Introduction: This study aimed to evaluate and quantify extraction spaces and their behavior at the end of treatment, short- and long-term stages, in orthodontic patients treated with extractions. Methods: The sample comprised dental casts of 1546 orthodontic patients treated with extractions with several malocclusions. Dental casts were divided into 3 groups, according to the chronological stage: at the end of treatment (T0), 1-year posttreatment (short-term, T1) and 5-year posttreatment (longterm, T2). Extraction spaces were measured in the three stages with a digital caliper. The descriptive analyses of the longitudinal space behavior were performed by amounts of patients, percentage of patients and percentage of quadrants. Intergroups comparison of space dimension in the three stages were performed by Analysis of Variance, followed by Tukey tests when necessary. Results: Class II malocclusion was the most prevalent sagittal discrepancy, followed by Class I and Class III, respectively. More than a half of the patients presented 1-4 quadrants open at the end of treatment. Less than 10% of quadrants persisted open at the three stages. Most of relapse and late closure occurred in the first year after treatment. About 5% of quadrants closed at T0 presented relapse at T1. Less than 3% of quadrants closed at T1 presented relapse at T2. Space dimension decreased significantly in the long-term evaluation. Conclusions: The percentage of patients with open spaces at the end of treatment was substantially large. Despite of the late space closure tendency, several spaces may remain open in the long-term. There was significant reduction in extraction space dimension in the long-term. / Introdução: O objetivo deste estudo foi avaliar e quantificar os espaços das extrações e seu comportamento ao final do tratamento, em curto e longo prazos. Materiais e métodos: a amostra consistiu em modelos ortodônticos de 1546 pacientes tratados ortodonticamente com extrações com diversas más oclusões. Os modelos foram divididos em 3 grupos, de acordo com o estágio cronológico: ao final do tratamento (T0), 1 ano pós-tratamento (curto prazo, T1) e 5 anos pós-tratamento (longo prazo, T2). Os espaços das extrações foram mensurados nos três estágios com um paquímetro digital. As análises descritivas do comportamento longitudinal foram realizadas por quantidade de pacientes, porcentagem de pacientes e porcentagem de quadrantes. A comparação intergrupos da dimensão do espaço nos três estágios foi realizada através da Análise de Variância, seguida pelo Teste Tukey quando necessário. Resultados: A má oclusão de Classe II foi a discrepância sagital mais prevalente, seguida pela Classe I e Classe II, respectivamente. Mais da metade dos pacientes apresentaram 1-4 quadrantes abertos ao final do tratamento. Menos de 10% dos quadrantes persistiram abertos nos três estágios. A maioria das reaberturas e fechamentos tardios ocorreu no primeiro ano pós-tratamento. Aproximadamente 5% dos quadrantes fechados em T0 apresentaram reabertura em T1. Menos de 3% dos quadrantes fechados em T1 apresentaram reabertura em T2. A dimensão do espaço diminuiu significativamente na avaliação em longo prazo. Conclusão: A porcentagem de pacientes com espaços abertos ao final do tratamento foi substancialmente grande. Apesar da tendência de fechamento tardio, muitos espaços podem restar abertos em longo prazo. Houve redução significante na dimensão dos espaços das extrações em longo prazo.

Introduction: This study aimed to compare the third molars angulation and eruption status in Class I and II malocclusions in orthodontic treatment with and without first premolar extractions. Methods: The sample was comprised by 96 patients divided into four groups: Group 1 Class I malocclusion treated with first premolars extraction; Class I malocclusion treated without extractions; Group 3 Class II malocclusion treated with first premolars extraction; Group 4 Class II malocclusion treated without extractions. Panoramic radiographs were used to evaluate third molars mesiodistal angulations at T1, T2 and at T3. Third molar eruption status was assessed in dental casts. Intergroup angulations and eruption status comparisons were performed using ANCOVA followed by Tukey tests and Kruskal-wallis test, respectively. Results: Significantly greater mesial angulation and percentage of erupted right maxillary third molars were found in Class I extraction group. Significantly greater distal angulation and percentage of erupted right mandibular third molars were found in Class II extraction group. Conclusion: Class I and II extraction treatment exhibited more favorable angulations and greater number of erupted third molars than nonextraction treatment. Regardless the treatment performed third molars showed a more uprighted position in each malocclusion type. / Introdução: Este estudo comparou as angulações mesiodistais e o grau de irrompimento dos terceiros molares nas más oclusões de Classe I e II no tratamento ortodôntico com e sem extrações dos primeiros pré-molares. Métodos: Foram avaliados 96 pacientes divididos em quatro grupos. Grupo 1, indivíduos com má oclusão de Classe I tratada com extrações dos primeiros pré-molares. Grupo 2, má oclusão de Classe I tratada sem extrações. Grupo 3 indivíduos com má oclusão de Classe II tratada com extração dos primeiros pré-molares. Grupo 4 má oclusão de Classe II tratada sem extrações. As angulações mesiodistais dos terceiros molares foram avaliadas em radiografias panorâmicas e o grau de irrompimento em modelos de estudo. Para comparar as angulações e o grau de irrompimento entre os grupos, utilizou-se o teste ANCOVA seguido do teste Tukey e o teste de Kruskal-wallis, respectivamente. Resultados: O grupo 1 apresentou significativamente maior angulação mesial do terceiro molar superior direito assim como uma porcentagem maior de molares irrompidos. O grupo 2 apresentou significativamente maior angulação distal do terceiro molar inferior direito e uma porcentagem maior de molares irrompidos. Conclusão: Os tratamentos de Classe I e II com extrações apresentaram angulações mais favoráveis e uma porcentagem maior de terceiros molares irrompidos do que os tratamentos sem extrações. Independentemente do tratamento realizado, os terceiros molares apresentaram uma posição mais vertical.

