Adult Orthodontic Patients Research Articles

EVALUATION OF MINI-IMPLANT ANCHORAGE SYSTEM FOR EN-MASSE RETRACTION OF MAXILLARY ANTERIOR TEETH VERSUS CONVENTIONAL METHOD

Objectives: The purpose of this study was to compare the skeletodental and soft tissue changes and the duration needed for closure of extraction space after en-masse retraction of maxillary anterior teeth using mini-implant anchorage system in the treatment of maxillary dentoalveolar protrusion cases compared with two step retraction with conventional method of anchorage reinforcement. Materials and Methods: The study sample consisted of twenty adult orthodontic patients (3 males and 17 females) with maxillary dentoalveolar protrusion and required first premolar extraction and maximum anchorage. They were randomly divided into two treatment groups (10 subjects in each group). Group 1, anterior space closure with en-masse retraction aided by mini- implant anchorage system, or group 2, anterior space closure with two-step retraction technique aided by conventional method of anchorage. Lateral cephalometric head films were taken just before retraction of maxillary anterior teeth and immediately after closure of the extraction space for the evaluation of the treatment changes. Statistical analyses of the data were performed at a significance level of P <0.05. Results: For the skeletal parameters, a statistically significant decrease in the facial vertical dimensions was seen in G1, but the variables in G2 showed no significant differences (P > 0.05). Anchorage loss, in both the horizontal and vertical directions, was noted in G2, whereas G1 showed anchorage gain and intrusion of molars. Group 1 had greater anterior tooth retraction (7.8 mm in 9.6 months) than did the conventional anchorage group (5.5 mm in 12.4 months). However, no significant differences in the mean retraction time were noted between the 2 groups. Upper incisors were intruded in G 1 (2.3 mm) and extruded (1.1 mm) in G 2. The soft-tissue response was greater changes in G1 with significant differences were found in the nasolabial angle and amount of upper lip retraction between the groups (P < 0.05). Conclusion: Mini-implants provided absolute anchorage to allow greater skeletal, dental, and esthetic changes in patients requiring maximum anterior retraction, when compared with other conventional methods of anchorage reinforcement. However no differences in the mean retraction time were noted between the 2 groups.

Retrospective study of 100 autotransplanted teeth with complete root formation and subsequent orthodontic treatment.

Autotransplantation has become a major therapeutic option for replacing missing teeth in adult orthodontic patients. However, little systematic information is available about the long-term stability of autotransplanted teeth with complete root formation after the application of an orthodontic force. The objective of this study was to investigate the outcomes of autotransplanted teeth with complete root formation that underwent orthodontic treatment. One hundred teeth, autotransplanted in 89 patients, were examined over a mean observation period of 5.8 years. Orthodontic force was applied with nickel-titanium wires 4 to 8 weeks after autotransplantation. Root resorption, ankylosis, mobility, pocket depth, and inflammation at the recipient site were investigated clinically and with radiographs. The survival rate of the autotransplanted teeth was 93.0%. Abnormal findings were found in 29 teeth, including 7 lost teeth, for a success rate of 71.0%. Donor tooth type and occlusal condition of the donor tooth before transplantation were associated with abnormal findings. The early application of orthodontic force may increase the success rate of autotransplanted teeth, and the type and presurgical occlusal condition of donor teeth affect the success rate.

Comments on: Assessment of acid phosphatase and alkaline phosphatase in gingival crevicular fluid in growing and adult orthodontic patients : An in vivo study

Comments on: Assessment of acid phosphatase and alkaline phosphatase in gingival crevicular fluid in growing and adult orthodontic patients : An in vivo study

Comments on: Assessment of acid phosphatase and alkaline phosphatase in gingival crevicular fluid in growing and adult orthodontic patients : An in vivo study

Comments on: Assessment of acid phosphatase and alkaline phosphatase in gingival crevicular fluid in growing and adult orthodontic patients : An in vivo study

A preliminary study for determination of three-dimensional root apex position of the maxillary teeth using camera calibration technology.

