Condylar movement analysis in subjects with clinically normal temporomandibular joints, utilizing an amorphous sensor.

The purpose of this study was to determine the range of condylar movements in normal subjects, by the use of an amorphous sensor. The pair-matched sample consisted of 17 Caucasian males (aged 25.8 +/- 2.5 years) and 17 Caucasian females (aged 25.5 +/- 2.8 years) who had no subjective or objective symptoms related to temporomandibular joint (TMJ) sounds. Bilateral condylar and jaw movements were recorded simultaneously. The results showed that the typical condylar movement points plotted on the X-Y coordinates indicated a uniform or approximately straight line, that is X = Y. The mean +/- standard deviation (s.d.) for the maximum velocity of condylar movement during the opening and closing phases was 32.6 +/- 16.9 and 39.8 +/- 21.5 mm s-1, respectively. The mean +/- s.d. for the degree of jaw opening at the turning point of condylar movement was 36.9 +/- 21.7%. Significant correlations existed between any two measurements of maximum velocity of condylar movement. Moreover, significant correlations existed between the left and right sides in the degree of jaw opening at the turning point of condylar movement. These results suggest that a range of normal values of condylar movements can be developed when utilizing the amorphous sensor method.

Changes in tooth position in humans in relation to arterial blood pressure.

The three-dimensional physiological tooth movement synchronized with the heartbeat is called periodontal pulsation. This study utilized a computer-assisted amorphous sensor to evaluate the relation between tooth position and arterial blood pressure, and also between the amplitude of periodontal pulsation and arterial blood pressure. The measuring device consisted of a small magnet attached to the tooth and an amorphous sensor that was used to detect displacement of the tooth without actually contacting it. The sample consisted of the upper left central incisors of six healthy Japanese volunteers. The three measuring points for each tooth were on the labial surface. The cold-pressor test was used as an autonomic nerve stimulus that induces an increase in blood pressure and heart rate. Periodontal pulsation, electrocardiogram, blood pressure and heart rate were recorded simultaneously during a 1 min pre-test relaxation, a 2 min cold-pressor test and a 1 min recovery. The results showed significant correlations between tooth position and mean blood pressure in five of the six volunteers and between tooth position and pulse pressure in four. Moreover, it was confirmed that tooth position shifted in the labial direction in conjunction with an increase of the mean blood pressure induced by cold stimulation. Significant correlations were found between the amplitude of periodontal pulsation and pulse pressure in four of the volunteers. These findings suggest that in humans tooth position might be affected by the force of blood pressure transmitted through periodontal vessels and that the amplitude of periodontal pulsation tends to reflect changes of pulse pressure rather than changes in mean blood pressure.

Posttreatment evaluation of the distal jet appliance.

This study analyzed molar distalization with the distal jet appliance, its effect on the anchor teeth, and the outcome at the completion of orthodontic treatment. Pretreatment, after distalization, and posttreatment lateral cephalometric radiographs were evaluated for 21 adolescent girls and 12 adolescent boys. The mean age of the subjects at the time of the pretreatment radiograph was 12.8 +/- 2.2 years. The mean time for the correction of the Class II molar relationship was 6.7 +/- 1.7 months, and the mean total treatment time was 25.7 +/- 3.9 months. The results of this study showed that the distal jet appliance distalized the maxillary molars, but there was significant loss of anchorage. The distal jet also showed less tipping of the maxillary molars and better bodily movement of molars because the force was applied closer to the center of resistance. The observations of treatment outcome indicate that the 1.8-mm mean net anterior movement of the maxillary first molar was more than offset by the 4.8-mm mesial movement of the mandibular first molar. There was no significant increase in lower face height. Consequently the effect on the facial balance was negligible.

The effect of saliva on shear bond strengths of hydrophilic bonding systems.

