Quality of orthodontic care-A multicenter cohort study in a German convenience sample : Part 2: Cross-sectional patient-reported outcomes after orthodontic treatment.

OBJECTIVES: In light of the growing interest in orthodontic care and its effectiveness in Germany, part 2 of this multicenter cohort study evaluated patient-reported outcomes such as oral health-related quality of life (OHRQoL), oral hygiene habits, oral health beliefs, and potential influencing factors. METHODS: Of 586 patients screened from seven German study centers, data from 343 patients were analyzed for this part of the study. At the end of their orthodontic treatment, study participants filled out a questionnaire of either the German long version of the Oral Health Impact Profile (OHIP-G 49) or the German short version of the Child Oral Health Impact Profile (COHIP-19), depending on their age, as well as questions about their oral hygiene behavior and beliefs. Patient-, treatment- and occlusion-related factors were analyzed to account for potential influencing factors with regard to patients' OHRQoL after orthodontic treatment. RESULTS: In all, 222 study participants filled out the OHIP-based and 121 the COHIP-based questionnaire. The mean OHIP-G 49 score was 12.68 and the mean OHIP-G 14 score was 3.09; the mean COHIP-19 score was 6.52 (inverted score 69.48). For OHIP-G 49 scores, a nonsignificant trend towards a higher score for male patients (14.45 vs 11.54; p = 0.061) was detected, while this trend was inverse for the COHIP-19 scores, i.e., female patients reported more impairment (total score 6.99 vs. 5.84; p = 0.099). Analyses suggested a trend towards better OHRQoL for patients who classified for the Peer Assessment Rating (PAR) Index improvement rate group 'greatly improved' as well as for nonsmokers. Oral hygiene habits and beliefs after orthodontic treatment were estimated to be good. CONCLUSION: In this German cohort, OHRQoL proved to be good and was rather unimpaired after orthodontic treatment. Furthermore, self-reported oral hygiene behavior and oral health beliefs represented good health awareness.

Novel concept for posterior crossbite correction : Preliminary results.

PURPOSE: The efficiency of dentoalveolar compensation involving both jaws for posterior crossbite correction using computer-aided design/computer-aided manufacturing (CAD/CAM) expansion and compression archwires was evaluated. Treatment outcome was tested against the null hypothesis that the transverse correction achieved would be significantly smaller than planned. METHODS: This retrospective study included 64 patients (mean age 23.5 years, median 17.0, minimum/maximum: 9.0/63.0, standard deviation 13.7) with uni- or bilateral posterior crossbite. In all consecutively debonded patients, expansion and/or compression archwires were used for dentoalveolar correction involving both jaws. Plaster casts prior to (T1) and following treatment (T2) with completely customized lingual appliances (CCLA) were compared with the treatment plan represented by an individual target set-up. The statistical analysis was carried out using the Schuirmann TOST (two one-sided t­tests) equivalence test on the basis of a one-sample t­test with α = 0.025 to one side. The non-inferiority margin was set at δ = 0.5 mm. RESULTS: All posterior crossbites could be corrected by dentoalveolar compensation involving both jaws. The mean total correction achieved was 6.9 mm (mean maxillary expansion: 4.3 mm/mean mandibular compression: 2.6 mm) with a maximum of 12.8 mm. The transverse corrections achieved in both arches at T2 were equivalent to the planned corrections in the set-up (p < 0.001). CONCLUSION: The results of this study indicate that CAD/CAM expansion and compression archwires can be an efficient tool to achieve the desired correction in patients with a posterior crossbite even in more severe cases.

Class II correction by maxillary en masse distalization using a completely customized lingual appliance and a novel mini-screw anchorage concept - preliminary results.

