Cortical bone remodeling/tooth movement ratio during maxillary incisor retraction with tip versus torque movements

The validity of the postulate "bone traces tooth movement" was examined on 40 Angle Cl II cases. It was hypothesized that a 1:1 cortical bone remodeling/tooth movement ratio is preserved during maxillary incisor retraction. The sample was divided into retraction with tip (13 patients), retraction with torque (18 patients), and control (9 patients) groups. Two time point cephalograms were analyzed with two superimposition techniques, SN at S and a newly developed static tooth analysis, with the maxillary left central incisor serving as a reference object. In both retraction with tip and retraction with torque groups, the postulate bone traces tooth movement was not preserved and a bone remodeling/tooth movement ratio of 1:2 and 1:2.35 was obtained, respectively. In retraction with tip movement, the apical one third of the root tipped labially reducing the superior area of labial maxillaris by 19%. However, due to the compensating effect of the retraction movement, no apex approximation to the labial cortical plate occurred (eliminating the hazard of root resorption, dehiscence, or fenestration). In retraction with torque movement, the increase in both superior (28%) and inferior (65%) labial maxillaris areas was indicative for the hazard of root approximation to the palatal cortical bone. It is recommended to use the 1:2 bone remodeling/tooth movement ratio as a guideline to determine the biocompatible range of orthodontic tooth movements. Furthermore, a judicious interplay between the two modes of retraction can prevent major biologic impairments associated with the ratio and can extend the orthodontic range of treatment.

Rare earth magnets and impaction

Aberration in the eruption process was found to be a prime etiologic factor in inducing impaction. Thus an ideal treatment approach should attempt to mimic the normal eruption modus. However, conventional traction methods have been found to be associated with gingiva inflammation, bone recession, reduced attached gingiva, periodontal pockets, exposed cementoenamel junction, and root resorption of the impacted and adjacent teeth. These side effects are the result of premature exposure of the impacted tooth to the oral cavity through a nonself-cleansing pathway and an uncontrolled force system. The present study introduces a new, magnetic attraction system, with a magnetic bracket bonded to an impacted tooth and an intraoral magnet linked to a Hawley type retainer. Vertical and horizontal magnetic brackets were designed, with the magnetic axis magnetized parallel and perpendicular to the base of the bracket, respectively. The vertical type is used for impacted incisors and canines, and the horizontal magnetic bracket is applied for impacted premolars and molars. A three-dimensional analysis of the magnetic force system, by means of the OMSS apparatus, found the small magnetic bracket combined with a large pole surface area of the intraoral magnet to exhibit the most efficient convergent guidance. For this report the magnetic eruption device was examined on one animal subject and four patients. The Nd2Fe14B magnets were coated with parylene and/or encapsulated in stainless steel housings. In deep impaction, the magnetic bracket was cold-sterilized before surgery, and the surgical mucoperiosteal flap was then sutured over the bonded magnetic bracket. Attraction was initiated 1 to 2 weeks after healing. Thus tooth emergence into the oral cavity replicated normal eruption conditioning. The system operated at an attractive force level of 0.2 to 0.5 N. Adjustment was accomplished by temporarily interposing a magnetic spacer between the two magnetic units. No side effects were observed in this restricted number of treated cases, and treatment time was reduced. The study recommends the application of magnets in the treatment of impaction on the grounds of less invasive surgical procedure, effective attractive forces at short distances, and controlled spatial guidance.

Magnetic versus mechanical expansion with different force thresholds and points of force application

