This study evaluated the effects of vibration therapy using an AcceleDent device on the rate of orthodontic leveling and alignment in the mandibular arch. The study found that patients who used the AcceleDent device for 20 minutes per day experienced faster leveling and alignment times compared to control groups. For leveling, the AcceleDent group achieved the desired outcome in an average of 160 days, which was 48 and 55 days faster than the study and pre-study control groups respectively. For alignment, the AcceleDent group achieved the desired outcome in an average of 93 days, which was 27 and 38 days faster than the study and pre-study control groups, though the differences for alignment were not
Increased occurrence of dental anomalies associated with infraocclusion of de...EdwardHAngle
Objective: To test the null hypothesis that there is no relationship between infraocclusion and the
occurrence of other dental anomalies in subjects selected for clear-cut infraocclusion of one or
more deciduous molars.
Materials and Methods: The experimental sample consisted of 99 orthodontic patients (43 from
Boston, Mass, United States; 56 from Jerusalem, Israel) with at least one deciduous molar in
infraocclusion greater than 1 mm vertical discrepancy, measured from the mesial marginal ridge of
the first permanent molar. Panoramic radiographs and dental casts were used to determine the
presence of other dental anomalies, including agenesis of permanent teeth, microdontia of
maxillary lateral incisors, palatally displaced canines (PDC), and distal angulation of the mandibular
second premolars (MnP2-DA). Comparative prevalence reference values were utilized and
statistical testing was performed using the chi-square test (P< .05) and odds ratio.
Results: The studied dental anomalies showed two to seven times greater prevalence in the
infraocclusion samples, compared with reported prevalence in reference samples. In most cases,
the infraoccluded deciduous molar exfoliated eventually and the underlying premolar erupted
spontaneously. In some severe phenotypes (10%), the infraoccluded deciduous molar was
extracted and space was regained to allow uncomplicated eruption of the associated premolar.
Conclusion: Statistically significant associations were observed between the presence of
infraocclusion and the occurrence of tooth agenesis, microdontia of maxillary lateral incisors,
PDC, and MnP2-DA. These associations support a hypothesis favoring shared causal genetic
factors. Clinically, infraocclusion may be considered an early marker for the development of later
appearing dental anomalies, such as tooth agenesis and PDC.
Influence of common fixed retainers on the diagnostic quality of cranial magn...EdwardHAngle
Introduction: Orthodontists are often asked to remove fixed retainers before magnetic resonance imaging
(MRI). This study was undertaken to assess the effects of 2 commonly used fixed retainers on MRI distortion
and whether they should be removed. Methods: MRI scans were performed on a dry skull with Twistflex (Dentaurum,
Ispringen, Germany) and Ortho Flex Tech (Reliance Orthodontic Products, Itasca, Ill) retainers. Two
neuroradiologists independently ranked the distortions. The influence of the fixed retainers' alloys, their distance
to the area of diagnosis, location, strength of the magnetic field, and the spin-echo sequence were examined.
Statistical analysis included kappa and Pearson chi-square tests. Results: Ortho Flex Tech retainers caused
no distortion. Twistflex retainers caused distortion in 46% of the tests in areas close to the retainer (tongue
and jaws). Maxillary fixed retainers and the combination of maxillary and mandibular fixed retainers further
increased the distortion. Greater distortion was observed with 3-T magnetic fields and T1-weighted spin-echo
sequences. Conclusions: Removal of the Ortho Flex Tech retainer is unnecessary before MRI. Removal of
the Twistflex should be considered if the MRI scans are performed to diagnose areas close to the fixed retainers,
when 3-T magnetic fields and T1-weighted sequences are used, and when both maxillary and mandibular fixed
retainers are present.
Subjective classification and objective analysis of the mandibular dental arc...EdwardHAngle
Our objective was to evaluate the relationship between subjective classification of dental-arch shape, objective analyses via arch-width measurements, and the fitting with the fourth-order polynomial equation.
Gingival recession—can orthodontics be a cure? evidence from a case presentationEdwardHAngle
Does orthodontic treatment help or hinder a patient’s periodontal status? What factors affect the
periodontium? Can those factors be managed in a way that remedies existing periodontal issues?
A 35-year-old woman presented with severe gingival recession and a unilateral Class II
malocclusion. The treatment plan was to correct the malocclusion in a way that torques the roots
more onto bone and to change her dental hygiene methods. With an extensive review of the
literature, this case review attempts to make sense of the enigma of gingival recession and
demonstrates an excellent treatment solution to concomitant orthodontic and periodontal
problems.
Mandibular arch form the relationship between dental and basal anatomyEdwardHAngle
We investigated mandibular dental arch form at the levels of both the clinically relevant application points of the orthodontic bracket and the underlying anatomic structure of the apical base. The correlation of both forms was evaluated and examined to determine whether the basal arch could be used to derive a standardized clinical arch form.
Increased occurrence of dental anomalies associated with infraocclusion of de...EdwardHAngle
Objective: To test the null hypothesis that there is no relationship between infraocclusion and the
occurrence of other dental anomalies in subjects selected for clear-cut infraocclusion of one or
more deciduous molars.
Materials and Methods: The experimental sample consisted of 99 orthodontic patients (43 from
Boston, Mass, United States; 56 from Jerusalem, Israel) with at least one deciduous molar in
infraocclusion greater than 1 mm vertical discrepancy, measured from the mesial marginal ridge of
the first permanent molar. Panoramic radiographs and dental casts were used to determine the
presence of other dental anomalies, including agenesis of permanent teeth, microdontia of
maxillary lateral incisors, palatally displaced canines (PDC), and distal angulation of the mandibular
second premolars (MnP2-DA). Comparative prevalence reference values were utilized and
statistical testing was performed using the chi-square test (P< .05) and odds ratio.
