Evidence-based care in orthodontics and periodontics: a review of the literature

Evaluation of dental plaque reduction using microcurrent-emitting toothbrushes in orthodontic patients: a randomized, double-blind, crossover clinical trial

This study aimed to compare the effectiveness of microcurrent-emitting toothbrushes (MCTs) and ordinary toothbrushes in reducing the dental plaque index (PI) and dental caries activity among orthodontic patients. The evaluation was performed using a crossover study design involving 22 orthodontic patients randomly assigned to the MCT or ordinary toothbrush groups. The participants used the designated toothbrush for 4 weeks and had a 1-week wash-out time before crossover to the other toothbrush. PI (Attin's index) and dental caries activity were measured at baseline and at the end of each 4-week period. Additionally, patients completed questionnaires to assess patient satisfaction for "freshness in mouth" and "cleansing degree." The results showed that the MCT group had a significant reduction in PI (p = 0.009), whereas the ordinary toothbrush group did not (p = 0.595). There was no significant difference in the dental caries activity between the two groups (p > 0.05). Patient satisfaction assessment revealed that 65% patients in the MCT group had more than "fair" experience of freshness, in contrast to 50% of patients in the ordinary toothbrush group. Satisfaction with cleansing degree was similar in both groups. Overall, these findings suggest that MCTs are more effective in reducing dental PI than ordinary toothbrushes.

Precautions and possibilities in orthodontic treatment of periodontally compromised patients: Current recommendations

OBJECTIVE

Orthodontic treatment plays a crucial role in achieving optimal dental esthetics and functional occlusion. However, when periodontally compromised patients are involved, additional precautions and considerations are critical. This article aims to provide up-to-date recommendations for the orthodontic treatment of periodontally compromised patients.

CLINICAL CONSIDERATIONS

Comprehensive diagnosis of the patient's periodontal status, inherent malocclusion, and secondary malocclusion resulting from periodontal disease are essential for achieving optimal esthetics and functional occlusion. This can be facilitated through the use of a simplified checklist. Prior to orthodontic treatment, pre-existing periodontal diseases should be managed. Light and controlled forces should be used to minimize the risk of adverse effects on the periodontium, and any potential traumatic occlusion during tooth movement should be minimized. Furthermore, careful anchorage management is required, and proper application of temporary anchorage devices can significantly expand the scope of orthodontic treatment. Finally, treatment results are maintained by ongoing supportive periodontal therapy even during the retention period.

CONCLUSIONS

This article presents clinical cases demonstrating the importance of accurate diagnosis in orthodontics and periodontics and the positive impact of orthodontic treatment on patients with pre-existing periodontal diseases.

CLINICAL SIGNIFICANCE

An up-to-date orthodontic treatment protocol for periodontally compromised patients is presented.

A randomized controlled trial evaluating the effect of two low-level laser irradiation protocols on the rate of canine retraction

The objective of this study was to evaluate the canine retraction rate with two low-level laser therapy (LLLT) irradiation protocols, involving both a high and a low application frequency. Twenty patients were randomly divided into two equal groups. In Group A, one side of the maxillary arch randomly received LLLT on days 0, 3, 7, 14, and every 2 weeks thereafter, whereas in Group B, one side received LLLT every 3 weeks. Tooth movement was checked every three weeks since the onset of canine retraction, over the 12-week study period. Moreover, Interleukin-1β (IL-1β) levels in the gingival crevicular fluid were assessed. Results revealed a significant increase in the canine retraction rate on the laser sides of groups A and B, in comparison with the control sides (p < 0.05), with no significant differences reported between the laser sides in both groups (p = 0.08–0.55). Also, IL-1β levels were significantly higher on the laser sides of both groups, in comparison with the control sides (p < 0.05). Therefore, LLLT can effectively accelerate tooth movement, with both frequent and less frequent applications, which is attributed to an enhanced biological response as reflected by the elevated IL-1β levels on the compression sides.

Role of the general dental practitioner in managing the risks of orthodontic treatment

The aim of this article is to outline the potential risks in orthodontic treatment and the general dental practitioner's role in reducing and managing such risks. The success of orthodontic treatment largely depends on patient understanding of the risk/benefit implications of the orthodontic treatment and all of the potential consequences involved in such treatment. A perfect blend of good case selection, sound clinical judgement and, more importantly, a patient's clear understanding of the potential risks involved and the treatment implications help minimise and manage potential hazards that occur during the course of the treatment.

Is the buccal alveolar bone less affected by mini-implant assisted rapid palatal expansion than by conventional rapid palatal expansion?-A systematic review and meta-analysis

OBJECTIVE

To systematically review the existing literature comparing mini-implant assisted rapid palatal expansion (MARPE) and conventional rapid palatal expansion (RPE) regarding the effect on the buccal alveolar bone thickness (BT) and marginal bone level (BL).

