READERS’ FORUM
Letters to the editor*
Bisphenol-A and lingual retainer
bonding materials
After I read the interesting and appropriate editorial in
the July issue on bisphenol-A (Turpin DL. Early bisphe-
nol-A studies negative for orthodontic adhesives. Am J
Orthod Dentofacial Orthop 2008;134:1-2), I wondered why
the composite material orthodontists use regularly to bond
fixed lingual retainers was not mentioned. It comes close to
the use of restorative materials, which, after all, might be
a risk.
Frank R. de Winter
Aerdenhout, The Netherlands
Am J Orthod Dentofacial Orthop 2008;134:465
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.08.006
Editor’s response
Yes, composite materials used for bonding fixed lingual
retainers might be an unfavorable scenario, definitely not
anticipated by most researchers until now. These retainers
expose all surfaces of the composite to the oral environ-
ment—literally 2-dimensional surfaces with limited depth
and a vast surface.
To the best of my memory, the release of bisphenol-A
from bonded lingual retainers has not yet been studied in
humans. A change in adhesive might be the answer, espe-
cially if in-vivo studies show a potential problem.
David L. Turpin, Editor-in-Chief
Seattle, Wash
Am J Orthod Dentofacial Orthop 2008;134:465
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.08.013
Long-term follow-up needed of RME
treatment
There is much to like about the study by Garrett et al
(Garrett BJ, Caruso JM, Rungcharassaeng K, Farrage JR,
Kim JS, Taylor GD. Skeletal effects to the maxilla after rapid
maxillary expansion assessed with cone-beam computed
tomography. Am J Orthod Dentofacial Orthop 2008;134:
8.e1-11). Their study was based on data from an earlier
study.1
The use of CBCT has the potential to increase measure-
ment accuracy to a level previously unattainable. As mea-
surement improves, subjective observation will tend to be
replaced by science. In the end, treatment effects will be more
*The viewpoints expressed are solely those of the author(s) and do not reflect
those of the editor(s), publisher(s), or Association.
clearly understood. It is hoped that a follow-up study can be
developed by the authors that would provide even more
understanding of RME with the Hyrax for orthodontists.
The proposed study could do the following.
1. Separate the sexes. The mean female age of 13.3 ⫾ 1.5
years is old enough that their response or lack of response
to RME could skew the overall conclusions about its
dental and skeletal effects. Specifically, it is suspected
that older female patients could be contributing to more
than their fair share of alveolar bending and to more
dental buccal inclination (called “orthodontic tipping” in
the article) and to less orthopedic expansion (expansion at
the midpalatal suture)—terms diagrammatically defined
in the article.
2. Include a T3 that could be 2 to 12 months after RME
removal and before placement of braces or retainers. T2
was the last measurement in the study and was taken
“within 3 months after the end of appliance activation.” It
apparently was not taken 3 months after appliance re-
moval. This means, presumably, that the RME was still in
place when evaluated by CBCT. It would be important to
record the lasting effects of RME—after dental relapse or
any other relapse. This study leaves one in midstream
regarding important conclusions about posttreatment sta-
bility. The landmark Haas expander study by Cameron et
al2 had nearly a 9-year waiting period after RME removal
to reexamine stability.
3. Additionally, the full expansion gained by RME should
likely not be maintained with the appliance itself or later
with archwires because that could be problematic.3 It
would seem helpful to have an unretained rest period of at
least 6 weeks to allow for likely dental relapse. This rest
period could help mitigate against possible untoward
periodontal effects caused by holding the posterior teeth
in the expanded position with resulting increased inclina-
tions.4
4. Although the average total appliance activation was 5.08
mm, total average dental and skeletal expansion at the
first molars was computed to be 6.66 mm. The new study
could explain how more can be gained from less.
5. We were told that the subjects “ . . . required RME with
Hyrax appliances.” In the next study, it would be helpful
if the authors would discuss in more detail their criteria
for diagnosis and the methodology used for determining
RME treatment. Finally, they could evaluate their success
in meeting the criteria.
John L. Hayes
Williamsport, Pa
Am J Orthod Dentofacial Orthop 2008;134:465-6
0889-5406/$34.00
Copyright © 2008 by the American Association of Orthodontists.
doi:10.1016/j.ajodo.2008.08.010
465