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Den ry
Askari et al., Dentistry 2015, 5:10
DOI: 10.4172/2161-1122.1000336
Dentistry
ISSN: 2161-1122

Research Articles Open Access

CBCT Assessment of Dental and Skeletal Changes Using the Damon

versus Conventional (MBT) System
Marjan Askari1,2, Robert Williams3, Elaine Romberg4, Maureen Stone5 and Stanley A Alexander6,7*
1
Assistant Clinical Professor, Department of Pediatric Dentistry, School of Dental Medicine, Tufts University, Massachusetts, United States
2
Director of Orthodontics, Holyoke Health Center, Holyoke, Massachusetts, United States
3
Clinical Assistant Professor of Orthodontics, School of Dentistry, University of Maryland, Maryland, United States
4
Professor of Endodontics, School of Dentistry, University of Maryland, Maryland, United States
5
Professor of Neural and Pain Sciences, School of Dentistry, University of Maryland, Maryland, United States
6
Chief Dental Officer, Holyoke Health Center, Holyoke, Massachusetts, United States
7
Distinguished Teaching Professor Emeritus, Stony Brook University, Stony Brook, New York, United States

Abstract
Introduction: The primary aim of this pilot study was to compare cases treated with the Damon System and a
Conventional Mechanics system utilizing Cone Beam Computed Tomography (CBCT) in the evaluation of changes in
dental and skeletal arch width and length. The secondary purpose was to evaluate differences between the three CBCT
views (3-D coordinate, sectional, and volume views).
Methods: Eleven patients (≥ 18 years of age; measured total of 40 maxillary antimeres and 44 mandibular
antimeres) with moderate to severe crowding who had both pre and post-treatment CBCTs and were treated non-
extraction, either with conventional edgewise or self-ligating Damon appliances were retrospectively selected from
two orthodontic practices. The arch length, inter-occlusal, inter-apical, inter-buccal and inter-lingual alveolar crest arch
widths and the bucco-lingual angulation for canine, premolars and first molars were measured. Different CBCT views
were evaluated by first measuring the inter-occlusal distances of the respective teeth in the coronal section and the
volume views. These measurements were compared with those gathered previously using the 3-D coordinate system.
A paired t-test, an independent t-test, and an ANOVA were used for statistical analysis.
Results: Both non-extraction treatment modalities resulted in inter-occlusal arch width expansion in both the
maxilla and mandible. The overall expansion of arches in the Damon treated cases was statistically greater than in the
Conventional cases. Maxillary and mandibular arch lengths were increased, but not significantly in both groups. There
were no statistically significant differences between the three CBCT views.
Conclusions: Both the Damon and the Conventional systems resulted in increased arch width and length, but
the Damon system caused significantly more overall arch expansion. There was less tipping of the teeth during arch
expansion in the Conventional system. The ratio of crown to root movement in the Conventional system versus the
Damon system in the maxilla was approximately 1:1 versus 3:1, and in the mandible 3.6:1 versus 6:1, respectively.

Keywords: CBCT; Class I malocclusions; Damon system modality resulted in a generalized expansion of the buccal segments
along with the advancement of the lower incisors, and found that
Introduction expansion was greatest at the second premolars and least at the canines
The evolution of the shape of the human dental arch is distinct [8]. Other studies using a single type of expansion appliance (rapid
when compared to other primates, while hominid evolution has palatal expansion, quad-helix, lip bumper, or tandem mechanics) all
demonstrated that the arch form in man is parabolic [1]. For over resulted in a greater mean change in mandibular arch width [9-12].
100 years the size and shape of the ideal dental arch has been used The Damon system was first introduced in the 1990s and
for diagnosis and treatment of malocclusions and two diverging incorporates low friction and low force wire technology with the use
methods of therapy: extraction versus non-extraction. Proponents of of passive self-ligating brackets. The general philosophy underlying
non-extraction treatment have indicated that extractions result in a this system is to approximate biologically induced tooth moving forces
detrimental result in profile and smile esthetics, large buccal corridors that results in the alteration of the arch form. The new arch form is
and faulty final occlusions. Recent reports indicate that extraction adapted from the basic arch form and is “physiologically determined”,
therapy does not negatively impact on soft tissue [2,3], nor does it while creating a new equilibrium that allows the arch to reshape itself
negatively affect smile esthetics [4-6]. If the current state of evidence
points in the direction that extraction therapy has no detrimental effect
in facial esthetics and provides a superior occlusion to non-extraction
*Corresponding author: Stanley A Alexander, DMD, Chief Dental Officer, Holyoke
treatment, one would expect a greater predominance of patients treated Health Center, 230 Maple Street, Holyoke, MA 01041, United States, Tel: 413-420-
with the extraction of teeth to successfully resolve their malocclusions. 6257; E-mail: [email protected]
However, with the advent of the Damon philosophy and through the Received July 22, 2015; Accepted September 03, 2015; Published September
use of self-ligation with low force, low friction arch wires, the pathway 13, 2015
to non-extraction treatment has been resurrected and gaining favor in
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015)
orthodontic therapy. CBCT Assessment of Dental and Skeletal Changes Using the Damon versus
Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336
Opposition to non-extraction therapy was largely based on the
retention period where relapse of crowding was due to lateral expansion Copyright: © 2015 Askari M, et al. This is an open-access article distributed under
the terms of the Creative Commons Attribution License, which permits unrestricted
of the arches and proclination of the incisors [7]. The treatment of use, distribution, and reproduction in any medium, provided the original author and
Class I malocclusions without extraction irrespective of the treatment source are credited.

Dentistry Voume 5 • Issue 10 • 1000336

ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 2 of 10

to accommodate the full complement of teeth [13,14]. Treatment Exclusion criteria

