Orthodontics

Current Dental Research…

Current Dental Research titles are worldwide, Medline-based lists of recently published articles in English, produced by the BDA Library to assist members in identifying the articles needed.

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Last updated: January 2018 16/01/2018

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1. Bayram M. Combined orthodontic-orthopedic treatment of an adolescent Class II Division 2 patient with extreme deepbite using the Forsus Fatigue Resistant Device. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Sep;152(3):389-401. Class II Division 2 malocclusion is often characterized by severe, traumatic deepbite with lingually inclined and overerupted incisors. Combined orthodontic-orthopedic treatment of this malocclusion is a challenging issue for orthodontists. This case report describes the combined orthodontic-orthopedic treatment of an adolescent Class II Division 2 patient with an extreme deepbite and a retrognathic mandible using the Forsus Fatigue Resistant Device. 2. Cochrane NJ, Lo TWG, Adams GG, Schneider PM. Quantitative analysis of enamel on debonded orthodontic brackets. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Sep;152(3):312-319. INTRODUCTION: Iatrogenic damage to the tooth surface in the form of enamel tearouts can occur during removal of fixed orthodontic appliances. The aim of this study was to assess debonded metal and ceramic brackets attached with a variety of bonding materials to determine how frequently this type of damage occurs. METHODS: Eighty-one patients close to finishing fixed orthodontic treatment were recruited. They had metal brackets bonded with composite resin and a 2-step etch-and-bond technique or ceramic brackets bonded with composite resin and a 2-step etch-and- bond technique, and composite resin with a self-etching primer or resin-modified glass ionomer cement. Debonded brackets were examined by backscattered scanning electron microscopy with energy dispersive x-ray spectroscopy to determine the presence and area of enamel on the base pad. RESULTS: Of the 486 brackets collected, 26.1% exhibited enamel on the bonding material on the bracket base pad. The incidences of enamel tearouts for each group were metal brackets, 13.3%; ceramic brackets, 30.2%; composite resin with self-etching primer, 38.2%; and resin-modified glass ionomer cement, 21.2%. The percentage of the bracket base pad covered in enamel was highly variable, ranging from 0% to 46.1%. CONCLUSIONS: Enamel damage regularly occurred during the debonding process with the degree of damage being highly variable. Damage occurred more frequently when ceramic brackets were used (31.9%) compared with metal brackets (13.3%). Removal of ceramic brackets bonded with resin-modified glass ionomer cement resulted in less damage compared with the resin bonding systems. 3. Janson G, Valarelli DP, Rizzo M, Valarelli FP. Prevalence of extraction space reopening in different orthodontic treatment protocols. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Sep;152(3):320-326. INTRODUCTION: In this study, we aimed to compare the amount and frequency of extraction space reopening after 2- and 4-premolar extraction treatments in Class II and 4-premolar extractions in Class I malocclusion patients. METHODS: The sample comprised 105 subjects with full-cusp Class II and Class I malocclusions, divided into 3 groups. Group 1 consisted of 33 full-cusp Class II malocclusion patients treated with a 2-premolar extraction protocol. Group 2 had 34 full-cusp Class II malocclusion patients treated with 4-premolar extractions, and group 3 included 38 Class I malocclusion patients treated with 4-premolar extractions. The Peer Assessment Rating index was used to assess initial malocclusion severity and quality of the occlusal outcome, measured on dental casts. The amounts of extraction spaces were measured with a

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digital caliper on the final and long-term posttreatment dental casts, after an average of 9.79 years posttreatment. Intergroup comparisons were performed by analysis of variance, followed by Tukey tests and chi-square tests. RESULTS: There were no significant differences regarding the amount and frequency of extraction space reopening among the groups. CONCLUSIONS: Two- and 4-premolar extractions in Class II and 4-premolar extraction treatment in Class I malocclusion patients show similar reopening of extraction spaces in the long term. 4. Al-Moghrabi D, Johal A, Fleming PS. What are people tweeting about orthodontic retention? A cross-sectional content analysis. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Oct;152(4):516-522. INTRODUCTION: Social media can offer valuable insights in relation to the perceptions and impact of medical treatments on patient groups. There is also a lack of information concerning patient experiences with orthodontic retainers and little appreciation of barriers to optimal compliance with orthodontic retention. The aim of this study was to describe the content of Twitter posts related to orthodontic retainers. METHODS: Publicly available tweets were prospectively collected over a period of 3 to 4 weeks using a bespoke social media monitoring tool. A total of 7037 tweets were collected, of which 827 were randomly selected for the analysis. Pilot coding was undertaken on a subset of tweets (n = 70), and a coding guide was developed. Tweets were iteratively categorized under the main themes and subthemes. The frequencies of tweets in each theme and subtheme were subsequently determined. RESULTS: Of 827 tweets, 660 were included in the analysis. The main themes identified included compliance, impact, maintenance, patient-clinician relationship, and positive and negative feelings. Compliance with orthodontic retainers was the most frequently coded theme (n = 248), with most reporting suboptimal compliance. The negative impact of orthodontic retainers on social and daily activities (n = 192) and the maintenance requirements (n = 115) were commonly mentioned. Patients also frequently expressed feelings about their clinician. CONCLUSIONS: Subjective experiences in relation to orthodontic retainers were commonly shared on Twitter. Most of the publicly available tweets portrayed retainer wear in a negative light. 5. Favero CS, English JD, Cozad BE, Wirthlin JO, Short MM, Kasper FK. Effect of print layer height and printer type on the accuracy of 3-dimensional printed orthodontic models. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Oct;152(4):557-565. INTRODUCTION: Three-dimensional (3D) printing technologies enable production of orthodontic models from digital files; yet a range of variables associated with the process could impact the accuracy and clinical utility of the models. The objective of this study was to investigate the effect of print layer height on the accuracy of orthodontic models printed 3 dimensionally using a stereolithography format printer and to compare the accuracy of orthodontic models fabricated with several commercially available 3D printers. METHODS: Thirty-six identical models were produced with a stereolithography-based 3D printer using 3 layer heights (n = 12 per group): 25, 50, and 100 mum. Forty-eight additional models were printed using 4 commercially available 3D printers (n = 12 per group). Each printed model was digitally scanned and compared with the input file via superimposition analysis using a best-fit algorithm to assess accuracy. RESULTS: Statistically significant differences were found in the average overall deviations of models printed at each layer height, with the 25-mum and 100-

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mum layer height groups having the greatest and least deviations, respectively. Statistically significant differences were also found in the average overall deviations of models produced using the various 3D printer models, but all values fell within clinically acceptable limits. CONCLUSIONS: The print layer height and printer model can affect the accuracy of a 3D printed orthodontic model, but the impact should be considered with respect to the clinical tolerances associated with the envisioned application. 6. Pinto AS, Alves LS, Zenkner J, Zanatta FB, Maltz M. Gingival enlargement in orthodontic patients: Effect of treatment duration. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Oct;152(4):477-482. INTRODUCTION: In this study, we aimed to assess the effect of the duration of fixed orthodontic treatment on gingival enlargement (GE) in adolescents and young adults. METHODS: The sample consisted of 260 subjects (ages, 10-30 years) divided into 4 groups: patients with no fixed orthodontic appliances (G0) and patients undergoing orthodontic treatment for 1 year (G1), 2 years (G2), or 3 years (G3). Participants completed a structured questionnaire on sociodemographic characteristics and oral hygiene habits. Clinical examinations were conducted by a calibrated examiner and included the plaque index, the gingival index, and the Seymour index. Poisson regression models were used to assess the association between group and GE. RESULTS: We observed increasing means of plaque, gingivitis, and GE in G0, G1, and G2. No significant differences were observed between G2 and G3. Adjusted Poisson regression analysis showed that patients undergoing orthodontic treatment had a 20 to 28-fold increased risk for GE than did those without orthodontic appliances (G1, rate ratio [RR] = 20.2, 95% CI = 9.0-45.3; G2, RR = 27.0, 95% CI = 12.1-60.3; G3 = 28.1; 95% CI = 12.6-62.5). CONCLUSIONS: The duration of orthodontic treatment significantly influenced the occurrence of GE. Oral hygiene instructions and motivational activities should target adolescents and young adults undergoing orthodontic treatment. 7. Watanabe T, Miyazawa K, Fujiwara T, Kawaguchi M, Tabuchi M, Goto S. Insertion torque and Periotest values are important factors predicting outcome after orthodontic miniscrew placement. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Oct;152(4):483-488. INTRODUCTION: Approximately 14% of orthodontic anchor screws (miniscrews) become dislodged regardless of the accuracy of placement. It is therefore important to investigate the factors causing dislodgement. We evaluated the stability of miniscrews after placement to identify factors influencing outcome in orthodontic treatment using miniscrews. METHODS: We investigated 120 miniscrews (Dual-top Auto Screw III; Jeil Medical, Seoul, Korea) (diameter, 1.4 mm; length, 6 mm) placed on the buccal or lingual side between the maxillary second premolar and the first molar in women. Patient age and rate and time of screw dislodgement were examined. Insertion torque values and Periotest (Tokyo Dental Industrial, Tokyo, Japan) measurements indicating horizontal and vertical mobility of the inserted screws were compared between groups with and without dislodgement (failure and success groups, respectively). RESULTS: Mean insertion torque values were 10.7 +/- 1.9 N.cm and 8.5 +/- 2.1 N.cm in the failure and success groups, respectively. Cortical bone thickness measurements (success group, 1.34 +/- 0.35 mm; failure group, 0.99 +/- 0.09 mm) were significantly higher, whereas Periotest values at placement (success group, horizontal, 4.9 +/- 1.4; vertical, 4.7 +/- 1.3; failure group, horizontal, 7.0 +/- 0.8; vertical, 7.1 +/- 0.9) were significantly lower in the success group than in the failure group.

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CONCLUSIONS: The Periotest value, together with insertion torque and cortical bone thickness, could serve as an index of initial stability for predicting the outcome of miniscrew placement. 8. Yatabe M, Natsumeda GM, Miranda F, Janson G, Garib D. Alveolar bone morphology of maxillary central incisors near grafted alveolar clefts after orthodontic treatment. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Oct;152(4):501-508.e1. INTRODUCTION: The aim of this study was to evaluate the thickness and the height of the maxillary central incisors' alveolar bone near the grafted alveolar cleft area, after comprehensive orthodontic treatment. METHODS: The sample comprised 30 patients with unilateral alveolar cleft with a mean age of 20.5 years (range, 17-25.8 years). High-resolution cone-beam computed tomography images of the maxilla were obtained 6 to 24 months after the comprehensive orthodontic treatment. The contralateral maxillary central incisor was used as a comparison group. Axial sections at the level of the central incisor root were used to measure the labial and lingual alveolar bone thicknesses. Cross sections were used to measure the bone crest heights using the cementoenamel junction as the reference. Paired t and Wilcoxon tests were used to compare the cleft and noncleft sides. RESULTS: The labial and lingual bone thicknesses of the maxillary central incisors' alveolar bone were significantly thinner (0.16 and 0.39 mm, respectively), and the labial alveolar crest height distance was significantly greater on the cleft side compared with the noncleft side (-1.2 mm). CONCLUSIONS: In patients with unilateral cleft lip and palate, the maxillary central incisors adjacent to the grafted alveolar cleft had thinner labial and lingual alveolar bones and an apically displaced labial alveolar crest level than the controls. 9. Zhang J, Zhang AM, Zhang ZM, et al. Efficacy of combined orthodontic-periodontic treatment for patients with periodontitis and its effect on inflammatory cytokines: A comparative study. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Oct;152(4):494-500. INTRODUCTION: In this study, we aimed to investigate the efficacy of combined orthodontic-periodontic treatment in the treatment of patients with periodontitis and its effects on the levels of inflammatory cytokines. METHODS: A total of 117 patients with periodontitis were randomly assigned to the basic group (receiving basic periodontic treatment, n = 58) and the combined group (receiving combined orthodontic-periodontic treatment, n = 59). In addition, 52 healthy people without periodontal disease were selected as the normal group. Probing depth, tooth mobility, plaque index, clinical attachment level, and sulcus bleeding index were recorded. ELISA was applied to detect gingival crevicular fluid (GCF) and serum levels of inflammatory cytokines. A 2-year clinical follow-up was conducted. RESULTS: Before treatment, the periodontal parameters (probing depth, tooth mobility, plaque index, clinical attachement level, and sulcus bleeding index) and GCF and serum levels of inflammatory cytokines (high-sensitivity C-reactive protein, interleukin-1beta, interleukin-5, interleukin-6, interleukin-8, tumor necrosis factor-alpha, and prostaglandin E2) in the combined and basic groups were higher than those in the normal group. After 6 and 18 months of treatment, the periodontal parameters and GCF and serum levels of inflammatory cytokines decreased in the combined and basic groups. The periodontal parameters and the GCF and serum levels of inflammatory cytokines in the combined group were significantly lower than those in the basic group after 18 months of treatment. The combined group had a lower recurrence rate compared with the basic group. CONCLUSIONS: Combined orthodontic-periodontic treatment had good clinical efficacy in the treatment of periodontitis and could effectively decrease the

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levels of inflammatory cytokines. 10. Hamanaka R, Yamaoka S, Anh TN, Tominaga JY, Koga Y, Yoshida N. Numeric simulation model for long-term orthodontic tooth movement with contact boundary conditions using the finite element method. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Nov;152(5):601-612. INTRODUCTION: Although many attempts have been made to simulate orthodontic tooth movement using the finite element method, most were limited to analyses of the initial displacement in the periodontal ligament and were insufficient to evaluate the effect of orthodontic appliances on long-term tooth movement. Numeric simulation of long-term tooth movement was performed in some studies; however, neither the play between the brackets and archwire nor the interproximal contact forces were considered. The objectives of this study were to simulate long-term orthodontic tooth movement with the edgewise appliance by incorporating those contact conditions into the finite element model and to determine the force system when the space is closed with sliding mechanics. METHODS: We constructed a 3-dimensional model of maxillary dentition with 0.022-in brackets and 0.019 x 0.025-in archwire. Forces of 100 cN simulating sliding mechanics were applied. The simulation was accomplished on the assumption that bone remodeling correlates with the initial tooth displacement. RESULTS: This method could successfully represent the changes in the moment-to-force ratio: the tooth movement pattern during space closure. CONCLUSIONS: We developed a novel method that could simulate the long-term orthodontic tooth movement and accurately determine the force system in the course of time by incorporating contact boundary conditions into finite element analysis. It was also suggested that friction is progressively increased during space closure in sliding mechanics. 11. Jung JG, Park JH, Kim SC, et al. Effectiveness of pulsed electromagnetic field for pain caused by placement of initial orthodontic wire in female orthodontic patients: A preliminary single-blind randomized clinical trial. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Nov;152(5):582-591. INTRODUCTION: The purpose of this 2-arm parallel trial was to assess the effects of pulsed electromagnetic field (PEMF) on the reduction of pain caused by initial orthodontic tooth movement. METHODS: Thirty-three female patients (mean age, 16.8 +/- 3.8 years) who began orthodontic treatment using fixed appliances were examined. In the pilot study, male patients were less likely to use the PEMF device (epatchQ; Speed Dental, Seoul, Korea) and answer a survey consistently, so eligibility criteria were female patients who were periodontally and systemically healthy at the initiation of treatment and had no history of dental pain in the prior 2 weeks or who used no medications (anti-inflammatory or analgesic drugs) during the experiment period. Each patient had brackets bonded on the maxillary teeth, and a 0.014-in nickel-titanium archwire was tied with elastomeric rings. Their maxillary arches were randomly divided into left and right sides in a split-mouth design: a normal PEMF device (experimental group) was used on 1 side, and a PEMF device with an inversely inserted battery (placebo group) was used on the opposite side of the arch for 7 hours on 3 consecutive nights. A Google survey link was sent to the patients' mobile phones via text message, and they were instructed to record their current pain on the survey. The survey was sent a total of 6 times after insertion of the initial archwire at 0 (T0), 2 (T1), 6 (T2), 24 (T3), 48 (T4), and 72 (T5) hours. Patients recorded the degree of pain in resting and clenching states using a numeric rating scale (NRS) from 1 (no pain) to 10 (worst pain). PEMF devices were used after T2. Generalized linear mixed models, along with ancillary pairwise analyses, were used to model and

