Orthodontic Brackets

The purpose of this 2-part opinion article was to project the developments expected to occur in the next few years in orthodontic materials research and applications. Part 1 reviewed developments in bonding to enamel. Part 2 looks at other orthodontic materials applications and explores emerging research strategies for probing the biological properties of materials. In the field of metallic brackets, expansion of the use of titanium alloys with improved hardness and nickel-free steels with better corrosion resistance and increased hardness is expected. Manufacturing techniques might be modified to include laser-welding methods and metal injection molding. Esthetic bracket research will involve the synthesis of high-crystallinity biomedical polymers with increased hardness and stiffness, decreased water sorption, and improved resistance to degradation. New plastic brackets might incorportate ceramic wings. Fiber-reinforced composite archwires, currently experimental, could soon be commercially available, and long-term applications of shape-memory plastics might become viable. Advancements in elastomeric materials will result in polymers with reduced relaxation, broader use of fluoride-releasing elastomers with decreased relaxation, and large-scale film coating of elastomers to decrease reactivity, water sorption, and degradation. Finally, biocompatibility assessments will incorporate testing of potential endocrinological action. New polymer formulations might be tested in adhesive and plastic bracket manufacturing, based on benzoic ring-free monomers to avoid the adverse effects of the estrogenic molecule bisphenol-A. (Am J Orthod Dentofacial Orthop 2007;131:253-62) T he second part of this article includes a review of the current status of brackets, elastomerics, and archwires along with a projection of future developments in materials technology and clinical applications. It also gives a brief description of the novel assessment of the biological properties of polymers, which have already been implemented in associated biomedical disciplines.

of the bur. Additional abrasion mesial and distal to the center line of the base can further reduce the force needed to fracture the bracket in debonding (C). Once the fracture line has been created, use either a Weingart or a How plier to squeeze and fracture the tie wings (D). How pliers tend to produce better results than Weingart pliers because of the greater distance between the plier hinge and tips, which makes for a better fit between the internal surfaces of the tips and the external surfaces of the tie wings. In most cases, the two halves of the bracket will debond simultaneously. If one half stays on the tooth, it is easily removed by applying a rocking motion with the same plier. Ceramic fragments often remain on the enamel after debonding of monocrystalline brackets1 (E), requiring removal with the same high-speed diamond bur under water cooling. Any adhesive remnants should be removed by using a low-speed, sixor 12-blade tungsten carbide bur with a smooth, rounded tip. ...

The aim of this study was to assess in vitro the influence of the CO2 laser and of the type of ceramic bracket on the shear bond strength (SBS) to enamel. A total of 60 enamel test surfaces were obtained from bovine incisors and randomly assigned to two groups, according to the ceramic bracket used: Allure (A); Transcend (T). Each group was divided into 2 subgroups (n = 15): L, laser (10W, 3s); C, no laser, or control. Twenty-four hours after the bonding protocol using Transbond XT, SBS was tested at a crosshead speed of 0.5 mm/min in a universal testing machine. After debonding, the Adhesive Remnant Index (ARI) was evaluated at 10 x magnification and compared among the groups. Data were analyzed by one-way ANOVA, Tukey's, Mann-Whitney's and Kruskal-Wallis tests (α = 0.05). Mean SBS in MPa were: AL = 0.88 ± 0.84; AC = 12.22 ± 3.45; TL = 12.10 ± 5.11; TC = 17.71 ± 6.16. ARI analysis showed that 73% of the specimens presented the entire adhesive remaining on the tooth surfaces...

Objective: To evaluate whether the debonding procedure leads to restitutio ad integrum of the enamel surface by investigating the presence of enamel within the bracket base remnants after debonding. Materials and Methods: Sixty patients who completed orthodontic treatment with fixed appliances were included. A total of 1068 brackets were microphotographed; the brackets presenting some remnants on the base (n 5 818) were selected and analyzed with ImageJ software to measure the remnant area. From this population a statistically significant sample (n 5 100) was observed under a scanning electron microscope to check for the presence of enamel within the remnants. Energy dispersive x-ray spectrometry was also performed to obtain quantitative data. Results: Statistically significant differences in the remnant percentage between arches were observed for incisor and canine brackets (P , .0001 and P 5 .022, respectively). From a morphologic analysis of the scanning electron micrographs the bracket bases were categorized in 3 groups: group A, bases presenting a thin enamel coat (83%); group B, bases showing sizable enamel fragments (7%); group C, bases with no morphologic evidence of enamel presence (10%). Calcium presence was noted on all evaluated brackets under energy dispersive x-ray spectrometry. No significant difference was observed in the Ca/Si ratio between group A (16.21%) and group B (18.77%), whereas the Ca/Si ratio in group C (5.40%) was significantly lower than that of the other groups (P , .323 and P 5 .0001, respectively). Conclusion: The objective of an atraumatic debonding is not achieved yet; in some cases the damage could be clinically relevant. (Angle Orthod. 2013;83:885-891.) a Visiting Professor,