To propose a novel method for determining the three-dimensional (3D) root apex position of maxillary teeth using a two-dimensional (2D) panoramic radiograph image and a 3D virtual maxillary cast model. The subjects were 10 adult orthodontic patients treated with non-extraction. The multiple camera matrices were used to define transformative relationships between tooth images of the 2D panoramic radiographs and the 3D virtual maxillary cast models. After construction of the root apex-specific projective (RASP) models, overdetermined equations were used to calculate the 3D root apex position with a direct linear transformation algorithm and the known 2D co-ordinates of the root apex in the panoramic radiograph. For verification of the estimated 3D root apex position, the RASP and 3D-CT models were superimposed using a best-fit method. Then, the values of estimation error (EE; mean, standard deviation, minimum error and maximum error) between the two models were calculated. The intraclass correlation coefficient values exhibited good reliability for the landmark identification. The mean EE of all root apices of maxillary teeth was 1.88 mm. The EE values, in descending order, were as follows: canine, 2.30 mm; first premolar, 1.93 mm; second premolar, 1.91 mm; first molar, 1.83 mm; second molar, 1.82 mm; lateral incisor, 1.80 mm; and central incisor, 1.53 mm. Camera calibration technology allows reliable determination of the 3D root apex position of maxillary teeth without the need for 3D-CT scan or tooth templates.

Mandibular vertical asymmetry in adult orthodontic patients with different vertical growth patterns: A cone beam computed tomography study.

To evaluate condylar and ramal vertical asymmetry in adult orthodontic patients with different vertical growth patterns and a clinically normal sagittal skeletal pattern using cone-beam computed tomography (CBCT). The study sample consisted of 101 adult orthodontic patients (48 men and 53 women) divided into three groups according to their vertical growth patterns: high- (33 patients; mean age, 25.06 ± 6.05 years), low- (34 patients; mean age, 24.88 ± 5.22 years), and normal-angle (34 patients; mean age, 24.14 ± 4.26 years) groups. Condylar, ramal, condylar plus ramal height, and index measurements were performed using CBCT images and analyzed using one-way analysis of variance and post hoc Tukey tests. There was no statistically significant difference in height measurements between right and left sides in each group, except a slight difference of approximately 0.5 mm for condylar height (CH) in the low-angle group (P < .05). No statistically significant gender differences were found for the values (P > .05). In the high-angle group, the ramal height (RH) and condylar plus ramal height (CH + RH) on both sides were found to be less than those of the low- (P < .001) and normal-angle groups (P < .017 and P > .017, respectively), and the asymmetry index values were slightly higher than those of the low- and normal-angle groups (P > .05). The high-angle group showed statistically significantly smaller values of RH and CH + RH on both sides and statistically insignificantly higher asymmetry index values than the low- and normal-angle groups.

Differences of treatment outcomes between self-ligating brackets with microimplant and headgear anchorages in adults with bimaxillary protrusion

Our aim was to determine differences between the outcomes of treatment using microimplant anchorage compared with headgear anchorage in adult patients with bimaxillary protrusion treated with self-ligating brackets. Thirty-one adult orthodontic patients (13 men, 18 women; age, 25.87 ± 3.37 years) who were diagnosed with bimaxillary protrusion were selected. All patients were treated with self-ligating brackets and maximum anchorage after extraction of 4 first premolars. Group 1 received microimplant anchorage, and group 2 received headgear. Lateral cephalometric radiographs were obtained before and after treatment. Differences in the skeletal and dental parameters between and within groups were analyzed. No significant difference was observed in the mean treatment times between the groups (21.93 ± 3.10 vs 23.88 ± 2.68 months). There was no significant difference in skeletal measurements before or after treatment in patients who received microimplant anchorage. Patients who received headgear anchorage had an increase of the mandibular plane angle. The microimplant anchorage group had greater anterior tooth retraction and less maxillary molar mesialization than did the headgear group. In both the anteroposterior and vertical directions, microimplant anchorage achieved better control than did the traditional headgear appliance during the treatment of bimaxillary protrusion.