BACKGROUND: The aim of the study was to evaluate the efficacy of a novel en masse distalization method in the maxillary arch in combination with a completely customized lingual appliance (CCLA; WIN, DW Lingual Systems, Germany). Therefore, we tested the null-hypothesis of a significant deviation from an Angle-Class I canine relationship and a normal overjet defined by an individual target set-up after dentoalveolar compensation in Angle Class II subjects. METHODS: This retrospective study included 23 patients, (m/f 3/20, mean age 29.6 years (min/max, 13.6/50.9 years)), with inclusion criteria of an Angle Class II occlusion of more than half a cusp prior to en masse distalization and treatment completed consecutively with a CCLA in combination with a mini-screw (MS) anchorage for uni- or bilateral maxillary distalization (12 bilateral situations, totalling 35). Plaster casts taken prior to (T0) and following CCLA treatment (T3) were compared with the treatment plan / set-up (TxP, with a Class I canine relationship and a normal overjet as the treatment objective). MSs were placed following levelling and aligning (T1) and removed at the end of en masse distalization at T2. Statistical analysis was carried out using Schuirmann's TOST [two one-sided tests] equivalence test, based on a one-sample t-test with α = 0.025 on each side (total α = 0.05). RESULTS: Ninety-seven percent of planned correction of the canine relationship was achieved (mean 3.6 of 3.7 mm) and also 97 % of the planned overjet correction (mean 3.1 of 3.2 mm), with a statistically significant equivalence (p < 0.0001) for canine relationship and overjet between the individual treatment plan (set-up) and the final outcome. Adverse effects were limited to the loss of n = 2 of 35 mini-screws. However, in each instance, the treatment was completed, as scheduled, without replacing them. Accordingly, the null-hypothesis was rejected. CONCLUSIONS: The technique presented allows for a predictable correction of an Angle-Class II malocclusion via dentoalveolar compensation with maxillary en masse distalization.

[Implementation of treatment by enzymatic debridement in burns: results of an interprofessional German-speaking expert workshop]. / Implementierung der Behandlung durch enzymatisches Debridement bei Verbrennungen ­ Ergebnisse eines interprofessionellen, deutschsprachigen Expertenworkshops.

INTRODUCTION: Since its introduction in 2013 Bromelain-based Enzymatic Debridement (ED) is increasingly used in burn centers. Published evidence shows its efficiency in eschar removal as well as a superiority in blood loss and necessity of further surgical procedures compared to standard-of-care. While the procedure is safe and shows reliable results in experienced hands, some practical and logistical issues must be challenged that are not described sufficiently in available literature. METHOD: A multi-professional panel, consisting of experienced users of ED from German-speaking burn units has been invited to an expert workshop. Topics concerning indication, definition of treatment pathways, practical issues, post-treatment and handling of complications have been coordinated in advance to allow discussion during the workshop. RESULTS: To each topic practical recommendations were developed and consented. Summarizing key messages have been additionally highlighted. They aim on helping to achieve optimal results after establishing the technique by new users as well as optimizing results by experienced users. Amongst others, the resulting recommendations deal with indications for ED beyond the classic domain, different treatment pathways depending on burn depth and primary result after ED with adapted post-treatment, management of treatment failure and implementation of infrastructural conditions. DISCUSSION: While efficiency of ED as well as superiority in some aspects of treatment of burn wounds could be shown in available literature, user-oriented recommendations for practical implementation are scarce. Although the recommendations and experts opinions published here are only partly evidenced based, they are still based on the pooled experienced of the panelists that easily outnumbers the cases published in literature so far and allow valuable support for a successful implementation of the technique.

Controlling incisor torque with completely customized lingual appliances.

PURPOSE: To test the null hypothesis of no significant deviation between the center of rotation (CROT) and the center of resistance (CRES) during space closure in Angle class II division 2 subjects achieved using a completely customized lingual appliance (CCLA) in combination with class II elastics and elastic chains. METHODS: This retrospective study included 29 patients (male/female 11/18; mean age 15.6 [13-27] years) with inclusion criteria of an Angle class II/2 occlusion of least of half of a cusp, maxillary dental arch spacing, completed CCLA treatment (WIN, DW Lingual Systems, Bad Essen, Germany) in one center with a standardized archwire sequence and use of class II elastics and elastic chains only. Maxillary incisor root inclination was assessed by X­ray superimpositions of the maxilla at the beginning (T1) and the end (T3) of CCLA treatment. Using Keynote software (Apple®, Cupertino, CA, USA), the incisor's CROT was assessed with the point of intersection of the incisor axes (T1; T3) following vertical correction of overbite changes. CRES was defined at 36% of the incisor's apex-incisal edge distance. RESULTS: The null hypothesis was rejected: the mean CROT - CRES difference was 52.6% (p < 0.001). The mean CROT was located at 88.6% (min-max 51-100%) of the incisor's apex-incisal edge distance. Although 6.9% of CROT were located between the CRES and the alveolar crest, the vast majority (93.1%) were assessed between the alveolar crest and the incisal edge, or beyond. CONCLUSION: CCLAs can create upper incisor palatal root torque even in cases in which lingually oriented forces applied incisally to the center of resistance of the upper incisors counteract these intended root movements.

