Cariostatic effect of glass ionomer retained orthodontic appliances. An in vivo study. Comparison of occlusal contacts with use of Hawley and clear overlay retainers. Efficacy of ultrasonic, electric and manual toothbrushes in patients with fixed orthodontic appliances. Effectiveness of the Sonicare sonic toothbrush on reduction of plaque, gingivitis, probing pocket depth and subgingival bacteria in adolescent orthodontic patients. Outcomes in a 2-phase randomized clinical trial of early Class II treatment. Comparative study of 2 electric and 2 manual toothbrushes in patients with fixed orthodontic appliances. Cariostatic effect of a light-cured, resin-reinforced glass-ionomer for bonding orthodontic brackets in vivo. A combined study using microradiography and confocal laser scanning microscopy. An evaluation of preoperative ibuprofen for treatment of pain associated with orthodontic separator placement.
The cariostatic effect of a fluoride releasing bonding agent was investigated and compared with a conventional composite based material in connection with bonding of orthodontic brackets in 22 homologous pairs of premolars. All subjects had malocclusions requiring orthodontic treatment with fixed appliances and extraction of at least two premolars. 6-13 weeks prior to extraction, orthodontic brackets were bonded to the labial surfaces of the extraction teeth with either a glass ionomer cement or a bis-GMA resin. Initially, the children were instructed in tooth brushing and the regular use of fluoride. After extraction, the bonded teeth were stained and evaluated in a stereo-microscope regarding the incidence and extension of initial enamel demineralisation. The zone of intact enamel adjacent to the bracket base and bonding material was measured in a stereo-microscope at four predetermined locations with the aid of an electronic ruler and scored according to four categories. The incidence of enamel demineralisation adjacent to glass ionomer bonded and composite bonded brackets was 68% and 77% respectively. In 12 pairs of premolars however, the demineralisation appeared to a lesser extent on the enamel around the brackets was generally wider when glass ionomer cement was used compared to the composite resin. These differences were statistically significant (p < 0.05) mesially and distally, but non-significant cervically and incisally. The results indicate that bonding with glass ionomer cement may have a local cariostatic effect in children requiring fixed orthodontic appliances. Following orthodontic treatment, an increase in the number of occlusal contacts is usually desired during retention. In this study, Hawley and clear overlay orthodontic retainers were compared relative to changes in the number of occlusal contacts. Occlusal contacts were quantified in 30 orthodontic patients at debonding, at retainer delivery, and after 3 months of retention. The paired t-test was applied to evaluate longitudinal changes in the number of and intensity of contacts. Results show that with the Hawley retainer there was a significant increase in occlusal contacts on posterior teeth and no change on anterior teeth. With the clear overlay retainer there was no significant change in either posterior or anterior contacts during retention. The retentive capacities of the two retainers differ: the Hawley retainer allows relative vertical movement (settling) of the posterior teeth while the clear overlay retainer holds teeth in their debanding position. This crossover study compared the efficacy of an ultrasonic toothbrush for the reduction of plaque, gingival inflammation, and levels of Streptococcus mutans, in relation to an electric and a manual toothbrush.
                Twenty-one patients with orthodontic appliances were divided into three groups. All patients were evaluated by a periodontist and samples of saliva were collected for quantification of S mutans. The patients received their first brushes with appropriate instructions. For each crossover leg, patients used each toothbrush for a period of 30 days. At the end of each washout period, participants received a periodontal evaluation and new samples of saliva were collected. After 15 days of using their own toothbrushes, patients received the next toothbrushes in the experimental sequence.
                The ultrasonic brush group presented significant improvement in the reduction of visible plaque on the buccal surfaces (-6.36%, P = .007). The counts of S mutans decreased in the electric (2.04 x 10(5) to 1.36 x 10(5) colony-forming units [CFU]/mL) and ultrasonic (2.98 x 10(5) to 1.84 x 10(5) CFU/mL) groups. There were no statistical differences among the three brushes for the clinical and microbiological parameters evaluated.
