Outcomes of orthodontic treatment performed by individual orthodontists vs 2 orthodontists collaborating on treatment.

INTRODUCTION: One factor that can affect treatment outcomes is the treatment provider, and this factor has not been extensively studied. This research aimed to evaluate orthodontic treatment quality, length, and efficiency when 2 orthodontists collaborated on treatment, compared with the treatment provided solely by either orthodontist. METHODS: A total of 150 consecutively treated subjects were divided into 3 equal groups based on the treating clinician. Patients in group A were treated by orthodontist A, group B by orthodontist B, and group C by both orthodontists in collaboration. The Peer Assessment Rating (PAR), Index of Complexity, Outcome, and Need (ICON), American Board of Orthodontics-Discrepancy Index, and American Board of Orthodontics-Cast and Radiographic Evaluation were used to assess the pretreatment and posttreatment status. Patient age, gender, type of malocclusion, extraction treatment, orthognathic surgery, treatment length, number of visits, and treatment efficiency index were assessed. RESULTS: Posttreatment PAR and ICON indices showed excellent results in all 3 groups. American Board of Orthodontics-Cast and Radiographic Evaluation was significantly higher in group C (25.3 points) than in group A (21.5 points) or group B (22.0 points) (P = 0.014). Patients in group A had significantly shorter treatment time (23 months) than those in either group B or C (26 months) (P = 0.011). Patients in group C required more appointments (27 visits) than those in either group A or B (23 and 25 visits, respectively). The treatment efficiency index showed no statistically significant difference among the 3 groups. CONCLUSIONS: There was no difference in treatment quality among the 3 groups, as assessed by the PAR index and ICON. Jointly treated cases required 2 to 4 more visits and had higher American Board of Orthodontics-Cast and Radiograph Evaluation scores than those treated by either orthodontist. Complex cases required 6 to 7 more months when they were treated collaboratively.

Mandibular dental changes following serial and late extraction of mandibular second premolars.

OBJECTIVES: To determine changes in occlusal curves and dental tipping occurring from mandibular second premolar serial extraction, early extraction of deciduous mandibular second molars with missing second premolars, and late second premolar extraction compared with untreated controls. MATERIALS AND METHODS: Information was collected from 85 subjects at three time points: T0, prior to serial extraction; T1, after serial extraction and drift prior to orthodontic treatment, and pretreatment for the late premolar extraction patients; and T2, posttreatment. Untreated age- and gender-matched controls were used for comparison. Three occlusal curves were measured on digitized mandibular casts, and dental tipping was assessed using lateral cephalograms. RESULTS: At T0, there were no significant differences among groups. At T1, there was significant steepening of Monson's sphere and the curve of Wilson between early and late extraction and control groups. At T2, the differences in Monson's sphere and the curve of Wilson were fully corrected. At T1, there were significant differences in the tipping of mandibular 6's, 4's, and 3's between the early extraction groups compared with the late extraction and control groups. At T2, these differences in tipping were fully corrected. There were no differences in mandibular incisor tipping between groups at T1 or T2. CONCLUSIONS: Serial extraction produced steeper occlusal curves and significant tipping of mandibular first molars, first premolars, and canines after extraction and physiologic drift (T1). Accentuated occlusal curves and tooth tipping were fully corrected following orthodontic treatment (T2). Mandibular incisor position was unchanged by serial or late second premolar extraction.

Outcomes of early versus late treatment of severe Class II high-angle patients.

INTRODUCTION: The aim of this work was to compare the skeletal and dental outcomes of 1- versus 2-phase treatment in Class II subjects with difficult-to-treat high-angle severe Class II malocclusions. METHODS: The sample of 120 cases was collected from the private offices of 3 experienced clinicians. The following selection criteria were used: (1) ANB ≥6°, (2) SN-GoGn ≥37° or mandibular plane to Frankfort horizontal plane ≥30°; and (3) overjet ≥6 mm. Patients were classified into either the early or the late treatment group according to dental age (early Tx: ≥5 primary teeth; late Tx: otherwise). Thirty-four angular, linear, and proportional measurements were determined for each patient. Statistical significance was assessed with the use of a 2-tailed t test, analysis of covariance test, and chi-square test. RESULTS: The results showed that early 2-phase treatment for severe Class II high-angle patients offered no skeletal anteroposterior advantages over late 1-phase treatment. Severe high-angle Class II patients also showed similar dental anteroposterior outcomes with the use of both approaches. Vertically there was a higher frequency of increased mandibular plane angles and extrusion of upper incisors and lower molars in the late treatment group. CONCLUSIONS: Early 2-phase treatment for severe Class II high-angle patients offered no skeletal or dental advantage over late 1-phase treatment.

Management of a Class I malocclusion with traumatically avulsed maxillary central and lateral incisors.

