The introduction of CBCT imaging has the potential to transform orthodontic imaging. However, concerns remain about its comparatively high radiation dose compared to traditional two-dimensional imaging. Nevertheless, in recent years, advancements in CBCT technology have aimed to minimise the radiation exposure for children. This may allow us to use panoramic and cephalometric images extracted from CBCT images. However, there has been limited research into the image quality of potential reduced-dose radiographs. This paper provides us with valuable information on this subject. A multinational predominantly based in the Netherlands did this study.

Readers of this blog will know that I have been calling for good clinical research into how expansion affects the airway. This is because orthodontists are using expansion to solve airway issues without enough evidence to prove its effectiveness. Although there are several expansion methods, the one that shows the most promise seems to be MARPE. In a previous post Martyn Cobourne analysed the methods of expansion and concluded: "There are few high-quality RCTs, significant heterogeneity between studies, and limited long-term follow-up. We may achieve Maxillary skeletal expansion…

Correcting an anterior crossbite in the mixed dentition is one of the simplest forms of orthodontic treatment. Traditionally, this has been achieved using a basic removable appliance with springs to procline the upper teeth or a sectional fixed appliance such as the 2 x 4. Recently, advances in clear aligner technology have indicated that aligners may be utilised for interceptive orthodontic treatment. The main benefit of this approach is that the appliances are aesthetic.  This new study examined the effectiveness of clear aligners and a straightforward removable appliance for correcting crossbites.

Despite their popularity, the effectiveness of clear aligners in complex cases remains uncertain. This is because there has been little research conducted into this type of treatment. However, there have been some systematic reviews, but most of them appear to include large numbers of retrospective studies. The authors of this new paper aimed to conduct a rigorous evaluation of the quality of the outcomes we have achieved with clear aligners. Regular readers of this blog will be aware that I do not write about systematic reviews due to the problems with their methodology, as I feel that they often include too many outcomes derived from retrospective studies.

It is standard clinical practice for us to delay the use of Class II elastics until our patients are in rectangular wires. This is due to concerns about the lack of control when we are in light wires. There has been limited research on this practice, with our evidence mostly comprising clinical experience and case reports. I was therefore interested to see this new paper that examined the effects of early and late Class II elastics. A team from Egypt did this study. The Angle orthodontist published the paper. Early versus late intermaxillary elastics in patients with Class II malocclusion: a randomized clinical trial…

We all try to intercept the impaction of a palatally displaced canine. This new paper was written to provide general dental practitioners with information about this treatment. Its contents are very relevant and helpful for both general practitioners and orthodontists. Interceptive treatment aims to improve the position of the PDC and ideally enable its eruption without treatment. To achieve this, patients with suspected PDCs must be referred and treated early. A team from London, South of England, and Zurich, Switzerland wrote this open-access paper. The British Dental Journal published it.

A few weeks ago, I posted about an interesting study in which a team reached a consensus on the usefulness of clear aligners. They used a Delphi process to achieve this agreement. Their most important finding was that clear aligners served as an effective alternative to traditional fixed appliances in class I patients with mild to moderate crowding. This study method is novel in orthodontic research and has provided us with valuable information about aligner treatment; however, it is based on a low level of evidence. I then discovered another research team conducting a nearly identical project.

The number of bonded retainer trials is increasing, and we are gaining evidence on this important aspect of orthodontic care. However, most of these trials are conducted in dental schools with inexperienced operators, which limits the generalisability of their findings. This new study was carried out in a specialist orthodontic practice and provides us with valuable, clinically relevant information on different retainers. The study team evaluated several retainer materials and bonding methods. A team based in London and Dublin, Ireland, did this study. The AJO-DDO published the paper. A comparison of survival rates using three methods of mandibular fixed retainer fabrication: A randomised clinical tria…