METHODS

PubMed/MEDLINE, Scopus, Web of Science, The Cochrane Library, Virtual Health Library, Embase, Ovid, LIVIVO, CINAHL, the Portal de Periódicos da CAPES, Google Scholar and SIGLE were searched up to January 2020. Risk of bias (RoB) assessments were performed using the Cochrane Collaboration and ROBINS-I tools. Fixed-effects meta-analysis of standardized mean differences (SMD) was implemented to assess the pooled estimates for the BT outcome. The analyses were performed adopting a significance level of 5%. A narrative synthesis was performed to summarize the results on the BL. The GRADE tool was used to assess the quality of the evidence.

RESULTS

Three randomized clinical trials and one retrospective study were included. Only one study was rated as with low RoB, while the others were scored as with moderate to serious RoB. Limited evidence indicated that patients using conventional RPE had a greater loss of the BT compared to patients using MARPE (SMD = 0.55; 95% CI: 0.29-0.80; P < .0001). Subgroup analyses showed that differences were significant in both premolars' regions, right (SMD = 0.75; 95% CI: 0.24-1.25; P = .004) and left (SMD = 1.05; 95% CI: 0.52-1.57; P < .0001), and these were not significant for the molars' regions (P > .05) (Low quality of evidence).

LIMITATIONS

Limited amount of selected papers, methodological issues that could lead to bias and high clinical heterogeneity among the studies. Due to the statistical model applied for the quantitative synthesis of the results, no generalization to any other population is recommended.

CONCLUSIONS

Limited evidence suggests that MARPE could decrease the loss of the buccal alveolar bone when compared to conventional RPE.

Periodontal clinical evaluation before and after surgically assisted rapid maxillary expansion

Introduction:

The surgically assisted rapid maxillary expansion is a procedure that reduces the resistance of the sutures correcting the posterior crossbite in adults.

Objective:

The aim of this study was to evaluate the periodontal status of 17 adults submitted to this procedure.

Methods:

The clinical attachment level (CAL), gingival recession, attached gingiva and bleeding were evaluated in maxillary first premolars and molars, central and lateral incisors of right and left sides before surgery, 5 days and 6 months after. Means, standard deviation, medians, minimum and maximum values were compared among the evaluations using the Friedman and McNemar tests.

Results:

There was a statistically significant increase in CAL in the right central incisor, right and left premolars and right and left molars. There was a statistically significant increase in gingival recession in the right and left premolars and molars. The amount of attached gingiva significantly decreased in right premolars and right and left molars. There was increase in bleeding in most of the teeth.

Conclusion:

Results indicated that the surgically assisted rapid maxillary expansion might cause alterations in periodontal tissue.

Combined Periodontal-Orthodontic Treatment of Pathologic Tooth Migration: A Case Study with 10-Year Follow-Up

Pathologic tooth migration is a change in tooth position resulting from disruption of the forces that maintain teeth in a normal position in relation to their arch. The disruption of the equilibrium in tooth position may be caused by various etiologic factors. Loss of attachment apparatus along with a non periodontal related condition such as excess occlusal force, a progressive migration of tooth may take place. Mostly this migration can be associated with aesthetic damage of the smile line. To solve these issues, a combination of periodontal and orthodontic treatment is often needed. In this presentation a 23-year-old, systemically healthy, non-smoking female presented with the complaint of bleeding gums, mobility and increased space between upper and lower front teeth causing un-aesthetic appearance and low self esteem. She was treated with interdisciplinary approach of orthodontic and periodontal intervention. Improvement of facial esthetics contributed to the self-confidence of an adult periodontal patient with pathologic tooth migration. Follow up at 10 years post treatment confirmed the good choice of treatment planning and the tendency to improve the results over time. Periodontally compromised orthodontic patients can be satisfactorily treated, achieving correction of the malocclusion and a marked improvement in esthetics when an interdisciplinary approach is used.

Influence of nicotine on orthodontic tooth movement: A systematic review of experimental studies in rats

OBJECTIVE

The objective of this systematic review was to assess the impact of nicotine administration on orthodontic tooth movement (OTM).

METHODS

A systematic search was conducted in PubMed, Scopus, EMBASE, MEDLINE (OVID) and Web of Knowledge databases and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Studies evaluating the influence of nicotine on OTM, and with the presence of a control group (OTM without nicotine administration), were included. Quality assessment of the selected studies was performed following the Animal Research Reporting in Vivo Experiment (ARRIVE) guidelines.

RESULTS

Six of the initially identified 108 articles fulfilled the inclusion criteria and were selected. All included studies were performed in male rats, which underwent OTM with or without nicotine administration. Since there was a variation among the included studies regarding nicotine dosage and the duration and magnitude of force application during OTM only a qualitative analysis could be performed. The studies reported that nicotine administration accelerated OTM by inducing alveolar bone resorption around the moving teeth. It was also found that nicotine increased root resorption during experimental OTM. More standardized animal research or clinical studies are warranted to further evaluate the impact of nicotine on OTM.

