Implications of pretreatment incisor inclinations for the achievement of cephalometric normal values-a study on two patient collectives.

PURPOSE: The objective was to clarify whether standardized multibracket therapies-differing only in finishing-wire dimensions (0.016â€¯× 0.022 inch vs. 0.017â€¯× 0.025 inch CNA [Connecticut New Archwire]) and excluding any extraction treatment or additional appliances other than intermaxillary elastics-can produce normal incisor inclinations starting from different baseline inclinations. METHODS: We analyzed pre- and posttreatment cephalograms of 156 patients (age: 15.6 ± 1.3 years) treated with Roth system (0.018 inch slot). Each archwire group (n = 89 or 67) was divided into subjects with initially retroclined, orthograde, or proclined upper and/or lower incisors (U1, L1). For the resultant 12 subgroups, descriptive statistics were compiled relative to five reference planes (NL, ML, NA, NB, BOP), followed by multiple intragroup (Kolmogoroff-Smirnoff and Wilcoxon signed-rank test) and intergroup (Kruskal-Wallis and Mann-Whitney U test) comparisons relative to NL or ML. RESULTS: The following intra- (1, 2) and intergroup (3, 4) differences were statistically significant (p ≤ 0.05) in both archwire groups: (1) post- vs. pretreatment inclinations in the subgroups initially retroclined U1, retroclined L1 and orthograde U1, but without normal values being achieved (subgroups retroclined U1, L1) or preserved (subgroup orthograde U1); (2) observed vs. expected alterations for the subgroups initially orthograde and proclined U1 and L1; (3) posttreatment inclinations for the subgroups initially retroclined vs. orthograde L1 and proclined L1; (4) observed alterations for the subgroups initially retroclined vs. proclined U1 and L1, but neither retroclined nor proclined vs. orthograde. Archwire thickness influenced the outcome to only a limited extent under the special circumstances of this study. CONCLUSION: The bracket/archwire combinations evaluated did not lead to normal incisor inclinations in most cases. Posttreatment values did significantly depend on the pretreatment situation. Most frequently, alterations were protrusive in direction, which notably even included incisors that showed norm values at the outset of treatment. It can be concluded that bracket torque will influence but not dominate incisor inclinations.

Coordinating bracket torque and incisor inclination : Part 2: Reproducibility and statistical measures of the torque coordination angle (TCA).

PURPOSE: To determine the reproducibility and statistical measures of the torque coordination angle (TCA). METHODS: A total of 107 final cephalograms and corresponding casts were included, all reflecting treatment outcomes that met high qualitative standards, one of them being a Peer Assessment Rating (PAR) score of ≤3. Based on these records, the TCA was measured as a parameter to identify differences related to tooth morphology and bracket position between the torque-relevant reference plane at the bracket base and the long axis of a tooth. All measurements were performed on upper and lower central incisors (U1 and L1). RESULTS: Several reproducibility assessments for the TCA measurements yielded good results, including objectivity at 1.26 ± 0.81° (U1) or 1.41 ± 1.18° (L1), examiner reliability at 1.30 ± 0.97° (U1) or 1.25 ± 0.82° (L1), and method reliability at 1.80 ± 1.13° (U1) or 1.53 ± 1.07° (L1). The statistical measures revealed a high degree of interindividual variability. With bracket placement 4.5 mm (U1) or 4.0 mm (L1) above the incisal edge, the differences between the maximum and minimum TCA values were similarly large in both jaws (21.0° for U1 or 20.0° for L1), given mean TCA values of 24.6 ± 3.6° (U1) or 22.9 ± 4.3° (L1). Moving the bracket placement from 3.5 to 5.5 mm (U1) or from 3.0 to 5.0 mm (L1) changed the mean TCA values by 4.5° (U1) or 3.2° (L1). CONCLUSIONS: The TCA is a suitable cephalometric parameter to identify differences related to tooth morphology and bracket placement. Given its high interindividual variability, the fixed torque value of a specific bracket system should not be expected to produce the same incisor inclinations across patients.