Original Article

Mandibular irregularity index stability following alveolar corticotomy

and grafting:
A 10-year preliminary study
Laith Makkia; Donald J. Fergusonb; M. Thomas Wilckoc; William M. Wilckod; Krister Bjerkline;
Roelien Stapelbergf; Anas Al-Mullag

ABSTRACT
Objective: To evaluate mandibular irregularity index stability following orthodontic treatment
facilitated by alveolar corticotomy and augmentation bone grafting (Cort+).
Materials and Methods: The irregularity index of 121 orthodontically treated and 15 untreated
patient study casts was analyzed at 5 years and 10 years.
Results: Cort+ resulted in significantly lower mandibular irregularity index scores at both 5 years
(1.5 mm vs 4.2 mm, P , .000) and 10 years (2.1 mm vs 4.1 mm, P , .000) compared with
conventionally treated patients.
Conclusions: Unmatched samples advise caution with conclusions, but orthodontic therapy
combined with Cort+ enhanced the stability of the postorthodontic mandibular irregularity index for
at least 10 years in this preliminary study. (Angle Orthod. 2015;85:743–749.)
KEY WORDS: Orthodontics; Corticotomy; Irregularity index; Bone grafting; Outcome stability;
10 years

INTRODUCTION irregularity index. Whether long term stability of

the mandibular anterior segment is affected by alveolar
Long-term stability is a key objective in orthodontic
corticotomy and augmentation bone grafting (Cort+)1,2
treatment, especially satisfactory alignment of the
has yet to be demonstrated.3
mandibular anterior dentition as quantified by the
Mandibular Anterior Dental Arch Stability
a
Instructor, Advanced Orthodontics Program, European
A consensus of refereed orthodontic literature is that
University College, Dubai, United Arab Emirates.
b
Professor of Orthodontics and Dean, European University mandibular incisor crowding increases over time and
College, Dubai, United Arab Emirates. there are no dependable predictors.4–7 Increased crowding
c
Private Practice in Periodontology, Erie, PA; Departments of shows great variation in both untreated8,9 as well as
Periodontology, Case Western Reserve University, Cleveland, orthodontically treated individuals. Eighteen Swedish
Oh and University of Pennsylvania School of Dental Medicine,
dentists having no missing teeth or prosthodontic or
Philadelphia, PA.
d
Private Practice in Orthodontics, Erie, PA; Department of orthodontic treatment were followed over a period of
Orthodontics, University of Pennsylvania School of Dental 40 years from ages 20 to 60; the authors found a
Medicine, Philadelphia, PA. significant increase in Little’s irregularity index (1.0 mm; P
e
Associate Professor, Department of Orthodontics, Faculty of , 0.01).10 The untreated mandibular arch dimensions of
Odontology, Malmö University, Sweden.
15 adolescents and 18 adults were observed over a span
f
Instructor, Advanced Orthodontics Program, European Uni-
versity College, Dubai, United Arab Emirates. of about 3 decades, and the rate of mandibular irregularity
g
Assistant Professor, Advanced Orthodontics Program, Eu- index increase was greater in adolescents than in adults.11
ropean University College, Dubai, United Arab Emirates. Increases in mandibular anterior crowding are also
Corresponding author: Dr Donald J. Ferguson, Dubai Health- well documented in postorthodontically treated sam-
care City, Bldg 27, Block D, Office 302, PO Box 53382, Dubai,
ples.12,13 Fifty-two females with mostly Class II maloc-
UAE
(e-mail: [email protected]) clusion were followed for nearly 2.5 decades after
premolar extraction therapy; the authors reported a
Accepted: September 2014. Submitted: June 2014.
Published Online: December 4, 2014 1.1-mm increase in mandibular irregularity index over
G 2015 by The EH Angle Education and Research Foundation, the 24 years.14 A mandibular irregularity index increase
Inc. was reported in 96 patients following an average of