CONCLUSIONS

On an experimental level, nicotine exposure in rats jeopardizes OTM by increasing alveolar bone loss and root resorption. From a clinical perspective, further studies are needed to assess the impact of habitual use of tobacco products on OTM.

Correlation of Orthodontic Treatment by Fixed or Myofunctional Appliances and Periodontitis: A Retrospective Study

INTRODUCTION

Malocclusion plays an important role in the development of periodontitis. Thus, by treating malocclusion, a good gingival health can be achieved. This study was conducted to establish the correlation between orthodontic tooth movement and periodontitis.

MATERIALS AND METHODS

This is a retrospective study conducted on 220 patients who underwent orthodontic treatment for malocclusion. They were divided into two groups: Group I patients were treated with fixed orthodontics, while group II patients received myofunctional appliances.

RESULTS

The value for plaque, gingival recession, and tooth mobility significantly increased in group I patients. However, the difference was statistically nonsignificant in group II patients.

CONCLUSION

The authors concluded that there is correlation between malocclusion and periodontitis. Malocclusion leads to periodontitis.

CLINICAL SIGNIFICANCE

Malocclusion is the main reason for the development of poor periodontal health. Combined effort has to be played by both periodontist and orthodontist for the treatment of various orthodontic-periodontal problems.

Orthodontic Management in Aggressive Periodontitis

Aggressive periodontitis is a type of periodontitis with early onset and rapid progression and mostly affecting young adults who occupy a large percentage of orthodontic patients. The role of the orthodontist is important in screening the disease, making a provisional diagnosis, and referring it to a periodontist for immediate treatment. The orthodontist should be aware of the disease not only before starting the appliance therapy, but also during and after the active mechanotherapy. The orthodontic treatment plan, biomechanics, and appliance system may need to be modified to deal with the teeth having reduced periodontal support. With proper force application and oral hygiene maintenance, orthodontic tooth movement is possible without any deleterious effect in the tooth with reduced bone support. With proper motivation and interdisciplinary approach, orthodontic treatment is possible in patients with controlled aggressive periodontitis.

Interdisciplinary management of a patient with advanced dental needs

The present case report outlines the interdisciplinary management of an adult patient presenting with advanced generalised periodontal attachment loss, an upper dental midline discrepancy following the previous extraction of the upper left central incisor, and significant lower arch crowding. The endodontic and periodontal condition was stabilised prior to the commencement of fixed appliance orthodontic treatment and subsequent prosthetic replacement of the upper left central incisor. Interdisciplinary management provided a functional occlusion and stability of the periodontal condition along with pleasing facial and smile aesthetics.

The effect of bracket ligation on the periodontal status of adolescents undergoing orthodontic treatment. A systematic review and meta-analysis

INTRODUCTION/OBJECTIVES

This systematic review aimed to critically appraise the evidence regarding the effect of bracket ligation type on the periodontal conditions of adolescents undergoing orthodontic treatment.

DATA

Search terms included randomized controlled trial (RCTs), controlled clinical trials, ligation, bracket, periodontal, inflammation. Risk of bias assessment was made using the Cochrane risk of bias tool and the quality of evidence was assessed with GRADE.

SOURCES

Electronic Database search of published and unpublished literature was performed without language restriction in May 25, 2016 (MEDLINE via Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Clinical Trials.gov and National Research Register).

STUDY SELECTION

Of 140 articles initially retrieved, 8 were eligible for inclusion in the systematic review, while 4 RCTs with unclear risk of bias were included in the quantitative synthesis, all comparing self-ligating to conventional steel ligated brackets. Random effects meta-analyses were implemented. At 4-6 weeks after bracket placement there was no evidence to support the use of either type of bracket for achieving improved plaque- (PI) and gingival index (GI). At 3-6 months, there was scarce evidence of greater PI increase for conventional brackets. GI and pocket depth pooled estimates did not reveal significant differences between the two systems. The quality of the evidence was moderate according to GRADE for all outcomes.

CONCLUSIONS

Overall, non-significant differences on the periodontal status of adolescents undergoing orthodontic treatment with either conventional or self-ligating brackets were detected.

CLINICAL SIGNIFICANCE

The periodontal status of adolescents undergoing orthodontic treatment is of considerable importance. The synthesis of the available evidence on oral hygiene related factors will provide insights to best clinical practice during the course of orthodontic treatment.

Iatrogenic Damage to the Periodontium Caused by Orthodontic Treatment Procedures: An Overview

In orthodontic treatment, teeth are moved in to new positions and relationships and the soft tissue and underlying bone are altered to accommodate changes in esthetics and function. Function is more important than esthetics. The speciality of orthodontics has in addition to its benefits, complications as well as risks associated with its procedures. However the benefits outweigh the risks & complications in most of the treatment cases. Few of the unwanted side effects associated with treatment are tooth discolorations, enamel decalcification, periodontal complications like open gingival embrasures, root resorption, allergic reactions to nickel & chromium as well as treatment failure in the form of relapse.

