The KPG index--a novel 3D classification system for maxillary canine impactions.

INTRODUCTION: Advancements in Cone Beam Computed Tomography (CBCT) have improved localization of impacted canines. The KPG index is the first 3-D classification system for classifying the position of canines based on their distance from the norm (1). The aim of this study was to determine if this index provides an estimate of the time necessary to treat an impacted canine using closed eruption. MATERIALS AND METHODS: CBCT scans of 28 impacted canines at The University of Texas School of Dentistry at Houston Department of Orthodontics were classified using the KPG index. The scores and categories were compared to the time from surgical exposure to proper positioning. RESULTS: Four canines were classified as "Easy," 11 as "Moderate," 9 as "Difficult," and 4 as "Extremely Difficult." Average treatment times associated in months were: "Easy"--11.23, "Moderate"--11.36, "Difficult"--12.76, and "Extremely Difficult"--13.23. CONCLUSIONS: The KPG index currently cannot be confirmed as an accurate means of estimating treatment time for an impacted canine. Further verification studies should include larger sample sizes and compare differing mechanics. However, there are limitations to 2-D imaging; therefore, the 3-D CBCT images and the KPG index, with further validation, will become increasingly valuable to orthodontists.

Surface analysis of study models generated from OrthoCAD and cone-beam computed tomography imaging.

INTRODUCTION: The purpose of this research was to determine the accuracy of digital models generated by cone-beam computed tomography and compare it with that of OrthoCAD models (Cadent, Carlstadt, NJ) for orthodontic diagnosis and treatment planning by using surface area analysis. MATERIALS: Two sets of maxillary and mandibular digital models of 30 subjects were obtained. The models were made from impressions scanned with OrthoCAD and by conversion of related cone-beam computed tomography files. Each patient's matched pairs of maxillary and mandibular models were superimposed by using a software program and a best-fit algorithm; surface-to-surface analysis was then performed. The average linear differences between the 2 files at all points on the surfaces were measured, and tolerance levels of 0.25, 0.5, 0.75, 1.0, 1.25, and 1.5 mm were set to determine the surface correlation amounts between the 2 files. Additionally, 6 linear measurements from predetermined landmarks were also measured and analyzed. RESULTS: The average maxillary model linear difference was 0.28 to 0.60 mm, whereas the average mandibular model linear difference ranged between 0.34 and 0.61 mm. Greater than a 90% surface correlation was obtained on average at 1.00 mm in the maxillary models and at 1.25 mm in the mandibular models. The mean differences obtained from the linear measurements of the maxillary and mandibular models were 0.071 and 0.018 mm, respectively. CONCLUSIONS: Surface-to-surface analysis of OrthoCAD and digital models generated by cone-beam computed tomography pointed to a fair overlap between the protocols. The accuracy of digital models generated by cone-beam computed tomography is adequate for initial diagnosis and treatment planning in orthodontics.

Latex and non-latex orthodontic elastic force loss due to cyclic temperature.

UNLABELLED: The purpose of this study was to compare the force loss of 1/4 inch (6.35mm) 3.5oz (99g) medium latex elastics from Ormco Corp. to non-latex elastics from ClassOne Orthodontics and Phoenix after being cycled between different temperatures. Elastics were stretched to 1.57 inches (40mm) on jigs and cycled in water baths for 4 minutes at 5 degrees C and 37 degrees C, 21 degrees C and 37 degrees C, 5 degrees C and 50 degrees C, 37 degrees C and 50 degrees C, and a control group was held at 3 degrees 7 degrees C. The force produced by new elastics and elastics after incubation was measured using a Mini 44 Instron. RESULTS: All elastics experienced increased force loss that correlated with increased temperatures with the exception of Ormco latex elastics. The latex elastics had the greatest force loss upon cycling between 5 degrees C and 50 degrees C while the non-latex elastics had the greatest force loss while cycling between 37 degrees C and 50 degrees C. All elastics were strongest when cycled between 5 degrees C and 37 degrees C. CONCLUSION: This study suggests that hot liquids reduce the force of latex and non-latex elastics even when cycled between hot temperatures for brief periods of time.