I am going to discuss a new study on childhood obstructive sleep apnea (OSA). As we are all aware, this remains a highly controversial topic in orthodontics. Over the past few years, I have outlined the relationship between orthodontics, facial growth, and obstructive sleep apnoea several times. In my posts, I have asked those advocating orthodontics for OSA to provide evidence supporting this link. It is, therefore, encouraging to see this new paper addressing an important question. The lead author is Derek Mahoney, a specialist practitioner based in Australia. On his…

Regular readers of my blog will have noticed that I and Jan were doing a sponsored walk for Maggies Cancer Support Centres. I would like to give you an update. The walk was last Saturday, and we managed to complete the 22 miles (35K) over pretty rough ground in 11 hours. We started at 8.00 am and finished at 7.00 pm. The weather was mixed the sun shone and then it rained a lot! Thanks to the support of this blog we have raised £5,600 and this reflects the generosity of those who read my blog.

There have been many recent studies on the effectiveness of orthodontic retainers. As a result, we are getting a substantial body of good clinical evidence on their use. However, trials consistently show a high failure rate for bonded retainers. Consequently, researchers are conducting more research to find ways to address this issue. One approach involves considering sandblasting the enamel surface as part of the bonding protocol. This study examined the effectiveness of this method. A team from Strasbourg, France, did the study. The AJO-DDO published the paper. Comparison of bonding failure rates of mandibular retainers after 2 ename…

I spent most of my career working in inner-city Manchester. Unfortunately, the dental health of the children living in the city was poor. As a result, paediatric dentistry colleagues often asked for my input on the decision to do early extraction of carious first molars. Most of the time, we followed traditional criteria for extracting these teeth when the children were about 8-10 years old, depending on their dental development. We believed this would allow reasonable spontaneous closure of any extraction space. These practices were mostly based on clinical experience. However, we were not truly sure if our treatment was effective because it was very difficult to follow up with these children.

Researchers are publishing an increasing number of trials on the treatment of paediatric obstructive sleep apnoea (OSA). These studies continue to contribute to the evidence regarding the role of orthodontics and/or adenotonsillectomy in managing this disorder. In previous posts, I have been critical of the quality of research conducted in this area. Therefore, I was very interested in this new trial. One treatment proposed by those who advocate for the impact of orthodontic treatment on OSA is rapid maxillary expansion (RME). Unfortunately, the current evidence is derived from non-randomised studies. As a result, we need randomised trials to evaluate this form of treatment fully.

Clear aligners are a central component of orthodontic care. However, recent research shows they do not offer the same level of control as fixed appliances. Paradoxically, many practitioners recommend them as an alternative to fixed appliances. Strangely, despite its popularity, there is limited prospective research on this treatment option. This means that our knowledge of the use of clear aligners is somewhat limited. This study team attempted to address this situation by conducting a study to reach consensus on the utility of aligners. A team from Naples and Florence did this research.

There has been considerable high-quality research into the effects of functional appliances, particularly the Twin Block, for the treatment of Class II malocclusion. This suggests that most of the changes are dento-alveolar, with only a small amount of skeletal change. Most of these studies have employed 2D images. However, the advent of 3D imaging has enabled us to make detailed measurements of the condyles and glenoid fossa. This development has opened up new avenues of 3D research. In a previous blog post, I examined a trial of the Herst and X-Bow appliances.

I am raising funds for Maggie's Cancer Support Centres. I will be walking 22 miles across the U.K. moors in memory of my dear friend Betsy Bennett. Sadly, she passed away from leukaemia at only 61. I want to honour her by using the power of this blog to raise a substantial amount. If everyone who reads this blog donates £5.00, we will raise an amazing amount! Betsy was a psychologist. We collaborated in Pittsburgh and North Carolina. Her kindness and personality touched everyone she met. She introduced me to research on patient and psychological outcomes, which changed my research direction.

Adenotonsillar hypertrophy can obstruct the upper airway, which may result in children breathing through their mouths. It is a common belief that this may influence their craniofacial growth and dental occlusion.  This concept tends to be based on various interpretations of the classic papers by Linder-Aronson and Harvold. However, these two papers are not the only sources of information on the relationship between enlarged tonsils and craniofacial morphology. We should consider other studies. This new systematic review, which incorporates data from many studies, is of both clinical and scientific importance.

