofac Res 2013 Jan 3 [Epub ahead of print]Maintaining the results of orthodontic treatment is a challenge despite all the advances in contemporary orthodontics. This randomized controlled trial compared 3 retention protocols: group V-CTC (2-mm vacuum-formed maxillary retainer, bonded mandibular canine-to-canine retainer), group V-S (vacuum-formed maxillary retainer with 0.22-0.34 mm stripping of 10 proximal mandibular anterior surfaces), and group P (prefabricated positioner covering all erupted teeth). The sample included 75 patients treated with 4 premolar extractions and fixed appliances. Their instructed wear time for the vacuum retainers was 22 to 24 hours per day for the first 2 days, followed by nighttime use for 12 months, and 30 minutes during the day and while sleeping for 12 months for the positioner. In the second year, all patients were on an every-other-night schedule. Mean age at the start of retention was 14.4 years. Study casts were obtained before treatment, at debond, and at 12 and 24 months into retention. Little's irregularity index, intercanine and intermolar widths of the maxilla and the mandible, arch length, overjet, overbite, and body height were measured. Values less than 3.5 mm for Little's irregularity index were defined as successful for retention. All 3 methods were successful in retaining the treatment results, although there was a significant difference among the protocols with Little's irregularity index for the groups: V-CTC (0.9) and V-S (1.2) vs P (2.0). The majority of relapse was in the mandibular anterior teeth during the first year of retention with minor changes during the second year. The authors suggested avoiding indiscriminate use of bonded lingual retainers and choosing retention appliances according to the initial diagnosis, cooperation, and oral hygiene.Reviewed by Manika Patwari Maintaining the results of orthodontic treatment is a challenge despite all the advances in contemporary orthodontics. This randomized controlled trial compared 3 retention protocols: group V-CTC (2-mm vacuum-formed maxillary retainer, bonded mandibular canine-to-canine retainer), group V-S (vacuum-formed maxillary retainer with 0.22-0.34 mm stripping of 10 proximal mandibular anterior surfaces), and group P (prefabricated positioner covering all erupted teeth). The sample included 75 patients treated with 4 premolar extractions and fixed appliances. Their instructed wear time for the vacuum retainers was 22 to 24 hours per day for the first 2 days, followed by nighttime use for 12 months, and 30 minutes during the day and while sleeping for 12 months for the positioner. In the second year, all patients were on an every-other-night schedule. Mean age at the start of retention was 14.4 years. Study casts were obtained before treatment, at debond, and at 12 and 24 months into retention. Little's irregularity index, intercanine and intermolar widths of the maxilla and the mandible, arch length, overjet, overbite, and body height were measured. Values less than 3.5 mm for Little's irregularity index were defined as successful for retention. All 3 methods were successful in retaining the treatment results, although there was a significant difference among the protocols with Little's irregularity index for the groups: V-CTC (0.9) and V-S (1.2) vs P (2.0). The majority of relapse was in the mandibular anterior teeth during the first year of retention with minor changes during the second year. The authors suggested avoiding indiscriminate use of bonded lingual retainers and choosing retention appliances according to the initial diagnosis, cooperation, and oral hygiene. Reviewed by Manika Patwari Soft-tissue cephalometric norms for surgical approachShindoi JM, Matsumoto Y, Sato, Y, Ono T, Harada K. Soft tissue cephalometric norms for orthognathic and cosmetic surgery. J Oral Maxillofac Surg 2013;71:e24-30Ethnic and sex variations in soft-tissue thicknesses have great importance in diagnosis and treatment planning for orthodontic and orthognathic surgery patients, especially in the lower and middle thirds of the face. Japanese patients with normal occlusion are considered more dolichofacial with a retruded maxilla and a flatter profile. Variance of the soft-tissue envelope complicates the accurate assessment of these proportions. The purpose of this study was to identify sex differences and establish norms for young Japanese adults by using soft-tissue cephalometric analysis in the diagnosis and treatment planning of orthognathic and cosmetic surgery cases. Lateral cephalograms of 49 young subjects (19 men, 30 women; ages, 18-30 years) were retrospectively selected from the archival records of Tokyo Medical and Dental University Hospital. All subjects had a Class I molar relationship with minor crowding and a well-balanced facial profile with no previous orthodontic treatment or orthognathic surgery. The cephalometric norms, standard deviations, and significance values were calculated. The results showed significant differences in facial morphology between the