protocols using the Damon system have attempted to mirror biological
and physiological principles of tooth movement with the use of light • Patients prior to pubertal growth
arch wires that do not overpower lip musculature, thereby producing a • Extraction at any point during treatment
lip bumper effect on the maxillary and mandibular incisors. According
to Damon principles, the teeth take on the path of least resistance • Missing teeth, excluding second or third molars
which in extraction cases means teeth move into the extraction site; • Pathology associated with head and neck area
however in non-extraction therapy, this treatment philosophy purports
posterior expansion with maintenance of the incisor anteroposterior • Radiation to the head and neck area
position [13,14]. This statement has been disputed by various studies
Five patients who received treatment of both the maxillary and
that have indicated we know very little from the early Damon study
mandibular arches in both treatment groups (Damon and Conventional
of photographs of ‘great smiles’, and that this philosophy of care
results in an increase in both arch length, interbicuspid width, forward MBT), and one patient in the Damon group with only the mandibular
movement of the lip, and proclination of the incisors [15-17]. arch fitting the criteria were included in the study for a total of 40
maxillary antimeres and 44 mandibular antimeres measured. Both
Study casts and lateral cephalograms have been used to evaluate treatment groups were equally composed of patients with crowding
arch expansion and incisor proclination for both conventional and self- ranging from both the 3-6 mm and greater than 6 mm levels and with
ligating systems. Images obtained by cone beam computer tomography ovoid arch forms. Cephalometrically, all eleven patients presented with
(CBCT) provides an undistorted view of tooth roots and 3-D spatial Class I skeletal relationships (Wits appraisal = to -1 mm to +1 mm
orientation of both bones and teeth [18]; this technology can be utilized and ANB relationships of +1°-3°), Class I (Angle) dental relationships,
to evaluate the effects of treatment on the crown, roots and alveolar
normal mandibular plane angles ranging from 29°-32°, and normal
bone of individual patients.
vertical proportions. Mandibular incisor positions ranged from 88°-97°
The purpose of this investigation therefore, was fourfold: to the mandibular plane, while the maxillary incisor positions to the
sella-nasion plane ranged from 105°-112°.
• to evaluate the changes in arch dimensions of non-extraction
treated cases using CBCT; In the group treated with the Conventional edgewise system, the
• to evaluate the changes in dental and skeletal arch width and brackets used were 3M Unitek APC with MBT prescription (0.022
length in patients treated with the Damon System; slot). The treating orthodontist used the following arch wire sequence
(ovoid arch form, 3M Unitek Corp.) that was ligated with elastomeric
• to evaluate the changes in dental and skeletal arch width and ligation:
length in patients treated with conventional mechanics, and
Maxilla/Mandible
• to evaluate the differences in the dental and skeletal arch width
and length measurements of patients treated with the Damon • 0.014 to 0.016 inch nickel-titanium
System when compared to patients treated with Conventional
• 0.018 inch stainless steel
mechanics.
• 0.016 x 0.022 inch nickel-titanium
Method and Materials
• 0.019 x 0.025 inch stainless steel
Approval to conduct this study was obtained from the Human
Research Protections Office (HRPO) of the University of Maryland The final arch wires were customized to the individual patient’s
Institutional Review Board. Patients were retrospectively selected from arch form.
the offices of two private practices, one office that exclusively utilized In the group treated with the Damon appliance (Ormco Corp.),
a self-ligating Damon system and the second office that utilized a Damon Q Standard, self-ligating brackets were utilized. The following
conventional edgewise system with an MBT prescription. Both systems arch wires (Damon Arch; Ormco Corp.) were sequentially used:
used 0.022-in archwire slots. Patients with moderate (3-6 mm) to
severe (>6 mm) crowding as judged by the clinicians were utilized. Maxilla
Eleven subjects were selected in this study based on the following:
• 0.014 to 0.016 inch copper nickel-titanium
Inclusion criteria • 0.016 x 0.025 inch copper nickel-titanium
• Patients having an age of 18 years or older • 0.018 x 0.025 inch copper nickel-titanium
• Class I occlusion or mild class II/III malocclusion • 0.019 x 0.025 inch stainless steel
• Moderate to severe crowding The final arch wire was customized to the individual patient’s arch
• Non-extraction treatment from.

• No interproximal reduction Mandible

• No therapeutic intervention exclusive of arch wires • 0.014 to 0.016 inch copper nickel-titanium
• No surgical intervention • 0.014 x 0.025 inch copper nickel-titanium
• Available initial and final CBCT • 0.018 x 0.025 copper nickel-titanium
• No missing teeth, excluding second and third molars • 0.016 x 0.025 inch stainless steel

Dentistry Voume 5 • Issue 10 • 1000336

ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 3 of 10

The final arch wire was customized to the individual patient’s arch numbers indicate the actual measurements, and the other two lines
form. (green and orange line) are to coordinate the views.
Each arch wire placement, on average, was for a 4-5 month period Conventional lateral cephalograms compared to CBCT were taken
for each treatment group for an average treatment time of 17-20 with teeth in occlusion. The segmentation (separation) of maxillary
months. and mandibular teeth becomes more difficult because the cusps of
antagonist teeth overlap. Teeth in occlusion scans make it more difficult
Both the Conventional and Damon treated cases were scanned in to build an accurate dental model as they reduce the visibility of teeth
an i-Cat machine (Imaging Sciences). DICOM files were obtained via surfaces [19]. Since the CBCTs of patients in this study were taken with
the i-Cat machine with 0.3 voxel resolution. The Anatomage Invivo patients in centric occlusion, the non-functional cusps were chosen for
Dental 5.0 volumetric imaging software was used for all measurements interocclusal arch width and angular measurements.
used in the study.
Dental measurements
Since all CBCTs were obtained with patients in centric occlusion,
the non-functional cusps in each arch were used to measure the Arch width; Inter-occlusal (IOD) and Inter-Apical (IAD)
inter-occlusal arch width for better cusp tip view. The arch width was Distances: Individual arch width measurements of paired teeth were
measured at the first molar, first and second premolars, and the cuspids made from cusp tip to cusp tip. The non-functional cusps were chosen
in both arches. The arch width measurements included not only the except for mandibular first premolars. Combined IOD differences
occlusal portions of the teeth, but also their respective buccal and for canines, premolars and molars were also made in each arch for
lingual cortical plates. The inter-apical areas of each of the respective statistical purposes (Table 1).
teeth were also measured along with the angulations of each tooth. Arch Canines: Interocclusal arch width for canines was measured from
length was measured as the distance between the mid-point of the line cusp tip to cusp tip; inter-apical distance was measured from apex to
connecting the mesial of the first molars to the contact point between apex.
the central incisors. Arch width, arch length, and tooth angulation were
Premolars: Interocclusal arch width for maxillary premolars and
measured at pre-treatment, T1 and post-treatment, T2.
mandibular second premolars was measured between non-functional
A clear view of the object being measured was obtained using in cusp tips; however, the inter-occlusal arch width for the mandibular
vivo tools. Two 3rd year dental students who were trained to work first premolars wre measured from the functional cusps due to
with the software, but were blind to the study recorded pictures and rudimentary lingual cusps of these teeth. Inter-apical distance was
data for each patient. Both dental students worked together for all measured from premolar apex to apex. When two roots were present,
measurements for all of the patients and consulted with each other as to the buccal root apex was chosen. The first and second premolars were
the optimal placement of reference points on every measurement taken measured separately and then combined for all measurements for
as well as what constituted the most accurate view. Table 1 indicates statistical purposes.
the measurements that were obtained on the frontal section view after Molars: The inter-occlusal arch width was measured in two
the image was coordinated in the sagittal and coronal views as seen different ways. One measurement was made from the central fossa to
in Figure 1, unless otherwise stated. The red dots indicate points of central fossa. This measurement is less affected by tipping of these teeth
interest, blue lines show the distance between the two points, the green than if the cusp tips were chosen. The second measurement was made

