Original Articles
The effect of fluoride on orthodontic tooth movement in humans. A two-and three-dimensional evaluation
Ersan Ilsay Karadeniz, Carmen Gonzales, Selma Elekdag-Turk, Devrim Isci, Aynur M. Sahin-Saglam, Huseyin Alkis, Tamer Turk and
Ali Darendeliler
The presence of TNF-α and TNFR1 in aseptic root resorption. A preliminary study
Linda Curl and Wayne Sampson
Comparison of the effects of fixed and removable functional appliances on the skeletal and dentoalveolar structures
Fundagül Bilgiç, Orhan Hamamci and Güvenç Başaran
New clinical classification of dental arch form using facial axis points derived from three-dimensional models
Mohamed Bayome, Seong Ho Han, Jong-Hyuk Choi, Seong-Hun Kim, Seung-Hak Baek, Dong-Jae Kim and Yoon-Ah Kook
Finite element method (FEM) analysis of the force systems produced by asymmetric inner headgear bows
Allahyar Geramy, Natalya Kizilova and Leonid Terekhov
The effects of lubrication on the static frictional resistance of orthodontic brackets
Noor Al-Mansouri, Graham Palmer, David R. Moles and Steven P. Jones
Bond failure rates of two self-ligating brackets: a randomised clinical trial
J. Luke Chapman
Orthodontic treatment provision and referral preferences among New Zealand general dental practitioners
S. Aldawood, S.N.H. Ampuan, N. Medara and W.M. Thomson
Differences in dentofacial characteristics between southern versus northern Chinese adolescents
Yan Gu, Urban Hagg, John Wu and Shadow Yeung
A comparative diagnostic assessment of anterior tooth and bone status using panoramic and periapical radiography
Tina Le, Khash Nassery, Bill Kahler and Geoffrey Heithersay AO
Changes in malocclusion over time in New Zealand adolescents
Lyndie A. Foster Page, W. Murray Thomson and Andrew N. Quick
Case Reports
Management of severe Class II division 1 malocclusion: a case report
A. Sumathi Felicita, Shyamala Chandrasekar and K.K. Shantha Sundari
Abstracts
The effect of fluoride on orthodontic tooth
movement in humans. A two- and threedimensional
evaluation
Ersan Ilsay Karadeniz,* Carmen Gonzales,† Selma Elekdag-Turk,+ Devrim Isci,+
Aynur M. Sahin-Saglam,± Huseyin Alkis,‡ Tamer Turk+ and M. Ali Darendeliler†
Department of Orthodontics, The University of Sydney, Sydney, Australia;* Department of Orthodontics, The University of Sydney, Sydney Dental Hospital, South Western Sydney Area Health Service, Sydney, Australia;† Department of Orthodontics, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey;+ Inci-Dent Dental Hospital, Isparta, Turkey± and Department of Orthodontics, Faculty of Dentistry, Suleyman Demirel University, Isparta, Turkey‡
Aims: The aim of the present study was to determine whether high and low fluoride concentrations in drinking water affected
the early stages of tooth movement when heavy and light orthodontic forces were applied for 4 weeks. A further aim was to
compare and evaluate the resulting two-dimensional (2-D) and three-dimensional (3-D) orthodontic tooth movement.
Methods: The sample consisted of 96 maxillary upper first premolars from 48 patients who required premolar extractions as part
of their orthodontic treatment. Patients were selected from two different cities in Turkey with low and high fluoride concentrations
of 0.05 and 2 ppm, respectively. The patient sample was divided into four groups according to the magnitude of force
applied to the first premolars and the concentration of fluoride in the public water supply; Group 1, High fluoride intake (≥ 2
ppm)-Heavy force (225 g); Group 2, Low fluoride intake (≤ 0.05 ppm)-Heavy force; Group 3, High fluoride intake-Light force
(25 g); and Group 4, Low fluoride intake-Light force. A light or heavy buccal tipping orthodontic force was applied to the upper
first premolars for 4 weeks. The first three palatal rugae were used for the superimposition of patient casts in a 2-D and 3-D
evaluation of generated movements.