This case report describes orthodontic space closure for managing an avulsed maxillary central incisor and a lateral incisor in a growing girl with a Class I deep bite malocclusion with moderate lower and mild upper crowding. The treatment approach moved a central incisor across the midline and substituted a lateral incisor for a central incisor, in combination with canine substitution. Veneers on all maxillary anterior teeth attained acceptable esthetics. The right central incisor was moved to serve as the avulsed left central incisor. The right lateral incisor was moved to the position of the right central incisor and restored. The canines on both sides were substituted as lateral incisors; the posterior occlusion was left in Class II. Mesialization of central and lateral incisors with prosthetic rehabilitation is an acceptable treatment option.

Loss of Permanent First Molars in the Mixed Dentition: Circumstances Resulting in Extraction and Requiring Orthodontic Management.

Extraction of significantly compromised permanent first molars may be indicated during the mixed dentition stage of occlusal development. The purpose of this article was to review circumstances that can result in the loss of a permanent first molar-including dental caries, molar incisor hypomineralization, eruption disturbances of permanent teeth, and failure of restorative treatment to affirm that a complete dental arch is not necessary for the existence of a functional dental arch. The extraction of permanent first molar(s) with subsequent orthodontic treatment in a young patient can be considered a cost-effective alternative to placing complex restorations that require replacement over the lifespan. Approaches to establish a functional dental arch in the event of the loss of a permanent first molar(s) are outlined. Additionally, orthodontic diagnostic and treatment principles are reviewed. Case histories are provided to illustrate the clinical management of permanent first molar extractions to achieve a functional dental arch.

Mandibular changes secondary to serial extractions compared with late premolar extractions and controls.

INTRODUCTION: Variations in treatment times for serial extraction and late premolar extraction patients may be due to differences in the time needed to flatten the occlusal curves. In this study, we compared tooth tipping and occlusal curves in patients treated by serial extractions or late premolar extractions with untreated controls. METHODS: Mandibular dental casts and cephalometric radiographs were collected from 90 subjects (30 Class I control subjects, 30 patients with serial extractions, and 30 with late premolar extractions) at 3 time points: T0, baseline for the controls and serial extraction patients; T1, after natural drift and preorthodontics for the controls and the serial extraction patients, and pretreatment for the late premolar extraction patients; and T2, after comprehensive orthodontic treatment for the serial extraction and the late premolar extraction groups. The long axes of the central incisor, canine, and first molar to the palatal plane were measured on digitized headfilms to determine the direction and the amount of tipping between the time points. Three occlusal curves were measured by sphere fitting cusp-tip landmarks on digitized mandibular casts. RESULTS: From T0 to T1, incisors and canines in the patients with serial extractions tipped distally. Molars at T1 in the patients with serial extractions were tipped forward more than in the late premolar extraction patients and the controls. From T1 to T2, canines and molars in the patients with serial extractions were uprighted. CONCLUSIONS: Serial extractions produce steeper occlusal curves and distal tipping of the incisors and canines after drift (T1). Posttreatment (T2) occlusal curves in the patients with serial extractions are steeper than in the late premolar extraction patients and controls (except for the curve of Spee). After the serial extractions, orthodontic treatment included incisor and canine proclination, with molar uprighting and occlusal curve flattening.

Efficiency of serial extraction and late premolar extraction cases treated with fixed appliances.

INTRODUCTION: Severe crowding can be treated with serial extraction (SE) in the mixed dentition or with late premolar extraction (LPE) in the permanent dentition. The aim of this study was to investigate the efficiency of orthodontic treatment in SE patients and LPE patients. METHODS: Retrospective chart review identified 51 SE patients and 49 LPE patients treated with fixed appliances. Number of appointments, length of time, and estimated total chair time were determined prior to the placement of fixed appliances and during fixed appliance treatment. Peer assessment rating (PAR) scores were obtained at T1 (start of fixed appliances) and T2 (removal of fixed appliances) for both groups, and at T0 (prior to extraction of the first premolars) for the SE group. RESULTS: The mean T1 PAR score for SE patients was significantly lower than LPE patients (P <0.001); mean T2 PAR scores were not significantly different (P = 0.27). Active treatment time (T1 to T2) was significantly (P <0.001) less for SE patients than LPE patients. Total time (T0 to T2) and total number of appointments were significantly greater for the SE group compared with the LPEgroup (P <0.001). CONCLUSIONS: SE and LPEresulted in similar final occlusal outcomes. SEs might reduce active treatment time, but significant observation time precedes active treatment.

Arch dimension changes from successful slow maxillary expansion of unilateral posterior crossbite.