Objective: To compare the system of forces acting on curvature and preactivated V-bends in titanium T-loop springs (TTLSs) made of 0.017- × 0.025-inch TMA (titanium molibdenium alloy) wire. Materials and Methods: Pictures of TTLSs preactivated by curvature and V-bends were inserted in the LOOP software program to design both TTLSs. Symmetry was assured using the program. Both TTLSs used the same amount (length) of wire and had the same angulation between their anterior and posterior extremities when passive. The loops were activated 7 mm, and forces and moments were registered after each 0.5 mm of deactivation. The brackets were at the same height, separated by 23 mm and angulated 0°. Results: The preactivated curvature TTLS delivered horizontal forces ranging from 34 gF to 456 gF, while the TTLS preactivated by V-bends delivered forces ranging from 54 gF to 517 gF. The forces decreased more (30 gF vs 33 gF) with every 0.5 mm of activation on the preactivated V-bend TTLS than on the...

To compare the efficacy of manual and oscillating-rotating electric toothbrushes in removing plaque and reducing gingivitis in patients with fixed orthodontic appliances. Randomised clinical trial. 20 subjects aged 10 to 14 years (8 males; 12 females) scheduled for fixed orthodontic treatment were enrolled, randomly divided into two groups, A and B, and later assigned electric or manual toothbrushes, respectively. Three months after orthodontic appliance bonding (T1), and again after a further 4 (T2) and 8 (T3) weeks, plaque levels (PI), gingival bleeding (GBI) and hypertrophy were assessed. Between the two toothbrush types, statistically significant differences in PI were detected from T2 to T3 (P value 0.010), but not from T1 to T2. In contrast, the GBI was significantly different from T1 to T2 (P value 0.025), but not from T2 to T3. With respect to the manual orthodontic toothbrush, the electric oscillating-rotating toothbrush was found to better improve both PI and GBI.

This in vitro study evaluated the shear bond strength (SBS) between ceramic brackets (CBs) and resin composite restorations (RCRs) prepared using different surface treatments. The findings were also compared with a similar study that used stainless steel brackets (SSBs). Forty-five premolars were restored with a nano-hybrid composite resin (Tetric EvoCeram) and randomly assigned to three surface treatment groups: group 1, 5 per cent hydrofluoric acid (HF); group 2, air abrasion (50 mm alumina particles); and group 3, diamond bur. Specimens were bonded with CBs (Fascination) and exposed to thermo-cycling (500 cycles). The shear force at a crosshead speed of 1 mm/minute was transmitted to brackets. The adhesive remnant index (ARIs) scores were recorded after bracket failure. The analysis of SBS variance (P < 0.01) and chi-square test of ARIs scores (P < 0.01) revealed significant differences among three groups tested. The SBS in group 3 (mean: 26.34 ± 4.76 MPa) and group 2 (mean: 26.68 ± 5.93 MPa) was significantly higher than group 1 (mean: 16.25 ± 5.42 MPa). The SBS was significantly higher in CBs (mean: 23.09 ± 7.19 MPa) compared to SSBs (mean: 15.56 ± 5.13 MPa). High ARIs (100 per cent) occurred in SSBs treated with a diamond bur, whereas CBs primarily failed at the resin-adhesive interface (P < 0.01). In two-thirds of the specimens (SSBs or CBs), no adhesive was left on the restoration after HF conditioning. The ARIs profile of CBs and SSBs that received surface treatments with air abrasion were similar (P > 0.05) and bond failure occurred mainly in adhesive-bracket base and resin-adhesive interfaces. The diamond bur surface treatment is recommended as a safe and cost-effective method of bonding CBs to RCRs.

Objective: To comparatively assess the long-term failure rate of brackets bonded with a plasma or a high-intensity light-emitting diode (LED) curing light. Materials and Methods: Twenty-five patients with complete permanent dentitions with similar treatment planning and mechanotherapy were selected for the study. Brackets were bonded according to a split-mouth design with the 3M Ortholite Plasma or the high-power Satelec mini LED Ortho curing light. Irradiation with the two curing lights was performed for 9 seconds at an alternate quadrant sequence so that the bonded brackets cured with either light were equally distributed on the maxillary and mandibular right and left quadrants. First-time bracket failures were recorded for a mean period of 15 months (range 13-18 months) and the results were analyzed with the chi-square test and binary logistic regression. Results: The failure rate for brackets was 2.8% for the plasma light and 6.7% for the LED light source. Although significantly more failures were found for the mandibular arch, no difference was identified in failure rate between anterior and posterior teeth. Conclusions: High-intensity LED curing lights present a 2.5 times higher failure rate relative to plasma lamps for nominally identical irradiation time. Mandibular teeth show almost 150% higher failure incidence compared with maxillary teeth. No effect from the arch side (right vs left) and location (anterior vs posterior) was identified in this study.

