Purpose: The objective of this review was to investigate the recent reports on periodontally accelerated osteogenic orthodontics (PAOO) in major orthodontic journals in order to summarize the relevant updates and clinical findings. Materials and methods: The PubMed database was searched for PAOO-related articles published in The American Journal of Orthodontics and Dentofacial Orthopaedics (AJO-DO), The Angle Orthodontists (AO), The European Journal of Orthodontics (EJO), The International Journal of Oral and Maxillofacial Surgery (IJOMS), The Australian Orthodontic Journal (AOJ) and other major orthodontic journals. Keywords used for searching were corticotomy, PAOO, piezocision and micro-osteoperforations (MOPS). Based on the information from the titles and abstracts, relevant articles on PAOO were selected and analysed. Results: As an alternative surgical method, the PAOO technique can accelerate adult patients' tooth movement and shorten the treatment time. Compared with conventional orthodontic treatment, the PAOO technique shows advantages in terms of treatment cycle and treatment effect. Currently, scholars tend to believe that the PAOO technique does not increase the risk of root resorption, periodontium injury, and alveolar bone defect. Conclusions: Long-term efficacy of PAOO lacks randomized controlled clinical trials. However, with the deepening of research, PAOO - a relatively mature means of accelerating tooth movement - is likely to be more attractive in orthodontic treatment.
Purpose: This review aims to evaluate the available evidence to assess and understand the effectiveness of fluoride-releasing primers in reducing white spot lesions (WSLs) around orthodontic brackets. Materials and Methods: The protocol for the review was registered in the PROSPERO database (w.w.w.crd.york.ac.uk/prospero, protocol number - CRD42021230588). A systematic search of the scientific databases (PubMed, Cochrane CENTRAL, Google Scholar, and LILACS) was conducted to identify relevant studies. After screening titles and abstracts 120 articles were eliminated and the full text was sought for the four studies. Three articles were included in the qualitative analysis. Results: All studies included in the qualitative analysis showed a high risk of bias. On visual examination, no studies identified a significant difference in the incidence of WSLs among the intervention and control groups. On assessing WSLs using laser fluorescence, only one study identified a significant difference in the incidence of WSLs between the groups. Conclusion: With the limited available evidence, it can be concluded that there is a difference in the incidence of WSLs when fluoride-releasing primers are used to bond orthodontic brackets, although this decrease in incidence is not significant statistically. Further research is required to fully evaluate the effectiveness of using fluoride-releasing primers in orthodontics.
Purpose: To assess the influence of 0.12% chlorhexidine solution (CHX) in the strength degradation of different intermaxillary latex and non-latex elastics. Materials and methods: Eighty 1/4 inch elastics were separated into eight groups (n = 10) according to manufacturers (Morelli (TM) and American Orthodontics (TM)), elastic's type (latex and non-latex) and storage solution (artificial saliva and CHX). Each sample was extended to 19.2 mm, corresponding to 3x the size of their inner diameter, and initial force was verified on the universal testing machine. The elastics were then kept extended, immersed in artificial saliva and their strength was once again evaluated in the following period of time: 12 and 24 hours. Following the storage period, elastics of CHX groups were immersed for 1 min into PerioGard (0.12% chlorhexidine solution) before the strength evaluation. The data (gf) was submitted to a three-way repeated measure analysis of variance and Tukey's test (alpha = 0.05). Results: Significant differences between elastics and time were observed (p < 0.000). Statistically significant reduction in strength was found in non-latex and latex elastics between the initial condition and after 12 h and 24 h (p < 0.05). The non-latex elastics showed statistically higher degradation values than the latex elastics, in the three analysis times (p < 0.05). No statistical difference was found between saliva and CHX, regardless of the time and elastic type (p > 0.05). Conclusions: Generally, the latex elastics showed less strength degradation compared to non-latex elastics. CHX did not affect strength degradation and time influenced strength degradation in the first 12 hours, keeping practically constant for up to 24 hours.
