Conventional Orthodontic Treatment Research Articles

Scope of treatment with periodontally accelerated osteogenic orthodontics therapy

Guidelines for tooth movement limits are meant to help clinicians in treatment-planning decisions, especially for severe or borderline adult malocclusions. The purpose of this article was to review well-accepted scope of care beliefs and compare with suggested scope of treatment offered by periodontally accelerated osteogenic orthodontics (PAOO). PAOO is a surgical technique that accelerates tooth movement and expands the scope of conventional orthodontic treatment in the adult 2–3 fold in most spatial dimensions.

Orthognathic correction of dento-facial discrepancies.

Orthognathic treatment is a process which involves orthodontics and maxillofacial surgery and is used to treat those dento-facial discrepancies which are outside the scope of conventional orthodontic treatment, for example severe Class II or Class III problems, anterior open bites and facial asymmetries. Patients who present with these severe problems may encounter a wide range of different problems ranging from functional problems (for example, difficulties biting and chewing) to self-consciousness in a wide range of work and social situations. This paper discusses the possible indications for orthognathic treatment and looks at the risks and benefits of treatment. The treatment pathway is also described.

Residents' journal review

Residents' journal review

Are interventions for accelerating orthodontic tooth movement effective?

Pubmed, Embase, Sciences Citation Index, Cochrane Central Register of Controlled Trials (CENTRAL) and grey literature database of SIGLE were searched from January 1, 1990 to August 20, 2011 with no language restrictions. Randomised controlled trials (RCTs) or quasi-RCTs in which the participants were healthy and received additional interventions to conventional orthodontic treatment for accelerating tooth movements were included. Subjects with defects in oral and maxillofacial regions (ie, cleft lip/palate), dental pathologies and medical conditions were excluded. Studies were selected by two independent reviewers and disagreements were resolved by discussion with a third reviewer. The primary outcomes included accumulative moved distance (AMD) or movement rate (MR) and time required to move the tooth to its destination. Secondary outcomes were pain improvement, anchorage loss, periodontal health, orthodontic caries, pulp vitality and root resorption. The reviewers performed statistical pooling, where possible, according to a priori criteria on the basis of comparability of patient type, treatments and outcomes measured and risk of bias. The reviewers tested for heterogeneity, publication bias and sensitivity. A quality assessment test was conducted to evaluate the method used to measure AMD. The authors selected seven RCTs and two quasi-RCTs, which included a total of 101 patients with an age range of 12-26.3 years. Eight studies compared four intervention methods to no intervention group (control group). From them, four studies assessed low laser therapy (LLL), two evaluated corticotomy (CC), one assessed electrical current therapy (EC) and one evaluated pulsed electromagnetic field (PEF). Another study compared dentoalveolar distraction (DAD) vs periodontal distraction (PDD).Quality assessment scores showed that only two studies were of high quality, five studies were of medium quality, while two studies were of low quality. All studies, except one, compared left and right sides of the same participant (split mouth design), and measured the AMD.The method for measuring AMD was reliable in three studies, relatively reliable in one study and unreliable in four studies. The authors only performed pooled AMD mean meta-analysis for the LLL studies. The meta-analysis showed pooled mean AMD of 0.32 (95% confidence interval (CI), 20.04, 0.68), 0.76 (95% CI, 20.14, 1.65), and 0.73 (95% CI, 20.68, 2.14) for one month, two months and three months, respectively. Two LLL studies showed no differences regarding periodontal health and two LLL studies showed no differences in root resorption between LLL intervention and control groups. Compared to control group, one study reported that CS had significantly higher MR and another study showed that CS exhibited larger AMD for one month, two months, three months and four months. Two studies revealed that CS did not show any difference in the periodontal health status. One study reported the EC showed significantly larger AMD for one month, whereas another study reported that PEF induced larger AMD for five + 0.6 months. DAD showed faster MR and less anchorage loss compared to PDD. Teeth remained vital in both DAD and PDD interventions and one out of six cases presented root resorption in the PDD group. Among the five interventions corticotomy is effective and safe to accelerate orthodontic tooth movement, low-level laser therapy was unable to accelerate orthodontic tooth movement. The level of evidence does not support whether electrical current and pulsed electromagnetic fields are effective in accelerating orthodontic tooth movement and dentoalveolar or periodontal distraction is promising in accelerating orthodontic tooth movement.