Measurements Definition
Arch Length (AL) Perpendicular distance from line connecting the mesial of 1st molars to the contact point between central incisors
Arch Width
• K9: Distance between canine cusp tips
• Mand PM1: Distance between mandibular 1st premolars buccal cusp tips
• Mand PM2: Distance between mandibular 2nd premolars lingual cusp tips
Inter-occlusal dimension (IOD)
• Max PMs: Distance between maxillary premolars buccal cusp tips
• Mand M1: Distance between mandibular 1st molar lingual grooves
• Max M1: Distance between maxillary 1st molar buccal grooves
Inter-central-fossa (ICF) M1: distance between 1st molars’ central fossae
• K9: Distance between canine apices
• Mand PMs: Distance between mandibular premolar apices
Inter-apical dimension (IAD) • Max PMs: Distance between maxillary premolar apices
• Mand M1: Distance between mandibular 1st molar mesial root apices
• Max M1: Distance between maxillary 1st molar palatal root apices
Inter-buccal alveolar crest dimension (IBACD) Distance between buccal alveolar crestal bone
Distance between lingual alveolar crestal bone
Inter-lingual alveolar crest dimension (ILACD)

Tooth Angulation
Angulation of the tooth on the right/left side (R/L-angle)
• Mand canine: Angle between cusp tip to apex to mandibular border
• Max canine: Angle between cusp tip to apex to nasal floor
• Mand PM1: Angle between buccal cusp to apex to mandibular border
Tooth Angulation
• Mand PM2: Angle between lingual cusp to apex to mandibular border
• Max PMs: Angle between buccal cusp to palatal root apex to nasal floor
• Mand 1st M: angle between central fossa to furcation to mandibular border
• Max 1st M: angle between central fossa to furcation to nasal floor
Table 1: Measurements and abbreviations used for the description of arch length, arch width, and tooth angulation.

Dentistry Voume 5 • Issue 10 • 1000336

ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 4 of 10

A. Occlusal view, horizontal arrows indicate arch width expansion measurements of the buccal segments; vertical arrow indicates arch length;
B. Coronal view, arrows indicate angular change measurements as a result of expansion of the dental arches;
C. Lateral view, arrow indicates angular position of the incisors (not measured in this study).

Figure 1: An example of a 3-D Coordinate System of a subject’s CBCT scan.

between the non-functional cusps after first coordinating the points in line connecting the mesial of the first molars to the contact between
the coronal view. The non-functional cusp/groove in the frontal view the central incisors. The maxillary arch lengths were measured in the
was chosen. volume view, whereas the mandibular measurements were done in the
section view.
To measure the inter-apical distance in the mandible, the mesial
root apices were selected by scanning through sectional slices in the Inter-occlusal arch width measurements
frontal view until first molar root apices on either side of each arch
were visible. For maxillary first molars, the inter-apical distance of the The same data was also gathered for individual teeth using the
palatal roots were chosen. 3-D coordinate system for better visualization of individual teeth to be
measured. The measurements of the inter-occlusal arch width distances
Angular measurements were obtained using the section and volume views for all teeth as if
looking at a dental cast from the occlusal. This was done to compare
The angulations of the maxillary teeth were all measured relative
the relative accuracy of these views as opposed to the previously
to the point of intersection between the nasal septum and the nasal
measured inter-occlusal distances of the respective teeth using the
floor as was seen in the frontal view. The angulation of the mandibular three coordinate systems. This view helps to identify the most exact
teeth was measured relative to the lowest border of the mandible in the point of interest since you have the option of manipulating the section
frontal view. Angulations were measured separately on each tooth for view in the frontal, sagittal and coronal coordinate system before the
the right (R) and left (L) side, but the combined R and L for each tooth actual measurement is obtained.
is reported for statistical purposes.
Maxilla
Maxillary canine: Angle between cusp tip to apex to nasal floor.
• from cusp tip to cusp tip of canine
Mandibular canine: Angle between cusp tip to apex to the lower
border of mandible. • from buccal cusp tip to buccal cusp tip of 1st and 2nd premolar

Premolars: The non-functional cusp tips to apex to nasal floor in • from buccal groove to buccal groove of 1st molar
maxilla and to the lowest border of the mandible. Functional cusps were Mandible
chosen for the mandibular first premolars as a source of measurement.
If there were two premolar roots available, the buccal root was chosen. • from cusp tip to cusp tip of canine

Molars: The central fossa to furcation to nasal floor or lowest • from lingual cusp tip to lingual cusp tip of 1st and 2nd premolar
border of the mandible. • from lingual groove to lingual groove of 1st molar
Skeletal arch width measurements Assessment methods
The skeletal arch width measurements for each of the teeth included In order to evaluate the effect of each treatment separately,
the distance between the alveolar bone and the respective tooth to the changes in the inter-occlusal arch dimension (IOD), inter-apical
same point on the other side of the arch. arch dimension (IAD), and the arch length (AL) were compared. For
• IBACD = buccal crest of bone to buccal crest of bone comparison of the dental and skeletal differences between the Damon
and Conventional systems, differences between the pre- and post-
• ILACD = lingual crest of bone to lingual crest of bone treatment arch width and arch length in each treatment group were
Arch length measured. For evaluation of the translation of the alveolus laterally, the
pre- and post-treatment dimensional changes in buccal (IBACD) and
The arch length was measured as a perpendicular distance from a lingual (ILACD) plates were compared. To evaluate the axial tipping