Failure of orthodontic bonded attachments and brackets is mostly attributed to contamination of the enamel surface. To overcome this problem, materials have been developed that purportedly overcome the moisture and contaminants present in the oral environment. This study compared the shear bond strengths of 2 lightcured hydrophilic bonding systems, Transbond XT with MIP (3M/Unitek, Monrovia, Calif) and Assure (Reliance Orthodontics, Itasca, Ill) with a hydrophobic bonding system, Transbond XT with XT primer (3M/Unitek). Comparison tests were conducted under 4 enamel surface conditions: (1) etched and dried; (2) etched and moistened with artificial saliva; (3) etched, primed, and moistened with artificial saliva; and (4) etched, primed, moistened with artificial saliva, and reprimed. In addition, an adhesive remnant index score was used to determine the amount of adhesive remaining on the tooth. Stainless steel brackets with mesh-backed pads (n = 144) were bonded to bovine teeth. Bond strength was then tested in shear using an Instron mechanical testing instrument. There were significant differences in the bond strengths among the products (P <.05), within surface treatments (P <.05), and among the different bonding materials in combination with various surface treatments (P <.05). Treatments 1 and 4 showed the highest mean bond strengths adhesive remnant index scores, whereas treatments 2 and 3 showed the lowest mean bond strengths and scores.

Morphological differences in individuals with lip competence and incompetence based on electromyographic diagnosis.

The study group consisted of 19 subjects with positive overjet and overbite, and 17 subjects with skeletal open bite. Two bipolar surface electrodes were attached to the skin of the upper and lower lips. The mean integrated amplitude of the electromyographic (EMG) activity was obtained at the mandibular rest position with the lips in contact and with the lips apart. Subjects were divided into two groups based on positive or negative values of the difference in integrated EMG activity of the mentalis muscle between the two lip positions. Subjects displaying a negative value were classified as having competent lips and those displaying a positive value were classified as having incompetent lips. The EMG activity of the mentalis muscle was found to be more indicative of lip sealing as compared with the EMG activity of the depressor of the lower and the upper lips. The activities of the mentalis muscle at the mandibular rest position with the lips in contact and with the lips apart appear to offer an objective criterion for the evaluation of lip incompetence. In addition, the vertical dimension of the face, as well as the proclination of the incisors, appear to affect lower lip function.

Effect of orthodontic therapy on the facial profile in long and short vertical facial patterns.

The purpose of the present study was to evaluate the effects of orthodontic treatment on the soft tissue facial profile of patients with long and short facial types. Orthodontic treatment records of 99 white long-faced and short-faced patients were analyzed to determine the effects of edgewise orthodontic treatment over an average period of 2.16 +/- 0.32 years. The average ages at the initiation and conclusion of treatment were 13.40 +/- 0.40 years and 15.61 +/- 0.29 years, respectively. A significant finding in this study was the large variability in soft tissue response to tooth movement. This variability was due to a wide dispersion of individual results between upper and lower lip change to maxillary and mandibular incisor movement anteriorly or posteriorly. Because of this soft tissue variability among individuals, definite differences between the long-faced and short-faced types could not be identified, nor was it possible to establish definite ratios for change in lip response to incisor movements.

Evaluation of the Jones jig appliance for distal molar movement.

