The incidence of maxillary canine impaction is estimated at approximately 1.7% of the population and is multifactorial in etiology. Several case reports suggest a potential relationship between canine impaction and root dilaceration of the adjacent premolar, indicating mechanical interference due to their proximity. In such cases, when avoiding tooth extractions is desired, it is crucial to consider specific clinical approaches to prevent contact with the dilacerated root during traction. This case report describes traction of an impacted maxillary canine in a female patient resulting from severe palatal root dilaceration of the adjacent first premolar. The canine was surgically exposed and traction was initiated after endodontic therapy and root sectioning of the affected premolar. After 24 months of orthodontic treatment, the results were satisfactory, with adequate gingival contour, 2 mm overjet and overbite, and a Class I relationship of canines and molars. No apparent root resorption was observed, and bone structure was preserved. A multidisciplinary approach is fundamental for the success of treatment in such cases, enabling achievement of a functionally and esthetically stable occlusion while avoiding tooth extractions.ABSTRACT
To compare the effect of three different maxillary retainers: round multi-strand stainless steel (SS), rectangular white gold-plated SS, and vacuum-formed (VF) retainers on treatment stability, retainer integrity, and gingival health over 12 months. Seventy subjects who finished fixed orthodontic treatment and required orthodontic retainers in the upper arch were randomly divided into three groups. The first group (mean age: 21.0 years) received bonded three multi-strand round (0.0175-inch) SS retainer, the second group (mean age: 20.4 years) received bonded rectangular (0.038 × 0.016-inch) white gold-plated SS retainer, the third group (mean age: 20.0 years) received removable VF retainer. Bonded retainers were extended from lateral to lateral incisor while VF retainer was extended to the most distal molar. After 1 year, all subjects were recalled. The primary outcome was to assess relapse in upper labial segment alignment. The secondary outcome was to evaluate the plaque index (PI) and gingival index (GI) of the upper labial segment teeth and retainer failure rate. There was no statistical difference in the average irregularity index (IRI), PI, and GI among the three groups (P = .667, P = .781, P = .487, respectively). Retainer failure rate was significantly higher in Group III (60.9%) compared to Group I (20.8%) and Group II (34.8%, P = .017). After 1 year, anterior tooth alignment stability and gingival health parameters were not different between bonded and VF retainers. However, the VF retainer exhibited a higher failure rate compared to bonded retainers.ABSTRACT
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To investigate the effects of buccal osteotomy angulation on surgically assisted rapid palatal expansion (SARPE) patterns. A finite element analysis (FEA) model of the maxilla with Haas expander was constructed from a cone beam computed tomography (CBCT) image using Mimics, Geomagic, and solidWorks software. One-mm-thick buccal osteotomies were created with different combinations of 0°, 10°, 20°, and 30° from the horizontal plane to simulate differences in bilateral osteotomy angulation. Springs were placed at the buccal osteotomy gaps to mimic the strain of the bone callus. After applying 150 Newton of expansion force at the level of the expander jackscrew in each FEA scenario, the expansion pattern of the hemimaxillae was evaluated in Ansys software. Scenarios with 20° (0–20°; 10–30°) and 30° (0–30°) differences resulted in significant transverse asymmetric expansion. Among the groups with 10° difference, 0–10° resulted in relatively parallel expansion, while 10–20° and 20–30° experienced V-shaped expansion with more anterior widening. A larger difference between the angulations of the left and right buccal osteotomies resulted in increased asymmetry in both the transverse and vertical dimensions after expansion.Objectives
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Evaluate the changes in oral microbiota linked to orthodontic treatment by analyzing the 16S rRNA gene. A total of 22 articles was included in the systematic review. The methodological quality of these studies was assessed using the Newcastle-Ottawa Scale for nonrandomized studies and the Risk of Bias tool for randomized studies. Orthodontic appliances significantly influenced the composition of oral microbiota. Specifically, fixed orthodontic appliances were linked to an increase in periodontopathogenic bacteria associated with various systemic diseases. In contrast, transparent aligners correlated with an increase in Streptococcus species. In this study, we evaluated the changes in oral microbiota associated with orthodontic treatment by analyzing the 16S rRNA gene. Results revealed significant alterations in oral microbiota following orthodontic treatment; however, significant variability among studies prevents firm conclusions. Additional research is essential to clarify the effects on oral health.ABSTRACT