Dentistry Voume 5 • Issue 10 • 1000336

ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 5 of 10

of teeth, the pre- and post-treatment measurements of IOD and IAD final readings of Damon treated cases, a paired t-test was performed for
changes and the changes in angular dimension were determined. each respective tooth’s IOD, ICF, IAD, and arch length.
Finally, to evaluate the accuracy of the different views using CBCT,
Maxilla: All inter-occlusal arch width differences for the measured
readings on inter-occlusal arch dimensions were compared among the
teeth (K9, PM1, PM2, and M1) increased during treatment (Table 2).
three views: the section view for all involved teeth, the volume view
However, statistically significant differences were observed only for the
with arches handled like dental casts, and the individual measurements
cuspids (p=0.024) and the first and second premolars (PM1, p=0.021;
obtained via a 3-D coordinate system.
PM2, p=0.032). The inter-central fossa distance between the first
Statistical analysis molars increased to a statistically significant degree (M1-ICF, p=0.026).
However, the first molars inter-occlusal change, when measured at the
For the assessment of error, several CBCTs of patients were non-functional cusps did not show a significant difference. Inter-apical
randomly selected and re-measured. Systematic errors were estimated distances of all measured teeth decreased, but the changes were not
by using a paired 2-tailed t-test; no significant differences were found. statistically significant, while the arch length increase during treatment
Dahlberg’s formula [20] was used for calculation of combined method approached statistical significance (p=0.078).
Dahlberg’s Formula= √ Ʃd2/2n errors in locating and measuring different
landmarks: Mandible: All inter-occlusal arch width differences increased to
a statistically significant degree, (Table 3) (K9, p=0.04; PM1, p=0.004;
where d is the difference between the two measurements of a pair, PM2, p=0.01, and M1, p=0.005). Distance between the inter-central
and n is the number of double measurements. fossa of the first molars increased to a statistically significant degree
Since in this study the points of interest were located at different (M1-ICF, p=0.002). The inter-apical dimension for the cuspids and
spatial orientations and clinically some harder to locate than others, second premolars increased, while for the first premolars and molars
Dahlberg’s calculation was performed on duplicated measurements decreased, but none to a statistically significant degree. Arch length
with regard to their degree of difficulty. In case of very difficult increase also was not statistically significant.
measurements (i.e. maxillary teeth angulation), 15 calculations were Conventional cases
performed on random cases. The same calculations were performed for
four moderately difficult points (IBACD, ILACD) and four easy points In order to determine the changes from the initial measurements
(IOD, IAD). to the final measurements of the conventional cases, a paired t-test was
performed for each respective tooth’s IOD, ICF, IAD, and arch length.
To evaluate changes within each treatment category (Damon or
Conventional), a paired t-test was used; to evaluate dental and skeletal Maxilla: All inter-occlusal measurements (K9, PM1, PM2, and
changes between different treatment groups, an independent t-test was M1) increased during treatment. However, there were only statistically
performed on the differences between initial and final measurements significant differences in the inter-occlusal arch width for the first
in each treatment category; to evaluate significant difference between premolars (PM1, p=0.017). The inter-central fossa measurements
different views of CBCT, one-way ANOVA was used. between the first molars increased slightly during treatment but not to
a significant degree. The inter-apical measurements increased slightly
Results in all measured teeth except for the first molar which decreased slightly,
with only the first premolars approaching statistical significance
In this study method errors were 0.053 mm for easy points to
(p=0.06). Arch length increased, but not to a statistically significant
identify, 0.63 mm for moderately difficult measurement points, and
degree (Table 2).
5.3˚ for difficult angular measurements. This data is in agreement with
the findings of Damstra et al. [21]. Mandible: All inter-occlusal arch widths (K9, PM1, PM2 and M1)
increased during treatment, with statistically significant changes only
Damon cases in the cuspids (K9, p=0.045) and second premolars (PM2, p=0.031),
In order to examine the changes from the initial readings to the with the molars approaching statistical significance (M1, p=0.075).

Damon Treatment Conventional Treatment

Initial Final Initial Final
Measurement
Tooth N Mean ± SD Mean ± SD t p N Mean ± SD Mean ± SD t p
(mm) (mm) (mm) (mm)
K9 5 34.6 ± 2.1 37.1 ± 2.1 3.53 0.024* 5 34.7 ± 4.3 35.3 ± 3.2 0.548 0.613
PM1 5 41.3 ± 2.4 44.8 ± 2.5 3.688 0.021* 5 41.0 ± 3.5 43.1 ± 2.96 3.908 0.017*
IOD 1
PM2 5 47.0 ± 2.8 49.3 ± 3.0 3.236 0.032* 5 46.8 ± 3.6 48.0 ± 3.1 1.144 0.316
M1 5 53.6 ± 3.0 54.2 ± 3.2 1.404 0.233 5 54.9 ± 3.3 55.1 ± 2.4 0.403 0.708
ICF2 M1 5 46.2 ± 2.5 47.4 ± 3.2 3.466 0.026* 5 47.8 ± 3.0 47.9 ± 3.5 0.204 0.849
K9 5 29.0 ± 2.4 28.5 ± 2.7 0.695 0.525 5 29.4 ± 3.8 29.96 ± 3.3 0.543 0.616
PM1 5 36.9 ± 2.8 36.1 ± 1.7 0.911 0.414 5 33.6 ± 4.4 36.9 ± 3.3 2.597 0.06
IAD 3
PM2 5 36.9 ± 2.2 36.2 ± 2.8 1.389 0.237 5 39.2 ± 2.9 40.3 ± 3.5 1.705 0.163
M1 5 30.5 ± 2.9 28.5 ± 3.9 1.097 0.334 5 35.8 ± 8.7 34.3 ± 5.3 0.871 0.433
AL4 5 30.7 ± 0.8 32.4 ± 1.8 2.356 0.078 5 31.8 ± 4.7 33.1 ± 5.2 1.212 0.292
*indicates statistical significance ; 1indicates dental arch width, interocclusal, cusp tip to cusp tip; 2 indicates dental arch width, central fossa to central fossa of molars;
3
indicates dental arch width, interapical, root tip to root tip; 4indicates arch length.
Table 2: Damon and conventional maxillary arch measurements (mm) before and after treatment; inter-occlusal arch dimension (IOD), first molar inter-central fossa (ICF),
inter-apical dimension (IAD), and arch length (AL).

Dentistry Voume 5 • Issue 10 • 1000336

ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 6 of 10

Damon Treatment Conventional Treatment

Measurement Initial Final Initial Final

Tooth N Mean ± SD Mean ± SD t p N Mean ± SD Mean ± SD t p
(mm) (mm) (mm) (mm)
K9 5 22.5 ± 3.7 27.6 ± 5.8 2.752 0.040* 5 25.3 ± 3.3 28.3 ± 3.5 2.881 0.045*
PM1 5 24.9 ± 2.7 30.2 ± 2.5 5.061 0.004* 5 26.6 ± 6.3 27.2 ± 3.3 0.299 0.780
IOD 1
PM2 5 29.2 ± 3.5 32.9 ± 2.2 4.006 0.010* 5 31.0 ± 3.6 32.5 ± 2.7 3.251 0.031*
M1 5 33.5 ± 3.1 36.1 ± 3.2 4.671 0.005* 5 34.8 ± 3.7 35.5 ± 3.5 2.390 0.075
ICF2 M1 5 41.7 ± 3.4 44.5 ± 3.4 6.031 0.002* 5 42.8 ± 3.5 43.3 ± 3.8 2.390 0.075
K9 5 24.5 ± 3.3 24.9 ± 2.5 0.564 0.597 5 22.0 ± 1.1 24.3 ± 0.9 3.438 0.026*
PM1 5 33.4 ± 3.1 32.2 ± 2.5 1.537 0.185 5 32.9 ± 4.1 32.4 ± 3.2 0.769 0.485
IAD3
PM2 5 40.5 ± 2.2 41.4 ± 3.2 1.519 0.189 5 41.9 ± 3.8 41.7 ± 3.5 0.425 0.692
M1 5 49.8 ± 4.3 48.7 ± 3.4 0.836 0.441 5 49.0 ± 3.3 50.5 ± 4.4 1.517 0.204
AL4 5 21.6 ± 1.2 22.3 ± 1.8 1.755 0.140 5 23.7 ± 6.5 24.1 ± 2.2 0.150 0.888
* indicates statistical significance ; 1indicates dental arch width, interocclusal, cusp tip to cusp tip; 2 indicates dental arch width, central fossa to central fossa of molars;
3
indicates dental arch width, interapical, root tip to root tip; 4indicates arch length.
Table 3: Damon and conventional mandibular arch measurements (mm) before and after treatment; inter-occlusal arch dimension (IOD), first molar inter-central fossa
(ICF), inter-apical dimension (IAD), and arch length (AL).

