Photos vs silhouettes for evaluation of African American profile esthetics.

INTRODUCTION: Patient photos and silhouettes are commonly used in clinical evaluations and orthodontic research to evaluate profile esthetics. The purpose of this study was to determine whether the use of photos or silhouettes is a more appropriate method of evaluating African American profile esthetics and whether there are different profile esthetic preferences among clinicians when using photos compared with silhouettes. METHODS: Pretreatment records of 20 adolescent African American patients were selected (10 male, 10 female) from the orthodontic clinic at the Albert Einstein Medical Center in Philadelphia. Each patient's profile photo was digitally changed with imaging software (Dolphin Imaging and Management Solutions, Chatsworth, Calif) to fabricate a series of 7 photos and 7 silhouettes with lip positions at uniform distances relative to Ricketts' E-line standard. Fifteen raters consisting of orthodontic faculty and residents were asked to select the most esthetically pleasing profile from each patient's photo series and silhouette series. RESULTS: More rater preferences for the photographs (86%) were within the acceptable esthetic range (within 2 mm of the E-line in either direction) than were their preferences for silhouettes (66%) (P <0.001). Flatter profiles with less lip projection than the esthetic norm were more often preferred in the silhouettes than in the photos. Thirty-one percent of the silhouettes preferred by the raters were flatter than the norm compared with 9% of the photos (P = 0.003). Fuller profiles were preferred in only 3% of the silhouettes and 5% of the photos (P = 0.6). CONCLUSIONS: Esthetic attractiveness of faces of African American orthodontic patients is rated differently in photos and silhouettes. When evaluating soft-tissue esthetic profile preferences, rater preferences in the photographs were closer to the established esthetic norm than were their preferences in the silhouettes. Using silhouettes to evaluate patient esthetics could influence clinicians or researchers to select profiles that are flatter than the established esthetic norm.

Efficacy of a filled-resin sealant in preventing decalcification during orthodontic treatment.

INTRODUCTION: Enamel decalcification during orthodontic treatment is a persistent problem. Resin-based sealants have been developed to protect enamel from decalcification. The purpose of this in-vivo study was to compare the effect of a fluoride-releasing filled enamel sealant with that of an unfilled nonfluoride control. METHODS: A total of 177 teeth in 18 patients were evaluated over a period of 12 to 18 months. A split-mouth design was used; half the teeth were treated with the fluoride-releasing sealant (Pro Seal, Reliance Orthodontic Products, Itasca, Ill), and the contralateral teeth received the control (Transbond MIP, 3M Unitek, Monrovia, Calif). The teeth were photographed before (T1) and after (T2) treatment. A panel of 12 orthodontic faculty and residents evaluated the photographs for decalcification on a graded scale. RESULTS: Sixty-nine percent of the teeth treated with Pro Seal showed progressive decalcification from T1 to T2 vs 72% of those treated with Transbond MIP. In the comparison of the contralateral paired teeth, there was a small average net disadvantage of -0.06 of a tooth per patient (95% CI, -0.97 to 0.85) for Pro Seal compared with Transbond MIP. That difference of 0.06 of a tooth is neither statistically significant (P = 0.90) nor clinically important. CONCLUSIONS: The 2 products tested were equivalent in their inhibition of decalcification during orthodontic treatment. The additional time and expense of using the fluoride-releasing sealant to prevent decalcification does not appear to be justified.

In-vivo prospective comparison of bond failure rates of 2 self-etching primer/adhesive systems.

INTRODUCTION: The purpose of this study was to comparatively assess the bond failure rates of orthodontic brackets bonded with 2 self-etching primer (SEP) bonding systems over an 18-month period. METHODS: Thirty-six consecutively treated orthodontic patients were bonded with Transbond Plus SEP with Transbond XT adhesive (3M Unitek, Monrovia, Calif) and with Ideal 1 SEP with Ideal 1 adhesive (GAC International, Bohemia, NY). In each patient, the teeth were divided into 2 groups based on the universal numbering system (1-32). All even-numbered teeth (340) were bonded with the Transbond system, and all odd-numbered teeth (340) were bonded with the Ideal 1 system. A total of 680 teeth were bonded and followed for a minimum of 18 months. RESULTS: The average percentages of bond failures were 12.4% and 4.1% in the teeth treated with Ideal 1 and Transbond Plus, respectively (P<.001), for a difference of 8.4 percentage points (95% CI, 4.2 to 12.6 percentage points). CONCLUSIONS: Because the bond failure rate with the Transbond Plus SEP system was one third that of the Ideal 1 SEP system, Transbond Plus appears to be a better choice for routine orthodontic clinical practices.

Bond failure and decalcification: A comparison of a cyanoacrylate and a composite resin bonding system in vivo.

This prospective, in vivo study compared bond failure and enamel decalcification with a cyanoacrylate bracket bonding system (SmartBond, Gestenco International, Gothenburg, Sweden) and a traditional light-cured composite system (Light Bond, Reliance Orthodontic Products, Itasca, Ill). A total of 327 teeth were evaluated after a period of 12 to 14 months; 163 experimental teeth were bonded with the cyanoacrylate bonding system, and 164 control teeth were bonded with the light-cured composite resin. All teeth were evaluated for breakage (bond failure). The average percentage of bracket failures with cyanoacrylate was 55.6% compared with 11.3% with composite resin (P <.001). All maxillary anterior teeth (94) were evaluated for enamel decalcification on a graded scale. Occurrence of enamel decalcification between the 2 bonding systems after 1 year of orthodontic treatment was similar. The cyanoacrylate bonding material had more than 4 times as many bond failures and a similar amount of decalcification as the traditional composite material. Cyanoacrylate as a routine orthodontic bonding agent is not a suitable bonding material for clinical practice at this time. It is important to test new bonding systems in vivo in several studies before using them in routine clinical practice.