DesignCohort study.ExposureChildren who were examined in 1988/1989 were invited to a follow-up in 2005/2006. Respondents completed a questionnaire, which collected information on quality of life, receipt of orthodontic treatment and psychosocial factors, and were invited for a clinical examination. Oral health conditions including occlusal status using the Dental Aesthetic Index were recorded.Data analysisDescriptive statistics, bivariate analysis, analysis of variance and multivariate analyses using linear regression were conducted to determine the effects of various factors on the psychosocial outcomes of orthodontic treatment.ResultsNo statistically significant association between occlusal status at adolescence and quality of life at adulthood was found. Individuals who had orthodontic treatment but did not need orthodontic treatment had higher self-esteem and were more satisfied with life than other treatment groups. Occlusal status at adulthood was significantly associated with quality of life. Multivariate analyses showed a statistically significant association between occlusal status at adolescence and adulthood with quality of life. Orthodontic treatment was negatively associated with psychosocial factors fixed orthodontic treatment and self-esteem.ConclusionsOcclusal status appears to have limited association with quality of life and psychosocial factors. Receipt of fixed orthodontic treatment does not appear to be associated with oral health related quality of life but appears to be negatively associated with self-esteem and satisfaction with life.

DATA SOURCES The Cochrane Central Register of Controlled Trials, Medline and Embase databases were searched. A hand search was made of the American Journal of Orthodontics and Dentofacial Orthopaedics,(British) Journal of Orthodontics, European Journal of Orthodontics and Angle Orthodontist, Google Scholar and the reference lists of relevant articles. STUDY SELECTION Only randomised controlled trials (RCT) and quasi-randomised controlled clinical trials (CCT), which specifically stated that they assessed reductions in dental plaque levels and/ or gingival bleeding when comparing oral health promotion (OHP) interventions, were included. Trials that involved plaque removal by a professional (except at baseline) or the use of proprietary antiplaque agents were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was carried out independently by two reviewers. Study quality was assessed for their method of allocation, concealment of allocation, masking of assessment and reporting of withdrawals. Direct comparison between the trials was difficult because of the heterogeneity in the outcome measures between the included studies. RESULTS Six RCT and quasi-randomised CCT met the inclusion criteria. Positive effects on plaque and/ or gingival health were produced in only four of the included trials. OHP did not result in any detectable difference in two of the included trials. None of the trials that were included produced a negative effect of orthodontic OHP on oral hygiene and gingival health. CONCLUSIONS An OHP programme for people undergoing fixed appliance orthodontic treatment produces a short-term reduction (of up to 5 months) in plaque and improvement in gingival health. No particular OHP method produced a greater short-term benefit to periodontal health during fixed appliance orthodontic treatment. Further studies using appropriate methods and, in particular,r longer followup periods are required.

BACKGROUND The potential for premolar extractions to produce changes in the soft tissue profile after orthodontic treatment is controversial. AIM To evaluate the soft tissue changes associated with four first premolar extractions in adult females of South Indian ethnicity. METHOD Pre- and post-treatment lateral cephalometric radiographs of 30 adult female patients of South Indian ethnicity with bimaxillary dentoalveolar protrusion, requiring premolar extractions as a part of their orthodontic treatment, were used. The radiographs were traced and changes in three angular and 12 linear measurements measured relative to the perpendicular to the horizontal reference line, 7 degrees down from S-N through S. Correlation coefficients between the changes in the upper and lower incisors and the lip measurements were calculated. RESULTS All linear and angular measurements, except for changes in upper and lower lip thickness, B' point and the anterior point on the lower lip, showed statistically significant (p < 0.05) changes with treatment. A significant negative correlation was found between upper incisor change and nasolabial angle change and a significant positive correlation was found between upper incisor change and retraction of the most anterior point on the upper lip. CONCLUSION Extraction of the four first premolars followed by the retraction of incisors reduced the dental and soft tissue protrusion found in adult South Indian females with bimaxillary dentoalveolar protrusion.

DATA SOURCES PubMed, Embase, Web of Science and Biosis were used to search for relevant material, along with the reference lists of retrieved articles. STUDY SELECTION Both animal and clinical studies were included if they met the following criteria: they had study and control groups of at least five subjects each; used drugs or supplements with known effects on bone physiology; recorded drug dose and administration; gave details of the application of the forces used for tooth movement; described the technique used to measure the rate of tooth movement; and presented a statistical analysis of the results of the study. DATA EXTRACTION AND SYNTHESIS A formal data extraction process is not described. RESULTS Forty-nine studies were included in this review. Numerous problems were found in the information presented in the reviewed literature from the almost exclusively animal studies. Comparison of the data from these studies was difficult because of the variability in experimental design, animal models, administration regimens, application and duration of forces to the teeth involved. CONCLUSIONS The authors identified a need for more well designed studies on the effects of various types of medication on orthodontic tooth movement.

INTRODUCTION An esthetically pleasing smile is a key determinant of successful orthodontic treatment and patient satisfaction. The great variance in soft-tissue drape of the human face complicates accurate assessment of the soft-tissue profile. Variability is also characteristic of different faces and facial types, and normative data based on 1 population group do not represent all. This study was undertaken to establish norms for a South Indian ethnic population. METHODS The sample comprised lateral cephalograms taken in natural head position of 60 normal subjects (30 men, 30 women). The cephalograms were analyzed with a soft-tissue cephalometric analysis for orthodontic diagnosis and treatment planning, and the Student t test was used to compare the means of the 2 groups. RESULTS Statistically significant differences were found between South Indian men and women in certain key parameters. Men have thicker soft-tissue structures and a more acute nasolabial angle than women. Men have longer faces, and women have greater interlabial gap and maxillary incisor exposure. Men have more deep-set facial structures than women. Compared with established norms for white people, South Indian subjects have more deep-set midfacial structures and more protrusive dentitions. CONCLUSIONS Statistically significant differences were found between South Indian men and women in certain key parameters. Differences were also noted between white and South Indian faces.

