Dictation - 전남대학교 치과대학 교정과 대학원 세미나

Tongue Piercing and Its Adverse Effects Rachel Shacham. et al. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;95:274-6. March 19, 2004 Dr. Heung-Gyo Lee
[초벌원고] Imaging seeing a 18 years female on your office for recall. You are expected check retainers and discussed possible removable the wisdom teeth. Instead she complains of the tongue hurt and swelling when she has piercing the few days ago.	[수정원고]
She also has some swelling in the floor of the mouth, in complains of the hurt when she swollen. These complains were representative of somebody complications can occur from piercing of the tongue which was described in article called “Tongue Piercing and Its Adverse Effects”. This article was published in the March 2003 issue of Oral Surgery Oral Medicine and Oral Pathology.
It was written by referred oral surgeon from easiler that help communicate dental committee the kinds complications that they have seen following tongue piercing. Tongue piercing is generally done without anesthesia by individual with little training. Swelling is a cause predictable after tongue piercing and therefore a longer ball bell ornament as usually placed first so that the swelling is not cause embedding ornament in the tissue. Significantly swelling can cause difficult with bleeding as it airway becomes occluding. Other complications that frequency seen include infection, bleeding and inflammation of the tongue.
The article show three cases that presentative there emergency room following tongue piercing. Case number one was a 20 year old female pain and swelling that a worsen since tongue piercing 6 days earlier. She had hard submental swelling that with larging and tender lymph nodes. She was diagnose with infection and it required intravenous antibiotics as well as removal of the tongue ornament. Case number two was an 18 year old man with continuing bleeding since tongue piercing the day before. He required remove of the tongue ornament and electrocautery use stop the bleeding. Case number three was a 16 year old that barbell ball embedded ornament in her tongue while attempting to remove it. She required minor surgical incision to remove embedded ornament.
The article suggest that if patients seen with information of the tongue following piercing that the ornament be removed the area the bridle and the article given of the chlorhexidine mouth wash be used. These use good recommendations 18 years patient with discussed early of the present to your office for recall with tongue pain and swelling.
Ignoring the symptoms or thinking that it were occur ( ) is not a good idea. Since it infection this area can easily spread whole the mouth cause serious problems.
For more information on tongue piercing and its complications you can find this article by Dr. Shacham College in the March 2003 issue of the Triple O.

Long-term Follow-up of Class Ⅱ Adults Treated with Orthodontic Camouflage: A Comparison with Orthognathic Surgery Outcomes Mihalik CA, Proffit WR, Phillips C. Am J Orthod Dentofacial Orthop 2003;123:266-278. March 26, 2004 Dr. Chang-Hun Park
[초벌원고] I'm sure you-had happen the number of patients present to your office who were adult with Cl Ⅱ malocclusion and large, average anterior, posterior skeletal discrepancies. This patients present-problem for-orthodontist because many time they can be treated either by orthodontic alone or with combine surgical orthodontic treatment. If you had patient like this to whom me present two altered treatment plane. That is orthodontic alone or surgical orthodontic treatment-and-patient ask-to describe advantage or disadvantage-each approaches. How would you response?	[수정원고] I'm sure you have had the number of patients present to your office who were adults with Cl Ⅱ malocclusions and larger than average anteroposterior skeletal discrepancies. This patients present a problem for the orthodontist because many times they can be treated either by orthodontics alone or with combined surgical orthodontic treatment. If you had patient like this to whom you presented two alternative treatment plans, that is orthodontic alone or surgical orthodontic treatment, and the patient ask you to describe advantages and disadvantages of each approach, how would you respond?
An article title “Long-term Follow-up of Class Ⅱ Adults Treated with Orthodontic Camouflage: A Comparison with Orthognathic Surgery Outcomes” by column at all which appear on march 2003 issue of Am J Orthod Dentofacial Orthop addressed this question. In this study-researches who are formed in university of North Carolina evaluated sample of 31 adult patients who were treated with orthodontic alone for the correction-Cl Ⅱ malocclusion. -Average entered time since-ended orthodontic treatment was 12 years. Cephalometric radiograph, model and three questionnaire were used to compare long term stability and satisfaction with treatment for this group versus-group of patient that surgically for-correction of-Cl Ⅱ malocclusion. The surgery patient included patients who had maxillary impaction, mandibular advancement or combined two jaw surgery. The group that was treated-orthodontic alone was referred to-camouflage group. What this finding is interesting.	An article titled “Long-term Follow-up of Class Ⅱ Adults Treated with Orthodontic Camouflage: A Comparison with Orthognathic Surgery Outcomes” by Colin A. Mihalik and et al which appeard on March 2003 issue of Am J Orthod Dentofacial Orthop addressed this question. In this study, the researchers who are from the University of North Carolina evaluated sample of 31 adult patients who had been treated with orthodontics alone for the correction of Cl Ⅱ malocclusions. The average length of the time since the end orthodontic treatment was 12 years. Cephalometric radiographs, models and three questionnaires were used to compare long term stability and satisfaction with treatment for this group versus a group of patients who had been treated surgically for the correction of their Cl Ⅱ malocclusions. The surgery patients included patients who had maxillary impaction, mandibular advancement or combined two jaw surgery. The group that was treated with orthodontics alone was referred to as the camouflage group. What the authors found was interesting.
-Cephalomertric data for the camouflage patients showed almost no long term relapse change except-overbite. Overjet was stable for-orthodontic only group, which had increased 10% in-two-jaw surgery patients, 15% in-maxillary impaction group,-20% in-mandibular advancement group. In the camouflage group-small mean change-skeletal landmark position occurred in-long term which changes-generally smaller than in the surgery patient. The patient perception of outcome-treatment was high positive for both-orthodontic only and surgical group. Although both group had similarly-overall satisfaction with treatment, patient with mandibular advancement were significant more positive about-dentofacial image also-orthodontic only patient recorded fewer functional-temporomandibular- problem than-the surgery patient.-Bottom line of this study is that there is not whole a lot of difference in stability of result,-satisfaction with treatment if two group-patient were compared. When I first saw-article I was-little confused about-camouflage treatment. This term is initially used-early 70 related to surgical orthodontic patient who had deficient mandible. But we treated with combination maxillary anterior astronomy,-genioplasty advancement to avoid-risk of-instability which-occurred in mandible advancement at that time.	The cephalomertric data for the camouflage patients showed almost no long term relapse changes except for overbite. Overjet was stable for the orthodontic only group, which showed increase of 10% in the two-jaw surgery patients, 15% in the maxillary impaction group, and 20% in the mandibular advancement group. In the camouflage group, small mean changes in skeletal landmark positions occurred in a long term. But the changes were generally smaller than in the surgery patient. The patient's perceptions of outcomes of treatment were highly positive for both the orthodontic only and surgical groups. Although both groups had similar reports overall satisfaction with treatment, patients who had mandibular advancements were significantly more positive about their dentofacial images. Also the orthodontics only patients reported fewer functional or temporomandibular joint problems than did the surgery patients. The bottom line of this study is that there is not whole a lot of difference in stability of results, or satisfaction with treatment when the two group of patients were compared. When I first saw the article I was a little confused about the term, camouflage treatment. This term was initially used in the early 70's related to surgical orthodontic patients who had deficient mandibles, but were treated with combination of maxillary anterior osteotomy and the genioplasty advancement to avoid the risk of greater instability which had occurred with the mandiblular advancement at that time.
In this article-the author appeared to be going to simply make it dental compensation for-large-average anterior, posterior skeletal discrepancies. The other thing that was a little bit confusing was that-your discussing-ideal patient for camouflage treatment who has reasonable facial esthetic with overjet creates more-maxillary incisor protrusion and mandibular retrusion. I suddenly agree that patient with maxillary incisor protrusion-much better candidate-orthodontic treatment alone because maxillary protrusion were dental versus skeletal problem. However, patient who present-more difficult diagnostic challenge although who have larger skeletal discrepancy and normal-upright maxillary incisor but we can treat-orthodontic alone by making more severe dental compensation for the underline skeletal problem. I believe to prepare based on the result of this study-which suggest-patient that I initially describe to like to be satisfy-either form of treatment and that-decision to be based primary on your esthetic concern. I congratulate other long-term record-decision about-treatment can be made. You can find this article on March 2003 issue of American Journal of-Dentofacial Orthopedics.	In this article, the authors appeared to be referring to simply make it dental compensations for a larger than average anteroposterior skeletal discrepancies. The other thing that was a little bit confusing was that, in their discussion, the authors noted that the ideal patient for camouflage treatment showed have reasonable facial esthetics with overjet created more by maxillary incisor protrusion and mandibular retrusion. I certainly agree that patients who have maxillary incisor protrusion are much better candidates for orthodontic treatment alone because maxillary protrusion is a dental versus skeletal problem. However, patients who present a more difficult diagnostic challenge are those who have large skeletal discrepancies and normal to upright maxillary incisors but who can be treated with orthodontics alone by making more severe dental compensations for the underlying skeletal problem. I believe if would be fair, based on the results of this study, to suggest to the patient that I initially described that they are likely to be satisfied with either form of treatment and that their decision should be based primarily on their esthetic concerns. I congratulate the authors for handling and obtaining this long-term record so that the more informed decision about the results of treatment can be made. You can find this article in the March 2003 issue of American Journal of Orthodontics and Dentofacial Orthopedics.

Long-term Follow-up of Early Treatment with Reverse Headgear Hagg U, Tse A. et al. Eur J Orthod 2003;25:95-102. April 2, 2004 Dr. Eun-Ju Shim
[초벌원고] In recent years, maxillary protraction has become the treatment of choice for Cl III patients in the mixed dentition. Especially for those patients with the significant component of maxillary skeletal deficiency, protraction treatment in the mixed dentition has allowed-achievement of positive overjet through a combination of dental and skeletal effects. Up until now, no good information has been available regarding the long-term stability of this treatment.	[수정원고] In recent years, maxillary protraction has become the treatment of choice for Cl III patients in the mixed dentition. Especially for those patients with the significant component of maxillary skeletal deficiency, protraction treatment in the mixed dentition has allowed the achievement of positive overjet through a combination of dental and skeletal effects. Up until now, no good information has been available regarding the long-term stability of this treatment.
A recent publication from Hong Kong by professor Urban Hagg in the European Journal of Orthodontics now gives us some long-term follow-up information. The article is called-long-term follow-up of early treatment with reverse headgear,-and it appears in the February 2003 issue of-European Journal.	A recent publication from Hong Kong by professor Urban Hagg in the European Journal of Orthodontics now gives us some long-term follow-up information. The article is called “Long-term follow-up of early treatment with reverse headgear”and it appears in the February 2003 issue of the European Journal.
This study is further follow-up on a group of the Cl III patients that were originally reported on 1997 by Peter nun. The original group was studied consequently treated the Cl III patients that were diagnosed-matillary deficiency. They were just-nine years old on average at-starting of treatment, and were treated for about 9 months until positive overjet was achieved. This current study is attempted follow-up on these patients 8 years after treatment.	This study is further follow-up on a group of Cl III patients that were originally reported on 1997 by Peter Ngan. The original group was thirty consecutively treated Cl III patients that were diagnosed as maxillary deficiency. They were just under nine years old on average at the start of treatment, and were treated for about 9 months until positive overjet was achieved. This current study attempted follow-up on these patients 8 years after treatment.
Twenty-one of the original study were available for this follow-up. No differences-found between-characteristics of-21 available for follow-up and -original study. Leading-authors-believe-lots of the random and another follow-up sample were indeed representative of-original treatment group. Cephalometric films were available from before treatment, after treatment and the 8 year follow-up which was about age 17.	Twenty-one of the original thirty were available for this follow-up. No difference was found between the characteristics of the 21 available for follow-up and the original thirty, leading the authors to believe the lots was random and that the follow-up sample was indeed representative of the original treatment group. Cephalometric films were available from before treatment, after treatment and at 8 year follow-up which was about age 17.
The result showed that-the follow-up group-2/3 still have positive overjet 8 years later. These were designated the stable group. About 1/3 had relapsed in the negative overjet. These were designated the relapse group.	The result showed that, of the follow-up group, 2/3 still have positive overjet 8 years later. These were designated the stable group. About 1/3 had relapse in the negative overjet. These were designated the relapse group.
The author-is that look to see any differences-cephalometric appearance before treatment between these two groups that could be used as a predictor of treatment success. The answer of that question was that there were not cephalometric premier-could be predicted of the patients-later be part of-stable or relapsed group. They did find that during the treatment time, those subjects were later be part of-relapsed group had greater vertical increases than those in the stable group. In addition-they found-the relapsed changes that occurred in the relapse group were largely resulted unfavorable growth changes during the period of the lessen.	The authors then looked to see if there were any differences in cephalometric appearance before treatment between these two groups that could be used as a predictor of treatment success. The answer to that question was that there were not cephalometric parameters that could predict whether the patients would later be part of the stable or relapse groups. They did find that during the treatment time, those subjects that would later be part of the relapse group had greater vertical increases than those in the stable group. In addition, they found that the relapse changes that occurred in the relapse group were largely the result of unfavorable growth changes during the period of the adolescence.
From the study, that I think we have three important conclusions. 1. About 2/3 of Cl III patient treated in-mixed dentition with maxillary protraction will be stable long-term. 2. If significant increases in vertical measurement such as lower face side occured during treatment-the chance of long-term success are less. And, 3. About 1/3 of these patients-have a unfavorable growth during at a lessen. They'll relapse-negative overjet and may be required orthognathic surgery. Further details of this long term follow-up study of maxillary protraction can be found in the February 2003 issue of the European Journal of Orthodontics.	From the study, that I think we have three important conclusions. 1. About 2/3 of Cl III patients treated in the mixed dentition with maxillary protraction will be stable long-term. 2. If significant increases in vertical measurement such as lower face height occur during treatment, the chances of long-term success are less. And, 3. About 1/3 of these patients will have an unfavorable growth during adolescence that they'll relapse in the negative overjet and may require orthognathic surgery. Further details of this long term follow-up study of maxillary protraction can be found in the February 2003 issue of the European Journal of Orthodontics.

