1,720,980 research outputs found
Occurrence and severity of enamel decalcification adjacent to bracket bases and sub-bracket lesions during orthodontic treatment with two different lingual appliances
No full textUsing lingual enamel surfaces for bracket placement not only has esthetic advantages, but may also be suitable in terms of reducing frequencies of enamel decalcifications. To test the null-hypothesis that there is no significant difference in enamel decalcification or cavitation incidence adjacent to and beneath bracket bases between two lingual multi-bracket (MB) appliances that are different in terms of design, material composition, and manufacturing technology (group A: WIN, DW-LingualSystems; group B: Incognito, 3M-Unitek), taking into account patient- and treatment-related variables on white spot lesion (WSL) formation. Standardized, digital, top-view photographs of 630 consecutive subjects (16214 teeth; n (Incognito) = 237/6076 teeth; n (WIN) = 393/10138 teeth; mean age: 17.47 +/- 7.8; m/f 43.2/56.8%) with completed lingual MB treatment of the upper and lower permanent teeth 1-7 were screened for decalcification or cavitation adjacent to and beneath the bracket bases before and after treatment, scored from 0 to 7. Non-parametric ANOVA was used for main effects 'appliance type', 'gender', 'treatment complexity', 'grouped age' (a parts per thousand currency sign16/> 16 years), and 'treatment duration' as covariable, at an alpha-level of 5%. About 2.57% [5.94%] of all teeth in group A [B] developed decalcifications. Subject-related incidence was 9.59% [16.17%] for upper incisors in group A [B], and 12.98% [25.74%] for all teeth 16-46. There were significant effects by gender, age, and treatment duration. The null-hypothesis was rejected: sub-bracket lesions were significantly less frequent in group A, while frequencies of WSL adjacent to brackets were not significantly affected by appliance type. In view of the overall low incidences of lingual post-orthodontic white-spot lesions, the use of lingual appliances is advocated as a valid strategy for a reduction of enamel decalcifications during orthodontic treatment
In-vivo durability of a fluoride-releasing sealant (OpalSeal) for protection against white-spot lesion formation in orthodontic patients
Full text linkBackground Sealant application during fixed appliances orthodontic treatment for enamel protection is common, however, reliable data on its durability in vivo are rare. Objective This study aims at assessing the durability of a sealant (OpalSeal, Ultradent) for protection against white-spot lesion formation in orthodontic patients over 26 weeks in vivo, taking into account the provision or absence of an adequate oral hygiene. We tested the null hypothesis of (1) no significant abatement of the sealant after 26 weeks in fixed orthodontic treatment compared to baseline, and (2) no significant influence of the factor of brushing and oral hygiene (as screened by approximal plaque index, API) on the abatement of the sealant. Methods Integrity and abatement of OpalSeal applicated directly following bracketing was assessed in thirty-six consecutive patients (nteeth = 796) undergoing orthodontic treatment with fixed appliances (male/female12/24; mean age/SD 14.4/1.33 Y). Assessment of the fluorescing sealant preservation was by a black-light lamp, using a classification that was concepted in analogy to the ARI index: (3, sealant completely preserved; 2= > 50% preserved; 1 = 80%). Results At baseline, 43.4% of teeth had a positive API. Oral hygiene deteriorated after bracketing (T1, 53%) significantly. Null hypothesis (1) was rejected, while (2) was accepted: Mean values of both the well brushed and non-brushed anterior teeth undercut the score “1” at T3 (week 14). Despite a slightly better preservation of the sealer before and after T3 in not-sufficiently brushed (API-positive) teeth, this finding was statistically not significant. Conclusion One single application of OpalSeal is unlikely to last throughout the entire fixed appliance treatment stage. On average, re-application of the sealant can be expected to be necessary after 3.5 months (week 14) in treatment
Lingual appliances reduce the incidence of white spot lesions during orthodontic multibracket treatment