OBJECTIVE: To evaluate the long-term effects of successful slow maxillary expansion without fixed appliances or retainers in the mixed dentition on patients with unilateral crossbites, using Haas-type, hyrax, or quad helix appliances. MATERIALS AND METHODS: Serial dental casts of 110 patients were evaluated at three time points: preexpansion (T1) (mean age 7 years/7 months), postexpansion (T2) (mean age 8 years/8 months), and approximately 4 years later in the permanent dentition (T3) (mean age 12 years/9 months). Maxillary and mandibular intercanine and intermolar widths, arch length, and perimeter and molar angulation were measured at all three time intervals with the Michigan published growth norms serving as a control. RESULTS: Successful treatment by slow maxillary expansion (SME) produced similarly favorable expansion by all three expanders in all measurements for both arches. Maxillary arch widths were narrower than controls pretreatment (T1) and wider than controls immediately post treatment (T2). Long-term (T3) maxillary intermolar width was the same as controls, with intercanine width significantly wider than controls. Maxillary intercanine and intermolar width increased from T1 to T3, by 4.5 mm and 3.5 mm, respectively, with 98% of intercanine and 80% of intermolar expansion remaining at T3. Maxillary arch circumference increased by 1 mm from T1 to T3. Mandibular width did not change significantly. CONCLUSION: Maxillary arch dimensions in early mixed dentition in patients with unilateral posterior crossbite showed good stability 4 years post treatment in the permanent dentition.

Treatment response and stability of slow maxillary expansion using Haas, hyrax, and quad-helix appliances: a retrospective study.

INTRODUCTION: In this retrospective study, we evaluated the short- and long-term effects of slow maxillary expansion with Haas, hyrax, and quad-helix appliances on posterior crossbite (PXB) correction stability, and maxillary intermolar width and angulation, in the deciduous or early mixed dentition. METHODS: The inclusion criteria were models and treatment notes of patients with PXB at the start of treatment (T1), after PXB correction (T2), and at least 2 years posttreatment (T3). Exclusion criteria were craniofacial anomalies, fixed appliance use, or more than 1 expander type. From 312 consecutive expansion patients, 74 Haas, 41 hyrax, and 45 quad-helix subjects were evaluated regarding PXB correction, intermolar width, and angulation and compared with published norms to separate treatment effects from growth. The mean ages at T1, T2, and T3 were 8, 9, and 13 years. RESULTS: There were no significant differences in PXB correction stability or treatment response at T2 and T3 among the 3 expanders. Expansion increased intermolar width by 5 mm and tipped each molar by 2.3 degrees. At least 2 years after expander removal, molar width decreased by 1.3 mm, and the molars uprighted by 6 degrees. Compared with noncrossbite norms, PXB subjects had narrower intermolar width before treatment and greater width after expansion, and were slightly wider at least 2 years posttreatment. Both younger age at T1 and retainer use resulted in statistically greater intermolar width at T3. CONCLUSIONS: Eighty-four percent of PXB correction remained with about one third of the initial expansion lost; retainer use and early treatment provided increased intermolar width. Haas, hyrax, and quad-helix appliances were equally effective. Slow maxillary expansion altered the PXB patients' maxillary widths from narrower to slightly wider than the widths of the noncrossbite norms.

Management of an ectopically erupting permanent mandibular molar: a case report.

Ectopically erupting permanent first molars occur in approximately 3% to 4% of children, and presentation in the mandible is very rare. When the malocclusion warrants a nonextraction treatment plan in the mandible, early correction of an impacted ectopic molar with space regaining is appropriate. The purpose of this case report was to describe and document the correction of a severely impacted permanent mandibular left first molar in the early mixed dentition along with long-term results. A bilateral lingual arch was placed on the primary mandibular second molars with a Halterman-type extension in conjunction with a bonded button on the occlusal surface of the impacted permanent molar and chain elastic Early space regaining allowed future nonextraction treatment.

Failure rates and survival analysis of maxillary expansion appliances: a 24-year retrospective analysis.

PURPOSE: The purpose of this study was to describe the failure rates of maxillary expansion appliances (MEAs) and assess risk variables associated with failures and treatment time. METHODS: Retrospective chart reviews were performed on 436 primary or mixed dentition patients presenting with crossbite to a private practice between 1981-2005. Survival analysis was used to analyze and compare the types of MEAs with respect to the treatment time. The effect of demographic and clinical characteristics on appliance failure and treatment time was assessed using linear and logistic regression models. RESULTS: The average age at insertion of a MEA was 8 years, 4 months (+/-1.72 SD). Nineteen percent (n=84) of the MEAs failed, with a median treatment time for all appliances of 216 days (interquartile range=126 days). Cement loss (69%) was the most common type of failure. The likelihood of an appliance failing increased in children with a malocclusion other than Class I (adjusted odds ratio=1.91; 95% CI=1.16-3.14) and was nearly 4 times greater when a quad helix was used compare to the Haas appliance (adjusted odds ratio=3.60; 95% CI=1.92-6.75). The treatment time was significantly affected by the type of crossbite present and the occurrence of an appliance failure (P=.001). CONCLUSIONS: The use of a quad helix appliance and the presence of malocclusion other than Class I was significantly predictive of appliance failure. Treatment time was increased when MEAs failed and bilateral crossbite was present.