Purpose: To compare the change of IL-1β and TNF-α expression during orthodontic tooth movement in rats, which were under regular diet and ketogenic diet (KD).Materials and Methods: The maxillary right first molars of 3-month-old male Sprague-Dawley rats were subjected to mesial movement by 50 g of force for 14 days under ketogenic diet. A control group was also established in which rats were subjected to the same tooth movement conditions but under a regular diet. The distance of tooth movement was measured by using precision electronic calipers. After 14 days, the rats were sacrificed and the mesial surface of the palatal root of the right first molar was analysed to determine the expression levels of IL-1β and TNF-α through immunohistochemical staining. The images obtained were then quantified using ImageJ program.Results: After 14 days of orthodontic tooth movement, the amount of tooth movement in the ketogenic group was lesser by approximately half the distance compared to that of the control group. Moreover, the expression of IL-1β and TNF-α was also lower.Conclusions: Consuming ketogenic diet reduces the expected amount of tooth movement which was evidently shown by a significant lower cytokine expression of IL-1β and TNF-α than the group under regular diet. This suggests that ketogenic diet is a contributing factor in delaying the tooth movement during orthodontic treatment.
Purpose: Review of topics related to orthodontics and the COVID19 pandemic. Materials and Methods: Originally planned as a Critical Appraisal of select research questions, it became evident there are insufficient studies; rather, this is a comprehensive review of the scientific literature, professional news sources, and lower tier publications. Results: The effect of the pandemic on orthodontic private practice and orthodontic education starting in March 2020 was keenly felt as most closed completely or opened for emergencies only. When practices reopened, it was realized that orthodontic care was urgent - patients could not wait for months without continuing their treatment. Orthodontists were confronted with the need to make broad and costly modifications to the way they practiced in a short time. 15 Changes included full personal protective equipment, increased disinfection protocols, airflow considerations, and fewer patients seen with longer appointments and longer workdays. Orthodontic residencies closed for 3 months or more, and like private practices, were forced to make the same changes while trying to ensure residents received the training and experience required to graduate. Fortunately, fifteen months later practices in most countries are 20 returning to normal levels of income and production, albeit at higher costs. Conclusion: Changes in infection control, airflow in an office, aerosol generation, and the trend towards intraoral scanning and the contact-less or paperless office are probably permanent. Orthodontists must also be aware of their obligation as health providers interested in the overall well-being of their patients.
Purpose: The purpose of the present study was to investigate the effect of the size variation of the mandibular dental arch on the magnitude and direction of orthodontic forces delivered by a variety of commercially available preformed rectangular Ni-Ti archwires. Materials and methods: The means and standard deviations (SDs) of intercanine and intermolar widths and the means of dental arch depths at the canines and first molars were established based on our previous studies of subjects with untreated normal occlusions. The mandibular dental arch of a multi-sensor measuring system was adjusted to the mean, enlarged to +1SD and reduced to -1SD sizes of the normal dental arch. Fifty-nine types of 0.019 x 0.025-inch NiTi archwires were selected, and the intercanine and intermolar widths of the archwires were measured. Delivered forces were measured at the central incisors, canines, and first molars for each dental arch condition. Results: Significant correlations were found between archwire width and forces at all examined teeth for all dental arch widths. Significantly greater facial direction forces were delivered at the central incisor for the large dental arch condition than for the small and mean dental arch conditions. Significantly greater facial direction force was delivered at the canines for the small dental arch than for the large dental arch condition. Conclusion: Possible risks of clinically significant magnitudes of orthodontic force in the facial direction at the central incisors and canines were observed when using preformed rectangular NiTi archwires for patients with relatively large and small dental arches, respectively.
Purpose This survey aimed to estimate the incidence and severity of impacted teeth indicated for fenestration or fenestration and traction in patients who visited several dental institutions nationwide in Japan from 1 April 2015 to 31 March 2016.Materials and Methods An online survey was conducted, and 236 dental institutions responded, with 176 reporting their experience with cases of impacted teeth indicated for fenestration/traction.Results Of the 1,683 cases of impacted teeth indicated for fenestration/traction, 434 (25.8%), 391 (23.2%), and 858 (51.0%) were treated using fenestration alone, fenestration/traction, and fenestration/traction and orthodontic treatment, respectively. Impacted teeth were most prevalent in the anterior maxillary region, especially in the canine region, with 435 (24.0%) and 411 (22.7%) impacted teeth on the right and left quadrants, respectively. The most commonly used diagnostic criteria were the radiographic findings of clear inversion or horizontal impaction showing that spontaneous eruption would be difficult in 123 (37.4%) cases. The most severe cases indicated for fenestration/traction were those with two or more impacted teeth, observed in 279 (56.7%) cases, followed by 174 cases of root resorption of adjacent teeth (35.4%). Root resorption due to impacted teeth was most prevalent in the maxillary left lateral incisors, evident in 65 cases (24.5%).Conclusion This study found that impacted teeth often have serious sequelae such as root resorption of adjacent teeth. Thus, early detection and intervention of impacted teeth, as well as preoperative and postoperative orthodontics to establish a physiologically normal occlusion, are necessary.