The effects of force magnitude (high versus low) and point of force application (teeth versus direct palatal endosseous pins) on palatal expansion treatment were studied on four juvenile female Macaca fascicularis monkeys. Three subjects received one of the following appliances: (1) conventional type jackscrew maxillary plate bonded to the posterior teeth with a high force magnitude of 2033 g, (2) a similar tooth-borne appliance but with rare earth repulsive magnets having a low force of 258 g, or (3) a specially designed palatal acrylic appliance pinned directly to the palatal shelves also utilizing rare earth repulsive magnets with a low force of 258 g. A fourth animal, the control, received a passive sham appliance bonded to the abutment teeth. Spatial changes of dental markers and facial implants were studied radiographically. In the low force, magnetically induced appliances, treatment was longer (95 days for the palatally pinned appliance and 135 days for the bonded tooth-borne appliance). The force radiated superolaterally, dissipating in the zygomaticofrontal suture, and the overjet significantly increased because of the marked widening of the incisive and transverse sutures. With the conventional jackscrew high-force appliance bonded to the teeth, the treatment lasted 33 days. A diastema developed between the incisors and the force was transmitted superolaterally and then transmedially, thus causing fractures in the nasal complex and other iatrogenic sequelae. The palatally pinned magnetic appliance induced bodily tooth movement, the greatest increase in intermolar distance, and a superior repositioning of the maxillopalatine region. The latter two effects were caused by selective excitation of the transverse suture over the premaxillary suture. Symmetry decreased with remoteness from the point of application. These results suggest reduction of the conventional force by up to eightfold--a level supplied by the rare earth magnets. Extrapolating from these results, the slow palatal expansion regimen for the treatment of Class III malocclusions with maxillary transverse deficiency is preferred at an early age (not more than 6 years). In the event of a suture disorder, the use of direct forces to the palate might be considered.

Skeletal and dental response to rapid maxillary expansion with 2- versus 4-band appliances

PURPOSE

Banding a rapid palatal expansion (RPE) appliance to the 2 first molars has been proposed as an equivalent to the conventional 4-band RPE appliance. However, the dentoskeletal response to this treatment has not been evaluated.

MATERIAL

Twenty-eight subjects (aged 8-20 years) who required maxillary expansion were matched by age and randomly assigned to either a 2-band or a 4-band RPE group. Skeletal and dental responses were measured from standardized anteroposterior cephalometric and occlusal radiographs and dental casts before treatment (T1), at the end of expansion (T2), and at 1 year postexpansion (T3).

RESULTS

At T2, suture expansion was 2.5 times greater and arch perimeter was 6-fold larger in the 4-band than in the 2-band group. Both appliances displayed the typical "V" expansion of the suture and "reverse V" expansion of the dental arch. At T3, remineralization reduced the suture opening by 75%, but 95% to 99% of the dental reaction was maintained. The 2-band group demonstrated a significant inverse age-dependent correlation ( r = -0.795), with treatment failure beyond 12 years of age, whereas the 4-band group was age-independent.

CONCLUSIONS

The greater the skeletal resistance, the smaller the sutural response but the greater the dental response to RPE therapy. Four-band RPE is indicated when severe anterior crowding is accompanied by a tapered arch form, and 2-band RPE is recommended in the mixed dentition when mild crowding occurs with posterior constriction.

Duration and Anchorage Management of Canine Retraction with Bodily Versus Tipping Mechanics

Objective: To compare tipping mechanics (TM) and bodily mechanics (BM) with respect to duration, angulation, and anchorage loss during canine retraction.

Materials and Methods: TM and BM brackets were bonded to the upper right and left canines, respectively, of 14 subjects requiring maxillary first premolar extractions. The upper canines were retracted with variable nickel titanium closed coil springs (F = 0.50 or 0.75 N) attached posteriorly to a Nance anchorage appliance through the first molars. Panoramic radiographs and dental casts were taken at five time points. Canine angulation was assessed with custom metallic jigs inserted into the vertical slots of the canine brackets prior to radiographic exposure.

Results: The canine crown contacted the second premolar after 102.2 ± 106 and 99.0 ± 80.0 days, and achieved root uprighting in 72.0 ± 31.3 and 37.2 ± 42.7 additional days with the TM and BM groups, respectively. Only the uprighting stage differed significantly between the two mechanics (P < .05). During retraction, tooth angulation differed significantly (P < .001) between the TM (6°) and BM (−0.8°) groups. Anchorage loss, as assessed by mesial molar movement, was 1.2 ± 0.3 mm and 1.4 ± 0.5 mm for the TM and BM groups, respectively.

Conclusions: Bodily canine retraction occurred faster (38 days) than tipping due to a shorter duration of root uprighting. Anchorage loss (17%–20%) was similar for both retraction methods, ie, maximum anchorage could not be provided by the Nance appliance. Both TM and BM brackets had inadequate rotational control of the retracted canine.