The first molars inter-central fossa measurements increased slightly, while the first molar had the greater change in the Conventional group.
but not to a statistically significant degree. The inter-apical distance of The inter-buccal alveolar crest dimension (IBACD) of the first premolar
the first molars and cuspids both increased, however only the cuspids was greater in the Conventional group than the Damon group. The
were statistically significant (p=0.026). Both first and second premolars lingual alveolar crest accompanying the Conventional cuspid teeth also
inter-apical distances decreased, but not significantly. Arch length increased respectively, (p=0.05). For all other measured teeth there was
increased, however not to a statistically significant degree (Table 3). a significantly greater increase in ILACD in the Damon treated cases as
opposed to the Conventional cases (PM1, p=0.05; PM2, p=0.005; M1,
Damon treatment changes versus conventional treatment p=0.01). Although arch length increased in both treatment groups in
changes both arches with slightly more increase in the Damon group, there was
Maxilla: In the maxilla, the inter-occlusal arch width (IOD) no statistically significant difference between the two groups (Tables 4
increase of the Damon treated group for cuspids and premolars was and 5).
larger, approaching significance (K9, p=0.10; PMs, p=0.10). Statistical No statistically significant difference was observed between the
analysis showed a significant increase in the combined changes for different CBCT views (3D coordinate system, coronal section, and
inter-occlusal arch widths during treatment for the Damon versus the volume) for inter-occlusal arch width measurements for the combined
Conventional treated cases (p=0.025). The changes in the first molars maxilla and mandible (Table 6) or for the inter-occlusal arch width
inter-central fossa widths (M1-ICF) of the Damon group approached measurements for the maxilla and mandible separately (Table 7).
significance, with a greater change in the Damon group (p=0.10). The
maxillary inter-apical distances however, had increased significantly The ratios of overall arch expansion between the groups were
more in the Conventional treated cases as opposed to the Damon measured and the ratios of crown versus root movement were
treated cases in premolars, whether they were examined individually examined. At the crown level in the maxilla, the Damon system resulted
(PM1, p=0.025; PM2, p=0.05) or combined as a group (PMs, p=0.005). in 2.2 (2.2:1) times more arch expansion than the Conventional system,
There was also a significantly greater increase in the second premolars (p=0.05). In the mandible, the Damon system resulted in 2.8 (4.2:1.5)
and the combined premolars’ buccal alveolar crest distances (PM2, times more arch expansion than the Conventional system, (p=0.01)
(Table 8). For the maxillary dentition in the Damon group the ratio of
p=0.01; PMs, p=0.005) versus greater change in the lingual alveolar
crown to root movement was 3.2:1, while in the Conventional group the
crest distances (ILACD) in the maxilla of the Conventional treated
ratio was 1:0.7, (p=0.01) (Table 9). For the mandibular dentition, the
cases (p=0.05). The only significant difference in the measured distances
apical distances increased more in the Conventional system as opposed
for the first molars was an increase in the lingual plates of bone in the
to the Damon system in all teeth, but significantly more in the cuspids
Conventional cases (p=0.05) (Table 4).
and molars. The ratio of crown to root movement for the Damon group
Mandible: The Damon cases exhibited a significantly greater was 5.9:1 versus 2.6:1 in the Conventional group, (p=0.01) (Table 10).
increase in inter-occlusal arch dimension for the premolars when
measured individually (PM1, p=0.025; PM2, p=0.05) and when the Discussion
measurements were combined (PMs, p=0.005), and for the first molars When a claim is made about the effects of one mechanics system as a
(p=0.025). The increase in inter-central fossa of the first molars was way of promoting that system over another, then it becomes necessary to
also significantly greater in the Damon group (p=0.005). There was compare the effects of the two systems. If the Damon system is purported
also a significantly greater change in the overall inter-occlusal arch to promote ‘arch development’ in a different or more effective way than
width changes during treatment in the Damon cases as opposed to the the Conventional system, then it is important to analyze the differences
Conventional cases (p=0.001). The only significant change between the between the two systems. If both the Conventional and Damon system
two treatments in the inter-apical dimension was between the cuspids, resolve crowding by virtue of the same biologic mechanism, then one
with a greater increase for the Conventional cases (p=0.025); however, cannot claim superiority. If however, some important differences
the second premolar and first molar approached significance. The exist, then those differences need to be quantified so that informed
second premolar in the Damon treated group had the greater change, decision-making can be made regarding treatment options. The two

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ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 7 of 10

Damon Conventional (Mean p

Tooth Measurement N t
(Mean ± SD) ± SD) (1-tailed)
IOD1 10 (5,5) 2.5 ± 1.6 0.5 ± 2.2 1.611 0.10
IAD2 10 (5,5) -0.5 ± 1.5 0.5 ± 2.2 0.843 0.40
IBACD3 10 (5,5) -1.1 ± 2.5 -2.6 ± 1.7 1.088 0.25
K9 ILACD4 10 (5,5) 1.1 ± 1.3 1.2 ± 2.0 0.021 0.99
R/L-angle5 20 (10,10) 3.5 ± 16.4˚ 3.3 ± 8.2˚ 0.029 0.99
IOD 10 (5,5) 3.5 ± 2.1 2.0 ± 1.2 1.352 0.25
IAD 10 (5,5) -0.8 ± 1.9 3.3 ± 2.8 2.667 0.025*
IBACD 10 (5,5) 2.8 ± 3.2 0.8 ± 1.5 1.298 0.25
PM1 ILACD 10 (5,5) 2.3 ± 2.7 1.0 ± 1.2 0.990 0.25
R/L-angle 20 (10,10) 3.0 ± 10.8˚ -3.5 ± 12.1˚ 1.253 0.25
IOD 10 (5,5) 2.3 ± 1.6 1.2 ± 2.4 0.833 0.25
IAD 10 (5,5) -0.69 ± 1.1 1.1 ± 1.4 2.199 0.05*
PM2 IBACD 10 (5,5) 1.9 ± 2.9 0.1 ± 0.5 3.308 0.01*
ILACD 10 (5,5) 1.3 ± 1.3 1.0 ± 1.3 0.331 0.40
R/L-angle 20 (10,10) 1.7 ± 12.4˚ -0.1 ± 12.5˚ 0.320 0.40
IOD 10 (5,5) 0.6 ± 1.0 0.23 ± 1.3 0.548 0.40
ICF 10 (5,5) 1.2 ± 0.8 0.2 ± 1.4 1.455 0.10
IAD 10 (5,5) -1.9 ± 3.9 -1.6 ± 4.1 0.126 0.25
IBACD 10 (5,5) 0.1 ± 1.4 -0.2 ± 2.0 0.285 0.40
M1
ILACD 10 (5,5) -1.5 ± 2.2 0.7 ± 1.3 1.914 0.05*
R/L-angle 20 (10,10) 2.3 ± 6.6˚ 3.5 ± 5.4˚ 0.442 0.40
IOD 20 (10,10) 2.9 ± 1.9 1.6 ± 1.8 1.530 0.10
IAD 20 (10,10) -0.7 ± 1.5 2.2 ± 2.4 3.272 0.005*
IBACD 20 (10,10) 2.9 ± 2.5 0.4 ± 1.1 2.878 0.005*
PM1 & PM2 ILACD 20 (10,10) 0.3 ± 1.92 2.1 ± 2.4 1.967 0.05*
R/L-angle 40 (20,20) 2.3 ± 11.4˚ -1.8 ± 12.1˚ 1.107 0.25
All Teeth IOD 40 (20,20) 2.2 ± 1.8 1.0 ± 1.8 2.107 0.025*
Arch Length6 10 (5,5) 1.7 ± 1.6 1.2 ± 2.3 0.408 0.40
*indicates statistical significance; 1indicates dental arch width; interocclusal cusp tip to cusp tip; 2indicates dental arch width; interapical, root tip to root tip; 3indicates
skeletal arch width; buccal crest to buccal crest; 4indicates skeletal arch width; lingual crest to lingual crest; 5indicates the angle between cusp tip and nasal floor; 6indicates
arch length.
Table 4: Comparison of the combined maxillary arch changes (final-initial) in mm or degrees between the Damon versus conventional systems.

