Orthodontic space closure during treatment of skeletal Class III malocclusions
Kim JW, Lee NK, Yun PY, Moon SW, Kim YK. Postsurgical stability after mandibular setback surgery with minimal orthodontic preparation following upper premolar extraction. J Oral Maxillofac Surg 2013;71:1968.e1-11
Retraction and uprighting of dentally compensated maxillary incisors by extraction of maxillary premolars is often beneficial when correcting surgical Class III skeletal malocclusions. Mandibular setback surgery after closure of the extraction space and other presurgical orthodontic preparations are associated with long treatment times and temporary deterioration of function and facial esthetics. Alternatively, a “surgery first” approach with only minimal presurgical orthodontics has been introduced to potentially shorten the total treatment time and provide immediate profile improvement. In this retrospective study, 15 patients underwent mandibular setback surgery after minimal orthodontic preparation and maxillary premolar extractions, and 11 patients underwent mandibular setback surgery after space closure with more complete orthodontic preparation. From the measurements made on lateral cephalograms obtained at 3 times, initial examination (T0), splint removal 4 weeks after surgery (T1), and immediately after debonding (T2), the changes from T0 to T1 and from T1 to T2 were evaluated and the groups compared. Statistical evaluations showed no difference between the 2 groups regarding total treatment duration. From T0 to T1, the group with minimal presurgical orthodontic preparation had an increased mandibular setback and a greater decrease in mandibular length than did the presurgical space-closure group. From T1 to T2, both groups exhibited forward and superior movement of the mandible, with counterclockwise rotation, but the changes in the group with minimal presurgical orthodontic preparation were greater than in the group with presurgical space closure. The investigators attributed the greater postsurgical relapse in the group with minimal presurgical orthodontics to disharmony of arch coordination at surgery, resulting in greater counterclockwise rotation of the mandible after the occlusal interferences were relieved during postsurgical orthodontics. The authors recognized the need for larger, more homogenous samples with longer follow-ups.
Reviewed by Brandon R. Knapp
Resin infiltration of white-spot lesions
Senestraro SV, Crowe JJ, Wang M, Vo A, Huang G, Ferracane J, et al. Minimally invasive resin infiltration of arrested white-spot lesions: a randomized clinical trial. J Am Dent Assoc 2013;144:997-1005
Enamel white-spot lesions (WSLs) are common sequelae of poor oral hygiene and often associated with fixed orthodontic appliances. The aim of this randomized, single-masked clinical trial was to assess the esthetic improvement of WSLs treated with minimally invasive resin infiltration. Twenty participants completed the study, with a total of 66 affected teeth meeting the inclusion criteria; 46 teeth were allocated to the treatment group, and 20 served as controls. In the treatment group, a standardized resin infiltration method was used to restore teeth with WSLs. Photographs of each affected tooth were made at 3 times: before infiltration (T1), immediately after infiltration (T2), and 8 weeks after infiltration (T3). Changes in WSLs were evaluated photographically by using a visual analog scale (0-100 mm), with 100 signifying complete disappearance of WSLs, and by using area measurements. Data were analyzed with 2-way analysis of variance. Mean visual analog scale ratings for the treated teeth were higher than those of the control teeth at T2 (67.7 vs 5.2; P <0.001) and T3 (65.9 vs 9.2; P <0.001). The treated teeth also had mean reductions in WSL areas of 61.8% at T2 and 60.9% at T3, whereas the control teeth showed −3.3% and 1.0% changes at T2 and T3, respectively. Patient age, sex, tooth type, time in orthodontic appliances, time elapsed since appliance removal, and initial WSL severity had no significant effect on the outcomes for WSLs in teeth restored with resin infiltration. The authors concluded that resin infiltration significantly improved the clinical appearance of WSLs and reduced their size, with stable results seen at 8 weeks after treatment. Further research was recommended to assess the long-term stability of resin infiltration for treatment of WSLs.
Reviewed by Patra V. Alatsis