Functional orthopedic magnetic appliance (FOMA) II--modus operandi

A new functional appliance (FA) to correct Class II dentoskeletal malocclusions is introduced. The functional orthopedic magnetic appliance (FOMA) II uses upper and lower attracting magnetic means (Nd2Fe14B) to constrain the lower jaw in an advanced sagittal posture. In vitro, a special gauge transducer measured the magnetic attractive path and forces. In vivo, 13 prepubertal female Macaca fascicularis monkeys received facial implants and were treated for 4 months with the following appliances: conventional FA (four subjects), FOMA II (five subjects), a combined FOMA II + FA (two subjects), and sham (control) appliance (two subjects). The in vitro results showed the following: vertico-sagitally displaced upper and lower magnets attracted ultimately along an oblique line with a terminal horizonal slide to become fully superimposed; the functional performance improved when the magnetic interface acted as a magnetic inclined plane; and the magnetic force was able to guide and constrain the mandible toward the constructive protrusive closure position (CPCP) (1.2 mm, F = 570 gm) from levels below the habitual rest position (3 mm, F = 219 gm) and the electromyographic (EMG) relaxed position (8.5 mm, F = 45 gm). The in vivo results demonstrated the following: functional performance increased in FOMA II (22%) and in the combined FOMA II + FA (28%) over the conventional FA; mandibular length increased significantly in the treated animals (means = 2.83 +/- 0.70 mm) over the control animals (means = 0.43 +/- 0.08 mm); incisor proclination was lower in magnetic appliances (means = 4.57 +/- 1.76 degrees) than in the conventional FA (means = 8.75 +/- 1.85 degrees); mandibular elongation and condylar posterior inclination resulted from posterosuperior endochondral growth (increased cell proliferation and/or hyperplasia of functional chondroblasts) and by bony remodeling of the condylar neck (apposition posterior border, resorption anterior border), respectively; virtually no anterior displacement of the postglenoid spine (means = 0.19 +/- 0.68 mm) nor the articular eminence (means = 0.36 +/- 0.69 mm) was found. Increased lower posterior alveolar height (means = 1.71 +/- 0.82 mm) is a major impediment in the correction of excessive lower anterior facial height. The results of the study highly recommend the exploration of the clinical application of the FOMA II.

Orthodontic tooth movement enhances bone healing of surgical bony defects in rats

BACKGROUND

The question of whether the repair of an alveolar bony defect can be enhanced by orthodontic tooth movement was addressed.

METHODS

Alveolar bone defects were created in 52 Wistar male rats anterior to both maxillary first molars. After 1 week of healing, orthodontic protraction was applied for 2 weeks on the right side, resulting in mesial tipping and displacement movement. Subsequently, a retention appliance was inserted for 1 week. The left side served as the untreated (control) group. Vital bone staining (procion brilliant red H-8) was administered before and after orthodontic traction. Histomorphometric analysis was performed on 62 hemimaxillae using UV confocal microscopy and an imaging program. The total area of the bony defect was divided into 4 equal quadrants, and the area of bony apposition in each quadrant was measured.

RESULTS

The total area of bony apposition was 6.5-fold larger in the treated (26.41 x 10(4) +/- 28.92 x 10(4) microm2) than in the control group (4.07 x 10(4) +/- 2.82 x 10(4) microm2), approaching statistical significance (P = 0.065). The treated occlusal quadrants demonstrated highly significant (P= 0.010), greater bone apposition compared to the control group (13.8-fold) and to the treated apical quadrants (P= 0.04, 5-fold).

CONCLUSIONS

This study confirms that orthodontic tooth movement is a stimulating factor of bone apposition. A conversion in the repair pattern of the bony defect from apicoocclusal in the control group (no tooth movement) to occlusoapical in the treated group (with tooth movement) further supports the linkage between tooth movement and enhanced bone deposition. Clinical implication suggests incorporation of orthodontic tooth movement in regenerative therapy.

Repair process of external root resorption subsequent to palatal expansion treatment

