The effects of rapid maxillary expansion on voice function.

OBJECTIVE: To evaluate the effects of rapid maxillary expansion (RME) on vocal function in patients with bilateral maxillary crossbite. MATERIALS AND METHODS: We designed our research as a prospective, controlled, clinical study. The treatment group and the control group each had 20 subjects for a total of 40 subjects. Acoustic voice samples were recorded from all patients at T1 and T2 by the Multi-Dimensional Voice Program (MDVP Model 5105) for acoustic analysis in Computerized Speech Lab (CSL). RESULTS: No statistically significant differences were found between the treatment and control groups in the means of any parameters. CONCLUSIONS: RME does not change vocal quality or resonance, so it can be safely used with patients.

Effect of menstrual cycle on orthodontic pain perception : A controlled clinical trial.

BACKGROUND AND OBJECTIVE: The aim of this prospective, single-center, controlled clinical trial was to evaluate the effects of menstrual cycle phases on orthodontic pain perception. MATERIALS AND METHODS: A total of 48 women between 16 and 20 years old with regular menstrual periods who were scheduled to undergo extraction of two upper first premolars for orthodontic treatment were enrolled in this study. Laceback ligatures were used to move canines distally. After activating the laceback ligatures, each patient completed a questionnaire in order to assess pain and quality of life. Pain perception was recorded by patients on a visual analogue scale (VAS) and a verbal rating scale-4 (VRS) immediately after activation (T1) and 24 h after activation (T2). During the appointment, each patient's menstrual-cycle phase (follicular or luteal) was determined by asking some questions about her cycle. For statistical analysis of data, the Mann-Whitney U, independent t test, and Wilcoxon tests were applied. RESULTS: Mean orthodontic pain score was 1.96 ± 0.80 and 47.08 ± 21.68 in the follicular phase, 1.92 ± 0.82 and 46.25 ± 18.92 in the luteal phase at T1 using the VRS and VAS, respectively. Orthodontic pain scores were worse in those patients in the luteal phase than those in the follicular phase (p < 0.05) in terms of both VRS (p = 0.025) and VAS (p = 0.046). No significant difference between pain scores at T1 and those at T2 in both luteal and follicular phases (p > 0.05) were observed. CONCLUSION: The menstrual phase has an influence on the perception of orthodontic pain which is higher in the luteal phase following the activation of laceback ligatures. In clinical practice, the phases of the menstrual cycle may have a significant role in how women perceive orthodontic pain.

Effects of different rapid maxillary expansion appliances on facial soft tissues using three-dimensional imaging.

OBJECTIVE: To determine three-dimensional (3D) effects of three different rapid maxillary expansion (RME) appliances on facial soft tissues. MATERIALS AND METHODS: Forty-two children (18 boys, 24 girls) who required RME treatment were included in this study. Patients were randomly divided into three equal groups: banded RME, acrylic splint RME, and modified acrylic splint RME. For each patient, 3D images were obtained before treatment (T1) and at the end of the 3-month retention (T2) with the 3dMD system. RESULTS: When three RME appliances were compared in terms of the effects on the facial soft tissues, there were no significant differences among them. The mouth and nasal width showed a significant increase in all groups. Although the effect of the acrylic splint RME appliances on total face height was less than that of the banded RME, there was no significant difference between the appliances. The effect of the modified acrylic splint appliance on the upper lip was significant according to the volumetric measurements (P < .01). CONCLUSIONS: There were no significant differences among three RME appliances on the facial soft tissues. The modified acrylic splint RME produced a more protrusive effect on the upper lip.

Effects of remineralization procedures on shear bond strengths of brackets bonded to demineralized enamel surfaces with self-etch systems.

OBJECTIVE: To compare the effects of different remineralization procedures on the surface roughness of teeth, shear bond strengths (SBSs), and Adhesive Remnant Index scores of self-etching primer (SEP) used to bond orthodontic brackets to previously treated demineralized enamel surfaces. MATERIALS AND METHODS: A total of 140 extracted human premolar teeth were randomly divided into seven equal groups. Group I was the control group. A demineralization procedure was performed in the other six groups. A remineralization procedure was performed before bonding by using casein phosphopeptide-amorphous calcium phosphate, fluoride, a microabrasion mixture (18% hydrochloric acid-fine pumice), a microabrasion agent, and resin infiltration in groups III to VII. Brackets were bonded using a self-etching primer/adhesive system. The specimens were tested for SBS. The roughness and morphology of the enamel surfaces were analyzed using profilometer and scanning electron microscopy. Data were analyzed with analysis of variance, Tukey, and G-tests at the α  =  .05 level. RESULTS: Significant differences were found in the SBS values among the seven groups (F  =  32.69, P  =  .003). The lowest SBS value was found in group II (2.62 ± 1.46 MPa). No significant differences were found between groups I, III, and VII, between groups III and IV, or between groups V and VI. The differences in the roughness values were statistically significant among the groups (P  =  .002). CONCLUSIONS: Remineralization procedures restore the decreased SBS of orthodontic brackets and decrease surface roughness caused by enamel demineralization. SEPs provide clinically acceptable SBS values for bonding orthodontic brackets to previously treated demineralized enamel surfaces.