Concurrent Bilateral Total Temporomandibular Joint Replacement Surgery and Conventional Maxillary Osteotomy Utilizing Virtual Surgical Planning Web-Based Technology

We describe the case of a 31-year-old lady who presented in 1999 with significant temporomandibular joint (TMJ) dysfunction following a previous vertical subsigmoid osteotomy. The previous surgery had displaced both condyles from their glenoid fossae, and a persistent malocclusion resulted. Despite initial conservative management, both condyles remained out of their fossae and she re-presented 10 years later. On presentation, she had significant progressive right TMJ dysfunction with severe pain. A class III malocclusion was apparent with a 5-mm anterior open bite and jaw deviation to the right on mouth opening. Her maximal interincisal opening was 32 mm. The case was prepared using conventional orthodontic treatment, with surgery being remotely planned by a design facility using a web-based virtual planning and design process. The definitive surgery consisted of bilateral condylectomy, coronoidectomy, and bespoke TMJ replacement prostheses. A simultaneous Le Fort I osteotomy was performed with a 4-mm maxillary advancement. A class I occlusion was achieved with full range of movement, and good functional and aesthetic outcomes. This case documents one of the first reported cases of bilateral total TMJ replacement surgery performed with a concurrent maxillary osteotomy. It demonstrates the potential of virtual surgical planning and the viability of simultaneous procedures.

Orthodontic treatment planning for impacted maxillary canines using conventional records versus 3D CBCT

The aim of this study was to compare the orthodontic treatment planning for impacted maxillary canines based on conventional orthodontic treatment records versus three-dimensional (3D) information taken from single cone beam computed tomography (CBCT) scans. This study consisted of 40 individuals with impacted maxillary canines. Patients were identified from among those referred for orthodontic treatment (26 females, 14 males) with a mean age of 12.5 years (± SD 3). In total, 64 impacted canines were identified, justifying the need for CBCT scans by the treating orthodontist. Two sets of information were obtained. The first set consisted of conventional planning records [two-dimensional (2D) panoramic, 2D lateral cephalograms, and dental casts] and the second set of 3D volumetric images obtained from a single CBCT scan (3D panoramic, 3D lateral cephalograms, 3D virtual study model). For both sets, intra- and extraoral images were included. The radiographic diagnostic features, treatment planning, orthodontists' opinions, and case classifications of both sets were produced and subsequently analysed by four orthodontists. There was no statistically significant difference in treatment planning between the use of both sets, in terms of either orthopaedic growth modification or orthodontic compensation. Also, anticipated complications during treatment and expected treatment duration did not differ significantly. Orthodontists found the conventional set to be insufficient for treatment planning in 22.5 per cent and requested additional radiographs needed in 63 per cent of cases, compared with 1.3 and 0.5 per cent, respectively (P < 0.001). The observers' confidence level was higher for therapy based on the 3D set compared with the conventional set (96.3 per cent versus 61.9 per cent, P < 0.001). There was no statistically significant difference in treatment planning between the use of conventional and CBCT sets. CBCT images have been shown to offer useful orthodontic treatment planning information similar to that of conventional planning with a high confidence level.

Orthodontic treatment in a patient with unilateral open-bite and Becker muscular dystrophy. A 5-year follow-up

INTRODUCTION: Becker muscular dystrophy is an X-chromosomal linked anomaly characterized by progressive muscle wear and weakness. This case report shows the orthodontic treatment of a Becker muscular dystrophy patient with unilateral open bite. METHODS: To correct patient's malocclusion, general anesthesia and orthognathic surgery were not considered as an option. Conventional orthodontic treatment with intermaxillary elastics and muscular functional therapy were employed instead. RESULTS: After 36 months, open bite was corrected. The case remains stable after a 5-year post-treatment retention period.