DOI: 10.2319/061714-439.1 743 Angle Orthodontist, Vol 85, No 5, 2015

744 MAKKI, FERGUSON, M. T. WILCKO, W. M. WILCKO, BJERKLIN, STAPELBERG, AL-MULLA

Table 1. Description of Study Subgroupsa

Post Tx Length (y)
Short Sample Age at Active Tx (Post to (Post to
Sample Description Descriptionb Size(s) Pre-Tx (Pre to Post) 5 y) 10 y)
Nonextraction, corticotomy + grafting. Cort+ 43/39/22 35.3 6.8 4.3 12.1
Removable retainers
Nonextraction. Conv-5 23 23.5* 22.7* 5.3 na
Removable retainers
Extraction (n 5 26) and nonextraction (n 5 29). Conv-10 55 12.7* 28.5* na 10.8
Fixed—19.6 mo ( n 5 13)
Fixed—36.0 mo ( n 5 18)
No retainers ( n 5 24)
No treatment Untreated 15 20.5* na na 9.1*
a
Includes sample size, age at pretreatment (or first observation), active treatment time (pre-Tx to post Tx), and average length of time between
posttreatment and 5-year or 10-year observation records. Note that sample size for Cort+ was 43 at pre- and posttreatment, 39 at 5 years, and 22
at 10 years posttreatment.
b
Cort+ indicates alveolar corticotomy and augmentation bone grafting; Conv-5, noncorticotomy 5-year sample; and Conv-10, noncorticotomy
10-year sample.
* Significant difference (P , .05) between subgroup value and Cort+ value.

13 years postretention; the increase in irregularity irregularity index 5 years and 10 years posttreatment
index was significantly greater in adolescents in than exists in patients treated with or without Cort+.
adults (1.25 mm vs 0.85 mm; P 5 0.03).15
The percentage of successful orthodontic treatment MATERIALS AND METHODS
outcomes, as measured by the mandibular irregularity Sample
index, diminishes as a function of time posttreatment in
the absence of permanent bonded retention.6 An Approval of the Institutional Review Board at the
irregularity index score of ,3.5 mm has been designat- European University College was obtained to conduct
ed as minimal and clinically acceptable by Little et al.5,7; this research project. Study casts of the mandibular
a success rate of 30% at 10 years’ postretention and dental arches of 136 white patients comprised the
only 10% at 20 years’ postretention was observed in sample; 121 were orthodontically treated and 15 were
premolar extraction cases. After decades of research, not. Removable retainers (thermoplastic or Hawley-
the factors responsible for mandibular incisor stability type retainers) were placed for 66 treated subjects;
remain elusive, and posttreatment stability is regarded semipermanent, bonded canine-to-canine retainers for
as highly variable and unpredictable. 31; and no retainers for 25 subjects (Table 1).
Booth et al.16 have demonstrated that 20 years of Inclusion criteria for treated subjects were (1) fixed,
fixed retention was effective in preventing the irregu- comprehensive, straight-wire orthodontic treatment;
larity index from reaching scores greater than 3.5 mm. (2) availability of mandibular study casts at pretreat-
When fixed retention is not used, a consensus of the ment, immediate post-treatment, and a minimum of
posttreatment stability literature suggests that the 3 years following active orthodontic treatment; and (3)
mandibular irregularity index will increase regardless availability of study casts at least 1 year after fixed
of retainer type if retention is not permanent.5,7 retainer removal if semipermanent retainers were
In the absence of fixed retention, Rothe et al.17 used. The criterion for exclusion was that study casts
compared 10-year postorthodontic samples of minimal did not include all mandibular permanent incisors,
(,3.5 mm) and high (.6 mm) irregularity index. The canines, and first molars.
authors measured mandibular inferior border cortices Patients’ records treated nonextraction with Cort+
and, by a priori application to the alveolus surrounding were from a private practice; these patients had been
the mandibular anterior dentition, concluded that requested to wear removable retainers posttreatment for
patients with thinner mandibular cortices were at 2 years. Cort+ samples included 43 patients at pretreat-
increased risk for mandibular anterior dental relapse. ment and immediate posttreatment, 39 at 5 years, and 22
The purpose of this investigation was to evaluate at 10 years posttreatment; age at pretreatment averaged
mandibular irregularity index stability following ortho- 35.3 years. Patient records were obtained for the study
dontic treatment facilitated by Cort+. The null hypoth- as they became available during recall appointments.
esis tested was that no difference in the mandibular Every Cort+ patient who fit the inclusion criteria was

