Which orthodontic archwire sequence? A randomized clinical trial.

The aim of this study was to compare three orthodontic archwire sequences. One hundred and fifty-four 10- to 17-year-old patients were treated in three centres and randomly allocated to one of three groups: A = 0.016-inch nickel titanium (NiTi), 0.018 x 0.025-inch NiTi, and 0.019 x 0.025-inch stainless steel (SS); B = 0.016-inch NiTi, 0.016-inch SS, 0.020-inch SS, and 0.019 x 0.025-inch SS; and C = 0.016 x 0.022-inch copper (Cu) NiTi, 0.019 x 0.025-inch CuNiTi, and 0.019 x 0.025-inch SS. At each archwire change and for each arch, the patients completed discomfort scores on a seven-point Likert scale at 4 hours, 24 hours, 3 days, and 1 week. Time in days and the number of visits taken to reach a 0.019 x 0.025-inch SS working archwires were calculated. A periapical radiograph of the upper left central incisor was taken at the start of the treatment and after placement of the 0.019 x 0.025-inch SS wire so root resorption could be assessed. There were no statistically significant differences between archwire sequences A, B, or C for patient discomfort (P > 0.05) or root resorption (P = 0.58). The number of visits required to reach the working archwire was greater for sequence B than for A (P = 0.012) but this could not be explained by the increased number of archwires used in sequence B.

Mandibular incisal edge demineralization and caries associated with Twin Block appliance design.

Demineralization and caries are well documented and unwanted complications of orthodontic therapy. These are most commonly reported in relation to fixed appliance therapy. Five cases are presented of patients undergoing Twin Block appliance therapy with the appliances incorporating lower labial segment capping, illustrating a pattern of demineralization and caries of the incisal tips of the mandibular labial segment, influenced by the incisal capping and the frequent intake of carbonated soft drinks.

A randomized clinical trial to compare the effectiveness of canine lacebacks with reference to canine tip.

AIM: To assess the effectiveness of canine lacebacks on the proclination of the upper incisors with reference to pre-treatment canine tip. STUDY DESIGN: Randomized clinical trial. SAMPLE: Patients receiving upper and lower fixed appliances attending the orthodontic departments of five orthodontic treatment providers. Sixteen patients received canine lacebacks as part of their treatment and 19 patients did not have canine lacebacks. METHOD: Patients were randomly allocated to receive canine lacebacks or not receive canine lacebacks. Upper study models were collected at the initial archwire placement and then when the working 0.019 x 0.025-inch stainless steel archwire was placed. The start canine angulation, change in upper incisor proclination/overjet, and any mesial movement of the upper first permanent molars during levelling and aligning was measured with a reflex metrograph. STATISTICS: The effect of the use of canine lacebacks on upper incisor proclination and mesial molar movement was assessed using Student t-tests. Regression analysis was used to evaluate any effect of the initial angulation of the canine. RESULTS: A mean incisor retroclination of 0.5 mm was observed in the canine lacebacks compared with a mean proclination of 0.36 mm when canine lacebacks were not used (P = 0.025). There was no statistically significant difference between groups for mesial movement of upper first molars (P = 0.99). If the canine was more distally inclined at the start of treatment, the incisors was more likely to procline, regardless of whether or not canine lacebacks were used (P = 0.027). CONCLUSIONS: The effect of canine lacebacks on preventing upper incisor proclination at the start of treatment is in the order of 1 mm and their effect on mesial molar movement is insignificant. Canines lacebacks have similar effects that are independent of pre-treatment canine angulation.

A comparison of parents' and patients' views of orthognathic treatment.

The aim of this study was to assess parents' views of orthognathic treatment and compare them with the views of their son or daughter who underwent the treatment. Fifty patients who had undergone orthognathic treatment and one of their parents were recruited over an 8-month period between July 1999 and March 2000. The study was a retrospective, questionnaire-based study. Comparison of parents' and patients' views was undertaken using Cohen's kappa coefficient. This was also used to compare individual parent and patient views pre- and posttreatment. Response rates were 90% (n = 45) for patients and 80% (n = 40) for parents. Parents rated their son or daughter as having a more attractive facial and dental appearance and higher levels of self-confidence both pre- and posttreatment than the patients graded themselves. Parents and patients both felt there was significant improvement in facial and dental appearance and self-confidence following treatment.