3D comparison of average faces in subjects with oral clefts.

This prospective cross-sectional, case-controlled morphometric study assessed three dimensional (3D) facial morphological differences between average faces of 103 children aged 8-12 years; 40 with unilateral cleft lip and palate (UCLP), 23 with unilateral cleft lip and alveolus (UCLA), 19 with bilateral cleft lip and palate (BCLP), 21 with isolated cleft palate (ICP), and 80 gender and age-matched controls. 3D stereophotogrammetric facial scans were recorded for each participant at rest. Thirty-nine landmarks were digitized for each scan, and x-, y-, z-coordinates for each landmark were extracted. A 3D photorealistic average face was constructed for each participating group and subjective and objective comparisons were carried out between each cleft and control average faces. Marked differences were observed between all groups. The most severely affected were groups where the lip and palate were affected and repaired (UCLP and UCLA). The group with midsagittal palatal deformity and repair (ICP) was the most similar to the control group. The results revealed that 3D shape analysis allows morphometric discrimination between subjects with craniofacial anomalies and the control group, and underlines the potential value of statistical shape analysis in assessing the outcomes of cleft lip and palate surgery, and orthodontic treatment.

Rehabilitation of children with ectodermal dysplasia. Part 1: an international Delphi study.

PURPOSE: An international Delphi study was undertaken to determine by consensus an agreed approach to the management of children with dental manifestations of ectodermal dysplasia, including the use of dental implants. This was done using a questionnaire developed by an interdisciplinary team. MATERIALS AND METHODS: The Delphi study questionnaire was built around 19 areas of clinical relevance and included 90 items. Topic areas included dental disability; initial diagnosis; global disability; oral health aspects of dental treatment (orthodontics, hypodontia, anodontia, implants); and case studies of selected treatment options. Eleven teams from six countries contributed to three iterations of the questionnaire. An algorithm was designed to standardize analysis of the questionnaire answers, all of which were blinded to ensure anonymity. The second and third rounds of the questionnaire excluded previously agreed-upon items but included the responses to the questions from the earlier rounds. The nonconsensus items inquired about the use of radiographs at initial diagnosis; sedation of an uncooperative child; use of a pretreatment questionnaire; the age range for specific treatments (eg, dentures, orthodontics, implants); specific uses of implants (eg, partial prostheses, overdentures, cantilevered prostheses); and case study 2. The residual nonconsensus questions were subsequently discussed at a 2-day meeting. RESULTS: Among the 90 questions and partial questions, there was progressive consensus, with agreements in rounds 1, 2, and 3 of 61%, 21%, and 8%, respectively. At the conclusion of round 3, there was 90% agreement and it was considered that the nonconsensus items required in-depth face-to-face discussion at a consensus meeting, which is described in part 2 of the study. CONCLUSION: The Delphi study provided an opportunity to engage specialist teams in recognized centers to integrate their clinical knowledge and draw on published data to develop a consensus of evidence-based responses.

Rehabilitation of children with ectodermal dysplasia. Part 2: an international consensus meeting.

A consensus meeting was arranged to provide an opportunity to discuss the residual nonconsensus questions following three rounds of a Delphi study. It was hoped that the nonagreements could be resolved to define a comprehensive protocol for the management of ectodermal dysplasia, particularly with respect to the use of dental implants in growing patients. An international panel of expert clinicians in pediatric dentistry, prosthodontics, and orthodontics was invited to be part of the Delphi study to develop agreement on clinical questions through a consensus of ideas. Each expert had been invited to form a study group or team within his or her home institution. As required by the Delphi protocol, a 90-part questionnaire was considered by the collaborating teams and progressed through three iterations with increasing agreement. This process is discussed in part 1 of the study. The residual nonconsensus questions, which represented 10% of the questionnaire, required collaborative interaction for resolution. The consensus meeting was held in London, England, over a 2-day period with support from Nobel Biocare and the British Dental Association.

Three-dimensional gender differences in facial form of children in the North East of England.

The aim of the prospective cross-sectional morphometric study was to explore three dimensional (3D) facial shape and form (shape plus size) variation within and between 8- and 12-year-old Caucasian children; 39 males age-matched with 41 females. The 3D images were captured using a stereophotogrammeteric system, and facial form was recorded by digitizing 39 anthropometric landmarks for each scan. The x, y, z coordinates of each landmark were extracted and used to calculate linear and angular measurements. 3D landmark asymmetry was quantified using Generalized Procrustes Analysis (GPA) and an average face was constructed for each gender. The average faces were superimposed and differences were visualized and quantified. Shape variations were explored using GPA and PrincipalComponent Analysis. Analysis of covariance and Pearson correlation coefficients were used to explore gender differences and to determine any correlation between facial measurements and height or weight. Multivariate analysis was used to ascertain differences in facial measurements or 3D landmark asymmetry. There were no differences in height or weight between genders. There was a significant positive correlation between facial measurements and height and weight and statistically significant differences in linear facial width measurements between genders. These differences were related to the larger size of males rather than differences in shape. There were no age- or gender-linked significant differences in 3D landmark asymmetry. Shape analysis confirmed similarities between both males and females for facial shape and form in 8- to 12-year-old children. Any differences found were related to differences in facial size rather than shape.