Results: The studied dental anomalies showed two to seven times greater prevalence in the
infraocclusion samples, compared with reported prevalence in reference samples. In most cases,
the infraoccluded deciduous molar exfoliated eventually and the underlying premolar erupted
spontaneously. In some severe phenotypes (10%), the infraoccluded deciduous molar was
extracted and space was regained to allow uncomplicated eruption of the associated premolar.
Conclusion: Statistically significant associations were observed between the presence of
infraocclusion and the occurrence of tooth agenesis, microdontia of maxillary lateral incisors,
PDC, and MnP2-DA. These associations support a hypothesis favoring shared causal genetic
factors. Clinically, infraocclusion may be considered an early marker for the development of later
appearing dental anomalies, such as tooth agenesis and PDC.
Influence of common fixed retainers on the diagnostic quality of cranial magn...EdwardHAngle
Introduction: Orthodontists are often asked to remove fixed retainers before magnetic resonance imaging
(MRI). This study was undertaken to assess the effects of 2 commonly used fixed retainers on MRI distortion
and whether they should be removed. Methods: MRI scans were performed on a dry skull with Twistflex (Dentaurum,
Ispringen, Germany) and Ortho Flex Tech (Reliance Orthodontic Products, Itasca, Ill) retainers. Two
neuroradiologists independently ranked the distortions. The influence of the fixed retainers' alloys, their distance
to the area of diagnosis, location, strength of the magnetic field, and the spin-echo sequence were examined.
Statistical analysis included kappa and Pearson chi-square tests. Results: Ortho Flex Tech retainers caused
no distortion. Twistflex retainers caused distortion in 46% of the tests in areas close to the retainer (tongue
and jaws). Maxillary fixed retainers and the combination of maxillary and mandibular fixed retainers further
increased the distortion. Greater distortion was observed with 3-T magnetic fields and T1-weighted spin-echo
sequences. Conclusions: Removal of the Ortho Flex Tech retainer is unnecessary before MRI. Removal of
the Twistflex should be considered if the MRI scans are performed to diagnose areas close to the fixed retainers,
when 3-T magnetic fields and T1-weighted sequences are used, and when both maxillary and mandibular fixed
retainers are present.
Subjective classification and objective analysis of the mandibular dental arc...EdwardHAngle
Our objective was to evaluate the relationship between subjective classification of dental-arch shape, objective analyses via arch-width measurements, and the fitting with the fourth-order polynomial equation.
Gingival recession—can orthodontics be a cure? evidence from a case presentationEdwardHAngle
Does orthodontic treatment help or hinder a patient’s periodontal status? What factors affect the
periodontium? Can those factors be managed in a way that remedies existing periodontal issues?
A 35-year-old woman presented with severe gingival recession and a unilateral Class II
malocclusion. The treatment plan was to correct the malocclusion in a way that torques the roots
more onto bone and to change her dental hygiene methods. With an extensive review of the
literature, this case review attempts to make sense of the enigma of gingival recession and
demonstrates an excellent treatment solution to concomitant orthodontic and periodontal
problems.
Mandibular arch form the relationship between dental and basal anatomyEdwardHAngle
We investigated mandibular dental arch form at the levels of both the clinically relevant application points of the orthodontic bracket and the underlying anatomic structure of the apical base. The correlation of both forms was evaluated and examined to determine whether the basal arch could be used to derive a standardized clinical arch form.
Malposition of unerupted mandibular second premolar in children with palatall...EdwardHAngle
Objective: To test the hypotheses that (1) the distal angulation of unerupted mandibular premolar
(MnP2) is significantly greater in children with palatally displaced canines (PDC) than in those in
a control sample; and (2) delayed tooth formation is significantly more frequent in children with
both malposed MnP2 and PDC than in children with PDC only.
Materials and Methods: We examined retrospectively panoramic radiographs from 43 patients
with PDC who had no previous orthodontics. A control sample consisted of age- and sex-matched
patients. The distal angle formed between the long axis of MnP2 and the tangent to the inferior
border was measured. Dental age was evaluated using the Koch classification.
Results: A significant difference was observed between the mean inclination of the right side
MnP2 in the PDC group (75.4 degrees) and that of the control group (85.8 degrees). This difference
was highly statistically significant (P < .0001). The same evaluation was carried out for the
left side, with similar results. The average dental age was found to be delayed in patients who
showed both abnormalities (malposed MnP2 and PDC) compared with patients who showed the
PDC anomaly only.
Conclusion: Both hypotheses are retained. Statistically, PDC and MnP2 malposition are significantly
associated suggesting a common genetic etiology, despite taking place on opposite jaws.
While the presence of PDC or MnP2 anomaly has been associated with a delay in tooth formation,
we find the presence of both anomalies to show a more profound delay. Our findings suggest a
delay in tooth formation as a possible common genetic mechanism for these 2 malposition anomalies.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Effects of rapid palatal expansion on the sagittal and vertical dimensions of...EdwardHAngle
The purpose of this study was to use cone-beam computed tomography imaging to examine the skeletal and dental changes in the sagittal and vertical dimensions after rapid palatal expansion.
Role of polycystin 1 in bone remodeling- orthodontic tooth movement study in ...EdwardHAngle
Objective: To test the hypothesis that polycystin-1 (PC1) is involved in orthodontic tooth movement as a mechanical sensor.