The purpose of this study was to determine the effects of the Jones jig appliance on distal movement of maxillary molars and reciprocal effects on premolars and maxillary incisors. Cephalometric radiographs before and after orthodontic treatment of 72 consecutively treated patients, 46 females and 26 males, were measured to define treatment changes attributed to the Jones jig. Comparative measurements were made on a matched sample of 35 patients (20 females and 15 males) treated with cervical headgear by the same clinician. Both series of patients were treated to correct an Angle Class II molar relationship. The molar correction in the Jones jig patients consisted primarily of molar distal movement. Dental, soft tissue, and skeletal changes were evaluated and compared for significant differences between techniques. The results from the Jones jig sample showed the mean maxillary first molar distal movement was 2.51 mm, with distal tipping of 7.53 degrees. The mean reciprocal mesial movement of the maxillary premolar was 2.0 mm, with mesial tipping of 4.76 degrees. The maxillary first molar extruded 0.14 mm; the maxillary premolar extruded 1.88 mm. The maxillary second molars were also moved distally 2.02 mm and tipped distally 7.89 degrees. The longitudinal assessment (initial to completion of orthodontic treatment) showed significant differences between the Jones jig sample and the cervical headgear sample for lower lip to E-line and SNA. The Jones jig sample showed a mean decrease in lower lip to E-line of 0.25 mm versus 1.20 mm (P < .0212) for the headgear sample. SNA decreased 0.40 degrees for the Jones jig sample versus 1.20 degrees (P < .0093) for the headgear sample. However, the Jones jig sample and cervical headgear sample did not show significant differences of the final position in either linear or angular measurements of the maxillary first molars and corresponding premolar-incisor anchor units. The Jones jig appliance demonstrated treatment results comparable with those of the sample treated with cervical headgear. The Jones jig sample demonstrated effective distal molar movement and maintenance of the Class I molar relationship. Advantages of the Jones jig include minimal dependence on patient compliance, ease of fabrication, and ease of buccal force application.

Longitudinal assessment of vertical and sagittal control in the mandibular arch by the mandibular fixed lingual arch.

The purpose of this investigation was to determine and quantify vertical changes in the position of the mandibular molars while maintaining arch perimeter with a fixed lingual arch. Twenty-three patients with a mean age of 10.4 +/- 0.6 years were selected to receive fixed lingual arch treatment as the only appliance in the mandibular arch. Average treatment time was 18.3 +/-+/- 0.6 months. Longitudinal records for 12 and 24 months of 24 individuals matched by ethnic origin, age, gender, and mandibular plane inclination were used as controls. Pretreatment and posttreatment cephalograms were used to determine positional changes. Statistically significant differences between the fixed lingual arch and control groups were found. The results of this investigation indicated that the mandibular fixed lingual arch is a useful tool to control the vertical development of the mandibular molars.

Evaluation of the vertical holding appliance in treatment of high-angle patients.

Controlling the vertical dimension of high-angle patients without the benefit of compliance can be a challenging aspect of orthodontic treatment. This retrospective study examines the skeletal and dental effects of a modified transpalatal bar, dubbed the vertical holding appliance (VHA), which was used in an attempt to control the vertical dimension of high-angle patients. Two cephalometrically similar groups of high-angle patients (16 patients each) were compared to determine advantages from using the VHA. Group I (n = 16, pretreatment age 13.4 +/- 1.6 years) was treated with 4 premolar extractions in conjunction with the VHA cemented in place for 17.4 +/- 6.1 months. Group II (n = 16, pretreatment age 13.4 +/- 1.9 years), which was matched for age and pretreatment skeletal pattern, was treated with the Tweed technique and 4 premolar extractions. Lateral cephalometric radiographs were taken before the placement of the VHA, as well as at the end of treatment. The results showed that although y-axis increased significantly in group II (P <.05), it remained the same in group I. Within group I, the Frankfort mandibular plane angle and gonion gnathion/sella nasion angle decreased, whereas both of these values increased in group II. However, these changes were statistically insignificant. Lower anterior face height increased more in group II than in group I (P <. 05). The percentage of lower anterior face height to total anterior face height decreased in group I, whereas it increased in group II. The difference between the 2 groups was determined to be significant (P <.01). Eruption of the maxillary first molar within group I was less than in group II. No significant differences were found between groups I and II for changes in overbite.

Muscle activity with the mandibular lip bumper.