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evaluate the differences in pain reported over 72 hours. RESULTS: The NRS scores did not differ across the groups during the before-PEMF phase for resting (mean difference, -0.07; 95% confidence interval [CI], -0.73 to 0.59; P = 0.842) and clenching (mean difference, -0.28; 95% CI, -1.11 to 0.56, P = 0.513). During the after-PEMF phase, NRS scores in the experimental group were significantly lower than those in the placebo group during both resting (mean difference, -1.46; 95% CI, -2.06 to -0.85; P = <0.001) and clenching (mean difference, -1.88; 95% CI, -2.74 to -1.02, P = <0.001). The NRS scores did not differ across the groups during the before-PEMF phase for either state but were significantly lower in the experimental group than in the placebo group at T3, T4, and T5 (P <0.01). The average NRS score in the clenching state was significantly greater than in the resting state. CONCLUSIONS: PEMF was effective in reducing orthodontic pain caused by initial archwire placement. REGISTRATION: The trial was not registered. PROTOCOL: The protocol was not published before trial commencement. 12. Laniado N, Oliva S, Matthews GJ. Children's orthodontic utilization in the United States: Socioeconomic and surveillance considerations. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Nov;152(5):672-678. INTRODUCTION: There has been no epidemiologic study of malocclusion prevalence and treatment need in the United States since the Third National Health and Nutrition Examination Survey, conducted from 1988 to 1991. In this descriptive study, the authors sought to estimate orthodontic treatment prevalence by examining a nationally representative survey to assess current pediatric dental and orthodontic utilization. METHODS: The 2009 and 2013 Medical Expenditure Panel Surveys were used to categorize and compare all types of pediatric dental and orthodontic procedures in children and adolescents up to 20 years old. Descriptive variables included dental insurance, poverty level, and racial/ethnic background. RESULTS: Visits for orthodontic procedures constituted the third largest treatment category (14.5%) and were greatest among the uninsured and higher income populations. Children with public insurance had the fewest orthodontic visits (9.4%). Racial/ethnic disparities were most pronounced among orthodontic visits, with black and Hispanic children receiving the fewest orthodontic procedures (8.89% and 10.56%, respectively). CONCLUSIONS: Orthodontic treatment prevalence data suggest that significant disparities exist in orthodontic utilization based on race/ethnicity, poverty level, and insurance status. To establish the burden of malocclusion, describe populations in greatest need of interventions, and craft appropriate programs and policies, an active orthodontic surveillance system is essential. 13. Paredes-Gallardo V, Garcia-Sanz V, Bellot-Arcis C. Miniscrew-assisted multidisciplinary orthodontic treatment with surgical mandibular advancement and genioplasty in a brachyfacial Class II patient with mandibular asymmetry. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Nov;152(5):679-692. This article describes the complex dental treatment of a 43-year-old man with skeletal Class II, mandibular asymmetry, severe brachyfacial pattern, Class II Division 2, canting of the occlusal plane, and an increased curve of Spee. To achieve optimal results, we adopted a multidisciplinary approach to treatment, involving periodontics, oral surgery, orthodontics, maxillofacial surgery, and prosthetics specialists. After periodontal treatment, miniscrews were placed to correct the occlusal plane canting and the excessive curve of Spee with orthodontic treatment. The surgical treatment plan consisted of a bilateral asymmetric

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sagittal split osteotomy for mandibular advancement and genioplasty. The patient had an infection after the surgery at the site of the right fixation plate, so the plate was removed, and active orthodontic treatment was continued and finished. Mandibular first molar implants and maxillary ceramic crowns using the Digital Smile Design method (Digital Smile Design, Doral, FL) were placed at the end of orthodontic treatment. The patient was satisfied with the treatment results and with his facial and dental appearance, as well as his oral function. The 2-year follow-up pictures show a stable result both esthetically and functionally. 14. Qamruddin I, Alam MK, Mahroof V, Fida M, Khamis MF, Husein A. Effects of low-level laser irradiation on the rate of orthodontic tooth movement and associated pain with self-ligating brackets. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Nov;152(5):622-630. INTRODUCTION: The aim of this study was to evaluate the effect of low-level laser irradiation applied at 3-week intervals on orthodontic tooth movement and pain associated with orthodontic tooth movement using self-ligating brackets. METHODS: Twenty-two patients (11 male, 11 female; mean age, 19.8 +/- 3.1 years) with Angle Class II Division 1 malocclusion were recruited for this split-mouth clinical trial; they required extraction of maxillary first premolars bilaterally. After leveling and alignment with self-ligating brackets (SmartClip SL3; 3M Unitek, St Paul, Minn), a 150-g force was applied to retract the canines bilaterally using 6-mm nickel-titanium closed-coil springs on 0.019 x 0.025-in stainless steel archwires. A gallium-aluminum-arsenic diode laser (iLas; Biolase, Irvine, Calif) with a wavelength of 940 nm in a continuous mode (energy density, 7.5 J/cm²/point; diameter of optical fiber tip, 0.04 cm²) was applied at 5 points buccally and palatally around the canine roots on the experimental side; the other side was designated as the placebo. Laser irradiation was applied at baseline and then repeated after 3 weeks for 2 more consecutive follow-up visits. Questionnaires based on the numeric rating scale were given to the patients to record their pain intensity for 1 week. Impressions were made at each visit before the application of irradiation at baseline and the 3 visits. Models were scanned with a CAD/CAM scanner (Planmeca, Helsinki, Finland). RESULTS: Canine retraction was significantly greater (1.60 +/- 0.38 mm) on the experimental side compared with the placebo side (0.79 +/- 0.35 mm) (P <0.05). Pain was significantly less on the experimental side only on the first day after application of LLLI and at the second visit (1.4 +/- 0.82 and 1.4 +/- 0.64) compared with the placebo sides (2.2 +/- 0.41 and 2.4 +/- 1.53). CONCLUSIONS: Low-level laser irradiation applied at 3-week intervals can accelerate orthodontic tooth movement and reduce the pain associated with it. 15. Nieto-Nieto N, Solano JE, Yanez-Vico R. External apical root resorption concurrent with orthodontic forces: the genetic influence. Acta Odontologica Scandinavica 2017 May;75(4):280-287. Root resorption is a pathological process of multifactorial origin related to the permanent loss of dental root structure in response to a mechanical, inflammatory, autoimmune or infectious stimulus. External apical root resorption (EARR) is a frequent clinical complication secondary to orthodontic tooth movement; apart from variables related to treatment, environmental factors and/or interindividual genetic variations can confer susceptibility or resistance to its occurrence. In this context, genetic predisposition has been described as an etiological factor, together with mechanical factors derived from orthodontic treatment. In recent years, international research groups have determined the degree of influence of some genetic biomarkers in defining increased/reduced susceptibility to postorthodontic EARR. The influences of the IL1 gene cluster (IL1B, IL1A, IL1RN, IL6), P2RX7, CASP1, OPG (TNFRSF11B), RANK

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(TNFRSF11A), Osteopontin (OPN), TNFalpha, the vitamin D receptor (TaqI), TNSALP and IRAK1 have been analyzed. The objective of the present review study was to compile and analyze the latest information about the genetic background predisposing to EARR during orthodontic treatment. Genetics-based studies along with other basic science research in the field might help to clarify the exact nature of EARR, the influence of genetic inheritance and possibly lead to the prevention or even eradication of this phenomenon during orthodontic treatment. 16. Fields HW, Kim DG, Jeon M, et al. Evaluation of objective structured clinical examination for advanced orthodontic education 12 years after introduction. American Journal of Orthodontics & Dentofacial Orthopedics 2017 May;151(5):840-850. INTRODUCTION: Advanced education programs in orthodontics must ensure student competency in clinical skills. An objective structure clinical examination has been used in 1 program for over a decade. The results were analyzed cross-sectionally and longitudinally to provide insights regarding the achievement of competency, student growth, question difficulty, question discrimination, and question predictive ability. METHODS: In this study, we analyzed 218 (82 first-year, 68 second-year, and 68 third-year classes) scores of each station from 85 orthodontic students. The grades originated from 13 stations and were collected anonymously for 12 consecutive years during the first 2 decades of the 2000s. The stations tested knowledge and skills regarding dental relationships, analyzing a cephalometric tracing, performing a diagnostic skill, identifying cephalometric points, bracket placement, placing first-order and second-order bends, forming a loop, placing accentuated third-order bends, identifying problems and planning mixed dentition treatment, identifying problems and planning adolescent dentition treatment, identifying problems and planning nongrowing skeletal treatment, superimposing cephalometric tracings, and interpreting cephalometric superimpositions. Results were evaluated using multivariate analysis of variance, chi-square tests, and latent growth analysis. RESULTS: The multivariate analysis of variance showed that all stations except 3 (analyzing a cephalometric tracing, forming a loop, and identifying cephalometric points) had significantly lower mean scores for the first-year student class than the second- and third-year classes (P <0.028); scores between the second- and third-year student classes were not significantly different (P >0.108). The chi-square analysis of the distribution of the number of noncompetent item responses decreased from the first to the second years (P <0.0003), from the second to the third years (P <0.0042), and from the first to the third years (P <0.00003). The latent growth analysis showed a wide range of difficulty and discrimination between questions. It also showed continuous growth for some areas and the ability of 6 questions to predict competency at greater than the 80% level. CONCLUSIONS: Objective structure clinical examinations can provide a method of evaluating student performance and curriculum impact over time, but cross-sectional and longitudinal analyses of the results may not be complementary. Significant learning appears to occur during all years of a 3-year program. Valuable questions were both easy and difficult, discriminating and not discriminating, and came from all domains: diagnostic, technical, and evaluation/synthesis. 17. Hourfar J, Bister D, Lux CJ, Al-Tamimi B, Ludwig B. Anatomic landmarks and availability of bone for placement of orthodontic mini-implants for normal and short maxillary body lengths. American Journal of Orthodontics & Dentofacial Orthopedics 2017 May;151(5):878-886. INTRODUCTION: Increasing numbers of orthodontic mini-implants are placed in the anterior maxilla. To our knowledge, bone levels and root proximity of patients with cephalometrically short maxillae have not been investigated before. The first, second, and third rugae were used as clinical reference lines, and

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the aim of this study was to measure bone availability in that area by comparing patients with short and normal maxillary body lengths. METHODS: The sample consisted of 21 patients in each group: short maxillary body length and normal maxillary body length. The patients' study models were bisected, and the outline of the palatal contour was marked on the surface. The models were scanned, and the palatal contours were superimposed on the palatal structures of their respective initial cephalometric headfilms, and the vertical and oblique bone levels of the sagittal plane were compared using the Student t test. The level of significance was set at P <0.05. RESULTS: Compared with maxillae of normal maxillary body length, less bone was available in maxillae of short maxillary body length. However, the differences did not reach clinical or statistical significance (P >0.05) at the third rugae. CONCLUSIONS: Almost equivalent average bone depth at the third rugae in patients with normal and short maxillary body lengths suggests that this site can be used for 8-mm long obliquely inserted orthodontic mini-implants. 18. Jacoby LS, Rodrigues Junior VDS, Campos MM, Macedo de Menezes L. Cytotoxic outcomes of orthodontic bands with and without silver solder in different cell lineages. American Journal of Orthodontics & Dentofacial Orthopedics 2017 May;151(5):957-963. INTRODUCTION: The safety of orthodontic materials is a matter of high interest. In this study, we aimed to assess the in-vitro cytotoxicity of orthodontic band extracts, with and without silver solder, by comparing the viability outcomes of the HaCat keratinocytes, the fibroblastic cell lineages HGF and MRC-5, and the kidney epithelial Vero cells. METHODS: Sterilized orthodontic bands with and without silver solder joints were added to culture media (6 cm²/mL) and incubated for 24 hours at 37degreeC under continuous agitation. Subsequently, the cell cultures were exposed to the obtained extracts for 24 hours, and an assay was performed to evaluate the cell viability. Copper strip extracts were used as positive control devices. RESULTS: The extracts from orthodontic bands with silver solder joints significantly reduced the viability of the HaCat, MRC-5, and Vero cell lines, whereas the viability of HGF was not altered by this material. Conversely, the extracts of orthodontic bands without silver solder did not significantly modify the viability index of all evaluated cell lines. CONCLUSIONS: Except for HGF fibroblasts, all tested cell lines showed decreased viability percentages after exposure to extracts of orthodontic bands containing silver solder joints. These data show the relevance of testing the toxicity of orthodontic devices in different cell lines. 19. Morris JW, Campbell PM, Tadlock LP, Boley J, Buschang PH. Prevalence of gingival recession after orthodontic tooth movements. American Journal of Orthodontics & Dentofacial Orthopedics 2017 May;151(5):851-859. INTRODUCTION: This study was designed to evaluate the long-term prevalence of gingival recession after orthodontic tooth movements, focusing on the effects of mandibular incisor proclination and expansion of maxillary posterior teeth. METHODS: Records of 205 patients (162 female, 43 male) were obtained from 2 private practice orthodontists. Using pretreatment (age, 14.0 +/- 5.9 years) and posttreatment (age, 16.5 +/- 6.0 years) lateral cephalograms and dental models, mandibular incisor proclination and maxillary arch widths were measured. Gingival recession was measured based on posttreatment and postretention (age, 32.3 +/- 8.5 years) intraoral photographs and models. Associations between tooth movements and gingival recession were evaluated statistically.

