By Prof Dr Sukhia
Over the years, lots of orthodontic appliances have come and become popular, and with time, they have faded away in the history books of orthodontics. One of the appliances is the Tip edge appliance. Although still widely used and religiously practiced in some parts of the world, the tip-edge risks loosing its popularity and use in the face of recent, more easier and attractive fixed appliance systems. Not widely used in Pakistan at all, the concept of the tip-edge is good and clear. However, practically the same occlusal result can be attained by an experienced orthodontist with a simpler and yet low-cost appliance.
What is the Tip-Edge
Fixed orthodontic appliance was developed by P. C. Kesling as a combination of the Begg and the straight-wire appliance (marketed by TP Orthodontics). It balances the best concepts of both the systems into one bracket. The appliance consists of specially designed brackets with modified slots that have the shape of an asymmetric bowtie. The brackets are bulky and special bio-mechanic instructions should be followed to handle the end-results.
Action of the Tip-Edge
The brackets are equipped with auxiliary vertical slots that can receive a variety of auxiliaries, including rotation springs, uprighting springs, power pins and position indicators to facilitate bonding. The shape of the main slots allows tipping of the teeth during space closure (a basic principle of the Begg technique). After space closure the angulation of the teeth is idealized by uprighting springs (side-winders). When a rectangular archwire is used during this uprighting process, the beveling and the dimensions of the modified, fully programmed slot permit gradual expression of the torque to simultaneously control tooth inclination.
The Tip-Edge bracket suffers from two modern day problems. Firstly it is bulky with lots of complaints regarding esthetics and intra-oral trauma. Secondly, the system is expensive and not widely available. So, in order to have them, you have to specifically order them from abroad in Pakistan. This increases the overall cost of the appliance. Plus debonding risks in patients may increase the cost three-folds. Orthodontists and, in general, the dental practitioners all over the world, and in Pakistan, have always relied on easier, faster, low-cost and result-producing braces systems. With new latest and well-known marketed fixed braces systems such as Roth and MBT straight-wire techniques, the tip-edge is also very soon destined for the history books of orthodontics. by casual, nonsexual contact is likely to be unusual.” The researchers explain:
“Our results have important research as well as public health implications. Natural history studies of cervical HPV infection were essential for the development of public health interventions, such as HPV vaccination to prevent and HPV detection to screen for cervical cancer. Natural history studies of oral HPV infection are therefore necessary to understand the effects of age, sex, and modifiable risk factors (e.g., smoking and sexual behavior) on the incidence and duration of oral HPV infection.”
“…vaccine efficacy against oral HPV infection is unknown, and therefore vaccination cannot currently be recommended for the primary prevention of oropharyngeal cancer. Given an analysis of U.S. cancer registry data recently projected that the number of HPV-positive oropharyngeal cancers diagnosed each year will surpass that of invasive cervical cancers by the year 2020, perhaps such vaccine trials are warranted. Such trials could inform ongoing discussions regarding the benefits of HPV vaccination for males, given the higher prevalence of oral HPV infection demonstrated here as well as higher incidence of HPV-positive OSCC among men.”
In an associated report, Hans P. Schlecht, M.D., M.M.Sc., of the Drexel University College of Medicine, Philadelphia, explains:
“Future research will need to identify the natural history of HPV-related oropharyngeal dysplastic lesions and evaluate potential screening methods to detect oropharyngeal dysplasia prior to invasion. Successful screening measures such as a Papanicolaou test, HPV polymerase chain reaction testing, or both may be daunting to achieve, but there is meaningful hope that prevention efforts will ameliorate the effects of HPV-related oropharyngeal cancer.”