Damon Conventional (Mean p

Tooth Measurement N t
(Mean ± SD) ± SD) (1-tailed)
IOD1 11 (6,5) 5.1 ± 4.5 3.0 ± 2.3 0.934 0.25
IAD2 11 (6,5) 0.4 ± 1.8 2.6 ± 1.3 2.306 0.025*
IBACD3 11 (6,5) -0.8 ± 2.7 -2.5 ± 4.2 0.841 0.25
K9 ILACD4 11 (6,5) 0.3 ± 1.8 2.0 ± 0.8 1.864 0.05*
R/L-angle5 22 (12,10) 0.4 ± 9.9 4.9 ± 10.4 1.043 0.25
IOD 11 (6,5) 5.4 ± 2.6 0.6 ± 4.2 2.335 0.025*
IAD 11 (6,5) -1.2 ± 1.9 -0.5 ± 1.5 0.624 0.40
IBACD 11 (6,5) 0.4 ± 2.0 0.6 ± 0.9 0.178 0.10
PM1 ILACD 11 (6,5) 2.0 ± 1.4 0.3 ± 1.3 2.076 0.05*
R/L-angle 22 (12,10) 6.1 ± 10.0 4.5 ± 8.5 0.424 0.40
IOD 11 (6,5) 3.7 ± 2.3 1.5 ± 1.0 1.998 0.05*
IAD 11 (6,5) 0.9 ± 1.5 -0.2 ± 1.1 1.410 0.10
IBACD 11 (6,5) 2.3 ± 1.5 1.3 ± 1.8 1.022 0.25
PM2 ILACD 11 (6,5) 2.1 ± 1.3 -0.5 ± 1.0 3.640 0.005*
R/L-angle 22 (12,10) 6.1 ± 9.5 0.5 ± 10.0 1.348 0.10
IOD 11 (6,5) 2.6 ± 1.4 0.7 ± 0.7 2.745 0.025*
ICF 11 (6,5) 2.8 ± 1.1 0.4 ± 0.8 3.921 0.005*
IAD 11 (6,5) -1.1 ± 3.1 1.5 ± 2.2 1.533 0.10
IBACD 11 (6,5) 1.5 ± 0.9 0.6 ± 1.7 1.021 0.25
M1 ILACD 11 (6,5) 1.5 ± 1.1 -0.1 ± 0.4 2.918 .0.01*
R/L-angle 22 (12,10) 5.9 ± 5.7 4.3 ± 6.2 0.634 0.40
IOD 22 (12,10) 4.5 ± 2.4 1.0 ± 2.9 3.012 0.005*
IAD 22 (12,10) -0.1 ± 1.9 -0.4 ± 1.2 0.314 0.40
IBACD 22 (12,10) 1.4 ± 2.0 0.9 ± 1.4 0.560 0.40
PM1 & PM2 ILACD 22 (12,10) 2.0 ± 1.3 -0.1 ± 1.2 4.065 0.001*
R/L-angle 44 (24,20) 6.2 ± 9.5 2.5 ± 9.3 1.282 0.25
All Teeth IOD 44 (24,20) 4.2 ± 2.9 1.5 ± 2.5 3.270 0.001*
Arch Length6 11 (6,5) 0.7 ± 0.9 0.3 ± 4.8 0.176 0.99
*indicates statistical significance; 1indicates dental arch width; interocclusal cusp tip to cusp tip; 2indicates dental arch width; interapical, root tip to root tip; 3indicates
skeletal arch width; buccal crest to buccal crest; 4indicates skeletal arch width; lingual crest to lingual crest; 5indicates the angle between cusp tip and nasal floor; 6indicates
arch length.
Table 5: Comparison of the combined mandibular arch changes (final-initial) in mm or degrees between the Damon versus conventional systems.

Dentistry Voume 5 • Issue 10 • 1000336

ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 8 of 10

IOD (Dental arch width) for combined arches

View (Mean ± SD)
Tooth N F p-value
Sectional Volume 3D
K9 126 (42, 42, 42) 29.5 ± 5.8 30.8 ± 5.2 30.2 ± 6.1 0.607 0.547
Maxilla & Mandible
PM2 126 (42, 42, 42) 39.1 ± 8.9 39.4 ± 9.3 39.2 ± 8.9 0.013 0.987
M1 126 (42, 42, 42) 44.3 ± 10.5 44.3 ± 10.7 44.2 ± 10.3 0.001 0.999
Table 6: ANOVA comparison of inter-occlusal arch width measurements (mm) via the sectional, volume and 3D views of CBCT for combined maxilla and mandible.

IOD (Dental arch width) for Maxilla and Mandible

View (Mean ± SD)
Tooth N F p-value
Sectional Volume 3D
K9 60 (20, 20, 20) 34.4 ± 3.3 35.5 ± 2.6 35.0 ± 2.9 0.651 0.525
Maxilla
PM1 60 (20, 20, 20) 42.4 ± 2.96 43.3 ± 2.8 42.6 ± 3.1 0.553 0.578
PM2 60 (20, 20, 20) 47.7 ± 3.09 48.5 ± 3.0 47.3 ± 3.1 0.792 0.458
M1 60 (20, 20, 20) 54.7 ± 3.4 54.9 ± 3.3 54.4 ± 2.8 0.792 0.908
K9 66 (22, 22, 22) 24.98 ± 3.3 26.6 ± 2.97 25.8 ± 3.7 1.103 0.338
PM2 66 (22, 22, 22) 31.2 ± 3.4 31.1 ± 3.4 31.3 ± 3.2 0.024 0.976
Mandible
M1 66 (22, 22, 22) 34.9 ± 3.4 34.7 ± 3.5 34.9 ± 3.3 0.019 0.981
Table 7: ANOVA comparison of inter-occlusal arch width measurements (mm) via the sectional, volume and 3D views of CBCT for separate maxilla and mandible.