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RESULTS: Only 5.8% of teeth exhibited recession at the end of orthodontic treatment (only 0.6% had recession >1 mm). After retention, 41.7% of the teeth showed recession, but the severity was limited (only 7.0% >1 mm). There was no relationship between mandibular incisor proclination during treatment and posttreatment gingival recession. Incisors that finished treatment angulated (IMPA) at 95degree or greater did not show significantly more recession than did those that finished less than 95degree. There were weak positive correlations (r = 0.17-0.41) between maxillary arch width increases during treatment and posttreatment recession. CONCLUSIONS: Orthodontic treatment is not a major risk factor for the development of gingival recession. Although greater amounts of maxillary expansion during treatment increase the risks of posttreatment recession, the effects are minimal. 20. Lipp MJ, Cho K, Kim HS. Types of Feedback in Competency-Based Predoctoral Orthodontics: Effects on Students' Attitudes and Confidence. Journal of Dental Education 2017 May;81(5):582-589. Feedback can exert a powerful influence on learning and achievement although its effect varies. The aim of this study was to investigate the effects of three types of feedback on dental students' attitudes and confidence in a competency-based course in predoctoral orthodontics at New York University College of Dentistry. In 2013-14, all 253 third-year students in a course using test-enhanced instructional methods received written feedback on formative assessments. The type of feedback varied across three groups: pass/fail grades (PF) N=77, emoticons (EM) N=90, or written comments (WC) N=86. At the end of the course, students completed surveys that included four statements addressing their attitudes toward course instruction and confidence in their abilities. The survey response rate ranged from 75% to 100% among groups. The lowest response rate (75%) was in the PF group. In attitudes toward course instruction and confidence in their abilities, the WC group trended to more positive responses than the other groups, while the PF group trended to negative responses. On two of the four statements, the trend for the WC group was significant (95% CI). In both statements concerning attitudes toward instruction, the PF group trended to negative responses that were significant (95% CI). These results support the effectiveness of descriptive written comments over pass/fail grades or emoticons in improving dental students' confidence in their abilities and their attitudes toward instruction. 21. Saloom HF, Papageorgiou SN, Carpenter GH, Cobourne MT. Impact of Obesity on Orthodontic Tooth Movement in Adolescents: A Prospective Clinical Cohort Study. Journal of Dental Research 2017 May;96(5):547-554. Obesity is a widespread chronic inflammatory disorder characterized by an increased overall disease burden and significant association with periodontitis. The aim of this prospective clinical cohort study was to investigate the effect of obesity on orthodontic tooth movement. Fifty-five adolescent patients (27 males, 28 females) with a mean (SD) age of 15.1 (1.7) years and mean (SD) body mass index (BMI) of 30.2 (3.5) kg/m² in obese and 19.4 (2.2) kg/m² in normal-weight groups were followed from start of treatment to completion of tooth alignment with fixed orthodontic appliances. Primary outcome was time taken to complete tooth alignment, while secondary outcomes included rate of tooth movement and change in clinical parameters (plaque/gingival indices, unstimulated whole-mouth salivary flow rate, gingival crevicular fluid biomarkers). Data collection took place at baseline (start of treatment: appliance placement), 1 h and 1 wk following appliance placement, and completion of alignment. Results were analyzed by descriptive statistics followed by generalized estimating equation regression modeling. There were no significant differences between groups in time taken to achieve tooth alignment (mean [SD] 158.7 [75.3] d; P = 0.486). However, at 1 wk, initial tooth displacement was significantly increased in the obese group ( P < 0.001), and

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after adjusting for confounders, obese patients had a significantly higher rate of tooth movement compared with normal-weight patients (+0.017 mm/d; 95% confidence interval, 0.008-0.025; P < 0.001) over the period of alignment. Explorative analyses indicated that levels of the adipokines leptin and resistin, the inflammatory marker myeloperoxidase (MPO), and the cytokine receptor for nuclear factor kappa-B ligand (RANKL) were significantly different between obese- and normal-weight patients and associated with observed rates of tooth movement. This represents the first prospective data demonstrating a different response in obese patients compared with normal-weight patients during early orthodontic treatment. These differences in the response of periodontal tissues to orthodontic force in the presence of obesity have potential short- and long-term clinical implications. 22. Antoszewska-Smith J, Sarul M, Lyczek J, Konopka T, Kawala B. Effectiveness of orthodontic miniscrew implants in anchorage reinforcement during en-masse retraction: A systematic review and meta-analysis. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Mar;151(3):440-455. INTRODUCTION: The aim of this systematic review was to compare the effectiveness of orthodontic miniscrew implants-temporary intraoral skeletal anchorage devices (TISADs)-in anchorage reinforcement during en-masse retraction in relation to conventional methods of anchorage. METHODS: A search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and Web of Science was performed. The keywords were orthodontic, mini-implants, miniscrews, miniplates, and temporary anchorage device. Relevant articles were assessed for quality according to Cochrane guidelines and the data extracted for statistical analysis. A meta-analysis of raw mean differences concerning anchorage loss, tipping of molars, retraction of incisors, tipping of incisors, and treatment duration was carried out. RESULTS: Initially, we retrieved 10,038 articles. The selection process finally resulted in 14 articles including 616 patients (451 female, 165 male) for detailed analysis. Quality of the included studies was assessed as moderate. Meta-analysis showed that use of TISADs facilitates better anchorage reinforcement compared with conventional methods. On average, TISADs enabled 1.86 mm more anchorage preservation than did conventional methods (P <0.001). CONCLUSIONS: The results of the meta-analysis showed that TISADs are more effective than conventional methods of anchorage reinforcement. The average difference of 2 mm seems not only statistically but also clinically significant. However, the results should be interpreted with caution because of the moderate quality of the included studies. More high-quality studies on this issue are necessary to enable drawing more reliable conclusions. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved. 23. Baik UB, Kim MR, Yoon KH, Kook YA, Park JH. Orthodontic uprighting of a horizontally impacted third molar and protraction of mandibular second and third molars into the missing first molar space for a patient with posterior crossbites. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Mar;151(3):572-582. A 22-year-old woman came with a unilateral missing mandibular first molar and buccal crossbite. The open space was closed by protraction of the mandibular left second molar and uprighting and protraction of the horizontally impacted third molar using temporary skeletal anchorage devices, and her buccal crossbite was corrected with modified palatal and lingual appliances. The total active treatment time was 36 months. Posttreatment records after 9 months showed excellent results with a stable occlusion. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

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24. Jackson TH, Guez C, Lin FC, Proffit WR, Ko CC. Extraction frequencies at a university orthodontic clinic in the 21st century: Demographic and diagnostic factors affecting the likelihood of extraction. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Mar;151(3):456-462. INTRODUCTION: The aims of this study were to report contemporary orthodontic extraction frequencies at a university center and to investigate what patient-related factors might influence the likelihood of extraction. METHODS: The records of 2184 consecutive patients treated at the University of North Carolina from 2000 to 2011 were analyzed. Year-by-year rates for overall orthodontic extractions and for extraction of 4 first premolars were calculated. Logistic regression, adjusting for all recorded patient risk factors for extraction, was used to examine both the changes in extraction frequencies over time and the influence of individual patient factors on the odds of extraction. RESULTS: Small linear decreases in orthodontic extraction frequency overall (OR, 0.91; 95% CI, 0.88-0.95) and in extraction of 4 first premolars (OR, 0.95; 95% CI, 0.90-0.99) were seen. The overall extraction rate was 37.4% in 2000, and it fell just below 25% from 2006 onward. Four first premolar extraction rates ranged from 8.9% to 16.5%. Extractions were significantly more likely as crowding and overjet increased (OR, 1.2; 95% CI, 1.14-1.25; OR, 1.1; 95% CI. 1.07-1.19), as overbite decreased (OR, 0.8; 95% CI, 0.77-0.89), with Class II dental or skeletal relationships (OR, 1.5; 95% CI, 1.12- 2.05; OR, 1.4; 95% CI, 1.04-1.85), and for nonwhite patients (OR, 3.0; 95% CI, 2.2-4.06 for other races; OR, 4.1; 95% CI, 3.03-5.66 for African Americans). CONCLUSIONS: Extractions were just as likely to be associated with Class II dental and skeletal problems and with open-bite problems as with crowding alone. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved. 25. Mohebi S, Shafiee HA, Ameli N. Evaluation of enamel surface roughness after orthodontic bracket debonding with atomic force microscopy. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Mar;151(3):521-527. INTRODUCTION: Achieving a smooth enamel surface after orthodontic bracket debonding is imperative. In this study, we sought to compare the enamel surface roughness values after orthodontic bracket debonding and resin removal using a white stone bur, a tungsten carbide bur, and a tungsten carbide bur under loupe magnification. METHODS: Thirty sound premolars were randomly divided into 3 groups, and their buccal surfaces were subjected to atomic force microscopy to measure initial surface roughness. Brackets were bonded to the buccal surfaces and debonded after 24 hours. Resin remnants were removed using a white stone bur, a tungsten carbide bur, or a tungsten carbide bur under loupe magnification. The teeth were then subjected to atomic force microscopy again. The time required for composite removal was calculated. Data were analyzed using repeated-measures analysis of variance, 1-way analysis of variance, and the Tukey test. RESULTS: Resin removal increased the enamel surface roughness compared with the initial values (P <0.001); however, no significant differences were noted among the 3 groups in this respect after resin removal. The mean times required for smoothing by the tungsten carbide bur and the tungsten carbide bur with a dental loupe were similar (P >0.05): significantly lower than the time with the white stone bur (both, P <0.001). CONCLUSIONS: The tungsten carbide bur is still recommended for composite removal. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.

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26. Moreira MR, Matos LG, de Souza ID, et al. Bisphenol A release from orthodontic adhesives measured in vitro and in vivo with gas chromatography. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Mar;151(3):477-483. INTRODUCTION: The objectives of this study were to quantify in vitro the Bisphenol A (BPA) release from 5 orthodontic composites and to assess in vivo the BPA level in patients' saliva and urine after bracket bonding with an orthodontic adhesive system. METHODS: For the in-vitro portion of this study, 5 orthodontic composites were evaluated: Eagle Spectrum (American Orthodontics, Sheboygan, Wis), Enlight (Ormco, Orange, Calif), Light Bond (Reliance Orthodontic Products, Itasca, Ill), Mono Lok II (Rocky Mountain Orthodontics, Denver, Colo), and Transbond XT (3M Unitek, Monrovia, Calif). Simulating intraoral conditions, the specimens were immersed in a water/ethanol solution, and the BPA (ng.g^-1) liberation was measured after 30 minutes, 24 hours, 1 day, 1 week, and 1 month by the gas chromatography system coupled with mass spectrometry. Twenty patients indicated for fixed orthodontic treatment participated in the in-vivo study. Saliva samples were collected before bracket bonding and then 30 minutes, 24 hours, 1 day, 1 week, and 1 month after bonding the brackets. Urine samples were collected before bonding and then at 1 day, 1 week, and 1 month after bonding. The results were analyzed statistically using analysis of variance and Tukey posttest, with a significance level of 5%. RESULTS: All composites evaluated in vitro released small amounts of BPA. Enlight composite showed the greatest release, at 1 month. Regarding the in-vivo study, the mean BPA level in saliva increased significantly only at 30 minutes after bonding in comparison with measurements recorded before bonding. CONCLUSIONS: All orthodontic composites released BPA in vitro. Enlight and Light Bond had, respectively, the highest and lowest BPA releases in vitro. The in-vivo experiment showed that bracket bonding with the Transbond XT orthodontic adhesive system resulted in increased BPA levels in saliva and urine. The levels were significant but still lower than the reference dose for daily ingestion. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved. 27. Park JH, Putrus RR, Pruzansky DP, Grubb J. Evaluation of American Board of Orthodontics certification protocols in postgraduate orthodontic programs in the United States and Canada. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Mar;151(3):463-470. INTRODUCTION: The objective of this study was to identify the board certification protocols that hospital and university-based postgraduate orthodontic programs have in place to prepare residents for the American Board of Orthodontics (ABO) certification examination. METHODS: An electronic survey was sent to the program directors of each of the 72 postgraduate orthodontic programs in the United States and Canada. The survey consisted of 49 questions about demographics, resident case assignment protocols, and ABO examination preparation methods. RESULTS: The response rate was 81%. Most programs were 30 to 36 months in length (72.7%). Many residents had a case load of 51 to 75 during their first year (50.9%), with an average maximum case load of 70 to 109. There was a positive correlation with both the number of cases that first-year residents start and the length of the program (Spearman correlation coefficient = 0.379; P <0.01) when compared with maximum case load. Approximately 72% of the programs do not offer a written mock board examination; however, 72% reported offering a clinical mock board examination. ABO cases are identified within the first 6 months of most programs. About 88% of respondents believe that residents take advantage of the banking system, and that over the past 5 years ABO Initial Certification Examination applications have increased. CONCLUSIONS: Most program directors (89.1%) believe that their program length is sufficient for board preparation. Subjects tested in the written examination are integrated into the didactic curriculum and strengthened with ongoing literature reviews, with a passing rate over 90%. Clinical examination

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preparation varies, with most programs requiring a mock board examination for graduation. Total participation in both the Initial Certification Examination and banking has increased since 2010; better follow-up protocols are needed to track residents after graduation. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved. 28. Zhylich D, Krishnan P, Muthusami P, et al. Effects of orthodontic appliances on the diagnostic quality of magnetic resonance images of the head. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Mar;151(3):484-499. INTRODUCTION: The influence of 4 commonly used fixed orthodontic appliances on artifact formation and diagnostic quality of magnetic resonance (MR) images of the head produced by a 3-T MR scanner was studied. METHODS: Stainless steel brackets, ceramic brackets, combination of ceramic brackets and steel molar tubes, and multistranded steel mandibular lingual retainers were embedded into custom-made trays for each of 10 adult subjects. Head MR scans of 9 regions were acquired for each subject wearing these trays. Sagittal T1-weighted, axial T2-weighted, axial gradient-recalled, axial diffusion-weighted, noncontrast axial MR angiography, and axial fluid-attenuated inversion recovery MR sequences were included. Two neuroradiologists evaluated image distortions and diagnostic qualities of the 1314 acquired images (13860 image slices). RESULTS: The images were affected by appliance, head region, and MR sequence. Stainless steel brackets and molar tubes affected the images the most, and ceramic brackets caused minimal image distortion. CONCLUSIONS: Head MR images are differentially affected by orthodontic appliances. The appliance, region imaged, and MR sequence should be considered before imaging patients wearing fixed orthodontic appliances. Copyright © 2016 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved. 29. Fleming PS. Timing orthodontic treatment: early or late? Australian Dental Journal 2017 Mar;62(Suppl 1):11-19. The timing of orthodontic interventions has been a contentious topic for many years with early treatment to address or indeed to prevent skeletal discrepancies in all three spatial planes and to alleviate crowding in common practice. In terms of effectiveness, however, broadly speaking early intervention has not been shown to be superior to later intervention. As such, in view of the additional burden and duration of early intervention, the weight of evidence points to reserving early treatment for localized problems and specific situations with definitive treatment typically initiated in the late mixed or early permanent dentition. 30. Krishnan V. Root Resorption with Orthodontic Mechanics: Pertinent Areas Revisited. Australian Dental Journal 2017 Mar;62(Suppl 1):71-77. Root resorption can occur at any time during orthodontic treatment and lead to a compromise in the prognosis of the tooth and the stability of the treatment