This prospective study was designed to measure muscle activity with lip bumper treatment. Surface electromyography was used to measure upper and lower lip activity with and without the appliance in place. Measurements were taken on a sample of 25 adolescent patients (age range, 10 to 17 years) before and after 12 months of lip bumper treatment. Recordings included a closed lip rest position, swallowing of water, and speech of the words "church," "phone," and "pop." Insertion of the lip bumper at the pretreatment recording resulted in significantly increased activity of the upper and lower lips at rest (P <.001) and while swallowing (P <.05), whereas the response for speech was variable. Pretreatment and posttreatment muscle activity measurements of the lower lip were compared to determine whether 12 months of treatment with the appliance resulted in muscle adaptation. The initial increase of muscle activity with insertion of the appliance for the closed lip rest position and for swallowing was not followed by a decrease during the treatment period. There were significant differences in muscle activity when comparing the "new" equilibrium introduced by the lip bumper to the "old" pretreatment equilibrium without the appliance. Although it was shown that the insertion of the appliance had a significant influence on muscle activity of the lips, the results of this study did not indicate adaptation of the lower lip to the appliance over the treatment period.

Relationship of natural head position to craniofacial morphology.

This investigation aimed at discussing the utility of natural head position-based cephalometric variables and to evaluate the relationship between natural head position and craniofacial morphology. Lateral facial photographs and cephalograms of 284 young adult males taken in a natural head position were analyzed. The average inclination of the intracranial reference planes, Frankfurt horizontal, and palatal plane, in relation to the true horizontal were nearly similar and smaller than 1 degrees. Variables based on the true vertical to describe mandibular sagittal position like B-N(vert) and Pg-N(vert) had very high variances. To study the topographic error, flexors and extenders were identified on basis of four positional variables: NSL/VER; FH/VER; PP/VER; and PMvert/VER. Only 15 measurements were different, according to at least 2 of the 4 positional variables. The 3 that were different in all categories were: facial axis (NBa/PmGn), lower face height (ANS-Me), and the facial ratio (N-ANS/ANS-Me). The "extenders" had higher values for the facial axis and lower face height, and smaller for the face height ratio. Besides these 3 measurements, there was a tendency for the extenders to have increased anterior vertical height, distal sagittal relations, and smaller and retrognathic mandibles. Correlation coefficients between postural and morphologic variables tended to confirm these observations.

Frictional resistance in orthodontic brackets with repeated use.

This study measured and compared the level of frictional resistance generated with a nonrepeated and repeated experimental design to evaluate whether the wear in the bracket slot will influence frictional resistance. Both 0.018 and 0.022 inch slot size edgewise brackets were tested in a specially designed apparatus. The frictional resistance was measured on an Instron Universal Testing Machine. A repeated measures ANOVA was used to determine differences among the 10 individual bracket wire specimens for each combination to study the influence of wear on static and kinetic frictional force. A paired t test (two-tail) procedure was used to compare the static and kinetic frictional forces in the nonrepeated and repeated study for each bracket slot, wire size, and bracket type. The results show that there was a distinct trend for the mean frictional force to be higher with the repeated use of the brackets.

Comparison of frictional resistance in titanium and stainless steel brackets.

This study measures and compares the level of frictional resistance generated between titanium and stainless steel brackets. Both 0.018 and 0.022 inch slot size edgewise brackets were tested with different sized rectangular stainless steel wires in a specially designed apparatus. The frictional resistance was measured on Instron Universal testing machine (Instron Corp, Canton, Mass) with a 10 pound load cell. The specimen population was composed of 180 brackets and 180 wire specimens. A completely randomized design (one way) ANOVA was used to test for significant differences among the three bracket/wire types in the 0.018 and 0.022 inch slot sizes. This was followed by the Student Newman Keuls Multiple Comparison of means ranking at P < .05 to determine differences between the different groups. The titanium brackets showed lower static and kinetic frictional force as the wire size increased, whereas stainless steel brackets showed higher static and kinetic frictional force as the wire size increased.

Comparison of load transmission and bracket deformation between titanium and stainless steel brackets.