No full textIntroduction: The aim of this study was to assess the incidence of white spot lesions (WSLs) in subjects treated with customized lingual multibracket appliances-separately for maxillary anterior teeth 12 to 22 (according to the Federation Dentaire Internationale numbering system) as well as for tooth groups 15 to 45, 16 to 46, and 17 to 47-and to determine the impact of patient-related and treatment-related variables on the frequencies of new WSLs. Methods: Of 214 subjects comprehensively treated between June 1, 2011, and May 31, 2014, in 1 orthodontic center (Bad Essen, Germany) with a completely customized lingual appliance (WIN; DW Lingual Systems, Bad Essen, Germany), 174 (47% boys, 53% girls; mean age, 14.35 +/- 1.23 years [minimum, 11.35 years; maximum, 17.91 years]) were recruited with inclusion criteria of completed lingual multibracket treatment of their maxillary and mandibular permanent teeth 17 to 47 (4582 teeth in the study), and age less than 18 years at the initial appointment. WSL assessment was accomplished using standardized digital high-resolution maxillary and mandibular occlusal photographs taken before bracketing and after debonding. Nonparametric analysis of variance was performed, taking into account the subjects' grouped ages (16 years), sexes, and treatment durations. Results: Of the total population of subjects, 41.95% developed at least 1 new WSL when all teeth, 17 to 47, were considered, and this incidence was 27.01% for tooth group 16 to 46, or 10.59% of subjects and 4.74% of the maxillary incisors (12 to 22). Of all teeth under consideration, 3.19% developed a WSL during treatment. The frequencies of decalcification were not significantly increased in preadolescents (16 years). Treatment duration had a significant adverse impact on WSL formation in tooth groups 15 to 45 and 16 to 46, and in complete dental arches (teeth 17 to 47). Conclusions: Subject-related and tooth-related WSL incidences of both single tooth groups and complete dental arches in subjects treated with the lingual WIN appliance were distinctly reduced when compared with previous reports of enamel decalcification after conventional labial multibracket treatment
Quality of occlusal outcome following space closure in cases of lower second premolar aplasia using lingual orthodontic molar mesialization without maxillary counterbalancing extraction
No full textAbstract Background Controlled space closure in cases of isolated lower second premolar aplasia (ILSPA) without maxillary counterbalancing extraction is challenging. Anterior anchorage loss may occur during space closure resulting in compromised occlusal results in terms of an absence of proper canine guidance during laterotrusive mandible movements. In order to evaluate the effectiveness of Herbst telescope anchorage in combination with double-cable, pull mechanics and a completely customized lingual appliance for orthodontic space management in cases of ILSPA, we tested the null hypothesis that there is a significant deterioration in the sagittal canine relationship towards an Angle-Class-II occlusion expressed as a loss of anterior anchorage following space closure with molar mesialization. Methods Twenty-five consecutively de-bonded subjects (female / male 17 / 8; aged at T0 (start of MB Tx) 12.3 to 20.6 years; mean age 15.0 / SD 1.7 years) were included in this retrospective analysis using the inclusion criteria of least of one lower second premolar aplasia; completed treatment with a totally customized lingual appliance (CCLA) in combination with Herbst telescopes. Exclusion criteria were the absence of counterbalancing maxillary extractions, as well as additional tooth aplasia other than lower second premolars. A total of 33 single, lower premolar aplasia space closures (right / left sided 17 / 16) were assessed using plaster casts and intra-oral photographs scaled to the plaster casts, at bonding (T0), Herbst insertion (T1), following gap closure (T2) and de-bonding (T3). Parallelism of roots was controlled by panoramic x-rays at T3. Results The mean aplasia space at T0 was 7.5 mm (SD 2.6). Complete space closure was achieved in all 33 situations. The null hypothesis was rejected. There was a significant improvement in the initial canine relationships (mean 3.5 mm distal occlusion at T0) to a mean 0.1 mm at T3. When evaluated against the individual treatment plan, the following amounts of planned improvements were achieved: space closure 100%, canine relationship 97.5%, overjet 93.9%, overbite 96.4%, parallel roots in space closure site 93.9%. Conclusion Herbst telescope anchorage in combination with double-cable pull mechanics and a CCLA for orthodontic space closure can deliver predictable, high-quality treatment results
