Thursday, November 18, 2010

I posted a couple of items from "Practical Reviews in Orthodontics" which is a subscription service that I strongly recommend.It can be found here:

Here is the description of the service (taken from the practical reviews website):

With the literally thousands of articles published annually in orthodontics, it is virtually an impossible task to sort through and read everything necessary to stay current. And there's the daunting task to even identify all the key clinical developments that are reported on in the numerous journals.

The physician-editors with Practical Reviews in Orthodontics sort through dozens of publications, find the most relevant studies, summarize them, and suggest ways to apply this information in practice. Most of the reviews are available to you in convenient audio format — allowing you to download this material to your laptop, MP3 player or almost any portable device.

Note: none of the material in this post was written by me. This post is taken directly from Practical Reviews. Hopefully, I have given the authors full credit.

An Evaluation of Clinicians' Choices When Selecting Archwires.

McNamara C, Drage KJ, et al: Eur J Orthod; 2010;32 (February): 54-59

Background: Many studies have looked at the stability of orthodontic results. In particular, attention has been paid to the form of the arch. Previous studies have found that using an arch form that maintains intercanine width, intermolar width, and arch length contributes to a stable result.

Objective: To determine the choices clinicians make when choosing arch wires during initial alignment and space closure.

Design: Survey.

Participants: 100 orthodontic practitioners within the Bristol Dental Hospital or who were contacted at local meetings were included in the survey. These consisted of consultant orthodontists (n=37), specialist practitioners (n=36), senior specialist registrars in orthodontics (n=10), and dentists with a special interest in orthodontics (n=17).

Methods: A questionnaire survey was distributed between November 2005 and March 2006. The questionnaire was divided into 2 parts, wires for initial alignment and wires for space closure in a Class I premolar extraction case. For initial alignment wires, clinicians were asked about arch-wire material, dimensions, trade name, arch form, and the importance of these factors when choosing a wire. For the space closure wires, clinicians were asked about arch-wire material, dimensions, use of study models for adaptation, use of symmetry charts, and the importance of these factors when using a wire.

Results: The 100 questionnaires returned represented a 92.6% response rate. A 0.022-inch slot was used by 99% of clinicians. For initial alignment wires, 1 clinician used 0.014 inch multi-stranded stainless steel, while the other 99% used nickel-titanium; of the 99%, 23 used classic NiTi (martensitic stable), 34 used super-elastic (austenitic active), and 34 used heat-activated (martensitic active) NiTi; 9 did not know what type of NiTi they used.

At this stage, arch form was found to be important by 16% of clinicians and the arch width by 23%.For space closure wires, 1 clinician used 0.018- x 0.025-inch NiTi, and the other 99% used stainless steel. All but 5 clinicians felt that adaptation to the canines was important, but there was great diversity on the other landmarks (incisors, premolars, or molars). In addition, the use of casts and symmetry charts varied.

Conclusions: A majority of clinicians felt that preserving a patient's pretreatment arch form was important in the later stages of treatment, but not for selection of initial alignment wires. No uniformity was found in the method used to preserve arch form.

Reviewer's Comments: Although this was not a scientific study of arch form or the ability to maintain arch form, it was interesting that most clinicians at least claimed to be concerned about preservation the lower arch intercanine width. Most of the clinicians rightly believed that arch form selection was less important for early alignment wires when tooth-to-tooth discrepancies override overall arch form characteristics. It would be interesting to look at actual treatment outcomes from this group of practitioners to see if the varied methods used during later treatment stages were equally successful in maintaining the lower arch form.(Reviewer–Brent E. Larson, DDS, MS).

Long-Term Effects of Rapid Maxillary Expansion Followed by Fixed Appliances.

Gurel HG, Memili B, et al: Angle Orthod; 2010;80 (January): 5-9

Background: Maxillary expansion is a routine procedure performed to correct narrow maxillary arch width and posterior cross-bite. We assume, as orthodontists, that our expansion will be stable long term, but is that assumption correct?