DATA SOURCES The Cochrane Oral Health Group's Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), Medline and Embase were searched. No language restrictions were applied. Authors were identified and contacted to identify unpublished trials. STUDY SELECTION Studies selected were randomised clinical trials (RCT) or quasi-RCT involving surgically assisted means of anchorage reinforcement in orthodontic patients. DATA EXTRACTION AND SYNTHESIS Data extraction was performed by two review authors working independently using a previously piloted data collection form. Data were entered into RevMan (The Nordic Cochrane Centre. Copenhagen, Denmark); planned analysis of mean differences and 95% confidence intervals (CI) for continuous outcomes, and risk ratios (RR) and 95% CI for dichotomous outcomes. Pooling of data and meta-analysis were not performed because there were too few similar studies. RESULTS To date, few trials have been carried out in this field and there are insufficient data of adequate quality in the literature to meet the objectives of the review. The review authors were only able to find one study that assessed the use of surgical anchorage reinforcement systems. This trial examined 51 patients with absolute anchorage requirements treated in two centres. Patients were randomly allocated to receive either headgear or a midpalatal osseo-integrated implant. Anchorage loss was measured cephalometrically by mesial movement of dental and skeletal reference points between the start of treatment and the end of anchorage reinforcement. All skeletal and dental points moved mesially more in the headgear group than the implant group. Results showed significant differences for mesial movement of the maxillary molar in both groups. The mean change in the implant group was 1.5 mm [standard deviation (SD), 2.6; 95% CI, 0.4-2.7] and for the headgear group was 3.0 mm (SD, 3.4; 95% CI, 1.6-4.5). The trial was designed to test a clinically significant difference of 2 mm, so the result was not statistically significant, but the authors conclude that midpalatal implants do effectively reinforce anchorage and are an acceptable alternative to headgear in absolute anchorage cases. CONCLUSIONS There is limited evidence that osseo-integrated palatal implants are an acceptable means of reinforcing anchorage. The review authors were unable to identify trials addressing the secondary objectives of the review relating to patient acceptance, discomfort and failure rates. In view of the fact that this is a dynamic area of orthodontic practice, there is a need for high-quality RCT. There are financial restrictions in running trials of this nature but it would be in the interest of implant manufacturers to fund such quality, independently conducted trials of their products.

BACKGROUND Space closure can be a difficult and uncomfortable procedure. Appliances able to be activated by the patient may reduce the number of visits for adjustment. OBJECTIVE To describe the closure of spaces with the Hycon device, an intra-oral screw that can be activated by the patient. METHOD Sliding mechanics were used to retract the upper and lower anterior teeth following extraction of the first premolars in a patient with bimaxillary protrusion. The active force for retraction was derived from the Hycon device activated twice a week by the patient. RESULTS The rate of space closure achieved was of the order of 1.9 mm/month. The extraction spaces were closed by distal movement of the anterior teeth and mesial movement of the posterior teeth. CONCLUSION The Hycon device proved to be an effective means of retracting the anterior teeth and protracting the posterior teeth. Because the device can be activated by the patient fewer visits for adjustment may be required.

Control of the vertical development of the face is a key element in assuring the success of orthopedic treatment, as much for its effects on anterior vertical dimension as for its influence on correction of the sagittal discrepancy between the jaws. An effective management of this control demands respect for the equilibrium between posterior and anterior face, as described by Schudy. The authors review the details of the application of orthopedic therapy on the different elements of this equilibrium and then, present the modalities of vertical control appropriate to each appliance.

The aim of this study was to evaluate the effectiveness of a fixed Twin-block appliance by using a study with a prospective cohort design. Thirty-two children were included in the study over a 2-year period. Cephalometric data were analyzed with the Pancherz cephalometric analysis. Study models were analyzed with the PAR index, and the treatment processes were recorded from the patients' records. The results showed that this appliance was effective in correcting Class II malocclusion; the noncompliance rate was only 6%. It can be concluded that this method of treatment might have some advantages over other fixed and removable functional appliances, but this should be tested with randomized trial methodology.

There are bewildering array of different orthodontic appliances. However, they fall into four main categories of removable, fixed, functional and extra-oral devices. The appliance has to be selected with care and used correctly as inappropriate use can make the malocclusion worse. Removable appliances are only capable of very simple movements whereas fixed appliances are sophisticated devices, which can precisely position the teeth. Functional appliances are useful in difficult cases and are primarily used for Class II Division I malocciusions. Extra-oral devices are used to re-enforce anchorage and can be an aid in both opening and closing spaces.

Clinical research has previously lacked good methodology and much opinion was based on anecdote which is widely regarded as the weakest form of clinical evidence. There are few randomised control trials in orthodontics which support or refute areas of dogma. The number of randomised control trials is increasing significantly. There is currently however no good evidence that orthodontics causes or cures temporomandibular joint dysfunction, that appropriate extractions in orthodontics ruin patients' profiles, or that the orthodontist is able to significantly influence facial growth with appliances.