Comparision of Peer Assessment Ratings (PAR) from 1-phase and 2-phase Treatment Protocols for Class II Malocclusions Gregory J. King. et al. Am J Orthod Dentofacial Orthop 2003;123:489-96. April 9, 2004 Dr. Kweon-Hee Jeong
[초벌원고] Do you do much 2-phase treatment in your practices? But what I mean using headgear or functional appliances with biteplate during the preadolescent. At later following up with the second case, a comprehensive treatment under permanent dentition is morphologic development. Also, if you do perform phase 1 treatment, do you continue the use of headgear or functional appliances as a retentional plan between the two stage s comprehensive treatment.	[수정원고]
If you do advocate the use of phase 1 treatment, I would assume it is because of belief equal are you to achieve very result at the completion of phase 2. Conversely, if you do not advocate the use of phase 1 treatment, I would assume it is becaused of feel makes no difference and the result of treatment. Does your rising first day s treatment improve overall of result of treatment when compared to 1-phase treatment?
The study is titled “Comparision of Peer Assessment Ratings (PAR) from 1-phase and 2-phase Treatment Protocols for Class II Malocclusions” by Gregory King, et al. which appears on May 2003 issue of American Journal of Orthodontics and Dentofacial Orthopedics addressed this question.
In this study, the authors evaluated 208 Class II patients for a randomly assingned to 1-phase or 2-phase treatment with either a bionator or headgear/biteplate combination. They used PAR index to evaluate the severity of malocclusion at the initiated treatment and the end of phase 1 treatment and after completion of phase 2 treatment.
What did they find? Simply put. The used phase 1 treatment with either a bionator or headgear make no differences in the crowdy and final treatment results when compared 1-phase treatment. Also, whether or not Phase 1 appliances suggest headgear or a bionator for use as retention protocols between the two stage s subjects treatment make no differences. Additionally, they reported this study suggest that most of the change in reduction in PAR scores came from finished results achieved regardless of the protocol or initial severity of the malocclusion.
The bottom line of this study is based on the crowdy and final results achieved as evaluated the PAR scores it is difficult to justify the use of 2 phase treatment. This is just one of a number of recent studies which supported the same conclusion.
I should know that the longitudinal, randomized, clinical trial that include the large sample patients were supported by the program at the National Institute of Dental Craniofacial Research. If you would like to read this study detail, you can find it in the May 2003 issue of American Journal of Orthodontics and Dentofacial Orthopedics.

Dental malocclusion and Upper Airway Obstruction, An Otolaryngologist's Perspective Dudley J. Weider, Greg L. Baker, Fred W. Salvatoriello. Int J Pediar Otorhinolaryngol 2003;67:323-31. April 23, 2004 Dr. Kwang-Taek Ko
[초벌원고] I am going to review an article that in the authors own words is “not presented as new knowledge but rather as an attempt to put forth to the non-dental, and non-orthodontic world a subject seldom covered in many otolaryngologic and pediatric training programs.”	[초벌원고]
The article appears in the April 2003 issue of the International Journal of Pediatric Otorhinolaryngology and is titled, “Dental Malocclusion and Upper Airway Obstruction: An Otolaryngologist's Perspective.” The primary author of this paper is Dr. Dudley Weider, an ENT surgeon from the Dartmouth-Hitchcock Clinic in New Hampshire.
The literature review presented by Dr. Weider is primarily literature that we are familiar with, from authors such as Harbold, Linder-Aronson, Angle, McNamara, Moss and others that supports the theory that mouth breathing may contribute to the development of malocclusion.
The study itself consists of 8 patients that were referred to Dr. Weider for ENT surgery. These 8 were identified by the author as having a malocclusion including posterior cross bite and/or anterior open bite. Prior to surgery, a frontal of photograph was taken of the dentition. The patients were photographed again at least one year after surgery to remove upper airway obstruction. And these photos were compared to the pre-treatment photos. This subject of comparison revealed that there was spontaneous improvement in the malocclusion by the time of the one year follow up in all cases. Six of the eight underwent orthodontic treatment to complete the correction and of the malocclusion. The author uses these results to confirm his opinion that surgery to remove airway obstruction leads to positive improvement in the dental relationships.
The scientific merit of these series of case reports is low. The study is not well done or controlled. The interesting part of this story to me is that the author felt the need to present this evidence, as weak as it is, to his medical colleagues to highlight the relationship between airway problems and the development of malocclusion. As I quoted him at the beginning of this review, this is not a subject that is taught to most pediatric or ENT residents.
The take home message from this report is that your medical colleagues may not be very informed about the relationship between nasal obstruction and malocclusion. But if they are educated about this topic, they will become more aware of malocclusions and be a valuable team member in their treatment. To read the opinions of Dr. Weider, relative to airway obstruction and malocclusion, look at his article in the April issue of “the International Journal of Pediatric Otorhinolaryngology.”

In virto surface corrosion of stainless steel and Ni-Ti orthodontic appliances Ji-Soo Shin, Keun-Taek Oh, Chung-Ju Hwang. Aust Orthod J 2003;19:13-8. May 7, 2004 Dr. Jin-Hyoung Cho
[초벌원고] Did you know the your orthodontic appliances actually corrode in a patient's mouth? That's true. Study is in the past that shown specially an stainless steel archwires corrosion can occurred, if the archwires remain in the mouth for extensive periods of time. And this corrosion could cause weakening or excess friction on the archwires because of irregularity. But is this seems corrosion problem occur with the newer Ni-Ti archwires? That question was addressed in the study was published in the April 2003 issue of the Australian Orthodontic Journal.	[수정원고]
The title of the article is “In Virto Surface Corrosion of Stainless Steel and Ni-Ti Orthodontic Appliances”. This study was coauthored by Dr. Shin and two research associates from the orthodontic department in the college of dentistry at Yonsei University in Seoul, Korea.
The purpose of paper was to determine the surface morphological changes on stainless steel attachments and archwires in to compared that with Ni-Ti archwires after prolonged exposure to saliva. Now in this study the appliances were subjected to artificial saliva since this was a laboratory study. And can it be wondering? Yes. It is possible to created artificial saliva that actually simulated constituency of human saliva.
A sample of stainless steel brackets and archwires as well as Ni-Ti archwires were subjected to the test. In fact this was huge sample, really 400 simulated appliances were tested. And they were divided into 4 groups, according to manufacturer, and type of archwire. Each of these groups were further divided into subgroups that were immersed in artificial saliva for periods from 1 day, other day, for up to 12 weeks. Then the authors evaluated the color change, surface morphology, and visualized the changes in using spectrophotometer which could detect the areas of corrosion.
OK. What is the researcher's find? We Know that stainless steel corrode in saliva. But how about Ni-Ti archwires ? Well, the author's data confirmed the earlier observations about stainless steel archwires. Corrosion could be seen on all stainless steel archwires from the first week and by the end of 12 weeks. All stainless steel samples appeared to be covered in corrosion products. But there was no evidence a corrosion of the Ni-Ti wires even up to 12 weeks. There may happen a slight change in color but no other changes in surface appearance were observed. So will they be happened? The Ni-Ti archwires do not corrode on compared to stainless steel appliances.
So in conclusion, uniform surface corrosion which increase for time was done all stainless steel appliances that were incubated in artificial saliva for up to 12 weeks. On the other hand, Ni-Ti archwires exhibit only a slight color change but no corrosion was evident.
If you interested in reviewing the excellent study, you can find it in the April 2003 issue of the Australian Orthodontic Journal.

Long-Term Assessment of Psychologic Outcomes of Orthognathic Surgery Lazaridou-Terzoudi T, Kiyak HA, et al. J Oral Maxillofac Surg 2003;61:545-52. May 14, 2004 Dr. Ji-Young Park
[초벌원고] Have you ever been asked this question by a patient? You're planning orthodontics and orthognathic surgery on a female with severe mandibular retrognathia. There is no way to correct her malocclusion orthodontically because the overjet is 10mms and her mandible is very retrusive. Now the patient understands that she'll need orthognathic surgery to improve her function. But her question to you is whether or not the improvement in jaw position will not only produce better function and aesthetics but whether or not it will have any psychological impact on her over the long-term. How would you answer that question? How important is a change in a patient's appearance several or many years after orthognathic surgery on that patient. Actually few studies have looked at psychosocial outcomes of orthognathic surgery long-term, but a paper published in the May 2003 issue of the Journal of Oral & Maxillofacial Surgery attempted to accomplish that task. This was an excellent study. It was coauthored by several researchers from the University of Aarhus in Denmark, the University of Washington in Seattle and the University of Thessaloniki in Greece.	[수정원고]
he title of the article is “Long-Term Assessment in Psychologic Outcomes of Orthognathic Surgery”. The purpose of this study was to evaluate patients' perceptions to their improved changes after orthognathic surgery many years later. In order to accomplish this task, the authors identified a group of over 100 subjects, who had orthognathic surgery about fifteen years ago in Denmark. Each of these patients received a series of questionnaires. The questionnaires were designed to answer researchers' questions about a patient's psychosocial behavior long-term after orthognathic surgery. In order to compare this to a control group, the authors identified a sample of patients of similar age, who had never had any orthodontic or orthognathic treatment, in addition to a group of patients who were awaiting the start of orthodontic treatment.
Now these questionnaires were designed to elicit information from subjects regarding their perception of 1. function, 2. their appearance, 3. their health, 4. their interpersonal relationships after the orthognathic surgery and orthodontics had been completed. So I think you get the idea of the experiment. In other words, instead of evaluating patients within a year or two after surgery while it was still fresh in their mind, this study was trying to determine the long-term impact of changes in facial aesthetics long after jaw surgery. What do you think the researchers found? Actually the results are very encouraging. The perception of individuals long-term after jaw surgery is that they are much better adjusted than patients who are anticipating treatment, or patients who have never had treatment. For the most part, individuals who have had orthognathic surgery believe that their investment of time and effort were well rewarded with the long-term result. The psychological questionnaires show that these patients, for the most part, are very well adjusted and happy that they went through the treatment. In fact, it was interesting, the authors closed their paper by stating that their studies support the hypothesis that improvement in appearance brought about by orthognathic surgery is associated with an improvement in psychosocial adjustment for the patient. If you'd like to review this paper, you can find it in the May 2003 issue of the Journal of Oral & Maxillofacial Surgery.

A Lingual Arch for Intruding and Uprighting Lower Incisors Senior W. J Clin Orthodontics 2003;37:302-6. May 21, 2004 Dr. Kyoung-Im Kim
[초벌원고] Imagine a 38-year old female presenting to your office for treatment. She is concerned about her upper incisors spacing. But you quickly realize the correction of the upper incisors will require intrusion and uprighting the lower incisors to provide room for retraction. How do you accomplish this lower incisor movement? Most of our force systems play the intrusive force on the facial of the lower incisor. This tends to further procline the lower incisor as it is intruded.	[수정원고]
The June 2003 issue of the Journal of Clinical Orthodontics has introduced interesting clinical technique presented by Dr. Winston Senior that provides for easy lower incisor intrusion and uprighting by placing the intrusion force on the lingual. The article that describes this technique is called “A Lingual Arch for Intruding and Uprighting Lower Incisors”. The purpose of the subject article is to describe this clinical technique and to demonstrate the use through the presentation of two case reports. The key to this intrusion technique is that the intrusive force is directed from a lower lingual arch to the lingual of the incisors. This provides an intrusive force that paths behind the center of resistance of the incisors so that the moment generated by the intrusion force tends to upright incisors at the same time.
To use this technique, a lower lingual arch is made out of 0.036 inch stainless steel and soldered to the first molar bands. In order to resist the distal tipping tendency on the molars, an occlusal extension rest is added to the second molars. Before cementing the lingual arch, four short segments of elastic chain wrap around the anterior segment of the arch. A button is bonded to the lingual surface of each of the four lower incisors about half between the incisal edge and the gingival margin. The segments of elastic chain are then stretched from the lingual arch to each of the four buttons. The elastic chain segments are then placing an intrusive force on the incisors that is lingual to the center of resistance and therefore, also uprighting the teeth.
Two case reports that presented adult females show this technique used to provide the requirement of lower incisor intrusion and uprighting. The cephalometric superimpositions show impressive incisor change using this lingual arch technique. So now when you consider treatment mechanics for the 38-year old female that we discussed initially who requires lower incisor intrusion and uprighting to allow proper placement of her upper incisors, you make consider using this technique of elastic chains and lower lingual arch.
To read more details about this technique and to see the impressive incisor change presented in the case reports, find copy of the June 2003 issue of the Journal of Clinical Orthodontics. And look for the article by Dr. Winston Senior.