Periodontally Assisted Osteogenic Orthodontic: Journey from Past to Present- a review

Now a days increasing number of adult patient come for Orthodontic treatment who wants their braces off as early as possible. Adults are more concerned about their aesthetics even with braces. To overcome this kind of psychological or psychosocial problem, new Orthodontic techniques have emerged to reduce treatment duration without compromising stability. There have been theories suggested by various authors for rapid tooth movement. One of such theories is periodontically accelerated osteogenic Orthodontics (PAOO) which is patented by Wilckodontics, which is said to harness the regional acceleratory phenomenon (RAP). PAOO technique definitely reduces treatment time than conventional orthodontic treatment. Studies also shows that, it increases alveolar bone thickness due to bone grafting, enhancing post orthodontic stability with lesser chances of root resorption.

Corticotomy-assisted retraction: an outcome assessment.

To assess the efficiency and treatment outcome of patients treated with corticotomy-assisted en-masse orthodontic retraction as compared with the en-masse retraction without corticotomy. Forty adult patients with bimaxillary protrusion requiring correction of bidental proclination constituted the sample. The study group consisted of 22 patients (male 11, female 11) willing to undergo surgery to reduce the duration of their orthodontic treatment and 18 patients (male 9, female 9) desirous of undergoing conventional orthodontic treatment without surgical intervention constituted the control group. Comparison of rate of retraction and anchor loss between the study and the control group was assessed. Average rate of space closure of 1.8 mm/month in the maxilla and 1.57 mm/month in the mandible was observed in the study group compared to 1.02 mm/month in the maxilla and 0.87 mm/month in the mandible in the control group. The rate of retraction accelerated during the first 2 months of retraction. Molar anchor loss of approximately 0.6 mm occurred in the study group, and 1.8 mm occurred in the control group during the 4 months. The rate of retraction with study group was twice as faster when compared to the control group, accelerating during the first 2 months of retraction. There was better anchorage control with the undecorticated molar segment during the retraction period but was found to increase as time advanced.

Wilckodontics

ABSTRACTWilckodontics is also known as periodontally accelerated osteogenic orthodontics (PAOO). The periodontium is a dynamic tissue and regulation of its remodeling gives an edge in the traditional orthodontic treatment. The synergistic effort from the periodontic and orthodontic fields in the PAOO technique can shorten the conventional orthodontic treatment time to 3 to 9 months. This technique has roots in orthopedics, dating back to the early 1900s. Only recently, it was modified to assist in straightening teeth and fix bites. This article will help you to understand the indications, contraindications and the technicalities of Wilckodontics.How to cite this articlePathak TS, Kini V, Kanagotagi S, Balasubramanian K, Gupta H. Wilckodontics. J Contemp Dent 2013;3(1):15-19.

A restorative approach to the clinical and aesthetic management of adult patients with class ii division 2 incisor malocclusions

A Class II division 2 incisor malocclusion may be a cause of aesthetic and/or functional concern for some affected patients. Their particular concerns may include dark spaces around the misaligned teeth or uneven gingival contours. Orthodontic and/or orthognathic treatment can address some of these problems but frequently involves lengthy and expensive treatment in the adult dentition. Sadly, such treatment often produces an unstable result, with significant drawbacks such as the requirement for long-term retention. This article aims to describe alternative strategies for managing patients with this incisor malocclusion. This paper outlines a quicker, pragmatic and minimally destructive restorative treatment alternative to conventional orthodontic treatment and the associated long-term retention.

Rapid Tooling Method for Soft Customized Removable Oral Appliances

Traditionally oral appliances i.e. removable orthodontic appliances, bite splints and snoring / sleep apnea appliances are made with alginate impressions and wax registrations. Our aim was to describe the process of manufacturing customized oral appliances with a new technique i.e. rapid tooling method. The appliance should ideally be custom made to match the teeth. An orthodontic patient, scheduled for conventional orthodontic treatment, served as a study subject. After a precise clinical and radiographic examination, the approach was to digitize the patient’s dental arches and then to correct them virtually by computer. Additive manufacturing was then used to fabricate a mould for a soft customized appliance. The mould was manufactured using stereolithography from Somos ProtoGen O-XT 18420 material. Casting material for the mould to obtain the final appliance was silicone. As a result we managed to create a customized soft orthodontic appliance. Also, the accuracy of the method was found to be adequate. Two versions of the described device were manufactured: one with small and one with moderate orthodontic force. The study person also gave information on the subjective patient adaptation aspects of the oral appliance.