An unusual dental anomaly in a hypodontia patient.

UNLABELLED: Hypodontia is the most common developmental dental anomaly known in humans. It is often associated with other dental anomalies such as disturbances in eruption, peg lateral incisors and taurodontism. This case report describes a ten-year-old female with hypodontia and a very unusual conical-shaped mandibular right central incisor, which has not previously been reported in the literature. The case highlights the importance of prompt referral to an interdisciplinary team so joint decisions on management can ensure an optimal outcome with the corresponding improvement in quality of life. CLINICAL RELEVANCE: Hypodontia and other developmental dental disorders are common and their early recognition and prompt referral is important.

Abnormal tooth size and morphology in subjects with cleft lip and/or palate in the north of England.

The aim of this study was to investigate tooth size and morphology in subjects with unilateral cleft palate (UCLP), bilateral cleft palate (BCLP), and isolated cleft palate (ICP) living in the north of England and to compare these with a control group. The measurements were undertaken retrospectively using dental study casts. To assess tooth size, the mesiodistal and buccolingual dimensions of each fully erupted permanent tooth were measured using digital Vernier callipers. The following morphological features of the teeth were assessed: upper incisor shovelling and crown form, the presence of Carabelli's tubercle on the upper molars, molar cusp number, and lower molar fissure pattern. Multilevel regression analysis was used to determine differences in tooth size, while chi-square tests and analysis of variance were used to assess differences in tooth morphology between the groups. Tooth size was reduced in all cleft groups in both jaws, with the smallest teeth being found in the ICP group. Upper lateral incisors on the cleft-affected side in UCLP and BCLP patients showed the greatest reduction in size. The upper central and lateral incisors on the cleft-affected side in the UCLP and BCLP groups were frequently hypoplastic or peg-shaped. Molar morphology in all the cleft groups was similar to that in the control group. Reduced tooth dimensions were found in both jaws in subjects with all types of clefts, suggesting a shared genetic basis. Additionally, the upper incisors were abnormal in morphology in UCLP and BCLP subjects with or without a cleft palate, suggesting shared local aetiological factors.

Dental arch dimensions in oligodontia patients.

INTRODUCTION: The aim of this study was to compare the dental arch sizes in a group of oligodontia patients with a group of age- and sex-matched untreated Class I control patients. METHODS: Dental casts were measured of 50 oligodontia patients and 50 untreated Class I patients between 8 and 16 years old. For each subject, dental arch length and width parameters were measured in the maxillary and mandibular arches with digital calipers. The various dental arch parameters were compared between the 2 groups by using ANOVA. RESULTS: The mean age of the subjects was 12.5 years. The average number of teeth missing in the oligodontia group was 11. The mean maxillary and mandibular arch lengths in the oligodontia group were reduced by 4.40 and 2.80 mm, respectively, when compared with the control group. The intercanine widths were reduced in the oligodontia group compared with the control group by 2.82 mm in the maxillary arch and 2.70 mm in the mandibular arch. The intermolar widths of the maxillary and mandibular arches in the oligodontia group were reduced by 3.40 and 1.80 mm, respectively, compared with the control group. These differences were statistically significant (P<0.01). CONCLUSIONS: The findings indicate that arch length and width are reduced in oligodontia patients; this should be taken into account when planning orthodontic treatment.

The management of hypodontia: present and future.

UNLABELLED: Developmental absence of teeth (hypodontia) is associated with characteristic morphological changes in the teeth, alveolar volume deficiencies, and skeletal jaw mal-relationships. Management may be complex, involving several dental specialties, ideally working as a close-knit team. Improved diagnostic and treatment technologies continue to evolve, ever widening the management opportunities for these patients. This paper reviews current treatment methods and looks to what the future may hold. CLINICAL RELEVANCE: Specialist teams with access to traditional and evolving diagnostic and treatment technologies are best able to manage patients with complex treatment needs such as some of those presenting with hypodontia.

Fluoride release for restorative materials and its effect on biofilm formation in natural saliva.