Interdisciplinary treatment for an adult patient with anterior open bite, severe periodontitis, and intellectual disability

This case report describes the beneficial effects of the interdisciplinary treatment of an adult patient with severe skeletal periodontal problems. A 30-year-old female patient presented with anterior open bite, gummy smile, and facial asymmetry. The patient had chronic generalized severe periodontitis with pathologic maxillary anterior teeth migration and mild intellectual disability. Treatment included 6 months of periodontal treatment, followed by presurgical orthodontic treatment, a Le Fort I osteotomy with anterior segmental osteotomy, a bilateral sagittal split ramus osteotomy, and postsurgical orthodontic treatment. After treatment completion, the patient exhibited functional and aesthetic improvements. Her periodontal condition improved and was maintained after the treatment. Here, we demonstrate a successful treatment outcome in a complicated case following a systematic interdisciplinary approach performed with the correct diagnosis and treatment planning.

The effect of orthodontic bands or tubes upon periodontal status during the initial phase of orthodontic treatment

Introduction

Orthodontic bands cause periodontal inflammation. In theory, the use of a buccal tube (bond) instead of a band should prevent or minimize periodontal changes because the bonds are positioned away from the gingival margins.

Objective

The primary aim of this study was to investigate the periodontal status of orthodontic bands compared with bonds in the first three months of orthodontic treatment.

Materials and methods

Twenty-four orthodontic patients (mean age = 12.6 years) were enrolled in this Randomized Controlled Trial (RCT). Using the cross-mouth technique, bands and bonds were used in opposite quadrants. Periodontal parameters including the presence or absence of Bleeding On Probing (BOP) and Probing Depths (PDs) were taken at the start and three months into treatment.

Results

Bands caused a statistically significant change in the Bleeding On Probing (BOP) (P = 0.001 and 0.021) and bonds displayed a statistically insignificant change in the Bleeding On Probing (BOP) (P = 0.125 and 1.00) for the upper and lower arch. The difference in Probing Depths (PDs) between bands and bonds was also statistically significant (P = 0.001).

Conclusion

Molar bands are associated with greater periodontal inflammation compared with molar bonds in the first three months of fixed orthodontic treatment.

The effect of orthodontic therapy on periodontal health: a review of the literature

Objectives. This review aims to evaluate the effect of orthodontic therapy on periodontal health. Data. Original articles that reported on the effect of orthodontic therapy on periodontal health were included. The reference lists of potentially relevant review articles were also sought. Sources. A literature search was conducted using the databases, Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The search was carried out by using a combined text and the MeSH search strategies: using the key words in different combinations: “periodontal disease,” “orthodontics” and “root resorption.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Articles published only in English language were included. Letters to the Editor, historical reviews and unpublished articles were not sought. Conclusions. Within the limitations of the present literature review, it was observed that there is a very close inter-relationship between the periodontal health and the outcome of orthodontic therapy.

Orthodontic management of dentition in patients with periodontally compromised dentition

Background:

An increasing number of adult patients are seeking orthodontic treatment to improve their dental appearance. However, special attention must be given to the periodontal status of the adults as periodontal disease and its sequel, such as pathologic migration of anterior teeth, result in esthetic and functional problems. In such adult patients, an interdisciplinary approach often offers the best option for achieving a predictable outcome to solve complex clinical problems.

Materials and Methods:

A prospective study was carried out on 20 adult patients [mean age = 33.3 ± 4.52 (SD), 11 females and nine males] with periodontally compromised and malaligned dentition. Loe and Silness Gingival Index (GI), Ramfjord's Periodontal Disease Index (PDI) and Dental Aesthetic Index (DAI) were recorded at the start and after completion of treatment.

Results:

Comparison of GI, PDI and DAI before and after completion of treatment showed statistically significant differences, indicating the relevance of combined orthodontic–periodontic treatment in periodontally compromised dentition (P < 0.01).

Conclusion:

The outcome of the study showed that an interdisciplinary approach is a simple solution for complex clinical problems arising as a sequel to periodontitis, such as pathological tooth migration, restoring function, esthetics and periodontal health.

Effects of 2 bracket and ligation types on plaque retention: a quantitative microbiologic analysis with real-time polymerase chain reaction

INTRODUCTION

The aim of this study was to evaluate the effects of self-ligating brackets and conventional brackets ligated with stainless steel ligatures on dental plaque retention and microbial flora.

METHODS

Twenty boys (mean age, 14.2 ± 1.5 years) underwent bonding with self-ligating bracket systems and conventional standard edgewise bracket systems ligated with stainless steel ligatures with a split-mouth design. Clinical measurements, including plaque index, probing pocket depth, and bleeding on probing, were obtained before bonding, 1 week after bonding, and 3 months after bonding. Supragingival plaque samples were obtained at baseline and 3 months after bonding for the detection of bacteria. A quantitative analysis for Streptococcus mutans, Streptococcus sobrinus, Lactobacillus casei, and Lactobacillus acidophilus was performed using real-time polymerase chain reaction. The Mann-Whitney U test and the Hotelling T(2) multivariate test were used for statistical comparisons of the groups.