Outcome study of computer-aided surgical simulation in the treatment of patients with craniomaxillofacial deformities.

PURPOSE: The purpose of this study was to determine whether the surgical outcomes achieved with computer-aided surgical simulation (CASS) are better than those achieved with traditional methods. MATERIALS AND METHODS: Twelve consecutive patients with craniomaxillofacial (CMF) deformities were enrolled. According to the CASS clinical protocol, a 3-dimensional computer composite skull model for each patient was generated and reoriented to the neutral head posture. These models underwent 2 virtual surgeries: 1 was based on CASS (experimental group) and the other was based on traditional methods 1 year later (control group). Once the 2 virtual surgeries were completed, 2 experienced oral and maxillofacial surgeons at 2 different settings evaluated the 2 surgical outcomes. They were blinded to the planning method used on the virtual models and each other's evaluation results. The primary outcome was overall CMF skeletal harmony. The secondary outcomes were individual maxillary, mandibular, and chin harmonies. Statistical analyses were performed. RESULTS: Overall CMF skeletal harmony achieved with CASS was statistically significantly better than that achieved with traditional methods. In addition, the maxillary and mandibular surgical outcomes achieved with CASS were significantly better. Furthermore, although not included in the statistical model, the chin symmetry achieved by CASS tended to be better. A regression model was established between mandibular symmetry and overall CMF skeletal harmony. CONCLUSION: The surgical outcomes achieved with CASS are significantly better than those achieved with traditional planning methods. In addition, CASS enables the surgeon to better correct maxillary yaw deformity, better place proximal/distal segments, and better restore mandibular symmetry. The critical step in achieving better overall CMF skeletal harmony is to restore mandibular symmetry.

A new method to orient 3-dimensional computed tomography models to the natural head position: a clinical feasibility study.

PURPOSE: The purpose of this study was to evaluate the clinical feasibility of a new method to orient 3-dimensional (3D) computed tomography models to the natural head position (NHP). This method uses a small and inexpensive digital orientation device to record NHP in 3 dimensions. This device consists of a digital orientation sensor attached to the patient via a facebow and an individualized bite jig. The study was designed to answer 2 questions: 1) whether the weight of the new device can negatively influence the NHP and 2) whether the new method is as accurate as the gold standard. PATIENTS AND METHODS: Fifteen patients with craniomaxillofacial deformities were included in the study. Each patient's NHP is recorded 3 times. The first NHP was recorded with a laser scanning method without the presence of the digital orientation device. The second NHP was recorded with the digital orientation device. Simultaneously, the third NHP was also recorded with the laser scanning method. Each recorded NHP measurement was then transferred to the patient's 3D computed tomography facial model, resulting in 3 different orientations for each patient: the orientation generated via the laser scanning method without the presence of the digital orientation sensor and facebow (orientation 1), the orientation generated by use of the laser scanning method with the presence of the digital orientation sensor and facebow (orientation 2), and the orientation generated with the digital orientation device (orientation 3). Comparisons are then made between orientations 1 and 2 and between orientations 2 and 3, respectively. Statistical analyses are performed. RESULTS: The results show that in each pair, the difference (Δ) between the 2 measurements is not statistically significantly different from 0°. In addition, in the first pair, the Bland-Altman lower and upper limits of the Δ between the 2 measurements are within 1.5° in pitch and within a subdegree in roll and yaw. In the second pair, the limits of the Δ in all 3 dimensions are within 0.5°. CONCLUSION: Our technique can accurately record NHP in 3 dimensions and precisely transfer it to a 3D model. In addition, the extra weight of the digital orientation sensor and facebow has minimal influence on the self-balanced NHP establishment.

Shear bond strengths of a selenium containing and a conventional light cured adhesive for orthodontic bonding.

