REVIEWS AND ABSTRACTS

Book reviews and article abstracts

Alex Jacobson, Associate Editor
Birmingham, Ala

THESIS ABSTRACTS

Detection of white spot lesions around

orthodontic brackets using
polarization-sensitive optical
coherence tomography

Comparative analysis of traditional

radiographs and cone-beam computed
tomography volumetric images in the
diagnosis and treatment planning of
maxillary impacted canines

Sherri Lyn Chong

University of California, San Francisco

Eric Haney
University of California, San Francisco

Introduction: The main purpose of this study was to

determine whether a light detection system, polarizationsensitive optical coherence tomography (PS-OCT), can
accurately track the initiation and progression of early
demineralized lesions around orthodontic bracket bases.
Another goal of the study was to analyze the protective
effects of different fluoride modalities in preventing decay
around bracket bases.
Methods: Sixty human molar samples used for this
in-vitro study were divided into 4 groups of 15. The groups
consisted of the control (Ormco Enlight adhesive, no
fluoride), fluoride in solution (2 ppm fluoride), fluoride
sealant (Reliance Proseal), and glass ionomer adhesive
(Fuji Ortho LC). Each section was mounted in acrylic and
then scanned with the PS-OCT system at time 0 (before
and after bracket placement), and subsequently at days 3,
6, 9, 12, and 15.
Results: Quantitative analysis demonstrated that
PS-OCT was effective in showing nondestructively that the
various fluoride modalities significantly reduced the severity of the lesions (P .001). The fluoride sealant group was
significantly more effective than the fluoride in solution
group and the glass ionomer group. Digital microradiography was completed as the gold standard with which the
PS-OCT measurements were compared to verify accuracy
of detection. Polarized light microscopy (PLM) was used
to examine lesion depth. Microradiography and polarized
light microscopy verified the presence of the lesions
depicted by OCT, and PLM verified the depth of the
lesions.
Conclusions: This study demonstrated that PS-OCT
can be used in the orthodontic clinical setting to monitor
the severity of demineralization and the efficacy of intervention with fluoride-based therapeutic agents.

Objective: This prospective study compared differences

in the diagnosis and treatment planning of impacted maxillary
canines by using traditional 2-dimensional (2D) planar radiographs versus 3-dimensional (3D) volumetric images generated from cone-beam computerized tomography (CBCT)
DICOM data.
Methods: Twenty-five consecutive impacted maxillary
canines were identified from the pool of patients seeking
orthodontic treatment at UCSF and enrolled in this study. For
each patient, 2 sets of radiographic information were obtained. The first set consisted of traditional images including
panoramic, occlusal, and 2 periapical radiographs. The second set was composed of prints of volumetric dentition
images obtained from a CBCT scan. A questionnaire was
developed to record the diagnosis and the resulting treatment
plan derived from the 2D and 3D images for each impacted
tooth. Specific questions related to the location of the cusp tip,
presence or absence of root resorption, the derived orthodontic or surgical treatment plan, and an assessment of the
confidence level of each diagnosis and treatment plan. Of the
7 UCSF diagnosticians who participated in this study, 4 were
orthodontic and 3 were oral and maxillofacial surgery faculty.
Three of the 7 judges were senior faculty with more than 10
years of clinical experience, and 4 were categorized as junior
faculty. Each faculty member completed a questionnaire for
every impacted canine and diagnostic radiographic modality
(2D and 3D). The patient data sets were presented in random
order. The data from 5 canine cases were randomly repeated
to evaluate intraexaminer reliability.
Results: The data showed that the judges altered their
decisions regarding localization to varying degrees. There
was a 21% lack of congruence in the perceived mesiodistal
cusp tip position and a 16% difference in the perceived
labial-palatal position. In the perception of root resorption of
adjacent teeth, there was a 36% lack of congruence (45% for
the orthodontists, 26% for the oral surgeons). Fifty-three
percent of the teeth that were treatment planned for extraction
with the traditional radiographs were selected for recovery,
rather than extraction, with the CBCT images (McNemar test,

Am J Orthod Dentofacial Orthop 2007;132:711

0889-5406/$32.00
Copyright 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2007.02.032