Three-dimensional evaluation of hybrid expander appliances: A pilot study.

OBJECTIVE: To evaluate transverse dimensional changes in dentoalveolar and skeletal structures caused by hybrid expander, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT records of nine patients (five boys and four girls) (mean age 13.61 ± 0.72 years) treated with hybrid expander were examined. CBCT images were taken at pretreatment and after the expansion. ELSA (point equidistant to both foramina spinosa) was determined as a reference point to compare the distances in all three dimensions. Nineteen transversal dimensions and four angles were measured for both right and left sides. Wilcoxon signed rank test was used for statistical comparison at P < .05 levels. RESULTS: A V-shaped expansion of suture was successfully achieved in all patients without teeth support. The amount of opening was greater in anterior than posterior and in inferior than superior. An 8.75-mm screw expansion was achieved for all patients. Expansion effects reverberated to maxillary central incisor, canine, first premolar, and first molar at 70%, 75%, 92%, and 89%, respectively. The molar teeth tipped buccally (right 3.06° and left 3.24°) as did premolars (right 2.88° and left 3.02°). CONCLUSION: The hybrid expander, minimally invasive expansion appliance that protects teeth by including bone support, can be used easily for rapid maxillary expansion treatment.

Effect of Ti:Sapphire-femtosecond laser on the surface roughness of ceramics.

BACKGROUND AND OBJECTIVES: Some of these adult patients have ceramic crowns, to which orthodontists have concerns about bonding brackets. The aim of the present study was to evaluate the effect of a Ti:Sapphire femtosecond (fs) laser (Integra-C-3.5, Quantronix, NY) on the surface roughness of two ceramic surfaces (feldspathic and IPS Empress e-Max) and to compare results with those of two other lasers (Er:YAG and Nd:YAG) and conventional techniques, i.e., sandblasting (50 µm) and hydrofluoric (HF) acid. MATERIALS AND METHODS: Ceramic discs were fabricated (n = 150) and divided into two groups, each of which was then divided into five subgroups prepared with Ti:Sapphire fs, Nd:YAG, or Er:YAG lasers, sandblasting, or HF acid (n = 15). The surface roughness of the ceramic discs was evaluated using a profilometer (Mitotoyo Surf Test SJ 201 P/M; Mitutoyo Corp, Japan) before and after each surface treatment. Three traces were recorded for each specimen at three different locations in each direction, providing nine measurements per sample, which were then averaged to obtain the surface roughness value. Data were analyzed using the Wilcoxon signed-rank test (P < <0.05), two-way ANOVA, and Tukey's HSD test (P < 0.05). Additional samples were prepared for each group and evaluated using atomic force microscopy (AFM; NTEGRA Solaris, NTMDT, Russia). RESULTS: No significant difference was found between the feldspathic and IPS Empress e-Max ceramics. The Ti:Sapphire fs laser was associated with the highest mean roughness value. AFM images of the ceramic surfaces treated confirmed that the fs-laser-treated surfaces had the highest degree of irregularity. CONCLUSION: Within the limitations of this in vitro study, the Ti:Sapphire fs laser yielded the highest surface roughness and could be an alternative ceramic surface treatment to increase bond strength.

Effect of Ti:sapphire laser on shear bond strength of orthodontic brackets to ceramic surfaces.

