Thursday, August 28, 2014


Consumer alert on the use of elastics as “gap bands”

The use of elastics in dentistry is not new. One of the earliest applications was to extract teeth in patients with bleeding disorders, cardiac problems, or mental deficiency. The practitioner simply placed a rubber band around the tooth to be extracted. The rubber band would slowly work its way down the sides of the tooth roots, destroying the bone and soft tissues, and the tooth would just fall out. Elastics have also been used in periodontal research in animals, to destroy the periodontal attachment between the bone and the cementum and produce inflammation and lesions similar to that seen in periodontitis.

So, why is a consumer alert needed today?

The answer can be found on the Internet. A recent search on the term “gap bands” produced links to sites selling elastics directly to consumers, for home use in closing a dental gap. The sites promoted the speed and benefits of this do-it-yourself orthodontic treatment, but spent very little time at all informing potential patients of the risks.

But the risks are quite real, as these images from a 1988 article in the Journal of Periodontology show. For the authors take on this topic 25 years later, see the Editorial in the September issue of the AJO-DO.

Fig. (Top row) A 7-year-old boy had acutely inflamed tissues and Class III mobility of the central incisors. The initial radiograph showed localized bone loss, confined to the distal aspects of the central incisors, with probing depths up to 10 mm.  (Bottom row). After 18 months of palliative therapy and splinting, close approximation of the root tips and arc-like pattern of bone loss was evident on the radiograph.  Given the poor prognosis of the central incisors, a decision was made to perform exploratory periodontal surgery, which revealed an embedded elastic band.
The first 3 images were originally published in the Journal of Periodontology and are reproduced
with permission from the American Academy of Periodontology. The final image was not part of the Journal of Periodontology article.

References and Information

Adcock, J.E.  Exfoliation of maxillary central incisors due to misapplication of orthodontic rubber bands.  Tex Dent J. 1999;116:8-13

Aiello, G. and D'Andria, A.  [Iatrogenic risks in orthodontic treatment]  Av Odontoestomatol 1991;7:549-551.  In Spanish

Almeida, R.C., Carvalho, Fde. A., Almeida, M.A., Capelli J. Jr., and Machado, W.A.  Controlled tooth movement to correct an iatrogenic problem.  Am J Orthod Dentofacial Orthop. 2011;139:271-278

Al-Qutub, M.N.  Orthodontic elastic band-induced periodontitis – A case report.  Saudi Dent J. 2012;24:49-53


September 2014; 146(3)
On the cover: Teeth are imperfect structures; shape and dimension varies between tooth types, and also within a particular tooth type. Designers of straight wire appliances relied on average values for crown angulation, inclination, and crown prominence, but small variations from the norms can affect alignment, and larger deviations might require treatment customization. Traditional measures of tooth size, such as the mesiodistal and buccolingual diameters, do not always provide sufficient information. Kim andKwon and colleagues the Seoul National University used 3D technology and occlusal polygon methods to explore the shape differences of the maxillary first molar, to see if variability in morphology would be enough to affect alignment in patients treated with straight wire appliances.
The smiling patient on the cover is Cole Hunt. He was treated orthodontically by David Sarver, Birmingham, Ala.
The September 2014 issue of the AJO-DO is now online.

Tuesday, August 19, 2014


How Novelists View Orthodontics and Malocclusion
Dr Larson R. Keso, former AAO President and voracious consumer of mystery and spy novels,  started noticing occasional references to orthodontics in popular novels. Some were cute, some were curious...

"She was setting at a computer wearing a pair of black librarian glasses, which meant that Virgil would almost certainly fall in love with her. The near-sighted intelligent look did him in every time. if she'd had an overbite, he would have proposed."2

"Luke gave an amused giggle and the big man leaned forward, his pronounced underbite making him look like he had an IQ of sixty"7

"Before a mouthful of braces had taken care of her striking resemblance to a certain animated rabbit"20

Log in  to the AAO members website, aaoinfo.org, and search on "novelists" to read more.

Saturday, August 16, 2014


Editorial; 146(2):133-4
Pitching speed

X-rays were discovered in 1895, closely followed in 1898 by the discovery of the radioactive properties of radium. Almost immediately, a flood of medical products were introduced, marketed, and purported to cure just about any ailment that existed. Companies and products were branded with terms related to radiation, because it was believed that radiation produced positive effects and such branding increased sales. Various forms of radiation sources were added to drinking water, elixirs, lipstick, suppositories, jock straps, and toothpaste, to name only a few. Even products that contained no source of radiation whatsoever—eg, soap, whiskey, golf balls, playing cards—were marketed with names that contained the words x-rays, radium, or radiation. The belief that radiation was good for you was so strong that such advertising, although false, was effective in driving sales. This enthusiasm for radiation lasted for over 50 years but eventually dissipated because, over time, science sorted things out; it became known and accepted that radiation could be useful in specific, carefully controlled applications, but was also dangerous in many other ways.

Now, what does this have to do with orthodontics and pitching speed? If patients could change only one thing about orthodontic treatment, what would it be?  What are doctors eager to provide, and companies spending big dollars pitching to consumers?

Read the August Editorial by Editor-in-Chief Rolf Behrents to find out.

Thursday, August 14, 2014

AUGUST VIDEO: Microelectronic wear-time documentation

The success of orthodontic treatment with a removable device depends on the patient’s wearing the appliance as directed. Doctors can prescribe . . . but do patients comply? Researchers in Germany incorporated a commercially available microsensor into removable appliances and then recorded wear time over a 6-month period. They found that initial compliance was variable, but generally poor; however, it improved later in the treatment period, after the patient was shown a graph that documented actual wear times.  Timm Cornelius Schott discusses the study and findings in our August video.

Friday, August 8, 2014


The easiest way for AAO members to access the AJO-DO online is to log in to the AAO website and pass seamlessly through to the AJO-DO. For the last month, however, this pass-through has been plagued with a time-out problem that prevented users from accessing archived content. Elsevier reports this morning that a code change has been released and the problem solved. So, if you have been frustrated lately in your attempts to access the archives, we are hopeful the problem is now solved.