Positional factors affecting the surgical management of impacted permanent mandibular canines.

OBJECTIVE: To assess which positional factors influence the decision to surgically remove or expose an impacted mandibular canine. Clinical and radiographic assessment are important considerations when treatment planning for the management of impacted mandibular canines. DESIGN: A cross-sectional study. SETTING: The Royal Surrey County Hospital, Guildford, UK. METHODS: The clinical notes and orthopantomogram radiographs were assessed for all patients aged 21 years or under who underwent surgical management of impacted mandibular canine teeth between 2017 and 2019. The following variables were recorded: angulation, horizontal position, vertical height, overlap of the adjacent tooth and bucco-lingual position of the canine. RESULTS: From the 67 patients and 77 canines included, surgical extraction was performed for 48 canines (62%) and surgical exposure was performed for 29 canines (38%). Chi-square and multivariable logistic regression revealed canine angulation to the midline, horizontal position of the canine root apex, vertical height of the canine crown and canine overlap of the adjacent tooth to be associated with the decision to remove or expose an impacted permanent mandibular canine (P < 0.001). The bucco-lingual position of the canine did not influence the decision to remove or expose an impacted permanent mandibular canine (P = 0.159). CONCLUSION: The decision to expose or remove an impacted mandibular canine is guided by its angulation, horizontal position and vertical position, and by the degree of overlap of the adjacent tooth. However, the bucco-lingual position is not related to the decision to surgically remove or expose an impacted permanent mandibular canine.

What are the differences in protective characteristics of orthodontic mouthguards? An in vitro study.

BACKGROUND: Orthodontic patients wearing fixed appliances are susceptible to traumatic dental injuries during contact-sport. This laboratory study investigated the protective qualities of orthodontic mouthguards using impact-testing to a typodont fitted with a fixed appliance through peak load transfer and retention of the mouthguard. METHODS: Seven orthodontic mouthguards [three custom-made (Medium-CM, Heavy-CM, Heavy-pro-CM); three commercially-available mouth-formed (Shock-Doctor® Ultra Braces, Opro® Ortho-Gold Braces, Opro® Ortho-Bronze Braces) and a Shock-Doctor® Instant-Fit] were fitted to a maxillary arch typodont bonded with a fixed appliance and impact-tested using 0.5 or 1 Joule (J) energy via hockey-ball, cricket-ball or steel-ball projectile. A load-cell recorded peak load transfer through mouthguard to typodont with retention scored in a binary manner dependent upon any displacement following impact. Differences across mouthguards were calculated with ANOVA or Kruskal-Wallis test for normal and non-normal data, respectively. Post hoc comparisons across mouthguards were conducted via Dunnett's test with Sidak correction. RESULTS: Only the three custom-made and Opro® Ortho-Gold Braces were not displaced by impact-testing. For these, Opro® Ortho-Gold Braces transferred the smallest load for 3/6 impact-tests, followed by Medium-CM. Heavy-pro-CM performed poorly, ranking penultimate or worst for all impact-tests. Significant differences were found between mouthguards for cricket-ball and steel-ball set-ups. The Opro® Ortho-Gold Braces performed better than the Heavy and Heavy-pro-CM for 0.5 J cricket-ball impact-test (P < 0.05), whilst Medium-CM performed better than Heavy-pro-CM. For 1 J cricket-ball, there were significant differences between Medium-CM and Heavy-pro-CM (P < 0.05). For 0.5 J steel-ball, the Medium-CM performed significantly better than both Heavy-pro-CM and Opro® Ortho-Gold Braces (P < 0.05), whilst Heavy-CM performed better than the Heavy-pro-CM (P < 0.05). For the 1 J steel-ball, Medium and Heavy-CM performed better than Opro® Ortho-Gold Braces (P < 0.05). CONCLUSIONS: Opro® Ortho-Gold and Medium-CM mouthguards offer the best protection for low-impact sports, whilst Medium or Heavy-CM mouthguards are recommended for high-impact sport.

Wearability and preference of mouthguard during sport in patients undergoing orthodontic treatment with fixed appliances: a randomized clinical trial.