BACKGROUND AND OBJECTIVES: With increasing demand for orthodontic treatments in adults, orthodontists continue to debate the optimal way to prepare ceramic surfaces for bonding. This study evaluated the effects of a Ti:sapphire laser on the shear bond strength (SBS) of orthodontic brackets bonded to two ceramic surfaces (feldspathic and IPS Empress e-Max) and the results were compared with those using two other lasers (Er:YAG and Nd:YAG) and 'conventional' techniques, i.e., sandblasting (50 µm) and hydrofluoric (HF) acid. MATERIALS AND METHODS: In total, 150 ceramic discs were prepared and divided into two groups. In each group, the following five subgroups were prepared: Ti:sapphire laser, Nd:YAG laser, Er:YAG laser, sandblasting, and HF acid. Mandibular incisor brackets were bonded using a light-cured adhesive. The samples were stored in distilled water for 24 hours at 37°C and then thermocycled. Extra samples were prepared and examined using scanning electron microscopy (SEM). SBS testing was performed and failure modes were classified. ANOVA and Tukey's HSD tests were used to compare SBS among the five subgroups (P < 0.05). RESULTS: Feldspathic and IPS Empress e-Max ceramics had similar SBS values. The Ti:sapphire femtosecond laser (16.76 ± 1.37 MPa) produced the highest mean bond strength, followed by sandblasting (12.79 ± 1.42 MPa) and HF acid (11.28 ± 1.26 MPa). The Er:YAG (5.43 ± 1.21 MPa) and Nd:YAG laser (5.36 ± 1.04 MPa) groups were similar and had the lowest SBS values. More homogeneous and regular surfaces were observed in the ablation pattern with the Ti:sapphire laser than with the other treatments by SEM analysis. CONCLUSIONS: Within the limitations of this in vitro study, Ti:sapphire laser- treated surfaces had the highest SBS values. Therefore, this technique may be useful for the pretreatment of ceramic surfaces as an alternative to 'conventional' techniques.

Shear-bond-strength of orthodontic brackets to aged nano-hybrid composite-resin surfaces using different surface preparation.

The aim of this study was to evaluate the effects of different surface preparation methods on the shear bond strength (SBS) of orthodontic metal brackets to aged nano-hybrid resin composite surfaces in vitro. A total of 100 restorative composite resin discs, 6 mm in diameter and 3 mm thick, were obtained and treated with an ageing procedure. After ageing, the samples were randomly divided as follows according to surface preparation methods: (1)Control, (2)37% phosphoric acid gel, (3)Sandblasting, (4)Diamond bur, (5)Air-flow and 20 central incisor teeth were used for the control etched group. SBS test were applied on bonded metal brackets to all samples. SBS values and residual adhesives were evaluated. Analysis of variance showed a significant difference (p<0.001) between the groups. Sandblasted group had the highest SBS value (12.85 MPa) in experimental groups. The sandblasting surface treatment is recommended as an effective method of bonding orthodontic metal brackets to nano-hybrid composite resin surfaces.

Attention-deficit/hyperactivity disorder symptoms in children with traumatic dental injuries.

AIM: The aim of this study was to compare the symptoms of attention-deficit/hyperactivity disorder (ADHD) in children with TDIs with to non-injured children. MATERIAL AND METHODS: Children between 7 and 16 years old who were admitted to the Selcuk University, Faculty of Dentistry, for treatment of dental trauma were included in the study group (SG). As a control group (CG), children with no reported history of dental trauma were recruited. The Conners' Parent Rating Scale-Revised: Short Form (CPRS-R: S) was used to assess ADHD symptoms. RESULTS: Both groups, SG and CG, composed of 55 children. There were no significant differences in age, gender, and duration of education between SG and CG. Children with TDIs had significantly higher CPRS-R: S Hyperactivity scores. Hyperactivity level was positively correlated with the history of previous dental trauma. There were no associations between number of injured teeth, type of injury, and ADHD symptoms. CONCLUSIONS: These findings suggest that children with TDIs have more hyperactive symptoms than children without dental trauma. Clinicians should screen ADHD symptoms in children with TDIs and refer them for treatment when necessary.

Alveolar bone changes after asymmetric rapid maxillary expansion.

OBJECTIVE: To quantitatively evaluate the effects of asymmetric rapid maxillary expansion (ARME) on cortical bone thickness and buccal alveolar bone height (BABH), and to determine the formation of dehiscence and fenestration in the alveolar bone surrounding the posterior teeth, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT records of 23 patients with true unilateral posterior skeletal crossbite (10 boys, 14.06 ± 1.08 years old, and 13 girls, 13.64 ± 1.32 years old) who had undergone ARME were selected from our clinic archives. The bonded acrylic ARME appliance, including an occlusal stopper, was used on all patients. CBCT records had been taken before ARME (T1) and after the 3-month retention period (T2). Axial slices of the CBCT images at 3 vertical levels were used to evaluate the buccal and palatal aspects of the canines, first and second premolars, and first molars. Paired samples and independent sample t-tests were used for statistical comparison. RESULTS: The results suggest that buccal cortical bone thickness of the affected side was significantly more affected by the expansion than was the unaffected side (P < .05). ARME significantly reduced the BABH of the canines (P < .01) and the first and second premolars (P < .05) on the affected side. ARME also increased the incidence of dehiscence and fenestration on the affected side. CONCLUSIONS: ARME may quantitatively decrease buccal cortical bone thickness and height on the affected side.