This study investigated the influence of natural saliva of varying pH on surface biofilm formation of restorative materials and how this influenced fluoride release. Columnar specimens of glass ionomer cement (GIC), resin modified glass ionomer cement (RMGIC), compomer, giomer and composite, were prepared, matured for 24 h at 37 degrees C and 100% humidity, lapped and then placed in natural stimulated saliva with a pH of 3.8 or 7.1. Fluoride release was determined daily using an ion-selective electrode. The surfaces of selected specimens were observed using Confocal Laser Scanning Microscopy in conjunction with a fluorescent dye. The surface biofilm formation and bacterial growth was most dominant under neutral conditions and on the surfaces of GICs compared with other materials. GICs released significantly higher amounts of fluoride than other materials. The results suggest that the increased fluoride release of GICs did not reduce the amount of bacterial growth and biofilm formation on the surfaces of these materials when stored in natural saliva.

A method for producing controlled fluoride release from an orthodontic bracket.

The aim of this study was to manufacture and test, in vitro, a novel modification to provide fluoride-releasing orthodontic brackets. Thirty-two orthodontic brackets were drilled to produce a recess (approximately 1.3 mm in diameter and 0.7 mm in depth) at the centre of the bracket base. Four materials, with and without the addition of sodium fluoride, a glass ionomer cement (Ketac Cem micro), a resin-modified glass ionomer cement (RMGIC; GC Fuji Ortho LC), a zinc phosphate (Zinc Cement Improved), and a resin (Transbond XT) were used to fill the recess in the bracket base. Fluoride release was measured daily during the first week and then weekly for 10 weeks. An ion chromatograph with suppressed conductivity was used for free fluoride ion determination. Statistical analysis to determine the amount of flouride release was undertaken using analysis of variance and Tukey's test. During the first 2 weeks, the resin group, with the addition of 38 per cent sodium fluoride added, released significantly more free fluoride (P < 0.05), but after 2 weeks the fluoride release markedly decreased. After 5 weeks, the RMGIC group, with 15 per cent added sodium fluoride, had significantly higher (P < 0.05) daily fluoride release than the other groups. The findings demonstrated that an appropriate fluoridated material can be used as a fluoride-releasing reservoir in a modified orthodontic bracket to enable it to release fluoride over the period of fixed appliance treatment.

Can crown-root ratio predict premolar eruption?

INTRODUCTION: The purpose of this study was to establish a method to prospectively predict the eruption of mandibular second premolars with panoramic radiographs. This technique could be used clinically to optimize the timing of comprehensive treatment, detect abnormalities of development and eruption, or effectively estimate eruption timing and determine the need for early intervention because of caries or defects of the deciduous dentition. METHODS: Three hundred one white children from an orthodontic practice in Alaska between the ages of 6 and 16 years were examined and monitored with serial panoramic radiographs until all premolars had erupted. Eruption of the mandibular second premolar was predicted at the first examination based on the panoramic radiograph. When the mandibular second premolar erupted, a researcher measured the crown length to crown-plus-root length ratio on the radiograph using the Simpson and Kunos scale, and the prospectively predicted timing of eruption was compared with the actual timing. RESULTS AND CONCLUSIONS: The Simpson and Kunos scale allowed a rapid assessment for predicting the time of eruption of mandibular second premolars. The mean age of eruption of the mandibular second premolar in these children was 12.5 years.

Micro-tensile bond strength to surface and subsurface enamel.

UNLABELLED: Testing of bond strength to enamel has been undertaken on both surface and subsurface enamel on the assumption that it is the same substrate. Over recent years, the micro-tensile method has become widely used for the evaluation of dental adhesives. However, there have been no micro-tensile bond strength studies comparing surface and subsurface enamel using orthodontic adhesives. It has been proposed that the bond strength to subsurface enamel is greater than that to surface enamel. OBJECTIVE: The micro-tensile bond strength (MTBS) of Transbond (light activated paste, 3 M Unitek, USA) to surface and subsurface enamel was investigated. METHODS: Ten sound freshly extracted lower human first molars were divided into two groups of five each. Surface enamel of the first group was removed with 500-grit silicone carbide paper, whilst in the second group it was left intact. Gelatin capsules filled with Transbond composite paste were bonded perpendicular to the enamel using light cure adhesive Primer (Transbond XT, 3 M Unitek, USA) in both groups, and stored in distilled water at 37 degrees C for 24 h. Crowns of all specimens were sectioned bucco-lingually into vertical slabs of approximately 0.6 mm thickness. Slabs in each group were prepared into an hourglass shape of 1mm width and 0.6 mm thickness. Micro-tensile bond strength was determined using a mini tensile testing machine (COMPACT Gauge, DILLON). RESULTS: Mean values of MTBS were: 31.2 MPa (SD14.5) for surface enamel and 47.9 (SD15.0) for subsurface enamel. SIGNIFICANCE: There was a significant difference between the two groups P = 0.001. It was concluded that subsurface enamel has significantly higher bond strength than surface enamel. This has implications for bonding in restorative dentistry and orthodontics.