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results. Recent research has focused more on the cause and effect relationship as well as preventive or treatment options to combat this unwelcome event. Investigations have highlighted the genetic as well as molecular aspects of the process and enabled clinicians to determine which patients might be susceptible. A proper medical history, an assessment of predisposing factors, a radiographic evaluation for alterations in root morphology and careful planning and execution of orthodontic mechanics may reduce the incidence of root resorption. The current review is aimed at providing clinicians and academics with an insight into the process of root resorption, the methods of identification during its early stages and intervention at the right time to reduce its severity. 31. McDonald F. Short term orthodontics. Australian Dental Journal 2017 Mar;62(Suppl 1):29-32. Short-term orthodontics is a growing area of clinical care delivery. Many practitioners who have not experienced specialist orthodontic education are involved in the provision of that care. Limited orthodontic treatment can provide a level of tooth movement but the essential challenge arises from the patient's expectations and their acceptance of the possible outcomes. As with all techniques, short-term orthodontics is not a panacea of care and the patient's motivation and the identification of specific cases which might benefit, is essential. Providers clearly use the technique in different ways and this paper highlights areas of caution. 32. Miles P. Accelerated orthodontic treatment - what's the evidence? Australian Dental Journal 2017 Mar;62(Suppl 1):63-70. The demand and accessibility of orthodontic care has increased but has also been accompanied by patient requests for shorter treatment times. Longer orthodontic treatment increases the risk of decalcification, gingival recession, and root resorption and so shorter treatment times have multiple advantages as well as appealing to patient's desires. Numerous techniques and materials have been suggested to reduce treatment times but, in most cases, are based upon selected case reports with no prospective clinical trials to validate claims. The present review examines many of the current options purported to accelerate orthodontic tooth movement and the level of evidence presently available. There is some evidence to suggest that low-level laser therapy and a corticotomy involving the raising of a muco-periosteal flap are associated with accelerated orthodontic tooth movement; however, the current level of evidence is low to moderate in quality. For this reason, further research is required before routine application could be recommended. 33. Scarfe WC, Azevedo B, Toghyani S, Farman AG. Cone Beam Computed Tomographic imaging in orthodontics. Australian Dental Journal 2017 Mar;62(Suppl 1):33-50. Over the last 15 years, cone beam computed tomographic (CBCT) imaging has emerged as an important supplemental radiographic technique for orthodontic diagnosis and treatment planning, especially in situations which require an understanding of the complex anatomic relationships and surrounding structures of the maxillofacial skeleton. CBCT imaging provides unique features and advantages to enhance orthodontic practice over conventional extraoral radiographic

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imaging. While it is the responsibility of each practitioner to make a decision, in tandem with the patient/family, consensus-derived, evidence-based clinical guidelines are available to assist the clinician in the decision-making process. Specific recommendations provide selection guidance based on variables such as phase of treatment, clinically-assessed treatment difficulty, the presence of dental and/or skeletal modifying conditions, and pathology. CBCT imaging in orthodontics should always be considered wisely as children have conservatively, on average, a three to five times greater radiation risk compared with adults for the same exposure. The purpose of this paper is to provide an understanding of the operation of CBCT equipment as it relates to image quality and dose, highlight the benefits of the technique in orthodontic practice, and provide guidance on appropriate clinical use with respect to radiation dose and relative risk, particularly for the paediatric patient. 34. Sifakakis I, Eliades T. Adverse reactions to orthodontic materials. Australian Dental Journal 2017 Mar;62(Suppl 1):20-28. Adverse effects can arise from the clinical use of orthodontic materials, due to the release of constituent substances (ions from alloys and monomers, degradation by-products, and additives from polymers). Moreover, intraoral aging affects the biologic properties of materials. The aim of this review is to present the currently identified major adverse effects of the metallic and polymeric components found in orthodontic appliances and materials. Corrosion in metallic orthodontic attachments releases metal ions, mainly iron, chromium, and nickel. The latter has received the greatest attention because of its reported potential for an allergic response. The formation of an oxide layer may inhibit the outward movement of ions, thereby acting as an obstacle for release. Titanium alloys have superior corrosion resistance than stainless steel. The efficiency of polymerisation is considered an essential property for all polymers. A poor polymer network is susceptible to the release of biologically reactive substances, such as bisphenol-A (BPA), which is capable of inducing hormone-related effects. The close proximity of a light-curing tip to the adhesive, pumice prophylaxis after bonding, indirect irradiation and mouth rinsing during the first hour after bonding may decrease BPA release. The adverse effects of some orthodontic materials should be considered during material selection and throughout orthodontic treatment, in order to minimise possible undesirable implications. 35. Weir T. Clear aligners in orthodontic treatment. Australian Dental Journal 2017 Mar;62(Suppl 1):58-62. Since the introduction of the Tooth Positioner (TP Orthodontics) in 1944, removable appliances analogous to clear aligners have been employed for mild to moderate orthodontic tooth movements. Clear aligner therapy has been a part of orthodontic practice for decades, but has, particularly since the introduction of Invisalign appliances (Align Technology) in 1998, become an increasingly common addition to the orthodontic armamentarium. An internet search reveals at least 27 different clear aligner products currently on offer for orthodontic treatment. The present paper will highlight the increasing popularity of clear aligner appliances, as well as the clinical scope and the limitations of aligner therapy in general. Further, the paper will outline the differences between the various types of clear aligner products currently available. 36. Wishney M.

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Potential risks of orthodontic therapy: a critical review and conceptual framework. Australian Dental Journal 2017 Mar;62(Suppl 1):86-96. This review examines some of the potential risks of orthodontic therapy along with their evidence base. The risks of orthodontic treatment include periodontal damage, pain, root resorption, tooth devitalization, temporomandibular disorder, caries, speech problems and enamel damage. These risks can be understood to arise from a synergy between treatment and patient factors. In general terms, treatment factors that can influence risk include appliance type, force vectors and duration of treatment whilst relevant patient factors are both biological and behavioural. Hence, the natural variation between orthodontic treatment plans and patients gives rise to variations in risk. A good understanding of these risks is required for clinicians to obtain informed consent before starting treatment as well as to reduce the potential for harm during treatment. After considering each of these risks, a conceptual framework is presented to help clinicians better understand how orthodontic risks arise and may therefore be mitigated. 37. Woods MG. The mandibular muscles in contemporary orthodontic practice: a review. Australian Dental Journal 2017 Mar;62(Suppl 1):78-85. It is widely accepted that all dentists should have a thorough understanding of the muscles involved in moving or stabilizing the mandible. However, there is still much discussion regarding the influence of the mandibular muscles on normal facial growth and dental development, as well as on orthodontic treatment and post-treatment stability. Potential patients with different underlying vertical muscle patterns will have differences in the expected directions of future mandibular growth, lateral profile shape, facial and arch widths and vertical occlusal relationships. In turn, thorough diagnoses are likely to lead to differences in individual aims and objectives, treatment plans, timing of commencement, mechanical design, lateral profile and smile-aesthetics outcomes, choice of retention and plans for long-term maintenance. The potential influence of the mandibular muscles on normal morphologic variation and the soft tissue implications on contemporary orthodontic treatment and stability will be addressed in this review. 38. Lima AA, Alves CM, Ribeiro CC, et al. Effects of conventional and orthodontic pacifiers on the dental occlusion of children aged 24-36 months old. International Journal of Paediatric Dentistry 2017 Mar;27(2):108-119. AIM: To investigate the effects of conventional and orthodontic pacifiers on the prevalence of malocclusion (MO) considering frequency, duration, and intensity of the sucking habit. DESIGN: Data were collected at three time-points: birth, T1; (12-24 months old), T2; (24-36 months old), T3 and were divided into three groups: control (GC; 110), without non-nutritive sucking habits; orthodontic pacifiers (GOrth; 55); conventional pacifiers (GConv; 55). A questionnaire was applied. Clinical examination was performed at T3. The groups were compared as to the prevalence and severity of anterior open bite (AOB), accentuated overjet, anterior crossbite, posterior crossbite (PCB). RESULTS: The use of pacifiers was associated with occurrence of MO compared to GC (P < 0.05). Frequency, intensity, and duration of pacifier use was also associated with of MO. There was significant difference in the prevalence of MO between GConv and GOrth for AOB (P = 0.027). Only GConv exhibited higher odds of PCB compared to GC (P = 0.040). The prevalence of MO was significantly higher in pacifiers users (P < 0.001). CONCLUSION: The prevalence of MO was higher among children who used pacifiers. According to a general trend, the use of conventional pacifiers was

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associated to severe anterior open bite and overjet. 39. Livas C, Delli K. Does Orthodontic Extraction Treatment Improve the Angular Position of Third Molars? A Systematic Review. Journal of Oral & Maxillofacial Surgery 2017 Mar;75(3):475-483. PURPOSE: To systematically assess the available evidence on the effect of orthodontic extractions on third molar (M3) angulation. MATERIALS AND METHODS: Three databases were searched up to April 25, 2016 to identify orthodontic studies comparing M3 angular changes in patients with and without extraction. Information on methodology, treatment procedures, and outcome was retrieved from each study. Assessment of overall and individual quality of the included studies was performed using validated criteria. RESULTS: Fourteen retrospective studies were considered eligible for this systematic review. Two studies achieved a moderate evidence score, whereas the lowest grade was assigned to 12 studies. The overall evidence level was classified as limited. Meta-analysis was not feasible because of the high heterogeneity across studies. Based on the best available evidence, premolar extraction followed by fixed orthodontic appliances can substantially improve the angular position of M3s by 10degree to 18degree. CONCLUSIONS: There is limited evidence that orthodontic extractions can substantially enhance the uprighting of M3s. Clinicians should be aware of the potentially beneficial effect of orthodontic extraction treatment on M3 development, although well-designed prospective studies are necessary to strengthen this statement. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved. 40. Yang X, He Y, Chen T, et al. Differences between active and passive self-ligating brackets for orthodontic treatment : Systematic review and meta-analysis based on randomized clinical trials. Journal of Orofacial Orthopedics 2017 Mar;78(2):121-128. PURPOSE: In orthodontic treatment, the effects of differences in the design between active and passive self-ligating bracket (ASLB and PSLB, respectively) are usually neglected. This study investigated differences in effectiveness and efficiency between ASLBs and PSLBs. METHODS: To identify randomized, controlled clinical trials (RCTs) comparing ASLB with PSLB, the electronic databases Medline, Embase, Cochrane Central Register of Controlled Trials, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, and Chinese Medical Journal Database were searched without language or time limits. Relevant available dental journals and reference lists from included studies were manually searched for applicable reports. Meta-analyses were conducted with the Review Manager program. Two independent reviewers performed all search processes; disagreements were discussed with a third reviewer. RESULTS: Eight studies were included in the systematic review, of which six were included in the meta-analysis due to the data consistency. Three had a low risk of bias, four had an unclear risk of bias, and one had a high risk of bias. With regard to alignment efficiency, meta-analysis favors ASLB [mean difference (MD) -10.24 days, 95% confidence interval (CI) -17.68 to -2.80]. However, the same analysis does not favor either design in terms of width change due to treatment for intercanine (MD -0.49 mm, 95% CI -1.10 to 0.13 mm) interfirst premolar (MD -0.07 mm, 95% CI -0.69, 0.56 mm) intersecond premolar (MD -0.58 mm, 95% CI -1.25 to 0.08 mm) and intermolar (MD 0.10 mm, 95% CI -0.82 to 1.02 mm) width.

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CONCLUSIONS: Based on current clinical evidence from RCTs, ASLB appears to be more efficient for alignment, while neither design shows an advantage for width change. Further research is needed to confirm present results. 41. Ferreira JTL, Romano FL, Sasso Stuani MB, Assed Carneiro FC, Nakane Matsumoto MA. Traction of impacted canines in a skeletal Class III malocclusion: A challenging orthodontic treatment. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jun;151(6):1159-1168. This case report describes the successful traction of 2 severely impacted canines. The patient, a 7-year-old girl, had good general health, nasal breathing, crossbite of the lateral incisors and canines, and a Class I molar relationship. The panoramic radiograph showed that the permanent canines were positioned above the roots of the lateral incisors, with the right canine in an accentuated inclination. The cephalometric analysis showed a skeletal Class III malocclusion with a predominance of horizontal growth. The Haas appliance associated with maxillary protraction was used during the first stage of treatment for 14 months. The second stage included the extraction of the deciduous molars, distal movement of the permanent molars to create space, and traction of the canines, and was associated with complete orthodontic treatment. The patient showed good esthetic and functional results at the end of treatment, verified by the stability over a period of 8 years after retention. 42. Manosudprasit A, Haghi A, Allareddy V, Masoud MI. Diagnosis and treatment planning of orthodontic patients with 3-dimensional dentofacial records. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jun;151(6):1083-1091. INTRODUCTION: Cephalometrics has been the foundation of orthodontic diagnosis for many years. However, for many orthodontic patients, a lateral cephalogram might not be necessary. The aim of this study was to compare the diagnosis and treatment planning agreement between standard records and nonradiographic 3-dimensional (3D) dentofacial photogrammetry records. METHODS: Twenty patients had standard orthodontic records taken for their treatment as well as extraoral and intraoral 3D images. Twelve evaluators examined the standard records and then completed diagnosis and treatment planning questionnaires. They repeated the process 4 to 6 weeks later by using 3D photographic images along with the panoramic radiographs. Each evaluator also evaluated 2 random orthodontic cases twice with each method to evaluate consistency within each method. At the end of study, each evaluator was asked to complete a survey to document his or her experiences with the 3D photogrammetry method. Descriptive and kappa statistics were used to determine the agreement. RESULTS: Most diagnosis parameters had fair agreement between the methods and within each method. Skeletal and dental relationships had excellent agreement between and within the methods as well as most treatment decisions such as the need for extractions and surgery. Most evaluators (91.7%) thought that cephalometric x-rays would be needed only some of the time in diagnosis and treatment planning. Most evaluators (83.33%) thought that cephalometric radiographs are not needed in patients with a Class I +/- a quarter cusp with crowding or spacing. CONCLUSIONS: Most diagnostic decisions had fair agreement within and between the 2 methods. The decision to extract and the need for orthognathic surgery had excellent agreement between the cephalometric and photogrammetric methods. The majority of examiners agreed that patients with Class I malocclusions +/- a quarter cusp with no obvious skeletal discrepancy can be diagnosed and planned without a cephalometric radiograph. 43.