This study measures the load transmitted and structural integrity of stainless steel and titanium brackets on application of torsional forces. Both 0.018 and 0.022 inch slot size edgewise brackets were tested in a specially designed apparatus that applied a torque value of 45 degrees. The load generated was measured by an Instron Universal Testing Machine at intervals of 15 degrees, 30 degrees, and 45 degrees of torque application. The structural stability of the brackets was evaluated by measuring the bracket slot width with a traveling stereoscopic microscope before and after the brackets were subjected to torsional forces. The specimen population was composed of 80 brackets and 80 wire specimens. An independent sample t test was used for comparison of mean load generated at 45 degrees of torque application. Repeated measures ANOVA (one-way) comparison was used to evaluate changes in load at different torque levels for the stainless steel and titanium brackets. A paired t test (two-tail) was used to determine the difference between initial and final bracket slot width at 45 degrees of torque applied for the two bracket types. The titanium brackets transmitted higher loads at 15 degrees and 30 degrees torque and lower load at 45 degrees torque on application of torsional forces in comparison to stainless steel brackets. The titanium brackets demonstrated superior dimensional stability compared to stainless steel brackets (P < .0001).

Comparison of treatment outcomes with banded and bonded RPE appliances.

The purpose of this retrospective study was to compare the treatment outcomes with a banded (n = 38) versus a bonded (n = 55) rapid palatal expansion appliance followed by edgewise orthodontics. Both lateral cephalometric radiographs and orthodontic study casts were evaluated at pretreatment and posttreatment time periods. Overall, the banded rapid palatal expansion group had more vertical change than the bonded group. However, most of these changes were less than 1 degrees or 1 mm and may be considered clinically insignificant. This study could not establish superiority of one type of rapid palatal expansion technique over another.

Orthodontists' assessment and management of patient compliance.

This study was designed to evaluate the use of predictors and methods of improving patient compliance. A survey of 118 items was developed by searching the literature for items that other researchers have found to be significant. The new questionnaire contained six sections. Sections 1 and 2 pertained to predictors of patient compliance; sections 3 and 4 related to methods of improving compliance. In section 5, the respondents were asked to evaluate patient personality traits that might be important in evaluating compliance, and in the last section, demographic background information on the respondents was collected. Questionnaires were mailed to 1,262 practicing orthodontists in the United States, and 429 responses were received. Patient-related items, such as desire for treatment and relationship with parents, were ranked as important factors motivating patients to comply. Verbal praise and communication were rated as important methods for improving compliance. Personality traits that orthodontists found to be predictive of patient compliance were: high self-esteem; obedient; accommodating; and self-confident. Patients' perceptions of their malocclusions, combined with their desire for orthodontic treatment, may be good indicators of compliance. Doctor-patient rapport and verbal praise may be useful ways to improve compliance.

Effect of behavior modification on patient compliance in orthodontics.

The purpose of this study was to evaluate the effects of a reward system for improving patient compliance in orthodontic treatment. The sample consisted of 144 orthodontic patients (63 male, 81 female, average age 12.8 years), 6 to 12 months into their treatment. The sample was divided into above-average and below-average compliers, based on the orthodontic patient cooperation scale (OPCS). Each group was further divided into three subgroups: (a) a control group, which received only standard instructions; (b) an award group, which received compliance instructions and a written evaluation of compliance; and (c) a reward group, which received compliance instructions, a report card, and eligibility to receive rewards for adherent behavior. Two measurements of patient compliance were used: (1) the OPCS, which divided the sample into high and low compliers and was used to compare compliance before and after the 6-month experimental period; and (2) a clinical evaluation of compliance that was based on oral hygiene, appointment punctuality, appliance wear, and appliance maintenance. Evaluations were completed at each monthly appointment. Average compliance scores of above-average compliers showed no significant improvement with rewards. The average scores of patients with below-average compliance did not improve significantly. Only oral hygiene scores in the low compliance reward group were better than in the low compliance control group. Academic performance in school was found to be correlated (p < 0.001) with compliance. Above-average compliers remained above average in their compliance. The award/reward system may help motivate below-average compliers to comply with prescribed instructions.