Asymmetric rapid maxillary expansion in true unilateral crossbite malocclusion: a prospective controlled clinical study.

OBJECTIVE: To investigate the short-term effects of the asymmetric rapid maxillary (ARME) appliance on the vertical, sagittal, and transverse planes in patients with true unilateral posterior crossbite. MATERIALS AND METHODS: Subjects were divided into two groups. The treatment group was comprised of 21 patients with unilateral posterior crossbite (mean age  =  13.3 ± 2.1 years). Members of this group were treated with the ARME appliance. The control group was comprised of 17 patients with Angle Class I who were kept under observation (mean age  =  12.3 ± 0.8 years). Lateral and frontal cephalograms were taken before the expansion (T1), immediately after expansion (T2), and at postexpansion retention (T3) in the treatment group and at preobservation (T1) and postobservation (T2) in the control group. A total of 34 measurements were assessed on cephalograms. For statistical analysis, the Wilcoxon test and analysis of covariance were used. RESULTS: The ARME appliance produced significant increases in nasal, maxillary base, upper arch, and lower arch dimensions (P < .01) and a clockwise rotation of the occlusal plane (P  =  .001). CONCLUSION: The ARME appliance created asymmetric increments in the transversal dimensions of the nose, maxilla, and upper arch in the short term. Asymmetric expansion therapy for subjects with unilateral maxillary deficiency may provide satisfactory outcomes in adolescents, with the exception of mandibular arch expansion. The triangular pattern of expansion caused clockwise rotation of the mandible and the occlusal plane and produced significant alterations in the vertical facial dimensions, whereas it created no displacement in maxilla in the sagittal plane.

Long-term stability of dentoalveolar, skeletal, and soft tissue changes after non-extraction treatment with a self-ligating system.

OBJECTIVE: To evaluate the long-term effects of self-ligating brackets (SLBs) on transverse dimensions of arches and skeletal and soft tissues and to quantitatively evaluate the treatment outcome after non-extraction treatment with SLBs. METHODS: The sample consisted of 24 (18 female and six male) subjects, with a mean age of 14.23 ± 2.19 years, who received treatment with the Damon®3 appliances. Complete records including cephalometric radiographs and plaster models were obtained before treatment (T1), immediately after treatment (T2), six months after treatment (T3), and two years (T4) after treatment. Digital study models were generated. Twenty lateral cephalometric, six frontal cephalometric, and eight dental cast measurements were examined. The Peer Assessment Rating index was used to measure the treatment outcome. The Wilcoxon test was applied for statistical analysis of the changes. RESULTS: There were significant increases in all transverse dental cast measurements with active treatment. There was some significant relapse in the long term, particularly in maxillary width (p < 0.05). Statistically significant increases were found in nasal (p < 0.001), maxillary base, upper molar, lower intercanine, and antigonial (p < 0.05) widths in T1-T2. Lower incisors were proclined and protruded in T1-T2. CONCLUSIONS: SLBs correct crowding by mechanisms involving incisor proclination and protrusion and expansion of the dental arches, without induction of clinically significant changes in hard and soft tissues of the face.

Relationship between P561T and C422F polymorphisms in growth hormone receptor gene and mandibular prognathism.

OBJECTIVE: To evaluate the allele and genotype frequencies of the P561T and C422F polymorphic sites of the growth hormone receptor (GHR) gene and the relationship between mandibular prognathism (MP) and these two single-nucleotide polymorphisms (SNPs). MATERIALS AND METHODS: A total of 99 subjects with severe skeletal Class III MP who planned to undergo orthognathic surgery and 99 subjects with Class I occlusion were examined in this study to evaluate the relationship between MP and two SNPs in exon 10 of the GHR gene. GHR was chosen as a candidate gene because growth hormone plays an important role in cartilage growth. A blood sample was used to extract genomic DNA, and the polymerase chain reaction-restriction fragment length polymorphism method was used to determine genotypes of P561T and C422F. The Minitab 14.0 packet program was used to perform statistical analysis. RESULTS: Allele frequencies of the C422F and P561T variants were determined. Because of the low allele frequency of the control group, statistical analysis could not be performed to test the difference between MP and control groups. Therefore, the data were combined to determine the association between the P561T polymorphism and craniofacial measurements. Effective mandibular length (condylion-gnathion) and lower face height (anterior nasal spina-menton) were associated with the P561T variant. CONCLUSION: This finding supports that the GHR might be a candidate gene for mandibular morphogenesis in this population.