The repair process of external root resorption (ERR) and the role of retention mechanics in enhancing ERR repair were studied on eight Macaca fascicularis monkeys that were divided equally into short- and long-term groups. Six monkeys received palatal expansion appliances, and two received sham appliances. The short-term group received active treatment. The long-term group received additional retention (4 months) and relapse (2 months) treatment periods with biweekly injections of individual vital dye per phase, i.e., procion red H-8B and violet H-3R (80 mg/kg B.W.), respectively. Histomorphologic examinations included scanning electron microscopy, light, and ultraviolet microscopy. The short-term group demonstrated penetrated resorption with pulp exposure at sites with initial deficiency of the protecting odontoblastic layer (apical zone, nutrition canal). The long-term group showed two forms of ERR repair: (1) Nonfunctional retarded repair cementum, comprised of overlapped incremental lines and deprived of extrinsic fibers, was delineated in severe pulp exposure. The pulp/dentin complex showed intense incorporation of procion dye in the dentinal tubuli, conceivably related to a defense response in the form of sclerotic dentin. (2) Functional rapid repair cementum, comprised of discriminated incremental lines mainly of mixed cellular cementum, with a consistent pattern of five sequential phases: the lag phase (14 to 28 days), the incipient phase (14 days), the peak phase (14 to 28 days), the steady phase (42 to 56 days) and the retreating phase (70 days). Sharpey's fibers at functional ERR sites were scarce, never emerging from the dentinocemental junction, and not developing into principal fibers. The pulp/dentin complex showed an increase in pulp stones but no formation of tertiary dentin. The apical area responded by hypercementosis in the form of apical occlusion and a displaced pulp canal. The application of a fixed retention device is recommended in light of accelerated apposition of repair cementum during the retention period. However, increased formation of Sharpey's fibers during the relapse period might suggest a restricted duration in splinting therapy.

Stem cells of the lamina propria of human oral mucosa and gingiva develop into mineralized tissues in vivo

AIMS

To characterize the mineralized tissue formed constitutively in the supracalvarial region of scid mice by a primitive stem cell population (hOMSC) derived from the lamina propria of the human oral mucosa and gingiva.

MATERIAL AND METHODS

Fibrin-hOMSC constructs were cultured for 14 days at which time point they were analysed for the expression of osteoblastic/cementoblastic markers and implanted between the skin and calvaria bones into scid mice. After 8 weeks, the animals were sacrificed and the implantation sites analysed.

RESULTS

Two-week-old cultures of fibrin-hOMSC constructs expressed osteogenic/cementogenic markers at the gene level. Macroscopic and radiographic examinations revealed mineralized masses at the implantation sites of fibrin-hOMSC constructs. Histology, histochemistry and immunofluorescence showed mineralized masses consisting of avascular cellular and acellular matrices that stained positively for collagen, Ca, cementum attachment protein, cementum protein 1, bone sialoprotein, alkaline phosphatase, osteocalcin, amelogenin and ameloblastin. Positive anti-human nuclear antigen indicated the human origin of the cells. Atomic force microscopy depicted long prismatic structures organized in lamellar aggregates.

CONCLUSIONS

Within the limitation of this study, the results indicate for the first time that fibrin-hOMSC constructs are endowed with the constitutive capacity to develop into mineralized tissues that exhibit certain similarities to cementum and bone.

Functional orthopedic magnetic appliance (FOMA) III--modus operandi

An intraoral intermaxillary appliance has been developed for the treatment of Class III malocclusions that exhibit midface sagittal deficiency with or without mandibular excess. The functional orthopedic magnetic appliance (FOMA) III consists of upper and lower acrylic plates with a permanent magnet incorporated into each plate. The upper magnet is linked to a retraction screw. The upper magnet is retracted periodically (e.g., monthly) to stimulate maxillary advancement and mandibular retardation. The attractive mode neodymium magnets used in this study produced a horizontal force of 98 gm and a vertical force of 371 gm. Six female Macaca fascicularis monkeys were treated with FOMA IIIs. An additional three animals were treated with sham appliances. After 4 months of treatment, the following results were found: the growth pattern of the cranial base (saddle angle) was not altered; midfacial protraction did occur along a recumbent hyperbolic curve with a horizontal maxillary displacement and an anterosuperior premaxillary rotation; the cumulative protraction of the maxillary complex was initiated at the pterygomaxillary fissure with an additional contribution provided by other circummaxillary sutures (zygomaticomaxillary s., transverse s., premaxillary s.); and inhibition of mandibular length was minimal, but a tendency toward a vertical condylar growth pattern was observed. The interaction between sutural and condylar growth sites appeared biphasic, characterized by an immediate and rapid excitation of the circummaxillary sutures followed by a delayed and slow suppression of the condylar cartilage. Long-term animal and clinical FOMA III studies are recommended.