Materials and Methods: The response to force application was compared between three mutant and four wild-type 7-week-old mice. The mutant mice were PC1/Wnt1-cre, lacking PC1 in the craniofacial region. An orthodontic closed coil spring was bonded between the incisor and the left first molar, applying 20 g of force for 4 days. Micro–computed tomography, hematoxylin and eosin staining, and tartrate-resistent acid phosphatase (TRAP) staining were used to study the differences in tooth movement among the groups.
Results: In the wild-type mice the bonded molar moved mesially, and the periodontal ligament (PDL) was compressed in the compression side. The compression side showed a hyalinized zone, and osteoclasts were identified there using TRAP staining. In the mutant mice, the molar did not move, the incisor tipped palatally, and there was slight widening of the PDL in the tension area. Osteoclasts were not seen on the bone surface or on the compression side. Osteoclasts were only observed on the other side of the bone—in the bone marrow.
Conclusions: These results suggest a difference in tooth movement and osteoclast activity between PC1 mutant mice and wild-type mice in response to orthodontic force. The impaired tooth movement and the lack of osteoclasts on the bone surface in the mutant working side may be related to lack of signal from the PDL due to PC1 deficiency.
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
Effects of bonded rapid palatal expansion on the transverse dimensions of the...EdwardHAngle
The purpose of this study was to examine the maxillary response on the transverse dimensions to rapid palatal expansion (RPE) by using cone-beam computed tomography (CBCT).
Transverse growth of the maxilla and mandible in untreated girls with low, av...EdwardHAngle
The purpose of this study was to investigate maxillary and mandibular transverse growth in
untreated female subjects with low, average, and high mandibular plane angles longitudinally from ages 6 to 18.
This journal club presents a case of prosthetic
rehabilitation of an amputated thumb. It emphasizes that
prosthetic replacement is a better option for aesthetic and
psychological improvement, particularly in cases where the
victim is unwilling to undergo complicated surgical procedures for reconstruction of thumb or where functioning
of thumb cannot be restored even by multiple surgeries. In
the present case, a 20 years old female patient, with
missing thumb of her right hand was rehabilitated aesthetically by a non-invasive and cost effective prosthetic
procedure by using heat temperature vulcanizing silicone
material. The prosthesis (the thumb) was attached using
medical adhesives. On 3 months recall appointment, no
complications were observed. The prosthesis was in good
shape and required no further intervention. The prosthetic
thumb lacks the sensation of a normal or reconstructed
thumb, although it does not require the multiple procedures
of surgical reconstruction and the accompanying loss of
time for rehabilitation and healing
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
Malposition of unerupted mandibular second premolar in children with cleft li...EdwardHAngle
Objective: To determine whether distoangular malposition of the unerupted mandibular second
premolar (MnP2) is more frequent in children with unilateral clefts of the lip and palate.
Materials and Methods: This retrospective study examined panoramic radiographs from 45 patients
with unilateral clefts of the lip and/or palate who had no previous orthodontics. A control
sample consisted of age- and sex-matched patients. The distal angle formed between the long
axis of MnP2 and the tangent to the inferior border was measured. The mean, standard deviation,
and range were calculated for the angles measured in the cleft and the control groups. The
significance of the differences between the means was evaluated by the paired t-test. The angles
of the cleft and noncleft sides were also measured and compared.
Results: The mean inclination of the MnP2 on the cleft side was 73.6°, compared with 84.6° in
the control group. This difference was highly significant statistically (P < .0001). The difference
in angles from the cleft and noncleft sides was 0.7°, not statistically significant. A significant association
was found between clefting and distoangular malposition of the developing MnP2, suggesting
a shared genetic etiology. This association is independent of the clefting side, ruling out
possible local mechanical effects.
Conclusion: Clinicians should be aware of the potential for anomalous development of MnP2 in
children with clefts.
Malposition of unerupted mandibular second premolar in children with palatall...EdwardHAngle
Objective: To test the hypotheses that (1) the distal angulation of unerupted mandibular premolar
(MnP2) is significantly greater in children with palatally displaced canines (PDC) than in those in
a control sample; and (2) delayed tooth formation is significantly more frequent in children with
both malposed MnP2 and PDC than in children with PDC only.
Materials and Methods: We examined retrospectively panoramic radiographs from 43 patients
with PDC who had no previous orthodontics. A control sample consisted of age- and sex-matched
patients. The distal angle formed between the long axis of MnP2 and the tangent to the inferior
border was measured. Dental age was evaluated using the Koch classification.
Results: A significant difference was observed between the mean inclination of the right side
MnP2 in the PDC group (75.4 degrees) and that of the control group (85.8 degrees). This difference
was highly statistically significant (P < .0001). The same evaluation was carried out for the
left side, with similar results. The average dental age was found to be delayed in patients who
showed both abnormalities (malposed MnP2 and PDC) compared with patients who showed the
PDC anomaly only.
Conclusion: Both hypotheses are retained. Statistically, PDC and MnP2 malposition are significantly
associated suggesting a common genetic etiology, despite taking place on opposite jaws.
While the presence of PDC or MnP2 anomaly has been associated with a delay in tooth formation,
we find the presence of both anomalies to show a more profound delay. Our findings suggest a
delay in tooth formation as a possible common genetic mechanism for these 2 malposition anomalies.
Long term clinical and bacterial effetcx of xylitol on paitnets with fixed or...EdwardHAngle
Background: The objective of this study was to evaluate long-term clinical and bacterial effects of using 6 g of
xylitol per day for 3 months on patients with full fixed orthodontic appliances.
