ABSTRACT
Objectives
To develop and validate a standardized protocol for clear aligner (CA) thickness measurement using a three-dimensional (3D)-printed auxiliary device to improve measurement reliability.
Materials and Methods
24 pairs of digital dental models (D0s) were included and 3D-printed into physical models (P0s), from which CAs were thermoformed using 0.75-mm polymer sheets. Measurement auxiliary devices (MADs) were designed on D0s through measurement point selection, direction determination, electronic gauge mapping, and base shaping, and then 3D-printed. Two operators measured CA thickness (40 points per CA, 48 CAs) using an electronic gauge both directly (direct measurement, D-M) and with MADs (auxiliary measurement, A-M) across three sessions. Measurement precision (repeatability and reproducibility) of D-M and A-M were analyzed using intraclass correlation coefficients (ICCs) and repeated-measures analysis of variance (ANOVA) or Friedman tests. Bland-Altman plots were used to evaluate intersession agreement.
Results
A-M demonstrated superior intersession repeatability with ICC > 0.90 at all points and high intersession agreement with a narrow 95% limit of agreement (LoA) and minimal outliers. Interoperator reproducibility for A-M was also higher, with ICCs above 0.75 at all points, compared to D-M, which showed ICCs below 0.75 at almost all points.
Conclusions
The 3D-printed auxiliary device-based protocol provides a precise and operator-independent method for CA thickness measurement, offering a tool for quality control and providing a foundation for future research on material advancement and design optimization to improve aligner functionality.
ABSTRACT
Objectives
To compare the effect of postsurgical orthodontic treatment between using clear aligners (CA) or fixed appliances (FA) on the postsurgical stability of patients with mandibular prognathism in the surgery-first approach (SFA).
Materials and Methods
This retrospective study included 54 patients with mandibular prognathism who underwent surgical orthodontic treatment with isolated mandibular setback surgery. The patients were divided into two groups according to the mechanics of postsurgical orthodontic treatment: the CA group included 27 patients treated with clear aligners, and the FA group included 27 patients treated with brackets during postoperative orthodontic treatment. Cone beam computed tomography scans were taken before, immediately after, and at 3, 6, and 12 months postsurgery to assess mandibular relapse. The measurements of postsurgical mandibular relapse including horizontal and vertical positions were compared according to the treatment progress and groups.
Results
Total postsurgical mandibular relapse at pogonion was 3.2 mm in the CA group and 2.2 mm in the FA group. Relapse was higher at 3 months postsurgery in both groups, with an average forward movement of 1.4 mm in the CA group and 1.7 mm in the FA group. Relapse in the CA group showed no significant changes over time, indicating persistence beyond the initial period. In contrast, the FA group showed a significant reduction in relapse by 3 months. Overall, the CA group tended to have greater and more persistent relapse than the FA group.
Conclusions
Careful consideration of skeletal relapse is needed in the postsurgical management of patients treated with clear aligners in SFA treatment.
ABSTRACT
Objective
To evaluate the effects of orthodontic traction of impacted maxillary canines on treatment duration, alveolar bone levels, white spot lesions (WSLs), root resorption, and the need for auxiliary appliances.
Materials and Methods
In this retrospective study, 116 patients were divided into two groups: 58 with unilaterally impacted maxillary canines and 58 controls without impaction. All patients received nonextraction treatment using labial fixed appliances. Pretreatment and posttreatment panoramic radiographs, intraoral photographs, and intraoral scans were analyzed. The collected data were used to compare the groups across five clinical parameters. Statistical analyses included the Mann-Whitney U-test, Wilcoxon signed-rank test, χ2 test, and Cochran’s Q test, with significance set at P < .05.