Risk factors for low molar bite force in adult orthodontic patients

The aim was to analyse which parameters in a standard orthodontic material are most important for identifying factors for low bite force. Such analyses have not previously been reported in adult orthodontic patients. The sample comprised 95 adults (67 females and 28 males) aged 18-55 years sequentially admitted for conventional orthodontic treatment. All subjects had moderate to severe malocclusions. Bite force was measured by a pressure transducer, craniofacial dimensions and head posture were measured on profile radiographs, number of teeth in contact were evaluated with a plastic strip in intercuspidal position, and symptoms and signs of temporomandibular disorders (TMD) were evaluated by TMD screening. Associations were assessed by Spearman correlations, Wilcoxon signed-rank sum test, and multiple stepwise regression analyses. Associations were found between bite force and craniofacial dimensions as mandibular prognathia (S-N-Pg, P < 0.05; S-N-sm, P < 0.05), sagittal jaw relationship (SS-N-Pg, P < 0.05), mandibular inclination (NSL/ML, P < 0.05), and mandibular plane angle (ML/RL, P < 0.01) and between bite force and TMD symptoms (P < 0.05) and TMD signs (P < 0.05). Multiple regression analysis showed that gender (P < 0.001), TMD symptoms (P < 0.01), and mandibular plane angle (P < 0.001) were the most important factors for the magnitude of the bite force in adult orthodontic patients (R (2) = 0.32). The results showed that particularly women with TMD symptoms and an increased mandibular plane angle are at risk of having low bite force. This may prove valuable in the clinic, especially in orthodontic cases with an increased need for vertical anchorage during treatment.

Conventional orthodontic treatment for isolated cleft palate with bilateral mild crossbite

This is a case report of a female patient who demonstrated bilateral posterior crossbite with isolated cleft palate. Molar relation was Class I on the right side and Class II on the left side. Maxillary dental midline was deviated 1.0 mm to the left. To establish the Class I relation, comprehensive orthodontic treatment without extraction was planned. Initially, an open coil spring was activated between the first premolar and the first molar to make space for the second premolar. Subsequently, Class II elastics were used to align the dentition and establish Class I relation. Bilateral crossbite was significantly improved, and the molar relation improved to Class I. Although the maxillary arch width was slightly decreased post-retention, intercuspation was maintained during the retention phase.

Does orthodontic tooth movement cause an elevation in systemic inflammatory markers?

The aim of this study was to evaluate the effects of orthodontic treatment on systemic levels of the inflammatory markers, C-reactive protein (CRP), tumour necrosis factor-alpha (TNF-alpha), and interleukin-6 (IL-6). The study group comprised 11 girls and 6 boys (mean age 13.1 years) treated with fixed appliances and distalizing headgear. Venous blood samples were taken from the cubital vein of each subject before treatment (T0) and then at three further time points during treatment (T1-T3), 2 months apart. The sera from these blood samples were analysed using enzyme-linked immunosorbent assay (ELISA) assay technology for CRP, TNF-alpha, and IL-6 concentration levels. Data were compared between baseline and subsequent sequential time points using a Mann-Whitney test for non-normally distributed variables. The results showed that there was no significant elevation of any of the three inflammatory markers at any of the time points. This research provides evidence that conventional orthodontic treatment is not associated with a systemic immune response in the factors investigated.