BACKGROUND Fibre reinforced composite bars (FRC) have applications as bonded retainers, space maintainers and anchorage/movement units. However, the bond strength of attachments to FRC anchorage bars is unknown. AIMS To compare the shear bond strengths of brackets bonded immediately to FRCs with different orthodontic adhesive systems and bonded with the same adhesives after a 48-hour delay, abraded with a diamond bur and etched with phosphoric acid. METHOD One hundred and five recently extracted upper premolars were randomly assigned to seven groups (N = 15 teeth per group). FRCs were bonded to the buccal surfaces of the teeth and stainless steel orthodontic brackets were bonded to the FRCs with the following adhesive systems: Group 0 (Tetric Flow); Groups 1, 2 and 3 (Immediate bonding with chemically cured, no-mix and light cured composites, respectively, the bars covered with Tetric Flow); Groups 4, 5 and 6 (Bonding to FRCs delayed 48 hours, then bonded with chemically cured, no-m...

Background: Numerous strategies have been proposed to decrease the treatment time a patient requires in orthodontic treatment. Recently, a number of device-accelerated therapies have emerged in orthodontics. Photobiomodulation is an emerging area of science that has clinical applications in a number of human biological processes. The aim of this study was to determine if photobiomodulation reduces the treatment time in the alignment phase of orthodontic treatment. Methods: This multicenter clinical trial was performed on 90 subjects (73 test subjects and 17 controls), and Little's Index of Irregularity (LII) was used as a measure of the rate of change of tooth movement. Subjects requiring orthodontic treatment were recruited into the study, and the LII was measured at regular time intervals. Test subjects used a device which produced near-infrared light with a continuous 850-nm wavelength. The surface of the cheek was irradiated with a power density of 60 mW/cm 2 for 20 or 30 min/day or 60 min/week to achieve total energy densities of 72, 108, or 216 J/cm 2 , respectively. All subjects were fitted with traditional orthodontic brackets and wires. The wire sequences for each site were standardized to an initial round alignment wire (014 NiTi or 016 NiTi) and then advanced through a progression of stiffer arch wires unit alignment occurred (LII < 1 mm). Results: The mean LII scores at the start of the clinical trial for the test and control groups were 6.35 and 5.04 mm, respectively. Multi-level mixed effect regression analysis was performed on the data, and the mean rate of change in LII was 0.49 and 1.12 mm/week for the control and test groups, respectively. Conclusions: Photobiomodulation produced clinically significant changes in the rates of tooth movement as compared to the control group during the alignment phase of orthodontic treatment.

iii Acknowledgment I would like to thank Dr. Eser Tüfekçi, who supported the idea of this research project and assisted me in writing the thesis. I appreciate all of her hard work and the timely manner in which she returned my thesis drafts. It has been a privilege working with her.

Adherence of oral bacteria to the surface of dental restorative materials is considered an important step in the development of secondary caries and periodontal disease. The aim of this study was to investigate and compare the adherence of different restorative materials to Streptococcus mutans strain (CCUG35176) in order to ascertain possible differences. The materials tested ranged across different classes including: flowable composites (Gradia Direct LoFlo; Filtek Supreme XT Flowable), anterior composites (Gradia Direct Anterior), universal composites (Filtek Supreme XT), packable composites (Filtek Silorane; Filtek P60), glass-ionomers (Fuji IX Gp Extra; Equia) and a control reference material (Thermanox plastic coverlips). Bacterial suspension was deposited onto each material and the adhesion was evaluated trough the colony forming units (CFUs) determination. Packable silorane-based composite was found to be less adhesive than posterior packable composite P60, flowable composit...

The labiolingual inclination of maxillary and mandibular incisors is considered by many orthodontists to be an important determinant of pleasing dental esthetics and ideal stable occlusion. In contemporary fixed appliances, attaching a rectangular orthodontic archwire to a bracket with a rectangular slot makes third-order control possible. The purpose of this study was to measure the difference in third-order moments that can be delivered by engaging 0.019 ϫ 0.025-in stainless steel archwires to 2 active self-ligating brackets (In-Ovation, GAC, Bohemia, NY; Speed, Strite Industries, Cambridge, Ontario, Canada) and 2 passive self-ligating brackets (Damon2, Ormco, Orange, Calif; Smart Clip, 3M Unitek, Monrovia, Calif). Methods: A bracket/wire assembly torsion device was developed. This novel apparatus can apply torsion to the wire while maintaining perfect vertical and horizontal alignment between the wire and the bracket. A multi-axis force/torque transducer was used to measure the moment of the couple (torque), and a digital inclinometer was used to measure the torsion angle. Fifty maxillary right central incisor brackets from each of the 4 manufacturers were tested. Results: There was a significant difference in the engagement angle between the 2 types of brackets; on average, torque started to be expressed at 7.5°of torsion for the active self-ligating brackets and at 15°of torsion for the passive self-ligating brackets. The torque expression was higher for the active self-ligating brackets up to 35°of torsion. Torsion of the wire past this point resulted in a linear increase of the measured torque for the Damon2, the Smart Clip, and the In-Ovation brackets. The torque was relatively constant past 35°of torsion for the Speed bracket. Conclusions: We conclude that active self-ligating brackets are more effective in torque expression than passive self-ligating brackets. (Am J Orthod Dentofacial Orthop 2008;133:721-8) d

