Residents’ journal review

Less white spot lesions with lingual braces

Van der Veen MH, Attin R, Schwestka-Polly R, Wiechmann D. Caries outcomes after orthodontic treatment with fixed appliances: do lingual brackets make a difference? Eur J Oral Sci 2010;118:298-303

The purpose of this study was to determine the incidence of caries and white spot lesions (WSLs) on tooth surfaces with buccal or lingual brackets before, during, and immediately after orthodontic treatment. A split-mouth design was used, randomly assigning lingual brackets to either the maxilla or the mandible, with buccal brackets placed on the opposite arch. The study included 28 subjects between the ages of 12.75 and 17.25 years who were free of cavitations and WSLs on smooth surfaces as determined by visual inspection. The presence of lesions was analyzed for both bracketed and nonbracketed surfaces using intraoral photographs and quantitative light-induced fluorescence. Eight subjects had WSLs before the start of treatment. The difference between the incidence of initial buccal and lingual lesions was insignificant. For the 8 subjects with preexisting WSLs, the lesions remained mostly stable on nonbracketed surfaces, whereas on bracketed surfaces, the existing lesions progressed, and new lesions formed. Of the remaining 20 subjects initially free of WSLs as detected by quantitative light-induced fluorescence, 15 were still free of WSLs at the end of treatment, and 5 developed WSLs, mostly on buccal surfaces. During treatment, there was a 4.8 times higher incidence of caries lesions on buccally bracketed surfaces forming or progressing and a 10.6 times higher caries extent, or integrated fluorescence loss, compared with lingual lesions. Overall, when caries and WSLs on smooth surfaces are considered, lingual brackets are preferred over buccal brackets.

Reviewed by Maryam Rezaie

Skeletal stability and neurosensory disturbance with bilateral sagittal split ramus osteotomy and distraction osteogenesis

Al-Moraissi EA, Ellis E 3rd. Bilateral sagittal split ramus osteotomy versus distraction osteogenesis for advancement of the retrognathic mandible. J Oral Maxillofac Surg 2015;73:1564-74

Bilateral sagittal split osteotomy (BSSO) is the most common surgical intervention for advancement of a retrognathic mandible, but it carries certain clinical disadvantages. Neurosensory disturbance is a frequent postsurgical complication caused by inferior alveolar nerve trauma. Additionally, skeletal relapse can develop from unfavorable postoperative sequelae. Previous research has introduced distraction osteogenesis (DO) as a surgical alternative for mandibular retrognathia with decreased risk of nerve damage, increased stability, and greater capacity for mandibular lengthening. This systematic literature review and meta-analysis was conducted to further investigate nerve function and stability in BSSO and DO. Nine reports (4 assessing skeletal stability, 5 evaluating neurosensory disturbance) were included in the qualitative and quantitative synthesis with a total of 357 patients. Of these reports, 3 were randomized controlled trials, 1 was a controlled clinical trial, and 5 were retrospective studies. The results showed no statistically significant difference in skeletal stability analyzed cephalometrically in the vertical and horizontal dimensions, but significantly fewer neurosensory disturbances occurred with DO compared with BSSO. The authors concluded that both surgical methods give similar stability, and 1 in every 7 patients undergoing mandibular advancement surgery with DO will benefit by half the incidence of neurosensory disturbance. This added gain of DO must be measured against recognized procedural complexities. Specifically, a high level of technical skill in positioning the distraction device is required to prevent a nonideal distraction vector and a suboptimal occlusion. The authors suggest considering outcome predictability, complications other than neurosensory disturbance, treatment time, and financial cost to determine the best method of mandibular advancement surgery for each patient.

Reviewed by Zachary Levin

Skeletal stability and neurosensory disturbance with bilateral sagittal split ramus osteotomy and distraction osteogenesis

Al-Moraissi EA, Ellis E 3rd. Bilateral sagittal split ramus osteotomy versus distraction osteogenesis for advancement of the retrognathic mandible. J Oral Maxillofac Surg 2015;73:1564-74

Bilateral sagittal split osteotomy (BSSO) is the most common surgical intervention for advancement of a retrognathic mandible, but it carries certain clinical disadvantages. Neurosensory disturbance is a frequent postsurgical complication caused by inferior alveolar nerve trauma. Additionally, skeletal relapse can develop from unfavorable postoperative sequelae. Previous research has introduced distraction osteogenesis (DO) as a surgical alternative for mandibular retrognathia with decreased risk of nerve damage, increased stability, and greater capacity for mandibular lengthening. This systematic literature review and meta-analysis was conducted to further investigate nerve function and stability in BSSO and DO. Nine reports (4 assessing skeletal stability, 5 evaluating neurosensory disturbance) were included in the qualitative and quantitative synthesis with a total of 357 patients. Of these reports, 3 were randomized controlled trials, 1 was a controlled clinical trial, and 5 were retrospective studies. The results showed no statistically significant difference in skeletal stability analyzed cephalometrically in the vertical and horizontal dimensions, but significantly fewer neurosensory disturbances occurred with DO compared with BSSO. The authors concluded that both surgical methods give similar stability, and 1 in every 7 patients undergoing mandibular advancement surgery with DO will benefit by half the incidence of neurosensory disturbance. This added gain of DO must be measured against recognized procedural complexities. Specifically, a high level of technical skill in positioning the distraction device is required to prevent a nonideal distraction vector and a suboptimal occlusion. The authors suggest considering outcome predictability, complications other than neurosensory disturbance, treatment time, and financial cost to determine the best method of mandibular advancement surgery for each patient.

Reviewed by Zachary Levin

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Apr 6, 2017 | Posted by in Orthodontics | Comments Off on Residents’ journal review
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