Results: It was found that heavy force application and fluoride intake increased the average rate of tooth movement. It was
further shown that age was negatively correlated with tooth movement in the 2-D and 3-D measurements.
Conclusions: The average rate of tooth movement was found to be greater in the heavy force and high fluoride intake group
(Group 1HH). Age was negatively correlated with orthodontic tooth movement. Two- and three-dimensional methods were
accurate for the assessment of tooth movement after four weeks of buccal tipping force application when the palatal rugae were
used for superimposition.
(Aust Orthod J 2011; 94-101)
Received for publication: December 2010
Accepted: July 2011
Ersan Ilsay Karadeniz: eikdeniz@hotmail.com; Carmen Gonzales: gonzales_carmenb@yahoo.com; Selma Elekdag-Turk: elekdagturk@yahoo.com Devrim Isci: devrimisci@yahoo.com; Aynur M. Sahin-Saglam: asahinsaglam@yahoo.com; Huseyin
The presence of TNF-α and TNFR1 in aseptic
root resorption. A preliminary study
Linda Curl and Wayne Sampson
Orthodontic Unit, School of Dentistry, The University of Adelaide, Adelaide, South Australia, Australia
Background: It is hypothesised that osteoprotegerin (OPG), as an osteoclast antagonist, may offer molecular control over the
process of orthodontic root resorption. Previous work investigating OPG in a rat periodontal ligament (PDL) ankylosis model found
no inhibitory effect on osteoclasts and odontoclasts when given at a recommended dosage of 2.5 mg/kg. It was considered that
traumatically-induced PDL inflammation produces mediators and cytokines with the ability to stimulate clast cell differentiation and
counter the effects of OPG.
Aims: The present study investigated the presence of Tumour Necrosis Factor Alpha (TNF-α) and its receptor Tumour Necrosis
Factor Receptor 1 (TNFR1) in a PDL sterile inflammatory model.
Methods: Dry ice was applied for 15 minutes to the upper right first molar crown of eighteen, 8-week-old, male Sprague-Dawley
rats of which 9 were injected with OPG at a dose of 2.5 mg/kg of body weight at the time of freezing. After 7 days, the rats
were sacrificed and each maxilla processed for immunohistochemical identification of TNF-α and TNFR1.
Results: Results showed the presence of root resorption in varying amounts and locations in both experimental and control rats.
Reparative processes appeared greater in the OPG-treated rats, often with the presence of an ankylotic union. Immunolabelling
showed the presence of TNF-α and TNFR1 in the sterile inflammation located mainly in the interradicular PDL area. More
definitive labelling appeared in OPG-treated rats.
Conclusion: The results indicated that TNF-α, and its receptor TNFR1, by their presence, may modify OPG effectiveness by
offering an alternative pathway for osteoclast formation, which counters the anti-resorptive effects of OPG.
(Aust Orthod J 2011; 102-109)
Received for publication: December 2010
Accepted: August 2011
Linda Curl: curl80@hotmail.com; Wayne Sampson: wayne.sampson@adelaide.edu.au
Comparison of the effects of fixed and removable
functional appliances on the skeletal and
dentoalveolar structures
Fundagül Bilgiç, Orhan Hamamci and Güvenç Başaran
Dicle University, Faculty of Dentistry Department of Orthodontics, Diyarbakır, Turkey
Objective: To compare and analyse the effects of activator and Forsus FRD EZ appliances in the treatment of skeletal Class II
division I malocclusion.
Methods: Lateral cephalograms and hand-wrist radiographs were collected from 24 Class II division I growing patients (14
females, 10 males). The patients were randomly divided into two equal groups and either treated with an activator appliance
(Mean age 12.67 ± 1.24 years) or with a Forsus FRD EZ appliance (Mean age 12.31 ± 1.09 years). Pretreatment and posttreatment
cephalometric radiographs were obtained, traced, superimposed and data analysed using paired t-tests and the
Wilcoxon signed rank test.