BACKGROUND: Orthodontic patients wearing fixed appliances are susceptible to traumatic dental injuries during a wide range of sporting activities. This randomized clinical trial investigated wearability and preference of mouthguards during sporting activities in patients undergoing orthodontic treatment with fixed appliances. METHODS: A prospective three-arm crossover randomized clinical trial conducted in the UK. Thirty patients in active orthodontic treatment with fixed appliances undertaking at least 120 minutes of contact sport per 6-8-week observation period were randomly assigned to one of six mouthguard allocation sequences consisting of three mouthguard types: (MG1) custom-made laboratory constructed, (MG2) mouth-formed OPRO® Gold Braces, and (MG3) pre-fabricated Shock Doctor® Single Brace. Patients completed a nine-outcome 100-mm visual analogue scale (VAS) questionnaire relating to mouthguard wearability during sport. Once feedback was completed, subjects were allocated the next mouthguard in the sequence. At study-end, subjects were asked to identify their preferred mouthguard. RESULTS: Twenty-four patients (median age = 13; inter-quartile range 12-14.5 years) completed n = 72 follow-up questionnaires with most playing rugby union or field hockey. Considering VAS score as a continuous variable, for comfort, stability, hardness, ability to breathe, ability to not cause nausea, and inclination to chew, MG2 performed better than MG3. For categorization of VAS score into low (less than 80 mm) or high (at least 80 mm) wearability, for comfort, stability, ability to not cause nausea, and inclination to chew, MG1 and MG2 also rated superior to MG3. Patients preferred MG1 overall. CONCLUSIONS: This randomized clinical trial found that during contact sport patients in fixed appliances reported superior wearability for custom-made and mouth-formed mouthguards in comparison to pre-fabricated. Overall, patients preferred custom-made mouthguards. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov: NCT04588831.

Mandibular lateral incisor-canine transposition: A case series.

Dental transpositions are rare anomalies, which may present to the general dental practitioner or orthodontist. Transpositions occur less frequently in the mandible compared with the maxilla, with the most common mandibular transposition involving the mandibular lateral incisor and canine. The degree of displacement can vary from a relatively minor deviation to complete transposition of the mandibular lateral incisor with the adjacent canine tooth. Due to their highly visible position at the front of the mouth, treatment, ideally involving alignment of these teeth, is important for aesthetic, social and functional purposes. This case series reports six cases with mandibular lateral incisor-canine transposition. They demonstrate the variety in presentation and subsequent management of the ectopic teeth. The importance of early diagnosis in combination with interceptive treatment is discussed, to reduce the burden of potentially lengthy orthodontic treatment at a later date.

A recurrent central giant cell granuloma in a young patient and orthodontic treatment: a case report.

Central giant cell granuloma (CGCG) is an uncommon benign intraosseous lesion of the jaw, found predominantly in children and young adults below 30 years of age. The purpose of this article was to present a summary of the current literature and a case report of an 11-year-old boy diagnosed with an aggressive CGCG involving the anterior maxilla that was removed in 2004 and subsequently recurred almost 3 years later in 2006. The presenting features of the patient and the effect of combined surgical and orthodontic treatment for this condition are discussed. This case shows how the dentition was successfully maintained with conservative surgery and orthodontic treatment in spite of the extensive destruction of the supporting bone, and the importance of long-term follow-up. The report also reminds orthodontic practitioners that rare pathological conditions can occur in their child patient groups.

Orthodontic treatment and cemento-osseous dysplasia: a case report.

This report presents a case of florid cemento-osseous dysplasia (FCOD), affecting the mandibular teeth, in a 23-year-old Somalian female patient for whom orthodontic treatment was undertaken. The presenting features of the patient and the effect of orthodontic treatment on this case are discussed.

Exposure to 'ideal' facial images reduces facial satisfaction: an experimental study.

OBJECTIVE: Psychological research has suggested that exposure to media images of 'ideal' female models has a negative impact on women's perception of their body image. The present study examined the effects of exposure to images of faces rated as high in attractiveness upon facial satisfaction, compared with exposure to 'neutral' stimuli. METHODS: Participants comprised three groups of women: 24 women undergoing orthodontic treatment, 22 patients undergoing orthognathic treatment, and 20 women receiving no current dental treatment. All completed measures of facial and body image satisfaction after viewing images of houses or faces as follows: The Body Satisfaction Scale, The Revised Body Image Scale of Secord and Jourard and a Visual Analogue Scale measuring satisfaction with Facial Appearance. A repeated-measures design was adopted with a 4-6-week period between experimental conditions. All participants were randomly assigned to one of the two orders (Houses-Faces or Faces-Houses). The findings were analysed using general linear modelling analysis of variance. RESULTS: Exposure to idealized images of faces resulted in a significant decrease in facial satisfaction when compared with the control condition (mean facial satisfaction for all participants in Faces condition, Body Satisfaction Scale-Head Scale = 22.2, SD = 7.81; Revised Body Image Scale-Facial Subscale = 25.5, SD = 4.57; VAS = 7.8, SD = 2.47; Mean facial satisfaction for all participants in Houses condition, Body Satisfaction Scale-Head scale = 19.5, SD = 6.81; Revised Body Image Scale-Facial Subscale = 26.8, SD = 4.87; VAS = 6.2, SD = 2.72). CONCLUSIONS: Media may exert a negative influence on self-perception, particularly amongst individuals who, for one reason or another, are sensitive to the appearance of their face. The findings of the present study have implications for the demand for orthodontic treatment for aesthetic enhancement at a time when resources are limited. Interventions are discussed to help individuals question their acceptance of such media messages.