An ideal all-ceramic restoration that conforms well and demonstrates enhanced biocompatibility, strength, fit, and esthetics has always been desirable in clinical dentistry. However, the inherent brittleness, low flexural strength, and fracture toughness of conventional glass and alumina ceramics have been the main obstacles for extensive use. The recent introduction of zirconia-based ceramics as a restorative dental material has generated considerable interest in the dental community, which has been expressed with extensive industrial, clinical, and research activity. Contemporary zirconia powder technology contributes to the fabrication of new biocompatible all-ceramic restorations with improved physical properties for a wide range of promising clinical applications. Especially with the development of computer-aided design (CAD)/computer-aided manufacturing (CAM) systems, high-strength zirconia frameworks can be viable for the fabrication of full and partial coverage crowns, fixed partial dentures, veneers, posts and/or cores, primary double crowns, implant abutments, and implants. Data from laboratory and clinical studies are promising regarding their performance and survival. However, clinical data are considered insufficient and the identified premature complications should guide future research. In addition, different zirconia-based dental auxiliary components (i.e., cutting burs and surgical drills, extra-coronal attachments and orthodontic brackets) can also be technologically feasible. This review aims to present and discuss zirconia manufacturing methods and their potential for successful clinical application in dentistry.

The purpose of this study was to assess the effect of blood and saliva contamination on the shear bond strength of 4 orthodontic adhesives. Methods: Four adhesives (Transbond XT primer [3M Unitek, Monrovia, Calif], Transbond Plus self-etch primer [3M Unitek], Assure hydrophilic primer [Reliance, Itasca, Ill], and SmartBond cyanoacrylate [Gestenco, Gothenburg, Sweden]) were used to bond stainless steel maxillary central incisor brackets to 120 bovine permanent mandibular incisors. The teeth were randomly divided into 12 groups of 10 specimens, and each primer-adhesive combination was tested under different enamel conditions: dry, and blood and saliva contamination after priming. Shear forces were applied to the samples with a testing machine. Bond strengths were measured in megapascals. Results: Statistical evaluations showed that the shear bond strength of the SmartBond cyanoacrylate adhesive group was significantly lower than all other groups; however, it was the only adhesive that was not affected by contamination. Saliva and blood contamination resulted in significant drops in shear bond strengths of the Transbond XT and Assure groups. Transbond Plus self-etch primer was also negatively affected by blood contamination, although it was suitable for bonding with saliva contamination. (Am J Orthod Dentofacial Orthop 2007;131:238-42)

A new, highly filled primer is currently marketed as a fluoride delivery system effective in reducing white spot lesions in orthodontic patients. However, no studies in the literature support this claim. The purpose of this in-vivo study was to investigate the retention and the efficacy of this primer in reducing the formation of white spot lesions. In each patient for whom premolar extractions were planned (n = 22), 1 premolar was randomly chosen as the experimental tooth for the application of the fluoride delivery system (Opal Seal; Ultradent Products, South Jordan, Utah), and the contralateral tooth was assigned as the control to receive the standard treatment (Transbond XT; 3M Unitek, Monrovia, Calif). After the bonding procedures, separators were placed around the premolar brackets to encourage plaque retention over 8 weeks. After the extractions, the tooth surfaces were evaluated visually and with microhardness techniques for demineralization. Primer retention was also invest...

Introduction: Our aim was to compare the time required to complete the alignment of crowded maxillary anterior teeth (canine to canine) between Damon MX (Ormco, Glendora, Calif) and In-Ovation R (GAC, Central Islip, NY) self-ligating brackets. Methods: Seventy patients from the first author's office were included in this randomized controlled trial by using the following inclusion criteria: nonextraction treatment on both arches, eruption of all maxillary teeth, no spaces in the maxillary arch, no high canines, maxillary irregularity index greater than 4 mm, and no therapeutic intervention planned involving intermaxillary or other intraoral or extraoral appliances including elastics, maxillary expansion appliances, or headgear. The patients were randomized into 2 groups: the first received a Damon MX bracket; the second was bonded with an In-Ovation R appliance, both with a 0.022-in slot. The amount of crowding of the maxillary anterior dentition was assessed by using the irregularity index. The number of days required to completely alleviate the maxillary anterior crowding in the 2 groups was investigated with statistical methods for survival analysis, and alignment rate ratios for appliance type and crowding level were calculated with the Cox proportional hazard regression. An analysis of each protocol was performed. Results: No difference in crowding alleviation was found between the 2 bracket systems. Higher irregularity index values were associated with the increased probability of delayed resolving of crowding. Conclusions: The use of passive or active self-ligating brackets does not seem to affect treatment duration for alleviating initial crowding. (Am J Orthod Dentofacial Orthop 2010;137:12.e1-12.e6)