Assessment of acid phosphatase and alkaline phosphatase in gingival crevicular fluid in growing and adult orthodontic patients: An in vivo study

Assessment of acid phosphatase and alkaline phosphatase in gingival crevicular fluid in growing and adult orthodontic patients: An in vivo study

Adherence in orthodontic settings: understanding practitioner views in a UK sample.

To explore predictors of adherence in adult orthodontic patients as reported by orthodontists in the UK. Twenty-three orthodontists (47% female and 53% male) from the UK with approximately 15 years of experience each (M = 14.7; SD = 1.73) completed a questionnaire regarding the importance they give to a number of factors signaled in the literature as adequate predictors of adherence. This cross-sectional quantitative and exploratory survey consisted of four parts, requesting orthodontists to rate a list of predictors of adherence on (1) evaluation-how important they thought the predictor was to assess patient adherence, (2) application-the extent to which they used each predictor to assess adherence in their daily practice, (3) open-ended questions to collect any other perceived predictors of adherence, and (4) demographics. All participating orthodontists agreed that patients' regularity in attending appointments, maintenance of good oral hygiene, and utilization of dental appliances are the most important factors for predicting adherence. In the open-ended portion of the questionnaire, orthodontists also highlighted perceived cost of treatment as an important factor. The remaining factors included in the questionnaire were also rated as important or utilized, though they yielded a more varied pattern of response. Appointment keeping, cooperating in the use of removable appliances, and oral hygiene were rated as the most important factors by orthodontists when assessing adherence in adult patients. The perceived cost of treatment was also highlighted by orthodontists as an important factor for adherence.

The Adult Orthodontic Patient: More Options than Ever Before!

More and more adults are now presenting for orthodontic treatment. They not only present with malocclusions of varying severity but also additional restorative and periodontal needs requiring well coordinated interdisciplinary care. In addition, today?s adult patients also present with a demand for more aesthetic and less visible orthodontic appliances. This paper discusses the important considerations in managing adult orthodontic patients. It also highlights recent technological advances that enable us to better plan the management of adult patients as well as the available aesthetic treatment options and their strengths and weaknesses.

Effect of Three-wall Bony Defect along Various Root Surfaces on Position of Center of Resistance: A 3D Finite Element Analysis.

Increase in adult orthodontic patients has increased the challenges faced by orthodontists, as they often present themselves with a varying degree of dental and peri-odontal compromise, in which the entire orthodontic treatment planning will revolve around maintenance and augmentation of supporting apparatus. One of the many factors to be considered during treating an adult patient is the height of alveolar bone and its effect on center of resistance (CRes). Eight 3D analytical models of upper central incisor were designed using 'Solid Works Office Premium'. The models were subjected to 3 and 6 mm bone loss along all four surfaces, i.e. labial, lingual, mesial and distal. One Newton of retraction force was applied on labial surface of tooth on model number 1, 2, 5 and 6 and 1N of distalization force was applied to model number 3, 4, 7 and 8. The relative location of the CRes to the total root length was taken as 41.8% of total root length from the root apex. The ANSYS software was used to evaluate the change in CRes on all the models. It was observed that CRes shifted apically from its relative location (41.8% from apex); however, this shift was clinically insignificant. Minimum deflection of CRes, 0.0122 mm, was seen when a distalization force was applied on model with 6 mm bone loss on distal surface, while maximum deflection of 0.0245 mm was seen when retraction force was applied on model with 6 mm bone loss on labial surface. The resultant displacement in position of center of resistance is negligible; hence, there is no need of changing biomechanics during orthodontic treatment for a tooth with three wall infrabony defects. However, it is necessary to further study other infrabony defects like two wall or one wall defect, and their effect on position of CRes.

