Wednesday, October 11, 2017

Department of Pediatric Dentistry
Lutheran Medical Center
            
Resident’s Name: Michael Hatton                       Date: 10/11/2017
Article Title: Dental Arch Space Changes Following Premature Loss of Primary First Molars: A Systematic Review
Author(s): William Tunison BSc, Carlos Flores-Mir DDS DSc, Hossam ElBadrawy DDS MSc, Usama Nassar DDS MSc, Tarek El-Bialy DDS MSc OSci PhD
Journal: Pediatric Dentistry
Date: Jul/Aug 2008
Major TopicGrowth and Development
Type of Article:  Systematic Review
Main Purpose: To perform a systematic review of existing evidence to draw meaningful clinical conclusions concerning the space changes associated with premature loss of primary first molars.
Key Points: 
1)      Immediate space loss of 1.5mm per side in the mandible and 1mm in the maxilla (considering normal growth changes) after loss of primary first molars
2)      There is only a short window after loss of a 1st primary molar for a space maintainer to be effective
 
Conclusions of the article:
1)      Immediate space loss of 1.5mm per side in the mandible and 1mm in the maxilla (considering normal growth changes) after loss of primary first molars
2)      Clinical significance of the loss of space is questionable (but may have treatment implications by case i.e. incisor/lip protrusion or severe arch length deficiencies)
3)      Limited sample sizes and methodological quality of articles (and general lack of good quality and recent articles)
 
Keypoints from the article:
-          Ultimately study is to determine need for space maintenance. 
-          Given studies Kumari and Kumari as well as Cuoghi, the decreased rate of space loss occurs at 4 months post-extraction and most space loss occurs during 1st 6 months, respectively.
-          There is only a short window after loss of a 1st primary molar for a space maintainer to be effective
 

Tuesday, October 10, 2017

Changes in the molar relationship between the deciduous and permanent dentition: a longitudinal study


Article Title: Changes in the molar relationship between the deciduous and permanent dentition: a longitudinal study
Author(s): Bishara SE; Hoppens BJ; Jakobsen JR; Kohout FJ
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Date: 1988; 93: 19-28
Major Topic: Molar relationships and their progression from the primary to mixed to permanent dentition
Type of Article:  Longitudinal study
Main Purpose: This article aimed to describe the changes in molar relationship from the primary to the permanent dentitions.
Key Points: The more favorable the molar relationship in the primary dentition, the more likely the patient will end up in class I.
·      ~50% of patients in primary dentition have a flush-terminal plane relationship
·      2 mechanisms for how a cusp-cusp relationship in the mixed dentition can result in a class I permanent dentition
o   Greater anterior growth of the mandible relative to the maxilla
o   Greater leeway space in mandibular arch compared to maxillary arch, which would allow for greater mesial migration of mandibular molars
·      Distal steps occlusions (10% of total population) ALL resulted in class II permanent dentition relationships
o   Once a class II, always a class II
o   2 cases resulted in class I due to premature loss of mandibular primary second molars due to caries
o   Distoocclusion in the primary or mixed dentition will not self-correct and the patient will need orthodontic treatment when indicated
Flush Terminal Relationship (29% of total population)
Class I
56%
Class II
44%
Class III
None

Mesial Step (1.0mm) Relationship (42% of total population)
Class I
76%
Class II
23%
Class III
One

Mesial Step (2mm or more) Relationship (19% of total population)
Class I
68%
Class II
13%
Class III
19%

·      62% of patients ended class I; 34% ended with class II; 4% in class III
·      Comparisons of right and left sides demonstrated almost no difference between the two
·      Final occlusion is dependent on many dental and skeletal changes, both genetic and environmental, and leeway space is not a good predictor of final molar relationship
·      Mesial step primary dentition occlusion increases chance of having class I occlusion but the greater the mesial step the greater the chance of getting a class III occlusion

Remarks:
1-    I am not sure how to take the article because it took one patient and used them to get two different data sets by using their right and left sides. I think this may skew the results.
2-    Keeping male and female subjects separate in orthodontic studies?
Assessment of Article:  Level of Evidence/Comments: II-2


Outcomes in a 2-phase randomized clinical trial of early class II treatment


Article Title: Outcomes in a 2-phase randomized clinical trial of early class II treatment
Author(s): Tulloch JF, Proffit WR, Phillips C
Journal: Americal Journal of Orthodontics and Dentofacial Orthopedics   
Date: 2004; 125 (6) 657-67
Major Topic: Comparing phase 1 and phase 2 orthodontic treatment of class II malocclusion patients
Type of Article: randomized clinical trial
Main Purpose: This article aimed to compare the efficacy and efficiency of phase 1 versus phase 2 treatment of class II patients.
Key Points: Two stage treatment of most class II patients in children is no more effective and much less efficient than later one stage treatment.
·      This was a 2 phased, parallel, randomized clinical trial of preadolescent versus adolescent treatment for children with severe (≥7mm overjet) class II malocclusions.
·      Early treatment included using either a headgear or a functional appliance. The second phase consisted of fixed appliance therapy.
·      Early phase 1 treatment made a difference initially in skeletal and dental morphology but those differences disappeared after completion of phase 2 treatment.
·      Phase 2 patients were treated by only 1 orthodontist with a headgear or functional appliance
·      Despite differences in methodology of phase 2 treatment, orthodontist results for patients remained consistent
o   “It appears that orthodontists are quite prepared to do what needs to be done to treat each patient.”
·      Limitations of the study
o   No facial asymmetry patients included
o   Only normal facial height patients included (short and long facial height patients were excluded)
o   Amount of actual chair time spent by the practitioner was not recorded
·      Phase 1 treatment did not reduce treatment time nor complexity (did not the reduce need for extractions or orthognathic surgery)
·      Early treatment should not be thought of as an efficient way to treat most class II children
·      Special circumstances may still warrant early treatment of class II patients, such as psychosocial distress, accident potential, general convenience to the family