The aim of the present study was to compare the speed of archwire change between self-ligating (SL) brackets and conventional brackets with elastic and stainless steel (SS) ligatures. Fifty orthodontic patients, divided into five groups according to the type of fixed appliance and ligating system used (10 subjects=Time 2 SL brackets; 10 subjects = SmartClip SL brackets; 10 subjects = In-Ovation SL brackets; 10 subjects = conventional brackets with SS ligatures, 10 subjects = conventional brackets with elastic ligatures) were included in the study. The clinical phases were carried out by a unique operator experienced in both conventional and SL brackets techniques. Aligning and levelling were completed for each subject. The time needed to remove and ligate .019 x .025 SS archwires in both dental arches was measured for the 5 groups of patients. Independent sample t-test and ANOVA analyses were used. SL brackets had a significantly shorter mean archwire ligation and removal times when...

Introduction: The objectives of the study were to evaluate and compare the effects of the systemic consumption of probiotic curd and the topical application of probiotic toothpaste on the Streptococcus mutans levels in the plaque of orthodontic patients. Methods: The study consisted of 60 orthodontic patients divided into 3 groups of 20 each. Group 1 was the control group. The patients in group 2 were given probiotic curd, and those in group 3 were asked to brush twice daily with probiotic toothpaste (GD toothpaste; Dental Asia Manufacturing, Shah Alam, Selangor, Malaysia). Samples were collected at 2 times: before the study began and after 30 days. Plaque specimens were collected from the labial surfaces immediately surrounding the orthodontic brackets of the maxillary lateral incisors using a 4-pass technique. The presence of S mutans was evaluated using real-time polymerase chain reaction. Statistical analysis was performed, and comparisons were made using a 2-tailed chi-square test for categorical data (P \0.05). Results: At the end of the study, there were reductions in S mutans concentration in groups 2 and 3 that were statistically significant compared with group 1, but there was no statistically significant difference between groups 2 and 3. Conclusions: The consumption of probiotic curd and the use of probiotic toothpaste cause a significant decrease in the S mutans levels in the plaque around brackets in orthodontic patients. Although the probiotic toothpaste was more effective than systemic consumption, this was not statistically significant.

Introduction: The objective of this systematic review was to assess the short-and long-term release of components of orthodontic adhesives and polycarbonate brackets in the oral environment. Methods: Electronic database searches of published and unpublished literature were performed. The following electronic databases with no language and publication date restrictions were searched: MEDLINE (via Ovid and PubMed), EMBASE (via Ovid), Cochrane Oral Health Group's Trials Register, and CENTRAL. Unpublished literature was searched on ClinicalTrials.gov, the National Research Register, and Pro-Quest Dissertation Abstracts and Thesis database. The reference lists of all eligible studies were checked for additional studies. Two review authors performed data extraction independently and in duplicate using data collection forms. Disagreements were resolved by discussion or the involvement of an arbiter. Results: No randomized controlled trial was identified. In the absence of randomized controlled trials, observational studies were included. Eleven studies met the inclusion criteria. All were observational studies conducted in vivo or in vitro. The bisphenol-A release from orthodontic bonding resins was found to be between 0.85 and 20.88 ng per milliliter in vivo, and from traces to 65.67 ppm in vitro. Polycarbonate brackets released amounts of 22.24 mg per gram in ethanol solution and 697 mg per gram after 40 months in water. Bis-GMA and TEGDMA leaching in vitro reached levels of 64 and 174 mg per 10 mL, respectively. Because of the heterogeneity in methodologies and reporting, only qualitative synthesis was performed. Conclusions: The available evidence on this topic derived from observational in-vivo and in-vitro studies that represent a moderate level of evidence. The variety of setups and the different units allied to the diversity of reporting among studies did not allow calculation of pooled estimates. (Am J Orthod Dentofacial Orthop 2013;143:S104-12)

In this consecutive series, 14 patients with severe intrabony defects and pathologic tooth migration were treated with guided tissue regeneration (GTR) and subsequent orthodontic therapy in an attempt to evaluate the validity of this multidisciplinary approach. Probing pocket depths (PPD), clinical attachment levels (CAL), and gingival recessions were assessed at baseline, 1 year after GTR, and at the end of orthodontic therapy. Radiographs were obtained at all time points. Esthetic parameters were recorded with the papilla presence index (PPI). Statistical analyses were carried out to compare the data at each time point. From baseline to 1 year after GTR, the mean PPD reduction was 5.57 mm, with a residual mean PPD of 2.71 mm; mean CAL gain was 5.86 mm. Both differences were statistically significant. There were no statistically significant differences between 1 year after GTR and the end of orthodontic therapy (mean PPD reduction 0.07 mm; mean CAL gain 0.43 mm). The reduction in P...