Incorrect measurements and misleading conclusions in the article "Comparison of the efficacy of tooth alignment among lingual and labial brackets: an in vitro study".

BACKGROUND/OBJECTIVE: To reproduce the methods and results of the study by Alobeid et al. (2018) in which the efficacy of tooth alignment using conventional labial and lingual orthodontic bracket systems was assessed. MATERIALS/METHODS: We used the identical experimental protocol and tested (i) regular twin bracket (GAC-Twin [Dentsply]) and lingual twin bracket systems (Incognito [3M]), (ii) together with NiTi 0.014" wires (RMO), and (iii) a simulated malocclusion with a displaced maxillary central incisor in the x-axis (2 mm gingivally) and in the z-axis (2 mm labially). RESULTS: The method described by Alobeid et al. (2018) is not reproducible, and cannot be used to assess the efficacy of tooth alignment in labial or lingual orthodontic treatment. Major flaws concern the anteroposterior return of the Thermaloy-NiTi wire ligated with stainless steel ligatures. The reproduced experimental setting showed that a deflected Thermaloy-NiTi wire DOES NOT move back at all to its initial stage (= 0 per cent correction) because of friction and binding (see supplemented video), neither with the tested labial nor with the lingual brackets. Furthermore, an overcorrection of up to 138 per cent, which the authors indicate for some labial bracket-wire combinations and which deserves the characterization "irreal", stresses the inappropriateness of the method of measurement.Further flaws include: a) incorrect interpretation of the measurement results, where a tooth tripping around (overcorrection) is interpreted as a better outcome than a perfect 100 per cent correction; b) using a statistical test in an inappropriate and misleading way; c) uncritical copying of text passages from older publications to describe the method, which do not correspond to this experimental protocol and lead to calculation errors; d) wrong citations; e)differences in table and bar graph values of the same variable; f) using a lingual mushroom shaped 0.013" Thermaloy-NiTi wire which does not exist; g) drawing uncritical conclusions of so called "clinical relevance" from a very limited in vitro testing. CONCLUSIONS: Clinical recommendations based on in vitro measurements using the Orthodontic Measurement and Simulation System (OMSS) should be read with caution.

Quality of occlusal outcome following space closure in cases of lower second premolar aplasia using lingual orthodontic molar mesialization without maxillary counterbalancing extraction.

BACKGROUND: Controlled space closure in cases of isolated lower second premolar aplasia (ILSPA) without maxillary counterbalancing extraction is challenging. Anterior anchorage loss may occur during space closure resulting in compromised occlusal results in terms of an absence of proper canine guidance during laterotrusive mandible movements. In order to evaluate the effectiveness of Herbst telescope anchorage in combination with double-cable, pull mechanics and a completely customized lingual appliance for orthodontic space management in cases of ILSPA, we tested the null hypothesis that there is a significant deterioration in the sagittal canine relationship towards an Angle-Class-II occlusion expressed as a loss of anterior anchorage following space closure with molar mesialization. METHODS: Twenty-five consecutively de-bonded subjects (female / male 17 / 8; aged at T0 (start of MB Tx) 12.3 to 20.6 years; mean age 15.0 / SD 1.7 years) were included in this retrospective analysis using the inclusion criteria of least of one lower second premolar aplasia; completed treatment with a totally customized lingual appliance (CCLA) in combination with Herbst telescopes. Exclusion criteria were the absence of counterbalancing maxillary extractions, as well as additional tooth aplasia other than lower second premolars. A total of 33 single, lower premolar aplasia space closures (right / left sided 17 / 16) were assessed using plaster casts and intra-oral photographs scaled to the plaster casts, at bonding (T0), Herbst insertion (T1), following gap closure (T2) and de-bonding (T3). Parallelism of roots was controlled by panoramic x-rays at T3. RESULTS: The mean aplasia space at T0 was 7.5 mm (SD 2.6). Complete space closure was achieved in all 33 situations. The null hypothesis was rejected. There was a significant improvement in the initial canine relationships (mean 3.5 mm distal occlusion at T0) to a mean 0.1 mm at T3. When evaluated against the individual treatment plan, the following amounts of planned improvements were achieved: space closure 100%, canine relationship 97.5%, overjet 93.9%, overbite 96.4%, parallel roots in space closure site 93.9%. CONCLUSION: Herbst telescope anchorage in combination with double-cable pull mechanics and a CCLA for orthodontic space closure can deliver predictable, high-quality treatment results.