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To compare the efficacy of clear aligners and Z-spring (ZS) appliances in treating dental anterior crossbite (AC) during the mixed dentition period. Thirty patients (7–12 years) with Angle Class I occlusion and isolated pseudo-Class III AC were randomly assigned to clear aligners (Group A, n = 15) or ZS appliances (Group B, n = 15). Outcomes were evaluated based on duration, cephalometric changes, model analysis, and oral health-related quality of life (OHRQoL), assessed using the Child Oral Health Impact Profile-Short Form-19 (COHIP-SF-19). AC was successfully corrected in all patients. Treatment duration was significantly shorter in Group B (48.4 ± 27 days) than in Group A (96.3 ± 22.7 days) (P < .05). U1–NA angle increased by 5.9° and overjet by 4 mm in Group A; in Group B, U1–NA increased by 7.7° and overjet by 4.2 mm (P < .01). Intergroup cephalometric changes (ΔT1–T0) were not significant (P > .05). In Group A, incisal and gingival arch depths increased significantly (2.6 mm and 1.17 mm, respectively; P < .001), whereas no significant changes occurred in Group B (P > .05). COHIP-SF-19 scores were comparable (P > .05). Clear aligners and ZS appliances were effective in treating dental AC, achieving normal overjet relationships. However, ZS appliances may cause greater tipping, whereas clear aligners facilitate tipping, alignment, and bodily movement. Treatments demonstrated comparable effects on OHRQoL of children. This study provides a foundation for future research on different appliances for managing AC in the mixed dentition.ABSTRACT
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To compare the bracket positioning accuracy of a traditional and an artificial intelligence (AI)-assisted digital indirect bonding (IDB) method to explore the current usefulness of AI for optimizing orthodontic bracket positioning. Twenty-five clinicians positioned brackets using traditional and AI-assisted digital IDB methods. Bracket positioning differences were quantified using digital superimposition of bracket setups and compared with an optimal setup. A total of 1800 bracket positioning differences were evaluated. One-tailed t-tests were used to determine whether these differences were within limits of 0.5 mm in mesial-distal and occlusal-gingival dimensions and within 2° for tip. Overall mean bracket position differences between the traditional and digital setups were 0.28 mm for mesial-distal placement and 0.32 mm for occlusal-gingival placement; both were significantly below the 0.5-mm limit. In contrast, differences in tip were 3.4°, which was significantly greater than the 2° limit. Comparisons with an optimal setup showed overall statistically significant differences in mean bracket positioning for tip but not for the mesial-distal or occlusal-gingival measurements for both the traditional and AI-assisted digital IDB methods. However, the digital method was more accurate for bracket tip. Bracket positioning is consistent and highly accurate in linear dimensions with both traditional and digital IDB methods; however, AI may be useful for improving accuracy of bracket angulation. Clinicians who currently use traditional IDB methods may adopt AI-assisted digital IDB without compromising bracket positioning accuracy.ABSTRACT
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Influence of social media on the choice of orthodontist and different types of orthodontic treatment
To evaluate, from the perspective of patients, the influence of social media (SM) on the choice of orthodontist and the acceptance of orthodontic treatment (OT) proposed by a professional. This cross-sectional study was conducted using an online questionnaire that contained 17 items distributed across four sections. Individuals older than 18 years, who were treated or sought OT, and who had SM accounts were included. Data were collected via Google Forms using the snowball technique and subsequently analyzed using the Mann-Whitney U-test. Effect size (ES) was calculated (small, moderate, or large). Of the 206 participants, 148 were women (71.8%), and 58 were men (28.2%), with a mean age of 37.3 ± 15.0 years. The most used SM applications were WhatsApp (95.1%), Instagram (92.2%), YouTube (56.8%), and Facebook (30.1%). Women respondents 36 years old or younger who were single and had no higher education showed a significant difference in choosing a professional and accepting OT on all questionnaire items (P < 0.001). Among SM platforms, Instagram was the one used most often to choose a professional and OT modality as well as considered important for revealing the professional’s academic training. By contrast, WhatsApp was the least used for before-and-after posts, while YouTube was seldom used to evaluate posted comments. For variables with significant differences, the ES ranged from moderate to large. SM, especially Instagram, can influence decision-making when choosing an orthodontist and accepting the recommendations for OT proposed by a professional.ABSTRACT