Overall Arch Expansion

Damon Conventional p-value
Maxilla 2.2 1.0 0.05*
Mandible 4.2 1.5 0.01*
*indicates a statistical significance
Table 8: Comparison of overall arch expansion (mm) during treatment in the Damon and conventional treated cases.

Damon Conventional
Teeth p-value
IOD1 IAD2 IOD/IAD3 IOD IAD IOD/IAD
K9 2.5 -0.5 5 0.5 0.5 1
PM1 3.5 -0.8 4.3 2 2.3 0.6
PM2 2.3 -0.69 3.3 1.2 1.1 1.09
M1 0.6 -1.9 0.3 0.23 -1.6 0.14
Total 12.9 2.83
Total/4 tooth types 3.2/1 1/0.7 0.01*
*Indicates statistical significance; 1indicates dental arch width, interocclusal, cusp tip to cusp tip; 2indicates dental arch width, interapical, root tip to root tip; 3indicates the
ratio between movement of the cusps versus the roots
Table 9: Ratio of maxillary changes in crown to root movement (mm).

Damon Conventional
Teeth p-value
IOD1 IAD2 IOD/IAD3 IOD IAD IOD/IAD
K9 5.1 0.4 12.75 3.0 2.6 1.15
PM1 5.4 -1.2 4.5 0.6 -0.5 1.2
PM2 3.7 0.9 4.1 1.5 -0.2 7.5
M1 2.6 -1.1 2.36 0.7 1.5 0.46
Total 23.7 10.31
Total/4 tooth types 5.9/1 2.6/1 0.01*
*Indicates statistical significance; 1indicates dental arch width, interocclusal, cusp tip to cusp tip; 2indicates dental arch width, interapical, root tip to root tip; 3indicates the
ratio between movement of the cusps versus the roots
Table 10: Ratio of mandibular changes in crown to root movement (mm).

systems in this study were evaluated individually, and then changes utilizing both treatment modalities resulted in inter-occlusal expansion
during treatment were compared. As a pilot study, the sample size is in both arches. These increases were statistically and clinically
too small to draw specific and definite conclusions; however, the study significant in almost all measurements of maxilla and mandible for
is still capable of indicating a pattern of development between the two the Damon treated cases. For the maxilla in these cases, the significant
systems, and therefore has the potential to study these systems in a changes range from the smallest at M1-ICF (1.2 mm) to the greatest
larger scale. Additionally, when both bracket and wire systems differ change at PM1 (3.5 mm). For the mandible, the significant increases
during treatment as do the Damon and Conventional appliances, ranged from the smallest for M1 (2.6 mm) to the largest at PM1 (5.4
the comparison of effects for both systems may be compounded and mm). One would expect similar changes in the IOD and ICF when
difficult to interpret, yet a clinical relationship may be observed. measuring the first molar width. This was not the case in M1-IOD
The results of this study show that non-extraction treatment, of the maxilla in the Damon group: the M1-IOD increase of 0.6 mm

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ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 9 of 10

was not statistically significant, while M1-ICF increase of 1.2 mm was (maxilla: 1.7 mm, mandible: 0.7 mm) groups with changes in the
significant. This could be due to measurement error; however this also maxilla of the Damon group approaching significance. The study
could have resulted from the buccolingual tip of the molars. This can be therefore, does not support the claim that in Damon treated cases
further explained by the decrease in the M1-IAD (1.9 mm), while there there is less tipping of the incisors as compared to Conventional cases
was an increase in occlusal arch width. [13,14,22].