Correction: Growth of the hard palate in infants with Down syndrome compared with healthy infants-A retrospective case control study.

[This corrects the article DOI: 10.1371/journal.pone.0182728.].

[Completely-customized lingual orthodontics to correct class II malocclusion in adolescents]. / La correction de la classe II chez les adolescents à l'aide de l'orthodontie linguale totalement individualisée.

INTRODUCTION: Completely-customized lingual orthodontics is an efficient, predictable and esthetic solution for our patients. Adolescents showing a class II malocclusion represent the majority of patients in orthodontic practices. Several modes of treatment are available to correct this sagittal discrepancy such as inter-maxillary elastics, flexible or rigid protrusion devices, maxillary distalization using mini-screws or symmetric and asymmetric extractions. The choice depends on several decision criteria such as the severity of the malocclusion, the symmetry of the class II discrepancy as well as the age and the motivation of the patient. MATERIALS AND METHODS: In this article, the authors will describe the current therapeutical strategies to correct a class II malocclusion in adolescents with a completely-customized lingual appliance. CONCLUSION: It is as easy to correct a significant class II malocclusion with a lingual technique as it is with vestibular techniques, completely-customized lingual orthodontics providing the advantage of facilitating treatments.

Single tooth torque correction in the lower frontal area by a completely customized lingual appliance.

BACKGROUND: Aim of this study was to analyze the efficacy and precision of the completely customized lingual appliance (CCLA) regarding the single tooth torque correction. The study also examined external apical root resorptions as possible side effects of torque correction and the changings of the periodontal situation. METHODS: A case series of three patients were included. The patients showed a single tooth torque problem with a gingival recession and were treated with the CCLA. Plaster casts before and after treatment and plaster casts of the set up were scanned and superimposed. Deviations between the two plaster casts were analyzed at different points of interest. Changes of the gingival recession were compared before and after treatment. Relative root resorptions were measured by the orthopantomograms. Treatment times were assessed by the records of the patients. Results were presented descriptively. RESULTS: The mean change of the most apical part of the root reached by the orthodontic treatment was 1.8 ± 0.3 mm. The largest deviation between set up and final model was measured on the occlusal surface of the tooth 36 with 0.8 mm. Most measurement points showed a deviation of 0.5 mm or less. The depths of the gingival recession showed a significant reduction of 4.7 mm. The widths of the gingival recession were reduced by 1.1 mm. The average relative root resorption of the corrected teeth was 2.7 ± 1.5%. The average treatment time was 13.8 ± 4.5 months. CONCLUSIONS: This is the first study showing that the CCLA with its high precision is very effective in correcting single tooth torque problems. Orthodontic torque correction resulted in a significant reduction of gingival recessions and caused only negligible root resorptions.

Growth of the hard palate in infants with Down syndrome compared with healthy infants-A retrospective case control study.

OBJECTIVE: To investigate morphological differences of the hard palate in infants with Down syndrome (DS) compared with a volumetric-matched control group (CG). METHODS: Trial design: retrospective case control study. Based on inclusion and exclusion criteria, plaster casts of edentulous maxillae of 40 DS infants (20 females and 20 males, aged 221.3 ± 132.4 days) and 40 CG infants (20 females and 20 males, aged 53.9 ± 87.2 days) were digitized and converted into 3-dimensional stereolithography data. An automated landmark- and investigator-independent method for assessing two-dimensional measurements such as width, depth, and length of palate, as well as palatal index and the 3-dimensional volume, were used. RESULTS: Matching DS and healthy CG infants by age, we found reduced sizes in all linear and volumetric measurements in the DS group. Matching both groups by palatal volume, we found no differences between the groups according to palatal width (p = .93), palatal depth (p = .32), and palatal index (p = .31). Control infants with the same palatal volume compared with the DS infants were about 151 days younger, 95%-CI = [102, 200] (Hodges-Lehmann estimator). Except for palatal length and palatal volume, the growth pattern of DS palates decreased irregularly at age 6 to 9 months. CONCLUSIONS: The palate of DS infants in the first 6 to 9 month of life is of normal shape but considerably smaller compared with healthy normals. From 6 to 9 months onward, the growth pattern of the hard palate in DS infants decreases irregularly. High-arch-constricted palates could, therefore, be interpreted as secondarily acquired in later life. We therefore speculate that it could be advantageous to begin oral muscular stimulating therapy between 6 and 9 months of age which may prevent palatal shape alterations and enhance oral function which also contributes to maxillary development.