Results: The results demonstrated that the Forsus FRD EZ effectively corrected the Class II malocclusion, but the changes were
mainly dentoalveolar. The Forsus FRD EZ appliance induced a clockwise rotation of the occlusal plane without significant
alteration in the vertical facial dimension. Skeletally, maxillary growth was restricted and pogonion moved forward which
improved the profile.
Conclusion: The Forsus FRD EZ appliance may be an effective dentoalveolar treatment method to manage a skeletal imbalance
and improve the profile in growing patients.
(Aust Orthod J 2011; 110-116)
Received for publication: June 2010
Accepted: May 2011
Fundagül Bilgiç: fundagulbilgic@hotmail.com; Orhan Hamamci: ohamamci@dicle.edu.tr; Güvenç Başaran: basaran@dicle.edu.tr
New clinical classification of dental arch form
using facial axis points derived from threedimensional
models
Mohamed Bayome* and Seong Ho Han,† Jong-Hyuk Choi,*† Seong-Hun Kim,±
Seung-Hak Baek,+ Dong-Jae Kim‡ and Yoon-Ah Kook≠ Department of Orthodontics, Medical School, The Catholic University of Korea;* Department of Orthodontics, St. Vincent Hospital, The Catholic University of Korea;† Department of Orthodontics, Graduate School of Clinical Dental Science, The Catholic University of Korea;*† Department of Orthodontics, School of Dentistry, Kyung Hee University,± Department of Orthodontics, School of Dentistry, Seoul National University;+ Department of Biostatistics, The Catholic University of Korea‡ and Department of Orthodontics, Seoul St. Mary’s Hospital, The Catholic University of Korea,≠ Seoul, Korea
Introduction: The purpose of the present study was to use facial axis (FA) points to classify dental arch form generated from an
analysis of 3-D virtual models of a sample of normal occlusions . A secondary aim was to introduce a new arch form template
based on this classification for clinical application.
Methods: One hundred and twenty five plaster models of Class I occlusions were 3-D scanned (Orapix Co., Ltd, Seoul, Korea)
and FA points digitized on the virtual models using Rapidform 2006 software (INUS Technology Inc., Seoul, Korea). Following
intercanine and intermolar arch width and depth measurements, K-means cluster analysis was applied on 77 cases (Dataset 1) to
classify the sample into arch form types. A curve of best fit of the mean arch form of each type was generated. The remaining 48
cases (Dataset 2) were mapped into the clusters and a multivariate test was performed to assess the differences among the clusters.
Results: Classification into five clusters demonstrated maximum inter-cluster distance in the arch parameters and produced the most
homogeneous cluster size. The differences between the 5 cluster types were statistically but not clinically significant and so they
were recombined to form three clusters representing ‘narrow’, ‘moderate’ and ‘wide’ arch forms.
Conclusions: A template with three arch form types based on anterior and posterior dimensions has been proposed through 3-D
analysis of FA points for more accurate arch form identification and arch wire selection.
(Aust Orthod J 2011; 117-124)
Received for publication: September 2010
Accepted: May 2011
Mohamed Bayome and Seong Ho Han are co-authors.
Mohamed Bayome: mohamed@catholic.ac.kr; Jong-Hyuk Choi: cjh4290@hanmail.net; Seong Ho Han: seoghh@hotmail.com;
Seong-Hun Kim: bravortho@hanmail.net; Seung-Hak Baek: drwhite@unitel.co.kr; Dong-Jae Kim: djkim@catholic.ac.kr;
Yoon-Ah Kook: kook2002@catholic.ac.kr
Finite element method (FEM) analysis of the
force systems produced by asymmetric inner
headgear bows
Allahyar Geramy,* Natalya Kizilova† and Leonid Terekhov†
Orthodontic Department, Tehran University of Medical Sciences, Tehran,* Iran, and the Department of Theoretical Mechanics, Kharkov National University, Kharkov,† Ukraine
Background: Extra-oral traction appliances were introduced more than a century ago and continue to be used to produce
orthopaedic and/or dental changes in the maxilla. While force systems produced by asymmetric outer bows have been studied
extensively, the force systems produced by asymmetric inner bows have been overlooked.
Aim: To analyse the forces acting on the maxillary first molars: when the size of one bayonet bend is increased; when the point
of application of the distalising force on the inner bow is moved to one side; when one molar is displaced palatally.