This is a discussion about the interesting RCT on hemisection for space closure for missing mandibular primary molars that I posted about. The results of this trial were discussed in depth on social media, and I thought we should cover some of this discussion on my blog. This post includes contributions from Martyn Cobourne, Jörge Glockengießer , and Julia Naoumova, who is the author of the paper. I also decided to comment! Martyn Cobourne’s thoughts? Most people would agree that agenesis of mandibular second premolars is best managed by extracting the retained primary second molars and closing the space whenever possible; this can be acheived through spontaneous space closure after interceptive extraction or controlled closure with a fixed appliance.

We should all be concerned with the future environment. As a result, we must be aware of the ecological consequences of our actions. This paper presents the WFO's perspective on the environmental aspects of orthodontic practice. It is uncommon for me to review a paper of this kind, but it is an important publication. The WFO Task Force on "environmental footprints" authored this paper. The Journal of the World Federation of Orthodontists published the paper. Environmental footprints in orthodontics: The World Federation of Orthodontists’ white paper on sustainable practices, challenges and research imperatives…

Orthodontists traditionally used cervical headgear to correct molar relationships and attempt to correct Class II skeletal discrepancies. In the past decade, its use has declined, partly due to advances in anchorage, such as TADS, and the perception of low patient cooperation. Nonetheless, we can still learn from long-term research on the effects of headgear. This paper reports the findings of an RCT on the early effects of cervical pull headgear. It is notable because it follows a study that the team started in 2008. In this report, the team looked at the effect of headgear on the eruption and position of the permanent canines and molars.

Clinical photographs play a crucial role in orthodontic treatment. We commonly use these images for diagnosis, communicating with patients, and monitoring treatment progress. Traditionally, we feel that digital single-lens reflex (DSLR) cameras are the best option for capturing these photographs. However, advancements in smartphone camera technology have led to a growing trend of using smartphones for clinical photography. Despite this shift, we still do not know if there are any significant differences between images taken with smartphones and those captured with DSLR cameras. A team from Cambridge, London, and Bristol, in the beautiful South of England, examined this interesting subject.

Congenital absence of mandibular second premolars is relatively common. One treatment option when permanent tooth extractions are not needed as part of orthodontic treatment is to extract the deciduous molar and allow for spontaneous closure of the space. This has the advantage of promoting spontaneous space closure without orthodontic appliances.  An alternative treatment involves dividing the second molar and extracting the medial and distal segments at different time points. It has been suggested that this leads to better or more controlled spontaneous space closure. Nevertheless, this treatment method has yet to be examined through randomised trial methodology, and I found this new trial highly interesting.

Clear aligner therapy is very popular and has a strong following amongst orthodontists, dentists and their patients. Its use has revolutionised the delivery of orthodontic care. However, recent studies have suggested that the planned tooth movements are not always achieved with Invisalign. I have posted about the studies that have reported this problem for closing extraction spaces, torque control, overbite reduction and reducing overjets. This new study looks at the effects of Invisalign on controlling labial incisor movement when reducing overbites. A team from Adelaide and Bendigo, Australia did the study.

Last week's blog post on the risks of chlld CBCT sparked many questions and controversy, particularly on social media, where I received considerable criticism for suggesting that we should not routinely use CBCT examinations on children. I wonder if my message was lost amid the substantial “white noise” surrounding this issue. Therefore, I have written a new post to outline what I believe are the main points regarding the routine use of CBCT for children. I will start with the British Orthodontic Society Guidelines. Although they are getting rather old, their essential messages are still relevant.

There is no doubt that for very complex orthodontic cases, CBCT imaging is useful. However, there is a tendency to use CBCT for much more routine orthodontic problems.  I have posted about the risks of this before.  Here is another study suggesting there is a considerable risk of cancer following CT imaging. In my previous posts, I have emphasised research conducted by investigators using large-scale registries.  These have shown that following head CT scans in children, there is an increased risk of brain cancer. In another study, there was an…