sexes. Men had a flat occlusal plane, a more retruded orbital rim to the jaw, and an acute nasolabial angle. They had greater values for thickness of soft-tissue menton and the upper and lower lips. Men also had a longer vertical face, more so in the lower third. Women had a more projected midface and a convex profile. The authors believe that these differences should be kept in mind by orthodontists and surgeons during treatment planning.Reviewed by Syrah Quraishi Shindoi JM, Matsumoto Y, Sato, Y, Ono T, Harada K. Soft tissue cephalometric norms for orthognathic and cosmetic surgery. J Oral Maxillofac Surg 2013;71:e24-30Ethnic and sex variations in soft-tissue thicknesses have great importance in diagnosis and treatment planning for orthodontic and orthognathic surgery patients, especially in the lower and middle thirds of the face. Japanese patients with normal occlusion are considered more dolichofacial with a retruded maxilla and a flatter profile. Variance of the soft-tissue envelope complicates the accurate assessment of these proportions. The purpose of this study was to identify sex differences and establish norms for young Japanese adults by using soft-tissue cephalometric analysis in the diagnosis and treatment planning of orthognathic and cosmetic surgery cases. Lateral cephalograms of 49 young subjects (19 men, 30 women; ages, 18-30 years) were retrospectively selected from the archival records of Tokyo Medical and Dental University Hospital. All subjects had a Class I molar relationship with minor crowding and a well-balanced facial profile with no previous orthodontic treatment or orthognathic surgery. The cephalometric norms, standard deviations, and significance values were calculated. The results showed significant differences in facial morphology between the sexes. Men had a flat occlusal plane, a more retruded orbital rim to the jaw, and an acute nasolabial angle. They had greater values for thickness of soft-tissue menton and the upper and lower lips. Men also had a longer vertical face, more so in the lower third. Women had a more projected midface and a convex profile. The authors believe that these differences should be kept in mind by orthodontists and surgeons during treatment planning.Reviewed by Syrah Quraishi Ethnic and sex variations in soft-tissue thicknesses have great importance in diagnosis and treatment planning for orthodontic and orthognathic surgery patients, especially in the lower and middle thirds of the face. Japanese patients with normal occlusion are considered more dolichofacial with a retruded maxilla and a flatter profile. Variance of the soft-tissue envelope complicates the accurate assessment of these proportions. The purpose of this study was to identify sex differences and establish norms for young Japanese adults by using soft-tissue cephalometric analysis in the diagnosis and treatment planning of orthognathic and cosmetic surgery cases. Lateral cephalograms of 49 young subjects (19 men, 30 women; ages, 18-30 years) were retrospectively selected from the archival records of Tokyo Medical and Dental University Hospital. All subjects had a Class I molar relationship with minor crowding and a well-balanced facial profile with no previous orthodontic treatment or orthognathic surgery. The cephalometric norms, standard deviations, and significance values were calculated. The results showed significant differences in facial morphology between the sexes. Men had a flat occlusal plane, a more retruded orbital rim to the jaw, and an acute nasolabial angle. They had greater values for thickness of soft-tissue menton and the upper and lower lips. Men also had a longer vertical face, more so in the lower third. Women had a more projected midface and a convex profile. The authors believe that these differences should be kept in mind by orthodontists and surgeons during treatment planning. Reviewed by Syrah Quraishi No pain, no gain? Effect of laser therapy on painDomínguez A, Velásquez SA. Effect of low-level laser therapy on pain following activation of orthodontic final archwires: a randomized controlled clinical trial. Photomed Laser Surg 2013;31:36-40The fourth highest reason for fear and apprehension for orthodontic patients is the pain associated with treatment. Many approaches have been used to ease the patient's pain experience, such as pain-reducing oral and topical medications, chewing gum, and acupuncture. Laser therapy has been indicated as a safe and efficient method to increase the rate of orthodontic tooth movement and for pain relief during the initial stages of treatment and canine retraction. The goal of this study was to investigate the pain relieving effects of GaAlAs lasers during the finishing stages of orthodontic treatment. Sixty patients were included in this split-mouth study. Thirty patients were treated with conventionally ligated straight-wire brackets, and 30 were treated with self-ligating brackets. The type of bracket system used and the arch to be irradiated were randomized. Upon placement of the final 