Therapeutic accuracy of the completely customized lingual appliance WIN : A retrospective cohort study.

OBJECTIVE: The aim of this retrospective cohort study was to assess the accuracy of the completely customized lingual appliance WIN (DW Lingual Systems, Bad Essen, Germany) employing a three-dimensional (3D) comparison between the setup and the final result. MATERIALS AND METHODS: The setup and final models of 20 consecutively debonded patients (40 jaws; 7 males, 13 females; mean age 15.76 ± 4.45 years) with various malocclusions of a private practice specialized in orthodontics were digitalized using a 3D scanner. The 3D models of the setup and the final model of each jaw were then digitally matched using the best fit algorithm and segmented into single teeth. After placing individual coordinate systems, the homologous teeth of the setup and the final model were matched to be able to calculate the exact deviations of all rotational and translational components. The t test for unpaired samples, Kruskal-Wallis tests, U tests, and ANOVA with Duncan post hoc test were applied statistically. RESULTS: Regarding the incisors, the angle discrepancies between the setup and the final result appeared to be less than 3° (torque 2.96°; tip 2.04°; rotation 2.00°). The translations showed mean values less than 0.3 mm (mesiodistal 0.16 mm; buccolingual 0.15 mm; vertical 0.29 mm). Slightly higher values could be measured in the lateral segments regarding rotations (torque 5.18°; tip 3.10°; rotation 3.70°) as well as regarding translations (mesiodistal 0.26 mm; buccolingual 0.64 mm; vertical 0.36 mm). CONCLUSIONS: Using the completely customized lingual appliance WIN, it is possible to achieve the final result predicted by the setup with a high accuracy.

Herbst plus Lingual versus Herbst plus Labial: a comparison of occlusal outcome and gingival health.

OBJECTIVES: To analyse and compare the effects during Herbst treatment combined with a lingual (completely customized) or labial (straight-wire) multibracket appliance (MBA), with special regard to lower incisor gingival recessions. SUBJECTS AND METHODS: Eighteen Class II:1 patients [overjet ≥ 5mm, Class II molar relationship ≥ 0.5 cusp widths (CW) bilaterally or 1.0 CW unilaterally, median age 16.0 years] treated with a Herbst appliance in combination with a lingual MBA (group LINGUAL) were retrospectively matched (molar relationship and skeletal maturity) to 18 Class II:1 patients treated with a Herbst appliance combined with a labial MBA (group LABIAL). Study models and intraoral photographs from before and after treatment were evaluated regarding occlusal variables and gingival recessions. Lateral cephalograms from before, during (before and after Herbst), and after treatment were analysed to assess lower incisor changes. RESULTS: Both groups showed similar reductions of overjet (5.4/5.6mm), overbite, (2.9/2.7mm) and sagittal molar relationship (0.9/0.8 CW). During the Herbst phase, the changes in lower incisor inclination and incisal edge position were significantly smaller in the LINGUAL than in the LABIAL group (iiL/ML: +7.0/+12.7degrees, P = 0.002; ii-MLppg: +2.5/+3.9mm, P = 0.004). For the total treatment period, no significant differences were found (iiL/ML: +5.3/+8.6degrees; ii-MLppg: +2.1/+2.4mm). No clinically relevant gingival recessions were seen. CONCLUSION: Both treatment approaches successfully corrected the malocclusion. The group LINGUAL exhibited significantly less proclination during the Herbst phase only. Neither treatment approach induced deleterious gingival recessions.

Occurrence and severity of enamel decalcification adjacent to bracket bases and sub-bracket lesions during orthodontic treatment with two different lingual appliances.