Introduction: Until recently, much of the orthodontic biomechanics literature was restricted to 2-dimensional experimental studies and, more recently, to assumption-based 3-dimensional computer modeling. There is little evidence in the literature regarding 3-dimensional experimental measurements and analysis of orthodontic force systems. Methods: The purpose of this study was the design, construction, and validation of a laboratory-based human mouth model capable of accurately measuring forces and moments applied by orthodontic fixed appliances on all teeth in 1 arch. A high canine malocclusion was simulated, and forces and moments acting on the canine, lateral incisor, and premolar were measured with passive and conventional ligation. Results: We were successful in building this human mouth model. The error in force measurements of the 14 transducers was 1.54%. The force system resulting from passive ligation brackets was considerably different from that of conventional ligation. Conclusions: This method will allow us, for the first time in the history of our specialty, to determine with great accuracy the forces acting on orthodontically treated teeth. Future research will focus on simulating many types of orthodontic clinical applications of full-fixed or partialfixed appliances. (Am J Orthod Dentofacial Orthop 2009;136:518-28)

Laser technique now is widely applied in orthodontic treatment and proved to have many benefits. Soft tissue lasers can be used to perform gingivectomy, frenectomy and surgical exposure of tooth with less bleeding and swelling, improved precision, reduced pain and less wound contraction. Other laser applications include enamel etching and bonding and bracket debonding. Lower level lasers have the potential effects of pain control and accelerating tooth movement. Clinicians must be aware of the safety issues and risks associated with laser and receive proper training before the laser treatment is started.

The purpose of this study was to examine the effects of ultrasonic orthodontic bracket removal and cleanup and compare them with conventional debonding and cleaning of the enamel surfaces with burs and polishing disks. The amount of enamel loss and time for bracket removal and clean-up were also addressed. Thirty extracted human premolars were collected. The teeth were randomly placed in one of the three debonding groups: debonding with orthodontic pliers and enamel clean-up with finishing burs and polishing disks (group 1), debonding with orthodontic pliers and ultrasonic clean-up of the enamel surface (group 2), and ultrasonic debonding enamel clean-up (group 3). The teeth were stored for 48 hours in 100% humidity before bracket removal. All brackets were then removed. Polyvinyl siloxane impressions were made before and after bracket removal. Direct measurements of the teeth in micrometers were made at all steps. An additional 30 teeth were similarly prepared, and the brackets were debonded and cleaned-up as in the three groups previously described. The total time for bracket removal and enamel clean-up for each group was recorded in seconds. The results of this study indicated that (1) enamel loss as a result of orthodontic bracket removal is minimized by first removing the bracket with the debonding pliers, followed by ultrasonic removal of the residual composite (group 2); (2) the tooth surface was not significantly affected when either the combined debonding pliers and cleaning and ultrasonic clean-up technique (group 2) or the Ultrasonic debonding using a technique (group 3) were used; and (3) using the debonding pliers followed with the ultrasonic removal of the residual composite (group 2) required significantly less time than the other two techniques. (AM J ORTHOD DENTOFAC ORTHOP 1993;103:258-66.)

Papageorgiou SN, G€ olz L, Jäger A, Eliades T, Bourauel C. Lingual vs. labial fixed orthodontic appliances: systematic review and meta-analysis of treatment effects. Eur J Oral Sci 2016; 00: 000–000. © 2016 Eur J Oral Sci The aim of this systematic review was to compare the therapeutic and adverse effects of lingual and labial orthodontic fixed appliances from clinical trials on human patients in an evidence-based manner. Randomized and prospective non-randomized clinical trials comparing lingual and labial appliances were included. Risk of bias within and across studies was assessed using the Cochrane tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Random-effects meta-analyses were conducted, followed by subgroup and sensitivity analyses. Six electronic databases were searched from inception to July 2015, without limitations. A total of 13 papers pertaining to 11 clinical trials were included with a total of 407 (34% male/66% female) patients. Compared with labial appliances, lingual appliances were associated with increased overall oral discomfort , increased speech impediment (measured using auditory analysis), worse speech performance assessed by laypersons, increased eating difficulty, and decreased intermolar width. On the other hand, lingual appliances were associated with increased intercanine width and significantly decreased anchorage loss of the maxillary first molar during space closure. Based on existing trials, there is insufficient evidence to make robust recommendations for lingual fixed orthodontic appliances regarding their therapeutic or adverse effects, as the quality of evidence was low.