Introduction: Condylar hyperplasia (CH) is one of the causes of asymmetric facial growth resulting from overgrowth or hyperactivity in the mandibular condyles. The present review article describes the clinical and histopathological features of condylar hyperplasia and condylectomy with and without orthognathic surgery as a treatment approach to address this condition.Objectives and Conclusions: This article highlights the different classification systems to characterize CH. Clinical examination and radiographic examinations (including bone scintigraphy and single-photon emission computed tomography) over a period of time appear to be the gold standard in the diagnosis. Condylectomies, which removes a small portion of the mandibular condylar head, have been reported to produce adequate outcomes with minimal side effects on the temporomandibular joint. Timing of this surgical procedure and differences in indications and outcomes between high and low condylectomies are presented. A case report illustrating a low proportional condylectomy is reported.
Purpose: To evaluate the shear bond strength of orthodontic buttons bonded on various clear aligner materials using orthodontic plastic adhesive. Materials and methods: Three types of thermoplastic materials: 1) Duran (Polyethylene terephthalate glycol), 2) Essix A+ (Polyethylene terephthalate glycol), and 3) Zendura (Polyurethane) were bonded with either metal or plastic buttons using orthodontic plastic adhesive (Bond aligner (R)). Six experimental groups with 15 specimens per group were prepared. Bond strength testing was done according to the Lap Shear Test Method (ASTM D3163) using the universal testing machine. Bond failure mode (modified from ASTM D5573) was examined with a stereoscope. Kruskal-Wallis and post hoc tests were used to analyse the differences in shear bond strength among the six groups. Results: Mean bond strengths were as follows: 1) Duran-metal (DM) (7.04 MPa); 2) Duran-plastic (DP) (5.37 MPa); 3) Essix-metal (EM) (5.55 MPa); 4) Essix-plastic (EP) (4.62 MPa); 5) Zendura-metal (ZM) (1.17 MPa); and 6) Zendura-plastic (ZP) (1.40 MPa). Shear bond strength among the three thermoplastic materials were significantly different (p < .05). For the bond failure mode, regardless of button type, Duran and Essix A+ showed substrate failure of the thermoplastic sheet, while Zendura showed adhesive failure at the thermoplastic sheet interface. Conclusion: Orthodontic buttons bonded on Duran and Essix A+ using orthodontic plastic adhesive could achieve very high bond strength that the thermoplastic sheets would tear before button detachment occurred. Buttons bonded to Zendura resulted in significantly greater bond failure rates.
Outcome: This case reports the successful treatment of a 40-year-old female with a skeletal Class III malocclusion and knife-edge residual ridges by successfully protracting the lower molars orthodontically.Objectives: On a long-standing extraction space, resorption results in a decrease in the vertical height of the bone, but more importantly, remodelling produces a buccolingual narrowing of the alveolar process as well. Moving teeth into this area is considered almost impossible due to the anatomical limitations. This case places special emphasis on factors to be considered while levelling the curve of Spee on a patient with a very steep mandibular plane, by controlling posterior teeth extrusion, and at the same time elaborates on the biomechanics of molar protraction.Conclusion: In all, the apt use of calculated biomechanical strategies helped in achieving an acceptable, functional and esthetic occlusion in a conservative non-surgical line of treatment.
Purpose: The objective of the current study was to assess the effectiveness of photobiomodulation in managing gingival inflammation in patients undergoing orthodontic treatment. Materials and Methods: The addressed focus question was 'Is photobiomodulation effective in treating gingival inflammation in patients undergoing orthodontic treatment?' Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) model, indexed databases were searched up to and including January 2021. The risk of bias (ROB) was assessed using Joanna Briggs critical appraisal tool. Results: Eight studies which included, six randomized controlled trials (RCTs) and two clinical trials were included in the review. All the studies reported that PBM can be used in the management of gingival inflammation during or after the orthodontic treatment, but two studies reported that there is no difference between lasers and conventional scalpel therapy. Overall, the risk of bias was low for six studies and moderate for two studies. Conclusion: The efficacy of photobiomodulation in the management of gingival enlargement during orthodontic treatment is debatable as the heterogeneity associated with the included studies is high. Overall, majority of the studies are supportive and the conclusion of the present review indicates that photobiomodulation can be used as an adjunct tool for managing gingivitis during orthodontic treatment. Further, well-designed RCTs are needed.
