Editor’s note: Four topics are reviewed in this issue, all with ramifications for dentists. The first article looks at information retention in orthodontic patients and their parents. This graphic diagram of patient information can be beneficial in any dental office. The second article looks at the prognosis for impacted third molars following second molar protraction to replace missing premolars or extracted first molars in lieu of implant placement. The third article looks at microbial and periodontal measures associated with various types of retainers, as well as protocols that may mitigate risks. The final article looks at cone-beam computed tomographic evaluation of ectopic maxillary canines, the results of which demonstrate a high potential for root resorption in adjacent teeth.
Information recall of orthodontic patients and their parents
Effective communication among health care providers, patients, and families is an important aspect of health care delivery. In this prospective, randomized, controlled study, researchers compared 3 methods of delivering orthodontic information to patients and their parents. The study was published in the August issue of American Journal of Orthodontics & Dentofacial Orthopedics.
From May to December 2017, researchers in the United Kingdom recruited patients 10 years or older and their parents who attended a workshop before beginning orthodontic treatment. Exclusion criteria included patients or parents who lacked the capacity to consent; patients with craniofacial abnormalities or previous orthodontic treatment; and patients or parents who did not speak English.
A total of 93 patients (5 of whom were later lost to follow-up) and 89 parents (12 of whom were subsequently lost to follow-up) participated in the study. The mean (standard deviation [SD]) age of patients was 13.2 (1.8) years, and that of parents was 45.5 (9.1) years. At the workshop appointment, all participants watched a 45-minute audiovisual presentation on orthodontic treatment. They were then randomly allocated into 1 of 3 written information groups: (1) leaflets from the British Orthodontic Society (control group), (2) generic mind map, or (3) patient’s customized mind map.
Information on the generic mind map (group 2) was grouped into 8 main categories (such as oral hygiene measures, methods of reducing dental discomfort). The researchers incorporated emojis and colors into the mind map (an example of which is included in the article) to draw the attention of young patients and to facilitate information recall. Participants in group 3 were given a blank piece of paper and colored pens and asked to draw their own mind map consisting of orthodontic information deemed important to them.
The researchers designed a closed-end questionnaire for patients and parents to complete at baseline (T0), 30 minutes after the audiovisual presentation (T1), and 6 weeks later at a follow-up appointment (T2). The questionnaire was composed of 13 questions designed to assess participants’ short-term and long-term recall of oral health information. The maximum total score was 30.
Knowledge scores increased significantly in all groups from T0 to T1 and T2, indicating that the intervention had increased participants’ oral health knowledge, the authors wrote. Scores for parents were significantly higher (P = .002) than those for patients. Moreover, the results showed that knowledge scores for participants in either of the mind map groups were significantly higher (P = .025) than scores for participants in the leaflet group (controls). The difference in scores between the 2 mind-map groups was not statistically significant.
Further, in the T2 questionnaire, all parents responded that they had shared the information gained with their children. The correlation between patient and parental scores was significant (P < .001) at all 3 time points, the researchers wrote. However, information recall from T1 (30 minutes after the audiovisual presentation) to T2 (6 weeks later) declined in all patient and parent groups.
In this study, all 3 methods of disseminating information (leaflets, generic mind map, customized mind map) resulted in significant improvement in participants’ short-term and long-term information recall, the authors wrote. Because the generic mind map was as effective as the patient-prepared mind map, the researchers recommended use of the former as it is potentially less expensive and more consistent with respect to information conveyed. Finally, because of the decline in knowledge scores from T1 to T2, the authors recommended that information be repeated at follow-up appointments.
Read the original article here or contact the ADA Library & Archives for assistance.
Angular changes of impacted mandibular third molars due to second molar protraction
The objective of this retrospective study was to identify significant factors affecting angular changes of impacted mandibular third molars due to second molar protraction. The goal of this type of orthodontic treatment is to replace a missing second premolar or replace a decayed first molar, thus avoiding the need for an implant or a bridge prosthesis. The results were published in the August issue of American Journal of Orthodontics & Dentofacial Orthopedics.
This study comprised 41 mandibular third molars from 34 patients (10 male, 24 female) with a mean (standard deviation [SD]) age of 18.3 (3.7) years. Panoramic radiographs were obtained at the beginning of treatment (T1) and after second molar protraction (T2).
Inclusion criteria were as follows: (1) space caused by a missing mandibular first molar or a retained primary mandibular second molar with a missing succedaneous premolar space was closed via protraction of the second molar with use of temporary skeletal anchorage devices (TSADs); (2) impaction of the mandibular third molar on the side of the protracted second molar at the start of treatment; (3) third molars at Nolla stage 4 or greater; (4) second molar roots parallel to the adjacent teeth at the time of missing space closure; and (5) eruption of the third molars without application of any orthodontic forces.
Exclusion criteria were third molars that had erupted partially or fully at the start of treatment, malformed third molars that did not exhibit normal eruption, and chronic periodontitis with generalized alveolar bone resorption.
At T1 and T2, 1 investigator performed linear and angular measurements of the second and third molars using cephalometric software.