RESULTS

The numbers of S mutans, S sobrinus, L casei, and L acidophilus were not statistically different between self-ligating brackets and conventional brackets ligated with stainless steel ligatures (P >0.05). The 2 archwire ligation techniques showed no statistically significant differences in plaque index, bleeding on probing, and probing pocket depth values of the bonded teeth (P >0.05). All clinical parameters and the numbers of all microorganisms showed statistically significant increases from baseline to 3 months after bonding in both groups (P <0.001).

CONCLUSIONS

Self-ligating brackets and conventional brackets ligated with stainless steel ligatures do not differ with regard to dental plaque retention.

Aggressive periodontitis diagnosed during or before orthodontic treatment

OBJECTIVE

The aim was to review the literature on aggressive periodontitis diagnosed during or before the initiation of orthodontic treatment and to propose preventive recommendations before, during and after orthodontic treatment.

MATERIALS AND METHODS

Literature searches of free text and MeSH terms were performed by using PubMed, Embase and the Cochrane Library and the appropriate studies were selected. The retrieved articles were analyzed and the relevant data was tabulated according to different parameters.

RESULTS

A total of 220 articles were found in the preliminary search. Eighteen studies, all case reports, describing 21 cases from this search met all the criteria. The mean age of the reported cases was 21.12 years, all treated with combined periodontal and orthodontic modalities. Most of the reported cases were female.

CONCLUSION

An interdisciplinary dental team must approve the periodontal health prior to and during the course of the orthodontic therapy. In subjects with periodontal pathology, a periodontal consultation and interceptive/corrective therapy should be performed prior to commencing with orthodontic treatment. Orthodontic treatment should be postponed or replanned in order to shorten treatment duration and reduce the orthodontic forces exerted on the aggressive periodontitis involved dentition.

Surgical-orthodontic treatment of patients suffering from severe periodontal disorders - a clinical case study

INTRODUCTION

Orthodontic or, more precisely, surgico-orthodontic treatment of patients suffering from periodontal disorders generally requires a multidisciplinary approach by a qualified dental team. Periodontal bone healing is an essential factor for successful orthodontic treatment in a compromised periodontal situation.

CLINICAL CASE

We report on the case of an adult patient suffering from severe chronic periodontitis; he was a hyperdivergent skeletal Class III with dento-alveolar compensation, esthetic problems and a significant lack of dental material. A multidisciplinary approach was adopted. First of all, periodontal treatment was undertaken (root scaling and planing) accompanied by appropriate medical treatment and a bone graft to strengthen the area of the lower incisors. After that, surgical and orthodontic treatment to correct the malocclusion was begun. The difficulty lay in the significant absence of dental material to ensure proper intercuspation. A surgical repositioning splint was constructed on an articulator to ensure adequate mandibular retraction after maxillary advancement surgery. After treatment, the missing teeth were replaced by a prosthesis.

RESULTS AND DISCUSSION

Following treatment, the periodontal bone resorption was stabilized; the bone deficit was improved and the malocclusion had been corrected; the missing teeth were replaced by appropriate dentures. Short- and medium-term follow-up confirmed the stability of the results obtained, which will be discussed.

CONCLUSION

The right combination of properly managed orthodontic, periodontal and prosthetic treatment can contribute to effective elimination of chronic periodontitis, even at an advanced stage in an adult patient, while at the same time improving esthetic and functional parameters.

Iatrogenic possibilities of orthodontic treatment and modalities of prevention

The benefits of orthodontic treatment are numerous and in most cases, the benefits outweigh the possible disadvantages. Orthodontic treatment can play an important role in enhancing esthetics, function, and self-esteem in patients. However, it carries with it the risks of enamel demineralization, tissue damage, root resorption, open gingival embrasures in the form of triangular spaces, allergic reactions to nickel, and treatment failure in the form of relapse. These potential complications are easily avoidable by undertaking certain precautions and timely interventions by both the orthodontist and the patient. The orthodontist must ensure that the patient is aware of the associated risks and stress the importance of the patient's role in preventing these untoward outcomes. The decision whether to proceed with the orthodontic treatment is essentially a risk-benefit analysis, where the perceived benefits of commencing treatment outweigh the potential risks. This article provides an overview of the iatrogenic possibilities of orthodontic treatment and the role of the patient as well as the orthodontist in preventing the associated risks.

Endotoxins potentiate COX-2 and RANKL expression in compressed PDL cells

OBJECTIVE

This study aims to demonstrate in vitro the synergistic effect of orthodontic forces and periodontal pathogens on cyclooxygenase-2 regulation and the subsequent receptor activator of nuclear factor kappa-B ligand (RANKL) production from periodontal ligament (PDL) cells.