Comparison of anchorage reinforcement with temporary anchorage devices or a Herbst appliance during lingual orthodontic protraction of mandibular molars without maxillary counterbalance extraction
No full textBackground: Orthodontic protraction of mandibular molars without maxillary counterbalance extraction in cases of aplasia or extraction requires stable anchorage. Reinforcement may be achieved by using either temporary anchorage devices (TAD) or a fixed, functional appliance. The objective was to compare the clinical effectiveness of both methods by testing the null-hypothesis of no significant difference in velocity of space closure (in mm/month) between them. In addition, we set out to describe the quality of posterior space management and treatment-related factors, such as loss of anchorage (assessed in terms of proportions of gap closure by posterior protraction or anterior retraction), frequencies of incomplete space closure, and potential improvement in the sagittal canine relationship. Methods: Twenty-seven subjects (15 male/12 female) with a total of 36 sites treated with a lingual multi-bracket appliance were available for retrospective evaluation of the effects of anchorage reinforcement achieved with either a Herbst appliance (n(subjects) = 15; 7 both-sided/8 single-sided Herbst appliances; n(sites) = 22) or TADs (nsubjects = 12; 2 both-sided; 10 single-sided; nsites = 14). Descriptive analysis was based on measurements using intra-oral photographs which were individually scaled to corresponding plaster casts and taken on insertion of anchorage mechanics (T1), following removal of anchorage mechanics (T2), and at the end of multi-bracket treatment (T3). Results: The null-hypothesis was rejected: The rate of mean molar protraction was significantly faster in the Herbst-reinforced group (0.51 mm/month) than in the TAD group (0.35). While complete space closure by sheer protraction of posterior teeth was achieved in all Herbst-treated cases, space closure in the TAD group was achieved in 76.9 % of subjects by sheer protraction of molars, and it was incomplete in 50 % of cases (mean gap residues: 1 mm). Whilst there was a deterioration in the canine relationship towards Angle-Class II malocclusion in 57.14 % of space closure sites in TAD-treated subjects (indicating a loss of anchorage), an improvement in canine occlusion was observed in 90.9 % of Herbst-treated cases. Conclusion: Subjects requiring rapid space closure by molar protraction in combination with a correction of distal occlusion may benefit from using Herbst appliances for anterior segment anchorage reinforcement rather than TAD anchorage
Lingual orthodontic treatment duration: performance of two different completely customized multi-bracket appliances (Incognito and WIN) in groups with different treatment complexities
Full text linkINTRODUCTION: The occurrence of side-effects of fixed orthodontic therapy, such as white-spot lesions and root resorption, are known to be significantly more frequent with increasing duration of treatment. Multi-bracket treatment should be as short as possible, in order to minimize the risks of collateral damage to teeth. The aim of this non-randomized clinical trial was to compare treatment duration with each of two types of customized lingual orthodontic appliances (Incognito, 3 M-Unitek; WIN, DW LingualSystems), taking into account treatment complexity. The null-hypothesis was that there would be no significant difference in active orthodontic treatment duration between them. METHODS: Of 402 potentially eligible participants, a population sample of n = 376 subjects (n(Incognito) = 220; n(WIN) = 156; m/f 172/204; mean age ± SD 17.3 ± 7.7Y) treated in one orthodontic center (Bad Essen, Germany) with completely customized lingual appliances in upper and lower permanent dental arches was recruited with the inclusion criterion of initiated and completed lingual multi-bracket treatment within the assessment period of April 1st 2010 - Nov 30, 2013, and the exclusion criterion of less than 24 bracketed teeth. We used four-factorial ANOVA to assess the impact of the following factors: initial degree of severity of malocclusion (mild to moderate, S1; severe, S2), appliance type (Incognito; WIN), sex, and age group (16 Y) on the duration of lingual multi-bracket treatment. RESULTS: Overall, mean treatment duration