Intrusion of Posterior Teeth Using Mini-screw Implants Park Y-C, Lee S-Y, et al. Am J Orthod Dentofacial Orthop 2003;123:690-4. June 4, 2004 Dr. Min-Kyu Sun
[초벌원고] Providing adequate anchorage for tooth movement in adults is a common problem for orthodontists. In a previous article review in this month program, I discussed the use of individual canine distraction to retract the maxillary canine in an adult with no loss of posterior anchorage. Another source of anchorage support for tooth movement that is gaining increased popularity is the use of surgical mini-screws. These screws are similar to the screws that surgeons use to hole fixation plates in the maxilla or mandible during orthognathic surgery. They can be easily placed to provide orthodontic anchorage by simply screwing them through the attached gingiva into cortical plate and leaving the head of the screw exposed. Additionally, mini-screws have the advantage of greater flexibility in the area of placement which results in a greater ability to direct forces in an ideal direction. Additionally forces can be applied to them almost immediately after placement. In that article title intrusion of posterior tooth using mini-screw implants by Young-Chel Park et al which appeared in the June 2003 issue of the American Journal of Orthodontic & Dentofacial Orthopedics.	[수정원고]
The authors presented two case reports of patients who had extruded maxillary molars that were intruded with use mini-screws as anchorage. The first patient was a 49-years old woman who had an overerupted maxillary second molar that was interfering but the placement of implants in the mandibular arch. the second patient was a 52-years old woman whose maxillary left first and second molars were overerupted leaving very little vertical space for the placements of implants in the mandible. Both of these patients had mini-screws placed in the maxilla to provide a stable source of attachment for elastics to intrude the molars. Records from the cases show that in both instances, the molars were significantly intruded and adequate vertical space was provided for implants in the mandibular arch. In the first case, a surgical mini-plate was also used to help support anchorage. This is basically a plate that is placed across fracture sites in the maxilla and mandible during orthognathic surgery to stabilize individual bony segments. When used for anchorage, mini-plates are placed in the maxillary of mandibular cortical bone, leaving one loop exposed to the gingival tissue to act as a source of attachment.
The results demonstrated on these two cases of intrusion of maxillary molars were impressive. In addition to being very simple to insert, surgical mini-screws provide a source of anchorage for intrusion that does not require attachment to adjacent teeth which can result in unwanted reciprocal extrusion of these teeth. The screws are usually well tolerated by patients.
The bottom line is that the simple design of mini-screws makes them comfortable to the patients. Side effects such as extrusion of adjacent teeth are minimized so that results are more reliable and the implantation technique is relatively simple and allows control of the direction and the amount of force delivered. For these reasons, I feel very confident that you are going to see a greater and greater use of surgical mini-screws as a source of anchorage in orthodontic treatment.
When surgical mini-screws are compared with the type of individual tooth distraction that I discussed in the previous review, two major differences become apparent. The first is that the mini-screw has the advantage of being easier to place while the individual tooth distraction procedure has the advantage of creating much more rapid tooth movement,
You can find this article which has excellent photographs of two patients that were treated with surgical screws in the June 2003 issue of the American Journal of Orthodontics & Dentofacial Orthopedics. If you have a patient who has severe anchorage requirements and less than ideal cooperation, I would suggest that you read this article in detail.

Maxillary Expansion in Class II Correction with Orthopedic Cervical Headgear. A Posteroanterior Cephalometric Study Kirjavainen M, Kirjavainen T. Angle Orthod 2003;73:281-285. June 11, 2004 Dr. Yoon-Jung Choi
[초벌원고] Do you provide early treatment for Class II, division 1 malocclusions? For example, a 9-year old female presents to your office with the full Class II division 1 malocclusion and she is in the mixed dentition. She has no crowding and her overjet is about 7 mm. So, what do you do? For those of you that do provide early treatment keep listening to this review and for those of you that don't. Well, you still may want to listen if you do provide early treatment for this patient how would you widened maxillary arch so it will fit properly with mandibular arch when you achieve Class I molar relationship. We all realized that maxillary arch in the moderate to severe Class II relationship is narrow, it needs to be widened, and the widening needed depends upon the method of correction. If you to use cervical headgear to correct this malocclusion can you widened the maxillary arch enough with only a cervical headgear during phase I treatment.	[수정원고]
That question was answered in the study that was published in the June, 2003 issue of the Angle Orthodontist that the title of this article is “Maxillary Expansion in Class II Correction with Orthopedic Cervical Headgear”. This study was co-authored by Mirja Kirjavainen and Turkka Kirjavainen from the University of Helsinki in Finland.
The purpose of their study was to investigate the effects of cervical headgear therapy on skeletal and dental width of the maxilla and maxillary arch during early treatment of Class II malocclusions. The sample consisted of 40 children within average age of 9 years. There were 20 boys and 20 girls. A control sample of nearly 600 subjects was used to compare this information. New the only appliance used on the 40 treated subjects is cervical headgear with maxillary molar bands. All individual had Class II, division 1 malocclusions. Now in the cervical headgear was placed it was widened by 10 mm. All patients was treated until the Class II relationship had been corrected to Class I. Again, no other appliances were used. Then the authors compare the intermolar width and maxillary width using posterioanterior cephalometric radiographs to determine if widening actually occured. O.K. I think you get the idea. This was very straightforward study. It was clean. The only appliance used headgear. And then pre-and post dental casts were used to measure any changes in width. O.K. What happened? Actually, the widening in the maxillary molar region was significant. It was greater than 3 mm over year period time. In addition, evaluation of posteroanterior cephalometric radiographs showed that the maxilla itself also widened nearly 2 mm. In fact, when the mandibualr dental cast were evaluated even the mandibular intermolar width expanded nearly 1 mm. So there you have it. If you apply cervical headgear during mixed dentition and you widened the inner bows significantly you can expect a fairly significant change in a molar width both maxillary and a bit in the mandibular arch over period time. This is not only in dental change but it is also represent change in maxillary width. Of course, this width alteration is necessary in order to maintain normal buccolingual relationships as the mandible growth forward relative to the maxilla during the correction of the Class II relationship. Anyway I thought this was a very clean and interesting study. If you like to review it, you will find it in the June 2003 issue of the Angle Orthodontist.

Extraction vs Nonextraction: Arch Widths and Smile Esthetics Kim E, Gianelly AA. Angle Orthod 2003;73:354-358. June 18, 2004 Dr. Kyoung-Im Kim
[초벌원고] Let me begin this review by asking you a question. Which smile will be more esthetic after treatment, a patient treated with extraction of four first premolars or a patient treated nonextraction? Now, some of you might say “Well, it depends.” It depends on the shape of the teeth, the shape of the arch and may be some other factors. But I mean in general, which types of smile do you think on consistent bases will be regarded as more esthetic by laypeople after orthodontics, an extraction arch or a nonextraction arch?	[수정원고]
That issue was addressed in the studies was published in August, 2003 volume of the Angle Orthodontist. The title of the article is “Extraction vs Nonextraction: Arch Widths and Smile Esthetics”. This paper was co- authored by Eunkoo Kim and Anthony Gianelly, Goldman department of Orthodontics at Boston University.
This was very interesting study. The sample consisted of 60 subjects. In 30 of the cases, the patients were treated with extraction of four first premolars. In the other 30, the subjects were treated nonextraction. At the end of treatment, dental casts and close-up smiling photographs of these patients were evaluated.
As you did expect, there were some widening changes that occurred in the maxillary arch of the nonextraction group and some slight narrowing changes that occurred in the shape of the maxillary arch in patients with extraction of premolars. But these changes weren't significant, one compared to another. The question was whether or not laypeople could perceive a difference in the esthetics of the smile. So these authors asked 50 laypeople to assess all 60 of the smiles. They were allowed to look at these photographs three times and rate them from 1 to 10 with 1 being least esthetic and 10 being most esthetic.
OK. what do you think these laypeople found? Is nonextraction smile more esthetic than extraction arch after orthodontics in the eyes of laypeople? You'll be surprised. There were absolutely no differences. That's right. When laypersons evaluated, in compared the samples, the extraction and nonextraction smiles with close-up photographs, there were no significant differences in smiling esthetics between the two. Interesting. Today many people talk about nonextraction smiles and howthat may appear more esthetic. Not true based upon this study.
If you would like to review this article, you can find it in the August 2003 issue of the Angle Orthodontists.

The Eruption of Permanent Incisors and First Molars in Prematurely Born Children Harila-Kaera V, Heikkinen T, Alvesalo L. Eur J Orthod 2003;25:293-299. June 25, 2004 Dr. Min-Kyu Sun
[초벌원고] The permanent incisors and first molars are already critical time in development around birth. These teeth are beginning the first stages of mineralization during this time and it has been shown that dental defect in this teeth are more frequent in children with difficult a premature birth. How this premature birth affect the timing of eruption of this permanent teeth at rest during this neonatal time?	[수정원고]
This was a question that was asked by a group of researchers from Finland who recently published results they work in the June 2003 issue of the European Journal of Orthodontics. Their paper is titled “The Eruption of Permanent Incisors and First Molars in Prematurely Born Children”. The purpose of their study was to compare the eruption of the incisors and first molars in a group of premature infants with a group of normal term controls.
This study used information that was gathered in the 1960s and 1970s in the US a part of Collaborative Perinatal Project. Premature birth was defined as it just stational time of blossom 35-36 weeks as compared to controls who had average just station of 40 weeks. 328 prematurely born infants were identified in this way and than additional 1840 infants were able to serve as controls. The timing and stage of eruption was classified from dental casts that were obtain between the ages of 6 and 12. Each premature subject was matched with controls using age, sex, and race characteristics.
How do you premature birth affect the eruption of permanent incisors and first molars? Were they delayed since they were at a critical stage of development when the premature birth took place? Actually the opposite was true. The infant born prematurely has significantly earlier eruption of permanent incisors and first molars. This study was not designed to determine why this earlier eruption occurred but the authors theorized that since a period of catch up growth has been documented following premature birth, the same unknown factors responsible for this growth acceleration may also affect developing incisors and first molars and therefore result in earlier eruption.
So, what we can conclude from this study is that even though we don't know mechanism it is appears that permanent first molars and the incisors erupted in earlier time and prematurely born children. This information may be important for orthodontists if he or she is trying to accurately predict eruption time of the permanent teeth.
This article from the University of Oulu, in Finland also has a very good review of what is known about the mechanism of tooth eruption and factors that affect the timing of eruption.
If you would like to learn more about this process which is critical to the practice of orthodontics, I suggest that you find copy of the June 2003 issue of the European Journal of Orthodontics.

Constant versus dissipating forces in orthodontics:the effect on initial tooth movement and root resorption Weiland F. Eur J Orthod 2003;25:335-342. July 2, 2004 Dr. Yoon-Jung, Choi
[초벌원고] Do you use superelastic nickel-titanium wires to try to maximize the speed orthodontic tooth movement? The goal is to provide the light continuous force to cause continual frontal resorption and avoid areas of necrosis and undermining resorption. In real life, however, this is difficult. Root variations and tooth position and root anatomy it can be nearly impossible to avoid areas of necrosis in the PDL. Does this make teeth move with continuous forces more susceptible to root resorption? An interesting study from Austria published in the August 2003 issue of the European journal of orthodontics looks at this question. The article is titled “Constant versus dissipating forces in orthodontics: the effect on initial tooth movement and root resorption”. And this is written by Dr. Frank Weiland.	[수정원고]
The research is a prospective clinical trial done on human subjects to be able to look at tooth roots microscopically the experiment was done on premolars scheduled to be extracted for orthodontic reasons. A total of 84 premolars in 27 adolescents were included in the experiment. In addition, 6 premolars extracted before any tooth movement served as controls.
The subjects had special acrylic splint appliances constructed that allowed the buccal movement of the premolars. Brackets were placed on the premolars and on the splint about 5mm buccal to the bracket on the premolar. On one side, a superelastic wire was tied into the brackets to activate the buccal movement. On the other side, a stainless steel wire was placed with 1mm activation. The stainless steel wire was reactivated each 4 weeks during the 12-week experimental period while the superelastic wire remained continually active during the 12 weeks. After 12 weeks all the experimental teeth were extracted. The amount of tooth movement was measured from before and after dental casts. And the root resorption was objectively measured using a confocal laser scanning microscope. This technique allows three dimensional measurement of resorption areas.
Here is what Dr. Weiland’s found. As expected, the teeth with superelastic wires had more tooth movement than the stainless steel, 3.5 mm compared to 2.3 mm over the 12 weeks. But the teeth moved with continuous force of superelastic wires also had more areas of root resorption and each area of resorption was larger.
The message from this research is that we need to be aware that the continuous force may allow more rapid tooth movement but at the same time may put the tooth root at risk, for resorption. Especially in patients that may be susceptible to resorption care should be taken to occasionally give a teeth a rest to allow the root repair.
If you want to read more detail on this well done and perspective clinical trial you can find published in the August 2003 issue of the European journal of orthodontics

Relationship between Signs and Symptoms of Temporomandibular Disorders and Orthodontic Treatment Conti A, Freitas M, et al. Angle Orthod 2003;73:411-7. July 9, 2004 Dr. Chun-Sun, Eun
[초벌원고] Have you ever received this type of phone call? There is a dentist in your area who's highly involved with gnathology. He is calling you today to inform you that a patient, whom you just debanded about a month ago, now has significant temporomandibular joint symptoms. This is a 35 years old female who it had Cl I severely crowded malocclusion and you extracted 4 first premolars. Now that the appliances have been removed, she is reporting joint noises, limited opening, and pain. This gnathologically oriented dentist is calling wondering whether the extraction of premolars or perhaps the orthodontic treatment has initiated these problems. After all she didn't have these symptoms before the orthodontics.	[수정원고]
How would you respond to the dentist? Are these assumptions true? Do you have any ammunition to counter these types of claims from dentists? Well, let me give you something to use. There was an excellent study published in August 2003 issue of the Angle Orthodontist that discussed this information.
It was an excellent study that had many facts but I like to report on the most important aspects. First of all the title of paper is “Relationship between Signs and Symptoms of Temporomandibular Disorders and Orthodontic Treatment”. It's coauthored by Ana Conti and Marcos Freitas from the Department of Orthodontics at the University of S o Paulo in Brazil.
The purpose of this study was to evaluate the prevalence of temporomandibular disorders in individuals before and after orthodontic treatment: this was a cross-sectional study.
The sample for this study consisted of 200 individuals who were divided into 4 groups. Groups 1 and 2 consisted of adolescents with either Cl I or Cl II malocclusions who had not had any orthodontic treatment. Groups 3 and 4 consisted of older adolescents with Cl I and Cl II malocclusions who had had orthodontic treatment to correct these malocclusions. So basically the authors were trying to compare patients who had not been treated with those who had been treated as adolescents to determine the incidence of temporomandibular problems.
These signs and symptoms were assessed using a survey with 10 questions as well as an extensive examination to determine any symptoms relative to mouth opening, pain, joint noises, and other temporomandibular signs. Each of these areas was given a score from 0 to 3. 0 meant no problems, 1 were mild effects, 2 were moderate, and 3 were severe. You see by totaling the points scored for each of these areas the authors could determine that the degree of temporomandibular dysfunction an average in each group.
So as you can see this was a very extensive study. But, what did these authors find out? Let me take these areas one at a time. First of all, if the entire samples were looked at us whole about a third of the subjects in all groups had mild temporomandibular dysfunction. Furthermore less than 5% had moderate TMD and that left 60% of the samples who were free from any temporomandibular dysfunction.
Now for the big question! Was there any difference in those patients who had not been treated orthodontically and those who had been treated with orthodontic therapy? The answer to that question is “No”. And by the way, no individuals in the study reported severe temporomandibular disorders. But wait! How about differences between males and females? Well, you can probably “Yes” the answer to that 75% of the males were TMD free but about 50% of the females had temporomandibular dysfunction. OK! Now for the big question! Did extraction of teeth lead to higher incidence of the TMD? And the answer to that question is also “No”.
So what is this study shown us? I think this was a great experiment. This is something I think orthodontists can use to educate dentists. That in general orthodontic treatment does not cause TMD. In fact the conclusion of these authors is that orthodontic treatment does not seem to predispose subjects to TMD problems, nor is it indicated as an initial therapy for TMD patients. If you like to review the study, you find it in the August 2003 issue of the Angle Orthodontist.