MATERIALS AND METHODS

In comparison to a control group, three experimental groups were formed from human primary PDL cells stressed with compressive forces, bacterial endotoxins, or a combination of both. Gene expression of cyclooxygenase-2 and RANKL was analysed with RT real-time PCR. The prostaglandin E2 production was determined with ELISA. A co-culture of PDL cells and an osteoclast-progenitor cell line was used in order to demonstrate the osteoclast formation effect caused by the simultaneous combined stress.

RESULTS

The simultaneous combined stress resulted in a 56-fold up-regulation of cyclooxygenase-2 gene expression with a subsequent noticeable rise in the prostaglandin E2 in the culture medium. The RANKL/osteoprotegerin gene expression ratio was 50-fold up-regulated and the osteoclast formation assay revealed 153.5 ± 15.7 tartrate-resistant acid phosphatase (TRAP)-positive cells per well compared with 42.3 ± 3.8 TRAP-positive cells per well of the control group.

CONCLUSION

The synergistic action of periodontal pathogens and orthodontic forces leads to an increased expression of cyclooxygenase-2 from PDL cells that intensify the RANKL production which in turn induces osteoclast differentiation and subsequent osteoclastogenesis.

CLINICAL RELEVANCE

The present study puts an emphasis on the detrimental effect of orthodontic forces on patients with an active periodontal disease by underlining the significance of cyclooxygenase-2 activity and RANKL binding on the osteoclastogenesis process.

Orthodontic-periodontics interdisciplinary approach

In this present era, when a significant number of patients seeking orthodontic treatment are adults, importance of multidisciplinary treatment approach cannot be overemphasized. Higher susceptibility of plaque accumulation in patients undergoing orthodontic treatment makes involvement of periodontist almost unavoidable. Also, orthodontic treatment frequently results in undesirable periodontal changes which require immediate attention. More recently, orthodontics has been used as an adjunct to periodontics to increase connective tissue support and alveolar bone height. The purpose of this article is to review the adverse effects of orthodontic treatment on the periodontal tissues and to discuss the mutually beneficial relationship shared between the two specialties.

CBCT assessment of alveolar buccal bone level after RME

Objective:

To evaluate the maxillary alveolar buccal bone levels after expansion with banded and bonded expanders, using cone-beam computed tomography (CBCT).

Materials and Methods:

The population sample consisted of 22 patients who required expansion during their comprehensive treatment; 10 patients (five males and five females) with a mean age of 13.5 years (CVMS 3) had bonded hygienic expanders, and 12 (six males and six females) with a mean age of 12.6 years (CVMS 3) had banded hyrax expanders. CBCT was taken both before (T1) and 6 months after last activation (T2). Measurements were made for buccal bone thickness (BT), buccal marginal bone level (MBL), and bone thickness level (BTL) at the right first molar (MRt), left first molar (MLft), right first premolar (PMRt), and left first premolar (PMLft). A mixed-design analysis of variance assessed differences between and within the groups. Post hoc t-tests were completed on significant analysis of variance results to determine where differences occurred.

Results:

Analysis of variance revealed no significant differences between or within the two groups. BT significantly decreased horizontally following rapid maxillary expansion. The amount of bone lost was −0.59 mm MRt, −0.72 mm PMRt, −0.50 mm MLft, and −0.57 mm PMLft (P &lt; .003).

Conclusions:

There was no significant difference between or within the two groups. Buccal bone loss in the vertical dimension (MBL) only showed significance in the banded group for MRt (0.63 mm) and PMLFt (0.37 mm) as evidenced by the paired t-test (P &lt; .05).

Oral diagnosis and treatment planning: part 6. Preventive and treatment planning for periodontal disease

A high level of sustained personal plaque control is fundamental for successful treatment outcomes in patients with active periodontal disease and, hence, oral hygiene instructions are the cornerstone of periodontal treatment planning. Other risk factors for periodontal disease also should be identified and modified where possible. Many restorative dental treatments in particular require the establishment of healthy periodontal tissues for their clinical success. Failure by patients to control dental plaque because of inappropriate designs and materials for restorations and prostheses will result in the long-term failure of the restorations and the loss of supporting tissues. Periodontal treatment planning considerations are also very relevant to endodontic, orthodontic and osseointegrated dental implant conditions and proposed therapies.

An update on periodontic-orthodontic interrelationships

Talking about periodontic-orthodontic interrelationships is related primarily to the 1960s, where a generalized increase in salivary bacterial counts, especially Lactobacillus, had been shown after orthodontic band placement. The purpose of this article is to provide the dental practitioner with basic understanding of the interrelationship between periodontics and orthodontics by means of representing classical studies, and, to give an update on this topic by demonstrating the most recent opinions concerning periodontic-orthodontic interrelationships. Specific areas reviewed are the ability of orthodontic treatment to afford some degree of protection against periodontal breakdown, short-term and long-term effects of orthodontic treatment on the periodontium, and some mucogingival considerations. Topics considering orthodontic treatment in periodontally compromised patients were not included in this review. While past studies have shown that orthodontic treatment can positively affect the periodontal health, recent reviews indicate an absence of reliable evidence for the positive effects of orthodontic therapy on patients’ periodontal status. Periodontic-orthodontic interrelationships are still controversial issues. However, a standard language between the periodontist and the orthodontist must always be established to eliminate the existing communications barrier, and to improve the outcomes of the whole treatment.