Methods: The study was a pilot clinical trial that included 41 subjects who were undergoing orthodontic
treatment. The subjects were randomly divided into three groups. Group A received xylitol chewing gum, group B
received xylitol dissolvable chewable tablets, and Group C served as the control group and did not receive xylitol
gums or tablets. Clinical examination and the collection of plaque and saliva samples were carried out at baseline
and 3, 6, and 12 months. All three groups were given oral hygiene instruction and were put on a 6-month cleaning
and topical fluoride schedule. Plaque scores and bacterial counts were used to evaluate the effectiveness of the
different approaches at reducing the caries risk.
Results: Xylitol groups did not experience any more reduction in plaque score, plaque MS counts, or salivary MS
counts than the control group nor did they have lower values at any of the time points. Chewing gum did not
significantly increase the incidence of debonded brackets over the other groups.
Conclusions: Xylitol does not have a clinical or bacterial benefit in patients with fixed orthodontic appliances. Oral
hygiene instructions and 6-month topical fluoride application were effective at reducing plaque scores and bacterial
counts in patients with full fixed appliances regardless of whether or not xylitol was used.
Effects of rapid palatal expansion on the sagittal and vertical dimensions of...EdwardHAngle
The purpose of this study was to use cone-beam computed tomography imaging to examine the skeletal and dental changes in the sagittal and vertical dimensions after rapid palatal expansion.
Role of polycystin 1 in bone remodeling- orthodontic tooth movement study in ...EdwardHAngle
Objective: To test the hypothesis that polycystin-1 (PC1) is involved in orthodontic tooth movement as a mechanical sensor.
Materials and Methods: The response to force application was compared between three mutant and four wild-type 7-week-old mice. The mutant mice were PC1/Wnt1-cre, lacking PC1 in the craniofacial region. An orthodontic closed coil spring was bonded between the incisor and the left first molar, applying 20 g of force for 4 days. Micro–computed tomography, hematoxylin and eosin staining, and tartrate-resistent acid phosphatase (TRAP) staining were used to study the differences in tooth movement among the groups.
Results: In the wild-type mice the bonded molar moved mesially, and the periodontal ligament (PDL) was compressed in the compression side. The compression side showed a hyalinized zone, and osteoclasts were identified there using TRAP staining. In the mutant mice, the molar did not move, the incisor tipped palatally, and there was slight widening of the PDL in the tension area. Osteoclasts were not seen on the bone surface or on the compression side. Osteoclasts were only observed on the other side of the bone—in the bone marrow.
Conclusions: These results suggest a difference in tooth movement and osteoclast activity between PC1 mutant mice and wild-type mice in response to orthodontic force. The impaired tooth movement and the lack of osteoclasts on the bone surface in the mutant working side may be related to lack of signal from the PDL due to PC1 deficiency.
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
Effects of bonded rapid palatal expansion on the transverse dimensions of the...EdwardHAngle
The purpose of this study was to examine the maxillary response on the transverse dimensions to rapid palatal expansion (RPE) by using cone-beam computed tomography (CBCT).
Transverse growth of the maxilla and mandible in untreated girls with low, av...EdwardHAngle
The purpose of this study was to investigate maxillary and mandibular transverse growth in
untreated female subjects with low, average, and high mandibular plane angles longitudinally from ages 6 to 18.
This journal club presents a case of prosthetic
rehabilitation of an amputated thumb. It emphasizes that
prosthetic replacement is a better option for aesthetic and
psychological improvement, particularly in cases where the
victim is unwilling to undergo complicated surgical procedures for reconstruction of thumb or where functioning
of thumb cannot be restored even by multiple surgeries. In
the present case, a 20 years old female patient, with
missing thumb of her right hand was rehabilitated aesthetically by a non-invasive and cost effective prosthetic
procedure by using heat temperature vulcanizing silicone
material. The prosthesis (the thumb) was attached using
medical adhesives. On 3 months recall appointment, no
complications were observed. The prosthesis was in good
shape and required no further intervention. The prosthetic
thumb lacks the sensation of a normal or reconstructed
thumb, although it does not require the multiple procedures
of surgical reconstruction and the accompanying loss of
time for rehabilitation and healing
ABSTRACT
Objective: To evaluate the role of age as a moderator of bone regeneration patterns and
symphysis remodeling after genioplasty.
Method: Fifty-four patients who underwent genioplasty at the end of their orthodontic treatment
were divided into three age groups: younger than 15 years at the time of surgery (group 1), 15 to
19 years (group 2), and 20 years or older (group 3). Twenty-three patients who did not accept
genioplasty and had a follow-up radiograph 2 years after the end of their orthodontic treatment
were used as a control group. Patients were evaluated at three time points: immediate preoperative
(T1), immediate postoperative (T2,) and 2 years postsurgery (T3).
Results: The mean genial advancement at surgery was similar for the three age groups, but the
extent of remodeling around the repositioned chin was greater in group 1, less in group 2, and still
less in group 3. Symphysis thickness increased significantly during the 2-year postsurgery interval
for the three groups, and this increase was significantly greater in group 1 than in group 3.
Remodeling above and behind the repositioned chin also was greater in the younger patients. This
was related to greater vertical growth of the dentoalveolar process in the younger patients. There
was no evidence of a deleterious effect on mandibular growth.