Dental Tipping and Rotation immediately after Surgically Assisted Rapid Palatal Expansion Chung C-H, Goldman AM. Eur J Orthod 2003;25:353-358. July 16, 2004 Dr. Ye-Na Jeon
[초벌원고] You've just finished a meeting with a local oral surgeon and decided that the best treatment option for your adult patient with maxillary transverse deficiency will be surgically assisted rapid maxillary expansion. As you are writing up the details of your purposed treatment plan, you start thinking about whether overexpansion is indicated in these cases. You typically plan for some over expansion in your adolescent expansion cases, but is there any reason to do so with surgically assisted cases? The result of the study completed at University of Pennsylvania and reported in the August 2003 issue of the European Journal of Orthodontics may help you finalize your treatment plan.	[수정원고]
The title of this study done by Dr. Chung and Goldman is“Dental Tipping and Rotation after Surgically Assisted Rapid Palatal Expansion”. The purpose of the investigation is to determine rotation and tipping on the abutment teeth after the completion of the surgically assisted expansion. The authors recruited 14 patients, 10 females and 4 males who were having surgically assisted expansion as part of their orthodontic treatment plan. Alginate impressions were taken before treatment and again immediately after the expander was removed to create the dental casts used for the measurements. All 14 patients had expanders placed that were anchored on the 1st premolars and 1st molars. The surgery was done by one of three surgeons using a standard procedure that was basically Le Fort I without down fracture along with a midpalatal cut. After surgery, the patients expanded the appliance at 2 turns per day until the 7 mm limit of the expander was reached. Measurements of rotation and tipping were made from the casts by fastening reference wire segments from the buccal to lingual cusp tips on the abutment teeth. Rotation was measured from occlusal photographs of the casts with the wires in place. Tipping was measured by sectioning the base and measuring the angle of the wire segments to the base of the cast.
The result showed that 2 to 3 degrees of mesiobuccal rotation was measured on the abutment teeth, but this was not a statistically significant change from the pretreatment position. The buccal tipping of 6 to 7 degrees on the premolars and molars was significant, however. This degree of buccal tipping leads the authors to suggest that some overexpansion should be built into the treatment plan to compensate for the potential tipping relapse.
I have some questions about methodology used to measure the tipping and rotation in the study. It would have been nice to see a report of the method error involved in placing the reference wires on the cusp tips, and then the trimming of the cast basis to serve as a reference. But until we have better information, this study would suggest that as we are finalizing a treatment plan for an adult who will undergo surgically assisted expansion ,we should build in a bit of overexpansion to compensate for the 6 to 7 degrees buccal tipping that will likely result. If you would like to discuss this article with your oral surgeon colleagues, you can find it in the August 2003 issue of the European Journal of Orthodontics.

Miniscrew Anchorage Used to Protract Lower Second Molars into First Molar Extraction Sites Kyung S-H, Choi J-H, Park Y-C. J Clin Orthod 2003;37:575-9. July 23, 2004 Dr. Jin-Myoung, Song
[초벌원고] Imagine of a 15-year-old boy that is referred to your office for orthodontic treatment with two recent extraction sites where his lower first molars used to be. He has a good Class I occlusion with only mild irregularities and slight mesial tipping of the lower second molars into the first molar sites. The referring dentist suggested that you could operate the second molars to provide for more adequate prosthetic replacement of the lost first molars.	[수정원고]
If you had read the recent article from Korea in the October 2003, issue of Journal of Clinical Orthodontics. You may have another treatment option to suggest the patient and the dentist. The article from Korea is called “Miniscrew Anchorage Used to Protract Lower Second Molars into First Molar Extraction Sites”, and it's a basically case report showing the treatment of patient like the one we were imagining.
In this case report, the 15-year-old boy required to extraction of lower first molars but otherwise had an acceptable occlusion. The lower third molars were present, and had reasonable anatomy. The decision was made to protract the second molars into the first molar position using miniscrews as anchorage. The miniscrews that were used were 2 mm in diameter and 7 mm long. The screws were placed bilaterally into the lingual cortical bone between the first and the second premolars. The vertical position of the screws was designed to approximate the center of resistance of the lower second molars. The second molars were banded and connected with the distal insertion lingual arch to prevent rotation during protraction. The lingual arch had distal hooks that were again place vertically at the center of resistance of the second molars. The lingual arch with left the way from the incisors to allow mesial movement and an elastic chain with an initial force of 350 g was placed on each side from the miniscrew anchors to the hooks on the lingual arch.
The results in this case were impressive. The 9-mm space was closed in about 8 months. Then lower fixed appliances were placed for finishing with the total treatment time of 13 months. That's just over a year to protract the lower second molars almost a centimeter. The cephalometric film showed the lower incisor position was maintained during treatment by using the miniscrew anchors. This technique for absolute anchorage seems mechanically simpler than the technique described by Gene Roberts that uses implants in the retromolar areas for similar treatment results. There is some risk of root damage when placing the miniscrews between roots, but the authors minimize that in this in this case by using an acrylic stent for a miniscrew placement.
I have now reviewed several articles that described uses of miniscrew anchorage for orthodontic treatment. Judging by the result shown in this case report, this technique may definitely have a place in your office, especially to treat the type of case we discussed at the beginning with extracted first molars, or in some cases with congenitally missing teeth. I would encourage you to read this article from October 2003, JCO, to see the photographs and radiographs documenting this exciting technique.

Incisor Crowding in Untreated Persons 15-50 Years of Age: United States, 1988-1994 Buschang PH, Shulman JD. Angle Orthod 2003;73:502-508. July 30, 2004 Dr. Seok-Pil Kim
[초벌원고] What type of relapse occurs the most quickly after orthodontic therapy? In other words, when you debond patient if you didn't place retainers in that individual, what area were tempt to relapse the quickest. I think most orthodontist would answer "mandibular incisor crowding". The relapse of incisor irregularity or crowding tends to be very common after orthodontic therapy, whether the teeth extract or non-extract. But what would it happen if that patient had not had orthodontic therapy? In a natural state without orthodontics, what happens to mandibular incisor alignment over time? In additional interesting question, but we were take a huge sample to adequately assess that question.	[수정원고]
Well now that material and sample are available. A study published in the October 2003 issue of the Angle Orthodontists has assessed incisor irregularity in an untreated population over time. The title of the article is “Incisor Crowding in Untreated Persons 15-50 Years of Age.” The study was coauthored by Peter Buschang and Jay Shulman from the department of Orthodontics at Baylor collage of dentistry in Dallas.
Now the sample for this study was run from The Third National Health and Nutrition Examination Survey, more commonly known as NHANES III. This was a very large national survey that was performed in the 1999. It included over 9000 individuals, half male half female. These authors were able to evaluate this subjects and determent several aspects of incisor irregularity. This included the incidence, the relationship to race, the relationship to presence or absence of 3rd teeth, and finally the age at which crowding seem to be the most problem.
Let me review that with you and explain the findings for each of this question. First of all, although the differences were not large males still had significantly more crowding than females. In addition, blacks had significantly less crowding than whites in the population. As far as that timing or recurrence of incisor irregularity, it was greatest during early adulthood but they did not a lot.
How about the presence or absence of teeth? You know a common concern about incisor irregularity in the mandibular arch is the presence or absence of 3rd molars. But in this population, 3rd molars played no role in the severity of mandibular incisor crowding. That is erupted 3rd molars are not associated with increased crowding.
But how about the overall incidence of crowding, the authors noted that about 50% of the individuals in the United States, between 15 and 50 have little or no incisor irregularity. Interesting, about the quarter of population have moderate crowding and about 15% have severe crowding.
Finally the most significant contributor to the lack of incisor crowding was the absence of the mandibular 1st or 2nd molars, not and makes sense. If the 1st or 2nd molars are missing, the premolars could erupt distally. And incisor crowding would be minimal or absent.
So that you have in the United States, a child aged at age 8 has a 50% chance of having no crowding in the future, a 25% chance of having moderate crowding and 15% chance of significant irregularity long term. The 3rd molars were not influence the degree of irregularity. In a that person were a white male they were have significant more risk of the incisor crowding long term. And finally ones a person has reached middle age, the degree of crowding probably were level up and not become any worse.
Anyway I thought this was available information for orthodontists, after all were often as about the effect of no treatment overtime. This gives it a bit better prospective of the risk of the mandibular incisor crowding without orthodontic treatment. If you would like to review this article, you find it in the October 2003 issue of the Angle Orthodontists.

Radiation absorbed in maxillofacial imaging with a new dental computed tomography device Mah JK, Danforth RA, et al. Oral Sur Oral Med Oral Pathol Oral Radiol Endod 2003;96:508-513. August 6, 2004 Dr. Go-Woon Kim
[초벌원고] By now, most of you probably seen a heard of the NewTom 9000 scanner. This is the special CT scanning device designed specifically for dental applications. It gives a 3D radiographic scan of the maxilla and mandible which can be viewed in the many ways by the practitioner to enable visualization of impacted the teeth, purposed implant site, or malocclusions. As this technology becomes more readily available, we must ask the question of how the radiation dose from the NewTom machine compares to conventional dental radiography and to conventional CT imaging. This is precisely the question that was addressed the recent article published in the October 2003, triple-O.	[수정원고]
Dr. James Mah from USC led group that complete this research project called “Radiation Absorbed in Maxillofacial Imaging with the New Dental Computer Tomography Device”. The researchers acquired a tissue-equivalent phantom of a human head. This is a centrally dry skull that is encased in polymers designed to absorb radiation in a manner consistent with the living human tissue. In this phantom, thermoluminescent dosimeters are placed in areas are representing radiation susceptible tissues such as bone marrow, thyroid gland, salivary gland, eyes, and pituitary gland. The phantom was exposed to the NewTom scan which last about 70 seconds of which 18 seconds are really exposure time. The dosimeters were that read to determine a radiation dose at the specific sites.
Comparison of these results can then be made with the studies using the same phantom from panoramic and conventional CT imaging, and with other published results. So how is the radiation dose of NewTom device compared? The equivalent dose in the bone marrow was about 50μSv. This is slightly more than a panoramic film in the same range as a conventional dental full mouth series, and several times less than a conventional CT scan of the mandible. Other tissue areas showed similar results with the NewTom dose less than the conventional CT scans and the same general range as more conventional dental imaging studies. The NewTom device or other dental cone-beam scanners offers the distinctive advantage of true three dimensional imaging information. These three dimensional image scans can be used for diagnosis, localization, and treatment planning.
Based on the results of this study, the cone-beam imaging technique has a radiation dose comparable to traditional dental imaging techniques and substantially less than conventional CT images of the same areas. I suspected that over the next ten years, three dimensional cone-beam imaging will become a common tool in orthodontic diagnosis and treatment planning. The results of this study are comforting in showing us the relatively low radiation dose these imaging techniques deliver to the patient. To read more about the radiation dose delivered from the NewTom scanner, find the article written by Dr. Mah and colleagues in the October 2003 issue of Oral Surgery Oral Medicine and Oral Pathology.