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MANDIBULAR IRREGULARITY INDEX STABILITY 745

accepted, and no patient was rejected for any reason Table 2. Descriptive Statistics for Mandibular Irregularity Indexa
other than record nonavailability (Table 1). Irregularity Index
The source of 5-year posttreatment records for Subgroup Time n x SD Min Max
patients treated nonextraction without corticotomy
Cort+ Pre 43 9.4 3.0 4.7 18.8
(Conv-5) were from private orthodontic practices; (removable retainers) Post 43 1.1 0.5 0.2 2.4
patients were requested to wear removable retainers 5y 39 1.5 1.0 0.3 4.7
for 2 years posttreatment. Conv-5 patient records were 10 y 22 2.1 1.3 0.6 4.9
obtained as they became available during recall Conv-5 Pre 23 7.8 2.7 4.1 14.9
(removable retainers) Post 23 1.4 1.1 0.4 5.0
appointments; sample size was 23 patients and mean 5y 23 4.2 2.3 1.6 11.8
age at pretreatment was 23.5 years. Conv-10 Pre 55 4.3 2.6 1.0 12.0
Study casts for treated patients, both nonextraction (fixed retainers Post 55 1.7 1.3 0.4 6.2
and extraction, with and without fixed retainers, were & no retainers) 10 y 55 4.1 1.8 0.9 9.0
from a private orthodontic practice and included 10- Untreated Obs1 15 3.6 3.1 1.6 13.9
10 y 15 4.5 2.9 1.7 12.9
year posttreatment study casts. Mean fixed retainer
wear for the extraction (n 5 26) and nonextraction (n 5 * In millimeters, including sample size (n), mean (x), standard
deviation (SD), and range: minimum (min) and maximum (max) for
29) cases were 19.6 and 36.0 months, respectively. The each of the four subgroups at time periods (Time) pretreatment
irregularity index among these four subgroups was (Pre), immediate posttreatment (Post), and either 5 or 10 years
analyzed at pre- and posttreatment as well as 10 years posttreatment (5 y or 10 y); the untreated subgroup included first
after active treatment using both 1-way ANOVA observation (obs1) and observation at 10 years.
(parametric) and Kruskal-Wallis (nonparametric) test-
ing; results showed no statistically significant differenc- Reliability of the measurement technique was
es (P . .05), and the patients were pooled (n 5 55). The evaluated by remeasuring six study cast images using
mean age at pretreatment of the pooled, noncorticot- ImageJ by the same investigator five times separated
omy, 10-year sample (Conv-10) was 12.7 years. by at least 1 week. Intra-examiner reliability was tested
Mandibular casts of 15 adult (dentist), nonntreated using the paired t-test, and no significant statistical
subjects were part of a 40-year, follow-up sample differences were found (P . .05)
published recently about dental arch dimensions and Data were collected and stored in Excel (Microsoft,
incisor irregularity in adults13; only the initial and 10- Redmond, Wash) and later transformed for use with
year study casts were analyzed for the present the Statistical Package for Social Services (SPSS)
investigation. Sample size was 15 and the sample software (IBM, Armonk, NY), version 15.0.1 for
averaged 20.5 years of age at the first observation analysis. Homogeneity of variances was not rejected
time. during 1-way ANOVA parametric testing and therefore
Scheffè’s post hoc test was performed to determine
Procedures intergroup differences for irregularity index as well as
Mandibular study casts representing pretreatment, increments of change from pretreatment to posttreat-
immediate posttreatment, and at least 3 years post- ment, posttreatment to long term (either 5 years or
treatment were digitally photographed. The photos 10 years), and from pretreatment to long term. The
were taken 90u to the occlusal plane in a standardized paired t-test was used to determine intragroup
manner utilizing a 70-cm digital camera to study cast differences.
distance. Each photograph was secured with a
millimeter ruler scale placed at the level of the RESULTS
mandibular occlusal plane; the scale was used to Pretreatment age for the Cort+ subjects (35.3 years)
normalize the study cast images, thereby minimizing was significantly older than the other three subgroups,
magnification errors. ie, Conv-5, Conv-10, and the untreated subgroups
ImageJ, a public domain, downloadable software (23.5, 12.7, and 20.5 years, respectively; P , .000).
program, was used as a photogrammetric measure- The Cort+ sample size was 43 subjects at pretreat-
ment tool to record the target irregularity index on the ment and posttreatment and was 39 subjects at
mandibular study cast images. ImageJ has been shown 5 years, compared with Conv-5 having 23 subjects.
to be a generally reliable and valid photogrammetric The Cort+ sample size at 10 years (n 5 22) was
method,18 especially as a technique for measuring the dissimilar to the Conv-10 (n 5 55) but not different
irregularity index.19,20 Each study cast was normalized to from the nontreated subgroup (n 5 15; Table 1).
the scale. The mandibular irregularity index was Moreover, the nonextraction Cort+ active orthodontic
computed by measuring the displaced contact points treatment time of 6.8 months was significantly less
of the anterior teeth as described by Little.21 than those of Conv-5 or Conv-10 (22.7 months and