Methods: Four FEM models of cervical headgear attached to maxillary first molars were designed in SolidWorks 2010 and
transferred to an ANSYS Workbench Ver. 12.1. Model 1, each molar was 23 mm from the midpalatal line and the inner bow
was symmetrical; Model 2, the left molar was displaced 4 mm towards the midpalatal line and the inner bow was symmetrical;
Model 3, the molars were equidistant (23 mm) from the midpalatal line, but the left molar was engaged by a 2 mm larger
bayonet bend; Model 4, the molars were equidistant (23 mm) from the midpalatal line but the join between the inner and
outer bows was displaced 2 mm towards the left molar. In all FEM models, a 2N force was applied to the inner bow at the
join between inner and outer bows and the energy transmitted to the teeth and the von Mises stresses on the molar PDLs were
assessed.
Results: There were marked differences in the strain energy on the teeth and the von Mises stresses on their PDLs. A 14 to 20
per cent increase in energy and force was produced on the tooth closer to the symmetric plane of the headgear. In addition, the
increase in energy produced a 30 to 62 per cent increase in the von Mises stresses within the PDLs.
Conclusion: Small asymmetries in molar position, the size of a bayonet bend and the point of application of a force on an inner
bow resulted in asymmetrical forces on the molars. These forces were higher on the molar closer to the symmetric plane of the
headgear.
(Aust Orthod J 2011; 125-131)
Received for publication: April 2010
Accepted: December 2010
Allahyar Geramy: gueramya@tums.ac.ir; Natalya Kizilova: n.kizilova@gmail.com; Leonid Terekhov: dptmech@univer.kharkov.ua
The effects of lubrication on the static frictional
resistance of orthodontic brackets
Noor Al-Mansouri,* Graham Palmer,* David R. Moles† and Steven P. Jones*
UCL Eastman Dental Institute, London* and Peninsula Dental School, University of Plymouth,† United Kingdom
Background: Difficulties are experienced with the collection and storage of freshly harvested human saliva to use as a lubricant
for the laboratory testing of the frictional resistance of orthodontic brackets. In order to overcome these difficulties, researchers
have suggested the use of saliva substitutes due to their ease of storage and consistency of properties throughout testing. Others
have criticized the use of artificial saliva and prefer the dry state. The present study aimed to compare the effects of human saliva
and an artificial saliva (Saliva Orthana®) with the dry state for the static frictional resistance testing of orthodontic brackets.
Methods: The static frictional resistance and the lubrication effect of human saliva, Saliva Orthana® and the dry state were
investigated using upper central incisor stainless steel brackets and 0.019 x 0.025 inch stainless steel wires in an Instron®
Universal Testing Machine. Static frictional resistance was measured 100 times for each lubrication state. The ‘wettability’ of each
lubricant was determined by measuring the contact angle against a stainless steel surface using the CAM 200 Optical Contact
Angle Meter. Distilled water acted as a control. The viscosity of each lubricant and their Newtonian or non-Newtonian fluid
behaviour under stress was measured using a Brookfield Digital Rheometer Model DV-III+.
Results: The differences in static frictional resistance between the three lubricants when examined as a group did not reach
statistical significance (p = 0.059). The difference between human saliva and Saliva Orthana® was considered to be of
weak statistical significance and clinical relevance (Means: 0.917 N; 0.819 N: p = 0.053). Human saliva and the dry state
revealed very similar mean frictional values (Means: 0.917 N; 0.875 N: p = 0.932). The contact angle tests indicated a
statistically significant difference between the lubricants with Saliva Orthana® having the smallest angle and therefore the highest‘wettability’. Human saliva had the highest initial viscosity and behaved as a non-Newtonian fluid, contrasting with Saliva
Orthana® and distilled water, both of which behaved as Newtonian fluids.
Conclusion: The current results indicate that artificial saliva is not an ideal alternative to human saliva for friction testing in the
laboratory. The results therefore support the proposal that, when human saliva is not available, it may be preferable to test
orthodontic frictional resistance in the dry state.
