Andreas Karamouzos, Athanasios E. Athanasiou, Moschos A. Papadopoulos, and George Kolokithas

This study is important because it focuses on dental esthetics after treatment with fixed appliances. The authors used scientific criteria to examine the incidence of orthodontic bonding-induced tooth-color alterations: this was an in-vivo, prospective study of consecutive patients, with a split-mouth design. According to most parents, when the braces come off, the teeth should be as white and perfect as the alignment. That is not always the case, especially for patients with less than exceptional hygiene and resulting decalcification problems. Also, patients and parents easily forget what was beneath the appliances to begin with. Is it possible that the decalcification process or the bonding adhesives played a role in altering the color of the enamel surfaces?

The initial study sample consisted of 34 consecutive patients who started orthodontic treatment at the Department of Orthodontics, Aristotle University of Thessaloniki, in Greece. Two resin adhesives were used in a split-mouth design: a chemically cured product (System 1+, Ormco, Glendora, Calif) and a light-cured material (Transbond XT, 3M Unitek, Monrovia, Calif). Confounding variables were controlled, and multiple samplings were performed to address the issue of reliability (multiple sessions might have made the method even more powerful). At the end of the active treatment, bracket debonding and cleaning procedures were performed by 1 clinician, using the same debonding plier and a new carbide bur attached to a low-speed hand piece. A reflectance spectrophotometer, SpectroShade, was used to objectively assess color alterations of natural teeth before and after orthodontic treatment. Among the conclusions were the following.

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  The color of natural teeth, after comprehensive orthodontic treatment with fixed appliances, changes in various ways.

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  This outcome might be caused by the permanent iatrogenic enamel effects associated with bonding, debonding, and cleaning; the exogenous and endogenous discoloration of the remaining adhesive material; and the dental and pulp tissue alterations related to orthodontic tooth movement.

Hugo De Clerk, Lucia Cevidanes, and Tiziano Baccetti

Identifying the most effective time to start treatment for a Class III malocclusion has long frustrated both clinicians and parents. If corrective action begins early, then overall treatment times are invariably lengthy, and the patient still has a 50-50 chance of needing surgery after the completion of all growth. If treatment is delayed until the patient is well into adolescence or later, parental frustration builds with the passing of every year. I have seen it, I have felt it, and I have never been comfortable with it.

The purpose of this controlled clinical trial was to evaluate the effects of a treatment protocol for Class III malocclusion consisting of surgically placed miniplates at both the maxilla and the mandible connected by Class III elastics. More specifically, these authors assessed active treatment effects in the skeletal, dentoalveolar, and soft-tissue facial structures of consecutively treated patients. Growth in the treated patients was compared with growth changes in a matched control group of untreated Class III subjects. The treated group comprised 21 consecutive patients with dentoskeletal Class III malocclusion treated by 1 operator with the bone-anchored maxillary protraction (BAMP) technique. The success of the therapy after the observation period was not a determining factor for selecting patients, since the treated sample was collected prospectively. A control group of 18 untreated subjects with dentoskeletal Class III malocclusion was obtained from the Department of Orthodontics of the University of Florence in Italy.

Although cone-beam computed tomograms were taken immediately after the placement of the miniplates and approximately 1 year later, they were used to create 2-dimensional images that were used later when gathering data for comparison with the controls. This study is the first investigation of the effects of Class III treatment with bone anchorage in a sample of adequate size for statistical comparisons. Specific features of the study were the following: (1) Class III subjects treated consecutively in a prospective clinical trial, (2) well-matched control group of untreated Class III subjects used for comparisons, and (3) all subjects prepubertal before treatment. The results presented in this study were at the end of active therapy. Of critical importance will be longitudinal observations from this point on to evaluate the effect of adolescent growth on the final treatment outcomes. “Three-dimensional assessments planned in the future will deliver a more comprehensive analysis of the modifications induced by the BAMP protocol,” noted the authors.