BACKGROUND: Using lingual enamel surfaces for bracket placement not only has esthetic advantages, but may also be suitable in terms of reducing frequencies of enamel decalcifications. OBJECTIVE: To test the null-hypothesis that there is no significant difference in enamel decalcification or cavitation incidence adjacent to and beneath bracket bases between two lingual multi-bracket (MB) appliances that are different in terms of design, material composition, and manufacturing technology (group A: WIN, DW-LingualSystems; group B: Incognito, 3M-Unitek), taking into account patient- and treatment-related variables on white spot lesion (WSL) formation. METHODS: Standardized, digital, top-view photographs of 630 consecutive subjects (16214 teeth; n Incognito = 237/6076 teeth; n WIN = 393/10138 teeth; mean age: 17.47±7.8; m/f 43.2/56.8%) with completed lingual MB treatment of the upper and lower permanent teeth 1-7 were screened for decalcification or cavitation adjacent to and beneath the bracket bases before and after treatment, scored from 0 to 7. Non-parametric ANOVA was used for main effects 'appliance type', 'gender', 'treatment complexity', 'grouped age' (≤16/>16 years), and 'treatment duration' as covariable, at an α-level of 5%. RESULTS: About 2.57% [5.94%] of all teeth in group A [B] developed decalcifications. Subject-related incidence was 9.59% [16.17%] for upper incisors in group A [B], and 12.98% [25.74%] for all teeth 16-46. There were significant effects by gender, age, and treatment duration. CONCLUSION: The null-hypothesis was rejected: sub-bracket lesions were significantly less frequent in group A, while frequencies of WSL adjacent to brackets were not significantly affected by appliance type. In view of the overall low incidences of lingual post-orthodontic white-spot lesions, the use of lingual appliances is advocated as a valid strategy for a reduction of enamel decalcifications during orthodontic treatment.

Dentoskeletal effects during Herbst-Multibracket appliance treatment: a comparison of lingual and labial approaches.

OBJECTIVES: To analyse and compare the effects during Herbst treatment (Tx) when combined with lingual (completely customized) or labial (straight-wire) multibracket appliances (MBA). SUBJECTS AND METHODS: 18 Class II division 1 patients (Overjet ≥ 5mm, Class II molar relationship ≥ 0.5 cusp width bilaterally or 1 cusp width unilaterally, median age 16.0 years) treated with lingual (completely customized) MBA in combination with a Herbst appliance were matched (sagittal molar relationship and skeletal maturity) to 18 Class II division 1 Herbst patients treated with labial (straight-wire) MBA. Lateral cephalograms from before, during and after all active Tx were analysed using the SO-analysis and standard cephalometric variables. RESULTS: During the Herbst phase (LINGUAL: mean = 13.9 months, LABIAL: mean = 8.5 months) smaller average Overjet and molar relationship changes were seen in the LINGUAL (5.3mm/4.4mm) than in the LABIAL (8.0mm/5.9mm) group. This was due to the fact that the LABIAL patients were treated to overcorrected sagittal relationships. During the total Tx period (Herbst + MBA; LINGUAL: mean = 3.1 years, LABIAL: mean = 1.9 years) the average amounts of Overjet and molar relationship changes were similar in both groups (LINGUAL: 4.0mm/3.3mm, LABIAL: 5.1mm/3.7mm). Overjet correction was achieved by 45% (LINGUAL) and 37% (LABIAL) skeletal changes; the respective amounts for molar relationship correction were 55% (LINGUAL) and 51% (LABIAL). CONCLUSION: For most variables, similar effects occurred during Herbst Tx whether combined with lingual (completely customized) or labial (straight-wire) MBA.

The effect of e-learning on the quality of orthodontic appliances.

PURPOSE: The effect of e-learning on practical skills in medicine has not yet been thoroughly investigated. Today's multimedia learning environment and access to e-books provide students with more knowledge than ever before. The aim of this study is to evaluate the effect of online demonstrations concerning the quality of orthodontic appliances manufactured by undergraduate dental students. MATERIALS AND METHODS: The study design was a parallel-group randomized clinical trial. Fifty-four participants were randomly assigned to one of the three groups: 1) conventional lectures, 2) conventional lectures plus written online material, and 3) access to resources of groups one and two plus access to online video material. Three orthodontic appliances (Schwarz Plate, U-Bow Activator, and Fränkel Regulator) were manufactured during the course and scored by two independent raters blinded to the participants. A 15-point scale index was used to evaluate the outcome quality of the appliances. RESULTS: In general, no significant differences were found between the groups. Concerning the appliances, the Schwarz Plate obtained the highest scores, whereas the Fränkel Regulator had the lowest scores; however, these results were independent of the groups. Females showed better outcome scores than males in groups two and three, but the difference was insignificant. Age of the participants also had no significant effect. CONCLUSION: The offer that students could use additional time and course-independent e-learning resources did not increase the outcome quality of the orthodontic appliances. The advantages of e-learning observed in the theoretical fields of medicine were not achieved in the educational procedures for manual skills. Factors other than e-learning may have a higher impact on manual skills, and this should be investigated in further studies.