Statistical evaluation of torque angles in reference to straight-wire appliance (SWA) theories

Inconsistency in torque data on diverse straight-wire appliance (SWA) attachments calls for reassessment of the SWA theories. This study evaluates the SWA theories and suggests predictive torque models. A custom-made torque angle gauge was used on models from 54 ideal occlusion subjects (34 orthodontically treated and 20 untreated cases). This study is in close agreement with Andrews' mean torque values except those for the upper incisors. No agreement is found with Ricketts' torque data. A SD of +/- 5 degrees is characteristic for all teeth. Therefore, the maximal arch wire in a 0.018-inch slot that will not produce deleterious effects is 0.016 X 0.022 inches using Andrews' data and 0.016 X 0.016 inches with Ricketts' data. Neither the setup procedure nor the morphometric parameters predict individual torque data. Intertooth torque correlations indicate that the first premolar in each arch is the tooth of choice for predictive purposes, with unpredictability in the upper arch. Intertooth torque correlations demonstrate a systematic arrangement defined as follows: (1) a lower torque value for a known tooth indicates a lower value for a predicted tooth, (2) neighboring teeth show the strongest coefficient of correlation, and (3) intertooth torque correlations are ranked according to dental fields, showing a similar genetic pattern to tooth morphology.

Comparative study of 3 types of toothbrushes in patients with fixed orthodontic appliances

INTRODUCTION

Plaque and trapped debris that accumulate gingivally to orthodontic wire are difficult to remove. The triple-headed toothbrush (TH-TB) was designed to reach the gingival tooth margin. In this study, we examined its effectiveness in improving the oral health of orthodontic patients as compared with conventional and orthodontic toothbrushes.

METHODS

Orthodontic patients (n = 94; mean age, 15.6 +/- 3.9 years) receiving edgewise treatment in both arches were randomly assigned to 1 of 3 groups (TH-TB, orthodontic toothbrush, and conventional toothbrush). After toothbrushing instruction, each participant received professional tooth cleaning. Tooth plaque index, bracket plaque index, gingival index, and bleeding index were recorded at baseline and after 4 weeks of usage. Satisfaction level was obtained after 4 weeks.

RESULTS

The TH-TB was significantly more effective than conventional and orthodontic toothbrushes in tooth-plaque removal by 2-fold and 1.5-fold, respectively (P < .001); in bracket-plaque removal by 3-fold and 2-fold, respectively (P < .001); and in improving gingival health by 6-fold and 1.5-fold, respectively (P = .011). Patients who used the TH-TB were significantly more satisfied than those who used the other toothbrushes (P < .001).

CONCLUSIONS

The TH-TB is a practical alternative to other manual toothbrushes to improve tooth and gingival health in orthodontic patients wearing fixed appliances.

Mandibular second molar impaction. Part I: Genetic traits and characteristics

INTRODUCTION

Detection of mandibular second molar (MM2) impaction is imperative for orthodontic diagnosis and treatment. In this study, we examined a possible genetic trait in MM2 impaction in 2 populations and defined distinctive characteristics.

METHODS

Initial panoramic radiographs of patients of Israeli (n = 3500) and Chinese-American (n = 3000) origin, aged 11 to 15 years, were examined. Twelve distinctive characteristics were compared between the unilateral impacted and the nonimpacted sides.

RESULTS

A total of 120 subjects with MM2 impaction were found (1.8%). The Chinese-American population had a higher prevalence (n = 71, 2.3%) of MM2 impaction compared with the Israeli population (n = 49, 1.4%; P = 0.004). For the subjects with MM2 impaction, the Israelis had significantly (P = 0.039) fewer bilateral impactions (27%) than did the Chinese-Americans (45%). Mesially inclined impacted MM2s were more common (88% and 89%) in the Israeli and Chinese-American populations, respectively. The unilateral impacted side demonstrated reductions in the distance between the mandibular first molar and the ramus (P <0.001), the length of the mesial root of the MM2 (P <0.001), and the height between the MM2 and the mandibular third molar, and increases in the angulations of the MM2 (P <0.001) and the mandibular third molar (P <0.003).

CONCLUSIONS

An autosomal genetic trait is present in MM2 impaction with greater penetrance in the Chinese-American population. Within developmental impediments, the deficient mesial root length of the MM2 is the primary impaction factor.

Bone Apposition in Surgical Bony Defects Following Orthodontic Movement: A Comparative Histomorphometric Study Between Root- and Periodontal Ligament-Damaged and Periodontally Intact Rat Molars

BACKGROUND

The influence of orthodontic tooth movement with diminished periodontal support is unclear. The aim of the present study was to evaluate bone healing in surgical defects following orthodontic tooth movement with and without periodontal ligament (PDL) and root surface damage.