Biological responses to orthodontic forces involve various cell types, these include fibroblasts, endothelial cells, blood vessels and sensory nerves in the periodontal ligament as well as osteoblasts, osteoclasts and cementoblasts in roots and bone surfaces. Neurotrophins are believed to interact with these cells to initiate the process of bone resorption particularly during orthodontic tooth movement. Neuropeptides released from sensory neurons have been shown to modulate the tissue inflammatory responses. In addition, neurotrophins, including nerve growth factor (NGF), play an important role in neural cell differentiation and survival. The exact localization and function of neurotrophins and neurotrophic receptors in the dento-alveolar complex remains unclear. Moreover, the identity and distribution of structures expressing neurotrophins and neurotrophic receptors has yet to be fully determined. It is reasonable to propose that periodontal ligament and alveolar bone remodelling may be influenced by NGF. In addition, anti-NGF may block neurochemical changes and, hence, inhibit orthodontic tooth movement. The aims of this research were to investigate the cells responsible for NGF secretion within the periodontal ligament (PDL), pulp and bone, and the effect that anti-NGF might have on orthodontic tooth movement. 28, 8 week-old, male Sprague-Dawley rats were randomly divided into control and experimental groups. Fourteen experimental animals had anti-NGF injected paradentally. Animals were sacrificed at 7 and 14 days. Sections from an earlier study were examined and stained using TRAP for osteoclast identification and analysed histomorphometrically to enable comparisons between control and experimental groups. The findings of this investigation indicated that injections of anti-NGF did not significantly affect the rate of tooth movement with the use of different tooth movement measurement methods. TRAP staining proved to be a useful and reliable marker of osteoclasts. TRAP-positive osteoclastic cells were detected in both anti-NGF and control groups. However, the TRAP-positive cells were not stained intensely with NGF immunolabelling. On the other hand, cells that were stained intensely with NGF, were TRAP-negative. The results suggested that both sympathetic and nociceptive nerves might function in counter balance to modulate bone resorption, and osteoclasts might not be directly responsible for NGF secretion within the PDL and bone. Further studies to determine the effect of NGF on tooth movement are warranted to more clearly identify the NGF expressing cells within the rat dento-alveolar complex and possible role played by NGF in orthodontic tooth movement. / http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1297498 / Thesis (D.Clin.Dent.)-- School of Dentistry, 2007