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The aim of this study was to evaluate the effect of aging and mechanical brushing on the color stability and translucency of three-dimensionally (3D) printed and thermoformed transparent aligners (clear aligners [CAs]) of different thicknesses. Three types of CAs (Dentsply Sirona Essix [Group 1], Scheu-Dental Thermoforming Foils [Group 2], and 3D-printed Nexdent [Group 3]) in two thicknesses (0.75 mm and 1.0 mm) were used. Each group was divided into cleaned and noncleaned subgroups (n = 10). Samples were aged in artificial saliva and subjected to mechanical brushing. Color differences (ΔE00) and relative translucency parameter values (RTP00) were recorded at 1-week intervals over 4 weeks. Statistical analyses included generalized linear models and repeated measures analyses of variance (ANOVAs) for normally distributed parameters, and robust ANOVAs and Friedman tests for nonnormally distributed parameters (P < .05). Group 1 had the highest mean RTP00 values, while Group 3 had the lowest mean RTP00 values. Noncleaned CAs exhibited higher RTP00 values than cleaned CAs (P < .05). RTP00 values decreased significantly over time, with Group 3 showing notable differences between cleaned and noncleaned subgroups. Thinner materials (0.75 mm) displayed greater color changes than thicker ones (1 mm). 3D-printed CAs demonstrated more significant color variation and less translucency in comparison to thermoformed CAs. Regular cleaning helps maintain translucency and color stability, but the choice of aligner material is crucial.ABSTRACT
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To examine the relation of maxillary permanent central incisor rotation with the primary palatal margin (PPM) and overjet in the mixed dentition in complete unilateral cleft lip and palate (cUCLP). Dental casts and preorthodontic records taken before alveolar bone grafting were examined to exclude patients having permanent teeth distal to the cleft side maxillary central incisor (CS1) and mesial to the cleft. Maxillary central incisor rotation, the angle between PPM and midline, proximity of the lingual surface of the central incisor to PPM, and overjet were measured from standardized occlusal photographs of the dental casts of 54 children with repaired cUCLP (38 M, 16 F; aged 8.7 ± 1.0 years). Descriptive analysis and correlation statistics were performed. Rotations were noted in 92.6% of the CS1. Their magnitude (111.2 ± 24.2°) was significantly greater than the noncleft side maxillary central incisor (NCS1) rotations (76.7 ± 15.7°). Rotations were predominantly distolabial for the CS1 and distopalatal for the NCS1. The PPM was located within 2 mm of the lingual surface of the CS1 in 35.2% of the sample. Severe CS1 rotation existed in 48.2% of the sample and was significantly correlated with the PPM angle (r = 0.3; P = .046) and when its proximity to the PPM was within 2 mm (φ = 0.3; P = .028). Overjet was not significantly correlated with the magnitude of rotation. The angle between PPM and the midline and its proximity to CS1 are associated with the severity of CS1 rotation in repaired cUCLP. Orthodontic implications are discussed.ABSTRACT
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To evaluate the effectiveness and accuracy of clear aligners (CA) in maxillary molar distalization and rotation for nonextraction Class II correction in the permanent dentition. This systematic review of the literature (2015–2024) followed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies included orthodontic patients in the permanent dentition with dental Class II, mild or no skeletal discrepancies, 2–6 mm crowding, treated with CA without extractions (except maxillary third molars) or adjunctive therapies beyond Class II elastics. Data focused on maxillary molar distalization, rotation, accuracy, and complications. Risk of bias was assessed using ROBIN-I, with evidence level graded per the SBU protocol. Sixteen studies were categorized into Group A (initial aligner or distalization outcomes) and Group B (including refinements). Group B reported greater accuracy and distalization due to sequential distalization protocols, Class II elastics, and refinements. After refinements, CA achieved 1.84–2.98 mm of maxillary molar distalization with 85% maximum accuracy. First-molar rotation reached 8.09°, with 78.4% maximum accuracy. No significant vertical skeletal changes were observed. Challenges included anterior anchorage loss, buccolingual tipping of upper molars, and patient compliance monitoring. Methodological variability and participant demographics prevented a meta-analysis. CA effectively achieves maxillary molar distalization and rotation in nonextraction Class II patients. Sequential distalization protocols and refinements improve treatment outcomes, whereas early incorporation of Class II elastics, combined molar movements, and compliance monitoring may enhance treatment efficiency.ABSTRACT