0.019 × 0.025-in stainless steel archwire, the selected arch was irradiated with a GaAlAs laser at a wavelength of 830 nm for 22 seconds along the vestibular surface and 22 seconds along the palatal surface of the roots. The opposite arch was the placebo treated for the same amount of time. Patients scored their pain experience on a 100-mm scale after 2, 6, and 24 hours, and 2, 3, and 7 days. Each arch was scored separately. The maximum pain experienced for all treatment groups was at 24 hours after activation. The average pain experience between bracket types was not significantly different, whereas the pain reported for the irradiated arch was statically less than in the placebo group. Although the decrease in pain after laser irradiation has been shown to be statistically significant, it might not be clinically significant. Further cost-benefit analyses would likely be necessary before implementing this type of laser therapy into practice.Reviewed by Jake Spendlove Domínguez A, Velásquez SA. Effect of low-level laser therapy on pain following activation of orthodontic final archwires: a randomized controlled clinical trial. Photomed Laser Surg 2013;31:36-40The fourth highest reason for fear and apprehension for orthodontic patients is the pain associated with treatment. Many approaches have been used to ease the patient's pain experience, such as pain-reducing oral and topical medications, chewing gum, and acupuncture. Laser therapy has been indicated as a safe and efficient method to increase the rate of orthodontic tooth movement and for pain relief during the initial stages of treatment and canine retraction. The goal of this study was to investigate the pain relieving effects of GaAlAs lasers during the finishing stages of orthodontic treatment. Sixty patients were included in this split-mouth study. Thirty patients were treated with conventionally ligated straight-wire brackets, and 30 were treated with self-ligating brackets. The type of bracket system used and the arch to be irradiated were randomized. Upon placement of the final 0.019 × 0.025-in stainless steel archwire, the selected arch was irradiated with a GaAlAs laser at a wavelength of 830 nm for 22 seconds along the vestibular surface and 22 seconds along the palatal surface of the roots. The opposite arch was the placebo treated for the same amount of time. Patients scored their pain experience on a 100-mm scale after 2, 6, and 24 hours, and 2, 3, and 7 days. Each arch was scored separately. The maximum pain experienced for all treatment groups was at 24 hours after activation. The average pain experience between bracket types was not significantly different, whereas the pain reported for the irradiated arch was statically less than in the placebo group. Although the decrease in pain after laser irradiation has been shown to be statistically significant, it might not be clinically significant. Further cost-benefit analyses would likely be necessary before implementing this type of laser therapy into practice.Reviewed by Jake Spendlove The fourth highest reason for fear and apprehension for orthodontic patients is the pain associated with treatment. Many approaches have been used to ease the patient's pain experience, such as pain-reducing oral and topical medications, chewing gum, and acupuncture. Laser therapy has been indicated as a safe and efficient method to increase the rate of orthodontic tooth movement and for pain relief during the initial stages of treatment and canine retraction. The goal of this study was to investigate the pain relieving effects of GaAlAs lasers during the finishing stages of orthodontic treatment. Sixty patients were included in this split-mouth study. Thirty patients were treated with conventionally ligated straight-wire brackets, and 30 were treated with self-ligating brackets. The type of bracket system used and the arch to be irradiated were randomized. Upon placement of the final 0.019 × 0.025-in stainless steel archwire, the selected arch was irradiated with a GaAlAs laser at a wavelength of 830 nm for 22 seconds along the vestibular surface and 22 seconds along the palatal surface of the roots. The opposite arch was the placebo treated for the same amount of time. Patients scored their pain experience on a 100-mm scale after 2, 6, and 24 hours, and 2, 3, and 7 days. Each arch was scored separately. The maximum pain experienced for all treatment groups was at 24 hours after activation. The average pain experience between bracket types was not significantly different, whereas the pain reported for the irradiated arch was statically less than in the placebo group. Although the decrease in pain after laser irradiation has been shown to be statistically significant, it might not be clinically significant. Further cost-benefit analyses would likely be necessary before implementing this type of laser therapy into practice. Reviewed by Jake Spendlove Dentoskeletal changes after Class II Division 1 Herbst treatmentBock NC, Ruf S. Dentoskeletal changes in adult Class II division 1 