(Aust Orthod J 2011; 132-138)
Received for publication: January 2011
Accepted: July 2011
Noor Al-Mansouri: noormansoori1978@yahoo.com; Graham Palmer: g.palmer@eastman.ucl.ac.uk; David R. Moles: david.moles@pds.ac.uk
Steven P. Jones: s.jones@eastman.ucl.ac.uk
Bond failure rates of two self-ligating brackets: a
randomised clinical trial
J. Luke Chapman
Private Practice, Ville Platte, LA, United States of America
Aims: To evaluate the bond failure rates of two self-ligating appliance systems bonded with a self-etching primer.
Methods: Forty patients were randomly assigned to either Group SC (SmartClip, 3M Unitek, Monrovia, CA, USA) or Group IR
(In-Ovation R, GAC International, Bohemia, NY, USA) appliance groups. Seven hundred and sixty six brackets were bonded with
Transbond Plus Self-Etching Primer and Transbond Plus Color Change Adhesive according to the manufacturer’s instructions. Over
a 12- month period, the survival rates of the brackets were estimated with the Kaplan-Meier analysis. The survival distributions for
the appliance systems, dental arch and position in the dental arch were compared with the log-rank test.
Results: The bond failure rate for SC was significantly lower than IR (p = 0.022). There were no differences in failure rates
between either the maxillary and mandibular arches or between the anterior and posterior brackets.
Conclusion: SC provided a more reliable bond than IR over the 12-month observation period, however, both brackets had
clinically acceptable bond failure rates.
(Aust Orthod J 2011; 139-144)
Received for publication: August 2010
Accepted: November 2010
Luke Chapman : lukechapmandds@yahoo.com
Orthodontic treatment provision and referral
preferences among New Zealand general dental
practitioners
S. Aldawood, S.N.H. Ampuan, N. Medara and W.M. Thomson
Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand
Background: General dental practitioners (GDPs) are key clinicians in the orthodontic referral chain as they complement (and may
compete with) orthodontists in providing treatment for the public.
Objectives: To determine the nature and extent of GDPs’ involvement in orthodontic treatment provision and to identify influences
on GDPs’ choice of orthodontist.
Methods: An email survey was conducted of actively-practising GDPs in May-June 2010. Two timelines of contact were
followed, with non-responders to the first survey re-contacted three weeks later.
Results: Just under one-fifth (19.3 per cent) reported providing forms of orthodontic treatment. This proportion was higher among
males, more experienced practitioners, and dentists in rural locations. The percentage involvement ranged from 22.3 per cent in
Greater Auckland to 10.5 per cent in Greater Wellington and 11.9 per cent in Christchurch. In the remainder of New Zealand,
percentages ranged from 11.5 per cent in urban areas to 37.1 per cent in rural areas. Of those providing treatment, almost half
had 1-10 patients under management, and just over one-third had greater numbers. Sixty-one per cent of orthodontically-involved
GDPs in Auckland had more than 10 orthodontic patients. The most commonly treated condition was a simple crossbite, while
the least commonly treated condition was the severe Class III malocclusion.
Conclusions: The provision of orthodontic treatment by New Zealand GDPs has decreased in recent years to an average of
about one in five, but this figure is considerably higher in rural areas and is a notable feature of the greater Auckland area. The
findings suggest that the majority of the more complex cases are continuing to be referred to specialist orthodontists.
(Aust Orthod J 2011; 145-154)
Received for publication: February 2011
Accepted: August 2011
S. Aldawood: sukainah_aldawood@hotmail.com; S. Ampuan: ampsi815@student.otago.ac.nz; N. Medara: nidhi.medara@gmail.com;
W. Thomson: murray.thomson@otago.ac.nz
Differences in dentofacial characteristics between
southern versus northern Chinese adolescents
Yan Gu,* Urban Hagg,† John Wu+ and Shadow Yeung±
Department of Orthodontics, Peking University School and Hospital of Stomatology, P.R. China;* Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR and China and Institute of Odontolog, Faculty of Health Sciences, University of Copenhagen, Denmark;† Orthodontics, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China+ and Research Laboratories, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China±
Aim: To compare the dentofacial characteristics of southern and northern Chinese adolescents.