Assessment of acid phosphatase and alkaline phosphatase in gingival crevicular fluid in growing and adult orthodontic patients: An in vivo study

Introduction: Orthodontic treatment has been widely accepted among adults in the present years. It has been postulated that the tooth movement is faster in children when compared to the adults. This could be assessed more accurately by assessment of gene markers responsible for bone turnover in the gingival crevicular fluid (GCF). The purpose of this study was to assess the association of levels of acid and alkaline phosphatase activities in GCF with age during the tooth movement. Materials and Methods: A group of 14 growing and adult patients requiring fixed orthodontic therapy were selected. The maxillary canines were retracted in both the groups using coil springs. GCF samples were collected before the spring activation and subsequent sampling was done after the activation up to 6 th week. The levels of alkaline and acid phosphatase were then compared. Results: On comparison, the alkaline phosphatase levels were much higher in children at baseline and remained elevated suggesting increased osteoblastic activity. The levels of acid phosphatase were higher in the children at all-time intervals, indicating increase in the osteoclastic activity. Conclusion: Increase in enzymatic activity in children during the tooth movement as compared to adults partially supports the hypothesis of faster tooth movement in children.

Screening and Prevalence of the Novel Cariogenic Pathogen Scardovia wiggsiae among Adult Orthodontic and Non-Orthodontic Patient Saliva Samples

Orthodontic therapy in the United States has become routine among teenagers and increasing among adults. Despite these positive developments, orthodontic treatment has often been associated with changes to the oral environment, which may increase disease risk. Although numerous studies have demonstrated the causal link between Streptococcus mutans and carious lesions, more recent evidence suggest that it only constitutes part of a much larger oral microbial community. Several recent studies have demonstrated the presence of newly characterized cariogenic pathogen, the anaerobic Gram-positive bacillus Scardovia wiggsiae. This retrospective study of previously collected saliva samples originated with a convenience sample of pediatric and adult patients, previously recruited from the University of Nevada Las Vegas-School of Dental Medicine (UNLV-SDM) clinics. More than one hundred saliva samples from adult orthodontic (n=49) and non-orthodontic (n=52) patients were selected for inclusion in this study. All DNA extracted from these samples was subsequently screened using PCR, which revealed the presence of S. mutans (SM), P. gingivalis (PG), and S. wiggsiae (SW), which differed in prevalence among non-Orthodontic and Orthodontic patients. In non-orthodontic patients nearly all of the PG-positive and SW-positive samples were also SM-positive samples. However, among orthodontic patients, none of the SW-positive samples were either SM- or PG-positive. In addition, further analysis of demographic variables revealed decayed-missing-filled teeth (DMFT) score, periodontal pocket depth (PPD), age, gender, and BMI did not vary between groups, which suggest continued research in this area will be needed to elucidate these findings.

Aesthetic Orthodontics : An Overview

Through the influence of the media and increasing awareness amongst the people aesthetic concerns regarding orthodontic treatment have risen up. The adult orthodontic patients put higher demands for aesthetic results not only after the treatment but also during the treatment phase. Not only adults but all orthodontic patients give importance to their appearance and forsocial or work reasons would probably refuse visible orthodontic treatment therapy. This article describes some of the effective solutions to these problems that will not impair the patient from an aesthetic point of view during the treatment phase

Impact of extracorporeal shock-wave therapy on the stability of temporary anchorage devices in adults: A single-center, randomized, placebo-controlled clinical trial

