Rejuvenation of the ageing face and the role of orthodontics: Guidelines for management.

The article reviews the ageing changes of the midfacial and maxillary bones, the mandible, the overlaying soft tissues and the smile, and presents clinical guidelines aiming to rejuvenate older faces by means of orthodontic therapy. With regard to the ageing changes, the maxillary skeleton appears to rotate clockwise inferior to the orbit and becomes retrusive, and as a general pattern the midface contracts and deteriorates with age. Resorption below the mental foramen, reduction in alveolar height, loss of bone at the chin region, and relative increase in size and shape are signs of an aged mandible. Epidermal thinning and decrease in collagen in combination with the effect of gravity and various external factors contribute to the ageing of the skin. Atrophy of the superficial and deep fat, changes in ligamentous tissues and changes in muscle structure, position and tone, all contribute to the stigmata of the aged face. In the article, two late adulthood orthodontic cases are discussed as examples, and general guidelines for orthodontic management of the older face aiming at reversing the 'shrinkage' of the tissues by restoring the facial shape and tightening the soft tissue mask are described. The possible mechanisms explaining the changes observed on the faces of the clinical cases are also discussed. A properly planned and executed orthodontic intervention reversing changes from the inside-out before embarking on cosmetic surgery might have a synergistic effect multiplying the benefits for adult patients.

The effect of various adhesives, enamel etching, and base treatment on the failure frequency of customized lingual brackets: a randomized clinical trial.

Objectives: The aim of this paper was to compare failure differences in precious metal customized lingual brackets bonded with three adhesive systems. Also, differences in failure of non-precious metal brackets with and without a silicatized base layer bonded with the same adhesive, as well as the influence of enamel etching prior to using a self-etching dual cure resin were explored. Materials/methods: Five different groups were defined in a semi-randomized approach. Group 1 (IME): Maxcem Elite with 378 Incognito brackets and etched teeth, Group 2 (IMNE): Maxcem Elite with 193 Incognito brackets on non-etched teeth, Group 3 (INE): Nexus+Excite with 385 Incognito brackets, Group 4 (IRE): Relyx with 162 Incognito brackets, Group 5 (HRME) and Group 6 (HNRME): Maxcem Elite with 182 Harmony brackets with silicatized and non-slicatized bases respectively. Bracket failures were recorded over a 12-month period. Results: The number of failures during the observation period was small in the various adhesives types of groups, as well as in HRME and HNRME groups, and the comparisons among those groups were non-significant (P > 0.05). A statistically significant difference (P < 0.05) was found between the IME and IMNE groups. Conclusions: 1. During the first year of treatment customized lingual brackets failure frequencies (rates) are not different for the three adhesive materials tested. 2. Eliminating the etching stage when using self-etch/self-adhesive adhesives, may lead to a dramatic increase in the failure rates. 3. Silicoating of stainless steel customized lingual brackets does not seem to influence the failure of the bonds.

ISQ calculation evaluation of in vitro laser scanning vibrometry-captured resonance frequency.

BACKGROUND: Implant stability testing at various stages of implant therapy by means of resonance frequency analysis is extensively used. The overall measurement outcome is a function of the resulting stiffness of three entities: surrounding bone, bone-implant complex, and implant-Smartpeg complex. The influence of the latter on the overall measurement results is presently unknown. It can be investigated in vitro by use of imbedded implants with mounted Smartpegs. This enables to keep the influence of the two other entities constant and controlled. The purpose of this study is to verify if a laboratory laser Doppler vibrometry technology-based procedure results in comparable ISQ results after calculation of captured resonance frequency spectra by aid of the Osstell algorithm with direct Osstell IDX device measurements. METHODS: A laboratory procedure was engineered to record frequency spectra of resin-imbedded test implants with mounted Smartpegs, after electromagnetic excitation with the Osstell IDX device and laser Doppler vibrometry response detection. Fast Fourier transformation data processing of resonance frequency data resulted in determination of a maximum resonance frequency values allowing calculation of implant stability quotient (ISQ) values using the Osstell algorithm. RESULTS: Laboratory-based ISQ values were compared to Osstell IDx device-generated ISQ values for Straumann tissue level, Ankylos, and 3i Certain implant systems. For both systems, a correlation coefficient r = 0.99 was found. Furthermore, a clinically rejectable mean difference of 0.09 ISQ units was noted between both datasets. CONCLUSIONS: The proposed laboratory method with the application of the Osstell algorithm for ISQ calculation is appropriate for future studies to in vitro research aspects of resonance frequency analysis implant stability measurements.