Angle Orthodontist, Vol 85, No 5, 2015

746 MAKKI, FERGUSON, M. T. WILCKO, W. M. WILCKO, BJERKLIN, STAPELBERG, AL-MULLA

Figure 1. Bar chart demonstrating differences in mean irregularity

index scores at the four study periods. Figure 2. Bar chart demonstrating differences in rates of irregularity
index change, decreasing pretreatment to posttreatment and
increasing posttreatment to long term.
28.5 months, respectively; P , .000). Descriptive
statistics were computed per subgroup for the man-
Cort+ subjects had a significantly greater amount of
dibular irregularity index (Table 2).
reduction in irregularity index score (28.3 mm) than
did Conv-5 (26.3; P 5 .01) as well as the Conv-10
Irregularity Index
subgroup (22.5 mm; P , .000). From posttreatment to
At pretreatment, the Cort+ group had a significantly 5 years, the rate of irregularity index change for Cort+
higher irregularity index score (9.4 mm) than did either patients was significantly less than that of Conv-5
the Conv-10 or the untreated subgroups (4.3 mm and (0.4 mm vs 2.8 mm; P 5 .000). Moreover, from
3.6 mm, respectively; P , .000) but not the Conv-5 posttreatment to 10 years, the Cort+ (0.9 mm)
subgroup (7.8 mm; P . .05). At immediate posttreat- irregularity index changed significantly less than did
ment, there were no differences in mean irregularity Conv-10 (2.4 mm; P , .000). From pretreatment to
index scores among treated subgroups. Long term, long term, Cort+ demonstrated significantly more
Cort+ patients demonstrated significantly lower (P , reduction in irregularity index compared with Conv-5
.000) irregularity index scores than did Conv-5 (1.5 mm (28.0 mm vs 23.6 mm; P 5 .000), Conv-10, as well as
vs 4.2 mm; P , .000) or Conv-10 (2.1 mm vs 4.1 mm; the untreated subgroup (26.9 mm vs 20.2 mm and
P , .000) as well as the untreated (2.1 mm vs 4.5 mm; 0.9 mm; P 5 .000) at 10 years (Figure 2 and Table 4).
P , .000) subgroup (Figure 1 and Table 3).
Cort+ Irregularity Index Outcomes
Irregularity Index Increments
Paired t-tests demonstrated that the mandibular
The amount of irregularity index change during irregularity index significantly decreased during Cort+
therapy and following removal of active orthodontic treatment from a high at pretreatment of 9.4 mm to a
appliances was analyzed. From pre- to posttreatment, low at posttreatment of 1.1 mm (P 5 .000). Significant

Table 3. Mean Irregularity Index Scores (in Millimeters) for the Four Study Subgroupsa
Irregularity Index
Cort+ (n 5 varied) Conv-5 (n 5 23) Conv-10 (n 5 55) Untreated (n 5 15)
Study Period x x P sig x P sig x P sig
Pre-Tx 9.4 (n 5 43) 7.8 NS 4.3 .000 3.6 .000
Post-Tx 1.1 (n 5 43) 1.4 NS 1.7 NS – –
5y 1.5 (n 5 39) 4.2 .000 – – – –
10 y 2.1 (n 5 22) – – 4.1 .000 4.5 .000
a
One-way ANOVA testing revealed significant differences between Cort+ and all other subgroups except posttreatment and Conv-5s at pre-
and posttreatment. X 5 mean, n 5 sample size, P sig 5 probability significance level, NS 5 not significant at P . .05.

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MANDIBULAR IRREGULARITY INDEX STABILITY 747

Table 4. Rate of change for mean irregularity index scores (in millimeters) for study periodsa
Irregularity Index—Increments
Cort+ (n 5 varied) Conv-5 (n 5 23) Conv-10 (n 5 55) Untreated (n 5 15)
Study Period x x P sig x P sig x P sig
Pre to post 28.3 (n 5 43) 26.3 .01 22.5 .000 – –
Post to 5 y 0.4 (n 5 39) 2.8 .000 – – – –
Pre to 5 y 28.0 (n 5 39) 23.6 .000 – – – –
Post to 10 y 0.9 (n 5 22) – – 2.4 .000 – –
Pre to 10 y 26.9 (n 5 22) – – 20.2 .000 0.9 .000
a
One-way ANOVA revealed significant differences between Cort+ and all other subgroups at every study period. x 5 mean, n 5 sample size,
P sig 5 probability significance level.