This study was conducted to determine the efficiency of mini-implants as intraoral anchorage units for en-masse retraction of the 6 maxillary anterior teeth when the first premolars are extracted compared with conventional methods of anchorage reinforcement. Methods: Thirty patients requiring high anchorage after extraction of the maxillary first premolars were selected for this study. They were divided into 2 groups of 15 each. In the first group (G1), mini-implants were used for en-masse retraction; in the second group (G2), conventional methods of anchorage preservation were followed. Horizontal, vertical, and angular positions of the maxillary first molar and central incisor were evaluated cephalometrically before and after orthodontic retraction. Results: The maxillary first molars in the G1 patients showed net distal movement of 0.55 mm, and mesial movement of 1.95 mm was found in G2. The differences were statistically significant. Distal tipping of the first molar of Ϫ0.13°Ϯ 3.63°was seen in G1, and mesial tipping of 3.7°Ϯ 3.9°was observed in G2. No significant differences were found in the rates of incisor retraction between the 2 groups. However, G1 showed more than 2 mm of incisor intrusion; this was statistically significant. Conclusions: Mini-implants are efficient for intraoral anchorage reinforcement for en-masse retraction and intrusion of maxillary anterior teeth. No anchorage loss was seen in either the horizontal or the vertical direction in G1 when compared with G2. However, a statistically significant decrease in intermolar width was noted in G1. (Am J Orthod Dentofacial Orthop 2008;134:803-10) Fig 5. Force system involved: F, total force; i, intrusive force, r, retractive force (r is much greater than i).

Abstract
Purpose Although several prescriptions and techniques exist for comprehensive fixed appliance treatment, their treatment effects have not yet been adequately assessed in an evidence-based manner. The aim of this systematic review was to assess the therapeutic and adverse effects of various prescriptions or techniques for orthodontic appliances from randomized clinical trials on human patients.
Methods Eight databases were searched up to July 2016 for randomized trials assessing any orthodontic prescriptions or techniques in human patients. After elimination of duplicate studies, data extraction, and risk of bias assessment according to the Cochrane guidelines, random effects meta-analyses with mean differences (MD) and their 95% confidence intervals (CIs) were performed.
Results Compared to Roth preadjusted appliances, both Begg and modified Begg appliances were associated with statistically significantly worse occlusal outcome assessed with Peer Assessment Review (PAR) scores (1 trial, MD 3.1 points, 95% CI 1.9–4.3 points and 1 trial, MD 2.4 points, 95% CI 1.2–3.6 points, respectively) with low quality of evidence, due to bias and imprecision. Compared to a partially programmed fixed orthodontic appliance, a fully programmed appliance was associated with a statistically significant, but clinically irrelevant increase in treatment duration (1 trial, MD 2.4 months, 95% CI 0.6–4.2 months), supported by high quality of evidence. However, caution is needed in the interpretation of these results as only a limited number of small trials with methodological issues were available.
Conclusions Based on existing trials, there is limited evidence to support any robust clinical recommendation
regarding the prescriptions or techniques for fixed orthodontic appliances.
Registration: PROSPERO (CRD42016042727).
Funding: None.

The aim of this study was to present the orthodontic treatment of a 15-year-old boy with a unilateral maxillary molar distalization system, called the zygoma-gear appliance. It consisted of a zygomatic anchorage miniplate, an inner bow, and a Sentalloy closed coil spring (GAC International, Bohemia, NY). A distalizing force of 350 g was used during the distalization period. The unilateral Class II malocclusion was corrected in 5 months with the zygoma-gear appliance. The maxillary left first molar showed distalization of 4 mm with an inclination of 3 . The maxillary premolars moved distally with the help of the transseptal fibers. In addition, there were slight decreases in overjet (À0.5 mm) and maxillary incisor inclination (À1 ), indicating no anchorage loss from the zygoma-gear appliance. Preadjusted fixed appliances (0.022 3 0.028-in, MBT system; 3M Unitek, Monrovia, Calif) were placed in both arches to achieve leveling and alignment. After 14 months of unilateral distalization with the zygoma-gear appliance and fixed appliances, Class I molar and canine relationships were established with satisfactory interdigitation of the posterior teeth. Acceptable overjet and overbite were also achieved. This article shows that this new system, the zygoma-gear appliance, can be used for unilateral maxillary molar distalization without anchorage loss. (Am J Orthod Dentofacial Orthop 2012;142:e1-e7)

Distal movement of maxillary molars is a common approach for nonextraction treatment of Angle Class II patients. Because of known difficulties involving moving the maxillary first molars distally in the presence of second molars, this article describes how the distally directed force is applied immediately to the second molars. A rapid palatal expander can be used as a reliable unit to facilitate the distal movement of the second maxillary molars.

Anchorage loss (AL) is a potential side effect of orthodontic mechanotherapy. In the present study, it is defined as the amount of mesial movement of the upper first permanent molar during premolar extraction space closure. In addition, AL is described as a multifactorial response in relation to the extraction site, appliance type, age, crowding, and overjet. For this study, 87 university clinic and private practice subjects, who were defined as maximum anchorage cases and had undergone bilateral maxillary premolar extractions, were divided into four groups according to extraction site (first vs second premolars), mechanics (lingual vs labial edgewise appliances), and age (adolescents vs adults). Overjet and crowding were examined from the overall sample. Data were collected from serial lateral cephalograms and dental casts. The results showed that as the severity of dental crowding increased, AL significantly decreased (r = -0.66, P = .001). Labial edgewise appliances demonstrated ...

This clinical report presents a case treated by a currently available customized orthodontic treatment system. The use of patient-speci c brackets, indirect bonding transfer devices, and customized archwires decreases treatment and chairside time, making orthodontic cases more predictable, accurate, and ef cient. The need for time-consuming adjustments is greatly reduced, and appliance customization further facilitates the achievement of the nal desired occlusion from the rst day of treatment.