Remarks:
1-
2-
Assessment of Article:  Level of Evidence/Comments: I


Monday, October 9, 2017

Arch Width Changes from 6 Weeks to 45 Years of Age

Department of Pediatric Dentistry
Langone Medical Center
Resident’s Name: Albert Yamoah                                                                                                            Date: 10/11/2017

Article Title: Arch Width Changes from 6 Weeks to 45 Years of Age

Author(s): Bishara SE, Jakobsen JR, Treder J, Nowak A. 
Journal: American Journal of Orthodontics and Dentofacial Orthopedics
Date: April 1997
Major Topic: Arch width, Intercanine width, Intermolar width
Type of Article: Case-Series Report
Main Purpose: To evaluate on a longitudinal basis, the changes in intercanine and intermolar widths over a 45-year span
Key Points: Although the dental arch widths undergo changes from birth until mid-adulthood, the magnitude as well as the direction of these changes do not provide a scientific basis for expanding the arches in the average patient beyond its established dimension in the average patient beyond its established dimensions at the time of complete eruption of the canines and molars.
Background:
·  Parenting practices have undergone significant changes in the past 15 years that have impacted children’s behaviors
·  Many factors have influenced parents’ disciplinary techniques with children
·  Pediatric dentists are expected to deliver care to children who may not always be as compliant as they need to be
Methods:
·   28 males and 33 female infants were evaluated longitudinally at 6 weeks, 1 year, and 2 years
·   15 male and 15 female subjects were evaluated at ages 3, 5, 8, 13, 26 and 45 years of age
·   Arch width measurements on maxillary and mandibular dental casts were obtained independently by two investigators
o   Intraexaminer and interexaminer reliability were predetermined at 0.5 mm
Findings:
Male Versus Female Differences
·  Longitudinal comparisons of the changes in the absolute values between male and female subjects indicated that male subjects were significantly larger than female subjects in both maxillary and mandibular arch widths.
Changes in Intercanine Widths
·  Pre-eruptive stages: There was a significant increase in maxillary intercanine width between 6 weeks to 1 year and 1 to 2 years, in both boys and girls. Mandibular intercanine widths in both sexes, increased significantly between 6 weeks and 1 year but not between 1 and 2 years of age.
·  Post-eruptive stages: There was a significant increase in maxillary intercanine widths between 3 to 5, 5 to 8, and 8 to 13 years in both boys and girls. Between 13 to 26 years and 26 to 45 years, there was a small decrease in the mean intercanine width in both sexes, but the decrease was statistically significant only between 26 to 45 years, in female subjects.
·  There was an increase in mandibular intercanine width until age 13 years but the increase was significant until age 8 years in boys and 13 years in girls.
·  After 13 years of age, intercanine widths decreased slightly at 25 and 45 years of age. The decrease was significant between 26 and 45 years of age in both male and female subjects.
Changes in Intermolar Width
·  Pre-eruptive stage: There was a significant increase in maxillary intermolar width in both boys and girls between 6 weeks and 1 year, as well as between 1 and 2 years of age. There was a significant increase in mandibular intermolar width between 6 weeks and 1 year, but not between 1 and 2 years of age.
·  Posteruptive stage: In male subjects, there was a significant increase in maxillary and mandibular intermolar widths between 3 to 5, 5 to 8, and 8 to 13 years. There were no significant changes in intermolar width between 13 to 26 and 26 to 45 years.
·  In female subjects, there was a similar significant increase up to 13 years of age in both maxillary and mandibular intermolar widths.
·  Between 13 to 26 and 26 to 45 years, there was a slight decrease in both maxillary and mandibular widths but the decrease was statistically significant only between 13 and 26 years of age, in maxillary width.
Conclusions:
·  Between 6 wks and 2 yrs of age (before the complete eruption of the deciduous dentition), there were significant increase in the maxillary/mandibular intercanine and intermolar widths in both boys and girls
·  Intercanine width significantly increased between 3 and 13 yrs of age in the maxillary arch
·  Mandibular intercanine width, on the average, was established by 8 yrs of age (after complete eruption of incisors)
·  After the complete eruption of the permanent dentition, there was a slight decrease in the dental arch widths, more in the intercanine than intermolar widths
Remarks:
1.

Assessment of Article:  Level IV – Case-Series Report