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To evaluate how high-frequency vibration (125 Hz) combined with light or optimal orthodontic forces affects osteoclast numbers and root volume during tooth movement in Wistar rats. Using a split-mouth design, 96 sites in male Wistar rats were randomly assigned to six groups: control, high-frequency vibration (HFV), light force (LF, 5g), light force with vibration (LF/HFV), optimal force (OF, 10g), and optimal force with vibration (OF/HFV). First maxillary molars were moved mesially using nickel-titanium (NiTi) closed coil springs. Root volume and osteoclast numbers were measured using Micro-CT and histomorphometry at Days 1, 7, 14, and 21. After 21 days, osteoclast numbers increased significantly in HFV (5.25 ± 0.48, P =. 002), LF/HFV (10.00 ± 0.41, P < .0001), OF (13.75 ± 0.48, P <.0001), and OF/HFV (15.25 ± 0.85, P < .0001) groups. Root volume decreased significantly in LF/HFV (7.75 ± 0.18 mm3), OF (6.68 ± 0.24 mm3), and OF/HFV (6.28 ± 0.14 mm3) groups compared to control (all P < .0001). HFV alone increased osteoclast numbers but did not affect root volume. The OF/HFV group showed the highest osteoclast numbers and root volume reduction. Three-way analysis of variance revealed that time, vibration, and force significantly reduced root volume (P < .0001). Notably, the interaction effects on osteoclast numbers were significant in LF group (P < .0001), but not OF group (P = .338). Combined high-frequency vibration and orthodontic forces increased osteoclast numbers and root resorption. Light forces with high-frequency vibration promoted osteoclast formation while minimizing root resorption compared to optimal forces. Additionally, the duration of this combined treatment significantly affected the extent of root resorption.ABSTRACT
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To compare the treatment effects of pushing or pulling force mechanics applied to bimaxillary miniplates with those of deferred treatment control patients to evaluate mandibular skeletal growth changes in growing patients with skeletal Class II malocclusion due to mandibular deficiency. Thirty-nine patients (24 males, 15 females; mean age = 11.59 ± 0.56 years) were equally and randomly assigned to one of three groups: Group A, skeletally anchored fixed-functional appliance (pushing mechanics); Group B, skeletally anchored Class II spring (pulling mechanics); and Group C, deferred treatment skeletal Class II control patients. Pretreatment and posttreatment cone-beam computed tomography scans were used for assessment of measurements (time interval: 11.52 ± 0.32, 11.53 ± 0.31, and 9.63 ± 0.22 months for groups A, B, and C, respectively). Relative to the control group, both intervention groups showed significant increases in effective mandibular length (Co-Gn), with mean differences of 5.08 ± 2.25 mm in Group A, and 3.83 ± 2.79 mm in Group B. A significant improvement in the sagittal relationship was observed in both groups, with reductions in ANB angle by 4.31° in Group A, and 5.5° in Group B. The mandibular plane angle was increased significantly in Group B by 1.83 ± 0.72°. Mandibular growth was enhanced using either pushing or pulling skeletally anchored force mechanics. The use of pulling force mechanics, specifically, was associated with increases in lower facial height.ABSTRACT
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To assess three-dimensional (3D) changes in tooth position, arch dimensions, and gingival levels after mandibular total arch distalization in skeletal Class III malocclusion. Skeletal Class III patients treated with mandibular total arch distalization using interradicular temporary anchorage devices were analyzed using stepwise 3D superimposition and reorientation of serial cone beam computed tomography (CBCT) and digital casts (N = 19). After mandibular regional superimposition of pre- (T0) and post-treatment (T1) CBCTs, the mandibles were segmented and merged with the corresponding digital casts, generating reoriented, superimposed T0 and T1 digital casts. Changes in individual tooth position, arch dimensions, occlusal plane, and clinical crown height (CCH) were measured. Mandibular teeth exhibited posterior movement ranging from 1.74 to 2.50 mm with significant lateral movement of the premolars and increase of inter-premolar width by 2.15–2.66 mm (P < .05). Extrusive movement of the entire dentition excluding the second molar was noted (P < .05), inducing changes of the occlusal plane. The overall changes in CCH were limited to −0.23 to 0.16 mm. CCH significantly increased in the premolars and decreased in the first molar (P < .05). Based on a stepwise digital superimposition, mandibular total arch distalization induced complex 3D changes in the mandibular arch, including distalization, extrusion, and increase of interpremolar width. Gingival margins generally were maintained, though mild-to-moderate recession was suggested in around 20% of the premolars, which may require attention.ABSTRACT
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To assess and compare the accuracy of infrazygomatic crest screws (IZC) placed with and without a dynamic navigation system. Preoperative cone-beam computed tomography (CBCT) and intraoral scan of the maxillary arch were obtained for 12 patients requiring therapeutic first premolar extraction after leveling and alignment. Virtual planning of the final IZC screw position on both sides was done using Evalunav software. Maxillary left and right arches for each patient were randomized into experimental and control sides. A 12 × 2 mm dimension IZC screw was positioned with and without use of a dynamic navigation system randomly on either side. A postoperative CBCT was taken immediately to assess the final screw position. Preoperative and postoperative CBCTs were compared for deviation in the entry point, apical point, and angular point for experimental and control sides. Mean value deviations obtained were subjected to statistical analysis using SPSS 20.0 to describe the data. Paired t-tests were used to analyze the comparisons. Dynamic navigation showed a statistically significant difference in entry point and angular point compared to the freehand approach during implant placement. IZC screws implanted with the dynamic navigation system offered better control with less deviation and greater accuracy in all three planes of space. However, further studies are necessary to determine the stability and anchor value of implants placed with a dynamic navigation system.ABSTRACT