Seven Fundamentals to Achieving Consistently Excellent Clinical Results. Harry H. Hatasaka. PROD 2004;16(3). September 3, 2004 Dr. Chang- Hun, Park
[초벌원고] Thank you very much John. American Board of Orthodontics, Angle Society, Tweed Foundation and number of international board have established criteria for evaluating excellence of clinical result in orthodontics which have been goal of orthodontist to consistently attain standard of excellence. These papers are examine seven requirements that I believed fundamental to obtain clinical excellence. Seven fundamentals are number 1. Make sure the upper second bicuspid are socked in. 2. Respect anchorage 3. Maintain lower incisors over basal bone. 4. Parallel root in extraction site. 5. Make the time to detail and refine the case. 6. Complete case on time 7. Unconditionally commit to excellence.	[수정원고]
In 1972 Lawrence Andrews published landmark article in American journal of orthodontics title “sixty key to normal occlusion”. For control he studied 120 untreated normal occlusion models. Subsequently he studied 1152 cases selected ABO examinations between 1965∼1971. Base on his finding Andrews concluded sixty key to normal occlusion are 1. Class I molar relationship. 2. Crown angulation. 3. Crown inclination. 4. No rotation. 5. Tight contact. 6. Level curve of spee. In 1994, ABO began the development of an objective grading system to evaluate final dental case, panoramic x-ray. Over the next 5 years they fulfilled test this system and involved into official grading system in 1999. ABO objective grading system contains 8 criteria. These are alignment, marginal ridge, buccolingual inclination, occlusal relationship, occlusal contact, overjet, interproximal contact and root angulation. The national using these criteria can be obtained by accessing website, www. American board ortho. com. Incorporating Lawrence Andrews finding on normal occlusion, ABO grading criteria and influential member of principle orthodontic research group as my study which I have belongs to I respect suggest seven fundamental clinical practices required to achieve excellence orthodontics. Actions required to attain seven fundamental also be presented.
Fundamental 1. Make sure the upper second bicuspid are sock in. Not only is this ABO criteria under heading of occlusal contact but lately Dr. Robert Richette stated that it represents the corner stone to superb occlusion. To achieve interdigitation and occlusal contact upper second bicuspid it is essential to develop and maintain adequate space for the upper second bicuspid. This requires super class Ⅰ molar relationship. Any mesial drift or rotation of upper first molar creates space discrepancy for the second bicuspid. Actions required bending first order to assure upper first molar are adequately rotated. It finds many manufactures offset bracket. Offset are inadequate even if they are good look. Check proper distal rotation of upper first molar in evaluating mesial drift. The line drawing to the tip of distobuccal and mesiolingual cusp of upper first molar should intersect distal third of cuspid on the opposite side.
Fundamental 2. Respect anchorage. Anchorage is resistance to an applied force. Keep in mind for every action there is an equal and opposite reaction. Not yet develop elastics, power chain, closing loop, coil spring for only one direction. Actions required believed anchorage, use headgear. I believe headgears are still gold standard in orthodontics. Bending tieback loop with first order bend to prevent posterior teeth drifting or rotating forward during space close. Bending stop loop with first order bend to maintain arch length in non-extraction cases. Fabricate parallel arch and lingual arch to augment anchorage. Utilizing cortical bone mini implant extreme anchorage requirement situations.
Fundamental 3. Maintain lower incisors over basal bone. If you can maintain lower incisor perpendicular over basal bone during treatment, that to me is angel work. Its devil work on lower incisor thrown in tenuous over position during treatment. Actions required, minimized, May elimite use intra oral Class Ⅱ elastic which tend to advance lower incisor to. I do not use Class Ⅱ elastics in my office because I could not find a kind of most use only for one direction. Additional action utilizing straightforward J-hook headgear to retract cupid. Use utility arch to intrude upper and lower incisor into level curve of spee. use -3° labial root torque. Keep the apex of lower incisor in the medullar bone.
Fundamental 4. Maintain root parallel in extraction site. Actions required. Close extraction site slowly. Activate closing loop normal and direction. Take your time. This is one step you do not want to waste. Teeth need to move help biology. I wait for osteoclast osteoblast to do the job. Dr. Dubuque concluded from his research if something isnt working dont increase force and increase time. My experience orthodontic residence teeth tend to activate closing loop wastefully too much. This result collapses the arch. It takes extra time to relevel. Additional action, use angulated bracket, bending box loop. All being bend help upright teeth.
Fundamental 5. Make time to refine and detail the case. Check for alignment. Correct overbite and overjet. Check interincisal angle, torque, interdigitation and cuspid function. Action develop progressive coarsely check list during treatment. Make sure bracket height even for marginal height discrepancy and rotation. Rebracketing as necessary. Assure curve of spee is leveled, individual torque, alignment teeth especially upper lateral. Check head film and other radiography as necessary. Very important action step is to coordinate arches at each appointment to assure alignment and interdigitation. After checking esthetic relationships and centric relation check functional relationship. Check premature eccentric, immediate side shift, incisal guidance and cuspid lift. Clinical experiences demonstrate to me that if anchorage is preserved teeth interdigitate without too much anchor. On the other hand if posterior teeth migrated mesially it is difficult to detail and finish case. Additional action read reference article by Dr. Poling AJO-DO A method of finishing occlusion May, 1999.
Fundamental 6. Complete cases on time. It is called quality on time treatment. Actually required it onset treatment after treatment plane is established constructed a critical pass diagram. I ate a flow chart. They objectively engage most difficult problem first. Priority type of problem it take most time to correct. To assist process constructed program evaluation review technique chart. I ate a flow chart. Set reasonable individualized target date base on the complexity of the case. Write target date down. Writing down is powerful. Review the treat date each appointment. As you retain treatment going along on schedule utilizing following trial to assist continue motivation of your patients 1. set short term easily attainable goals 2. motivate patient efforts 3. give the patient positive reinforcement. Utilizing system approach set short term goals the key of a system approach is abbreviated MCI. M stands for molar. C stands for cuspid. I stand for incisor. An idea is breakdown of the problem. For incidence a Class Ⅱ malocclusion is to correct the molar relationship first and it demonstrates small increment short term easily attainable measurable monthly goals. That way is simple accuracy motivation to the patient effort and able to give positive reinforcement. Once Class Ⅰ molar relationship has been attained all kind of good thing is stairway to heaven. Similarly cuspid and incisor are retracted class 1 small measurable monthly increment.
Fundamental 7. Unconditionally commit to excellence. Set the statement down on letters to patients that all office is unconditionally commits to excellence. Reinforce this statement to your staff member. Let them know your practical philosophy all about. If professional goal states three days diploma, D.D.S., doctor. There 5 of day should be apart philosophy practices dedication, determination, discipline, devotion and diplomacy. If you ignore Fundamental you and your patient will suffer the consequence and consequence is mediocrity. Dean Arthur Gunning past President ABO stated difference between mediocrity and excellence is difference between common knowledge and consistent application. Excellence is moral lock to ask any failure. Dr. Korgy Hanada president Japan orthodontic association emphasis at recently meeting that the meeting was dedicated high quality orthodontic treatment desired by patient. That was the research for ways excellence orthodontic treatment can be provided to as many as need. I properly believed if you established stablished excellence that adds enjoying your practices. Thank again John for opportunity to address to my colleague. I also wish to make it principle to support the American orthodontics association, orthodontist foundation. Actions required contribute; give something back to your profession. Thank you.

Clinical Conditions for Eruption of Maxillary Canines and Mandibular Premolars Associated with Dentigerous Cysts Masamitsu Hyomoto et al. Am J Orthod Dentofacial Orthop 2003;124:515-520. September 10, 2004 Dr. Kweon-Heui Jeong
[초벌원고] If you have been in your practices for reasonable number of years, you probably encountered adolescent patients who presented with the dentigerous cyst in mandibular premolar or maxillary canine area. These are thin well-defined radiolucent area surrounding the crown of an unerupted tooth. Usually, reassociated primary tooth is present, untreated this cyst can drive reassociated permanent tooth significant distances to unusual positions in the jaws.	[수정원고]
In a article title “Clinical Conditions for Eruption of Maxillary Canines and Mandibular Premolars Associated with Dentigerous Cysts” by Masamitsu Hyomoto et al which appeared in the November 2003 issue of the American Journal of Orthodontic & Dentofacial Orthopedics contains some practical informations perduring with adolescent patients who presented with dentigerous cysts.
In this articles, the authors studied 58 cyst-associated teeth including 47 mandibular premolars and 11 maxillary canines realizing panoramic radiographs and histological materials. They divided subjects into 2 groups. The first which the level erupted group in which teeth had erupted successfully after marsupialization and the second the non-erupted group in which teeth had undergone orthodontic traction or cystetomy with the removal of cyst-associated tooth.
I should know that there are 3 potential ways to deal with dentigerous cyst in adolescent and include the removal type of cyst with infected tooth, marsupialization and orthodontic attachment and traction of infected tooth would do opened form after marsupialization if adequate space exists. This cyst most commonly occur at mandibular premolar and maxillary canine areas. In this study 81% at mandibular premolar and 36% of the maxillary canines in the cysts erupted successfully about 100 days after marsupialization without traction. The authors emphasize the average time to tooth eruption after marsupialization was 109 days and the number of erupting teeth decreased after 110 days. Based on the this finding, they suggested a period of 100 days after marsupialization as a critical time for deciding whether to extract or use orthodontic traction.
Sensely what their saying is it if you do simply marsupialization, you have resolvable chance to permanent tooth erupting. However, if this does not occur with 100 days you should consider places and attachment only about to tooth as using orthodontic traction. when you try to denufy characterics associated with dentigerous cyst they would help them for deep whether or not they successfully erupted, they noted root maturity for successfully correlated with tooth eruption. Immature root tend to contribute greatly likelihood to tooth eruption. In the maxillary canine groups 71% of the nonerupted teeth had matured roots. The impacted teeth in the erupted group an author projection significally shallower and had less severe angulation than nonerupted group.
So much was surprisely. The cyst size showed no significant difference between the erupted and nonerupted groups in the mandibular premolars. However for the maxillary canines erupted group demonstrated smaller cyst areas than in the nonerupted group. And so much was surprisely awesome. It was finding that no significant differences between the amount of space require all that of eruption.
The bottom line of this study is that all those children s cyst including associated permanent tooth open a treated surgical removal this permanent teeth can often continuously erupt if the root is not matured. If the eruption does not occur spontaneously within 100 days after marsupialization, you should consider attaching to the permanent tooth as using orthodontic tractions. If you denufy at adolescent patients who has dentigerous cyst, I would strongly urge to take it read articles in his titles. It is appeared in the November 2003 issue of the American Journal of Orthodontic & Dentofacial Orthopedics.

Twelve-Year Follow-Up of an Autogenous Mandibular Canine Transplant Ioannidou E, Makris GP. Oral Surg Oral Med Oral Pathol 2003;96:582-590. September 17, 2004 Dr. Kwang-Taek Ko
[초벌원고] I recently treated an adolescent male with an impacted lower right canine. My initial treatment attempt was to move the tooth orthodontically. But if it came apparent that the tooth was ankylosed, after discussing the options with the family, we made the decision to try autotransplantation of the tooth and the surgical procedure was done shortly thereafter. At first, everything was great. But after about 6 to 9 months the tooth showed evidence of replacement resorption and had to be removed. I had been wondering if anything could have been done differently that would have improved the attempted autotransplantation. So I was excited to see a case report in November 2003 trip below that showed a similar case.	[수정원고]
The article is called “Twelve-Year Follow-Up of an Autogenous Mandibular Canine Transplant.” And it also includes an excellent, thorough literature review on autotransplantation. The subject of this case report was an 11 year old female with the lower right canine impacted facially near the midline. The decision to do the autotransplantation was made at the beginning not after unsuccessful attempt to move the tooth orthodontically like my case. The tooth was carefully extracted and then placed in the recipient site where the retained primary canine had been removed. The tooth was held in the place with minimal splinting and antibiotics were used for 7 days.
In addition, chlorhexidine gel was used to promote periodontal healing. At one month the periodontal healing was excellent with no inflammation and minimal pocket depths. Follow up was continued and a radiographic exam at 5 years show total of pulpal obliteration but no evidence of external root resorption or periapical pathology. At this time the pulp still responded normally to electrical pulp testing. At the most recently recall which was 12 years after surgery the tooth is still functioning well with good periodontal health and with no evidence of root resorption or periapical pathology.
After complete literature review the authors make the following recommendations to improve the success of autotransplantations. 1. Ideally the root should be between 1/2 and 3/4 complete at the time of transplantation. 2. The tooth should be put in recipient site no more than 30 minutes after extraction. 3. Minimal splinting should be used. 4. Trauma should be minimized to the PDL and root sheath. 5. Endodontic treatment should be done in teeth with fully developed roots.
When I think about these recommendations and the case I had that failed, I think that my chances of success may be better if autotranplantation was done initially rather than after unsuccessful movement.
In addition, maybe endodontic treatment had been done at the time of transplantation since the root formation was nearly complete that may have prevented the root resorption and ankylosis that caused the problem.
If you are contemplating of an autotranspantation for one of your patients reviewing this case report and its literature review were very valuable. You can find it in November 2003 issue of Oral surgery, Oral medicine, Oral pathology.

Orhtodontic Preparation for Orthongnathic Surgery: How Long Does It Take and Why? A Retrospective Study Luther F, Morris DO, Hart C. Br J Oral Maxillofac Surg 2003;41:401-406. September 24, 2004 Dr. Eun-Ju Shim
[초벌원고] If I'm scheduled on an airline flight that is delayed, the way the airline step hembles communication with me makes a huge difference on my mental attitude towards the delay. If they tell me right up front that there is a flight delay and it is expected to be about an hour, I can accept that and plan a way to use my time until departure. If they don't give me an accurate estimate of the delay at the beginning or keep giving me overly optimistic estimates turn out not to be true, I tempt to get upset and angry.	[수정원고]
The same concept can apply to patients undergoing orthodontic treatment. Especially those with orhtognathic surgery and the plan, if they know how long it will take to be ready for surgery, they can plan and accept it even if they would like to be it less.
Reserchers from Leeds and United Kingdom designed to study to collect abjective data about the length of the presurgical orthodontic phase of orthognathic surgery. The article reporting the results is called “Orthodontic Preparation for Orthognathic Surgery: How Long Did It Take and Why, Retrospective Study.” The paper is published in the December 2003 issue of the British Journal of Oral and Maxillofacial Surgery.
This data was collected in a retrospective manner for orthodontic SyndLeeds area. What asked provided at least of orthognathic cases the day of treated over the past five years. The records of these patients were examined and the following information was extracted. Treated orthodontist, type of malocclusion that is Class II, III, etc., age, gender, and wheather extraction is part of treatment plan. This data within combined examined and displayed using graphite plots.
What do you think the averge presurgical treatment time was? It was about 18 months. But range from 7 to 47 months. Was the time affected by the age of the patient? No. Was the time affected by the gender of the patient? No. How about the type of malocclusion? Did it Class III take longer than Class II div. 1? No. But there is more variation in the Class III patients. Did having extraction in the treatment plan increase the presurgical time ? Not in this seriously cases anyway. The only factor that seemed influence the time was the orthodontist. One of four orhtodontists have presurgical time to attempted to a few month longer than other three.
Based on this data, the authors recommend the patients be told that the presurgical phase of treatment will take from 12 to 24 months. They expected that this realistic information based on the results of this study will provide patients with good information for planning that will help them avoid the feeling like you don't know when your plane will take off. The two more details of this study in investing normal time for presurgical orthodontics look in the December 2003 issue of British Journal of Oral and Maxillofacial Surgery.