Updated secondary implant stability data of two dental implant systems. A retrospective cohort study.

BACKGROUND: At present, updated secondary implant stability data generated by actual versions of resonance frequency analysis (RFA) and mobility measurement (MM) electronic devices of 2 different implant systems with actual manufactured surfaces seem to lack and/or are incomplete. MATERIAL AND METHODS: Secondary implant stability data based on both RFA and MM measurements were collected and analyzed from 44 formerly treated patients (24 f, 20 m) that received either Ankylos Cellplus (Ø3.5mm) (A) (n=36) or Straumann regular neck SLA tissue level (Ø4.1mm) (S) (n=37) implants in posterior positions of both jawbones (total number= 72). These results were interpretated in view of formerly published data. RESULTS: Estimated RFA outcomes (mean±SD) for A implants were of 81.23 (±0.65) (LP) - 76.15 (±1.57) (UP) isq; for S implants 76.15 (±1.48) (LP) - 73.88 (±2.34) (UP) isq. Estimated MM outcomes for A implants were (-4.0) (±0.23) (LP) - (-3.2) (±0.33) (UP) ptv; for S implants (-5.15) (±0.39) (LP) - (-4.4) (±0.84) (UP) ptv. According to GEE statistical modelling, implant type and - position seems to influence the outcome variables (p<0.05), gender and implant length did not (p >0.05). CONCLUSIONS: Secondary implant stability values, recorded with current RFA and MM devices, of A Cellplus implants are provided for the first time. A difference of 14.7-9.7 isq values was noted for CellPlus versus TPS S implants recorded with a cabled RFA device. This study supports the assumption that RFA outcomes generated with first generation RFA devices are different from those obtained with current RFA devices, meaning that its use in reviews need caution and correction. Key words:Secondary implant stability, resonance frequency analysis, Periotest, Osstell Mentor, Straumann, Ankylos, CellPlus, SLA.

Secondary implant stability outcome of immediate versus late placed variable-thread implants in the maxilla. A retrospective cohort study.

BACKGROUND: The healing of xenograft augmentated intra-alveolar gaps following immediate implant placement (IMIP) after tooth extraction is likely to differ in time and density compared to the native bone part that directly contacts the implant. MATERIAL AND METHODS: Secondary implant stability (SIS) data recorded 2-3 months following a late implant placement protocol (LIP) (n= 43) and 6-8 months following an immediate implant placement protocol (IMIP) (n=33) of variable-thread implants (Nobel Active™) in the maxilla were retrospectively collected from files of 63 patients (42 females, 21 males). Statistical analysis was performed using a generalized estimating equation model (GEE). Data split-up according to implant diameter (RP, Ø= 4.3mm) , narrow platform (NP, Ø= 3.5mm) was adopted. RESULTS: For NP implants, the mean ISQ (±SD) values were 70.84 (±4.86) in LIP group and 72.41 (±3.89) in the IMIP group. For RP implants, mean ISQ (±SD) values were 73.45 (±8.77) in the LIP group and 75.93 (±5.73) in the IMIP group. Significant effect of treatment modus in favour of the IMIP and gender in favour of males and implant position was noted (p<0.05). CONCLUSIONS: SIS following a IMIP protocol after 6-8 months is comparable to LIP protocol after 2-3 months. A minor ISQ outcome difference in favour of the IMIP protocol can be attributed to a difference in hard tissue alteration during healing of the xenograft part. Key words:Secondary implant stability, RFA, Osstell Mentor, variable thread implants, Nobel Active, Bio-Oss, immediate implant placement, late implant placement, non-submerged healing, gap.

Treatment duration and gingival inflammation in Angle's Class I malocclusion patients treated with the conventional straight-wire method and the Damon technique: a single-centre, randomised clinical trial.