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Severe vertical maxillary excess (VME) is a skeletal abnormality that typically requires orthognathic surgery for correction. Nonsurgical orthodontic treatment has been a fascinating but challenging alternative, especially when adverse anatomic factors hamper or pose risks for intrusive tooth movement. Despite well-documented efficiency of temporary anchorage device (TAD)-aided nonsurgical treatment for VME, evidence is scarce regarding the treatment efficacy and safety for cases with adverse anatomic traits. In this case report, we present nonsurgical treatment of a patient with severe VME, maxillary protrusion, and retrognathism. Additional challenges included compromised periodontal health, low maxillary sinus floor, short roots with axes deviating from the center of basal bone, and thin labial cortical bone with partial deficiencies. With anchorage from a transpalatal arch (TPA) and TADs and elaborate biomechanical control strategies, significant maxillary full-arch intrusion and anterior retraction with adequate root torque control were achieved, resulting in counterclockwise mandibular rotation and notable profile improvement. One-year follow-up showed stable treatment results. This case provided evidence on how balance may be achieved between treatment efficacy and anatomical limitations using biomechanical control strategies.ABSTRACT
To investigate the prevalence of bullying in schoolchildren and its relationship with malocclusion, accounting for demographic and psychosocial factors. This was a cross-sectional study on 10–14-year-old schoolchildren in the United Kingdom. Clinical examination was undertaken measuring Index of Orthodontic Treatment Need (IOTN), overjet, overbite, and crowding or spacing. Questionnaires were used to measure bullying, oral health-related quality of life (OHRQoL), self-esteem (SE), loneliness, and behavioral and emotional difficulties. Of 698 participants, 68 reported being bullied (9.7%). No difference was found in prevalence for gender, ethnicity, or age. Increased prevalence was found in participants with overjet > 6 mm (P = .02) and great need for treatment (IOTN Dental Health Component 5 P < .001, Aesthetic Component 9–10 P = .008). Bullied participants reported lower OHRQoL (P < .001) and SE (P < .001) and higher levels of loneliness (P < .001), emotional symptoms (P < .001), conduct problems (P = .002), and peer problems (P < .001). Multivariate analysis showed that being bullied was related to higher levels of loneliness (P = .007), poor peer relations (P < .001), and increased overjet (P = .032). Accounting for psychosocial factors, risk of being a victim of bullying was related to malocclusion, specifically an increased overjet.ABSTRACT
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To compare the accuracy and time required for orthodontic miniscrew placement using a dynamic computer-assisted surgery (d-CAS) system vs the conventional freehand (FH) approach. The effect of side, location, and operator experience was also evaluated. A randomized, in vitro experimental study was conducted using 10 maxillary resin models. After virtual planning, 40 miniscrews were randomly placed by one experienced and one novice operator. Twenty miniscrews were placed using a d-CAS system (test group) and 20 using the conventional FH method (control group). Preoperative and postoperative cone beam computed tomography scans were superimposed to measure deviations between the planned and final miniscrew position, and placement time was recorded. The d-CAS group showed less deviation at the entry point (95% confidence interval [CI] = 1.79 mm to 0.16 mm; P = .019) and less angle deviation (95% CI = 8.5° to 1.7°; P = .004). No significant differences were observed in other variables. Both operators achieved similar accuracy. Placement time was significantly longer in the d-CAS group, with a mean difference of 6.3 minutes (P < .001). Dynamic computer-assisted surgery improves the accuracy of orthodontic miniscrew placement vs the traditional FH method. However, d-CAS takes significantly longer. Clinician experience does not seem to significantly affect accuracy.ABSTRACT