Objective: To evaluate the long-term changes in maxillary dental arch widths in patients who were treated with rapid maxillary expansion (RME) appliances followed by edgewise appliances.

Design: This was a retrospective analysis of the records of 41 patients who had been treated for maxillary constriction.

Methods: Maxillary dental casts were available at 4 time periods: before treatment, after maxillary expansion, after complete nonextraction orthodontic therapy, and approximately 5 years later. The maxillary intercanine, interpremolar, and intermolar widths were measured at all 4 intervals. These widths were then compared over time.

Results: The maxillary intermolar, interpremolar, and intercanine widths all increased during palatal expansion treatment. During the time of full-banded, edgewise orthodontic therapy, the intermolar, interpremolar, and intercanine widths decreased. After appliance removal, these widths continued to decrease, with the greatest decrease occurring in the intercanine width, which nearly reached its original pretreatment distance.


A significant amount of relapse occurs after RME during a second phase of orthodontics, as well as long term.

Reviewer's Comments: I found the information in this study to be useful. I have had similar experiences in patients I have treated using RME followed by routine orthodontics. Long term, these arch widths tend to decrease with time. I believe it is probably due to the stretching of the palatal gingiva, which simply does not accommodate to these greater widths in all patients. It is good to be aware of this information before correction of posterior cross-bites and to consider long-term retention for patients who have been treated for significant palatal constriction.(Reviewer–Vincent G. Kokich, DDS, MSD).

Alignment Efficiency of Damon3 Self-Ligating and Conventional Orthodontic Bracket Systems: A Randomized Clinical Trial.

Scott P, DiBiase A, et al: Am J Orthod Dentofacial Orthop; 2008;134 (October): 470.e1-470.e8

Background: Self-ligating brackets have become increasingly popular. It has been suggested that the Damon3 self-ligating bracket encourages more rapid tooth alignment. In deciding to choose a bracket system, it is important to know if this is true.

Objective/Design: The purpose of this randomized, clinical trial was to compare the clinical efficiency of Damon3 self-ligating brackets with a conventional ligated bracket system during orthodontic tooth alignment.

Participants: The sample for this study consisted of 60 subjects (28 using Synthesis traditional brackets and 32 using Damon3 brackets). All subjects had a mandibular incisor irregularity of 5 to 12 mm, extraction of mandibular first premolars, and the absence of a complete overbite.

Interventions: The same series of initial arch wires ranging from a 0.014-in copper nickel titanium to a 0.019 x 0.025-in stainless steel arch wire were used for each group. Study casts were taken at the start of treatment, at the first arch wire change, and at placement of the final 0.019 x 0.025-in stainless steel arch wire. Little's Irregularity Index was used to measure changes in mandibular incisor alignment.

Results: No significant difference was noted in the initial rate of alignment for either bracket system. The influence of sex, age, and appliance type was statistically insignificant; however, the initial irregularity influenced the rate of tooth movement for both systems with greater irregularity related to more efficient tooth movement.


Damon3 self-ligating brackets are no more efficient than conventionally ligated preadjusted brackets during tooth alignment.

Reviewer's Comments: Based on claims I have heard, I would have suspected that the Damon3 system would have been more efficient for mandibular incisor alignment. However, once again, it does not surprise me that commonly held orthodontic claims or theories are found to have no basis when exposed to objective research. There may be several good reasons to use the Damon3 self-ligating bracket system, such as reduced staff time in changing arch wires, but the rate of tooth movement is not one of them. (Reviewer–John S. Casko, DDS, MS, PhD).


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Dear Dr Jim Prittinin,

How are you? Wonderful blog here from which one can learn alot, though there is no place to post questions as such.

If possible I would need some help in regards to a query, i have a case with a mesially tilted first premolar on one side, problem is that i am progressing on levelling and alignment but it fails to straighten up, I have made sure there is space available for aligning but even on 018 NiTi the anterior teeth are opening up unilaterally on the side of the tilted premolar but that is not straightening up.

What should be the plan at this stage? Should I use rectangular ss in upper and with same 018 use elastics on premolar?

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