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Pittman JW, Bennett ME, Koroluk LD, Robinson SG, Phillips CL. Characterizing the orthodontic patient's purchase decision: A novel approach using netnography. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jun;151(6):1065-1072. INTRODUCTION: A deeper and more thorough characterization of why patients do or do not seek orthodontic treatment is needed for effective shared decision making about receiving treatment. Previous orthodontic qualitative research has identified important dimensions that influence treatment decisions, but our understanding of patients' decisions and how they interpret benefits and barriers of treatment are lacking. The objectives of this study were to expand our current list of decision-making dimensions and to create a conceptual framework to describe the decision-making process. METHODS: Discussion boards, rich in orthodontic decision-making data, were identified and analyzed with qualitative methods. An iterative process of data collection, dimension identification, and dimension refinement were performed to saturation. A conceptual framework was created to describe the decision-making process. RESULTS: Fifty-four dimensions captured the ideas discussed in regard to a patient's decision to receive orthodontic treatment. Ten domains were identified: function, esthetics, psychosocial benefits, diagnosis, finances, inconveniences, risks of treatment, individual aspects, societal attitudes, and child-specific influences, each containing specific descriptive and conceptual dimensions. A person's desires, self-perceptions, and viewpoints, the public's views on esthetics and orthodontics, and parenting philosophies impacted perceptions of benefits and barriers associated with orthodontic treatment. CONCLUSIONS: We identified an expanded list of dimensions, created a conceptual framework describing the orthodontic patient's decision-making process, and identified dimensions associated with yes and no decisions, giving doctors a better understanding of patient attitudes and expectations. 44. Steinnes J, Johnsen G, Kerosuo H. Stability of orthodontic treatment outcome in relation to retention status: An 8-year follow-up. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jun;151(6):1027-1033. INTRODUCTION: Our aim was to evaluate the stability of orthodontic treatment outcome and retention status 7 or more years after active treatment in relation to posttreatment or postretention time, type of retention appliance, and duration of retainer use. METHODS: The subjects were former patients who completed orthodontic treatment with fixed appliances from 2000 to 2007. The pretreatment eligibility criteria were anterior crowding of 4 mm or more in the maxilla or the mandible and Angle Class I or Class II sagittal molar relationship. Acceptable pretreatment and posttreatment dental casts were required. A total of 67 patients participated, 24 men and 43 women, with a mean age of 24.7 years (range, 20.0-50.0 years). All participants had a follow-up clinical examination, which included impressions for follow-up casts, and each completed a questionnaire. Data were obtained from pretreatment, posttreatment, and follow-up (T2) casts as well as from the patients' dental records. Treatment stability was evaluated with the peer assessment rating (PAR) index and Little's irregularity index. RESULTS: The participation rate was 64%. The average posttreatment time was 8.5 years (range, 7.0-11.0). All participants had received a retainer in the mandible, maxilla, or both after active treatment. At T2, the PAR score showed a mean relapse of 14%. The majority (78%) of participants still had a fixed retainer at T2 (retainer group), and 22% had been out of retention for at least 1 year (postretention group). The relapse according to the PAR did not differ significantly between participants with and without a retainer at T2. From posttreatment to T2, the irregularity of the mandibular incisors increased almost 3 times more in participants with no retainer in the mandible compared with those with an intact retainer at T2 (P = 0.001). In the maxilla, no corresponding difference was found. CONCLUSIONS: Our results suggest that occlusal relapse can be expected after active orthodontic treatment irrespective of long-term use of fixed retainers.

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Fixed canine-to-canine retainers seem effective to maintain mandibular incisor alignment, whereas in the maxilla a fixed retainer may not make any difference in the long term. 45. Larson BE, Lee NK, Jang MJ, Yun PY, Kim JW, Kim YK. Comparing Stability of Mandibular Setback Versus 2-Jaw Surgery in Class III Patients With Minimal Presurgical Orthodontics. Journal of Oral & Maxillofacial Surgery 2017 Jun;75(6):1240-1248. PURPOSE: The aim of this study was to compare treatment time and skeletal stability between mandibular setback surgery (MS) and 2-jaw surgery (2J) with minimal presurgical orthodontics (MPO) in patients with skeletal Class III. MATERIALS AND METHODS: One hundred ninety-five patients who underwent orthognathic surgery were enrolled in this retrospective cohort study. Consecutive patients were selected based on standardized inclusion criteria: Class III malocclusion with mandibular prognathism, surgery type, and presurgical orthodontics with non-extraction for less than 6 months (MPO). Lateral cephalograms were taken before surgery (T0), 1 month after surgery (T1), and at debonding (T2). To evaluate surgical changes (T0 to T1) and postsurgical changes (T1 to T2) in skeletodental tissue, linear, angular, and dental measurements were analyzed using paired t test and independent t test. RESULTS: Thirty-one patients were allocated to the MS-MPO group (n = 16) and the 2J-MPO group (n = 15). The 2J-MPO group showed a shorter duration of postsurgical orthodontic and total surgical and orthodontic treatment than the MS-MPO group. Although the 2J-MPO group exhibited advancement and superior impaction of the maxilla from T0 to T1, posterior movement with clockwise rotation of the mandible between the 2 groups did not show a statistical difference. In addition, from T1 to T2, the MS-MPO and 2J-MPO groups presented forward and upward movement and counterclockwise rotation of the mandible, but no intergroup difference was found. CONCLUSIONS: The MS-MPO and 2J-MPO groups showed similar horizontal and vertical mandibular stability. However, the 2J-MPO group presented a shorter surgical and orthodontic treatment time than the MS-MPO group. 46. Dumbryte I, Linkeviciene L, Linkevicius T, Malinauskas M. Enamel microcracks in terms of orthodontic treatment: A novel method for their detection and evaluation. Dental Materials Journal 2017 Jul 26;36(4):438-446. The study aimed at introducing current available techniques for enamel microcracks (EMCs) detection, and presenting a method for direct quantitative analysis of an individual EMC. Measurements of the detailed EMCs characteristics (location, length, and width) were taken from the reconstructed images of the buccal tooth surface (teeth extracted from two age groups of patients) employing a scanning electron microscopy (SEM) and our derived formulas before and after ceramic brackets removal. Measured parameters of EMCs for younger age group were 2.41 micro m (width), 3.68 mm (length) before and 2.73 micro m, 3.90 mm after debonding; for older -4.03 micro m, 4.35 mm before and 4.80 micro m, 4.37 mm after brackets removal. Following debonding EMCs increased for both groups, however the changes in width and length were statistically insignificant. Regardless of the age group, proposed method enabled precise detection of the same EMC before and after debonding, and quantitative examination of its characteristics. 47. Al-Moghrabi D, Salazar FC, Pandis N, Fleming PS.

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Compliance with removable orthodontic appliances and adjuncts: A systematic review and meta-analysis. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jul;152(1):17-32. INTRODUCTION: The primary aims of this systematic review were to assess objective levels of wear of removable orthodontic appliances and components vs both stipulated and self-reported levels. We also aimed to consider patient experiences and the effectiveness of interventions geared at enhancing compliance. METHODS: Electronic databases and reference lists of relevant studies were searched with no language restriction (PROSPERO: CRD42016036059). Randomized and nonrandomized controlled trials, prospective cohort studies, case series, qualitative and mixed-methods studies objectively assessing compliance levels were identified. The quality of the studies was assessed using the Cochrane Collaboration's risk of bias tool, risk of bias in non-randomized studies of interventions (ROBINS-I), or mixed-methods appraisal tool based on their design. RESULTS: Of 4269 records, 80 full texts were obtained, with 24 studies meeting the selection criteria. Of these, 11 were included in the quantitative synthesis. A weighted estimate of objectively assessed compliance levels in relation to stipulated wear time was calculated with the discrepancy highest in the headgear group (5.81 hours per day, 95% confidence interval, 4.98, 6.64) based on 6 studies. The mean discrepancy between self-reported and objectively assessed headgear wear was 5.02 hours per day (95% confidence interval, 3.64, 6.40). Compliance level was not directly related to appliance type (P = 0.211). Thematic synthesis was not undertaken because of the limited number of qualitative studies. CONCLUSIONS: Compliance with removable orthodontic appliances and adjuncts is suboptimal, and patients routinely overestimate duration of wear. Techniques for improving compliance have promise but require further evaluation in high-level research. 48. Mulimani PS. Evidence-based practice and the evidence pyramid: A 21st century orthodontic odyssey. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jul;152(1):1-8. Organized evidence-based practice is said to have started in the medical field in the late 20th century. Its principles and usage eventually spread to other health sciences, including orthodontics. Although the conceptual foundations and basic tenets of evidence-based orthodontics are based on the classical approach of testing medical interventions, differences unravel as we encounter the ground realities in orthodontics, which are unique due to the length, complexity, and diversity involved in orthodontic treatment and research. How has this led to the evolution of evidence-based orthodontics and changes in its applications? Is it being translated to better clinical answers, treatment strategies, patient satisfaction, and information for orthodontists? What more needs to be done, considering the rapidly changing orthodontic scenario? This article aims to explore these questions to evaluate how evidence-based orthodontics has played itself out so far, so that it can continue to grow strong and stand up to the challenges of 21st century orthodontics. 49. Smuthkochorn S, Palomo JM, Hans MG, Jones CS, Palomo L. Gingival crevicular fluid bone turnover biomarkers: How postmenopausal women respond to orthodontic activation. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jul;152(1):33-37. INTRODUCTION: Bone turnover associated with orthodontic tooth movement is evidenced by increased bone turnover markers in gingival crevicular fluid (GCF). Postmenopausal women have an increased concentration of serum bone turnover markers. The filtrate of this serum makes up GCF, but little is known of the bone turnover around teeth in this cohort. The objective of this investigation was to compare the GCF bone turnover markers in premenopausal

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vs postmenopausal women receiving orthodontic treatment at baseline and at orthodontic activation. METHODS: Twenty-eight women were enrolled in the study and separated into 2 groups: premenopausal (16) and postmenopausal (12). Bone turnover was evaluated by GCF at baseline and 24 hours after orthodontic appliance activation. GCF concentrations of RANKL and OPN were measured using ELISA. Baseline and change in concentrations were compared between groups. RESULTS: Baseline RANKL and OPN were significantly different between the premenopausal and postmenopausal groups (P <0.05). Both markers increased significantly from baseline to 24 hours after orthodontic appliance activation in both groups (P <0.05). However, the response to orthodontic activation was not significantly different between groups. CONCLUSIONS: Although postmenopausal women have a different bone turnover profile at baseline than do their premenopausal counterparts, there is no difference in their response to orthodontic activation. This confers a level of security associated with orthodontic activation. Future studies are warranted to construct biomarker curves throughout orthodontic therapy. 50. Tsiouli K, Topouzelis N, Papadopoulos MA, Gkantidis N. Perceived facial changes of Class II Division 1 patients with convex profiles after functional orthopedic treatment followed by fixed orthodontic appliances. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Jul;152(1):80-91. INTRODUCTION: The aim of this research was to investigate the perceived facial changes in Class II Division 1 patients with convex profiles after functional orthopedic treatment followed by fixed orthodontic appliances. METHODS: Pretreatment and posttreatment profile photographs of 12 Class II Division 1 patients treated with activators, 12 Class II Division 1 patients treated with Twin-block appliances, and 12 controls with normal profiles treated without functional appliances were presented in pairs to 10 orthodontists, 10 patients, 10 parents, and 10 laypersons. The raters assessed changes in facial appearance on a visual analog scale. Two-way multivariate analysis of variance was used to evaluate differences among group ratings. RESULTS: Intrarater reliability was strong in most cases (intraclass correlation coefficients, >0.7). The internal consistency of the assessments was high (alpha, >0.87), both within and between groups. The raters consistently perceived more positive changes in the Class II Division 1 groups compared with the control group. However, this difference hardly exceeded 1/10th of the total visual analog scale length in its highest value and was mostly evident in the lower face and chin. No significant differences were found between the activator and the Twin-block groups. CONCLUSIONS: Although the raters perceived improvements of the facial profiles after functional orthopedic treatment followed by fixed orthodontic appliances, these were quite limited. Thus, orthodontists should be tentative when predicting significant improvement of a patient's profile with this treatment option. 51. Zimmo N, Saleh MH, Mandelaris GA, Chan HL, Wang HL. Corticotomy-Accelerated Orthodontics: A Comprehensive Review and Update. Compendium of Continuing Education in Dentistry 2017 Jan;38(1):17-25; quiz 26. Of all the modalities reported to decrease orthodontic treatment time, corticotomy-accelerated orthodontics (CAO) is the only evidence-based approach. The aim of this article is to critically review the available evidence and to summarize the pros and cons of CAO. Articles published in the last 15 years related to CAO were screened and critically assessed. Based on the literature, CAO results in acceleration of the orthodontic treatment rate as much as three times on

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average, in addition to many benefits not commonly recognized by the profession or reported in the literature. CAO is effective and safe for shortening the orthodontic treatment time, as well as for enhancing interdisciplinary outcomes beyond what conventional treatment alone is able to yield. More investigations are needed to validate and verify, as well as understand, the long-term implications to treatment from both a periodontal and orthodontic outcome standpoint. 52. Morita H, Imai Y, Yoneda M, Hirofuji T. Applying orthodontic tooth extrusion in a patient treated with bisphosphonate and irradiation: a case report. Special Care in Dentistry 2017 Jan;37(1):43-46. Bisphosphonates and irradiation are useful medical treatments, but can often cause oral complications such as medication-related oral necrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) during oral surgery, including tooth extraction. Therefore, we should take all risks into consideration carefully before choosing dental treatment for patients with a medical history of such therapies. A 55-year-old woman who underwent cord blood transplantation to treat extranodal natural killer T (NK/T) cell lymphoma (nasal type IVB) had a medical history of bisphosphonate and irradiation treatments. We treated her residual tooth root by applying orthodontic extrusion to avoid extraction and successfully restored the tooth. Application of an orthodontic tooth extrusion technique for conservative treatment of a residual tooth is a useful means of avoiding MRONJ or ORN in patients who have a medical history of bisphosphonate and irradiation treatments. 53. Dumbryte I, Linkeviciene L, Linkevicius T, Malinauskas M. Does orthodontic debonding lead to tooth sensitivity? Comparison of teeth with and without visible enamel microcracks. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Feb;151(2):284-291. INTRODUCTION: Our aim was to assess the possible changes in sensitivity of teeth with and without visible enamel microcracks (EMCs) up to 1 week after the removal of metal brackets. METHODS: After debonding, 15 patients possessing teeth with visible EMCs and 15 subjects whose teeth were free of EMCs were enrolled in the study. For each experimental group, a control group was formed. The assessments of tooth sensitivity elicited by compressed air and cold testing were performed 5 times: just before debonding, immediately after debonding, and at 1, 3, and 7 days after debonding. Tooth sensitivity was recorded on a 100-mm visual analog scale. RESULTS: For the patients without visible EMCs, discomfort peaked immediately after debonding and started to decrease on day 1; at 1 week after debonding, the visual analog scale scores were lower than just before debonding and immediately after debonding. For the subjects possessing teeth with visible EMCs, the pattern of sensitivity dynamic was inherently the same. However, the patients with visible EMCs showed higher visual analog scale values at each time interval. CONCLUSIONS: Debonding leads to a short-term increase in tooth sensitivity. EMCs, a form of enamel damage, do not predispose to greater sensitivity perception in relation to bracket removal. 54. Heath EM, English JD, Johnson CD, Swearingen EB, Akyalcin S. Perceptions of orthodontic case complexity among orthodontists, general practitioners, orthodontic residents, and dental students.