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To provide a comprehensive critique of the diagnosis of root resorption using panoramic and periapical radiography, including discussion of the various methods of measurement, severity spectrum, and to shed light on a significant factor predisposing to resorption: treatment duration. The articles reviewed involved human subjects undergoing buccal fixed orthodontic treatment, diagnosed by panoramic or intraoral radiographs at the beginning and end of treatment. Treatment duration and external apical root resorption (EARR) had to be recorded to be included in the study. Relevant sources were searched using various platforms including PubMed, Scopus, and WoS. All sources of evidence, regardless of language, were included in the study. The search strategy yielded 704 studies; screening by title and abstract yielded 389 articles for full-text review. Forty studies were finally included and categorized according to the type of radiograph used to diagnose EARR: authors of 18 studies used panoramic radiographs, and authors of 22 studies used intraoral radiographs. In this study, we revealed a lack of agreement among authors concerning the diagnosis and measurement methods of external apical root resorption, resulting in inconsistencies in the results. Additionally, patient- and treatment-related factors, including treatment duration, were found to be inconsistently associated with the development of EARR. Standardization of diagnostic protocols and refinement of measurement techniques are essential to improve the accuracy of orthodontic care.Abstract
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To assess mandibular lingual bone thickness changes after molar distalization with microimplants and during retention. Twenty-one patients (10 men, 11 women; mean age: 20.5 ± 4.9 years) who underwent mandibular molar distalization with microimplants were included. Cone-beam computed tomography images at pretreatment (T0), posttreatment (T1), and retention (T2) were used to measure posterior space available and lingual bone thickness distal to the mandibular second molar at 0-, 2-, 4-, and 6-mm levels apical to the root furcation. Repeated measures analysis of variance with Bonferroni correction was applied to compare T0, T1, and T2 measurements. Pearson’s correlation analysis assessed the relationship between lingual bone thickness change and other variables. The mandibular second molar moved distally by 3.0 mm at crown level, and 1.2–1.8 mm at root level, after treatment. Posterior space available decreased significantly with root-cortex contact or radiographic lingual bone dehiscence observed at 6-mm root level. After retention, reduced cortical bone thickness increased significantly; however, T2 lingual bone thickness was less than T0. Although the decrease in lingual bone thickness at 6-mm root level correlated with crown and root distal movement after treatment, the increase in bone thickness during retention was not associated with tooth movement, patient age, or retention duration. Mandibular lingual bone thickness noticeably decreased after molar distalization with microimplants. After retention, significant bone recovery formation was observed at the thinned lingual cortex or radiographic bone dehiscence.ABSTRACT
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To compare efficacy and treatment duration of early versus late Class II elastics in patients with Class II malocclusion. Forty patients were randomized into two groups based on the timing of elastics use: early and late. In the early group, light short elastics were used from the day of placement of fixed preadjusted edgewise appliances. In the late group, elastics were inserted once 0.016 × 0.022-inch stainless steel archwires were in place. Lateral cephalograms and standardized smile photographs were taken before treatment and after achieving a Class I buccal segment relationship. Treatment duration, dental, skeletal, and soft tissue measurements were then compared between the two groups. Maxillary central incisors were retroclined relative to the SN plane (95% confidence interval (CI): 3.75°–11.99° and 3.96°–9.18° in the early and late groups, respectively) with clockwise rotation of the occlusal plane (95% CI: 3.75°–11.99° and 3.96°–9.18° in the early and late groups, respectively). Treatment duration to level and align and reach Class I buccal occlusion was significantly less in the early group (95% CI: 4.74–10.8 months). Comparison between groups revealed no significant differences for all measurements except MP/SN and PP/SN angles (P < .05). Class II elastics were equally effective and more efficient in the early group with significantly less time needed to level and align and reach Class I buccal occlusion compared to the late group.ABSTRACT