Objective: This case report emphasizes the importance of controlling vertical movement of posterior teeth for a non-growing Class II malocclusion with a complete deep overbite and large overjet. The intrusion of incisors without molar extrusion is one of the key factors for the aesthetics and stability of treatment outcomes. Case: A 19-year-old woman had a chief complaint of excessive incisor display while smiling. She was diagnosed with an Angle Class II malocclusion with a complete deep overbite and large overjet caused by the improper interposition of her lower lip and overerupted incisors. To achieve satisfactory results, the vertical movements of posterior teeth needed to be controlled. Two orthodontic miniscrews were used in her maxillary arch to intrude the incisors and control the movement of molars. Concurrently, a utility intrusion arch was used to intrude and labially incline the lower incisors. Treatment result: Her upper and lower incisors had been intruded by 4 mm and 3 mm, respectively, without the extrusion of posterior teeth. The-lip-to-incisor relationship at rest position had been improved and she was pleased with the results. Conclusion: These mechanics were effective for a complete deep overbite correction without undesirable effects.
Objective : The present study was aimed to analyse the efficacy of specs loop, a newly designed closing loop. Materials and Methods : A finite element maxillary model for en-masse anterior retraction was made. The newly designed specs loop was tested with different preactivation bends (alpha-30 degree; beta-15 degree, 30 degree and 45 degree) and without preactivation bends. The horizontal and vertical forces and moments at both the alpha and beta nodes and overall moment to force ratio, range of crown tip, root tip and vertical movement of all the individual teeth, stress acting on the teeth and bone were calculated for each group for a horizontal activation of 3 mm using Abaqus software. Results : Stress acting on the teeth and bone decreased with increasing beta bend. Moment-to-force (M/F) ratio acting on the anterior teeth was approximately 10:1 with preactivation bends of alpha 30 degrees and beta degrees 15, 30 and 45 degrees whereas the M/F ratio was only 2:1 without the preactivation bends. With increasing beta bend, distal crown tip of the teeth and the extrusive movement of the posteriors increased while the extrusive movements of the anterior decreased. Conclusion : The specs loop with preactivation bends can be efficiently used for en-masse anterior retraction.
Purpose: This study aimed to compare skeletal age determination by using the ratio of third and fourth cervical vertebral dimensions (CVDs) versus the cervical vertebral maturation (CVM) method in an Iranian population. Materials and methods: Lateral cephalometric radiographs of 240 patients were evaluated in this cross sectional study. The samples were classified into three groups (n = 80) of pre-peak of mandibular growth period (group 1), peak of mandibular growth period (group 2), and post-peak of mandibular growth period (group 3) according to the CVM stage. The dimensions of the third and fourth cervical vertebrae were measured. The anterior vertebral body height (AH) was divided by the anteroposterior vertebral body length (AP). The summation of the AH:AP ratio of C3 and C4 was calculated and reported as the SV. The correlation of SVs of 240 patients with their CVM stage was investigated. P-value less than 0.05 is statistically significant. Results: SVs had a significant correlation with the CVM groups (P < 0.05). The area under the curve (AUC) was high for discrimination of group 1 from group 2 (AUC = 0.9776; 95% CI = 0.9448-0.9960), and also group 2 from group 3 (AUC = 0.9848; 95% CI = 0.9539-0.9984). The Youden index specified SVs of 1.29 and 1.61 as the best cut-off points for discriminating group 1 from group 2, and group 2 from group 3, respectively. Conclusions: The two determined cut-off points could discriminate the groups with high sensitivity and specificity. Accordingly, we can use the CVD to determine the patients' mandibular growth status.