In this randomized, placebo-controlled clinical trial, we investigated the effect of noninvasive extracorporeal shock waves on the stability of temporary anchorage devices (TADs) under orthodontic loading. Thirty adult orthodontic patients of the Bernhard Gottlieb University Clinic in Vienna, Austria, were enrolled in this clinical trial and allocated by block randomization (size, 4) in a 1:1 ratio to either the treatment or the placebo group. Randomization was performed with software, and the allocations were concealed in sealed envelopes. Eligibility criteria included healthy adult patients with mesially directed orthodontic movement of the mandibular second molar into the extraction site of the mandibular first molar. The fixed orthodontic devices included active superelastic coil springs (200cN) and TADs in the mandibular alveolar bone. Blinding was performed for the subjects and the outcome assessor. The treatment group received 1 shock-wave application with 1000 impulses at 0.19 to 0.23mJ per square millimeter in the region of the TADs. The placebo group was treated with a deactivated shock-wave applicator and acoustic sham. The TADs positions were evaluated at placement and after 4months. The reliability and precision of the impression process of the TADs were evaluated in an in-vitro model. Thirteen participants finished the investigation successfully in the treatment group but only 12 finished in the placebo group because 1 TAD loosened. The difference of the total TAD displacement for the 4-month time period between the placebo and treatment groups was 0.17±0.95mm (95% CI: -0.96, 0.62). No statistically significant difference between the 2 groups was found when sex was evaluated. Primary stability of the TADs as measured by placement torque, amount of tooth movement, and age of the patients did not influence displacement of the TADs. The reliability and precision of TAD impressions were confirmed. No unintended pernicious effects occurred after shock-wave treatment during the study period. A single application of extracorporeal shock-wave treatment did not improve the stability of the TADs during orthodontic loading. Sufficient interradicular space should be provided to minimize the risk of periodontal and dental root defects. This trial was registered at https://clinicaltrials.gov. The protocol was published before trial commencement, NCT01695928. No funding or conflict of interest to be declared.

The efficacy of cognitive-behavioral intervention on anxiety and oral health-related quality of life in adult orthodontic patients

Objective To explore the influence of cognitive-behavioral intervention on the anxiety and oral health-related quality of life in adult orthodontic patients. Methods 152 adult orthodontic patients whose MDAS scores were greater than 11 were divided into the intervention group and the control group according Multistage Grouping Process. The former were treated with MBT appliance combined with cognitive-behavioral intervention, and the latter were treated with MBT appliance only. The State-Trait Anxiety Inventory(STAI) was adopted to evaluate anxiety in all patients during orthodontic treatment, and the UK oral health-related quality of life questionnaire(OHRQoL-UK) was adopted to evaluate the oral health-related quality of life in all patients before and after orthodontic treatment, respectively. Results 1.After 3 and 6 months cognitive-behavioral intervention, the scores of SAI in the intervention group(50.37±9.18, 35.65±8.92) were significantly reduced compared to the control group(56.62±10.52, 54.13±10.03) (P<0.01). After 6 months cognitive-behavioral intervention, the scores of TAI in the intervention group(47.92±6.82) were significantly reduced compared to the control group(51.52±7.41) (P<0.05). 2. After the orthodontic treatment, the scores of OHRQoL-UK in the intervention group(58.27±13.43) were significantly improved compared to the control group(51.99±11.69) (P<0.01). 3. The oral health-related quality of life after the orthodontic treatment were significantly related to post-treatment anxiety of adult orthodontic patients(r=-0.192~-0.459, P<0.05 ). Conclusion Cognitive-behavioral intervention can effectively reduce anxiety and improve the oral health-related life quality in the adult orthodontic patients. Key words: Cognitive-behavioral intervention; Adult orthodontic patients; Anxiety; Oral health-related quality of life

Adult orthodontic patients' views regarding dentofacial normality: A qualitative study

The concept of normality in orthodontic diagnosis and treatment is defined from the clinicians' point of view or derived from concepts developed from observation of "ideal" persons. In-depth appreciation of what a patient views as normal is paramount for effective shared decision making. In this study, we aimed to examine the concept of dentofacial normality in orthodontics from the patient's perspective. This was a qualitative study of adults attending for orthodontic consultations at a teaching hospital. Semistructured interviews were conducted until data saturation occurred (n= 15). The data were managed using a framework approach, and recurrent themes were identified. Three main themes were identified in the interviews: the components of dentofacial normality, the impact of dentofacial abnormality, and factors influencing patients' conceptualization of dentofacial normality. The components of normal appearance are apparent in the views of potential adult orthodontic patients. These ideas are formed from personal observations in conjunction with the external influences of family, friends, and the commercial media. There was a biopsychosocial impact of dentofacial abnormality with both enacted and felt stigma playing substantial roles. A normal dentofacial appearance cannot be solely constructed from measureable biologic variables. Patients view normality in terms of features that are acceptable biologically, psychologically, and socially, and there is significant overlap in these domains. Clinicians should be aware that traditionally held concepts of what they believe to be normal or abnormal might not fully represent patients' beliefs.