METHODS

The study comprised 33 adult male Wistar rats, divided into two groups: group 1 (n = 14) with bony defect and no root damage and group 2 (n = 19) with periodontal bony defect including root/PDL damage on the mesial root of the maxillary first molar. One week after a surgical defect was created, orthodontic protraction of the right maxillary first molar was initiated in both groups. After 2 weeks of protraction, retention of 1 week was established; at the end of this period block sections were made. Histomorphometric analysis through light microscopy of decalcified tissue was performed. Results were statistically analyzed using independent samples t test and analysis of variance (ANOVA) with repeated measures.

RESULTS

Differences between groups in total area of bone defect and bone apposition were not statistically significant. Bone apposition calculated as percentage of the bone defect was significantly (t-test) greater (P = 0.002) in group 2 (46.21%) than in group 1 (24.95%). Within each group, area of bone apposition was significantly (ANOVA) greater in the distal than in the mesial quadrants of the bony defect (P = 0.006) and in the apical than the occlusal ones (P = 0.021).

CONCLUSION

Following orthodontic tooth movement, periodontal bony defects showed enhanced bony healing compared with alveolar bone defects with no direct association with the periodontal attachment apparatus.

In vivo debonding strength and enamel damage in two orthodontic debonding methods

Bracket debonding strength related to diverse debonding methods and enamel damage has not been assessed in vivo. The study hypothetized a direct relationship between these three parameters. Debonding strength was measured clinically in the wings method and base method on 50 patients in a split mouth method using a calibrated debonding plier. Brackets from 30 of these patients were scanned in SEM and EDAX for adhesive remnant index and enamel calcium remnants. Base method debonding force was significantly greater than wings method (163.5+/-68.7 N, 106.1+/-66.2 N, respectively, p < 0.001). A positive adhesive remnant index score was found in both methods (68.7%, 66.7%, respectively). Debonding strength vs. adhesive remnant index or calcium index scores were not correlated. However, the latter two were significantly correlated (0.524 < R < 0.895, p < 0.031). Half of the debonding failures developed at the adhesive enamel interface. The results warnts the potential of enamel damage during debonding.

Stability of magnetic versus mechanical palatal expansion

Spatial stability following palatal expansion (PE) treatment was studied longitudinally on 8 Macaca fascicularis monkeys. The sample was divided into short-term and long-term groups. The four subjects in each group received: (1) an indirect screw (IS) PE appliance (F = 2035 g), (2) an indirect magnetic (IM) PE appliance (F = 258 g and 360 g), (3) a direct magnetic (DM) PE appliance (F = 258 g and 360 g) and (4) a sham appliance. The terms direct and indirect describe force transmission directly, via pinning to the palatal shelves or indirectly, via abutment teeth. Active treatment in the long-term group was followed by a 4 month retention phase and a 2 month relapse phase. The implant study indicated the transverse stability to be greatest in the skeletally borne appliance. Correspondingly, intercanine distance relapse was 53 per cent and 23 per cent for the IS and DM subjects, respectively. Intermolar expansion was significantly more stable than intercanine expansion due to selective activity of the circum-maxillary sutures (transverse suture) and root configuration. Sagittal advancement and vertical superior translation, which are controlled by selective activity of the premaxillary suture, were particularly apparent in the magnetic appliances with a low force PE regimen. Clinical implications suggest that the use of a low force PE regimen can be of substantial benefit in young skeletal Class III patients with transverse maxillary deficiency.

Centric slide, bite force and muscle tenderness changes over 6 months following fixed orthodontic treatment

OBJECTIVE

The postorthodontic change of the masticatory muscles was evaluated using three parameters: maximal voluntary bite force (MVBF), slide in centric (difference between maximal intercuspation and retruded contact position), and muscle sensitivity to palpation.

MATERIALS AND METHODS

MVBF was measured with a custom-made rubber tube bite force device, centric slide with a digital caliper, and sensitivity to palpation of the masseter and temporalis muscles (scale 0-3) during application of standardized digital force (10 N). Data were collected at four time points: T0, before bracket removal; T1, immediately after bracket removal; T2, after 3 months of retention; and T3, after 6 months of retention. Patients (n = 41; 22 females, 19 males; mean age 17.4 +/- 5.4 years) were examined from T0 to T1 and from T1 to T2. Of these, 28 (15 females, 13 males) were followed at T3.