Can demineralized enamel surfaces be bonded safely?

OBJECTIVE: To evaluate and compare the effects of enamel demineralization, microabrasion therapy and casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) application on the shear bond strength (SBS) of orthodontic brackets bonded to enamel surfaces and enamel color. MATERIALS AND METHODS: Eighty freshly extracted human maxillary premolar teeth were allocated to one of the four groups. Brackets were bonded directly to non-demineralized enamel surfaces in Group I (control group), directly to the demineralized enamel surfaces in Group II, to demineralized enamel surfaces after CPP-ACP application in Group III and to demineralized enamel surfaces after microabrasion therapy in Group IV. The samples were stored in water for 24 h at 37°C and then underwent thermocycling. The SBS in megapascals (MPa) was determined by a shear test with 0.5 mm/min crosshead speed and failure types were classified with modified adhesive remnant index scores. The data were analyzed with one-way analyses of variance (ANOVA), Tukey and chi-square tests at the α = 0.05 level. RESULTS: Significant differences were found among the four groups (F = 21.57, p < 0.01). No significant difference was found between Group I and III (17.12 ± 2.84 and 15.08 ± 3.42 MPa, respectively) or between Group III and IV (12.82 ± 2.64 MPa). The lowest SBS value was determined in Group II (5.88 ± 2.12 MPa). Enamel demineralization, microabrasion therapy and CPP-ACP application affected enamel color significantly. CONCLUSION: CPP-ACP application and microabrasion therapy are able to increase the decreased SBS of orthodontic brackets because of enamel demineralization.

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.

Effect of Nd:YAG laser bleaching and antioxidizing agents on the shear bond strength of brackets.

OBJECTIVE: The aims of this study were to evaluate the effect of hydrogen peroxide bleaching agents, both nonactivated and activated by a neodymium:yttrium-aluminum-garnet (Nd:YAG) laser, and of antioxidant treatment on the shear bond strength (SBS) of orthodontic brackets. BACKGROUND DATA: Nd:YAG laser activation is expected to accelerate the bleaching therapy without decrease shear bond strength. MATERIALS AND METHODS: Ninety extracted maxillary central incisors were divided into two experimental groups and a control group. Group I was the control group, Group II was bleached with 35% hydrogen peroxide and had no photoactivation, and Group III was bleached with 35% hydrogen peroxide with activation by a Nd:YAG laser (4.0 W, 60 Hz frequency, 1 mm distance, 20 sec). Each group was divided into two subgroups: Subgroup A was immersed in artificial saliva for 2 weeks, and then bonded using the total etch system, whereas subgroup B was treated with an antioxidant agent (10% sodium ascorbate) and then bonded using the same system. The samples were stored in water for 24 h at 37°C, and thermocycled. The SBS in megapascals (MPa) was determined by a shear test with 1 mm/min crosshead speed, and failure types were classified with modified adhesive remnant index scores. The data were analyzed with two way analyses of variance, Tukey, and χ(2) tests at the α = 0.05 level. RESULTS: In both Groups II and III, the SBSs of brackets bonded after bleaching (Group II 15.16, Group III 17.50 MPa) were significantly lower than those of brackets in the bonded unbleached group (Group I 22.13 MPa); however, sodium ascorbate treatment significantly increased the SBSs of brackets in the bleached groups (Group II 21.52, Group III 22.43 MPa), but had an insignificant effect on the SBS of the control group (Group I 23.66MPa). CONCLUSIONS: Hydrogen peroxide bleaching agents reduce the SBSs both with and without Nd:YAG laser activation; however, treatment of the bleached enamel surface with 10% sodium ascorbate prior to bonding negates the effect.

The effect of tooth bleaching on the shear bond strength of orthodontic brackets using self-etching primer systems.