OBJECTIVE: To compare the duration of orthodontic treatment and Gingival Index (GI) scores in Class I malocclusion patients treated with a conventional straight-wire method (CG) or the Damon technique (DT). DESIGN: Two-arm, parallel, randomised clinical trial Setting: A postgraduate orthodontic clinic Participants: Patients with a balanced facial profile, a full permanent dentition and Angle's Class I malocclusion with moderate crowding. METHODS: The primary outcome was the duration of orthodontic treatment in months. GI scores throughout treatment were secondary outcomes and the PAR index was also assessed. Randomisation was accomplished using a table of random numbers and the allocation was concealed in sequentially numbered and opened, opaque, sealed envelopes. Blinding was applicable for PAR assessment only. Comparison of data between groups was performed with appropriate tests for independent samples. RESULTS: Twenty-two patients were randomly allocated to treatment in a 1:1 ratio to either CG or DT group. Age at the start of treatment, initial PAR index and GI scores were similar between groups. All patients completed the study, but the total duration of orthodontic treatment was almost half of the initial assumption. No statistically significant differences were observed in treatment duration (CG: Mean ([Formula: see text]) = 14.5 months, Standard Deviation (SD) = ±3.03; DT: [Formula: see text] months, SD = ±2.93; 95% Confidence Interval: -0.40 to 4.90; P = 0.093; t-test). The two groups did not differ statistically regarding the GI scores during the observational period. No serious harms were observed other than gingival inflammation associated with oral biofilm accumulation. CONCLUSIONS: The present study did not reveal statistically significant differences between the compared, conventional straight-wire method and Damon technique-treated, Angle's Class I malocclusion groups regarding total treatment duration and GI scores.

How orthodontic records can influence torque choice decisions?

INTRODUCTION: The aim of this study was to investigate whether the addition of records can influence intra- and inter-rated agreement on torque choices made to treat a group of patients with various malocclusions. METHODS: Forty-eight patients were presented to five orthodontic specialists in three different occasions. During the first session, the participants were shown only the models and intraoral photos of the patients; extraoral photos were added during the second session, and cephalometric X-rays were further supplemented during the third session. Mean weighted kappa coefficients were calculated to measure agreement. RESULTS: The inter-observer agreement was low with the mean coefficients measured:κ1 = 0.34 (SD ± 0.09), κ2 = 0.57 (SD ± 0.12), and κ3 = 0.54 (SD ± 0.28) for the three attempts, respectively. The mean kappa coefficients for the intra-rater agreement were also low ranging from 0.18 to 0.66 and the mean coefficients were 0.27 (SD ± 0.11) between first and second, and 0.53 (SD ± 0.11) between second and third attempt, respectively. CONCLUSIONS: This study shows that the addition of extraoral photographs, and subsequently cephalograms to plaster models and intraoral photos, does affect intra-, and inter-rater agreement on torque selection. It seems that the addition of extraoral photos plays a more important role in torque selection decisions than lateral cephalograms. Different clinicians do not have a uniform opinion on the size of torque required to treat cases. Further research is required to define rules on torque choices.

Orthodontics and its interactions with other dental disciplines.

Preservation or alteration of the natural dentition to an optimal state of health, function, comfort, and esthetics remains the primary goal of dentistry. However, referral of patients by general dentists to orthodontic specialists may be complex as it involves the interaction of the two dental professionals and the patient. Because there is a marked variation in referral rates between the dentists and many patients may be referred inappropriately, a clear understanding of what is known about current orthodontic treatment possibilities, limitations and inherent risks is necessary. The purpose of this article is to outline the existing orthodontic therapeutic possibilities for adjunctive dental work and to emphasize the importance of teamwork among the general dentist, the orthodontic specialist and possibly other dental specialists during treatment planning.

Factors affecting the duration of orthodontic treatment: a systematic review.

The aim of this study was to systematically investigate the literature for articles referring exclusively to the duration of orthodontic therapy and to explore the various factors that could affect this. A Medline search from 1990 to the first week of March 2005 was conducted, the Cochrane Database for Systematic Reviews was utilized, five orthodontic journals were hand searched, the abstracts of related articles were reviewed to search for any relevant studies that might have been missed, and the reference lists of the retrieved articles were hand assessed. Eligibility was determined by reading the reports identified by the search. The end result of this search provided 41 articles. Although there is a need for more conclusive research, the present review revealed several conclusions concerning the duration of orthodontic treatment: (1) there are indications that extraction treatment lasts longer than the non-extraction therapy; (2) age does not seem to play a role provided the patients are in the permanent dentition; (3) when Class II division 1 malocclusions are considered, there is evidence that the earlier the orthodontic treatment begins the longer its duration; (4) there is conflicting information regarding treatment duration within public health systems; (5) combined orthodontic-surgical treatment duration is variable and appears to be operator sensitive; (6) various factors, such as the technique employed, the skill and number of operators involved, the compliance of the patients, and the severity of the initial malocclusion, all seem to play a role; and (7) impacted maxillary canines appear to prolong treatment.