Accelerated orthodontic treatment by alveolar corticotomies: a clinical and experimental approach

Indications for orthodontic treatments are in constant augmentation in the adult population. Patients want the shortest possible treatments. Alveolar corticotomies speed up the tooth movement in comparison to conventional orthodontic treatments, therefore decrease treatment duration.This technique consists in the surgical section of cortical bone that leaves the medullar bone uninjured. The biological effects of corticotomies rely on decreasing medullary bone density and increasing bone remodelling activity (RAP regional acceleratory phenomenon).We are currently testing this combined approach of alveolar corticotomies and orthodontic treatments on a pig model with special attention given to potential secondary effects on pulp vitality, dental root morphology and length.We also present here two adult patients with malocclusion cases who underwent alveolar corticotomies as part of their surgical-orthodontic treatments.These experimental and clinical preliminary studies confirm that corticotomy requires a shorter time of orthodontic movement. Our clinical results showed that this technique resolves malocclusion at least twice as fast as conventional orthodontic treatment.No secondary effects of corticotomies on pulp vitality dental root morphology were observed.

Treatment of severe bimaxillary protrusion with miniscrew anchorage: treatment and complications

Abstract Background Problems involving excessive face height and severe bimaxillary protrusion are usually treated with orthognathic surgery. When this form of treatment is rejected, retraction and intrusion of the anterior teeth using skeletal anchorage afforded by miniscrews may be employed. Aims To describe the treatment of severe bimaxillary protrusion with the aid of miniscrews and to discuss the complications encountered during treatment. Methods Following extraction of the four first premolars, miniscrews were placed bilaterally in both jaws to permit maximum retraction of the anterior teeth, and intrusion of the posterior and upper anterior teeth. Results The upper incisors were retracted 12 mm and intruded 5 mm over 20 months. The mandible rotated forward and upward, the face height reduced and the facial aesthetics improved. During treatment an irregular ridge of bone developed labial to the upper incisors, bone was deposited in the incisive fossae and the apices of the upper incisors were resorbed. An alveoloplasty was carried out to recontour the labial bone and the incisive fossae. Conclusions Absolute anchorage provided by miniscrews may become an effective alternative to orthognathic surgery for treatment of severe bimaxillary protrusion. During extensive retraction, the teeth may contact structures not normally encountered during conventional orthodontic treatment.

Masticatory dysfunction in persons with Down’s syndrome. Part 2: management

The functional and anatomical characteristics of Down's syndrome have direct repercussions on oral health; orofacial dysfunction results and feeding and swallowing are impaired. These problems have been described in an earlier article. Different techniques are proposed for the prevention of the development of orofacial dysfunction in Down's syndrome. In particular, early myofunctional therapy coupled with appliance wear has been shown to be successful over the long term when multidisciplinary management is possible. Functional or conventional orthodontic treatment may be successful for older children when performed concurrently with the use of appropriate behaviour management techniques. More recently, techniques for the compensation of masticatory dysfunction in adults have been proposed, although further research is necessary to confirm their efficacy. The aim of this second article was to review techniques for the prevention, treatment and compensation of orofacial dysfunction in persons with Down's syndrome from birth to adulthood.

Orthodontic bracket lost in the airway during orthognathic surgery

In orthodontic treatment before orthognathic surgery, all erupted molars should be banded or bonded to prevent the creation of an occlusal step. Bonded attachments are often used rather than bands because it is easier to bond to partially erupted teeth, there is no need for orthodontic separation or cementation, and they offer improved periodontal health and patient comfort. However, bonded brackets can fail during conventional orthodontic treatment, and the chance of failure might be greater during surgical procedures. Our purpose in this article was to report an intraoperative second-molar bracket failure in the airway during orthognathic surgery. Although there are advantages of bonding relative to banding for molars, the technique should be used with caution in patients who will require surgery because of the high failure rate of molar bonds and the potential for serious consequences associated with failure during surgery, including contamination or infection.

S231: Surgically Assisted Tooth Movement and Transportation of Dentoalveolus by Distraction Osteogenesis

Conventional orthodontic treatments rely on biological tooth movement and can only be achieved at a limited rate. Most of the cases imply shortage of space and crowding. In such cases extractions are most often needed for an ideal treatment outcome. Therefore an increased orthodontic treatment period is unavoidable especially when teeth movements require more than minor relocations. The literature is abounding to identify optimal biological teeth movements with minimal deleterious effects on the tissues involved during tooth movement including root, periodontal ligament and alveolar bone.