Results
The impaction group had significantly longer treatment duration (mean = 2.64 ± 0.99 years) than controls (mean = 1.85 ± 0.60 years). Alveolar bone loss was significantly greater in teeth adjacent to the impacted canine and between the impacted and nonimpacted sides within the impaction group (P < .05). WSL incidence was higher in the impaction group, especially in posterior teeth (P = .0034). Root resorption patterns differed by region: maxillary incisors were more affected in the impaction group, whereas mandibular posterior teeth showed more resorption in controls. The use of auxiliary appliances was significantly greater in the impaction group.
Conclusions
Impacted canine treatment is associated with increased treatment time, greater alveolar bone loss, higher risk of WSLs, and distinct root resorption patterns. These findings highlight the importance of individualized treatment planning, careful biomechanical control, and preventive strategies in managing impacted canines.
ABSTRACT
Objectives
To evaluate factors influencing the prediction error of artificial intelligence (AI) that predict craniofacial growth and to identify an optimal AI training condition to improve the predictive performance of the AI model.
Materials and Methods
Original growth data were collected from the Mathews longitudinal serial growth study. From the original data consisting of 1257 datasets from 33 growing children of northern European descent, 60 data subsets were generated using random resampling procedures to include 12, 18, and 24 subjects, with data sizes of 100, 200, 300, 400, and 500 datasets. The resampling procedures were repeated four times. Each subset was used to train and create a total of 60 AI models. The prediction accuracy of these models was evaluated using growth prediction errors at the lower lip landmark, labrale inferius, as a benchmark indicator. The prediction errors of the 60 AI models were analyzed according to the number of subjects and data sizes.
Results
Prediction error decreased as the data size increased. However, increasing the number of subjects within the growth data led to higher prediction errors. Notably, the increase in prediction error caused by adding more subjects was more substantial than the improvement achieved by increasing the data size.
Conclusions
The findings suggest that developing highly accurate AI-based craniofacial growth prediction models remains a significant challenge, even with extensive datasets.
ABSTRACT
Objectives
To determine if adhesive remnants and enamel loss after debonding and cleanup with a finishing bur were affected by hardness properties of the adhesive resins.
Materials and Methods
Stainless steel orthodontic brackets (American Orthodontics, Mini Master series) were bonded on facial surfaces of extracted premolars using a relatively soft bioactive resin (ACTIVA BioACTIVE-Restorative, Pulpdent) or harder traditional adhesive (Transbond XT, 3M; N = 20/group). Bracketed teeth underwent 5000 thermocycles before brackets were debonded. Debonding surfaces were examined qualitatively and categorized by three examiners. Remaining adhesive was removed with a carbide finishing bur. Teeth were scanned with an optical scanner before brackets were bonded (baseline), after debonding, and after cleanup. Surface changes (mean thickness or depth, affected surface area, and volume) were calculated quantitatively after aligning scans to the baseline. Differences between the two groups were analyzed statistically with Mann-Whitney U-test or pairwise comparison at a significance level of 0.05.
Results
Qualitative examination of debonded surfaces did not show a significant difference (P = .7949) in adhesive remnants between groups, which was confirmed by quantitative evaluation (P > .05). After cleanup, enamel loss was significantly higher in the softer bioactive resin group (mean depth = 91 ± 16 µm, area = 24.48 ± 9.88 mm2) than the harder traditional adhesive (mean depth = 66 ± 9 µm, area = 6.34 ± 4.41 mm2; P < .0001).
Conclusions
The likelihood of adhesive remnants after debonding a bracket bonded with the bioactive resin was similar to traditional adhesive. However, enamel loss from cleaning up with a finishing bur was higher for the softer bioactive resin.
ABSTRACT
Objectives
To evaluate and compare the accuracy of four AI chatbots, ChatGPT-3.5, ChatGPT-4.0, Copilot, and Gemini, in response to orthodontic emergency scenarios.
Materials and Methods
Forty frequently asked questions related to orthodontic emergencies were posed to the chatbots. These questions were categorized as fixed orthodontic treatment, clear aligner treatment, eating and oral hygiene, pain and discomfort, general concerns, retention, and sports and travel. The responses were evaluated by three orthodontic experts using a five-point Likert scale, and statistical analysis was conducted to assess variations in accuracy across chatbots.