Localizing Ectopic Maxillary Canines- Horizontal or Vertical Parallax? Armstrong C, Johnston C, et al. Eur J Orthod 2003;25:585-589. October 01, 2004 Dr. Heung-Gyo Lee
[초벌원고] Some people have suggested using the vertical-parallax technique for localization of impacted maxillary canines. The rationale is that normaly a panoramic film are already exist so if one additional peri-apical or occlusal radiographs_taken at a greater vertical angulation_than any image shift principles can be applied with little additional radiation to the patients.	[수정원고] Some people have suggested using the vertical-parallax technique for localization of impacted maxillary canines. The rationale is that normaly a panoramic film already exists. So if one additional peri-apical or occlusal radiograph is taken at a greater vertical angulation, then the image shift principles can be applied with little additional radiation to the patients.
Authors have suggested taking two additional radiographs that different horizontal angulation for better localization. Which is best? Can it canine be localized justice well using one anterior X-ray and addition to the panoramic film or is it best_take two additional films even if the radiation exposures slightly higher.	Others have suggested taking two additional radiographs that different horizontal angulation for better localization. Which is best? Can a canine be localized just as well using one anterior X-ray in addition to the panoramic film or is it best to take two additional films even if the radiation exposure is slightly higher.
Research is from Queen's University in Belfast address this question in the December 2003 issue of the European Journal of Orthodontics. The article was presented research finding is called “Localizing Ectopic Maxillary Canines_Horizontal or Vertical Parallax?”. In order to compare the vertical or horizontal parallax techniques_the authors went to the clinical records the find cases that has sufficient radiographs to apply both techniques to the same teeth.	Researchers from Queen's University in Belfast addressed this question in the December 2003 issue of the European Journal of Orthodontics. The article that presents the research finding is called “Localizing Ectopic Maxillary Canines, Horizontal or Vertical Parallax?”. In order to compare the vertical and horizontal parallax techniques, the authors went through their clinical records to find cases that had sufficient radiographs to apply both techniques to the same teeth.
This results in radiographs from 39 patients that had_total_43 impacted maxillary canines. Six experienced orthodontist all asked to locate the 43 impacted teeth from the radiographs. First_there were given the panoramic film and one additional anterior peri-apical_occlusal film that differ the vertical angulation and asked to identified localization as buccal, palatal or in the line of the arch.	This resulted in radiographs from 39 patients that had a total of 43 impacted maxillary canines. Six experienced orthodontists were asked to locate the 43 impacted teeth from the radiographs. First, they were given the panoramic film and one additional anterior peri-apical or occlusal film that differed in vertical angulation and asked to identify the location as buccal, palatal or in the line of the arch.
If they could make a judgement they answered unsure. They were_than given a proper radiographs for the same 43 teeth that varied in horizontal angulation and gain ask_make the same localization decision. The true canine position was taken to be that_was true identified after time of surgical uncovery. The result were interesting. There were more unsure response given when_examiner use the vertical parallax technique. The horizontal parallax technique correctly identified_canine position 83 percent of the time at some examiners as good as 93 percent and some_only 70 percent correct. The vertical technique was worse. Only 68 percent of the time was_correct position identified ranging from 60 to 74 percent many examiners.	If they could make a judgement they answered unsure. They were, then given appropriate radiographs for the same 43 teeth that varied in horizontal angulation and again asked to make the same localization decision. The true canine position was taken to be that which was identified at the time of surgical uncovery. The results were interesting. There were more unsure responses given when the examiners used the vertical parallax technique. The horizontal parallax technique correctly identified the canine position 83 percent of the time with some examiners as good as 93 percent and some with only 70 percent correct. The vertical technique was worse. Only 68 percent of the time was the correct position identified ranging from 60 to 74 percent among the examiners.
Although of over performance of the horizontal technique was better, both techniques identified_buccal impactions correctly only 63 percent of the time. We can conclusion to the study is that localization of impacted maxillary canines is significantly better using a horizontal parallax technique rather than a vertical technique. Taking when additional anterior peri-apical film to applied horizontal technique is justified to improved_diagnostic accuracy even if_means_small amount_positional radiation exposure.	Although the overall performance of the horizontal technique was better, both techniques identified the buccal impactions correctly only 63 percent of the time. The conclusion to this study is that localization of impacted maxillary canines is significantly better using a horizontal parallax technique rather than a vertical technique. Taking an additional anterior peri-apical film to apply the horizontal technique is justified to improve the diagnostic accuracy even if it means a small amount of additional radiation exposure.
For further reference_this article by Dr. Armstrong and colleagues can be found in the December 2003 issue of the European Journal of Orthodontics.	For further reference, this article by Dr. Armstrong and colleagues can be found in the December 2003 issue of the European Journal of Orthodontics.

Periodontal status following surgical-orthodontic alignment of impacted central incisors with an open-eruption technique Chaushu S, Brin I, et al. Eur J Orthod 2003;25:579-584. October 8, 2004 Dr. Ji-Young Park
[초벌원고] A young patient of yours has an impacted maxillary central incisor. The impaction was due to the obstruction of a mesiodens which has now been removed. You have decided that it is time to begin orthodontic traction on the impacted central and are ready to send the patient for surgical uncovering and bonding. As you prepare to dictate your referral letter, you remember that surgeon A prefers to do open-exposures to allow easy bonding of the attachment after healing and to prevent the need for a second surgery if the attachment should come off the tooth. Surgeon B, on the other hand, prefers to use the closed-eruption technique where the tissue is placed back over the impacted tooth once the attachment has been bonded. Which is better for the impacted central incisor? Some new information that relates to this decision has recently been published in the December 2003 issue of the European Journal of Orthodontics.	[수정원고]
The study was done in Israel and is called “Periodontal status following surgical-orthodontic alignment of impacted central incisors with an open-eruption technique”. The purpose of this study was to compare the long-term periodontal and esthetic results of central incisors treated with an open-exposure to the adjacent central incisor that was not initially impacted. The authors had a difficult time finding patients treated in this way that were available for follow-up but ended up identifying 12 patients from 6 orthodontic practices that met their criteria. These twelve were then recalled and subjected to a clinical and radiographic examination that measured various periodontal and esthetic parameters.
The results of this study showed that treatment with open-exposure leads to some differences when compared to the adjacent incisor. The pocket depths are slightly greater, the attached gingiva is less and the clinical crown is almost 1½mms longer on average. In addition, the radiographic exam showed that the bone support on the mesial of the previously impacted teeth was less than their adjacent counterparts. These same authors had earlier studied a group of similar patients that were treated with a closed-eruption technique and although they are careful to say that the studies are not directly comparable, they believe that the closed-eruption technique generally results in better esthetic and periodontal results.
The conclusion of this study is that if you treat an impacted central incisor with an open-exposure technique, some unwanted periodontal and esthetic effects are likely. So getting back to your patient ready to have the impacted central incisor exposed, this paper would suggest that you send for patient to surgeon B, the one that prefers a closed-eruption technique. To get a copy of this article to share with your surgeon or periodontist, look in the December 2003 European Journal of Orthodontics.

Growth Modification of the Rabbit Mandible Using Therapeutic Ultrasound: Is it Possible to Enhance Functional Appliance Results? El-Bialy T, El-Shamy I, et al. Angle Orthod 2003;73:631-639. October 15, 2004 Dr. Jin-Hyoung Cho
[초벌원고] Suppose you are examining a 12-year-old female patient. All of her permanent teeth have erupted. She has a Class II division 1 malocclusion with no crowding in either arch, and the aesthetics of her smile are quite good. The problem is, she has a 7 ㎜ overjet, and when you look at her in the lateral facial view, she has an extremely retrusive mandible. Her upper lip to nose relationship is perfect.	[수정원고]
Now what do you do? She may not have a lot of growth left. Extracting upper premolars would retract her maxillary incisors too far. She may not wear a functional appliance, and it probably won't do much for this patient at this age anyway. What you would really like to do is simply grow her mandible longer. Now unfortunately, we can't do that, or can we? We simply need something to stimulate condylar growth. You know, in the medical literature, researchers have used ultrasound to enhance healing across bone fracture sites and also after distraction osteogenesis. It works quite well. Could ultrasound be used to stimulate condylar growth? What a ridiculous thought! But that question was asked in a study that was published in the December 2003 issue of the Angle Orthodontist. The title of the article is “Growth Modification of the Rabbit Mandible Using Therapeutic Ultrasound”. The study was co-authors by Tarek El-Bialy and 3 other research colleagues from the department of orthodontics in Saudi Arabia and Ezypt.
The purpose of this article was to determine whether or not ultrasound would enhance cartilage proliferation and bone growth of the condyle in rabbits. Now just we will start on the same page, let me defined the term “ultrasound”. It is a form of mechanical energy that's transmitted through and into biological tissues as an acoustic pressure wave. It has various frequencies that are widely used in medicine for therapeutic and also diagnostic purposes. Low intensity ultrasound that's pulsed has been used to encourage the proliferation of fibroblasts. So you see in this study, the researchers wanted to determine if the same type of pulsed ultrasound could be used to stimulate condylar growth. 8 growing rabbits were used as the sample. Ultrasound was applied for 20 minutes a day for 4 weeks to the left mandible of each rabbit. Nothing was applied to the right mandible. After 4 weeks, all animals were evaluated to determine changes in the length of the mandibular condyle and also the amount of proliferation of cartilage. Both condylar height, and condylar length, as well as ramus height, and mandibular height were measured. The side receiving the ultrasound was compared to the non-treated condyle.
OK! what would you think these researchers found? Actually the difference in condylar growth between the treated and non-treated sides was significant. Not only was ramus height longer, but condylar height and mandibular length were also significantly longer on the side treated with ultrasound compared to the non-treated condyle. That's really good news. So, this then mean we should prepare purchase these types of devices for our patients? I don't think so. At least not yet. But I do like the innovative thinking of these researchers.
I'm sure it will take many more studies of this same methodology in different laboratories and in conjunction with other types of orthodontic appliances to verify the result of study. But I think the finding gives us wonderful news. After all these years, maybe we have some way of stimulating growth in an area of the skull that would help orthodontists and their patients tremendously. So if you are interested in reading the study on ultrasound stimulations of mandibular growth, you will find it in the December 2003 issue of the Angle Orthodontist.

Stability of Combined Le Fort Ⅰ Maxillary Advancement and Mandibular Reduction Arpornma P, Shand JM, Heggie AA. Aust Orthod J 2003;19:57-66. October 22, 2004 Dr. Kyoung-Im Kim
[초벌원고] Suppose you're planning treatment for a 25-year-old female patient who has a Cl Ⅲ malocclusion. Her anterior overjet is -6 ㎜. When you evaluate her in lateral view, she could definitely benefit from both maxillary advancement and mandibular setback. Now, both arches are centrally non-extraction arches. So it should be free straight forward to simply align a teeth and then do surgery. Here is the problem. She has relatively constricted posterior maxilla. So when you look at a dental cast and move the maxilla forward over the mandible, there is still a crossbite. So, here is choice. You could have the surgeon split the maxilla and have and correct crossbite surgically or you could use palatal expansion to wide maxilla first and then do surgery. My point is “Will maxillary advancement surgery be more or less stable at the maxilla is divided into 2-segments compared to advancemet without dividing the maxilla.” That question was answered in a study that was published in the November 2003 issue of the Australian Orthodontic Journal.	[수정원고]
The title of the article is “Stability of combined Le Fort Ⅰ maxillary advancement and mandibular reduction”. This study was co-authored by Premjit Arpornmaek and Jocelyn Shand from the Department of Orthodontics at the University of Melbourne in Melbourne, Australia. The purpose of this study was to evaluate the stability of combined maxillary and mandibular surgery to correct Cl Ⅲ malocclusions after 1 year post-operatively. The sample consisted of 30 patients. All of these individuals has Cl Ⅲ malocclusions initially and were treated in combined mandibular sagittal osteotomy and setback as well as maxillary Le Fort Ⅰ osteotomy with advancement. The average change or total movement of the maxillary and mandibular repositioning, was about 10 ㎜. So, you see, these were significant changes. But in about half samples, the maxilla was split in the middle and widen the posterior as it was brought forward. In the other half, the maxilla was advanced in 1-segment.
The question is “Was there any difference in the stability between these two?”. And the answer of that question is “definitely not”. When the authors evaluate the relapse tendencies on average, the mandible tended to move forward about 1 ㎜ after surgery. This was compensated before by the use of intermaxillary elastics to move the maxillary anterior teeth slightly forward during the finishing orthodontics. Ah, what about maxilla changes? Did maxilla move after surgery? The authors found no significant differences in relapse of maxilla posteriorly if the surgery was done in 1- or 2-segments. This is good news. This means that orthodontists should not be concerned if the maxilla has to be divided in half when it advanced. This study has shown there's no instability of the maxilla if the Le Fort Ⅰ osteotomy is done in 2-pieces.
If you would like to review this study on post-operative changes following combined maxillary and mandibular osteotomy in Cl Ⅲ malocclusions, you can find it in the November 2003 issue of the Australian Orthodontic Journal.