Impact of extracorporeal shock wave therapy (ESWT) on orthodontic tooth movement—a randomized clinical trial

This randomized clinical trial investigated the effect of extracorporeal shock waves on the amount of orthodontic tooth movement and periodontal parameters. Twenty-six adult orthodontic patients participated in this clinical trial; all of them receiving lower second molar mesially directed movement. The fixed orthodontic device included superelastic coil springs (200cN) and miniscrews as temporary anchorage device. The active treatment group received a single shock wave treatment with 1,000 impulses in the region of tooth movement. The placebo group was treated with deactivated shock wave applicator with an acoustic sham. The study period lasted 4months with amonthly data exploration. No statistically significant difference in posterior-anterior tooth movement between the treatment and placebo group was seen during observation period. Gender had no significant influence on tooth movement in either group. No significant difference occurred in mesio-distal tipping and rotation, but a significant difference (p = 0.035) in bucco-lingual tipping of the molars was found. Periodontal status of the patients (sulcus probing depth, gingival index) did not significantly differ in both groups. The plaque index showed a significant difference (p = 0.003). Single application of extracorporeal shock wave treatment was associated neither with a statistically significant acceleration of tooth movement nor with an altered periodontal status in vivo. Shock waves showed no harmful effects in the investigated area. Their clinical use for lithotripsy during orthodontic therapy might be permitted.

Factors influencing positive and negative affects of orthodontic patients

Objective To investigate the factors influencing positive and negative affects ot orthodontic patients.Methods 145 orthodontic patients were selected and finished questionnaire survey.The questionnaires included demographic data,psychosocial impact of dental aesthetic questionnaire (PIDAQ),aesthetic content of index of orthodontic treatment need (IOTN-AC),perception of occlusion scale (POS),and positive affect and negative affect scale (PANAS).Mann-Whitney U-test,Kruskal-Walis H-test,and Spearman correlation analysis were used to analyze the relation between impact of dental aesthetics and positive and negative affects in orthodontic patients.Results The scores of adolescent patients were higher than adult patients in negative affect (U =1886.500,P＜0.05).The patients under orthodontic treatment scored higher than those before treatment (U=2228.000,P＜0.05).The subdomains of PIDAQ,such as social impact (x2=ll.794,P＜0.05),aesthetic attitude (x2 =45.853,P＜0.05),and dental confidence (x2 =33.551,P＜0.05) were related with negative affect.The scores of IOTN-AC,PIDAQ,POS demonstrated positive correlation with negative affect (P＜0.05).The scores of social impact showed negative correlation with positive affect (P＜0.05).Conclusions Adult orthodontic patients suffer more negative affect than adolescent patients.Orthodontic treatment could promote patients' positive affect.However,the negative psychosocial impact in dental aesthetics would strengthen the negative affect. Key words: Orthodontics; Medical aesthetic; Emotions; Rating scales

The use of fibre-reinforced composite for the creation of anchor units in sectional orthodontic appliances

The benefits of fibre-reinforced composite (FRC), such as strength, excellent bonding characteristics and aesthetics, are widely appreciated in restorative dentistry. These properties are well suited to the creation of orthodontic anchorage units in full-arch or sectional appliances. In this article, two clinical cases are presented where FRC has been used to create anchorage units in adult orthodontic patients with high aesthetic demands. Anchorage units created in this way are immediate, aesthetic, comfortable and require minimal unwanted tooth movement. Clinical Relevance: The article describes techniques that may be of interest to clinical orthodontists by describing a novel use for a material not commonly used in orthodontics.