was 21.7 (SD 7.2) months, which was significantly shorter for WIN for both sub-groups of treatment complexity (S1: 17.96 mo; S2: 20.49 mo) compared to Incognito (S1: 22.7 mo; S2: 29.79 mo). ANOVA revealed a significant influence of the main effects 'appliance type', and 'severity', independent of each other. Therefore, the null-hypothesis was rejected. CONCLUSION: In terms of treatment duration, the WIN appliance performed significantly better than the Incognito appliance. Consequently, subjects treated with the WIN appliance are expected to be exposed to lower risks of the typical side-effects associated with longer multi-bracket treatment durations, such as root resorption and enamel decalcification
Kontrolle des Schneidezahntorques mit vollständig individuellen lingualen Apparaturen
No full textAbstract Purpose To test the null hypothesis of no significant deviation between the center of rotation (C ROT ) and the center of resistance (C RES ) during space closure in Angle class II division 2 subjects achieved using a completely customized lingual appliance (CCLA) in combination with class II elastics and elastic chains. Methods This retrospective study included 29 patients (male/female 11/18; mean age 15.6 [13–27] years) with inclusion criteria of an Angle class II/2 occlusion of least of half of a cusp, maxillary dental arch spacing, completed CCLA treatment (WIN, DW Lingual Systems, Bad Essen, Germany) in one center with a standardized archwire sequence and use of class II elastics and elastic chains only. Maxillary incisor root inclination was assessed by X‑ray superimpositions of the maxilla at the beginning (T1) and the end (T3) of CCLA treatment. Using Keynote software (Apple®, Cupertino, CA, USA), the incisor’s C ROT was assessed with the point of intersection of the incisor axes (T1; T3) following vertical correction of overbite changes. C RES was defined at 36% of the incisor’s apex–incisal edge distance. Results The null hypothesis was rejected: the mean C ROT − C RES difference was 52.6% ( p < 0.001). The mean C ROT was located at 88.6% (min–max 51–100%) of the incisor’s apex–incisal edge distance. Although 6.9% of C ROT were located between the C RES and the alveolar crest, the vast majority (93.1%) were assessed between the alveolar crest and the incisal edge, or beyond. Conclusion CCLAs can create upper incisor palatal root torque even in cases in which lingually oriented forces applied incisally to the center of resistance of the upper incisors counteract these intended root movements.Zusammenfassung Ziel Es wird die Nullhypothese getestet, dass bei der Korrektur der lückigen Angle-Klasse II/2-Malokklusion mit einer vollständig individuellen lingualen Apparatur („completely customized lingual appliance“, CCLA) keine signifikante Abweichung zwischen dem Rotationszentrum (C ROT ) und dem Widerstandszentrum (C RES ) der Oberkieferinzisivi während der Bisslagekorrektur und des Lückenschlusses mit Klasse-II-Gummizügen und elastischen Ketten auftritt. Methoden Es wurden 29 Patienten (m:w = 11:18, mittleres Alter 15,6 [13–27] Jahre) in diese retrospektive Studie gemäß folgender Inklusionskriterien aufgenommen: Angle-Klasse II/2-Okklusion von mindestens einer halben Prämolarenbreite, lückiger oberer Zahnbogen, abgeschlossene CCLA-Behandlung (WIN, DW Lingual Systems, Bad Essen) an einem Standort mit standardisierter Bogensequenz sowie ausschließlicher Verwendung von Klasse-II-Gummizügen und elastischen Ketten zum Lückenschluss. Die Wurzelinklination der oberen Inzisivi wurde per Röntgenüberlagerungen der Maxilla zu Beginn (T1) und am Ende (T3) der CCLA-Behandlung bestimmt. Unter Verwendung der Software Keynote (Apple®, Cupertino/CA, USA) wurde das C ROT der Inzisivi durch den Schnittpunkt der Schneidezahnachsen (T1; T3) nach vertikaler Korrektur therapeutischer Overbite-Veränderungen bestimmt. Das C RES wurde per definitionem auf 36 % der Apex-Schneidekante-Distanz festgelegt. Ergebnisse Die Nullhypothese wurde zurückgewiesen: Die mittlere Differenz zwischen C ROT und C RES betrug mehr als eine halbe Zahnlänge (52,6 %). Das mittlere C ROT lag im Bereich der Zahnkrone bei 88,6 % (min–max 51–100 %) der Distanz von Apex zu Schneidekante. Zwar lagen 6,9 % der C ROT zwischen dem C RES und dem Alveolarkamm, doch die deutliche Mehrheit (93,1 %) befand sich im Bereich der Zahnkrone oder jenseits davon. Schlussfolgerung Mit CCLA ist auch bei schwierigen Ausgangssituationen die kontrollierte Retraktion der Oberkieferfrontzähne mit adäquatem palatinalen Schneidezahn-Wurzeltorque möglich