increases in irregularity index were found from mandibular anterior arch in all study subgroups. But it
posttreatment to 5 years (1.1 mm vs 1.5 mm; P 5 appeared that the process of mandibular incisor
.04), from posttreatment to 10 years (1.2 mm vs recrowding after orthodontic therapy was slowed
2.1 mm; P 5 .009), and from 5 years to 10 years significantly by Cort+ therapy for at least a decade.
(1.5 mm vs 2.2 mm; P 5 .006; Table 5). Results of the present investigation demonstrated
that the mandibular irregularity index was more stable
Conv-* and Untreated Irregularity Index Outcomes in the Cort+ subgroup, as follows:
The Conv-5 and Conv-10 subgroups responded in N The irregularity index score, while not statistically
similar ways, as follows: different from the conventionally treated subgroups
at posttreatment, was significantly less than in all
N As expected, active orthodontic treatment signifi-
other subgroups at 5 years and 10 years.
cantly (P , .000) reduced the irregularity index
N The increment of change in the irregularity index
scores in both Conv-5 and Conv-10 subgroups.
following orthodontic therapy was significantly less in
N The irregularity index increased significantly (P ,
Cort+ than in all other subgroups at 5 years and
.000) from posttreatment to long term for Conv-5
10 years.
(1.4 mm vs 4.2 mm) as well as for Conv-10 (1.7 mm
vs 4.1 mm). Results of research have also indicated an increased
N The irregularity index for untreated subjects signifi- stability of the mandibular dental arch following
cantly increased (3.6 mm vs 4.5 mm, P 5 .002) Cort+.22
during the 10-year observation period (Table 5). Clinically relevant in the present study were the
findings that the irregularity index for Cort+ was greater
at pretreatment and was reduced during active
DISCUSSION
orthodontic treatment to a much greater extent, yet
A fundamental tenet in orthodontics is that mandib- remained significantly more stable at 5 years and
ular incisor irregularity increases as a function of time. 10 years posttreatment. The scale of the differences is
In the present study, this principle was observed in the demonstrated in Figure 3.

Table 5. Changes in Irregularity Index Increment Revealed by Paired T-testinga

Subgroup Irregularity Index N x1 x2 x-dif P sig
Cort+ Pre to Post 43 9.4 1.1 28.3 .000
(removable retainers) Post to 5 y 39 1.1 1.5 0.4 .040
Pre to 5 y 39 9.5 1.5 28.0 .000
5 to 10 y 19 1.5 2.2 0.8 .006
Post to 10 y 22 1.2 2.1 0.9 .009
Pre to 10 y 22 9.0 2.1 26.9 .000
Conv-5 Pre to Post 23 7.8 1.4 26.3 .000
(removable retainers) Post to 5 y 23 1.4 4.2 2.8 .000
Pre to 5 y 23 7.8 4.2 23.6 .000
Conv-10 Pre to Post 55 4.3 1.7 22.6 .000
(fixed or no retainers) Post to 10 y 55 1.7 4.1 2.4 .000
Pre to 10 y 55 4.3 4.1 20.2 NS
Untreated Obser1 to Obser2 15 3.6 4.5 .9 .002
a
During and after active treatment all periods tested statistically different with one exception, that is, there was no significant difference
between pretreatment and 10 years’ post treatment in the Conv-10 sample.

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748 MAKKI, FERGUSON, M. T. WILCKO, W. M. WILCKO, BJERKLIN, STAPELBERG, AL-MULLA

Figure 3. Mandibular study casts with irregularity index scores of Cort+ (top row) and Conv-10 nonextraction, no retainer (bottom row) at
pretreatment, posttreatment, and 10 years posttreatment, demonstrating relative differences in scale of initial malocclusion and 10 years
posttreatment. The two cases are representative of the overall study results.