Conclusion: The outcomes of forward-upward genioplasty include increased symphysis
thickness, bone apposition above B point, and remodeling at the inferior border. When indications
for this type of genioplasty are recognized, early surgical correction (before age 15) produces a
better outcome in terms of bone remodeling. (Angle Orthod. 0000;00:000–000.)
Clinical study of impacted maxillary canine in the Arab population in IsraelAbu-Hussein Muhamad
The objective of the present study was to determine the prevalence of impacted maxillary canine in patients in Arabs Community in Israel (ARAB48,Israel) visiting our Center For Dentistry,Research & Aesthetics,Jatt,Almothalath,Israel, 4250 patients . This study comprises data from patients who attended the O.P.D.2200 patients between Jun. 2006 to Dec 2013. Patients were examined in order to detect the impacted maxillary canines by intraoral examination, palpation, dental records and followed by radiographs. It was found that the prevalence of canine impaction was 0,8 % (N=4250), 1,6 (N=2200), 43,9 (N-82) in males and 1,1% (N=4250), 2,1 (N=2200), 56,1 (N-82) in females suggesting that prevalence of impacted maxillary canines is more in females than males and it is statistically significant. The overall prevalence for maxillary impacted canines was found to be 3,7 % (N=2200) which suggested that it is much higher than previous studies. The results of this study were slightly different than other studies, while the dissimilarities may be attributed to the sample selection, method of the study and area of patient selection, which suggest racial and genetic differences.
Malposition of unerupted mandibular second premolar in children with cleft li...EdwardHAngle
Objective: To determine whether distoangular malposition of the unerupted mandibular second
premolar (MnP2) is more frequent in children with unilateral clefts of the lip and palate.
Materials and Methods: This retrospective study examined panoramic radiographs from 45 patients
with unilateral clefts of the lip and/or palate who had no previous orthodontics. A control
sample consisted of age- and sex-matched patients. The distal angle formed between the long
axis of MnP2 and the tangent to the inferior border was measured. The mean, standard deviation,
and range were calculated for the angles measured in the cleft and the control groups. The
significance of the differences between the means was evaluated by the paired t-test. The angles
of the cleft and noncleft sides were also measured and compared.
Results: The mean inclination of the MnP2 on the cleft side was 73.6°, compared with 84.6° in
the control group. This difference was highly significant statistically (P < .0001). The difference
in angles from the cleft and noncleft sides was 0.7°, not statistically significant. A significant association
was found between clefting and distoangular malposition of the developing MnP2, suggesting
a shared genetic etiology. This association is independent of the clefting side, ruling out
possible local mechanical effects.
Conclusion: Clinicians should be aware of the potential for anomalous development of MnP2 in
children with clefts.
Angular changes and their rates in concurrence to developmental stages of the...EdwardHAngle
In the early developmental stage of the mandibular second premolar (MnP2), it is not unusual to find the tooth extremely angulated to the lower border of the mandible, as seen in the panoramic roentgenogram. On eruption, the tooth, in most cases, is close to being upright. However, impaction or other types of malocclusions due to its ectopic eruption are not rare.
Craniofacial growth in untreated skeletal class i subjects with low, average,...EdwardHAngle
The dental measurements showed few changes with growth in all groups. In terms of skeletal measurements from ages 9 to 18, similar growth changes were found between the sexes in most angular measurements, but males had larger values in linear measurements than females.
Purpose: To assess the amount of dental and skeletal expansion and stability after surgically assisted
rapid maxillary expansion (SARPE).
Patients and Methods: Data from 20 patients enrolled in this prospective study were collected before
treatment, at maximum expansion, at the removal of the expander 6 months later, before any second
surgical phase, and at the end of orthodontic treatment, using posteroanterior cephalograms and dental
casts.
Results: With SARPE, the mean maximum expansion at the first molar was 7.48 1.39 mm, and the
mean relapse during postsurgical orthodontics was 2.22 1.39 mm (30%). At maximum, a 3.49 1.37
mm skeletal expansion was obtained, and this expansion was stable, such that the average net expansion
was 67% skeletal.
Conclusion: Clinicians should anticipate a loss of about one third of the transverse dental expansion
obtained with SARPE, although the skeletal expansion is quite stable. The amount of postsurgical relapse
with SARPE appears quite similar to the changes in dental-arch dimensions after nonsurgical rapid palatal
expansion, and also quite similar to dental-arch changes after segmental maxillary osteotomy for
expansion.
International Journal of Engineering Research and DevelopmentIJERD Editor
Electrical, Electronics and Computer Engineering,
Information Engineering and Technology,
Mechanical, Industrial and Manufacturing Engineering,
Automation and Mechatronics Engineering,
Material and Chemical Engineering,
Civil and Architecture Engineering,
Biotechnology and Bio Engineering,
Environmental Engineering,
Petroleum and Mining Engineering,
Marine and Agriculture engineering,
Aerospace Engineering.
“Comparative Evaluation between Physics Forceps and Conventional Extraction F...inventionjournals
:Tooth extraction procedure, although known as a minimal traumatic procedure, some sort of trauma is subjected to underlying soft and hard tissues, resulting in immediate destruction and loss of alveolar bone. Conventional extraction forceps are designed on the principle of simple machine incorporating two first-class levers, connected with a hinge. The physics forceps are the newly invented forceps. The design of physics forceps which implements a first class lever, creep, and type of force that provides a mechanical advantage, which makes it more efficient. AIM: The aim of the present study to evaluate the efficacy between the conventional extraction forceps and physics forceps in orthodontic extraction of maxillary premolars. Patients & Methods:A total of 50 healthy patients with indicated for extraction of bilateral maxillary premolar for orthodontic reasons; split mouth design (control side, test side) in a randomized manner; were included in the present study. Results:Ease of technique, buccal cortical plate fracture, fracture of tooth or root, gingival laceration, soft tissue healing was not significant. The extraction time and bleeding associated with extraction socket were significant. Post operative days 1-4 are not significant and on day 5-7 the pain on VAS score is 0. Conclusion:The results of present study suggest that, extraction using any forceps can produce predictable results and it totally depends on surgeon’s expertise in a particular technique.