Clinical tips for the Halterman appliance.

Ectopic eruption of permanent first molars occurs infrequently and causes some resorption of the adjacent primary second molar. The primary second molar can be used as an anchor tooth for the Halterman appliance to disimpact the permanent first molar, provided root resorption is not extreme. A modification of the Halterman appliance is a reverse band and loop appliance with a bonded button on the permanent molar and chain elastic for disimpaction. The purpose of this report was to suggest tips regarding placement and clinical management of this modified Halterman appliance design.

Laboratory-made space maintainers: a 7-year retrospective study from private pediatric dental practice.

PURPOSE: The purpose of this study was to report survival times and problems encountered with laboratory made space maintainers placed over 7 years by one pediatric dentist. METHODS: Charts were reviewed for 235 patients with fixed space maintainers placed between January 1, 1997, and December 31, 2003, and followed to December 31, 2005. Problems encountered and appliance lifetimes were recorded and assessed. Failures were recorded as: (1) cement loss; (2) solder breakage; (3) split bands; (4) eruption interference; (5) bent wire; (6) complete loss; or (7) not specified. Appliance outcomes, transferred patients, and those lost to follow-up were recorded. RESULTS: A total of 323 appliances were followed, with: (a) 93 (29%) successes; (b) 110 (34%) still in service; and (c) 104 (32%) known failures. Of the latter, most (62%) were from cement loss (60%) and 13 (12%) were totally lost. No statistically significant differences were noted between types of appliances, gender, and types of failure, except for the fact that bands and loops exhibited more cement loss (P=.045). Mean pooled survival times were between 26 and 27 months.. Of the 104 failures: (a) 34 (33%) were no longer needed (being considered clinically successful); (b) 57 (55%) were recemented; and (c) 13 (12%) were remade. Sixteen appliances were lost to follow-up or transferred. CONCLUSION: A total of 63% of all space maintainers lasted their anticipated lifetimes or were still in use.

Bilateral space maintainers: a 7-year retrospective study from private practice.

PURPOSE: The purpose of this study was to report survival times and problems encountered with bilateral space maintainers placed over a 7 year period. METHODS: Charts were reviewed for all patients who had bilateral space maintainers placed between January 1, 1996 and December 31, 2003. Appliance lifetime and problems encountered were recorded and assessed on July 30, 2005, if still in use. Failures were recorded as: (1) cement loss; (2) solder breakage; (3) split band; (4) eruption interference; (5) bent wire; (6) loss; or (7) not specified. Also recorded were: (1) failed appliances; (2) transferred patients; and (3) those lost to follow-up. RESULTS: A total of 482 space maintainers were evaluated, with 114 failures (24%) and 349 successes (72%). Of the 114 known failures: 68 (60%) were from cement loss; 12 (10%) were from solder breakage; 11 (10%) were from split bands; and 13 (11%) were from reasons not specified. No statistical differences were noted between types of failures or between genders. Mean pooled survival times were 20 months for lingual arches and 23 months for Nance appliances, with no statistical differences between arches, except in successful appliances where Nance was superior (P = .011). Of the 114 failed appliances: 44 (39%) were not recemented or remade, which was considered clinically successful; 51 (45%) were recemented; and 19 (17%) were remade. Eight appliances were lost to follow-up or transferred. CONCLUSION: The majority of bilateral space maintainers (72%) lasted their anticipated lifetimes.

Unilateral posterior crossbite with mandibular shift: a review.

Based on this literature review, early orthodontic treatment of unilateral posterior crossbites with mandibular shifts is recommended. Treatment success is high if it is started early. Evidence that crossbites are not self-correcting, have some association with temporomandibular disorders and cause skeletal, dental and muscle adaptation provides further rationale for early treatment. It can be difficult to treat unilateral crossbites in adults without a combination of orthodontics and surgery. The most appropriate timing of treatment occurs when the patient is in the late deciduous or early mixed dentition stage as expansion modalities are very successful in this age group and permanent incisors are given more space as a result of the expansion. Treatment of unilateral posterior crossbites generally involves symmetric expansion of the maxillary arch, removal of selective occlusal interferences and elimination of the mandibular functional shift. The general practitioner and pediatric dentist must be able to diagnose unilateral posterior crossbites successfully and provide treatment or referral to take advantage of the benefits of early treatment.