The researchers categorized the third molars into upright (U) or tilted (T) groups. The roots of the molars in the U group (n = 21) were almost parallel to those of the second molars at the end of second molar protraction (T2). Molars in the T group (n = 20) erupted with mesial angulation and subsequently underwent orthodontic appliance uprighting to attain proper position and occlusion.
The mean (SD) protraction time for the second molars was 3.0 (0.9) years. The mean (SD) amount of protraction achieved was 6.3 (2.5) mm at the crown and 7.3 (2.3 mm) at the root apex, the authors wrote. The study results also showed a mean (SD) change in third molar angulation of 1.0 (15.8) degrees (range, -23.7 degrees [mesial tipping] to 51.3 degrees [uprighting]).
The binary logistic regression analysis showed that the following measured variables were significantly associated with third molar uprighting after second molar protraction: (1) a greater Nolla stage of tooth development (odds ratio [OR] = 4.1); (2) a more upright position of third molars at T1 (OR = 1.1); (3) a greater eruption rate of third molars (OR = 23.3); and (4) a reduced rate of second molar protraction (OR = 0.2). A missing tooth space (OR = 0.006) was associated with a decreased chance of third molar uprighting. Moreover, available space for third molar eruption at T1 and T2 was not associated with third molar uprighting, the authors wrote.
In light of the study findings, the authors concluded that more developed third molars (greater Nolla stage) tended to undergo more spontaneous uprighting. They demonstrated that third molars in a more upright position before second molar protraction were more likely to erupt into acceptable positions. In addition, the position of third molars appeared to improve when the eruption speed matched the second molar protraction speed. Regarding future studies, the authors suggested that cone-beam computed tomography might provide more accurate results than panoramic radiography. In addition, prospective studies in which plaster models or digital scans are used to assess the second molar protraction rate might be warranted, the authors wrote.
Read the original article here or contact the ADA Library & Archives for assistance.
Periodontal status and salivary microbial levels in patients wearing fixed or removable retainers
Although many studies have assessed changes in microbial and periodontal parameters that occur during orthodontic treatment, few have evaluated these parameters during the retention phase. The objective of this study was to evaluate periodontal status and salivary microbial levels in patients assigned to 1 of 3 types of retainers. The study was published in the August issue of American Journal of Orthodontics & Dentofacial Orthopedics.
The study sample was composed of 45 patients (11 males, 34 females) who had just completed orthodontic treatment with fixed appliances and were about to begin the retention phase. Their mean (standard deviation) age was 15.2 (2.1) years. Inclusion criteria were as follows: no active caries, no antibiotic use within the preceding 3 months, no smoking, no periodontal or systemic disorders, and no oral prosthesis.
The researchers randomly assigned participants to 1 of 3 groups (n = 15 each): fixed lingual retainer, removable vacuum-formed retainer, or Hawley retainer. The fixed lingual retainers were bonded to the lingual surfaces of the 6 maxillary and mandibular anterior teeth. The vacuum-formed retainers covered all maxillary and mandibular tooth surfaces up to the gingival margin. The Hawley removable retainers, also on both the maxilla and mandible, engaged the lingual or palatal aspects of the teeth.
At the outset of the study, patients received toothpaste and toothbrushes and were instructed to brush their teeth 3 times a day. Those assigned to 1 of the 2 removable retainer groups were also instructed to wear their retainers all day, except during meals, and brush them after brushing their teeth.
One experienced clinician performed all periodontal assessments and collected all saliva samples. Periodontal measurements, including the plaque index (PI), gingival index (GI), probing depth, and bleeding on probing, were conducted at debonding (T0) and 1 week (T1), 5 weeks (T2), and 13 weeks (T3) after debonding. At T0, T2, and T3, the clinician collected saliva samples from patients, which were stored in sterile tubes at -80°C until analyzed by means of real-time polymerase chain reaction for Streptococcus mutans and Lactobacillus casei.
The study findings showed no statistically significant differences between the 3 retainer groups with respect to salivary S mutans and L casei levels (P > .05), the authors wrote. In the lingual retainer and Hawley retainer groups, S mutans and L casei levels decreased significantly from T2 (5 weeks) to T3 (13 weeks), while S mutans levels in the vacuum-formed retainer group decreased significantly from T0 to T3, and L casei levels decreased significantly from T0 to T3 and from T2 to T3 (P < .05).
Similarly, the study results revealed no statistically significant differences between the 3 retainer groups in PI, GI, probing depth, and bleeding on probing ( P > .05). These measurements decreased significantly in the vacuum-formed retainer group from T0 to T2, from T0 to T3, and from T1 to T3. In the lingual retainer and Hawley retainer groups, these 4 measurements decreased significantly from T0 to T2 and from T0 to T3, the authors wrote.
On the basis of the study findings, the researchers concluded that fixed and removable orthodontic retainers do not differ with regard to salivary S mutans and L casei levels or periodontal status. They noted that their findings are at odds with other reports of observations over longer periods and postulated that, in this clinical study, the hygiene materials provided and follow-up may have been differentiating factors. In this study, regardless of the type of retainer used, oral hygiene improved after orthodontic treatment with fixed appliances.
