RESIDENTS' JOURNAL REVIEW
ARTICLES FROM THE CURRENT
ORTHODONTIC LITERATURE, SELECTED AND
REVIEWED BY:
SENIOR RESIDENTS, TRI-SERVICE
ORTHODONTIC RESIDENCY PROGRAM, JOINT
BASE SAN ANTONIO-LACKLAND AIR FORCE
BASE, TEX
David P. Lee, Chairman; Brian W. Penton,
Program Director; and Brent J. Callegari, Past
Program Director
Dan Grauer, Associate Editor for Residents'
Journal Review
Los Angeles, Calif
Effects of pacifiers on the occlusion of
children aged 24 to 36 months
Lima AA, Alves CM, Ribeiro CC, Pereira AL, da Silva
AA, Silva LF, et al. Effects of conventional and
orthodontic pacifiers on the dental occlusion of
children aged 24-36 months old. Int J Paediatr Dent
2016 Feb 9 [Epub ahead of print].
N onnutritive sucking habits (NNSHs) change the
pattern of facial muscle contraction and may
contribute to malocclusion. Both conventional and or-
thodontic pacifiers are available commercially, with or-
thodontic pacifiers claiming an anatomic design that
does not interfere with normal growth or development.
The authors of this Brazilian study investigated the ef-
fects of conventional and orthodontic pacifiers on the
severity and prevalence of malocclusion in the deciduous
dentition, subjectively accounting for the duration, fre-
quency, and intensity of NNSH. Data were collected at 3
time points: birth, 12 to 24 months old, and 24 to
36 months old. A random sample of 220 children was
selected by lottery and separated into control (110), con-
ventional pacifier (55), and orthodontic pacifier (55)
groups. Precalibrated orthodontic examiners did not
know the child's history of NNSH and evaluated erupted
teeth, terminal plane of deciduous molars, overbite,
overjet, and posterior crossbite. Parents were asked to
assess the frequency, intensity, and duration of pacifier
use. A total of 168 children (76.4%) had malocclusions,
with rates significantly higher among pacifier users
The views expressed in these abstracts are those of the authors and do not reflect
the official policy of the Department of Defense or other departments of the
United States government.
(96.3%) compared with the control group (3.7%). Only
2 children among all the pacifier users did not have a
malocclusion. However, the subjects in the conventional
group exhibited malocclusions that were more severe
than those in the orthodontic group and were 10.7 times
more likely to have a posterior crossbite than the subjects
in the control group. Additionally, the average duration
of use was significantly longer for conventional pacifiers,
and a strong positive correlation was found between
habit duration and anterior open bite. The authors
concluded that the children in both pacifier groups
had an increased risk of malocclusion compared with
nonusers.
Reviewed by Casey J. Burns
Mandibular stability with surgery-first vs
orthodontics-first treatment
Akamatsu T, Hanai U, Miyasaka M, Muramatsu H,
Yamamoto S. Comparison of mandibular stability
after SSRO with surgery-first approach versus
conventional ortho-first approach. J Plast Surg
Hand Surg 2016;50:50-5.
T he orthodontics-first approach (OF) typically re-
quires 1 to 2 years of preoperative treatment
before orthognathic surgery, during which the pa-
tient's facial esthetics worsen. With the surgery-first
approach (SF), esthetics improve immediately, most
tooth movement occurs during the accelerated post-
surgical window, but the occlusion remains unstable
until orthodontic treatment is complete. The authors
of this study looked at skeletal Class III patients who
received only sagittal split ramus osteotomy setback
(14 SF patients, 24 OF patients). The SF patients
received an average of 2.9 months of preoperative or-
thodontic treatment to eliminate transverse discrep-
ancies, and both groups received intermaxillary
fixation for 2 weeks after surgery with positioning
elastics thereafter. Because the SF group had minimal
orthodontic preparation, cuspal interferences were
resolved postsurgically, and the expected mandibular
rotation occurred. To correct for this in calculating
relapse, the authors compared postsurgical mandib-
ular tracings taken at 2 weeks and 1 year rotating
about articulare. They then recorded horizontal and
vertical changes. No significant difference was found
between the treatment groups in the amounts of hor-
izontal movement of pogonion and B-point after sur-
gery (SF, 0.86 mm forward; OF, 0.90 mm forward).
However, the mean vertical relapse at pogonion was
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significant, and the 2 groups moved in opposite direc-
tions (SF, 1.59 mm downward; OF, 0.14 mm upward).
The authors attributed this difference to the SF
group's heavier reliance on intermaxillary elastics for
postoperative stability in the absence of interdigita-
tion, thereby extruding the posterior teeth. Skeletal
anchorage for elastics is suggested if vertical relapse
is a concern (eg, open-bite patients). The authors rec-
ommended minimal orthodontic treatment before sur-
gery, even in SF patients, and cautioned that
autorotation of the mandible in finishing SF patients
tends to hide any relapse.
Reviewed by Stona Jackson
Organic solvents and ultrasound for
removal of orthodontic brackets
Santana RM, Rached RN, Souza EM, Guariza-Filho
O, Camargo ES, Pithon MM, et al. Effect of organic
solvents and ultrasound on the removal of
orthodontic brackets. Orthod Craniofac Res 2016
Feb 22 [Epub ahead of print].