Resin-modified glass ionomer, modified composite or conventional glass ionomer for band cementation? -an in vitro evaluation Millett DT, Cummings A, et al. Eur J Orthod 2003;25:609-614. October 29, 2004 Dr. Min-kyu Sun
[초벌원고] Over the past ten to fifteen years glass ionomer cement have become popular for band cementation because they can release fluoride and bond to both in enamel and metal band. More recently attempts to improve the strength of glass ionomers have resulted in resin modified glass ionomer cement that have some characteristics of composite resins but yet retained acid based setting reaction characteristics of glass ionomer cements. In addition, traditional composite resins have been modified to add a richable glasses of the filler so that they can act as a fluoride resorvior and yet retained a rapid set of composites. All three of these cement conventional glass ionomers, resin modified glass ionomers, and modified composite resins are being sold these band cement.	[수정원고]
Which one you should use? One factor that you want to consider is the strength of this cement, that is, how well did they hold the band to the tooth. To help us answer that question researcher from Glasgow published results their laboratory testing these band cement in an article titled “Resin-modified glass ionomer, modified composite or conventional glass ionomer for band cementation?-an in vitro evaluation”Their report is published in the December 2003 issue of the European Journal of Orhtodontics.
This study tested four band cements. One was conventional glass ionomer, Ketac-Cem, one was a modified resin, Ultra Band-Lok, and two were classified as resin modified glass ionomers, Fuji Ortho LC and 3M Multi-Cure. Each of these four cements was used to cement 20 bands on 20 extracted 3rd molars. These 80 teeth were then subjected the shear strength testing in a universal testing machine to determine how much forces required to pull the band off the tooth. A second laboratory test was done the further compare the four cement. Ten additional teeth or band of each cement and then this teeth were placed in a rotating ball mill which ceramic spheres. As the mill rotates the ceramic spheres bang randomly against the band and tend to eventually not get loosed, the average time those require the band loose was then determined for each cement.
So how did these four cements compare using these two tests? These was no difference between any of the four in the shear strength testing. So the force require pull the band off the tooth did not really vary. There was a difference though in the ball mill survival testing. The conventional glass ionomer, Ketac-Cem last average only 3.5 hours. Well Fuji Ortho LC, 3M Multi-Cure and Ultra Band-Lok last to 8 to 11 hours. The authors believe that the ball mill survival testing may be more pridictable clinical success than the standard strength testing. If this is true then the conventional glass ionomer may not have the clinical success of the modified resin or modified glass ionomer.
As you decide which band cement to use there many factors to consider. This study suggests that there is not a big difference between the resin modified glass ionomers and the modified composite resin in terms of shear strength or their survival in a simulated mechanical stress test. However the conventional glass ionomer suffered earlier failure in the ball mill testing than the other two types. If you want further information about this study from Glasgow you can find it published in the December 2003 issue of European Journal of Orhtodontics.

The remineralizing effect of an essential oil fluoride mouthrinse in an intraoral caries test Zero DT, Zhang JZ, et al. J Am Dent Assoc 2004;135:231-237. November 19, 2004 Dr. Yoon-Jung Choi
[초벌원고] The potential for decalcification is a problem that every orthodontist faces. Gingivitis is another orthodontic problem that has the potential to mase to severe periodotal disease. It has been well-documented that sodium fluoride rinses can significantly reduce or even reverse the initiation and progression of dental caries. Entire microbial mouthrinses including mouthrinses containing a fixed combination of antiseptic essential oils have been shown to be effective in controlling plaque accumulation and in helping to reduce gingivitis. Listerine, anitseptic mouthwash, containing 4 essential oils, mainly thymol, eucalyptol, methyl salicylate and menthol and has been shown effective in controlling in plaque accumulation and helping to reduce gingivitis. What would happen if you combine an essential oil mouthrinse like listerine with sodium fluoride solution? With the two rinses acts synergistically and improve both antibacteiral and anticaries effect or what want carry out the other. With combining them the anymore effective than using each mouthrinses individually.	[수정원고]
This question was addressed in an article title, “The remineralizing effect of an essential oil fluoride mouthrinse in an intraoral caries test” by D.T. Zero. et al which appeared in the February 2004 issue or the journal of the American Dental Association. In this study, the authors evaluated the overall remineralization effectiveness of three different mouthrinses. One was a fluoride mouthrinse with an essential oil which was a test mouthrinse. The second was a fluoride-non essential oil mouthrinse and the third was an essential oil-nonflouride mouthrinse. The effectiveness on remineralization was tested by mounting two partially demineralized human enamel specimens in patients who were wearing partial dentures. The enamel specimen were embeded in the clayey pot of the partial denture. 125 subjects were evaluated at the end of two weeks study period. The subjects were randomly divided in two groups, each group use one of the three mouthrinses twice a day. After two weeks, the enamel specimen were removed and tested for surface microhardness and the enamel fluoride uptake.
What do you think happened? The combining essential oil mouthrinse like listerine with sodium fluoride mouthrinse increase the overall remineralization effectiveness? The answer is that the surface microhardness recovery was 42% in the group with the combined rinses, 37% in the group with the fluoride rinse and 16% in the group that received only essential oil mouthrinses. When fluoride uptake was evaluated the group with the combined mouthrinses also had the highest fluoride uptake. The bottom line of this study is that essential oil mouthrinse such as listerine combine with 100 parts per million fluoride is effective in promoting enamel remineralization and fluoride uptake, thus providing protection not only against demineralization but also against gingivitis without having to take two separated mouthrinses.
You can find this interesting article in the February 2004 issue of the Journal of the American Dental Association.

The Effect of Washing Water on Bonding to Etched Enamel Schneider DJ, Combe EC, et al. J Oral Rehabil 2004;31:85-9. November 26, 2004 Dr. Chun-Sun Eun
[초벌원고] In recent years, the quality of the water in dental units has been a focus. Many studies have shown high concentrations bacteria in dental waterlines. In fact, the new CDC infection control guidelines for dental offices specifically address dental waterlines. The primary focus on water quality has been on possible harm to the patient from the bacteria present in the water. But recently, a group of researchers from the University of Minnesota published to report looking at the effect that bacteria in the water may have on the bond strength to etched enamel. The report appears in the January 2004 issue of the Journal of Oral Rehabilitation and is called “The Effect of Washing Water on Bonding to Etched Enamel.”	[수정원고]
This was a laboratory study looking at the bond strength of composite resin to bovine enamel. In addition, the critical surface tension of the etched enamel surface was measured. The study was divided into 5 groups. All groups had composite resin bonded etched enamel in the same manner. The only difference between the groups was the water there was used for rinsing. The first group was a control and a rinse was done with distilled water. The second group was rinse with water containing iodine, a chemical now frequently added to dental water that control bacterial growth. Group 3, 4, and 5 were rinsed with water containing increasing concentrations of bacteria in the range commonly measured in untreated dental units.
After bonding, the bond strength was measured in an Instron universal testing machine. I would guess of that the presence of the bacteria in the rinse water would have no effect on the shear bond strength. But I would be the wrong. This study showed significant reduction in shear bond strength etched enamel with bacterial counts about tends the force colony forming unit/mL. The reduction in bond strength was nearly 50%. The results also showed that the present of iodine in the water at a level recommended the control bacteria in waterlines had no effect on the bond strength. The authors also found strong correlation between the reduced bond strength and reduced enamel surface tension.
The lesson to be learned from this report is that it is important the control of bacteria in dental waterlines not only from an infection control standpoint, but from a bond strength perspective. You'll want to comply with a new CDC recommendations not only to make your offices safer place but also to reduce the likely adhered bonding failures. I wonder how many times would have tribute loose brackets other causes, when the true problem was bacteria in waterlines. The real shooting part of this study is that iodine can be used control waterline bacteria and if does not appear that effect any change in shear bond strength. For more information about the enamel bonding and water quality reported January 2004 issue of the Journal of Oral Rehabilitation.

Semirapid Maxillary Expansion - A Study of Long-Term Transverse Effects in Older Adolescents and Adults Iseri H, Ozsoy S Angle Orthod 2004;74:71-78. December 3, 2004 Dr. Min-Kyu, Sun
[초벌원고] When you use a palatal expander to correct posterior crossbites, do you expand rapidly or slowly? Or do you apply a combination of rapid and slow expansion? What if you are expanding the maxilla in a young adult or late adolescent? Do you always need to expand surgically? Or could you expand the maxilla in an adult with slow palatal expansion? These are all issues that effect orthodontists when they are faced with making a decision about palatal expansion in an older individual. A study published in the February 2004 issue of the Angle Orthodontists discuss a combination of rapid and slow expansion in older individuals. The title of this article is “Semirapid Maxillary Expansion - A Study of Long-Term Transverse Effects in Older Adolescents and Adults”. This study is coautherd by Haluk iseri and Serhat Ozsoy.	[수정원고]
The purpose of the study was to evaluate the short and long term effects of semirapid maxillary expansion on the dentofacial structures in older adolescents and young adults. Their sample consisted of 40 individuals. 20 were treated orthodontic patients who required maxillary expansion, and the other 20 were control subjects who received no orthodontic treatment. The age range of the sample was between 11 and 17 years. Now the definition of adulthood for the sample was based upon skeletal maturity and the evaluation of wrist films.
All subjects had unilateral or bilateral crossbites due to maxillary transverse insufficiency. A bonded acrylic device was used to deliver the expansion force. A typical jackscrew expander was embedded in the palatal portion of the acrylic of this appliance.
For the first five to seven days, two turns were made each day, one in the morning and one in the evening. Now the expansion screw each turn produced two tenth (0.2) mm of expansion. Then the expander was debonded, and it was used as a removable expansion device after the first seven days. At this point it was activated three times per week, so that only six tenth (0.6) mm of expansion occurred each week. I think you would agree this is definitely slow. Therefore, the average expansion time in this sample was a little more than four months. Then the expansion was retained with the same expander for a period of about three months afterwards. The authors then followed these individuals and evaluated them nearly three years after retention to determine if the changes were stable. So I think you get the idea of study the authors initially used rapid expansion for 1 week in a was followed by very slow expansion over a longer period of time.
So what happened? The authors evaluated anteroposterior cephalometric head films as well as lateral head films and the measurement of dental casts to determine their observations. Based upon their data, the authors found that only minimal relapse occurred following their expansion. The authors found that changes occurred in the lower nasal cavity as well as in the dentition. These results seemed to be stable over time. Of course the greatest widening effect of semirapid maxillary expansion occurred in the region of the dentoalveolus.
So in the authors calculated the average increase in maxillary base width, it was less than one half the amount of the dentoalveolar widening. Widening at the maxillary base was about 40%. When the authors evaluated this sample three years after this slow expansion technique, they found that all transverse skeletal and dental changes were stable.
So, in conclusion, these authors believe that this technique produces less tissue resistance and stimulates the adaptation process in the circummaxillary sutures. Other recent studies have also proposed a less rapid rate of expansion for adult subjects, which would allow the intermaxillary sutures and the periodontal membrane to accommodate to this gradual widening force. If you interested in reading this particular study that semirapid maxillary expansion, you can find it in the February 2004 issue of the Angle Orthodontists.

Perception of Pain During Orthodontic Treatment With Fixed Appliances Erdin AME, Din er B. Eur J Orthod 2004;26:79-85 December 10, 2004 Dr. Yoon-Jung Choi
[초벌원고] When talking to teenagers about wearing braces, one of the most frequent question has to do with this amount of pain can be expected after braces are placed. We all know that there are tremendous individual variation in the perception of pain from the braces but it is nice to have some general information the path on the patients and parents during the consultation visit. For instance, the boys and girls have the same pain responses to braces? In addition, are their things that we as orthodontist can do tell the initial pain such as using smaller diameter Nickel-Titanium wire at the beginning. This questions and others were addressed the paper published February 2004 issue of the European Journal of Orthodontics called“Perception of Pain During Orthodontic Treatment with Fixed appliances”.	[수정원고]
The paper has resulted the research done in Izmir Turkey. The study population was 109 adolescent patients undergoing initial fixed appliance placement. The group was about half boys and half girls and the average age was 13 to 14 years. At the time of appliance placement, the initial arch wire was randomly assigned to be either 014 or 016 Nickel-Titanium. The patient for them asked to fill out the questionnaire for the first 7 days about their perception of the pain from the braces. The authors complied the results with the questionnaires and analyze the resulting data.
The boys and girls perceived the pain from orthodontic appliances differently? No, at least not in the population study in this project. There was no statistical difference in the pain readings between the genders. Does make it sense to start out with the 014 instead of the 016 Nickel-Titanium arch wire in order to reduce the initial pain from braces? Again the answer is No. this study found no difference between pain reported by patients receiving 014 versus 016 Nickel-Titanium wires. In fact, those receiving 014 wire actually took more pain relier than those with 016 wires. So it doesn't make sense to start out with the 014 Nickel-Titanium wire if you so reason for doing so is to minimize the initial pain for the patient. Other findings of this study include that a typical patient were first feel pain at about 2 hours , it will peak after the first day and then steadily decrease after day three. Also, the most intense pain was rated and the model category from most but they were individuals who rated the pain as extreme.
As we talk to a patient about discomfort they can expect from braces, this study would support telling boys and girls same thing. We can indicate to them the day will begin to feel soreness about two hours after the braces go on that the soreness will be the worst after the first day and after the third day the soreness began to decrease rapidly.
If you would like to read more detail of this study from Turkey, regarding the pain perceive from orthodontic appliances, you can find the article in the February 2004 issue of the European Journal of orthodontics.

Has Hypodontia increased in Caucasians during the 20th Century? A meta-analysis Mattheeuws N, Dermaut L. Martens G. Eur J Orthod 2004;26:99-103. Dec 17, 2004 Dr. Jin-myoung Song
[초벌원고] Does it seem like you see more and more patients for orthodontic treatment that are congenitally missing at least one permanent tooth? If so, you think the differences that more people with missing teeth are now referred for orthodontic treatment or is a prevalence of congenitally missing teeth is actually increasing. Researchers from Belgium attempted to answer this question through the use of meta-analysis. Meta-analysis is a technique where the data from many studies are reanalyzed in a consistent manner to make it more like a one big study that combines all the data. This can potentially result in a more powerful study than any of the individual studies alone. The results of the meta-analysis on missing teeth are published in the February 2004 issue of the European Journal of Orthodontics in an article titled "Has Hypodontia increased in Caucasians during the 20th Century? A meta-analysis".	[수정원고]
The authors began by locating all the studies that they could find about the prevalence of congenitally missing teeth going all the way back to the early 1900's. They located 42 studies. They then limited the studies based on some strict criteria so that the data from all of them could be reasonably compared. To be included, the studies had have been done in Caucasian populations, the diagnosis had have been confirmed radiographically, the study participants had have been randomly selected in at least 3 years old and the sample size had have been a at least 1,000. After applying those criteria, 19 studies were left be included in a meta-analysis. The data from the 19 studies were recalculated in a consistent manner and presented graphically from earliest to latest publication date.
Some interesting results were seen. The percentage of missing teeth seem to increase from 3 to 4% in the first half of the 20th century, to about 6% in those studies published after 1956. Nearly all the studies found slightly higher prevalence of missing teeth in girls compared to boys.
The most frequently seen missing tooth was the lower second premolar, with the upper second premolar and upper lateral incisor missing about half is often. The authors were unable to explain why the sudden jump in the number of missing teeth was seen in reports after 1956. They're not sure if it really represents and evolutionary trend or whether it is result of improved diagnostic techniques available in more recent years. Whatever the reason, it seems clear that the percentage of missing teeth is certainly not decreasing, and may be slowly increasing as time goes on.
In summary, from the middle of the 20th century on, the percentage of people with missing teeth seems to be about 6%. The lower second premolar is a most frequently missing tooth followed by the upper second premolar and upper lateral incisor. To find out more about the trends and tooth agenesis, consult the February 2004 issue of the European journal of Orthodontics.