OBJECTIVE: The purpose of this study was to determine the effect of 10% carbamide peroxide and 38% hydrogen peroxide bleaching agents on the shear bond strength of orthodontic brackets using self-etching primer systems. METHODS: Forty five freshly extracted human premolar teeth were randomly divided into 3 groups of 15 teeth each: control (group 1), 10% carbamide peroxide at-home bleached (group 2), and 38% hydrogen peroxide in-office bleached (group 3). Three weeks later, all brackets were bonded using a self-etching primer system. The shear bond strength of these brackets was measured and recorded in MPa. Adhesive remnant index (ARI) scores were determined after the brackets failed. Data were analyzed using Kruskal- Wallis test, pairwise comparisons were made using the Mann-Whitney U test and ARI scores were analyzed using a chi-square test at a significance level of P<.05. RESULTS: The shear bond strengths of group 1 (mean: 17.7 ± 9.7 MPa) were significantly higher (P<.05) than those of group 3 (mean: 9.9 ± 5.4 MPa). No significant differences were found between group 2 (mean: 12.3 ± 4.7) and either group 1 or group 3 (P>.05). ARI scores did not differ significantly among the 3 groups. CONCLUSIONS: The use of 10% carbamide peroxide bleaching does not significantly reduce shear bond strength values. In contrast, use of 38% hydrogen peroxide bleaching significantly reduces these values.

Bilateral geminated teeth with talon cusps: A case report.

Talon cusps and gemination are rare dental anomalies that can cause significant aesthetic and clinical problems. Bilateral talon cusps on geminated teeth have not been reported so far. The case of gemination with talon cusps on both maxillary central incisors was presented in this report. The main complaints of the patient were tongue irritation and aesthetic problems. The talon cusps were gradually reduced at 2 consecutive sittings and the exposed surface was treated with a fluoride gel. The aesthetical appearance was improved using a composite resin. Fixed orthodontic treatment was initiated for repositioning the left maxillary lateral incisor. A long term, multidisciplinary approach is necessary for the treatment of gemination with talon cusps.

Can white spot lesions be treated effectively?

OBJECTIVE: To compare the effects of sodium fluoride mouth rinse, casein phosphopeptide-amorphous calcium phosphate (CPP-ACP), and the microabrasion technique in treating white spot lesions. MATERIALS AND METHODS: The study population consisted of 80 patients (46 females, 34 males; 966 affected teeth) who had developed multiple decalcified enamel lesions after fixed orthodontic therapy. The study population was divided into four groups of 20 patients each. The control group (group I) participants were to just brush their teeth, the fluoride group (group II) participants were instructed to use 20 ml of neutral 0.025% sodium fluoride rinse, the participants in the CPP-ACP group (group III) were instructed to use tooth mousse twice a day in addition to fluoride toothpaste for 6 months, and the participants in the microabrasion group (group IV) were to undergo treatment by the microabrasion technique, which is a commonly used mixture of 18% hydrochloric acid. Data were analyzed with the generalized linear mixed model and Tukey HSD at the P < .05 level. RESULTS: The area of the white spot lesions decreased significantly in all groups. Inter group differences in the treatment success rates were significant. The highest success rate was observed for group IV (97%). The success rate of group III (58%) was significantly higher than that of groups II (48%) and I (45%). CONCLUSIONS: The use of CPP-ACP can be more beneficial than fluoride rinse for postorthodontic remineralization. Microabrasion is an effective treatment for cosmetic improvement of long-standing white spot lesions.

Comparison of the outcomes of the lower incisor extraction, premolar extraction and non-extraction treatments.

The aim of this retrospective study was to evaluate the treatment outcome of lower incisor extraction and to compare it with premolar extraction and non-extraction treatment. The sample consisted of 60 subjects with Class I malocclusion and moderate crowding. The sample was separated into three groups: extraction of a lower incisor group, extraction of a four first premolar group and a non-extraction group. All groups involved 13 girls and 7 boys with a total of 20 patients. The Peer assessment rating (PAR) index was applied to a patient's pre-treatment (T1) and post-treatment (T2) dental casts. T1 dental casts were also used for determining Bolton discrepancy. One-way analysis of variance and post hoc Tukey HSD tests were used for statistical analysis. For the mean percentage PAR score reduction for each group, there was one significant difference seen between the lower incisor extraction group and the non-extraction group (P = 0.047). For the mean anterior ratios, there were significant differences among premolar extraction group versus non-extraction group (P = 0.042) and non-extraction group versus lower incisor extraction group (P = 0.000). For the mean overall ratios, there were significant differences among the premolar extraction group versus lower incisor extraction group (P = 0.048) and the non-extraction group versus lower incisor extraction group (P = 0.001). Orthodontic treatment without extraction has a better treatment outcome than the four-first premolar extraction and single lower incisor extraction protocols in Class I cases with moderate to severe mandibular anterior crowding.