                This study did not demonstrate that the ultrasonic toothbrush was better in reducing gingival inflammation in adolescent orthodontic patients, but plaque scores were lowered on buccal surfaces of teeth with orthodontic brackets. In addition, S mutans counts were markedly decreased in the electric and ultrasonic groups, which should be related to a reduced risk of oral disease. The Sonicare sonic toothbrush and a traditional manual toothbrush were compared for efficacy in improving periodontal health in young orthodontic patients with existing gingival inflammation. A 4-week, single-blind clinical trial was employed. Twenty-four subjects, ages 11-17 years, who were fully bonded and banded with fixed orthodontic appliances were selected. Subjects were randomly assigned to use either the manual or the Sonicare toothbrush, instructed in its use, and asked to brush each morning and evening for 2 minutes. Plaque index, gingival index, percentage of sites which bled on probing, pocket depth, and total gram-negative bacteria in a subgingival plaque sample were assessed at baseline and 4 weeks around the banded teeth. The results demonstrate that the Sonicare brush was significantly more effective than the manual brush in all clinical parameters. Sonicare was statistically superior to the manual brush in supragingival plaque reduction (57% vs. 10%, respectively; p < 0.001). Gingival Index scores fell by 29 percent in the Sonicare group, but only 3 percent in the manual group. Reduction of bleeding on probing was significantly greater in the Sonicare group than in the manual group (p < 0.001). The Sonicare group decreased from 78% bleeding sites at baseline to 24.5% after 1 month. In the manual group there was only a slight reduction in bleeding on probing (70% of sites at baseline and 64.6% sites after 1 month). Mean pocket depths were significantly reduced compared to baseline values in both the Sonicare and the manual groups (p < 0.001). Pocket depth reduction in the Sonicare group was, however, significantly greater than in the manual group (28% vs. 6%, respectively: p < 0.001). Total gram-negative bacteria in subgingival plaque samples from banded test teeth of a subset of patients were reduced in the Sonicare group (p < or = 0.05), but increased in the manual group. These results clearly demonstrate that the Sonicare sonic toothbrush is superior to a manual toothbrush in improving periodontal health in adolescent orthodontic patients with existing gingivitis. In a 2-phased, parallel, randomized trial of early (preadolescent) versus later (adolescent) treatment for children with severe (>7 mm overjet) Class II malocclusions who initially were developmentally at least a year before their peak pubertal growth, favorable growth changes were observed in about 75% of those receiving early treatment with either a headgear or a functional appliance. After a second phase of fixed appliance treatment for both the previously treated children and the untreated controls, however, early treatment had little effect on the subsequent treatment outcomes measured as skeletal change, alignment, and occlusion of the teeth, or length and complexity of treatment. The differences created between the treated children and untreated control group by phase 1 treatment before adolescence disappeared when both groups received comprehensive fixed appliance treatment during adolescence. This suggests that 2-phase treatment started before adolescence in the mixed dentition might be no more clinically effective than 1-phase treatment started during adolescence in the early permanent dentition. Early treatment also appears to be less efficient, in that it produced no reduction in the average time a child is in fixed appliances during a second stage of treatment, and it did not decrease the proportion of complex treatments involving extractions or orthognathic surgery. The objective of this prospective single-blind crossover clinical trial was to evaluate the efficacy of 4 toothbrushes in 33 children undergoing fixed appliance orthodontic therapy. The toothbrushes included in this study were the Braun Oral-B 3D Plaque Remover (Kronberg, Germany), the Philips-Jordan HP 510 (Philips Domestic Appliances, Groningen, The Netherlands), the Lactona orthodontic toothbrush (Bergen op Zoom, The Netherlands), and the Oral-B Advantage Control Grip (Braun); the first 2 are electric, and the last 2 are manual. Every patient tested each type of toothbrush in a randomly designed sequence. Plaque and gingival scores were recorded at baseline and after every 4-week test period. All patients received professional prophylaxis after each clinical evaluation. The data were analyzed with the Friedman test, which showed no significant differences among the 4 brushes for any of the parameters measured. The Wilcoxon signed rank test, comparing the plaque and the gingival scores between the upper and lower jaw for each brush, indicated that plaque removal was more efficient in the lower jaw than in the upper. The aim of this study was to evaluate in vivo the cariostatic potential of the resin-reinforced glass-ionomer (Vitremer core build-up restorative; 3M Dental Product Division) when used as a bonding agent for orthodontic brackets. The mineral distribution and topography of the enamel surface adjacent to the bracket base was determined by quantitative microradiography (TMR) and confocal laser scanning microscopy (CLSM). The study was designed in split-mouth technique using 9 pairs of premolars to be extracted for orthodontic reasons. One tooth of each pair was bonded with the resin-reinforced glass-ionomer, and the control contralateral premolar with the non-fluoridated composite (Concise, 3M Dental Products Division). After 4 weeks all teeth were extracted and stored until analysis. The lesion depths and mineral loss values in enamel adjacent to brackets bonded with Vitremer were significantly lower than in teeth bonded with the composite, indicating that the resin-reinforced glass-ionomers significantly reduced caries lesion development in vivo. CLSM images show a severe cariogenic challenge around orthodontic brackets and support TMR measurements. Patients undergoing orthodontic treatment can experience significant levels of pain. This study assessed the effectiveness of preoperative ibuprofen in reducing the incidence and the severity of pain after orthodontic separator placement. Sixty-three adolescent patients (mean age, 13 years) were included in this randomized, double-blind, placebo-controlled, prospective study. Patients were randomly assigned to 1 of 3 experimental conditions: (1) 400 mg of ibuprofen taken orally 1 hour before separator placement and a lactose placebo taken orally immediately after the appointment, (2) a lactose placebo taken orally 1 hour before separator placement and 400 mg of ibuprofen taken orally immediately after the appointment, or (3) a lactose placebo taken orally 1 hour before separator placement and again immediately after the appointment. The patient's level of discomfort was assessed with a visual analog scale at 2, 6, and 24 hours, as well as at 2, 3, and 7 days after placement of the orthodontic separators. An analysis of variance and Duncan's multiple range test revealed that 2 hours after their orthodontic appointment the patients who had taken ibuprofen 1 hour before separator placement had significantly less pain with chewing than did the patients who received either ibuprofen postoperatively or a placebo. Additional measures suggest a trend for less pain for this group of patients. These results support the use of pretreatment ibuprofen for patients requiring analgesics for orthodontic discomfort. Future study of the use of preemptive analgesics in orthodontics is warranted.
The evidence suggests that providing early orthodontic treatment for children with prominent upper front teeth is no more effective than providing one course of orthodontic treatment when the child is in early adolescence.