Myanmar Society of Oral Implantology collaborates with Dental Implant system using in Myanmar and celebrates Two days seminar. At this event, as the President of MSOI, I present this topic on Astra Tech Dental Implant System. It was sponsored by Biosys Company.
The demands for orthodontic treatment are in continuous increasing, hence producing an ideal treatment plan need to cover all stages of the treatment carefully, especially the retention and stabilization stage. As, any changing in the arch width through changing the inter-molar width will lead to impair the stabilization of the arch and will lead to relapse. Due to that, the present study performed to evaluate the inter-molar width of the mandible using three different commercial orthodontic wires. Thirty patients had been allocated in this study, using a cone beam computed tomography to create an assessment for the inter-molar width. It concluded that there is an increase in the inter-molar width between pre-treatment and after finishing of aligning stage, also there is a highly significant increase in post-aligning stage between the three groups.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. 679VOLUME XLVIII NUMBER 11
Dr. Bowman is a Contributing Editor of the Journal of Clinical
Orthodontics; an Adjunct Associate Professor, St. Louis University,
St. Louis; a straight-wire instructor, University of Michigan, Ann
Arbor, MI; an Assistant Clinical Professor, Case Western Reserve
University, Cleveland; a Visiting Clinical Lecturer, Seton Hill
University, Greensburg, PA; and in the private practice of orthodon-
tics at 1314 W. Milham Ave., Portage, MI 49024; e-mail: drjwyred@
aol.com.
In addition to producing biological effects,
vibration may also work on a biomechanical level
to accentuate orthodontic tooth movement. Braun
and colleagues credited the dynamic environment
of the oral cavity (“vibrational” perturbations) as
the primary influence in moderating the rate of
tooth movement with fixed appliances.15 Research-
ers at the University of Missouri-Kansas City
found that the most important factor was the am-
plitude of archwire vibrations.16 Other authors have
refuted the simplistic claims that “reducing [elas-
tic] friction” by the mere choice of appliance can
shorten treatment time. It is actually the inelastic
friction (or “notching”) that must be overcome
with perturbations, and all brackets are subject to
that property—we are not just sliding pearls along
a string.17-19 Consequently, it appears that vibration
could affect the rate of orthodontic tooth move-
ment in two ways: reducing the “lag” phase by
stimulating changes in the periodontal apparatus,
or inducing mechanical perturbations within the
appliance interface.
Materials and Methods
This retrospective evaluation of the effects
of vibration on the time required for mandibular
leveling and alignment included 117 consecu-
tively treated Class II nonextraction patients (47
male, 70 female) who underwent maxillary molar
distalization and concurrent mandibular leveling
and alignment (Table 1). Thirty patients were
enrolled in the AcceleDent vibration (AD) group
(mean age = 13.1 years) and 37 in the study con-
trol (SC) group (mean age = 12.8 years). The
pre-AD (PAD) control group comprised 50 Class
II patients (mean age = 14.3 years) who were
treated prior to the initiation of a separate pro-
spective examination of the effects of vibration
on molar distalization, whose results will be pub-
lished later.
Each patient presented with a half-to-full-
step Class II molar relationship and mild-to-mod-
erate crowding. The nonextraction treatment in-
volved a miniscrew-supported Horseshoe Jet**
maxillary molar distalizer20 and a preadjusted
.022" Butterfly System***21 mandibular appliance
(Figs. 2-4). Upon completion of molar distaliza-
tion, the Horseshoe Jet was “locked” to serve as
**AOA Orthodontic Appliances, Sturtevant, WI; www.aoalab.
com.
***Trademark of American Orthodontics, Sheboygan, WI; www.
americanortho.com.
Fig. 1 A. AcceleDent* activator and charging port (images used by permission of OrthoAccel Technolo-
gies). B. AcceleDent device in use.
A B
3. 680 JCO/NOVEMBER 2014
The Effect of Vibration on the Rate of Leveling and Alignment
indirect miniscrew anchorage for subsequent re-
traction of the remaining maxillary teeth, and up-
per brackets were bonded for the finishing stage.
The PAD patients had been previously treat-
ed with orthodontic adjustments at five-to-seven-
week intervals. The AD and SC subjects were
instructed to return every four weeks as part of a
different prospective investigation of molar distal-
Fig. 2 A. 14-year-old female Class II patient before treatment. B. After placement of Horseshoe Jet** max-
illary molar distalizer and preadjusted Butterfly System*** mandibular brackets with initial .016" nickel tita-
nium archwire. Patient was scheduled for appointments every four weeks and instructed to use Accele-
Dent vibration unit for 20 minutes per day (continued on next page).