Orthodontic treatment in periodontal patients: a case report with 7 years follow-up

INTRODUCTION

Tooth flaring of the anterior segment is often unesthetic and therefore a primary reason for combined orthodontic and periodontal treatment in adult patients with periodontal disease. Thus, a multidisciplinary approach is frequently chosen for these patients by a qualified dental team.

MATERIALS AND METHODS

A clinical case of an adult patient suffering from chronic periodontitis with horizontal bone loss in the anterior segment and consequent flaring of the anterior teeth is described. A combined approach was chosen, initially to improve and stabilize the periodontal situation via multiple scaling and root planning sessions with additional pharmacological therapy and, finally by orthodontic treatment, to resolve the malocclusion.

RESULTS

At the end of treatment, bone resorbtion was stabilized, the vertical bone defect was improved and incisor flaring was absent. Follow-up at 7 years post-treatment confirmed the stability of the orthodontic and esthetic results.

CONCLUSIONS

The correct combination of orthodontic and periodontal treatment may contribute efficaciously to eliminate the effects of chronic periodontitis in adult patients, as well as improving esthetic parameters.

Efeito da amarração em Ortodontia, com ligaduras elastoméricas e de aço inoxidável, na saúde periodontal

OBJETIVO: o presente estudo avaliou clinicamente as condições periodontais de um grupo teste e um grupo controle utilizando-se os seguintes três sistemas de indexação periodontal: índice de biofilme, índice de sangramento e profundidade de sondagem. MÉTODOS: o grupo teste foi composto por 20 indivíduos com média etária de 13,5 anos, submetido ao tratamento ortodôntico fixo, que recebeu duas formas de ligaduras: a elastomérica e a de aço inoxidável. Os resultados foram comparados entre si e com um grupo controle, sem tratamento ortodôntico, composto de 15 indivíduos com média etária de 15,3 anos. As mensurações foram realizadas previamente ao tratamento ortodôntico (T1) e seis meses após a colocação do aparelho ortodôntico fixo (T2); e, no grupo controle, após seis meses da mensuração inicial (T2). Ambos os grupos foram orientados quanto à higiene bucal, segundo a técnica de Bass, antes do início do tratamento. RESULTADOS E CONCLUSÕES: os resultados das análises das faces dentárias demonstraram um aumento estatisticamente significativo nos índices de biofilme (P=0,000), sangramento gengival (P=0,000) e profundidade de sondagem (P=0,000), quando T1 e T2 e os grupos foram comparados; entretanto, não foram encontradas diferenças estatisticamente significativas entre as ligaduras elastoméricas e de aço inoxidável na avaliação desses índices periodontais.

Adverse effects of orthodontic treatment: A clinical perspective

Orthodontic treatment is associated with a number of adverse effects, such as root resorption, pain, pulpal changes, periodontal disease, and temporomandibular dysfunction (TMD). Orthodontists should be aware of these effects and associated risk factors. Risk factors linked to root resorption include the duration of treatment, length, and shape of the root, trauma history, habits, and genetic predisposition.

Long-term 3D cast model study: bone-borne vs. tooth-borne surgically assisted rapid maxillary expansion due to secondary variables

OBJECTIVE

This study aims to compare bone-borne (BB) surgically assisted rapid maxillary expansion (SARME) to tooth-borne (TB) SARME with regard to dentoskeletal effects.

PATIENTS AND METHODS

Measurements were performed on 3D scanned cast models of 34 patients preoperatively and 20.5 +/- 1.34 months post-expansion. Secondary variables were pterygomaxillary disjunction or not; bimaxillary osteotomy or not and patient age.

RESULTS

BB SARME without pterygomaxillary disjunction on patients <20 years led to a symmetric increase in transverse widening; however, simultaneously, to more dental tipping (canines/second molars) and to the biggest overall attachment loss (frontal teeth/premolars), especially, after the performance of bimaxillary osteotomy. TB SARME led to an asymmetric decrease in transverse widening and to more dental tipping (premolars/first molars).

CONCLUSION

In long-term effects, BB SARME led to a symmetric increase in transverse widening; however, at the price of frontal attachment loss, resulting from the initial asymmetric, but bigger, overall transverse widening, the initial major segmental rotation and the necessary orthodontics for tooth arch alignment before and after bimaxillary osteotomy.

Perception of occlusion, psychological impact of dental esthetics, history of orthodontic treatment and their relation to oral health in naval recruits

OBJECTIVE

To investigate whether the oral health of young male adults was related to (1) the degree of self-perceived malocclusion, (2) the degree of experienced negative psychosocial impact of dental esthetics, and (3) the history of orthodontic treatment and its duration.