Methods: A southern Chinese sample comprised 70 males (Mean age 12.4 ± 0.60 years) and 60 females (Mean age 12.5± 0.4 years), and a northern Chinese sample consisted of 50 males (Mean age 12.8 ± 1.8 years) and 50 females (Mean age
12.4 ± 1.2 years). All subjects had a Class I molar relationship with no or minimal crowding, a well balanced cephalometric
profile, and no history of orthodontic treatment. Patient cephalograms were traced and digitized and McNamara’s analysis
applied.
Results: A smaller midface and a shorter overall mandibular length were observed in southern Chinese, whereas significantly
increased vertical dimension and a retrusive chin were noted in northern Chinese. Protrusive upper and lower incisors and a
protrusive upper lip were found in southern Chinese.
Conclusions: There were significant differences in dentofacial morphology between southern and northern Chinese adolescents.
It is suggested that separate cephalometric norms be used for patients originating from different parts of China.
(Aust Orthod J 2011; 155-161)
Received for publication: July 2011
Accepted: October 2011
Yan Gu: guyan99@yahoo.com; Urban Hagg: euohagg@hku.hk; John Wu: drjohnwu@gmail.com; Shadow Yeung: skwyeung@hkucc.hku.hk
A comparative diagnostic assessment of anterior
tooth and bone status using panoramic and
periapical radiography
Tina Le,* Khash Nassery,* Bill Kahler† and Geoffrey Heithersay AO*
School of Dentistry, The University of Adelaide, Adelaide* and School of Dentistry, University of Queensland,
Brisbane,† Australia
Aims: The aim of the present study was to compare diagnostic assessments of anterior tooth and bone status in a randomised
cohort of pre-orthodontic patients using panoramic and periapical radiographs.
Method: Four hundred and forty-four cases with matched periapical and panoramic radiographs were examined by three
observers. Two were final-year postgraduate endodontic students and the other, a final-year Honours degree dental student. Multirater
Kappa values were used to assess the reliability of the observers, with a value of 1 equating to complete agreement.
Results: With the exception of endodontic Class 1 and 2 palatal invaginations, reliability exceeded 0.95 for all three observers.
An assessment of the graduate endodontic students revealed only a marginal increase in the kappa values. Statistical analysis
(p < 0.05) determined that developmental anomalies or tooth/bone pathoses were more reliably detected by observers using
periapical radiographs compared with panoramic films. This finding has relevance given the likelihood of anterior dental trauma
among young children.
Conclusion: While there have been considerable improvements in the quality of dental panoramic radiography, the present
study indicated that a reliable pre-orthodontic or post-trauma diagnostic assessment should include both panoramic and intra-oral
radiographs.
(Aust Orthod J 2011; 162-168)
Received for publication: July 2011
Accepted: October 2011
Bill Kahler: w.kahler@uq.edu.au; Geoffrey Heithersay: geoffrey.heithersay@adelaide.edu.au
Changes in malocclusion over time in New
Zealand adolescents
Lyndie A. Foster Page,* W. Murray Thomson† and Andrew N. Quick†
Department of Oral Rehabilitation* and Department of Oral Sciences,† Sir John Walsh Research Institute, School of Dentistry, University of Otago, Dunedin, New Zealand
Background: The Dental Aesthetic Index (DAI) has been used in many cross-sectional studies of population samples, but its
use in assessing changes in malocclusion is less common. The aim of the present study was to describe the natural history of
malocclusion and investigate the utility of the DAI as a measure for describing changes in malocclusion in a population-based
sample of adolescents.
Method: A repeat examination was conducted of a sample of 430 children first assessed in 2003 at age 13 and re-examined
at age 16 (255 or 59.3 per cent of the baseline sample) with their DAI and orthodontic history recorded at each age.
Results: Of the adolescents re-assessed, 28 were in active orthodontic treatment, 30 had completed treatment and 197 had
not received any treatment. There were substantial changes in the DAI items from age 13 to 16, with the greatest improvement
in maxillary anterior irregularity. Overall, almost one-quarter of participants showed an improvement in their DAI treatment need
category which was considerably higher among those who had either received treatment or were in treatment.