A
B
B
4. 681VOLUME XLVIII NUMBER 11
Bowman
Leveling was defined as the sufficient resolu-
tion of vertical dental discrepancies to allow com-
plete seating of a rectangular archwire with a min-
imum dimension of .019" × .025" stainless steel
into the bracket slots (Figs. 2D, 3C, 4C). Although
most subjects achieved this degree of leveling with
a three-wire sequence, some also received an in-
terim .017" × .025" stainless steel or .019" × .025"
nickel titanium archwire before the larger stainless
steel working wire was placed. Some patients were
excluded from the study because their archwire
sequences were interrupted by earlier bonding of
second-molar brackets prior to insertion of the
.019" × .025" stainless steel wires. This reduced
the sample size for completion of leveling from 117
to 93 subjects.
The time points and subjective goals selected
for analysis did not guarantee that all rotations
were absolutely resolved, nor that every curve of
ization. Otherwise, all patients experienced the
same sequence of treatment mechanics.
Each patient in the AD sample received an
AcceleDent vibrational unit with directions to use
the device 20 minutes per day during the entire
course of orthodontic treatment. The AcceleDent
activator supplies mild vibration (30Hz, .25N) to
the teeth as the patient lightly bites down on a
mouthpiece to hold the device in place.22
For purposes of this study, alignment was
defined as the sufficient resolution of dental ir-
regularities to permit complete seating of a rect-
angular archwire with a minimum dimension of
.017" × .025" stainless steel or superelastic alloy
(but smaller than .019" × .025" stainless steel) into
.022" × .028" brackets (Fig. 2C). Every patient
began treatment with an .016" nickel titanium arch-
wire, usually followed by .017" × .025" nickel
titanium.
Fig. 2 (cont.) C. Mandibular .019" × .025" nickel titanium archwire inserted after 95 days of treatment,
marking end of alignment phase. D. Mandibular .019" × .025" stainless steel archwire inserted after six
months of treatment, marking completion of leveling. E. Maxillary brackets bonded and second molars
banded after seven months of treatment (continued on next page).
C
D
E
5. 682 JCO/NOVEMBER 2014
The Effect of Vibration on the Rate of Leveling and Alignment
Spee was completely leveled, when the working
archwire was placed. Since the clinical decisions
were all made by the same orthodontist and all
patients were selected for the same type of treat-
ment mechanics, it seems reasonable to make com-
parisons among these three groups.
Statistical analysis was conducted using SAS
version 9.2.† The significance of differences in age
was tested by analysis of variance, while gender
differences were evaluated with chi-square testing.
For the primary outcomes, two-sided t-tests were
used to compare the three groups, using a two-
tailed significance level of .05.
Results
Although the PAD group was older on aver-
age than the other two samples, no statistically
significant differences in age were found (Table
1). Likewise, there were no significant differences
among the three groups in terms of gender.
The average time period needed to attain
alignment of the mandibular dentition (Table 2)
was shorter in the AD group (93 days) than in
either the SC group (120 days) or the PAD control
group (131 days). The .017" × .025" archwire was
Fig. 2 (cont.) F. Treatment completed in 20 months.
†SAS Institute, Cary, NC; www.sas.com.
F
6. 683VOLUME XLVIII NUMBER 11
Bowman
than other sequences tested.24 In contrast, both
Ong and colleagues25 and Jian and colleagues26
found no significant differences in alignment ef-
ficiency among three typical archwire sequences.
In the Ong study, the time needed to reach an .016"
× .022" stainless steel working archwire with an
.018" appliance was 4.0-4.4 months using a three-
wire sequence: .014" nickel titanium or copper
nickel titanium followed by .017" × .017", .016" ×
.022", or .014" × .025" heat-activated superelastic
wires.25 These authors attributed the faster leveling
and alignment in comparison to the Mandall
study23 to the replacement of archwires “as soon
as complete engagement was possible”, also noting
“decreased ‘play’ in an .018" slot appliance”.
Interestingly enough, neither group found any dif-
ference in alignment efficiency between conven-
tional nickel titanium and superelastic heat-
activated wires.
In the present study, a three-to-four-wire se-
quence (similar to that of the Mandall23 and Flores-
Mir24 investigations) was used to reach a rectan-
gular stainless steel working wire in the mandibular
arch. This required an average of five months with
vibration (AD) or seven months without vibration
(PAD). The difference between our results and
those of Ong and colleagues25 may simply confirm
their supposition that the difference in tolerance
placed in the AD patients about 27 days earlier
(29% faster) on average than in the SC patients and
38 days earlier (40% faster) than in the PAD sub-
jects. It is important to note that these differences,
while clinically relevant, were not statistically
significant.
The average time needed to achieve leveling
(Table 2) in the AD group was 160 days—48 days
less than in the SC patients (30% faster) and 55
days less than in the PAD patients (35% faster). In
other words, leveling took a little more than five
months with vibration, compared to seven months
without vibration. These differences were both
clinically and statistically significant.
Discussion
Alignment and Leveling
in the Mandibular Arch
Mandall and colleagues reported that the
mean time required to reach a mandibular .019" ×
.025" working archwire with an .022" appliance
was 6.8-9.3 months, depending on which of three
archwire sequences was chosen.23 Flores-Mir
agreed that an archwire sequence of .016" nickel
titanium, .018" × .025" nickel titanium, and .019"
× .025" stainless steel was slightly more efficient
TABLE 2
TIME REQUIRED FOR ALIGNMENT AND LEVELING
AcceleDent (AD) Study Control (SC) Pre-AD Control (PAD) p*
Alignment 0.0988
N 30 37 50
Mean 93.0 ± 50.3 days 119.9 ± 75.8 days 130.5 ± 85.8 days
Median 81.5 days 100.0 days 115.0 days
Range 37-228 days 49-346 days 22-385 days
Leveling 0.0265**
N 25 29 39
Mean 160.0 ± 65.7 days 208.3 ± 77.0 days 215.3 ± 93.8 days
Median 141.0 days 186.0 days 200.0 days
Range 56-344 days 116-393 days 83-419 days
*Analysis of variance.