BACKGROUND: The objectives of this study were to evaluate the debonding strength and mode of failure of a selenium containing adhesive compared to an established orthodontic adhesive. MATERIALS AND METHODS: One hundred sixty bovine mandibular incisors were allocated to eight groups: steel and clear brackets were bonded with either selenium containing adhesive (Group 1: SeLect Defense) or a conventional light-cured adhesive (Group 2:Transbond XT) to measure debond strength and the adhesive remnant index was used to assess the location of bond failure. Data was evaluated using a three-way analysis of variance and Fisher's PLSD multiple comparisons test for mean debond strengths. RESULTS: Group 2 debond strengths were greater than that of Group 1 with the steel and clear brackets. Group 1 debond strengths were greater with clear than with steel brackets at both time points. Both adhesives demonstrated increased debond strengths from zero to 24 hours and the clear brackets exhibited a greater ARI than steel after debonding. Comparisons of debond strength means among adhesives, brackets, and times were all statistically significant. CONCLUSIONS/DISCUSSION: All debond strengths were within a clinically acceptable range according to previous literature. SeLect Defense may be desirable due to its potential for preventing white spot lesions despite the reduced strength compared to Transbond XT.

A comparison of shear bond strengths on bleached and unbleached bovine enamel.

INTRODUCTION: This study investigated whether tooth whitening with two different bleaching systems affects the shear bond strength achieved using an orthodontic self-etching primer. METHODS: The sample of 210 bovine incisors was divided into three groups. One group served as the control, while the other two groups received either an over-the-counter "white strip" bleaching regimen (Opalescence TresWhite) or a "power bleaching" in-office regimen (Opalescence Boost). Each bleaching group was divided into three groups to be tested at three time intervals post-bleaching: immediately, 24 hours, and 7 days. RESULTS: When compared to the control, the shear bond strength attained on Opalescence TresWhite treated specimens was not significantly lower at any time interval post-bleaching. Immediately after bleaching and 24 hours after bleaching, the Opalescence Boost treated groups showed significantly lower shear bond strengths than both the control groups and the Opalescence TresWhite groups. CONCLUSIONS: Bleaching with 38 percent hydrogen peroxide immediately and 24 hours before bonding reduced the shear bond strengths. After seven days the bond strengths were normal. Bleaching with 10 percent hydrogen peroxide in the form of white strip material did not reduce shear bond strengths.

Soft tissue images from cephalograms compared with those from a 3D surface acquisition system.

OBJECTIVE: To assess whether 2D cephalometrics is comparable with 3D imaging devices and whether 3D technology could replace traditional 2D image capture in posttreatment evaluation. MATERIALS AND METHODS: The study is a prospective evaluation of superimposition techniques obtained from a cohort of 40 patients who underwent orthognathic surgery in a private practice environment. Surgical records were obtained from lateral cephalometric radiographs taken by a Kodak 8000C machine, and the 3D images were obtained from the 3dMD stereo photogrammetric camera capture system. Pre- and postlateral cephalometric records were superimposed on the cranial base (SN line) while pre- and post-3D surgical records were superimposed on the regional best-fit method. A mathematical algorithm, or best-fit calculation, was carried out on the selected surfaces. Each set of superimposed records was analyzed, and five soft tissue landmarks were plotted. The differences between the five surface points were analyzed for each set of records. RESULTS: The final sample consisted of 34 subjects with full records. A total of 680 surface landmarks were plotted and analyzed. The mean differences of the soft tissue landmarks were analyzed for each pair of data sets and were found to range between 1.06 and 8.07 mm and 1.26 and 7.34 mm for lateral cephalometric and 3D readings, respectively. Paired t-tests were carried out using the SPSS 15.0 software, and they showed that the results were not statistically significant between the superimposition techniques on the image capture systems (P > .05). CONCLUSIONS: The types of superimposition techniques used in the imaging modalities studied were comparable with one another.

A comparison of shear bond strengths among different self-etching primers.

By the 1980's, bonding of orthodontic brackets had become the routine technique for attaching fixed appliances to teeth, replacing the need to fit and cement bands on each tooth (1). This modification in appliance attachment revolutionized orthodontics. Before, each tooth required a band. This meant a band must be fitted, have a bracket welded to it, and be cemented onto each tooth. Not only was this process time consuming and frustrating, but it meant 4 to 6 millimeters of space per arch was needed to seat the bands. Many cases that perhaps could have been treated without tooth extraction ended up needing extractions to accommodate the band space.