CONTENTS

Editor’s choice

David L. Turpin, Editor-in-Chief

Early treatment for Class II Division 1malocclusion with the Twin-blockappliance: A multi-center randomizedcontrolled trial

Kevin O’Brien and 23 members of United Kingdom Class II

study group

This multi-center randomized clinical trial was de-signed to evaluate the effectiveness of early orthodontictreatment with the Twin-block appliance for the correc-tion of Class II Division I malocclusion. At the start ofthis 10-year study, children were randomized to an earlytreatment group and an observation group. In an earlierarticle, the authors reported interim results from the firstphase of the study. They showed that early treatmentwas effective, leading to reduction in overjet, a smallamount of skeletal change, and improvement in chil-dren’s self-esteem. In this new article, final results,including phase 2 treatment during adolescence, arereported.

One hundred forty-one patients completed treat-ment or accepted their occlusion. Those who had earlytreatment had more appointments, experienced longeroverall treatment times, and incurred more costs thanthe adolescent treatment group. Notes O’Brien, ‘‘Earlyorthodontic treatment with the Twin-block appliancefollowed by further treatment in adolescence at the ap-propriate time does not result in any meaningful long-term differences when compared with 1 course oftreatment started in the late mixed or early permanentdentition. There are definite disadvantages to the2-phase approach including increased burdens for thepatient in terms of attendance, costs, length of treat-ment, and an inferior final occlusal result.’’ This studyreinforces the findings of similar randomized con-trolled trials previously published in the AJO-DO.Early treatment for Class II skeletal problems is notroutinely justified.

Am J Orthod Dentofacial Orthop 2009;135:11A-12A

0889-5406/$36.00

Copyright � 2009 by the American Association of Orthodontists.

doi:10.1016/j.ajodo.2009.03.022

Efficiency of mandibular archalignment with 2 preadjusted edgewiseappliances

Padhraig S. Fleming, Andrew T. DiBiase, Grammati Sarri,

and Robert T. Lee

You’ve been happy for many years using a conven-tional twin bracket from a leading orthodontic manufac-turer, but, with so much talk about the increased speedof a self-ligating bracket system, it is tempting to givesomething else a try. ‘‘Maybe a different appliance willalign teeth faster,’’ you wonder. This article might providepart of the picture and help you make a decision. It is a ran-domized controlled trial comparing the efficiency of man-dibular incisor alignment between a self-ligating bracketsystem (SmartClip, 3M Unitek, Monrovia, Calif) andconventional twin brackets (Victory, 3M Unitek).

Sixty patients were randomly divided into 2 groupsfor this prospective study. All patients had mild incisorcrowding and were treated without extractions by 2 cli-nicians working in parallel groups. The conventionaltwin brackets were ligated with elastomeric modules af-ter placement of a .016-in round martensitic activenickel-titanium archwire, which was used initially inboth groups of patients. After 8 weeks of treatmentwith the initial archwire, a second set of study castswas taken and the alignment evaluated.

The findings were clear: in nonextraction treatmentfor patients with mild incisor crowding, the self-ligatingbracket system used in this trial was no more effectiveat relieving irregularity than the conventional preadjustededgewise bracket ligated with elastomaric modules orstainless steel ligatures. Enhanced resolution of irregular-ity is positively correlated with pretreatment irregularity.

Combined use of miniscrews and clearappliances for the treatment ofbialveolar protrusion withoutconventional brackets

Nak-Chun Choi, Young-Chel Park, Yong-Min Jo, and Kee-

Joon Lee

This case report describes the orthodontic treatmentof a teenage girl with a Class I bimaxillary protrusive

11A

12A Editor’s choice American Journal of Orthodontics and Dentofacial Orthopedics

May 2009

dentition characterized by mild anterior openbite. Thetreatment was unique because the patient demanded tobe treated with no braces visible. With this objective inmind, a plan of treatment was devised, making use of clearaligners after the segmental retraction of the maxillaryand mandibular anterior segments with lingual splinted

wires and miniscrew anchorage. The quality of the treat-ment is excellent, proving that an innovative clinician cancombine esthetic appliances with skeletal anchorage totreat the most demanding patient. In addition, the authorprovides posttreatment records 16 months after applianceremoval to show the stability of the correction.