Herbst treatment—how much is left after the retention period? Eur J Orthod 2012;34:747-53Several articles have been published on the use of a Herbst appliance in adult Class II Division 1 patients as an alternative to orthognathic surgery or camouflage treatment. However, few authors have investigated the stability after Herbst treatment in adults. The purpose of this study was to analyze the dentoskeletal changes after treatment with a Herbst appliance in white Class II Division 1 adult patients. Fifteen patients (11 women, 4 men) with a Class II Division 1 malocclusion were treated with Herbst and fixed appliances at the University of Giessen in Germany. Their mean age was 25.6 years at the beginning of treatment; a hand-wrist radiograph was taken to ensure that growth had ceased. The patients were treated for an average of 22.9 months and monitored through retention for an average of 35.5 months. Skeletal and dental changes were observed in the lateral cephalometric radiographs acquired before treatment, after Herbst and fixed appliance treatment, and after retention. The amount of skeletal change was drastically less in adults compared with previously reported amounts of skeletal change in adolescents. Significant changes in molar relationship, overjet, overbite, incisor angulation, and profile convexity were observed after treatment, and the minimal relapse after the retention period was considered clinically irrelevant. Whereas only minor skeletal changes were maintained after the retention period, Herbst and fixed appliance treatment provided a stable result in correcting Class II Division 1 malocclusions in borderline adult patients.Reviewed by Nicholas Valeri Bock NC, Ruf S. Dentoskeletal changes in adult Class II division 1 Herbst treatment—how much is left after the retention period? Eur J Orthod 2012;34:747-53Several articles have been published on the use of a Herbst appliance in adult Class II Division 1 patients as an alternative to orthognathic surgery or camouflage treatment. However, few authors have investigated the stability after Herbst treatment in adults. The purpose of this study was to analyze the dentoskeletal changes after treatment with a Herbst appliance in white Class II Division 1 adult patients. Fifteen patients (11 women, 4 men) with a Class II Division 1 malocclusion were treated with Herbst and fixed appliances at the University of Giessen in Germany. Their mean age was 25.6 years at the beginning of treatment; a hand-wrist radiograph was taken to ensure that growth had ceased. The patients were treated for an average of 22.9 months and monitored through retention for an average of 35.5 months. Skeletal and dental changes were observed in the lateral cephalometric radiographs acquired before treatment, after Herbst and fixed appliance treatment, and after retention. The amount of skeletal change was drastically less in adults compared with previously reported amounts of skeletal change in adolescents. Significant changes in molar relationship, overjet, overbite, incisor angulation, and profile convexity were observed after treatment, and the minimal relapse after the retention period was considered clinically irrelevant. Whereas only minor skeletal changes were maintained after the retention period, Herbst and fixed appliance treatment provided a stable result in correcting Class II Division 1 malocclusions in borderline adult patients.Reviewed by Nicholas Valeri Several articles have been published on the use of a Herbst appliance in adult Class II Division 1 patients as an alternative to orthognathic surgery or camouflage treatment. However, few authors have investigated the stability after Herbst treatment in adults. The purpose of this study was to analyze the dentoskeletal changes after treatment with a Herbst appliance in white Class II Division 1 adult patients. Fifteen patients (11 women, 4 men) with a Class II Division 1 malocclusion were treated with Herbst and fixed appliances at the University of Giessen in Germany. Their mean age was 25.6 years at the beginning of treatment; a hand-wrist radiograph was taken to ensure that growth had ceased. The patients were treated for an average of 22.9 months and monitored through retention for an average of 35.5 months. Skeletal and dental changes were observed in the lateral cephalometric radiographs acquired before treatment, after Herbst and fixed appliance treatment, and after retention. The amount of skeletal change was drastically less in adults compared with previously reported amounts of skeletal change in adolescents. Significant changes in molar relationship, overjet, overbite, incisor angulation, and profile convexity were observed after treatment, and the minimal relapse after the retention period was considered clinically irrelevant. Whereas only minor skeletal changes were maintained after the retention period, Herbst and fixed appliance treatment provided a stable result in correcting Class II Division 1 malocclusions in borderline adult patients. Reviewed by Nicholas Valeri