Nickel stands out as the main cause of contact allergy in both children and adults, which has given rise to concern and the introduction of regulations by official bodies. Today´s youths are frequently exposed to body piercing and orthodontic treatment. Changes in youth lifestyle practices are also likely to influence nickel exposure and thus, the occurrence of nickel allergy. However, against patient and parental concern regarding nickel exposure to orthodontic appliances, often evoked by allergies following piercing, stand results from studies indicating that early orthodontic appliance treatment may reduce, rather than increase, prevalence of nickel allergy; a finding that has been suggested to result from tolerance induction by early exposure to nickel via the oral route. The objective of the present thesis was to investigate the association between nickel allergy and exposure to different orthodontic appliances and lifestyle, in particular piercing, as well as to study nickel release from orthodontic appliances into the oral cavity. Furthermore, one objective was to establish baseline prevalence data of nickel allergy in a Swedish adolescent population. Data was generated from a cross-sectional survey, in which about 6000 youths completed a questionnaire and almost 4500 of these were patch-tested for contact allergy. Information on exposure to orthodontic appliances was verified by dental records, whilst nickel content in saliva and dental biofilm was measured in a clinical study. Questionnaire data demonstrated a reduced risk of nickel allergy when orthodontic treatment preceded piercing (OR 0.5; 95 % CI 0.3-0.8) and similar results were found for data verified from dental records, however statistical significance was lost when adjusting for background factors (OR 0.6, 95 % CI 0.4-1.0). Exposure to full fixed appliances with NiTi-containing alloys, as well as a pooled ‘high nickel-releasing’ appliance group prior to piercing correlated with a significantly reduced risk of nickel allergy and a trend towards a reduced risk with exposure duration. Nickel could also be found in significantly higher concentrations from dental plaque samples, but not saliva samples, in orthodontic patients who were well into treatment compared to patients who had not been exposed to orthodontic appliances. The effect was not found to be due to differences in estimated dietary nickel intake between the two groups. Significantly more girls than boys (13.3 % versus 2.5 %) were found to be patch-test positive to nickel. Positive nickel tests were also most prevalent in occupational programmes and least prevalent in natural science programmes, indicating differences in lifestyle and exposure to nickel. Dropout from testing was handled using a missing-value analysis. This internal validation showed that our results overestimated the occurrence of nickel allergy to a minor degree. More girls than boys reported piercing, vegetarian/vegan diet, and smoking practices, whereas an interesting shift in tattooing prevalence was observed with a larger proportion of girls reporting this practice compared to boys. Sex, number of piercings, smoking and orthodontic appliance treatment prior to piercing were found to influence weighted risk estimates of nickel allergy. To conclude, although orthodontic patients are exposed to nickel intraorally, we found no increased risk of sensitising adolescents to nickel by the use of oral orthodontic appliances. On the contrary, early orthodontic treatment preceding piercing reduced the risk of nickel allergy by a factor of 1.5-2.0. This reduced risk appears to be associated with estimated nickel release of the appliance and duration of treatment, in all supporting a hypothesised induction of immunological tolerance via oral administration of nickel. Our study also showed a strong association between lifestyle and nickel allergy. Although there have been changes in lifestyle over time, as indicated by the strong shift in tattooing practices, no large change in nickel allergy prevalence was found compared with previous Swedish data. Our data will serve as a baseline for future studies of the effect of nickel exposure regulations, such as the Nickel Directive, and for studies of lifestyle changes and their effects on nickel allergy.

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20 year old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to “Index of Orthodontic Treatment Need - Dental HealthComponent” (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 percent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and 6IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory “Being under the pressure of social norms” was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

In der Literatur wird die kieferorthopädische Bewegung auch als ätiologischer Faktor für die Entstehung gingivaler Rezessionen gesehen (Dorfman 1978; Toker und Ozdemir 2009). Bereits 1942 beschäftigte sich Oppenheim mit dem Einfluss der Kieferorthopädie auf das parodontale Gewebe und stellte bereits damals fest, dass selbst bei größter Sorgfalt negative Einflüsse auf das Parodont nicht vermieden werden können (Oppenheim 1942). Nach derzeitiger Datenlage scheint folgende Antwort gerechtfertigt zu sein. Im Zuge einer kieferorthopädischen Therapie kann es zu Rezessionen der marginalen Gingiva kommen und dies kann auch teilweise nicht verhindert werden. Die fachlich korrekt durchgeführte kieferorthopädische Therapie scheint per se kein erhöhtes Risiko für die Entstehung von Rezessionen zu sein. Dies setzt eine sorgfältige prätherapeutische Diagnostik, geeignete Kräfte und Verankerungselemente, Beibehaltung einer suffizienten Mundhygiene und die Beachtung anatomischer Limits voraus.

published_or_final_version / Dentistry / Master / Master of Orthodontics

Increasing the rate of orthodontic tooth movement (OTM) can reduce risks such as periodontal disease and caries. This study investigated whether light emitting diode (LED) phototherapy could accelerate the rate of OTM. Orthodontic patients with bilaterally symmetric extraction of premolars were recruited. During space closure, LED phototherapy was applied to one side of the dental arch for a specified time and the contralateral side acted as the control. Space closure was measured immediately prior to, during and later in space closure. All 11 patients were compliant with LED application. The results revealed no significant changes in the rate of OTM with LED phototherapy over 3 months of extraction space closure. The findings were contrary to previous findings with laser phototherapy and could be related to the dosage or method of LED phototherapy delivery. Further investigations are needed to determine whether LED phototherapy application can influence the rate of OTM.

Nitric oxide (NO) plays a role in regulating the rate of orthodontic tooth movement (OTM) in rat models; however, in humans this role remains less clear. In this study, samples of gingival crevicular fluid (GCF) were collected from each maxillary central incisor and first and second molar immediately before (T0), 1 hour after (T1), and 3-4 days after (T2) application of light orthodontic forces in thirteen male participants (ages 11-18 years) undergoing orthodontic therapy. NO levels were measured in each GCF sample, and significantly higher NO levels (p<0.05) were found at T1 at the buccal surfaces of the central incisors when compared to the posterior teeth. The results indicate a possible role for NO in OTM at the pressure sites of incisors at early time points. Further studies are required to determine whether NO levels in the PDL of human teeth are affected by the magnitude of an applied force.

No description available.