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To investigate transverse treatment outcomes in patients with skeletal Class III malocclusion treated with a surgery-first orthognathic approach (SFA) vs conventional orthognathic surgery (COS). This retrospective cohort study included 128 patients, divided into four groups of 32 based on the inclusion of presurgical treatment and extraction of the maxillary premolars: (1) COS with extraction, (2) COS without extraction, (3) SFA with extraction, and (4) SFA without extraction. CBCT scans were taken before and after treatment, with an additional scan after presurgical orthodontic treatment for the COS group only. The primary outcome variable was transverse decompensation, assessed through changes in maxillary and mandibular molar inclination and intermolar width. Predictor variables included treatment approach (SFA vs COS) and extraction status (extraction vs nonextraction). Transverse measurements were compared among the four groups throughout the treatment process. Maxillary molar inclination relative to the occlusal plane increased after treatment, whereas the mandibular molar inclination decreased after treatment, indicating transverse decompensation in the COS and SFA groups, and the extraction and nonextraction groups. There were no statistically significant differences in transverse changes between the COS and SFA groups. Although the difference in transverse decompensation between the COS and SFA groups was not statistically significant, clinicians may still need to consider careful management of transverse decompensation during postsurgical treatment, particularly in SFA cases.ABSTRACT
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To evaluate the accuracy of three fully automated software systems compared to nonautomated cephalometric analysis software tested using cephalograms featuring correct and incorrect head positions. The study sample consisted of 40 lateral cephalograms retrieved retrospectively from a larger pool of pretreatment orthodontic records. Cephalograms were recruited and divided into correct head posture group (CHP) and incorrect head posture group (IHP). Cephalometric data were obtained by manual landmarking (Dolphin software), which served as a reference, and by fully automated AI software (WebCeph, Ceph Assistant, and AudaxCeph). Intraclass correlation coefficients (ICC) and paired t-tests were used for intragroup comparisons, whereas analysis of variance and post-hoc analysis were used to compare performance among artificial intelligence (AI) based software applications. The tested software exhibited a good level of consistency for angular measurements whereas linear measurements were more error-prone. AudaxCeph demonstrated the most consistent accuracy, achieving excellent agreement (ICC > 0.90) for several skeletal parameters; however, it failed in detecting soft tissue accurately. WebCeph and Ceph Assistant showed greater variability, especially for linear measurements (ICC < 0.50). Positional errors drastically reduced measurement accuracy, with linear parameters such as Go-Me showing the poorest agreement across all software. AI-based cephalometric software demonstrated variable accuracy depending on the cephalometric measurement, and this pattern was exacerbated under conditions involving positional errors in cephalograms. Accordingly, oversight by expert clinicians is still required to minimize marginal error.ABSTRACT
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To evaluate the influence of lip protrusion and thickness on the perception of facial profile attractiveness among subjects with different ethnic backgrounds. 424 participants were divided into four groups (European, Black African, Far Eastern, and Middle Eastern) and further subdivided into two subgroups according to age (18 to 40 and 41 to 60 years). An idealized female profile silhouette image was manipulated to generate 18 images with three different lip thicknesses and six sagittal lip positions. To assess perception of facial profile attractiveness, participants completed the developed questionnaire. Statistically significant differences were found among subjects with different ethnic backgrounds for all images (P < .01). Percent agreement averaged 13.89%. Within each group, scores varied with lip thickness and protrusion, with significant interaction between the two factors. Gender and age had a significant impact on profile attractiveness mean scores. Ricketts norms for the most favorable lip position to E-line need to be updated. Middle Eastern and Europeans regarded lips positioned + 1 mm to the norm in relation to E-line as the most attractive. Thick lips that were mildly protruded were preferred by Africans. Far Eastern participants preferred normal thickness and thin lips that were protrusive; thick lips were ranked lowest. Among the thick lips, protrusive lips were ranked higher. More personalized and culturally sensitive orthodontic treatment planning is needed to help patients achieve their desired facial esthetic outcome.ABSTRACT
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In this case report, we present the treatment of a 28-year-old patient with lip incompetence and vertical maxillary excess (VME), using a combination of a midpalatal miniscrew-anchored cantilever clip appliance and submerged buccal shelf miniscrews. The patient exhibited a convex profile, long face, gummy smile, and protrusion, with a Class II skeletal relationship and mentalis strain. The patient declined conventional orthognathic surgery, leading to an orthodontic camouflage treatment plan involving extraction of four first premolars, maximum retraction, and active vertical control with skeletal anchorage devices. Treatment included the use of infrazygomatic crest miniscrews, anterior subapical miniscrews, and a cantilever clip appliance for molar intrusion, resulting in significant improvement in facial profile, reduction of gummy smile, resolution of lip incompetence, and alleviation of mentalis strain. This case demonstrates the effectiveness of a nonsurgical orthodontic intervention in managing a complex case of VME and lip incompetence.ABSTRACT