Multidisciplinary approach to the immediate esthetic repair and long-term treatment of an oblique crown-root fracture Villat C, Machtou P, Naulin-Ifi C. Dent Traumatol 2004;20:56-60. Dec 24, 2004 Dr. Kyoung-im Kim
[초벌원고] Do you participate in the treatment of incisor fractures? You may think that this is not within the scope of orthodontic practice. But the incisors that were fractured obliquely may require orthodontic extrusion for optimal esthetics and long-term periodontal health. A case report that was published in the February 2004 issue of Dental Traumatology describes innovative multidisciplinary treatment of a fractured incisor that combine reattached fractured crown for immediate esthetics with orthodontic extrusion for long-term periodontal health. The article is titled “Multidisciplinary approach to the immediate esthetic repair and long-term treatment of an oblique crown-root fracture.”	[수정원고]
Oblique incisor fractures often result in a portion of fracture line that is at, or below, the crest of the alveolar bone. In order to allow for long-term gingival health, there must be biologic width about 2㎜ to allow for proper periodontal attachment above the bone. In order to provide this 2㎜ of width, bone must be removed in a crown lengthening procedure or the root must be orthodontically extruded to bring the fracture margin about the bone level. In many cases of the maxillary incisor fracture, orthodontic extrusion can result in much better gingival esthetics.
The case report in this article involves a 19-year-old male with assulted. The injury resulted in an oblique fracture of maxillary central incisor with the parallel fracture line at the level of the alveolar bone. The goal of the immediate treatment was to restore the esthetics of the patient and to allow for orthodontic extrusion for long-term restoration. These goal were complished by reattaching the fractured incisor crown. The use of the fractured tooth crown allow for excellent shade matching, ideal tooth size and shape, and provided an enamel surface that allow easy attachment of orthodontic appliances for orthodontic extrusion.
When the patient was foreseen, an immediate root canal was completed and then the fill was removed within 4㎜ of the apex. A post was placed in the root and the fractured crown attached the post with composite resin. After the excess resin was removed, the fractured crown and the attached post were cemented in the root.
In some cases, the fractured crown act as permanent restoration. But, in this case, the reattached crown was used as transitional restoration while the tooth was orthodontically extruded and then replaced by permanent post and crown once the biologic width had been reestablished. This kind combined treatment for tooth fractures it something to remind you restore the dentist about. It is easy to not consider orthodontic extrusion in these cases, if this is not something you're familar with.
I recently did similar a sort of treatment an a member of my extended family and the result were very rewarding. Next time your having a lunch with one of your referring dentist, you may want to bring a log copy of this article from the February 2004 issue of Dental Traumatology and discuss the advantage of working together on incisor fracture to benefit your patients.

An In Vitro Study Simulating Effects of Daily Diet and Patient Elastic Band Change Compliance on Orthodontic Latex Elastics Beattie S, Monaghan P. Angle Orthod 2004;74:234-239 December 31, 2004 Dr. Seok-Pil Kim
[초벌원고] Do you recommend the use of orthodontic elastics or rubber bands on treating patients? That's probably silly questions because most orthodontist use rubber bands to help move the teeth in many of their patients. If so, how often do you recommend that the patient change rubber bands during the day? Do you ask patients for example to remove the rubber bands while eating? After all certain food products could degrade the effects of the rubber bands. If patient don't change the rubber bands during at 24-hour period, were they loose the effect of the elastic force? Although you may not be giving instructions to your patients about elastic wear, your assistant certainly do, what were they saying to your patients and doesn't make it difference.	[수정원고]
All those issued were addressed studied was published in the April 2004 issue of the Angle Orthodontist. The title of this study is "An In Vitro Study Simulating Effects of Daily Diet and Patient Elastic Band Compliance on Orthodontic Latex Elastics". This study is coauthored by Sean Beattie and Peter Monaghan from the orthodontic department at Marquette University in Milwaukee, Wisconsin.
The purpose of this study was to evaluate the effect of various food exposures and patient compliance levels in an artificial saliva environment during at 24-hour period on the degradation of applied force in orthodontic elastics. In addition, specific commercially available foodstuffs and food preparations were selected to simulate a daily diet, which might be typical for orthodontic patients.
Now the sample for this study consisted of rubber bands that were 3/16, 7 inch in diameter from 3 orthodontic manufacturers. These rubber bands were then placed on degraded and stretched to distance of 25 mm. 10 each of the rubber bands were tested for each manufacturer. Then a typical simulated daily cycle of food and saliva was constructed to determine if either of these had on effect on the degrading the force of rubber bands. All of this was done in a laboratory. The rubber bands were capped in artificial saliva for the entire experiment and less they were removed and placed in a mixture of particular type of foodstuffs. Now the authors may the variety of concoctions that were represent of orthodontic patients might typically eat during a day. These included candy bars, micro wave-ready meat, rice, vegetable meal, you named it they used it in the extensive experiment. The authors were very hard to simulate the amount of time that was foodstuffs would be in the mouth. So that the rubber bands were a most in these various materials for diet out of the time. Again, the authors were trying to simulate the effect of these liquids and food materials on the elastic force over at 24-hour period.
OK! That's enough methodology. I think you get the idea. What were they found? The authors found that neither saliva nor any of the food products had any effect on elastic force over 24-hour period. Isn't that interesting? How many of you recommend to your patient change the rubber bands 3 times a day? That's not necessary. The force didn't degrade over 24-hour period, even when the rubber bands were stretched to 25 mm and a most in various liquids. But what's the any difference between the manufacturers? Actually there was, some manufacturers had stronger initial force of the rubber band that didn't degrade over time. Other manufacturers started with weaker force, but it also did not degrade over time. So if you would like to review this study and find out if you using one of these manufacturers' rubber bands, you will find this study in the April 2004 issue of the Angle Orthodontist.

The Relation of Tobacco Smoking to Tooth Loss Among Young Adults Yl stalo PV, Sakki TK, et al. Eur J Oral Sci 2004;112:121-126. Jan 7, 2005 Dr. Go-Woon Kim
[초벌원고] We were all aware that smoking is not good for a long term dental and periodontal health. Smoking has been known to be a risk factor for tooth loss in older populations. But what about young adults the patients we are more likely to see in orthodontic practice.	[수정원고]
A group of research was in Finland, had the chance to see whether smoking was related to tooth loss in young adult population. There were a group of more than 12,000 people for any Northern Finland in 1966 who have been studied in prospective manners and birth. This group was asked to respond questions about tooth loss and health behaviors at age 31. The results of this study were published in April 2004 issue of the European Journal of Oral Sciences in a paper called “The Relation of the Tobacco Smoking to Tooth Loss Among Young Adults”. This was a cross sectional study but with a very large sample size. Of the 12,000 people in that study cohort, more than 8,600 responded to the questionnaire. They were asked about tooth loss, education, medical history, employment history, health behaviors and income. The authors theorize that because dental disease such as periodontal attachment loss which has been associated with smoking is unlikely decrease tooth loss in young adults. Then if the data was adjusted for health behaviors and socioeconomic status a link between tooth loss and smoking was not likely to appear in this younger age.
The results surprised the authors. Of this large group to the 3% were missing six or more teeth that heavier smokers were more than 5 times just likely to be on the group with six or more missing teeth, even when the result adjusted for socioeconomic status and health behavior. Remember the author started once the result with adjusted to eliminate differences socioeconomic status and health behavior that the tooth loss was not likely be associated with smoking in this younger group. The other thing that supports the true link between smoking and tooth loss is that the relationship the author has found with exposure-dependent. This means that risk of tooth loss increased as the level of smoking increased. This study does not determinate cause and effect and relationship between smoking and tooth loss barely that the two were associated. The authors theorize that the effect maybe the combination of increased dental diseases from smoking along with the smokers being more likely the tooth extraction as an option to treat that disease. This study provides more evidence that we should encourage orthodontic patients who smoke to quit smoking. We now have evidence the smoking is associated with increased tooth loss even in young adults. To read more about this study linking smoking with tooth loss, see the April 2004 issue of the European Journal of Oral Sciences.

Evaluation of the Frictional Resistance of Conventional and Self-Ligating Bracket Designs Using Standardized Archwires and Dental Typodonts Henao SP, Kusy RP. Angle Orthod 2004;74:202-11. February 18, 2005 Dr. Ye-Na Jeon
[초벌원고] Do you use self-ligating or conventional brackets in your orthodontic practice? Many orthodontist have switched over to the self ligating brackets. Why? Well, anecdotal comments typhically given by clinicians who use self-ligating brackets suggest that treatment occurs more rapidly. In other words, the teeth can move more rapidly at least during initial stages of alignment. But is that really true? A study published in the April 2004 issue of the Angle Orthodontist attempted to answer that question. The title of the article is “Evaluation of the Frictional Resistance of Conventional and Self-ligating Bracket Designs using Standardized Archwires and Dental Typodonts”. This study was co-authored by Sandra Henao and Robert Kusy from the department of biomedical engineering at the University of North Carolina. Robert Kusy is a well-known researcher in dental material that is published in many different and significant papers over the years.	[수정원고] Do you use self-ligating or conventional brackets in your orthodontic practice? Many orthodontists have switched over to the self ligating brackets. Why? Well, anecdotal comments typhically given by clinicians who use self-ligating brackets suggest that treatment occurs more rapidly. In other words, the teeth can move more rapidly at least during initial stages of alignment. But is that really true? A study published in the April 2004 issue of the Angle Orthodontist attempted to answer that question. The title of the article is “Evaluation of the Frictional Resistance of Conventional and Self-ligating Bracket Designs using Standardized Archwires and Dental Typodonts”. This study was co-authored by Sandra Henao and Bob Kusy from the department of biomedical engineering at the University of North Carolina. Bob Kusy is a well-known researcher in dental material that has published many different and significant papers over the years.
In this particular study, the purpose of their experiment was to determine if self-ligating brackets have less frictional resistance than conventional brackets using different sized archwires in both wet and dry states. This was an in-vitro study. In other words, it was performed at laboratory. Typodonts were constructed and orthodontic brackets were obtained from 4 participating manufacturers. 24 typodonts were constructed. These were made to simulate malocclusion with teeth irregular positions. Each of the different manufacturers placed either conventional or self-ligating brackets onto the malpose teeth. Then, these researchers placed varing sizes of archwires beginning with 0.014-inch round archwire made out of Nickel-Titanium upto 0.019 x 0.025 rectangular wire also Nickel-Titanium. Once the wires were in place, a testing machine was used to pull the archwire to dry through the brackets of the malpose teeth. The amount of frictional resistance was measured and compared between the various bracket types.	In this particular study, the purpose of their experiment was to determine if self-ligating brackets have less frictional resistance than conventional brackets using different sized archwires in both wet and dry states. This was an in-vitro study. In other words, it was performed at laboratory. Typodonts were constructed and orthodontic brackets were obtained from 4 participating manufacturers. 24 typodonts were constructed. These were made to simulate malocclusion with teeth in a regular positions. Each of the different manufacturers placed either conventional or self-ligating brackets onto the malpose teeth. Then, these researchers placed varing sizes of archwires beginning with 0.014-inch round archwire made out of Nickel-Titanium upto 0.019 x 0.025 rectangular wire also Nickel-Titanium. Once the wires were in place, a testing machine was used to pull the archwire to dry through the brackets of the malpose teeth. The amount of frictional resistance was measured and compared between the various bracket types.
I think you get the idea. Now, one other thing, in addition, both wet and dry states were evaluated. What do you think happened? Is there a big difference between the frictional resistance of self-ligating or conventional brackets? The answer is “yes”, in some cases. What does that mean? There was a statistically significant difference in the frictional resistance between self-ligating and conventional brackets with 0.014-inch round Nickel-Titanium archwires. The self-ligating brackets had less frictional resistance. But in the larger archwires, there were no statistically significant differences in frictional resistance between conventional and self-ligating brackets.	I think you get the idea. Now, one other thing, in addition, both wet and dry states were evaluated. What do you think happened? Is there a big difference between the frictional resistance of self-ligating or conventional brackets? The answer is “yes”, in some cases. What does that mean? There was a statistically significant difference in the frictional resistance between self-ligating and conventional brackets with 0.014-inch round Nickel-Titanium archwires. The self-ligating brackets had less frictional resistance. But in the larger archwires, there were no statistically significant differences in frictional resistance between conventional and self-ligating brackets.
So what does this mean? It suggests that there may be an advantage to tooth movement early on during orthodontics in patients with malpose teeth, if self-ligating brackets are used, especially if lighter archwires remain until the teeth are fully aligned. At least that`s what this study suggests. So, if you would like to review this article to determine if you are maximizing the use of brackets that you`re currently placing on the teeth. you can find this information in the April 2004 issue of the Angle Orthodontist.	So what does this mean? It suggests that there may be an advantage to tooth movement early on during orthodontics in patients with malpose teeth, if self-ligating brackets are used, especially if lighter archwires remain until the teeth are fully aligned. At least that`s what this study suggests. So, do you like to review this article to determine if you are maximizing the use of brackets that you`re currently placing on the teeth? You can find this information in the April 2004 issue of the Angle Orthodontist.