For the Conventional treated cases, only the occlusal arch width The results of this study indicate that in the maxilla there was no
increase in the maxillary PM1 and the mandibular K9 and PM2 statistically significant difference between the treatment groups in
proved to be significant with the mandibular M1 increase approaching arch width (IOD) for the teeth measured individually; however, when
significance. For the maxilla, these measurements were narrowest, but looked at as a group, the statistical analysis showed significantly larger
non-significant at the canine (0.5 mm) and widest at the first premolar differences in the Damon cases when compared to the Conventional
(2.0 mm). In the mandible, the least amount of expansion occurred at cases for the combined change in arch width for both arches. This
the first molar when measured at the central fossa (0.4 mm), followed indicated significantly greater overall arch expansion in the Damon
by the PM1 (0.6 mm), and was largest at the canine (3.0 mm). These group during treatment both in the maxilla and in the mandible. In
findings are in agreement with those of Gianelly who found increases the mandible, there was a significantly greater increase in the occlusal
in inter-premolar and intra-molar widths of non-extraction cases arch dimension for premolars both when measured individually and
ranging from 0.81-2.10 mm [6]. The Gianelly study measured arch when the values were combined. This was also true for the molars. The
widths from cusp tips of the canines, premolars, and molars on dental premolar inter-apical distances, however, increased significantly more
casts of randomly selected extraction and non-extraction cases [6]. As in the maxilla of the Conventional cases as opposed to the Damon cases,
a result, the root positions were not measured and therefore evaluation whether they were looked at individually or combined as a group. This
of expansion due to tipping or bodily movement of the respective teeth indicated that there was more bodily movement of the premolars in the
could not be determined. Weinberg and Sadowsky in their examination maxilla of the Conventional cases. For the mandible, neither treatment
of multimodality non-extraction treatment found that expansion was category displayed this result.
greatest at the second premolars (1.8 mm) and least at the canines (0.9 In the mandible of the Conventional cases, there were no significant
mm) [8]. The present study indicates the greatest expansion was at changes in the lingual plates of bone. The only significant increase was
PM1. In the lower arch of the Conventional cases however, the greatest in the buccal plate of the first premolars. In the maxilla, there were
increase was in the K9, followed by PM2, while the least expansion in significant increases in the lingual plates of first and second premolars
both the Conventional and Damon cases were in the M1 areas of both and molars, but no significant increases in the buccal plates. No specific
arches. pattern was observed. For the Damon cases, all lingual plates increased
In order to differentiate increases in arch width due to bodily significantly, which was not so for the buccal plates. In the maxilla,
versus tipping movements, evaluation of apical displacement must be there was no significant change in ther lingual plates, but significant
made. Mah et al. has indicated that CBCTs are of great value in this changes in the buccal plates for the second premolars and combined
regard [18]. The results of the inter-apical distance changes from initial premolars. This does not support the Damon claim that “as the arch is
to final treatment indicated that Damon cases resulted in decreased developed”, the buccal and lingual bones are carried with it.
IAD for all measured teeth in the maxilla (from -1.9 mm at M1 to 0.05 The mixed results in the mandible as opposed to the maxilla can be
mm at K9), with mixed results in the mandible (from -1.2 mm at PM1 due to the inherent differences in the bone morphology and physiology
to 0.9 mm at PM2). None of these changes were significant. For the between the respective jaws. The results of the IBACD and ILACD
Damon group, since the inter-apical distances decreased or remained might also be explained by volume averaging. Since these areas are the
stationery and the inter-occlusal measurements increased, the arch contact points between teeth and alveolar bone, the CBCT machines
width increase in the maxilla and mandible occurred with a tipping may not be able to distinguish these points as clearly as one would
movement and not translation. This is due to differences in occlusal expect. This can result in a misreading of data, and why the Damon
displacement of the involved teeth moving laterally, with no change or assertion is not supported. Additionally, since the resolution of CBCT
a slight decrease in the corresponding intra-apical areas. Conversely, at 0.2 mm voxel, less than 1 mm of bone may not be seen [23]; therefore
all inter-apical distances in the maxilla of Conventional cases increased to distinguish bone remodeling of either the buccal or lingual plates,
slightly (from 0.5 mm at K9 to 3.3 mm at PM1) with the exception of actual changes in these areas with the Damon or Conventional systems
a slight decrease (-1.6 mm) in the M1-IAD. There were mixed results may be inaccurately measured.
in the mandible however, with the greatest decrease at PM1 (0.5 mm)
and the greatest increase at the K9 (2.6 mm). The only significant To better understand the mode with which teeth moved during arch
change for the inter-apical distance was an increase in the mandibular expansion, the ratios of overall arch expansion between the Damon
canine of the Conventional group. An examination of the crown and and Conventional group were examined. To see the manner in which
root movements indicated that for the Conventional treatment in the teeth moved, the ratios of crown versus root movement were studied.
maxilla and mandible, there were bodily movements for the maxillary Arch expansion at the crown level for the Damon group in the maxilla
PM1 and mandibular K9. The mandibular PM2 and M1, on the other was 2.2 times greater, while approximately three times greater in the
hand had significantly more IOD expansion than IAD, indicating mandible when compared to the Conventional system. This inter-
tipping of these teeth. The movement in the remaining teeth did not occlusal arch expansion however, is via bucco-lingual tipping of the
have significant IAD/IOD changes, indicating a mixture of changes teeth and not bodily movement, with the crowns in the Damon group
with no specific pattern of tipping or bodily movement, whereas in the moving three times as much as their apices. Although arch expansion
Damon cases expansion occurred via tipping of the crowns of the teeth. was greater in the Damon treated cases as opposed to the Conventional
cases, this was at the expense of greater tipping.
Arch length in the maxilla and mandible increased for both the
Conventional (maxilla: 1.2 mm, mandible: 0.3 mm) and Damon No significant differences in arch length was observed between
the groups, yet overall arch length increased for both groups; the

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ISSN: 2161-1122 Dentistry, an open access journal
Citation: Askari M, Williams R, Romberg E, Stone M, Alexander SA (2015) CBCT Assessment of Dental and Skeletal Changes Using the Damon
versus Conventional (MBT) System. Dentistry 5: 336. doi:10.4172/2161-1122.1000336

Page 10 of 10

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the views. 13. Damon DH (1998) The Damon low friction bracket: a biologically compatible
straight wire system. J Clin Orthod 32: 670-680.
Conclusions 14. Damon DH (1998) The rationale, evolution and clinical application of self-
With the results of the study we can conclude that arch length in ligating bracket. Clin Ortho Res 1: 52-61.

the maxilla and mandible increased for both the Conventional and 15. Peck S (2008) What’s new? Arch expansion again. Angle Orthod 78: 574-575.
Damon groups, but without statistical differences between the groups. 16. Vajaria R, BeGole E, Kusnoto B, Galang MT, Obrez A (2011) Evaluation of
Both the treatment groups exhibited arch width expansion in both incisor and dental transverse dimension changes using the Damon system.
maxilla and mandible, with the Damon group significantly greater than Angle Orthod 81: 647-652.
the Conventional group. Arch expansion was statistically and clinically 17. Pandis N, Polychronopoulou A, Eliades T (2007) Self-ligating vs. conventional
significant in the majority of maxillary and mandibular measurements brackets in the treatment of mandibular crowding: a prospective clinical trial of
for the Damon group while the Conventional group only showed a treatment duration and dental effects. Am J Orthod Dentofacial Orthop 132:
208-215.
statistically significant difference during treatment for the maxillary
PM1 and mandibular K9 and PM2. The greatest expansion achieved 18. Mah JK, Huang JC, Choo HR (2010) Practical applications of cone-beam
computed tomography in orthodontics. J Am Dent Assoc 141: 7S-13S.
was at the PM1 site in both treatment groups. The ratio of the crown
to root movement for the Conventional group in the maxilla was 19. Hernandez-Soler V, Enciso R, Cisneros GJ (2011) The virtual patient specific-
model and the virtual dental model. Sem Orthod 17: 46-48.
approximately 1:1, versus 3:1 for the Damon group. The ratio of the
crown to root movement for the Conventional group in the mandible 20. Dahlberg G (1940) Statistical methods for medical and biological students.
was 3.6:1, versus 6:1 in the Damon group. No statistically significant Interscience Publications, New York.
difference was observed between the three different views in CBCT, 21. Damstra J, Fourie Z, Huddleston Slater JJR, Ren Y (2011) Reliability and the
therefore the coordination of an image in all three planes of space may smallest detectable difference of measurements on 3-dimensional cone- beam
computed tomography images. Am J Orthod Dentofac Orthop 140: e107-e114.
not be necessary for simple measurements.
22. Damon DH (2005) Treatment of the face with biocompatible orthodontics.
Acknowledgement Graber LW, Vanarsdall RL Jr, Vig KWL (eds). In: Orthodontics: Current
We gratefully acknowledge the cases provided by Dr. David Paquette, Dr. Ty Principles and Techniques. (4th edn), Elsevier Mosby, St. Louis.
Saini, and Dr. Raj Saini for use in this study and Dr. Dov Elman and Dr. Jeffrey 23. Patcas R, Müller L, Ullrich O, Peltomäki T (2012) Accuracy of cone-beam
Gardyn, 3rd year dental students who participated in data measurement at the computed tomography at different resolutions assessed on the bony covering
University of Maryland, Maryland, United States. of the mandibular anterior teeth. Am J Orthod Dentofac Orthop 141: 41-50.
References
1. Berkovitz BKB, Holland GR, Moxham BJ (1984) A Colour Atlas and Textbook
of Oral Anatomy. Wolfe, London.

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