Clinical complications during treatment with a modified Herbst appliance in combination with a lingual appliance.

OBJECTIVE: To assess the types and frequencies of clinical complications experienced when using a modified lingual Herbst appliance and to compare these with those associated with conventional Herbst appliances reported in the literature. METHODS: Treatment records for 35 consecutive subjects treated during the observation period from October 2013 to August 2014 who received a combination of a lingual appliance and a modified Herbst appliance (WIN, DW LingualSystems) were assessed for complications linked to Herbst treatment phase. Complications were analyzed descriptively, and complication-free intervals were calculated using Kaplan-Meier plots. To enable a comparison with data reported in the literature, the cumulative treatment time for all subjects was divided by the total number of complications. RESULTS: 71.4% of Herbst treatments were free from complications (n = 25). Complications were seen on 13 occasions (8 instances of Herbst attachment loosening, 5 L-Pin fractures). Most of these complications could be fixed chair side utilizing simple clinical measures. Considering all complications as identical statistical events, the percentage of treatments free from complications would be 88% for 100 days, 70% for 200 days and 56.8% for 300 days. For severe complications, the averaged complication-free treatment interval was found to be 27.8 months. CONCLUSION: In terms of clinical sturdiness, and taking into consideration the step-wise mode of activation used here as well as the differences in the design of the various Herbst appliances, the WIN-Herbst appliance was found to be superior to comparable vestibular Herbst appliances, as well as the banded Herbst appliance belonging to the preceding generation of customized lingual systems. Success in treatment of non-compliant Angle Class II correction is considered to have better predictability using the modified anchorage strategy of the WIN-Herbst appliance.

Lingual appliances reduce the incidence of white spot lesions during orthodontic multibracket treatment.

INTRODUCTION: The aim of this study was to assess the incidence of white spot lesions (WSLs) in subjects treated with customized lingual multibracket appliances-separately for maxillary anterior teeth 12 to 22 (according to the Fédération Dentaire Internationale numbering system) as well as for tooth groups 15 to 45, 16 to 46, and 17 to 47-and to determine the impact of patient-related and treatment-related variables on the frequencies of new WSLs. METHODS: Of 214 subjects comprehensively treated between June 1, 2011, and May 31, 2014, in 1 orthodontic center (Bad Essen, Germany) with a completely customized lingual appliance (WIN; DW Lingual Systems, Bad Essen, Germany), 174 (47% boys, 53% girls; mean age, 14.35 ± 1.23 years [minimum, 11.35 years; maximum, 17.91 years]) were recruited with inclusion criteria of completed lingual multibracket treatment of their maxillary and mandibular permanent teeth 17 to 47 (4582 teeth in the study), and age less than 18 years at the initial appointment. WSL assessment was accomplished using standardized digital high-resolution maxillary and mandibular occlusal photographs taken before bracketing and after debonding. Nonparametric analysis of variance was performed, taking into account the subjects' grouped ages (≤16 or >16 years), sexes, and treatment durations. RESULTS: Of the total population of subjects, 41.95% developed at least 1 new WSL when all teeth, 17 to 47, were considered, and this incidence was 27.01% for tooth group 16 to 46, or 10.59% of subjects and 4.74% of the maxillary incisors (12 to 22). Of all teeth under consideration, 3.19% developed a WSL during treatment. The frequencies of decalcification were not significantly increased in preadolescents (≤16 years) compared with adolescents (>16 years). Treatment duration had a significant adverse impact on WSL formation in tooth groups 15 to 45 and 16 to 46, and in complete dental arches (teeth 17 to 47). CONCLUSIONS: Subject-related and tooth-related WSL incidences of both single tooth groups and complete dental arches in subjects treated with the lingual WIN appliance were distinctly reduced when compared with previous reports of enamel decalcification after conventional labial multibracket treatment.