MATERIALS AND METHODS

The study subjects were 470 male naval recruits undergoing a routine dental health checkup. They answered the Perception of Occlusion Scale (POS) and Negative Impact of Dental Aesthetics Scale (NIDAS). The Approximal Plaque Index (API), the Sulcus Bleeding Index (SBI), and the number of decayed teeth (DT) and missing teeth (MT) were examined by a staff dentist. Statistical procedures were one-way analyses of variance in the API and SBI and nonparametric Kruskal-Wallis, Mann-Whitney, and chi(2) tests in DT and MT as dependent variables.

RESULTS

(1) The subjects ranging within the upper POS quartile scored higher on the SBI (contrast: P = .003) and DT (P = .002) than did those in the lower POS quartiles. (2) In contrast to the subjects reporting minor negative impacts in the NIDAS, those with strong impacts had higher scores on the API and MT (each P < .001). (3) In the subjects with a history of orthodontic treatment lasting 30 months and longer, lower API (P < .05), SBI and DT (each P = .002), and MT (P = .007) scores were found than in the subjects without previous orthodontic treatment.

CONCLUSION

The results suggest that self-perceived dental irregularity and negative impact of dental esthetics might affect oral health, whereas previous extensive orthodontic treatment may have favorable effects by improving dental health compliance.

Periodontal effects of rapid maxillary expansion with tooth-tissue-borne and tooth-borne expanders: a computed tomography evaluation

INTRODUCTION

The force delivered during rapid maxillary expansion (RME) produces areas of compression on the periodontal ligament of the supporting teeth. The resulting alveolar bone resorption can lead to unwanted tooth movement in the same direction. The purpose of this study was to evaluate periodontal changes by means of computed tomography after RME with tooth-tissue-borne and tooth-borne expanders.

METHODS

The sample comprised 8 girls, 11 to 14 years old, with Class I or II malocclusions with unilateral or bilateral posterior crossbites Four girls were treated with tooth-tissue-borne Haas-type expanders, and 4 were treated with tooth-borne Hyrax expanders. The appliances were activated up to the full 7-mm capacity of the expansion screw. Spiral CT scans were taken before expansion and after the 3-month retention period when the expander was removed. One-millimeter thick axial sections were exposed parallel to the palatal plane, comprising the dentoalveolar area and the base of the maxilla up to the inferior third of the nasal cavity. Multiplanar reconstruction was used to measure buccal and lingual bone plate thickness and buccal alveolar bone crest level by means of the computerized method.

RESULTS AND CONCLUSIONS

RME reduced the buccal bone plate thickness of supporting teeth 0.6 to 0.9 mm and increased the lingual bone plate thickness 0.8 to 1.3 mm. The increase in lingual bone plate thickness of the maxillary posterior teeth was greater in the tooth-borne expansion group than in the tooth-tissue-borne group. RME induced bone dehiscences on the anchorage teeth's buccal aspect (7.1 +/- 4.6 mm at the first premolars and 3.8 +/- 4.4 mm at the mesiobuccal area of the first molars), especially in subjects with thinner buccal bone plates. The tooth-borne expander produced greater reduction of first premolar buccal alveolar bone crest level than did the tooth-tissue-borne expander.

Interdisciplinary approaches to adult orthodontic care

The orthodontic treatment of adult patients is most frequently just one component of a more complex treatment involving several dental disciplines. This report discusses the potential problems related to the establishment of a treatment plan and the necessity for the patient's full acceptance, and understanding of the pros and cons related to different treatment approaches. In addition, the case report underlines the importance of a well-defined treatment goal. We have illustrated the team approach and the treatment principles in this combined perio-, ortho-, and prosthodontic patient.

The relevance of behavioural sciences in dental practice

The aim of this paper is to illustrate how knowledge from behavioural sciences is necessary and relevant in creating a successful dental practice, benefitting patients and dental professionals. There are many ways to create a successful dental practice, the products of which are the various treatments performed by dentists or dental hygienists for their patients. Advanced technologies and methods are constantly improving these treatments and thus the technical and managerial aspects of dentistry. However, the success of dental practice is not only dependent on the technique applied or the technical skills of dental professionals, but also on patients, their attitudes and behaviour and the interaction between dental professionals and patients. It is well known that the success of dental treatments (for example, periodontal, orthodontic or implants) depends on the patient's behaviour, which includes compliance with certain oral hygiene regimens or specific dental visiting patterns. The outcome of the treatment depends on both the dental professional's knowledge and skills and the patient's skills, objectives and expectations. Furthermore, dental professionals and patients should be satisfied with the treatment plan as well as the outcome. This paper argues that in order for this to happen dental professionals need additional knowledge and skills from fields outside traditional dental sciences. In order to treat patients successfully, dental professionals must understand and change or modify patient behaviour, and the knowledge necessary for this is provided by the behavioural sciences.