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American Journal of Orthodontics & Dentofacial Orthopedics 2017 Feb;151(2):335-341. INTRODUCTION: Our aims were to assess the perceptions of orthodontic case complexity among orthodontists, general dentists, orthodontic residents, and dental students and to compare their perceptions with the American Board of Orthodontics Discrepancy Index (DI). METHODS: Orthodontists, general dentists, orthodontic residents, and dental students (n = 343) participated in a Web-based survey. Pretreatment orthodontic records of 29 cases with varying DI scores were obtained. Respondents were asked to evaluate case complexity on a 100-point visual analog scale. Additional information was collected on participants' orthodontic education and orthodontic treatment preferences. Pearson correlation coefficients were used to assess the relationship between the average complexity score and the DI score. Repeated measures analysis with linear mixed models was used to assess the association between the average complexity score and the DI score and whether the association between the 2 scores varied by level of difficulty or panel group. The level of significance for all analyses was set at P <0.05. RESULTS: The results showed that 71.6% of general dentists provided some orthodontic services, with 21.0% providing full fixed appliances and 38.3% providing clear aligners. DI score was significantly associated with complexity perceptions (P = 0.0168). Associations between average complexity and DI score varied significantly by provider group (P = 0.0033), with orthodontists and residents showing the strongest associations. When the DI score was greater than 15, orthodontists and residents perceived cases as more complex than did the other provider groups. CONCLUSIONS: Orthodontists and orthodontic residents had better judgments for evaluating orthodontic case complexity. The high correlation between orthodontic professionals' perceptions and DI scores suggested that additional orthodontic education and training have an influence on the ability to recognize case complexity. 55. Johnson EK, Fields HW, Jr., Beck FM, Firestone AR, Rosenstiel SF. Role of facial attractiveness in patients with slight-to-borderline treatment need according to the Aesthetic Component of the Index of Orthodontic Treatment Need as judged by eye tracking. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Feb;151(2):297-310. INTRODUCTION: Previous eye-tracking research has demonstrated that laypersons view the range of dental attractiveness levels differently depending on facial attractiveness levels. How the borderline levels of dental attractiveness are viewed has not been evaluated in the context of facial attractiveness and compared with those with near-ideal esthetics or those in definite need of orthodontic treatment according to the Aesthetic Component of the Index of Orthodontic Treatment Need scale. Our objective was to determine the level of viewers' visual attention in its treatment need categories levels 3 to 7 for persons considered "attractive," "average," or "unattractive." METHODS: Facial images of persons at 3 facial attractiveness levels were combined with 5 levels of dental attractiveness (dentitions representing Aesthetic Component of the Index of Orthodontic Treatment Need levels 3-7) using imaging software to form 15 composite images. Each image was viewed twice by 66 lay participants using eye tracking. Both the fixation density (number of fixations per facial area) and the fixation duration (length of time for each facial area) were quantified for each image viewed. Repeated-measures analysis of variance was used to determine how fixation density and duration varied among the 6 facial interest areas (chin, ear, eye, mouth, nose, and other). RESULTS: Viewers demonstrated excellent to good reliability among the 6 interest areas (intraviewer reliability, 0.70-0.96; interviewer reliability, 0.56-0.93). Between Aesthetic Component of the Index of Orthodontic Treatment Need levels 3 and 7, viewers of all facial attractiveness levels showed an increase in attention to the mouth. However, only with the attractive models were significant differences in fixation density and duration found between borderline levels with female viewers. Female viewers paid attention to different areas of the face than did male viewers.

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CONCLUSIONS: The importance of dental attractiveness is amplified in facially attractive female models compared with average and unattractive female models between near-ideal and borderline-severe dentally unattractive levels. 56. Jung SY, Park JH, Park HS, Baik HS. Transport distraction osteogenesis combined with orthodontic treatment in a patient with unilateral temporomandibular joint ankylosis. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Feb;151(2):372-383. Temporomandibular joint ankylosis manifests a range of clinical characteristics dependent upon the age of onset, the affected side, and the severity. When it occurs during development, mandibular growth is affected, resulting in severe retrusion or asymmetry as well as limitation of mandibular movements. Progressive asymmetric mandibular growth in unilateral ankylosis causes canting of the occlusal plane. In this case report, we present a successful temporomandibular joint reconstruction using transport distraction osteogenesis combined with camouflage orthodontic treatment for occlusal canting correction of a patient with unilateral temporomandibular joint ankylosis and severe facial asymmetry. 57. Macedo de Menezes L, Deon Rizzatto SM, Martinelli Santayana de Lima E, Baccarin Matje PR, Picarelli MM. Juvenile idiopatic arthritis in orthodontics: Case report with a 6-year follow-up. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Feb;151(2):384-396. Juvenile idiopathic arthritis is a childhood disease that causes joint swelling and pain, and limitation in the range of joint movements. It is characterized by progressive destruction of the joints. Juvenile idiopathic arthritis is the most frequent systemic inflammatory disease of the temporomandibular joint. When the temporomandibular joint is involved, orthodontic treatment becomes more challenging. This case report shows the treatment of a young patient with a Class II subdivision malocclusion and juvenile idiopathic arthritis. Excellent results were achieved and maintained at the 6-year follow-up, when neither clinical symptoms nor radiographic changes in the temporomandibular joint were seen. 58. Al Makhmari SA, Kaklamanos EG, Athanasiou AE. Short-term and long-term effectiveness of powered toothbrushes in promoting periodontal health during orthodontic treatment: A systematic review and meta-analysis. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Dec;152(6):753-766.e7. INTRODUCTION: Although powered toothbrushes have been reported to reduce gingivitis more than manual toothbrushes in the general population, the evidence regarding orthodontic patients has been inconclusive. Thus, we aimed to compare their effectiveness in relation to any available parameter regarding oral health in orthodontic patients with fixed appliances. METHODS: Searches without restrictions for published and unpublished literature and hand searching took place up to August 2017. Oral-health relevant data from randomized controlled trials of at least 4-weeks duration comparing powered and manual tooth brushing without supervision were reviewed. Data were classified as short term (assessments at 1-3 months) and long term (assessments at >3 months), and the random-effects method was used to combine treatment effects. Individual study risk of bias was assessed using the Cochrane Risk of Bias Tool, and the quality of evidence was evaluated according to the Grades of Recommendation, Assessment, Development and Evaluation approach.

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RESULTS: The initially identified articles were finally reduced to 9 randomized controlled trials investigating the periodontal health in 434 patients. Eight studies followed patients up to 3 months, and 1 up to 12 months during treatment. One study was at low and the rest at unclear risk of bias. Overall, in the short term, there was low-quality evidence that powered toothbrushes provide a statistically significant benefit compared with manual brushing with regard to the gingival index (weighted mean difference, -0.079; 95% confidence interval, -0.146 to -0.012; P = 0.021) and indexes assessing gingival bleeding (standardized mean difference, -0.637; 95% confidence interval, -1.092 to -0.183; P = 0.006). In the long term, only 1 available study showed a statistically significant benefit of powered over manual toothbrushes with regard to gingival index and bleeding. No differences were observed in probing pocket depth and relative attachment loss. For the rotation-oscillation brushes that involved the greatest body of evidence, statistically significant reductions in gingival index and bleeding were demonstrated only in the long-term study. No included study provided quantified measurements regarding caries activity. CONCLUSIONS: Overall, powered toothbrushes may promote gingival health better than manual toothbrushes in orthodontic patients. However, no type demonstrated clear superiority. Better study standardization and reporting in longer follow-up studies are necessary to elucidate the clinical relevance of these results. 59. Bianchi J, Pinto ADS, Ignacio J, Obelenis Ryan DP, Goncalves JR. Effect of temporomandibular joint articular disc repositioning on anterior open-bite malocclusion: An orthodontic-surgical approach. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Dec;152(6):848-858. An anterior open bite is a challenge to orthodontic treatment; it has a multifactorial etiology and a wide range of intervention options. Temporomandibular joint (TMJ) disorders are a risk factor for the development of malocclusions such as the anterior open bite, especially in patients who have TMJ osteoarthritis with disc displacement. Articular disc repositioning surgery is an available option for treating this pathology, and it contributes to maintaining the condyles in a more stable position. The aim of this article was to report the case of a 20-year-old woman diagnosed with anterior open bite and TMJ osteoarthritis with bilateral disc displacement. The patient received both orthodontic treatment and TMJ disc repositioning surgery. Cone-beam computed tomography was used to create 3-dimensional models of the condyles with regional superposition, and assessment of bone remodeling was performed at different time intervals. Complete orthodontic and surgical treatment time was approximately 12 months. The results provided a stable correction of the patient's anterior open bite with a 2-year follow-up and favorable bone remodeling of the condyles due to functional improvement of the TMJ. 60. Neely ML, Miller R, Rich SE, Will LA, Wright WG, Jones JA. Effect of malocclusion on adults seeking orthodontic treatment. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Dec;152(6):778-787. INTRODUCTION: Our objective was to examine the Teen Oral Health-related Quality of Life (TOQOL) questionnaire for use in adults receiving orthodontic treatment and assess validity and reliability by age group. METHODS: Teenagers from 10 to 18 years and adults 18 and over completed surveys at the orthodontic clinic at Boston University. The survey consisted of sociodemographic information, dental behavior questions, and the TOQOL instrument. Malocclusion severity was assessed using the Index of Orthodontic Treatment Need. RESULTS: Overall, 161 teens and 146 adults participated. The mean ages were 13 years for the teens and 32 years for the adults. Subjects were represented by both sexes and diverse racial and ethnic backgrounds. In general, scores overall and by domains were higher for adults than for teens,

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signifying a greater effect of the malocclusion on the quality of life. Mean TOQOL scores as well as emotional and social domain scores (P <0.001) were worse (17.6) in adults than in teens (11.9; P <0.01). Construct validity was supported by strong a association of TOQOL scores with self-reported oral health. The Cronbach alpha was higher in adults overall and for all domains (0.75 in adults compared with 0.68 in teens). CONCLUSIONS: Adults who come for orthodontic treatment appear to be more affected by their malocclusion than are teens. The total TOQOL score and the emotional and social domains were significantly higher for adults. The total TOQOL score and the emotional and social domains were significantly higher (worse) for adults than teens. This project suggested that TOQOL may be a useful way to measure the impact of malocclusion on the quality of life in both adults and teens. 61. Ulhaq A, Esmail Z, Kamaruddin A, et al. Alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires in orthodontic patients over 8 weeks: A multicenter randomized clinical trial. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Dec;152(6):744-752. INTRODUCTION: The objective of this 4-arm parallel study was to evaluate the alignment efficiency and esthetic performance of 4 coated nickel-titanium archwires over an 8-week period. METHODS: Patients in the permanent dentition requiring maxillary and mandibular fixed orthodontic treatment with a preadjusted edgewise appliance were eligible for inclusion. Patients attending 4 hospital departments (United Kingdom and Italy) were randomly allocated to 1 of 4 treatment interventions: (1) BioCosmetic (Forestadent, Pforzheim, Germany), 0.017 in; (2) Titanol (Forestadent), 0.016 in; (3) TP Aesthetic (TP Orthodontics, La Porte, Ind), 0.014 in; and (4) Tooth Tone (Ortho Organizers, Calsbad, Calif) 0.016 in. Block randomization with block sizes of 4 and 8 was used to ensure an allocation ratio of 1:1:1:1. The primary outcome was alignment efficiency determined by the reduction in Little's irregularity index (mm). Secondary outcomes were color change using the Commission Internationale de L'Eclairage L*a*b* system and percentage of coating loss. Blinding was only applicable to outcome assessment of alignment efficiency. Regression models with Sidak's multiple comparison of means were used to analyze the data. RESULTS: One hundred fifty patients (300 dental arches) were allocated to the treatment interventions, including 61 male and 89 female subjects with a mean age of 16.60 years. The average duration of follow-up was 63.65 days. Baseline characteristics for the archwire groups were similar. One patient was lost to follow-up. Five percent (n = 15) of the archwires fractured: BioCosmetic, 5.3% (n = 4); Titanol, 6.8% (n = 5); TP Aesthetic, 5.3% (n = 4); and Tooth Tone, 2.7% (n = 2). We analyzed 283 dental arches for alignment efficiency. There was no statistically significant difference for mean reduction in irregularity between the archwire groups (P = 0.627): BioCosmetic (n = 71), 3.86 mm (95% CI, 3.31-4.41); Titanol (n = 69), 4.51 mm (95% CI, 4.00-5.02); TP Aesthetic (n = 71), 4.13 mm (95% CI, 3.49-4.78); and Tooth Tone (n = 72), 4.21 mm (95% CI, 3.89-4.46). There was a statistically significant difference between archwire groups for color change (P = 0.001) and percentage of coating loss (P = 0.001), with BioCosmetic performing best in both parameters. CONCLUSIONS: There was no difference between the archwires for alignment efficiency. BioCosmetic performed statistically significantly better than did the other groups for both color change and coating loss. REGISTRATION: This trial was registered with the East Midlands NHS Research Ethics Committee (12/EM/0190). PROTOCOL: The protocol was not published before trial commencement. 62. Varga S, Spalj S, Anic Milosevic S, et al.