RESULTS

Immediately after bracket removal (T0 to T1), MVBF increased significantly by 15%. Another significant increase (15.5%) was found 3 months posttreatment (T1-T2), and almost no increase (2%) at 6 months (T2-T3). The slide in centric remained within normal values during the three time points. A decline in sensitivity to palpation from T1 to T3 was found for both masseter and temporalis muscles.

CONCLUSIONS

Neuromuscular adaptability begins within several minutes after bracket removal. A second stage of muscular adaptation occurs within 3 months of retention. These findings suggest that muscular adjustment occurs within a short period after orthodontic treatment.

Periodontal healing following orthodontic movement of rat molars with intact versus damaged periodontia towards a bony defect

The aim of this research was to determine whether orthodontic tooth movement influences periodontal healing. In 16 male Wistar rats, 12 week of age, a bony defect was created mesial to both maxillary first molars, not including the attachment apparatus (group 1), and in 15 animals, the defect included the periodontal ligament (group 2). In both groups, the right first molar was moved mesially (orthodontic side) for 2 weeks followed by a 1-week retention period; the contralateral molar was not moved (control side). Histomorphometric analysis was performed. The results within and between the different treatment groups and sides were statistically compared by t-test and analysis of variance with repeated measures on logarithmic transformation. Junctional epithelium was significantly larger at the control than at the orthodontic side of both groups (P = 0.024), and significantly larger in group 2 than in group 1 (P < 0.001). A significantly (P = 0.034) larger pocket depth was found at the control side in group 1. Supracrestal connective tissue was larger at the control than at the orthodontic side for both groups and significantly larger in group 2 than in group 1 (P = 0.004). Root resorption was found infrequently only at the orthodontic side in both groups (five out of 31 cases). The principal findings suggest favourable effects of orthodontic tooth movement on restraining epithelial apical down-growth and decreasing pocket depth. Orthodontic treatment could not completely avoid formation of a long epithelial attachment. Therefore, periodontal regenerative surgery might be indicated prior to orthodontic tooth movement. Orthodontic movement, shortly after periodontal surgery, had no detrimental effect on periodontal soft tissue healing or on diminished but non-inflamed periodontal tissues.

Fiberotomy enhances orthodontic tooth movement and diminishes relapse in a rat model

OBJECTIVES

Accelerated orthodontic tooth movement is triggered by procedures that include mucoperiosteum flap surgery and surgical scarring of cortical bone. Our aim was to test whether fiberotomy by itself will accelerate orthodontic tooth movement and diminish relapse.

MATERIALS AND METHODS

In 34 Wistar rats, alveolar bone resorption and molar tooth movement were measured after fiberotomy, apical full-thickness flap without detachment of gingiva from the roots, or no surgery. Orthodontic appliance was installed at time of surgery and activated for 14 days, generating movement of the first maxillary molar buccal and then removed.

RESULTS

Percent of sections in which alveolar bone resorption was detected was significantly higher (p < 0.05) after fiberotomy (27%) in comparison with apical flap surgery (12%) or no surgery (6%), after 30 days. Also, at the end of active phase, the molar moved significantly faster (p < 0.01) and twice the distance after fiberotomy (0.54 ± 0.33) in comparison with apical surgery (0.26 ± 0.12) or no surgery (0.3 ± 0.09). Sixteen days after the appliance was removed, only 12% relapse was recorded in the fiberotomy group, while almost total relapse in other two groups.

CONCLUSION

We conclude that fiberotomy solely accelerated orthodontic tooth movement and diminished relapse.

