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As orthodontists, we are often unaware of the technical and methodological advances in other dental specialties. However, many of these new experimental developments may ultimately become accepted dental therapy and influence the diagnosis and treatment of our orthodontic patients. Therefore, as part of the dental community, we must keep abreast of current information in all areas of dentistry. The purpose of this section of The Angle Orthodontist is to provide a brief summary if what's new in dentistry.

Abstract

In 1994, 1155 eighth-grade students in Alachua County, Fla., were asked about self-perception of and level of concern for their occlusal status. Clinical assessments of orthodontic parameters were also recorded. Twenty-five percent of the students had a history of orthodontic treatment. Of the remaining students who had no history of orthodontic treatment, 74% reported satisfaction with the way their teeth looked, 64% expressed no perceived need for braces, and 57% were judged clinically to have optional or no orthodontic needs. Sex, soft tissue profile, overjet, anterior crowding, and molar classification were significantly associated with the perception of need for braces while race and overbite were not. Clinical judgment of orthodontic need differed significantly among levels of satisfaction with teeth. Eighth graders with no history of orthodontic treatment were generally satisfied with the appearance of their teeth and perceived less need for braces than clinicians.

Abstract

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

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

Abstract

Intermaxillary tooth-size discrepancies can be assessed using a diagnostic setup or predicted using a mathematical formula, such as the Bolton analysis. However, variations in tooth thickness may produce inaccuracies in the Bolton analysis ratio. To date, no method for incorporating tooth thickness into discrepancy prediction has been proposed. The purpose of this study was to design and test a new method of predicting anterior tooth-size discrepancy that takes into account tooth thickness and width. Forty-four positioner setup models were set to ideal overbite (2.5 mm) and occlusion (Class I canine relationship). Interproximal gaps between the maxillary or mandibular central incisors were allowed in order to optimize tip and torque. The mesiodistal width of all anterior teeth and the labiolingual thickness of the maxillary incisors were measured on these idealized setups to the nearest 0.1 mm. Actual intermaxillary anterior ratios were then calculated. A new method of prediction was developed by assuming a linear relationship between tooth thickness and ideal intermaxillary ratio. Errors in Bolton's method were compared with the new method. The results showed wide variations in mesiodistal tooth widths, tooth thicknesses, and intermaxillary anterior ratios in orthodontically treated patients. The correlation coefficient between the intermaxillary ratio and tooth thickness was r = 0.68 when tooth thickness was <2.75 mm, and r = 0.28 when tooth thickness was ≥2.75 mm. The mean absolute errors in predicting the actual intermaxillary ideal ratio was 1.29 ± 0.81 for Bolton's ratio and 0.84 ± 0.46 for the new prediction formula. These new formulas were better than Bolton's ratio in predicting tooth-size discrepancies (p = 0.003). Tooth thickness combined with mesiodistal width may be useful in predicting intermaxillary tooth-size discrepancies.

Commentary by Dennis M. Killiany

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This study describes mesial and distal enamel thickness of the permanent posterior mandibular dentition. The sample comprised 98 Caucasian adults (59 males, 39 females) 20 to 35 years old. Bitewing radiographs of the right permanent mandibular premolars and first and second molars were illuminated and transferred to a computer at a fixed magnification via a video camera. Enamel and dentin thicknesses were identified and digitized on the plane representing the maximum mesiodistal diameter of each tooth. The results showed that there were no significant sex differences in either mesial or distal enamel thickness. Enamel on the second molars was significantly thicker (0.3 to 0.4 mm) than enamel on the premolars. Distal enamel was significantly thicker than mesial enamel. There was approximately 10 mm of total enamel on the four teeth combined. Assuming 50% enamel reduction, the premolars and molars should provide 9.8 mm of additional space for realignment of mandibular teeth.

Abstract

After extraction of maxillary second molars, will the third molars erupt into a functional position in a timely manner? To answer this question, 56 consecutively treated cases of maxillary second molar extraction were reviewed. The unerupted positions of the maxillary third molars were measured on cephalometric radiographs, ages of eruption were evaluated, positions of erupted third molars analyzed, and interproximal periodontal health of adjacent first molars compared. The results showed that, generally, the eruption of third molars was accelerated. Most of the third molars had acceptable interarch and intra-arch occlusal relationships. The interproximal periodontal health of the third molars was similar to that of adjacent first molars. Most maxillary third molars will successfully erupt into an acceptable position by the late teens.

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The purpose of this research was to study the prevalence of ectopic eruption of the first permanent molars and possible etiologic factors. A group of 4,232 Thai students, from 6 to 9 years old, was examined. The prevalence of ectopic eruption of the first permanent molars in the subjects was 0.75%. Both the severity of the ectopic eruption and the amount of root resorption on the second primary molars were more pronounced in the maxilla than in the mandible. The important etiologic factors were the eruption path of the first permanent molars relative to reference lines and the size of the mandibular second primary molars. The amount of proximal caries did not seem to affect the prevalence of ectopic eruption.

Abstract

The aim of this investigation was to study the hyalinization of the periodontal ligament with time and its relationship to root surface resorption after the application of an orthodontic force, reactivated weekly, of 50 cN (≈50 g). Fifty-six patients (18 boys and 38 girls, mean age 13.8 years) were divided into 7 groups of 8. In each patient, one premolar was moved buccally 161 with a fixed orthodontic appliance. The contralateral premolar served as a control. The experimental periods ranged from 1 to 7 weeks. Local areas of overcompression in the periodontal ligament were recorded in 33 test teeth (59%) and 2 controls (4%). Hyalinization was seen in all experimental groups, more often after the first 4 weeks of force application. Hyalinized areas were recorded opposite an intact root surface (54%) or close to and just apical or coronal to an area of root resorption (45%), and were usually located buccocervically and linguoapically, corresponding to expected pressure zones of the periodonal ligament.

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This follow-up study reports on the periodontal status 1 to 18 years after the completion of orthodontic treatment of unilateral palatally impacted maxillary canines and their adjacent incisors and premolars. Registrations were performed on 42 patients, 19 to 59 years old (mean 35 years) at investigation. An orthodontic pin with eyelet had been placed after exploration of the canine and, in some cases, bone removal. A flap had been raised and resutured after bone removal in 11 cases. The results showed greater mesial probing depth of the canines on the treated side, on the adjacent lateral incisors distolingually, and on the first premolars mesiolingually. Marginal bone level was found to be lower on the distal aspect of the treated canines and adjacent laterals. In general, the results showed a good gingival and periodontal status with slight differences between treated and untreated sides.

Abstract

Impaction of permanent teeth is a relatively common occurrence and can involve any tooth in the dental arch. Impacted mandibular second molars are relatively rare, but when they occur they may present a clinical problem for the orthodontist and oral surgeon. A typical case of bilaterally impacted mandibular second molars is illustrated, with orthodontic and surgical treatment options presented. Emphasis is placed on early diagnosis and initiation of corrective orthodontic therapy.

Abstract

It is now possible to use the orthodontic extrusion of periodontally compromised teeth to facilitate the development of a future implant site in an area where the amount of bone in the inciso-apical dimension would otherwise have been inadequate. The purpose of this case report was to analyze the hard and soft tissue changes when forced eruption is used for implant site development.

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Orthodontic and periodontic management of a patient with bilaterally impacted maxillary canines and advanced resorption of the adjacent lateral incisors is presented. In treating the patient, the affected laterals were retained and the canines were surgically exposed, then moved away from the roots of the laterals and into position in the arch. Alternative treatment strategies are discussed. Long-term follow-up evaluation revealed successful maintenance of the dentition and of periodontal health.