**In pairwise comparisons using t-tests with Bonferroni correction, AD vs. SC (p = .0486) and AD vs. PAD (p = .0224) were statistically significant.
7. 684 JCO/NOVEMBER 2014
The Effect of Vibration on the Rate of Leveling and Alignment
Fig. 3 A. 13-year-old female Class II patient before treatment. B. After insertion of maxillary Horseshoe
Jet, bonding of mandibular Butterfly System brackets, and delivery of AcceleDent. C. After 55 days of
alignment and 83 days of leveling. D. Maxillary brackets bonded and right canine exposed with diode laser
after nine months of treatment (continued on next page).
A
C
D
B
8. 685VOLUME XLVIII NUMBER 11
Bowman
PAD) in either leveling or alignment, even though
the SC patients were seen at more regimented four-
week intervals compared to the five-to-seven-week
appointment windows for PAD subjects. This find-
ing lends additional support to the validity of the
three-way comparative analysis.
Effects of Vibration on
the Rate of Tooth Movement
In a preliminary clinical trial of an Accele-
Dent prototype with 14 patients, Kau and col-
leagues noted 2.1mm of tooth movement per
month in the mandibular arch (twice the normally
reported rate) and 3mm per month in the maxillary
arch.22 In a more comprehensive randomized con-
trolled trial of AcceleDent, Pavlin reported
2.71mm per month of initial maxillary dental
alignment in 23 premolar-extraction patients—a
51% reduction in treatment time compared to the
control group, with no adverse findings such as
root resorption or pain.28 The differences in align-
ment speed may be attributed to the typically fast-
er tooth movement in the maxillary arch; in addi-
between .022" and .018" slots was responsible for
the difference in the rate of alignment—espe-
cially since succeeding wires were inserted as soon
as possible in both studies.
Because this was a retrospective investiga-
tion, we did not consider collecting progress re-
cords at time points representing the completion
of leveling and alignment. Therefore, an objective
comparative analysis such as the Peer Assessment
Rating, Irregularity Index, or ABO score could
not be used. On the other hand, the retrospective
design prevented the introduction of a Hawthorne
Effect (“preferential” alteration of archwire se-
quences or appointment intervals among the three
samples) or a susceptibility bias that might have
affected the results27; in fact, the subjects were
already enrolled in a separate prospective trial.
Furthermore, the study design precluded any de-
tection or exclusion biases, since all patients pre-
sented with similar malocclusions, were treated
similarly, and were not selected out of a group of
finished cases.
No statistically significant difference was
found between the two control groups (SC and
Fig. 3 (cont.) E. Treatment completed in 20 months.
E
9. 686 JCO/NOVEMBER 2014
The Effect of Vibration on the Rate of Leveling and Alignment
Fig. 4 A. 12-year-old female Class II patient before treatment. B. After insertion of maxillary Horseshoe
Jet, bonding of mandibular Butterfly System brackets, and delivery of AcceleDent. C. After 37 days of
alignment and 95 days of leveling. D. Maxillary brackets bonded after 14 months of treatment (continued
on next page).
A
C
D
B
10. 687VOLUME XLVIII NUMBER 11
Bowman
no statistical significance in the rate of alignment
with vibration compared to control samples. Nev-
ertheless, we did find a significant increase in the
speed of leveling, which could not have been ac-
complished without the cumulative reduction in
alignment time resulting from the application of
vibration.
Conclusion
In the present study, the amount of time re-
quired to achieve both dental alignment and level-
ing in Class II nonextraction treatment was re-
duced by using an AcceleDent device to apply
vibration. Overall, we found a clinically beneficial
and statistically significant 30% increase in the
rate of tooth movement during orthodontic leveling
of the mandibular dentition. Future research on the
effects of vibration should focus on other aspects
of orthodontic treatment, different biomechanics,
pain reduction, gene expression, and tissue re-
sponses, along with testing of alternative force
levels, frequencies, and durations of vibration.
tion, the extraction spaces likely facilitated more
rapid resolution of irregularities, compared to the
speed of mandibular alignment without extractions
noted in the present study.
In contrast, Miles and colleagues found no
significant difference in the initial dental align-
ment of 66 consecutively treated orthodontic pa-
tients, appointed every five weeks over a 2.5-month
period, when half the patients were given a vibrat-
ing device (111Hz, .06N) to use for 20 minutes per
day.29 As the investigators acknowledged, however,
they used consecutive patients rather than a more
homogeneous sample, and the vibrational forces
were applied at a higher frequency and lower force
level than in comparable studies. Moreover, data
collection was invariably discontinued after 10
weeks of alignment with only an .014" thermal
nickel titanium archwire in an .018" appliance,
while data for the present study continued to be
collected until leveling was completed. It has yet
to be determined exactly how the force, frequency,
and duration of vibration contribute to the rate of
tooth movement.
Like Miles and colleagues,29 our study found
Fig. 4 (cont.) E. Treatment completed in 20 months.
E
11. 688 JCO/NOVEMBER 2014
The Effect of Vibration on the Rate of Leveling and Alignment
ACKNOWLEDGMENTS: The author would like to thank Sheri
Smith, President, Courante Oncology Clinical Research Services,
Excelsior, MN, for her statistical analysis and OrthoAccel Tech
nologies for their assistance with the AcceleDent units.
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