Tightness of dental contact points in spaced and non-spaced permanent dentitions

One of the characteristics of normal occlusion is tight dental contact points (CPs). However, the magnitude and distribution of the tightness of a dental contact point (TDCP) in non-spaced versus spaced dentitions are unknown, as well as the mechanism controlling this arrangement. Two hypotheses were examined: the compression theory, i.e. the teeth touch each other in a compressive state; and the resistance theory, i.e. size and number of roots determine TDCP values. For the study, 60 subjects (27 men, 33 women), mean age 25 +/- 4.3 years, with a complete permanent dentition and no missing teeth were divided into spaced (n = 22) and non-spaced dentitions (n = 38). For each CP, four repeated measurements of peak strain were performed with a one-month interval. No significant differences were found between repeated measurements. All CPs demonstrated a continuous decreased TDCP in the postero-anterior direction. Consequently, in non-spaced dentitions TDCPs between molars were 100 per cent higher than incisors. The five anterior CPs of each jaw demonstrated similar TDCP values. Maxillary TDCPs versus mandibular antagonists were not significant. Mandibular TDCPs were significantly higher in men than in women (14 per cent). Anterior TDCPs were less in spaced than in non-spaced dentitions (55 per cent). Posterior TDCPs were also lower in spaced dentitions, however, to a lesser extent (25 per cent). With the exception of TDCPnon-spaced > TDCPspaced, which is partially explained by the compression theory, most of the findings support the resistance theory regulating TDCP characteristics of the permanent dentition.

Posterior and anterior components of force during bite loading

Late anterior crowding of teeth has been associated with the anterior component of force (ACF) developed during biting. Possible physiologic mechanisms countering ACF, including the presence of a posterior component of force (PCF), are hypothesized. In this self-controlled study, 60 subjects aged 27.05+/-3.9 years were examined for ACF and PCF that were calculated as the change in tightness of a mandibular dental contact points from non-biting to biting state. Both ACF and PCF were found to develop simultaneously. However, the PCF was 4-7 folds smaller than the ACF (p<0.001). The ACF progressively declined by 10-20 folds (p<0.001) from the posterior to anterior dentition. The lateral incisor-canine contact point had the greatest ACF decline (63-74%). ACF effect on the anterior dentition is counteracted by a protective mechanism consisted of PCF, progressive dissipation of ACF, and canine blockage.

Anchorage loss--a multifactorial response

Anchorage loss (AL) is a potential side effect of orthodontic mechanotherapy. In the present study, it is defined as the amount of mesial movement of the upper first permanent molar during premolar extraction space closure. In addition, AL is described as a multifactorial response in relation to the extraction site, appliance type, age, crowding, and overjet. For this study, 87 university clinic and private practice subjects, who were defined as maximum anchorage cases and had undergone bilateral maxillary premolar extractions, were divided into four groups according to extraction site (first vs second premolars), mechanics (lingual vs labial edgewise appliances), and age (adolescents vs adults). Overjet and crowding were examined from the overall sample. Data were collected from serial lateral cephalograms and dental casts. The results showed that as the severity of dental crowding increased, AL significantly decreased (r = -0.66, P = .001). Labial edgewise appliances demonstrated a significantly greater AL than did lingual edgewise appliances (1.15 +/- 2.06 mm, P < .05). A greater, though not statistically significant, AL was found in adults than in adolescents (0.73 +/- 1.43 mm). There was a slight nonsignificant increase in AL between maxillary second compared with first premolar extractions (0.51 +/- 1.33 mm). Overjet was weakly correlated to AL. These results suggest that AL is a multifactorial response and that the five examined factors can be divided into primary (crowding, mechanics) and secondary factors (age, extraction site, overjet), in declining order of importance.

Gene profile in periodontal ligament cells and clones with enamel matrix proteins derivative

AIM

Evaluate enamel matrix proteins derivative effect on gene expression profiles in cultured human periodontal ligament cell population and its clones.

MATERIAL AND METHODS

Human periodontal ligament (PDL) cells were explanted. Cell cloning was performed and clones classified into fibroblastic (FB) and mineralized tissue forming (MTF) according to their capacity to express alkaline phosphatase and form mineralized tissue. All cell cultures were grown for 7 days, with and without enamel proteins added to the medium. Following RNA extraction, expression profiling was performed by hybridization with a DNA micro-array. Selected genes differed from the control at a significant level smaller than p<0.01.

RESULTS

Enamel proteins induced major qualitative changes in mRNA expression in all PDL cell populations, differently affecting the entire PDL cell population and its clones. In the entire PDL cell population, enamel proteins significantly enhanced PDL cell function, with a general effect on enhanced cell functional metabolism.

CONCLUSIONS

Enamel proteins enhanced gene expression responsible for protein and mineralized tissue synthesis in the entire PDL population. In the MTF clones, nucleic acid metabolism, protein metabolism and signal transduction related genes were up-regulated, while in the FB clones, up-regulated genes were related to cell adhesion, nucleic acid metabolism and signal transduction.