A 26-year-old woman came for orthodontic treatment to improve her profile with protrusive lips. Diagnosed as bimaxillary protrusion, extraction followed by anterior retraction was indispensable for the case. However, her left upper lateral incisor was absent, the left upper canine had moved mesially and replaced the adjacent incisor, and the original canine location was restored with a long implant, which was in good condition. Surgical removal of the implant would be tricky and might lead to atrophy of the alveolar bone. In addition, the upper left central incisor had a short, curved root, which could not undergo significant movement. After crucial discussion between orthodontists and implantologists, based on digital setup, an innovative treatment plan was developed. Four incisors were extracted followed by clear aligner therapy for anterior retraction. An individualized zirconia abutment was installed on the upper left implant in a retroclined direction, cemented with a zirconia crown to replace the upper lateral incisor. Minimally invasive veneers were made to reshape the other upper incisors for better esthetics. Finally, the patient had her profile greatly improved and the teeth well aligned without removal of the implant. Thus, the seemingly mission impossible was accomplished with a satisfactory outcome, thanks to imaginative treatment planning and delicate interdisciplinary collaboration based on digital simulation.Objective
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Conclusion
In this case report, we show a strategic approach to prolonging the lifespan of pathologically migrated maxillary canines with a hopeless prognosis in a 57-year-old female patient, highlighting the potential of orthodontic management for middle-aged patients to enhance both occlusion and facial esthetics while minimizing the need for extensive prosthetic treatment. According to the visual treatment objective, the nonextraction treatment plan showed advantages in the type of orthodontic tooth movement and final occlusal relationship. Therefore, considering the favorable periodontal treatment results and single-root teeth, the hopelessly migrated maxillary canines were relocated, eliminating the existing trauma from occlusion. Segmental tooth movement was performed, and orthodontic temporary skeletal anchorage devices were used to support strategic orthodontic tooth movement. After 27 months of treatment, proper occlusion was established with a significant improvement in facial esthetics. The periodontally compromised teeth were preserved with adequate periodontal support. The patient expressed satisfaction with the results, and the 30-month follow-up records confirmed the stability of treatment outcomes.ABSTRACT
To evaluate and compare dentoalveolar changes after orthopedic treatment of growing skeletal Class II patients using either pushing or pulling force mechanics anchored to bimaxillary miniplates in comparison with deferred treatment control subjects. A total of 39 patients (24 male, 15 female; mean age 11.59 ± 0.56 years) was equally and randomly allocated to one of three study groups: pushing group (A), pulling group (B), and control group (C). Dental changes were assessed using pretreatment (T1) and posttreatment (T2) cone-beam computed tomography scans. One patient dropped out; therefore, 13, 12, and 13 patients were analyzed in groups A, B, and C, respectively. In groups A and B, overjet decreased by 7.00 ± 1.35 mm and 8.17 ± 1.4 mm, respectively. No significant change was observed in axial inclination of the mandibular incisors in either of the intervention groups between T1 and T2. Axial inclination of the maxillary incisors decreased significantly in Group B by 3.75 ± 1.71°. The sagittal position of the mandibular first molar changed significantly in Group A (4.15 ± 1.28 mm) and Group B (4.00 ± 1.41 mm). Maxillomandibular basal arch width differences were greater than −0.39 ± 1.87 mm in all study groups. No significant transverse arch measurement changes were observed. The use of either pushing or pulling force mechanics using bimaxillary skeletal anchorage was effective in improving Class II dental relationships without dentoalveolar side effects. Pretreatment transverse discrepancy should be assessed to incorporate maxillary expansion into the treatment protocol for patients diagnosed with maxillary arch constriction.ABSTRACT
Objectives
Materials and Methods
Results
Conclusions
Orthodontic management of a patient with an impacted maxillary canine associated with severe palatal root dilaceration of the adjacent first premolar
Comparison of treatment stability among maxillary round multi-strand wire, chairside rectangular chain and vacuum formed retainers: a randomized clinical trial
Relationship between buccal osteotomy angulation and asymmetric expansion in surgically assisted rapid palatal expansion: a finite element analysis
Differences in the cooperation of teenagers for orthodontic treatment: Z Generation versus Y Generation
Dr. Robert B. Hedges
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