Results
Statistical analysis revealed significant differences among the chatbots. Gemini and ChatGPT-4.0 demonstrated the highest accuracy in response to orthodontic emergencies, followed by Copilot, whereas ChatGPT-3.5 had the lowest accuracy scores. Additionally, the “Fixed Orthodontic Treatment” category showed a statistically significant difference (P = .043), with Gemini outperforming the other chatbots in this category. However, no statistically significant differences were found in other categories.
Conclusions
AI chatbots show potential in providing immediate assistance for orthodontic emergencies, but their accuracy varies across different models and question categories.
ABSTRACT
Objectives
To compare differential changes in nasal patency and dentoskeletal morphology after rapid palatal expansion (RPE) vs hybrid miniscrew-assisted rapid maxillary expansion (MARPE).
Materials and Methods
Thirty patients presenting with bilateral crossbite were randomized into RPE or hybrid MARPE treatment groups. MARPE patients were treated using the two-point hyrax appliance and RPE patients were treated using the conventional hyrax appliance. Nasal patency was evaluated using rhinomanometry and dentoskeletal changes were evaluated using cone beam computed tomography images.
Results
The success of suture opening was 46.6% and 60% in the RPE (mean age: 17.36 ± 1.80) and MARPE groups (mean age: 18.52 ± 1.80), respectively. The MARPE group showed significantly increased nasal airflow and decreased nasal resistance during inspiration and expiration compared to the RPE group after 4 months of treatment. The RPE group demonstrated nonsignificant changes in the same parameters after 4 months. Although significant differences between groups were observed in nasal flow during inspiration and expiration for both nostrils, intergroup differences in nasal resistance were not significant (P > .05). The MARPE group exhibited greater expansion in nasal, maxillary basal, and alveolar widths compared to the RPE group. A more pronounced decrease in buccal bone thickness was observed in the RPE group. The buccal inclination of the first premolars and molars significantly increased in both groups.
Conclusions
Although similar success rates for sutural opening were observed between MARPE and RPE, MARPE facilitated more pronounced changes in nasal patency and skeletal maxillary expansion compared to conventional RPE.
ABSTRACT
Objectives
To evaluate the skeletal and dental effects of Class II correction in growing patients using clear aligners, with either elastics or mandibular advancement (MA).
Materials and Methods
The study included 66 growing Class II patients: 45 patients treated with clear aligners (20 using Class II elastics and 25 with MA) and 21 untreated controls observed over a comparable time period. Nine cephalometric and three study cast measurements were evaluated initially (T1) and the end of treatment (T2) to assess skeletal and dental changes.
Results
The control group maintained a Class II molar relationship and overjet, whereas both treatment groups corrected to Class I. In the MA group, statistically significant skeletal changes from T1 to T2 were observed, including reduction in SNA (–1.09°) and ANB (–1.69°), in addition to dentoalveolar Class II correction. The elastic group showed no statistically significant changes in SNA and ANB compared to the control group. Linear regression revealed 5.28° of lower incisor proclination with Class II elastics, whereas lower incisor inclination was maintained with MA treatment.
Conclusions
Clear aligner treatment with Class II elastics and MA were effective for correcting Class II malocclusion in growing patients that would have otherwise been maintained without intervention. Although Class II correction was mainly due to dentoalveolar changes, a skeletal component was observed with MA treatment.
ABSTRACT
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
Objectives
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.
Materials and Methods
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.
Results
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).
Conclusions
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.
Objectives
To investigate the effects of buccal osteotomy angulation on surgically assisted rapid palatal expansion (SARPE) patterns.
Materials and Methods
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.
Results
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.
Conclusions
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.