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Changes of bite force and occlusal contacts in the retention phase of orthodontic treatment: A controlled clinical trial. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Dec;152(6):767-777. INTRODUCTION: We aimed to determine whether appliance type affects changes in maximum voluntary bite force (MVBF) and the number of occlusal contacts (NOC) during retention, controlling for sex, age, and body mass index. METHODS: The sample comprised 176 examinees (70 male, 106 female) aged 14 to 20 years: 30 had maxillary and mandibular Essix retainers, 30 had wrap-around retainers, and 30 had a combination of fixed mandibular canine-to-canine retainers bonded on each tooth separately (double twisted, 0.254 mm in diameter, stainless steel ligature wire) and Essix retainer in the maxillary arch; 86 with normal occlusion were not treated. MVBF and the NOC were measured immediately after removal of preadjusted edgewise appliances (Roth prescription), 6 weeks after that, and after the next 4 weeks. RESULTS: Increases in MVBF and the NOC were demonstrated, but subjects with 2 Essix retainers showed lower values than did the others. Changes were related to type of appliance, sex, and age (P <0.05) but not to body mass index. The increase in NOC occurred faster than the increase of MVBF, more and sooner with the wrap-around retainer and in male subjects than with the Essix and in female subjects. MVBF and NOC nearly reached the values of the control subjects. CONCLUSIONS: Settling of the occlusion depends on appliance type: it takes longer in female patients and with Essix in both dental arches than with the other tested appliances. 63. Penning EW, Peerlings RHJ, Govers JDM, et al. Orthodontics with Customized versus Noncustomized Appliances: A Randomized Controlled Clinical Trial. Journal of Dental Research 2017 Dec;96(13):1498-1504. This randomized controlled trial aimed to evaluate the duration and outcome quality of orthodontic treatment with a customized fixed appliance system versus a noncustomized system. Patients ( n = 180) were randomized and received orthodontic treatment with the Insignia customized orthodontic system or the Damon Q noncustomized orthodontic system. The allocation sequence was concealed using identical, sequentially numbered, opaque, sealed envelopes. Patients with nonextraction treatment plans were treated by 2 equally experienced orthodontists. Pretreatment and posttreatment plaster casts were made for each patient, and the models were rated using the Peer Assessment Rating (PAR) score. Planning time, treatment duration, and numbers of loose brackets, visits, and complaints were recorded. The examined null hypothesis was that the customized appliance system was not associated with significantly ( P < 0.05) shorter treatment duration compared to a noncustomized appliance. We analyzed 85 patients in the customized group and 89 in the noncustomized group. Treatment duration was 1.29 +/- 0.35 y in the customized group and 1.24 +/- 0.37 y in the noncustomized group. In the customized group, the PAR score was 23.32 +/- 9.15 pretreatment and 5.38 +/- 3.75 posttreatment. In the noncustomized group, the PAR score was 21.84 +/- 7.95 pretreatment and 5.93 +/- 3.58 posttreatment. None of these outcomes significantly differed between groups. On the other hand, the orthodontist had a significant effect on treatment duration, quality of treatment outcome, and number of visits ( P < 0.05). A higher PAR score pretreatment was associated with increased treatment duration, posttreatment PAR, and number of visits ( P < 0.05). Compared to the noncustomized group, the customized group had more loose brackets, a longer planning time, and more complaints ( P < 0.05). The customized orthodontic system was not associated with significantly reduced treatment duration, and treatment quality was comparable between the 2 systems ( ClinicalTrials.gov : NCT01268852). 64. Chung CH, Tadlock LP, Barone N, et al.

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Common errors observed at the American Board of Orthodontics clinical examination. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Aug;152(2):139-142. The American Board of Orthodontics has developed tools to help examinees select patients to be used for the Board examination. The Case Management Form can be used to evaluate aspects of a patient's treatment that cannot be measured by other tools. The Case Management Form is a structured treatment-neutral assessment of orthodontic objectives and outcomes associated with a patient's treatment. Despite the availability of this form, examiners continue to see problems, including lack of attention to finishing details, inappropriate treatment objectives, excessive proclination of mandibular incisors due to treatment mechanics, excessive expansion of mandibular intercanine width, closing skeletal open bite with extrusion of anterior teeth leading to excessive gingival display, and failure to recognize the importance of controlling the eruption or extrusion of molars during treatment. In addition, some examinees exhibit a lack of understanding of proper cephalometric tracing and superimposition techniques, which lead to improper interpretation of cephalometric data and treatment outcomes. 65. Jashinsky JM, Liles S, Schmitz K, Ding D, Hovell M. Risk factors for tobacco susceptibility in an orthodontic population: An exploratory study. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Aug;152(2):171-177. INTRODUCTION: Tobacco use is related to increased periodontal disease, tooth loss, and decreased success of orthodontic appliances, and it may inhibit orthodontic tooth movement. Most smokers start during adolescence. Since most cessation attempts fail, prevention appears necessary. METHODS: A cross-sectional sample of orthodontic patients reported hypothesized risk factors for smoking and susceptibility to tobacco use initiation. Exploratory analyses regressed susceptibility to tobacco initiation on each hypothesized predictor variable in a separate logistic model that included a standard set of covariates. RESULTS: Significant odds ratios (OR) were found for the presence of a smoker in the home (OR, 2.168; 95% confidence interval [CI], 1.144-4.107), a friend having no-smoking rules in his or her home and car (OR, 0.337; 95% CI, 0.128-0.886), having been offered a cigarette (OR, 4.526; 95% CI, 1.190-17.207), and exposure to tobacco advertisements (OR, 1.910; 95% CI, 1.044-3.496). CONCLUSIONS: Peer, family, and environmental factors appear to increase children's susceptibility to smoking in orthodontic populations. Attention to such factors could help dental clinicians to more effectively identify susceptible young patients in need of antismoking advice. Prospective and experimental studies are required to confirm the role that dental clinicians might play in youth smoking prevention. 66. Lin F, He Y, Ni Z, et al. Individualized intervention to reduce anxiety in adult orthodontic patients based on Q methodology. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Aug;152(2):161-170. INTRODUCTION: In this study, we used Q methodology to assess the concerns of adults seeking orthodontic treatment and to determine individualized interventions to reduce their anxiety. METHODS: Statements of concern were derived by in-depth interviews with 70 adult patients. Q sorting methodology was then used to identify the main factors associated with anxiety in a cohort of 40 adults who had not been involved in the first part of the study. The final stage involved a randomized study in which 160 new adult patients were recruited and randomized into intervention and control groups. Participants in the intervention group sorted the statements,

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after which individualized interventions were implemented. Participants in the control group received routine treatment. The State-Trait Anxiety Inventory was used to measure changes in participants' anxiety levels before and during treatment. RESULTS: In total, 41 statements were identified, and participants were classified according to 5 factors. Factor 1 participants were concerned about the lack of treatment information; factor 2 represented concerns about cost and other people's opinions; factor 3 represented concerns about impact on work related to wearing braces; factor 4 encompassed concerns about treatment effects, pain, and dental fears; and factor 5 reflected concerns about side effects and finding a partner. The mean state anxiety inventory scores for both the intervention and control groups were highest 24 hours after bonding (intervention group, 44.63 +/- 4.49; control group, 49.43 +/- 5.42). The intragroup state anxiety inventory scores differed significantly across the 6 time points (P <0.01), with the state anxiety inventory scores of the intervention group significantly lower than those of the control group (P <0.01) at all time points except baseline. No significant intergroup or intragroup differences were found in relation to trait anxiety. CONCLUSIONS: Adult orthodontic patients expressed diverse concerns. Individualized interventions based on Q methodology may reduce anxiety in this patient population. 67. Lisboa CO, Borges MS, Medeiros PJD, Motta AT, Mucha JN. Orthodontic-surgical retreatment of facial asymmetry with occlusal cant and severe root resorption: A 3-year follow-up. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Aug;152(2):268-280. Our objective was to report the orthodontic and surgical retreatment of a patient who had undergone a prolonged orthodontic treatment with extractions, but who had unsatisfactory results and persistent side effects. The man, aged 25 years 3 months, sought treatment with major complaints of facial and smile asymmetries. The clinical examination showed a mandibular deviation to the right and a maxillary occlusal cant. A Class II Division 1 subdivision right was observed. Radiographic examination showed extensive root resorptions in the maxillary second premolars and absence of the 4 first premolars. The maxillary midline was deflected 2 mm to the left, and the mandibular midline was shifted 5 mm to the right. Aligning and leveling were performed with orthodontic fixed appliances, with a standard edgewise system (0.022 x 0.028 in), followed by LeFort I maxillary impaction and bilateral sagittal split osteotomy with asymmetrical advancement. Retreatment showed outstanding results that remained stable after 3 years of follow-up. Root resorption in the second premolars did not seem to increase. Orthodontic-surgical intervention is the main choice for correcting esthetic and functional problems in facial asymmetry, particularly in cases of retreatment. 68. Parker K, Cunningham SJ, Petrie A, Ryan FS. Randomized controlled trial of a patient decision-making aid for orthodontics. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Aug;152(2):154-160. INTRODUCTION: Patient decision-making aids (PDAs) are instruments that facilitate shared decision making and enable patients to reach informed, individual decisions regarding health care. The objective of this study was to assess the efficacy of a PDA compared with traditional information provision for adolescent patients considering fixed appliance orthodontic treatment. METHODS: Before treatment, orthodontic patients were randomly allocated into 2 groups: the intervention group received the PDA and standard information regarding fixed appliances, and the control group received the standard information only. Decisional conflict was measured using the Decisional Conflict Scale, and the levels of decisional conflict were compared between the 2 groups.

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RESULTS: Seventy-two patients were recruited and randomized in a ratio of 1:1 to the PDA and control groups. Seventy-one patients completed the trial (control group, 36; PDA group, 35); this satisfied the sample size calculation. The median total Decisional Conflict Scale score in the PDA group was lower than in the control group (15.63 and 19.53, respectively). However, this difference was not statistically significant (difference between groups, 3.90; 95% confidence interval of the difference, -4.30 to 12.11). Sex, ethnicity, age, and the time point at which patients were recruited did not have significant effects on Decisional Conflict Scale scores. No harm was observed or reported for any participant in the study. CONCLUSIONS: The results of this study showed that the provision of a PDA to adolescents before they consented for fixed appliances did not significantly reduce decisional conflict. There may be a benefit in providing a PDA for some patients, but it is not yet possible to say how these patients could be identified. REGISTRATION: This trial was registered with the Harrow National Research Ethics Committee (reference 12/LO/0279). PROTOCOL: The protocol was not published before trial commencement. 69. Uesugi S, Kokai S, Kanno Z, Ono T. Prognosis of primary and secondary insertions of orthodontic miniscrews: What we have learned from 500 implants. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Aug;152(2):224-231. INTRODUCTION: Although the success of using orthodontic miniscrews for primary insertion has been reported in the literature, few studies have followed up on secondary insertions after failure of the first insertion. In this study, we investigated not only the primary but also secondary success rates of miniscrews and considered the risk factors influencing their stability. METHODS: Five hundred miniscrews were inserted for orthodontic anchorage in 240 patients. Ninety-eight miniscrews lacked stability; thus, 77 of these were removed and reinserted. We calculated and compared the primary and secondary success rates of insertion. Moreover, we investigated which clinical parameters affected the stability of miniscrews. RESULTS: The success rate of secondary insertion (44.2%) was significantly lower than that of primary insertion (80.4%). The screw length and jaw receiving the insertion were significantly associated with the stability of miniscrews. The 8.0-mm miniscrews were significantly more stable than the 6.0-mm miniscrews, and the success rate for insertions into the maxilla was significantly higher than that for the mandible. CONCLUSIONS: Secondary insertions lack stability; therefore, clinicians should be aware of the reduced success rate of reinsertion and know the risk factors to avoid failure of secondary insertions. 70. Yehya Mostafa R, Bous RM, Hans MG, Valiathan M, Copeland GE, Palomo JM. Effects of Case Western Reserve University's transverse analysis on the quality of orthodontic treatment. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Aug;152(2):178-192. INTRODUCTION: The purpose of this study was to evaluate the effect of using the transverse analysis developed at Case Western Reserve University (CWRU) in Cleveland, Ohio. The hypotheses were based on the following: (1) Does following CWRU's transverse analysis improve the orthodontic results? (2) Does following CWRU's transverse analysis minimize the active treatment duration? METHODS: A retrospective cohort research study was conducted on a randomly selected sample of 100 subjects. The sample had CWRU's analysis performed retrospectively, and the sample was divided according to whether the subjects followed what CWRU's transverse analysis would have suggested. The American Board of Orthodontics discrepancy index was used to assess the pretreatment records, and quality of the result was evaluated using the

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American Board of Orthodontics cast/radiograph evaluation. The Mann-Whitney test was used for the comparison. RESULTS: CWRU's transverse analysis significantly improved the total cast/radiograph evaluation scores (P = 0.041), especially the buccolingual inclination component (P = 0.001). However, it did not significantly affect treatment duration (P = 0.106). CONCLUSIONS: CWRU's transverse analysis significantly improves the orthodontic results but does not have significant effects on treatment duration. 71. Cassetta M, Pranno N, Stasolla A, et al. The effects of a common stainless steel orthodontic bracket on the diagnostic quality of cranial and cervical 3T- MR images: a prospective, case-control study. Dento-Maxillo-Facial Radiology 2017 Aug;46(6):20170051. OBJECTIVES: To evaluate the effect of orthodontic stainless steel brackets and two different types of archwires on the diagnostic quality of 3-T MR images. METHODS: This prospective, case-control study was conducted following Strengthening the Reporting of Observational Studies in Epidemiology guidelines. The recruitment was conducted among orthodontic patients. 80 subjects, requiring MRI for the presence of temporomandibular disorders, were enrolled and divided into four groups: 20 patients using aligners (control group); 20 patients with stainless steel brackets without archwires; 20 patients with stainless steel brackets and nickel-titanium archwires; and 20 patients with stainless steel brackets and stainless steel archwires. Two experts in neuroradiology evaluated the images to determine the amount of distortion in 6 regions and 48 districts. A score was subjectively assigned according to a modified receiver operating characteristic method of distortion classification. Any disagreement was resolved through consensus seeking; when this was not possible, a third neuroradiologist was consulted. The following statistical methods were used: descriptive statistics, Cohen's kappa coefficient (k), Kruskal-Wallis test, pairwise comparisons using the Dunn-Bonferroni approach. The significance was set at p<=0.05. RESULTS: The presence of stainless steel brackets with or without archwires negatively influenced MRI of the cervical region, paranasal sinuses, head and neck region, and cervical vertebrae but did not influence MRI of brain and temporomandibular joint regions. CONCLUSIONS: Patients with a stainless steel multibracket orthodontic appliance should remove it before cervical vertebrae, cervical region, paranasal sinuses, and head and neck MRI scans. The brain and temporomandibular joint region MRI should not require the removal of such appliances. 72. Bock NC, Seibold L, Heumann C, Gnandt E, Roder M, Ruf S. Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part I: photographic data evaluation. European Journal of Orthodontics 2017 Apr 01;39(2):134-143. Background: White spot lesions (WSLs) are a frequent side-effect of multibracket appliance treatment. The effect of local fluoridation on post-orthodontic WSL is however inconclusive. Objective: Assessment of WSL changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment. Trial design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study. Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding. Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24). Outcomes: Photographic WSL assessment (dimension and luminance) of the upper front teeth (T0-T5).