In this study, we evaluated the root resorption degree in open bite and normal overbite patients, treated with and without premolar extractions. Methods: A sample of 120 patients was selected and divided into 4 groups. Group 1 comprised 32 patients treated with premolar extractions with an initial mean age of 14.01 Ϯ 2.58 years and an initial mean overbite of -3.45 Ϯ 0.23 mm. Group 2 included 28 open bite patients treated without extractions, with an initial mean age of 13.27 Ϯ 2.75 years and an initial mean overbite of -3.10 Ϯ 0.24 mm. Group 3 comprised 30 patients with normal overbite, treated with premolar extractions, having a mean age of 13.28 Ϯ 1.79 years and a mean overbite of 1.09 Ϯ 0.24 mm at the beginning of treatment. Group 4 consisted of 30 patients with normal overbite, treated without extractions, at a mean age of 12.87 Ϯ 1.43 years and a mean overbite of 1.67 Ϯ 0.24 mm at the beginning of treatment. The groups were matched by initial age, treatment time, and malocclusion type. Pretreatment and posttreatment periapical radiographs were used to evaluate the amount of root resorption. The groups were compared by using the Kruskal-Wallis and Dunn nonparametric tests. Correlations between the degree of root resorption and amount of tooth movement, usage time of anterior vertical elastics, and treatment time were investigated with the Spearman correlation coefficient. Results: No statistically significant difference was found between the root resorption degrees of open bite vs normal overbite groups, but the extraction groups had statistically significant greater root resorption than the nonextraction groups. Significant correlations were observed in the extraction groups between root resorption degree and amount of overjet correction and retraction of maxillary incisor apex. Conclusions: Root resorption was similar between open bite and normal overbite treatment protocols, but extraction treatment showed greater root resorption than nonextraction treatment. There was a statistically significant correlation of overjet correction and retraction of maxillary central incisor apices with the degree of root resorption. (Am J Orthod Dentofacial Orthop 2007; 132:143.e15-143.e22)

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Laser technique now is widely applied in orthodontic treatment and proved to have many benefits. Soft tissue lasers can be used to perform gingivectomy, frenectomy and surgical exposure of tooth with less bleeding and swelling, improved precision, reduced pain and less wound contraction. Other laser applications include enamel etching and bonding and bracket debonding. Lower level lasers have the potential effects of pain control and accelerating tooth movement. Clinicians must be aware of the safety issues and risks associated with laser and receive proper training before the laser treatment is started.

Introduction: The purpose of this study was to evaluate the treatment success rate of Class II malocclusion without extractions, according to initial severity. Methods: Class II subjects (n 5 276) were divided into 2 groups according to the severity of the malocclusion. Group 1 comprised 144 patients with bilateral half Class II malocclusion at the initial mean age of 12.27 years. Group 2 comprised 132 patients who initially had bilateral complete Class II malocclusion at the initial mean age of 12.32 years. The patients' initial and final study models were evaluated with Grainger's treatment priority index. Chi-square tests were used to test for differences between the 2 groups for categorical variables. Variables regarding occlusal results were compared with independent t tests. Results: Group 1 had a significantly better final occlusal result, a shorter treatment time, and a higher treatment efficiency index. Conclusions: Based on these results, it was concluded that bilateral half Class II malocclusion has a better treatment success rate than bilateral complete Class II malocclusion when treatment is conducted without extractions. (Am J Orthod Dentofacial Orthop 2009;135:274.e1-274.e8)

Objective: To evaluate the quantitative effects on torque expression of varying the slot size of stainless steel orthodontic brackets and the dimension of stainless steel wire, and to analyze the limitations of the experimental methods used. Materials and Methods: In vitro studies measuring torque expression in conventional and selfligating stainless steel brackets with a torque-measuring device, with the use of straight stainless steel orthodontic wire without second-order mechanics and without loops, coils, or auxiliary wires, were sought through a systematic review process. Results: Eleven articles were selected. Direct comparison of different studies was limited by differences in the measuring devices used and in the parameters measured. On the basis of the selected studies, in a 0.018 inch stainless steel bracket slot, the engagement angle ranges from 31 degrees with a 0.016 ϫ 0.016 inch stainless steel archwire to 4.6 degrees with a 0.018 ϫ 0.025 inch stainless steel archwire. In a 0.022 inch stainless steel bracket slot, the engagement angle ranges from 18 degrees with a 0.018 ϫ 0.025 inch stainless steel archwire to 6 degrees with a 0.021 ϫ 0.025 inch stainless steel archwire. Active stainless steel self-ligating brackets demonstrate an engagement angle of approximately 7.5 degrees, whereas passive stainless steel self-ligating brackets show an engagement angle of approximately 14 degrees with 0.019 ϫ 0.025 inch stainless steel wire in a 0.022 inch slot.