Auto-transplantation in the restorative management of traumatized anterior teeth: a case report.

UNLABELLED: Auto-transplantation can be used to replace missing anterior teeth following traumatic injuries. This technique has the advantage (over other forms of treatment) of maintaining alveolar bone height which allows orthodontic and further restorative intervention by way of implants later in life. Careful restorative management of transplanted teeth is vital to their long-term survival as inadequate maintenance post transplant may result in root resorption and eventual tooth loss. This paper describes the restorative management of two cases following transplantation. CLINICAL RELEVANCE: Dental practitioners should be aware of the option to auto-transplant teeth as part of an overall treatment plan and the subsequent interventions often required.

Effect of impression technique on bond strength.

If the effects of surface preparation (eg, acid etching, laser preparation, crystal growth) are to be investigated on the same tooth from which the bond strength is recorded, a method of surface replication is required that does not affect the subsequent bond. This study investigated the effect of 2 different methods of taking impressions on bond strength. Three groups of 11 mandibular incisors were used. The labial enamel was etched with 37% phosphoric acid for 30 seconds. Group A (control) had no impression taken; in group B (silicone), impressions were taken with silicone impression material before bonding; in group C (polyether), an impression was taken with polyether before bonding. After the impressions were taken, GAC brackets (A Company, San Diego, Calif) were bonded to the labial surfaces of the etched enamel with Transbond XT light-cured composite (3M Unitek, Monrovia, Calif). Teeth with bonded brackets were stored in water at 37 degrees C for 24 hours, and then bond strength was measured on a testing machine. The adhesive remnant index (ARI) was also recorded. The lowest bond strength was found after silicone replication (mean [standard deviation]: 8.6 [1.7] MPa) and the highest in the control group (21.2 [4.0] MPa). There was no significant difference between the control group and the polyether replication group (19.1 [4.7] MPa). The surface detail replications of polyether and silicone were found to be identical. It was concluded that polyether had no significant effect on bond strength and was suitable for surface replication before bonding. Polyether allows replication of the enamel surface without a significant effect on bond strength, and this technique could be used to examine the relationship between enamel preparation techniques and subsequent bond strength between composite and enamel.

Comparison of in vivo and in vitro shear bond strength.

Much of the research into composite adhesives suggests that these materials will deteriorate in the oral environment, but most of these claims are made on the basis of extrapolation from in vitro experiments; relatively little in vivo research has been conducted into the mechanical properties of composite adhesives. For this study, we recruited 20 volunteers to wear removable appliances containing orthodontic brackets bonded to enamel slabs for 12 weeks. Each appliance carried 3 brackets bonded with Transbond (3M Unitek UK; Bradford, United Kingdom) and 3 brackets bonded with Heliosit (Ivoclar-Vivadent; Leicester, United Kingdom). The bond strengths were tested at intervals of 4, 8, and 12 weeks. Control specimens were stored in sterile water at 37 degrees C and were debonded at the same time intervals. Transbond specimens debonded after 4 weeks in vivo had significantly (P <.05) lower bond strengths (9.78 megapascals [MPa]) than did the controls (14.34 MPa). In vivo, specimens bonded with Heliosit had significantly (P <.05) lower bond strengths after 4 weeks (8.16 MPa vs 10.96 MPa) and 8 weeks (9.96 MPa vs 13.61 MPa) than did the controls. These results indicate differences between bond strength testing in vitro and in vivo. Further research is required into the effects of the oral environment on bond strength.

The relationship between acid-etch patterns and bond survival in vivo.

The aim of this study was to investigate the relationship between acid-etch quality and bond survival in vivo. The subjects were 29 orthodontic patients. High-resolution silicone impressions were taken of the buccal tooth surfaces after etching for 30 seconds with 37% phosphoric acid. The impressions were replicated in epoxy resin and examined under high magnification in a scanning electron microscope. A 4-point classification system and histometric techniques were used to evaluate etch patterns on the enamel surfaces where orthodontic brackets were to be bonded. After impressions were made, all teeth (including first molars) were bonded with 0.022-in Andrews' prescription brackets ("A" Company, San Diego, Calif) and Right-On composite (TP Orthodontics, Leeds, England). The first date of bond failure for each tooth was recorded; it varied from 1 to 806 days. An ideal etch pattern was found on less than 5% of the orthodontic bonding area; type C pattern (pitted enamel surface) occupied the greatest area. Overall, the failure rate was 55.8% over 26 months; the greatest failure rate occurred in first molars. Multiple regression analysis revealed a positive and statistically significant relationship between the area occupied by ideal etch type and the length of survival of the bond (P <.001).