Orthodontics

21. Going straight to better gingival health

Fixed orthodontic appliances (FOA) temporarily interfere with periodontal health of patients, as the appliance complicates oral hygiene. This cross-sectional study evaluated oral hygiene and patients’ satisfaction during orthodontic treatment with FOA or Invisalign. One hundred patients (FOA = 50, Invisalign = 50) were included who underwent orthodontic treatment for more than 6 months. Clinical periodontal examinations were performed before and after the orthodontic treatment and oral hygiene, patients’ satisfaction and dietary habits were documented by a questionnaire. Significantly better gingival health conditions were recorded in Invisalign patients while the amount of dental plaque was also less but not significantly different (API: 37.7 % +/- 21.9 for FOA versus 27.8 % +/- 24.6 for Invisalign). The evaluation of the questionnaire showed greater patients’ satisfaction in those treated with Invisalign than with FOA. Patients treated with Invisalign have better periodontal health and greater satisfaction during orthodontic treatment than patients treated with FOA.

Azaripour A et al. Braces versus Invisalign: gingival parameters and patients’ satisfaction during treatment: a cross-sectional study. BMC Oral Health 2015 15: 69.

Q Invisalign patients:

A Are more satisfied than patients treated by fixed orthodontic appliances

B Have better gingival health post-treatment

C Exhibit lower plaque levels

D All of the above

22. Inside story

The aim of this study was to assess the incidence of white spot lesions (WSLs) in subjects treated with customised lingual multibracket appliances - separately for different tooth groups and to determine the impact of patient-related and treatment-related variables on the frequencies of new WSLs. Over 200 patients were recruited with inclusion criteria of completed lingual multibracket treatment of their maxillary and mandibular permanent teeth (4,582 teeth in the study), and age less than 18 years at the initial appointment. WSL assessment was accomplished using standardised digital high-resolution maxillary and mandibular occlusal photographs taken before bracketing and after debonding. Of all teeth under consideration, 3.19% developed a WSL during treatment. The frequencies of decalcification were not significantly increased in preadolescents (<16 years) compared with adolescents (>16 years). 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.

Wiechmann D et al. Lingual appliances reduce the incidence of white spot lesions during orthodontic multibracket treatment. American J Orthodont Dentofacial Orthopedics.2015 148: 414-422.

Q White spot lesions:

A Appear to be more widespread with lingual multibracket appliances

B Vary enormously between pre-adolescents and adolescents

C Appear to be less widespread with lingual multibracket appliances

D Are far less frequent with labial multibracket treatment

23. Predicting adherence

Exploring predictors of adherence in adult orthodontic patients as reported by orthodontists in the UK was the core activity in this research. Twenty-three orthodontists from the UK with approximately 15 years of experience each completed a questionnaire regarding the importance they give to a number of factors signalled 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, cooperating in the use of removable appliances and utilisation of dental appliances are the most important factors for predicting adherence. Perceived cost of treatment was also highlighted as an important factor.

Shammary NH et al. Adherence in orthodontic settings: Understanding practitioner views in a UK sample. Angle Orthodontist 2015 85: 826-832.

Q One of the following was NOT identified by orthodontists as a predictor of adherence in adult orthodontic treatment. Please identify it.

A Distance from home to surgery

B Good oral hygiene

C Regularity of attendance

D Cooperation with removable appliances

24. CAT scan

This review assessed the scientific evidence related to the efficacy of clear aligner treatment (CAT) in controlling orthodontic tooth movement. Literature sources were searched from January 2000 - June 2014 to identify all potentially relevant peer-reviewed articles. Eleven relevant papers were selected and reported a mean intrusion of 0.72 mm. Extrusion was the most difficult movement to control (30% of accuracy), followed by rotation. Upper molar distalisation revealed the highest predictability (88%) when a bodily movement of at least 1.5 mm was prescribed. A decrease of the Little's Index (mandibular arch: 5 mm; maxillary arch: 4 mm) was observed in aligning arches. CAT aligns and levels the arches; it is effective in controlling anterior intrusion but not anterior extrusion; it is effective in controlling posterior buccolingual inclination but not anterior buccolingual inclination; it is effective in controlling upper molar bodily movements of about 1.5 mm; and it is not effective in controlling rotation of rounded teeth in particular. However, the results of this review should be interpreted with caution because of the number, quality, and heterogeneity of the studies.

Rossini G et al. Efficacy of clear aligners in controlling orthodontic tooth movement: A systematic review. Angle Orthodontist 2015 85: 881-889.

Q This review suggests that clear aligner treatment:

A Is particularly efficient at anterior extrusion

B Can be highly predictability for upper molar distalisation

C Excels at de-rotating rounded teeth

D All of the above