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Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each). Recruitment: The clinical study duration lasted from March 2011 to September 2013. Blinding: Unblinding was performed after complete data evaluation. Numbers analysed: Intent-to-treat analysis set comprising 39 participants (test: n = 21, placebo: n = 18). Outcome: Dimensional WSL quantification showed limited reliability. Luminance improvement (%) of WSL, however, was seen after 6 months (test/placebo: tooth 12, 24.8/18.0; tooth 11, 38.4/35.4; tooth 21, 39.6/38.3; and tooth 22, 15.2/25.0). No statistically significant group difference existed. Data suggest that WSLs are difficult to measure with respect to reliability and repeatability and methods for monitoring WSLs in clinical trials require improvement/validation. Harms: Similar adverse events occurred in both groups; none was classified as possibly related to the study product. Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation. Conclusion: Based on the results of this study, no difference could be detected with respect to the development of WSL under post-orthodontic high-dose fluoride treatment. Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731). Protocol: The protocol wasn't published before trial commencement. 73. Bock NC, Seibold L, Heumann C, Gnandt E, Roder M, Ruf S. Changes in white spot lesions following post-orthodontic weekly application of 1.25 per cent fluoride gel over 6 months-a randomized placebo-controlled clinical trial. Part II: clinical data evaluation. European Journal of Orthodontics 2017 Apr 01;39(2):144-152. Background: White spot lesions (WSL) frequently occur as side-effect of multibracket appliance treatment. The clinical effects of local fluoridation on post-orthodontic WSL and oral health development are however inconclusive. Objective: In vivo monitoring of clinical WSL and oral health changes in response to weekly 1.25 per cent fluoride gel application after multibracket appliance treatment. Trial design: Randomized, single-centre, double-blind, parallel-group, placebo-controlled study. Participants: Patients with not less than 1 WSL (modified score 1 or 2) on not less than 1 upper front teeth after debonding. Interventions: Professional fluoride/placebo gel application during weeks 1-2; self-administered home application (weeks 3-24). Outcomes: Clinical evaluation of WSL index, lesion activity, plaque index, gingival bleeding index, and decayed, missing, and filled teeth index as well as saliva buffer capacity and stimulated salivary flow rate (T0-T5). Randomization: Random assignment to test (n = 23) or placebo group (n = 23) using a sequentially numbered list (random allocation sequence generated for 50 subjects in 25 blocks of 2 subjects each). Recruitment: The clinical study duration lasted from March 2011 to September 2013. Blinding: Unblinding was performed after complete data evaluation. Numbers analysed: Intention-to-treat analysis set comprised 39 participants (test: n = 21, placebo: n = 18). Outcome: No clinical parameter except stimulated salivary flow rate (fluoride group: 1.1ml/min, placebo group: 0.74ml/min; P = 0.022) showed a statistically

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significant group difference after 24 weeks. Harms: Several adverse events occurred similarly frequent in both groups; none was classified as possibly related to the study product. Limitations: The number of dropouts was higher than expected and the socio-economic status was not assessed. Furthermore, the unknown level of compliance during the home application phase must be considered as limitation. Conclusion: Based on the results of this study, no clinical effect of post-orthodontic high-dose fluoride treatment on WSL and oral health changes could be detected. Registration: The study was registered with ClinicalTrials.gov (Identifier: NCT01329731). Protocol: The protocol wasn't published before trial commencement. 74. Hochli D, Hersberger-Zurfluh M, Papageorgiou SN, Eliades T. Interventions for orthodontically induced white spot lesions: a systematic review and meta-analysis. European Journal of Orthodontics 2017 Apr 01;39(2):122-133. Background: Although orthodontic white spot lesions (WSLs) are one of the most often and most evident adverse effects of comprehensive fixed appliance treatment, the efficacy of interventions for WSLs has not yet been adequately assessed in an evidence-based manner. Objective: Aim of this systematic review was to assess the therapeutic and adverse effects of interventions to treat post-orthodontic WSLs from randomized trials in human patients. Search methods: An unrestricted electronic search of eight databases from inception to May 2016. Selection criteria: Randomized controlled trials assessing any interventions for post-orthodontic WSLs on human patients. Data collection and analysis: After duplicate study selection, data extraction, and risk of bias assessment according to the Cochrane guidelines, random-effects meta-analyses of mean differences (MDs), standardized mean differences (SMDs), and odds ratios (ORs), including their 95% confidence intervals (CIs) were performed, followed by subgroup and sensitivity analyses. Results: A total of 20 unique studies and a total of 942 (42 per cent male and 58% per cent female) patients were included, with an average age of 16.2 years and a mean number of 8.2 WSLs (range 2.2 to 45.4) per patient. These were allocated to adjunct treatment with casein phosphopeptide-stabilized amorphous calcium phosphate creams, external tooth bleaching, low- or high-concentration fluoride films, gels, mouthrinses or varnishes, resin infiltration, miswak chewing sticks, bioactive glass toothpastse, or to no adjunct treatment (i.e. conventional oral hygiene). The monthly use of fluoride varnish was the best supplement to improve WSLs in terms of lesion area (1 trial; MD = -0.80 mm2; 95% CI = -1.10, -0.50 mm2; P < 0.05; high quality) and enamel fluorescence (3 trials; SMD = -0.92; 95% CI = -1.32, -0.52; P < 0.05; high quality), followed by the use of fluoride film. WSL treatment did not provide a considerable improvement in their clinical evaluation (3 trials; OR = 0.97; 95% CI = 0.60, 1.56; P > 0.05; moderate quality), with imprecision due to small sample size being the main limitation of existing evidence. Conclusions: Based on the existing trials, interventions for post-orthodontic WSLs, mainly fluoride varnish, seem to be effective, but further research is needed to elucidate their clinical relevance. Registration: PROSPERO (CRD42016037538). 75. Masoud MI, Bansal N, J CC, et al.

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3D dentofacial photogrammetry reference values: a novel approach to orthodontic diagnosis. European Journal of Orthodontics 2017 Apr 01;39(2):215-225. Background: Orthodontic diagnostic standards generally use the cranial base as a reference and rely on samples selected by orthodontists. Objective: The purpose of this study was to provide male and female standards for a novel non-radiographic approach for orthodontic diagnosis that utilizes 3D dentofacial photogrammetry using the eyes and natural head orientation as references instead of the cranial base. Methods: One hundred and eighty females and 200 males between the ages of 18 and 35 years from 2 modeling agencies were orthodontically screened for near ideal occlusion. Subjects that met the inclusion criteria were rated by a sample of 40 lay people for attractiveness on a visual analogue scale. The final sample that had 3D facial and dental imaging included 49 subjects 25 males and 24 females with near ideal occlusion and considered attractive by the public. Results: Inter and Intra-examiner ICC were greater than 0.8 for both landmarking and indexing. Relative to a coronal plane contacting the pupils (MC), the mean sagittal position of the alar curvature (representing the nasomaxillary complex) was 14.36 +/- 3.08 mm in males and 12.4 +/- 3.58 mm in females. The sagittal position of soft tissue pogonion relative to the pupils was 14.84 +/- 3.63 mm in males and 12.78 +/- 5.68 mm in females. The angle between the alar curvature and pogonion relative to the pupils was 9degree in males and 10degree in females. With the exception of the occlusal plane which was steeper in females, no ratios or angular facial measurements showed a significant gender difference. Relative to MC, males had more proclined upper incisors (20degree vs 16degree) and more retroclined Lower incisors (27degree vs 31degree; P > 0.05). A Procrustes ANOVA and permutation test showed that the shapes of males and females are different enough to be considered two distinct populations. Conclusions: 1. When using the proposed method for orthodontic diagnosis, male and female patients should be compared to their respective dentofacial standards. 2. Validation of the proposed method and standards on an orthodontic population is underway to determine the scope its use. 76. Peck S. Extractions, retention and stability: the search for orthodontic truth. European Journal of Orthodontics 2017 Apr 01;39(2):109-115. Background and objectives : From the beginnings of modern orthodontics, questions have been raised about the extraction of healthy permanent teeth in order to correct malocclusions. A hundred years ago, orthodontic tooth extraction was debated with almost religious intensity by experts on either side of the issue. Sheldon Friel and his mentor Edward H. Angle both had much to say about this controversy. Today, after significant progress in orthodontic practice, similar arguments are being voiced between nonextraction expansionists and those who see the need for tooth extractions in some orthodontic patients. Furthermore, varying concepts of mechanical retention of treatment results have evolved over the years which have been misinterpreted as enhancing natural orthodontic stability. Materials and methods : In this essay, representing the Ernest Sheldon Friel Memorial Lecture presented in 2016 at the 92nd Congress of the European Orthodontic Society, a full spectrum of evidence from biology, anthropology and history is critically discussed in the search for truth among highly contested orthodontic variables: extraction versus nonextraction, fixed retention versus limited retention, and rationalized stability versus biological homeostasis. Conclusions and implications : Conscientious clinicians should try to develop individualized treatment plans for their patients, and not be influenced by treatment 'philosophies' with untested claims in clinical orthodontics. 77. Schott TC, Meyer-Gutknecht H, Mayer N, Weber J, Weimer K.

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A comparison between indirect and objective wear-time assessment of removable orthodontic appliances. European Journal of Orthodontics 2017 Apr 01;39(2):170-175. Background/Objectives : Patients do not always adhere to the wear times prescribed for removable orthodontic appliances. We evaluated the validity and usability of indirect wear-time assessment methods by comparing wear-time estimates with microelectronically measured wear times in patients with removable orthodontic appliances. Methods : Wear times of 33 expansion plates, 34 functional appliances, and 42 retention plates of patients aged 6-20 years (12.3+/-2.9 years, 50.5% female) were indirectly determined by practitioners using a questionnaire assessing five parameters on a 5-point Likert scale: appliance handling, appliance appearance, bite shift, tooth movement, and appliance fit. The perceived difficulty in assessing each parameter was rated. Actual wear times were evaluated with microelectronic sensors in the appliances. Results : Regression analyses revealed that practitioners' decisions about wear times varied depending on the type of appliance and criteria used, with only one standard criterion best predicting estimated wear time for each appliance. Different standard criteria were better predictors of measured wear time: 22.3% of wear-time variability was explained by expansion plate appearance, 31.2% by functional appliance handling, and 18.8% by retainer fitting. However, practitioners rated the difficulty of assessment in most cases as 'easy'. Limitations : The study was not double blinded for technical reasons, and practitioners may have considered the evaluation criteria more carefully than in normal daily practice. Conclusions : Practitioners' decisions about wear times based on standard criteria strongly vary depending on the type of appliance and criteria used. 78. Sonesson M, Bergstrand F, Gizani S, Twetman S. Management of post-orthodontic white spot lesions: an updated systematic review. European Journal of Orthodontics 2017 Apr 01;39(2):116-121. Background/objectives : The management of post-orthodontic white spot lesions is based on remineralization strategies or a minimal-invasive camouflage of the lesions. Aim : The aim of this systematic review was to identify and assess the quality of evidence for the various clinical technologies. Search methods : Four databases were searched for relevant literature published in English between 2011 and 31 October 2015 according to a pre-determined PICO. Only controlled clinical studies were considered. Abstract lists and the selected full-text papers were independently examined by two reviewers and any differences were solved in consensus. The Cochrane handbook and the AMSTAR tool were used for grading the risk of bias. The quality of evidence was rated according to GRADE. Results : Out of 280 identified publications, seven studies on remineralization, micro-abrasion and resin infiltration met the inclusion criteria. Two of them were assessed with low risk of bias. No pooling of results was possible due to study heterogeneity. The quality of evidence for all technologies was graded as very low. Limitations : Only papers published in English with more than 20 adolescents or young adults were considered. Furthermore, a follow-up period of at least 8 weeks was required. The publication bias could not be assessed due to the paucity of included trials. Conclusions/clinical implications : There is a lack of reliable scientific evidence to support re-mineralizing or camouflaging strategies to manage post-orthodontic white spot lesions. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

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79. Graham DM, Graham MJ, Mupparapu M. Use of redundant arrays of inexpensive disks in orthodontic practice. American Journal of Orthodontics & Dentofacial Orthopedics 2017 Apr;151(4):816-820. In a time when orthodontists are getting away from paper charts and going digital with their patient data and imaging, practitioners need to be prepared for a potential hardware failure in their data infrastructure. Although a backup plan in accordance with the Security Rule of the Health Insurance Portability and Accountability Act (HIPAA) of 1996 may prevent data loss in case of a disaster or hard drive failure, it does little to ensure business and practice continuity. Through the implementation of a common technique used in information technology, the redundant array of inexpensive disks, a practice may continue normal operations without interruption if a hard drive fails. Copyright © 2017 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved. 80. Chan A, Antoun JS, Morgaine KC, Farella M. Accounts of bullying on Twitter in relation to dentofacial features and orthodontic treatment. Journal of Oral Rehabilitation 2017 Apr;44(4):244-250. Social media offers an accessible resource for gaining valuable insights into the social culture of bullying. The purpose of this study was to qualitatively analyse Twitter posts for common themes relating to dentofacial features, braces and bullying. Twitter's database was searched from 2010 to 2014 using keywords relevant to bullying, teeth and orthodontics. Two investigators assessed the Twitter posts, and selected those that conveyed the experiences or opinions of bullying victims. The posts were qualitatively analysed using thematic analysis. Of the 548 posts screened, 321 were included in the final sample. Four primary categories relating to 'dental-related bullying' were identified: (i) morphological features, (ii) psychological and psychosocial impact, (iii) coping mechanisms and (iv) the role of family. Bullied individuals reported a diverse range of psychological impacts and coping mechanisms. Secondary categories were also identified. Family members, for example, were found to play both a contributory and mediatory role in bullying. In summary, social media can provide new and valuable information about the causal factors and social issues associated with oral health-related bullying. Importantly, some coping mechanisms may mitigate the negative effects of bullying. 81. Long H, Gao M, Zhu Y, et al. The effects of menstrual phase on orthodontic pain following initial archwire engagement. Oral Diseases 2017 Apr;23(3):331-336. OBJECTIVES: To explore the effects of menstrual cycle on orthodontic pain following initial archwire engagement. METHODS: Female participants with regular menstrual cycles were recruited and assigned into follicular group or luteal group. Demographical and baseline variables were collected: age, education, menstrual duration, anxiety, oral health impact profile-14 (OHIP-14), and index of complexity outcome and need (ICON). Following initial archwire engagement, orthodontic pain was determined through visual analogue scale (VAS) on 1st day, 2nd day, and 3rd day. Demographical and baseline variables were compared between the two groups. Two-way repeated-measures anova was used to examine the effects of menstrual phase, time, and their interactions on orthodontic pain. Multivariate linear regression was employed to examine the independent effect of each variable on orthodontic pain.

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RESULTS: Finally, 37 and 39 were assigned to the follicular and luteal groups, respectively, with balanced demographical and baseline data. Orthodontic pain was significantly affected by menstrual phase and time (both P < 0.001), but there was no interaction (P > 0.05). Moreover, orthodontic pain was independently predicted by menstrual phase, OHIP, education level, and anxiety (all P < 0.05). CONCLUSION: We suggest that practitioners arrange female patients to receive initial archwire engagement during their follicular phases to relieve orthodontic pain. 82. Ko SJ, Seo JY, Kwon YD, Cheon K, Park JH. Orthodontic Treatment in Conjunction with Twin-bock Treatment and Growth Hormone Therapy in Silver Russell Syndrome. Journal of Clinical Pediatric Dentistry 2017;41(5):392-397. Silver-Russell syndrome (SRS) is a very rare genetic disorder characterized by intrauterine growth retardation, short stature, and typical craniofacial abnormalities including micrognathia. While growth hormone (GH) therapy in children with SRS significantly improves somatic growth, functional orthopedic treatment can also be effective in adolescents with mandibular deficiency. We report the effects of Phase 1 functional orthopedic treatment of a twin-block appliance in conjunction with GH administration in a 9-year-old boy with GH deficiency and SRS, and the result of the subsequent Phase 2 orthodontic treatment.