Read the original article here or contact the ADA Library & Archives for assistance.
Prevalence of root resorption of teeth adjacent to impacted maxillary canines
Displacement and impaction of maxillary canines is 1 of the most frequently occurring eruption disturbances, and root resorption of adjacent teeth is a common complication. In this retrospective study, researchers assessed the prevalence of root resorption of teeth adjacent to impacted canines, as well as associated risk factors. The study was published online December 7, 2018, in European Journal of Orthodontics.
Patients were referred to a dental radiology department by an orthodontist for cone-beam computed tomographic (CBCT) evaluation of abnormal or ectopic eruption of 1 or both permanent maxillary canines. Prospective participants were excluded from the study if they were older than 17 years; had undergone or were undergoing orthodontic treatment; had odontogenic tumors, odontomas, supernumerary teeth, or cysts associated with the maxillary canine; or had a craniofacial syndrome.
Sixty patients (34 girls, 26 boys) with 83 displaced canines (37 unilateral, 23 bilateral) met the criteria for inclusion in the study. Their mean (standard deviation) age was 12.2 (1.9) years.
All CBCT images were acquired with a NewTom VGi unit (QR srl) set to high resolution. The investigators viewed the images on an NNT viewer (QR srl) in a dimly lit room using 3-dimensional multiplanar reconstructions (MPR) and curved planar reconstructions (CPRs) that simulated a panoramic view.
The researchers evaluated the following variables associated with the canine teeth:
- labio-palatal location of the displaced canine (palatal, labial, or center of the arch)
- mesiodistal position of the canine cusp tip
- inclination of the canine to the midline (alpha angle) on the CPR
- distance from the canine cusp tip to the occlusal plane on the CPR
- maximum width of the canine follicle (considered enlarged if 3 mm or greater)
- contact relationships between the canine tooth and adjacent roots (considered to be in contact if the distance was less than 0.5 mm).
The investigators assessed the presence or absence of root resorption in teeth adjacent to the displaced canine on 3D MPR views and along the long axis of each adjacent root. They graded the severity of resorption as slight (up to half the dentin thickness), moderate (dentin resorption midway to the pulp), or severe (resorption affecting the pulp). In addition, they recorded the vertical location of the resorption (cervical, middle, or apical third of the root).
The researchers detected root resorption of at least 1 adjacent tooth in more than two-thirds of the affected quadrants. Specifically, resorption occurred in 55.7% of all lateral incisors, 8.4% of all central incisors, and 19.5% of all first premolars. Of the root resorptions, 71.7% were graded as slight, 14.9% were moderate, and 7.5% were severe. The authors noted that other studies with older participants reported higher rates of severe resorption, likely due to worsening of resorption with changes in canine position or adjacent tooth position over time. The middle and/or apical third of the root was resorbed in 92.5% of cases, while the cervical third was resorbed in only 7.5% of cases. This predilection for apical resorption agrees with the findings of many prior studies.
Contact between the displaced canine and the adjacent tooth roots was the only statistically significant risk factor identified in this study (odds ratio, 18.7; 95% CI, 2.26 to 756; P < .01). An enlarged canine dental follicle, a peg lateral tooth, or agenesis of a lateral tooth was not significantly associated with root resorption of adjacent teeth in this study.
Future studies should focus on moderate and severe root resorption, which are identified with a higher degree of certainty on CBCT, the authors concluded.
Read the original article here or contact the ADA Library & Archives for assistance.
The SunClear advantage
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Learn to help your younger patients with airway problems
When a child has breathing problems, orthodontics is not usually the first thought when it comes to treatment. However, in these two courses by the experts at the ADA, you will learn how this field can help younger patients with issues such as snoring and obstructive sleep apnea. The courses offer ideas for tests and treatment options. You will discover your role in a child’s overall health beyond their dental concerns.
- Orthodontics with an Airway Focus
- 2019 ADA Children's Airway Conference Session Five: Nasal Breathing 24/7: What Does That Even Mean? Habit Correcting for Children and Dental Teams: Growth and Development
Visit ADACEOnline.org to find out more information about these and other orthodontics courses.
AAO educational tool for dental professionals on orthodontic check-ups available
To support the dental community in timely identification of common malocclusions and the importance of an orthodontic evaluation no later than age 7, the American Association of Orthodontists provides dentists and dental hygienists an educational tool, Problems to Watch for in Seven Year Olds, in English and Spanish. Please download and share this with your office team.
![Dr. Graber Preferred Photo[2]](https://pages.ada.org/hs-fs/hubfs/Dr.%20Graber%20Preferred%20Photo%5B2%5D.jpg?width=140&name=Dr.%20Graber%20Preferred%20Photo%5B2%5D.jpg)
The consulting editor for JADA+ Specialty Scan — Orthodontics is Lee W. Graber, DDS, MS, MS, PhD; Diplomate, American Board of Orthodontics. |
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