Conclusion: The DAI is a valid and responsive tool for measuring change in malocclusion over time. Anterior mandibular
irregularity shows the greatest change with age, and orthodontic treatment is effective in treating malocclusion, at least in the
short term.
(Aust Orthod J 2011; 169-175)
Received for publication: October 2010
Accepted: October 2011
Lyndie Foster Page: lyndie.fosterpage@otago.ac.nz; Murray Thomson: murray.thomson@otago.ac.nz; Andrew Quick: andrew.quick@otago.ac.nz
Long term follow up of clinical outcome of
orthodontic tooth movement following extraction
of previously auto-transplanted maxillary canines
and bone grafting: a case report
Tony Collett
Orthodontist, Private practice and Cleft Clinic, Monash Medical Centre, Clayton, Victoria, Australia
Background: The present case is a 13-year follow up of a patient in which the treatment plan involved removal of unsatisfactory
auto-transplanted maxillary canines together with a bone graft to re-establish normal dento-alveolar ridge morphology. Active
tooth movement occurred in the graft site. At the time, this was a new approach and there was no information in the literature as
to the outcome of this treatment modality. Long-term reports regarding the success of this treatment are lacking.
Aims: To assess the long-term outcome of active tooth movement into a site that required bone grafting.
Methods: The upper right canine was non-vital with poor periodontal support on its buccal aspect. Examination revealed a
substantial bony defect with a loss of the buccal cortical plate following extraction. To augment the ridge defect bone was taken
from the maxillary tuberosity and grafted in the upper right canine extraction site and fixed with a bone screw. Protraction of the
first premolar and retraction of the lateral incisor into the graft site was slow and constant.
Results: Significant closure of the upper canine extraction space was achieved. There were no significant detrimental bone
changes in the interproximal areas of 14 and 12.
Conclusion: By employing a bone graft to re-establish alveolar bone prior to tooth movement, excellent bone support, periodontal
health and a long-term stable result were obtained.
(Aust Orthod J 2011; 176-180)
Received for publication: April 2011
Accepted: August 2011
Tony Collett: tonycol@netspace.net.au
Management of severe Class II division 1
malocclusion: a case report
A. Sumathi Felicita, Shyamala Chandrasekar and K.K. Shantha Sundari
Department of Orthodontics, Saveetha Dental College, Chennai, India
Aims: To describe the two-phase treatment of a pre-adolescent boy with a severe skeletal Class II division 1 malocclusion with
vertical maxillary excess and spaced upper incisors.
Methods: Treatment involved an orthopaedic phase using high-pull headgear and a maxillary intrusion splint followed by nonextraction
orthodontic treatment with a pre-adjusted edgewise appliance. The case was assessed at the start of treatment (T1), at
the end of orthopaedic treatment (T2), at the end of orthodontic treatment (T3) and 2 years after debanding (T4).
Results: At T2 the Class II molar occlusion was corrected to a Class I molar relationship and the overjet and overbite were
considerably reduced. A lower lip trap was relieved and a normal mentolabial sulcus obtained. The cephalometric changes at
T2 revealed a 4 degree reduction in the ANB angle but no change in the SNA angle. At T3, the inclination of the upper central
incisors, the overjet and overbite were normal and the spaces between the upper anterior teeth were closed. At T4, the Class I
molar and canine relationships, reduced overjet, reduced overbite and intercuspation were maintained. The curve of Spee
deepened slightly.
Conclusion: A severe skeletal Class II division 1 malocclusion with vertical maxillary excess may be successfully treated in two
phases with an initial orthopaedic appliance in the form of high-pull head gear and a maxillary intrusion splint followed by fixed
appliances.
(Aust Orthod J 2011; 181-190)
Received for publication: May 2010
Accepted: May 2011
A. Sumathi Felicita: sumifeli@hotmail.com; Shyamala Chandrasekar: shyamala_sc@yahoo.co.uk; K.K. Shantha Sundari: shanta_kk@yahoo.co.in