R emoval of orthodontic appliances and residual resin
after treatment without damaging the enamel is a
constant concern for orthodontists. The goal of this study
was to evaluate the effects of organic solvent gels and ul-
trasound on the removal of metallic brackets. Brackets
were bonded to 120 extracted human premolars using
an etch, rinse, and prime protocol (3M Transbond XT) or
a self-etching primer (3M Transbond Plus Self-Etching
Primer). These 2 groups were each divided into 6 sub-
groups based on the predebonding treatment received:
no treatment, acetone gel, ethanol gel, ultrasound,
acetone gel 1 ultrasound, or ethanol gel 1 ultrasound.
The specimens were subjected to the predebonding treat-
ments listed above followed by shear bond strength
testing. Adhesive remnant index (ARI) scores were deter-
mined for each specimen. Higher ARI scores indicate
greater amounts of adhesive remaining on the tooth after
bracket removal and are correlated with enamel preserva-
tion. The authors of this study found no decrease in shear
strength after treatment with organic solvents. However,
although not statistically significant, it was noted that sol-
vents tended to increase the ARI scores for the self-etching
primer group and decrease them for the etch-and-rinse
group. This suggests that solvents may decrease the risk
of enamel damage at debond when self-etching bonding
agents are used. The authors also found that ultrasonics
did not significantly affect the ARI scores of the 2 adhesive
systems, but they did significantly decrease the shear
August 2016  Vol 150  Issue 2 American Journal of Orthodontics and Dentofacial Orthopedics
Residents' journal review
strength in the self-etching group. Reducing the force
necessary to remove a bracket may decrease the incidence
of enamel damage. These methods may not be practical
for every debond, but they may reduce the chance of
damaging the enamel when the risk is higher as with
heavily restored teeth or when removing ceramic brackets.
Reviewed by Gary S. Mayne
Dental arch changes produced by a
passive self-ligating system
Lineberger MB, Franchi L, Cevidanes LH, Huanca
Ghislanzoni LT, McNamara JA Jr. Three-
dimensional digital cast analysis of the effects
produced by a passive self-ligating system. Eur J
Orthod 2016 Feb 3 [Epub ahead of print].
M any practitioners advocate arch expansion to alle-
viate crowding. Promoters of the Damon system
purport that it is feasible to significantly increase
arch perimeter and transverse dimension using self-
ligating brackets and broad arch forms while
decreasing the need for extractions and increasing
overall stability. The purpose of this retrospective study
was to evaluate maxillary and mandibular dental arch
changes induced by a passive self-ligating system
with digital casts. Twenty-five patients were treated
consecutively with a nonextraction protocol involving
the Damon 3MX system and progressive sequences of
broad archwires. The untreated control group was
matched to the treated subjects according to age,
dentition stage, sex, and Angle classification. Pretreat-
ment and posttreatment casts were digitized and
measured using a 3Shape R700 scanner. When the
posttreatment to pretreatment changes were compared,
the treated group showed greater increases in arch
width measurements, arch perimeters, and maxillary
premolar buccal torque. The authors hypothesized
that expansion in the mandibular posterior region,
not incisor proclination, contributed to improvements
of anterior crowding. The self-ligating system produced
modest but statistically significant widening of the
dental arches, with the greatest increments about
2 mm in the maxillary and mandibular premolar areas.
These were associated with net gains in the arch perim-
eters of about 2.5 mm. Minimal change was recorded
for maxillary intercanine width; this can be explained
because some treated patients initially had buccally
displaced maxillary canines. Only the maxillary premo-
lars showed a significant increase in buccal crown
torque of 3.9 to 4.6 . Further research incorporating
Residents' journal review
torque measurements based on the long axis of a
tooth, not the clinical crown, may alter the conclusions
about the treatment effects of the self-ligating system.
Reviewed by Michael David Segall
Nickel-titanium springs vs stainless steel
springs: 2 methods of space closure
Norman NH, Worthington H, Chadwick SM. Nickel
titanium springs versus stainless steel springs: A
randomized clinical trial of two methods of space
closure. J Orthod 2016 [Epub ahead of print].
T here are various methods for space closure, with
sliding mechanics currently being favored. Nickel-
titanium coil springs (NCS) have been suggested as
providing a greater and more consistent rate of space
closure. This 2-centered parallel group randomized clin-
ical trial study compared the rates of orthodontic space
closure between patients with extracted premolars using
NCS (3M Unitek; 200 g force, 9 mm) or stainless steel coil
American Journal of Orthodontics and Dentofacial Orthopedics
215
springs (SSCS) (3M Unitek; 226.8 g force, 0.188 in/
4.8 mm). The 2 groups each had 15 patients randomly
assigned. All patients were treated with a 0.022-in slot
MBT appliance (3M Unitek), and 0.019 3 0.025 stainless
steel wires were placed for a minimum of 4 weeks before
initiating space closure. The investigators used 1 type of
spring for each patient and closed space en masse, as
opposed to a split-mouth design with each type of
spring retracting only the canines. No statistically signif-
icant difference in the amount of space closure was
noted between the NCS and SSCS groups. The difference
in the rate of closure was statistically significant; the
NCS closed the space at a rate of 0.58 mm in 4 weeks
compared with the SSCS at a rate of 0.85 mm in 4 weeks.
This rate difference could add 2 months to the treatment
time for a 3-mm space, which can have clinical signifi-
cance. Both the SSCS and the NCS were clinically effec-
tive; however, the costs of the NCS were 4 times those of
the SSCS. The authors recommended considering SSCS
for orthodontic space closure because of more rapid
space closure and greater cost effectiveness than NCS.
Reviewed by Sara M. Wilson
August 2016  Vol 150  Issue 2