A number of investigators have cited an irregularity nonextraction cases, leaving 7 to 8 years of unretained
index of ,3.5 mm as ‘‘clinically acceptable’’ in dentitions. The factor of retainer wear compliance as a
describing mandibular anterior segment stability suc- confounding factor did not appear to influence the
cess after orthodontic treatment.5–8 The irregularity long-term results of the study.
index of ,3.5 mm at 5 years posttreatment in Cort+ Dependable predictors of postorthodontic treatment
was 97.4% (38 of 39 patients) compared with 47.9% stability have not, to date, been identified. In a search
(11 of 23 patients) in the Conv-5 subgroup. At 10 years for predictors of mandibular irregularity index stability,
posttreatment, 76.3% (17 of 22 patients) of Cort+ Rothe et al.17 evaluated whether the amount and
demonstrated a ,3.5 mm irregularity index compared structure of mandibular bone affected the potential of
with 36.4% (20 of 55 patients) in Conv-10. postorthodontic mandibular incisor relapse. The authors
Confounding factors related to the case-control compared orthodontically treated samples of 263
study design that may have influenced our results patients having a ,3.5-mm irregularity index with a
and therefore the findings of the current investigation sample of 60 with a .6.0-mm irregularity index
should be regarded as preliminary. Dissimilar sample approximately 10 years after therapy. They reported
sizes were used; the largest subgroup size difference that the mean mandibular inferior border cortical
was Cort+ (n 5 22) vs Conv-10 (n 5 55). Pretreatment thickness, as measured cephalometrically and indica-
ages were significantly different, with the largest tive of the alveolus housing mandibular incisors, was
spread between the Cort+ (35.3 years) and Conv-10 significantly smaller in the relapse (.6 mm) group at all
(12.7 years) subgroups. Even though the scale of study periods. They concluded that patients with thinner
difference in irregularity index magnitude between mandibular cortices were at increased risk for dental
Cort+ and Conv-10 at 10 years posttreatment was relapse. This finding was confirmed 2 years later in
substantial, results should be interpreted with caution another study by the same investigative group.23
given the sample age differences. Mandibular cortical thickness may be an important
Retainer wear compliance as a confounding factor issue, and augmentation bone grafting was used in the
was considered. Requested of patients was 2 years of present study in combination with orthodontic treat-
removable retainer wear (full time for 6 months ment and selective alveolar decortication.2 Greater
followed by 1.5 years’ nighttime wear) in the Cort+ stability of the mandibular anterior segment in Cort+
and Conv-5 subgroups. Retainer wear was rated by a may be due to increased cortical bone thickness
patient questionnaire using a scale of 3 5 excellent, 2 following these procedures if cortical bone thinness is
5 average, and 1 5 poor. Mean retainer wear was a risk factor for anterior segment instability and
rated 2.0 and 2.1 in the Cort+ and Conv-5 subgroups, increased incisor irregularity.17,23 It has been demon-
respectively. In Conv-10, fixed retainers were removed strated that bone grafting is effective for at least 1 year
after 19.6 months in extraction and 36 months in following active corticotomy-facilitated treatment.24

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MANDIBULAR IRREGULARITY INDEX STABILITY 749

We also surmised that enhanced posttreatment 5. Little RM, Riedel RA, Artun J. An evaluation of changes in
stability is likely due to the increased turnover of mandibular anterior alignment from 10 to 20 years postreten-
tion. Am J Orthod Dentofacial Orthop. 1988;93:423–428.
tissues following corticotomy. It is reasonable to 6. Little RM. Stability and relapse of mandibular anterior
believe that there is substantial tissue memory loss alignment: University of Washington studies. Semin Orthod.
due to the intensity and proximity of the insult created 1999;5:191–204.
when full thickness flaps are elevated and the alveolar 7. Little R, Wallen T, Riedel R. Stability and relapse of
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CONCLUSIONS 10. Tsiopas N, Nilner M, Bondemark L, Bjerklin K. A 40 years
follow-up of dental arch dimensions and incisor irregularity in
N The irregularity index increased in all subgroups with adults. Eur J Orthod. 2013;35:230–235.
time, but mandibular incisor recrowding was slowed 11. Eslambolchi S, Woodside DG, Rossouw PE. A descriptive
significantly for 10 years in adult orthodontic patients study of mandibular incisor alignment in untreated subjects.
following Cort+. Am J Orthod Dentofacial Orthop. 2008;133:343–353.
N Although the case-control study design of the present 12. Boley JC, Mark JM, Sachdeva RCL, et al. Long-term
stability of Class I premolar extraction treatment. Am J
investigation was compromised by differences in Orthod Dentofacial Orthop. 2003;124:277–287.
subgroup sizes and ages, the results demonstrated 13. Bondemark L, Holm A-K, Hansen K, et al. Long-term
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5 years (1.5 mm vs 4.2 mm; P , .000) and 10 years 16. Booth FA, Edelman JM, Proffit WR. Twenty-year follow-up
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N The rate of irregularity index change for Cort+ was canine retainers. Am J Orthod Dentofacial Orthop. 2008;
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18. Kerner S, Etienne D. Root coverage assessment: validity
N Although the limitations of the imperfectly matched and reproducibility of an image analysis system. Clin
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