711

712 Reviews and abstracts

chi-square 4.45, P .035). Eleven of the 12 teeth treatment planned for an initial distal recovery vector with the
traditional 2D data set had a different recovery vector when
treatment planned with the CBCT data set. Sixty-five percent
of initial recovery vectors were different for the senior judges
compared with 75% for the junior judges (Fisher exact test,
P .013). For 34% of the traditional images, additional
images were requested compared with 19% of the CBCT
images (McNemar test, P .02). The surgeons decision
regarding the location of the initial surgical access changed
16% of the time. Confidence of the accuracy of diagnosis and
treatment plan was statistically higher for the CBCT images
(P .001).
Conclusions: These results suggest that the use of 2D
and 3D images of impacted canines in the maxilla can
produce very different diagnoses and resulting treatment
plans.
Am J Orthod Dentofacial Orthop 2007;132:711-2
0889-5406/$32.00
Copyright 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2007.02.033

Force characteristics of nickeltitanium closed-coil springs

Wilbur L. Chow
University of Toronto, Toronto, Ontario, Canada

Introduction: This in-vitro study was conducted to

investigate 4 clinically relevant material properties of nickeltitanium closed-coil springs: mean force, maximum force,
load/deflection ratio, and force degradation over 16 weeks.
Methods: A universal testing machine was used to test the
force exerted by 150, 200, and 250 g springs from 3 manufacturers (Sentalloy, GAC International, Bohemia, NY; Reflex, TP
Orthodontics, LaPorte, Ind; Nitinol, 3M Unitek, Monrovia,
Calif) in their respective published working ranges. Twenty
springs of each force level from each manufacturer were tested
at 4-week intervals for 16 weeks, during which they were held
under constant tension in saline solution at 37C.
Results and conclusions: At the initial recording, the
mean forces of the GAC and the Unitek springs were 6% to
8% and 23% to 36% below their nominal forces, respectively.
In contrast, the mean forces of the TP springs were 1% to
24% above their labeled forces. The maximum forces generated by the GAC and the TP springs were 53% to 130%
greater than their labeled forces, whereas the Unitek springs
exhibited maximum forces within 11% of their nominal
values at the initial recording. The Unitek springs generated
the lowest load/deflection ratios (P .0001); this best approximates constant force delivery. Only the GAC 150 g springs
demonstrated both statistically (P .05) and clinically

American Journal of Orthodontics and Dentofacial Orthopedics

November 2007

(10% loss) significant force degradation over 16 weeks. The

Unitek springs generated the lowest load/deflection ratios of
the 3 manufacturers, and thus delivered the most constant
force throughout the recommended activation range. Only the
GAC springs had both statistically and clinically significant
force degradation over 16 weeks.
Am J Orthod Dentofacial Orthop 2007;132:712
0889-5406/$32.00
Copyright 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2007.02.031

Airway changes after orthognathic

surgery as assessed by cone-beam
computed tomography
Chad R. Sears
University of California, San Francisco

Purpose: The purpose of this prospective study was to

determine how surgical movements of the maxilla, the mandible, or both jaws alter airways in the short term and the long
term as assessed by conventional 2-dimensional (2D) radiography and 3-dimensional (3D) cone-beam computed tomography (CBCT).
Methods: A total of 20 patients were recruited from the
Orthodontic Clinic and the Oral and Maxillofacial Surgery
Clinic at the University of California, San Francisco. Lateral
cephalograms and CBCT scans were obtained at 3 time
points: preoperatively (T0), within 1 month postoperatively
(T1), and after 6 months postoperatively (T2). The nasopharynx,
the oropharynx, and the hypopharynx were segmented for
each patient in a repeatable manner at each time point and
analyzed for significant changes and correlated to the type of
surgery performed.
Results: When all surgical procedures were analyzed for
global airway changes, significant amounts of change were
noted in both the 2D and the 3D measures, especially from T1
to immediate T1. The 2D and 3D data were shown to be
correlated for the measures taken, especially at T0 and T2.
Conclusions: Our findings suggest that changes seen on
lateral x-ray films with regard to airway changes can serve as
a guide for the changes seen in the airway on a CBCT scan.
There is more information in a CBCT scan, as represented by
more significant changes noted from time point to time point
with the 3D data. However, the 2D changes can be used as a
guideline for the results of surgical treatment.
Am J Orthod Dentofacial Orthop 2007;132:712
0889-5406/$32.00
Copyright 2007 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2007.02.034