ABSTRACT
Objectives
Evaluate the changes in oral microbiota linked to orthodontic treatment by analyzing the 16S rRNA gene.
Materials and Methods
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.
Results
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.
Conclusions
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
Objectives
To compare the efficacy of clear aligners and Z-spring (ZS) appliances in treating dental anterior crossbite (AC) during the mixed dentition period.
Materials and Methods
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).
Results
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).
Conclusion
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
Objectives
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.
Materials and Methods
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.
Results
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.
Conclusions
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.
Influence of social media on the choice of orthodontist and different types of orthodontic treatment
ABSTRACT
Objectives
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.
Materials and Methods
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).
Results
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.
Conclusions
SM, especially Instagram, can influence decision-making when choosing an orthodontist and accepting the recommendations for OT proposed by a professional.
ABSTRACT
Objectives
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.
Materials and Methods
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).
Results
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).
Conclusions
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
Objectives
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).
Materials and Methods
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.
Results
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.
Conclusions
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
Objectives
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.
Materials and Methods
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.
Results
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.
Conclusions
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
Objective
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.
Materials and Methods
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.
Results
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).
Conclusions
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
Objectives
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.
Materials and Methods
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).
Results
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°.
Conclusion
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
Objectives
To assess three-dimensional (3D) changes in tooth position, arch dimensions, and gingival levels after mandibular total arch distalization in skeletal Class III malocclusion.
Materials and Methods
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.
Results
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).
Conclusions
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
Objectives
To assess and compare the accuracy of infrazygomatic crest screws (IZC) placed with and without a dynamic navigation system.
Materials and Methods
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.
Results
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.
Conclusions
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
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
Objectives
To investigate the prevalence of bullying in schoolchildren and its relationship with malocclusion, accounting for demographic and psychosocial factors.
Materials and Methods
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.
Results
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).
Conclusions
Accounting for psychosocial factors, risk of being a victim of bullying was related to malocclusion, specifically an increased overjet.
ABSTRACT
Objectives
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.
Materials and Methods
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.
Results
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).
Conclusions
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
Objectives
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.
Materials and Methods
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.
Results
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.
Conclusions
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
Objectives
To assess mandibular lingual bone thickness changes after molar distalization with microimplants and during retention.
Materials and Methods
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.
Results
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.
Conclusions
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
Objectives
To compare efficacy and treatment duration of early versus late Class II elastics in patients with Class II malocclusion.
Material and Methods
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.
Results
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).
Conclusions
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
Objectives
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).
Materials and Methods
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.
Results
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.
Conclusions
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
Objectives
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.
Materials and Methods
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.
Results
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.
Conclusions
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
Objectives
To evaluate the influence of lip protrusion and thickness on the perception of facial profile attractiveness among subjects with different ethnic backgrounds.
Materials and Methods
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.
Results
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.
Conclusions
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
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.
Objective
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.
Materials and Methods
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.
Results
Finally, the patient had her profile greatly improved and the teeth well aligned without removal of the implant.
Conclusion
Thus, the seemingly mission impossible was accomplished with a satisfactory outcome, thanks to imaginative treatment planning and delicate interdisciplinary collaboration based on digital simulation.
ABSTRACT
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
Objectives
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.
Materials and Methods
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.
Results
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.
Conclusions
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.
A standardized protocol for clear aligner thickness measurement using a 3D-printed auxiliary device
The impact of orthodontic traction on outcomes in impacted canine management: a quantitative analysis
Soft adhesives may cause more iatrogenic damage than hard adhesives during cleanup following bracket removal
Factors influencing the predictive performance of artificial intelligence for craniofacial growth
Prize Essay Contest
Overbite and Vertical Facial Dimensions in Terms of Muscle Balance*
TREATMENT OF A CLASS II, DIVISION I CASE, COMPLICATED BY IMPACTED SUPERNUMERARY INCISORS
eISSN: 1945-7103 | ISSN: 0003-3219