Clinical complications during treatment with a modified Herbst appliance in combination with a lingual appliance
No full textAbstract Objective To assess the types and frequencies of clinical complications experienced when using a modified lingual Herbst appliance and to compare these with those associated with conventional Herbst appliances reported in the literature. Methods Treatment records for 35 consecutive subjects treated during the observation period from October 2013 to August 2014 who received a combination of a lingual appliance and a modified Herbst appliance (WIN, DW LingualSystems) were assessed for complications linked to Herbst treatment phase. Complications were analyzed descriptively, and complication-free intervals were calculated using Kaplan-Meier plots. To enable a comparison with data reported in the literature, the cumulative treatment time for all subjects was divided by the total number of complications. Results 71.4 % of Herbst treatments were free from complications (n = 25). Complications were seen on 13 occasions (8 instances of Herbst attachment loosening, 5 L-Pin fractures). Most of these complications could be fixed chair side utilizing simple clinical measures. Considering all complications as identical statistical events, the percentage of treatments free from complications would be 88 % for 100 days, 70 % for 200 days and 56.8 % for 300 days. For severe complications, the averaged complication-free treatment interval was found to be 27.8 months. Conclusion In terms of clinical sturdiness, and taking into consideration the step-wise mode of activation used here as well as the differences in the design of the various Herbst appliances, the WIN-Herbst appliance was found to be superior to comparable vestibular Herbst appliances, as well as the banded Herbst appliance belonging to the preceding generation of customized lingual systems. Success in treatment of non-compliant Angle Class II correction is considered to have better predictability using the modified anchorage strategy of the WIN-Herbst appliance
Class II correction by maxillary en masse distalization using a completely customized lingual appliance and a novel mini-screw anchorage concept – preliminary results
No full textAbstract Background The aim of the study was to evaluate the efficacy of a novel en masse distalization method in the maxillary arch in combination with a completely customized lingual appliance (CCLA; WIN, DW Lingual Systems, Germany). Therefore, we tested the null-hypothesis of a significant deviation from an Angle-Class I canine relationship and a normal overjet defined by an individual target set-up after dentoalveolar compensation in Angle Class II subjects. Methods This retrospective study included 23 patients, (m/f 3/20, mean age 29.6 years (min/max, 13.6/50.9 years)), with inclusion criteria of an Angle Class II occlusion of more than half a cusp prior to en masse distalization and treatment completed consecutively with a CCLA in combination with a mini-screw (MS) anchorage for uni- or bilateral maxillary distalization (12 bilateral situations, totalling 35). Plaster casts taken prior to (T0) and following CCLA treatment (T3) were compared with the treatment plan / set-up (TxP, with a Class I canine relationship and a normal overjet as the treatment objective). MSs were placed following levelling and aligning (T1) and removed at the end of en masse distalization at T2. Statistical analysis was carried out using Schuirmann’s TOST [two one-sided tests] equivalence test, based on a one-sample t-test with α = 0.025 on each side (total α = 0.05). Results Ninety-seven percent of planned correction of the canine relationship was achieved (mean 3.6 of 3.7 mm) and also 97 % of the planned overjet correction (mean 3.1 of 3.2 mm), with a statistically significant equivalence (p < 0.0001) for canine relationship and overjet between the individual treatment plan (set-up) and the final outcome. Adverse effects were limited to the loss of n = 2 of 35 mini-screws. However, in each instance, the treatment was completed, as scheduled, without replacing them. Accordingly, the null-hypothesis was rejected. Conclusions The technique presented allows for a predictable correction of an Angle-Class II malocclusion via dentoalveolar compensation with maxillary en masse distalization
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