To treat facial asymmetry with severe inclination of the frontal occlusal plane, unilateral maxillary impaction in the molar region must be performed to reposition the maxilla. We herein report the successful surgical-orthodontic treatment of a patient with facial asymmetry and significant canted occlusal plane by LeFort I combined with unilateral horseshoe osteotomy and mandibular bilateral intraoral vertical ramus osteotomy (IVRO). A 20-year-old male patient had a chief complaint of mandibular protrusion and mandibular dental crowding. The total active treatment period was 31 months. After postsurgical orthodontic treatment, the right side of the maxilla was impacted by 4.0 mm, while the left side was maintained vertically. The facial asymmetry and canted occlusal plane had mostly improved and satisfactory occlusion, and a straight-type profile had been obtained. In addition, the condylar path length was increased during maximum reciprocal jaw movement, and the incisal path became stable during lateral excursion. Acceptable occlusion and a satisfactory facial profile were maintained after the two-year retention period. Our results suggest that the combination of LeFort I with unilateral horseshoe osteotomy is a useful technique for achieving reliable, superior repositioning of maxillae with a severe cant.
ABSTRACT Purpose: This study aims to explore the possible relationship between mandibular dimensions and bite force. Subjects and Methods: Forty-one subjects (mean age 22.4 ± 1.6 years) were recruited from a pool of dental students and patients seeking dental treatment at the outpatient clinics, College of Dentistry, Taibah University. Digital panoramic radiographs were used and five angular and eleven linear measurements were taken. Comparisons were drawn between right and left sides and eating and non-eating sides using the Mann–Whitney test. Pearson correlation and multiple regression tests were used to assess the existence of any relationship between the bite force and mandibular dimensions. Results: No significant variations were detected in the bite force measurements between the right and left sides or between the eating and non-eating sides. Significant correlations were found between average and maximum posterior bite force and the inclinations of the lower first molar and the lower canine. Conclusion: No relationship exists between the mandibular dimensions and bite force except that the posterior bite force positively correlated with the inclinations of molars and canines.
Aim: To evaluate and compare occlusal contact force distribution, occlusion time and disclusion time following wear of Begg's wrap around retainer and Vacuum formed retainer after completion of orthodontic treatment using a T-scan III. Materials and Methods: Twenty subjects after completion of active orthodontic treatment were randomly allocated into two groups, Group I - Begg's wrap-around retainer (n-10) and Group II-vacuum formed retainer (n-10) one patient was lost to follow up in each group and the final sample size assessed at T1 in each group was 9. T-scan III was used at two-time intervals, T0 - first scan taken immediately after debonding and T1 - taken during retention any time between 10 and 12 months. Comparison of parameters within the groups was done using paired t-test and comparison between the groups was done using independent t-test. Results: No statistically significant difference in the distribution of occlusal contact forces was noted in both groups at T0 and T1 (p value<0.05). Disclusion time reduced in both groups at T1 but a statistically significant reduction in the disclusion time of left lateral excursive movement and protrusive movements (p value<0.05) was noted (T0-T1) in Group I. Statistically significant increase in the occlusion time was noted in Group II (T0-T1) at T1 between the two groups. Conclusion: No differences in occlusal contact force distribution was noted within and between the two groups. Disclusion time reduced in subjects on Begg's wrap around retainers indicating favourable muscle activity and Occlusion time increased in subjects on vacuum formed retainers.
ABSTRACT Purpose The purpose of this study was to biomechanically evaluate maxillary protraction using an orthodontic anchor screw. We conducted three-dimensional finite element analysis to determine the initial displacement and stress distribution during maxillary protraction by comparing a conventional method involving fixation on teeth with maxillary protraction using an orthodontic anchor screw. Materials and methods We used X-ray computed tomography data obtained from Hellman Dental Age IIIA dry human skulls to create a skeletal anchorage model and a dental anchorage model as finite element models. In each model, a load of 6 N was applied in the anteroinferior direction at 0°, 10°, 20°, 30°, and 40° to the occlusal plane by means of a traction hook and the initial displacement and stress distribution were analysed. Results For the anterior nasal spine (ANS) sagittal displacement was greater in the skeletal anchorage model than in the dental anchorage model. In the central incisors and first molars, greater sagittal displacement was observed in the dental anchorage model compared with the skeletal anchorage model. In both models, vertical displacement was 20°, indicating maximum suppression of rotation in the maxilla. The zygomaticomaxillary and zygomaticofrontal sutures demonstrated high stress at 0° and 10° in the dental anchorage model, and at 20°, 30°, and 40° in the skeletal anchorage model. Conclusions These results indicate that tooth and bone–borne maxillary protraction using an orthodontic anchor screw inserted in the palatal region may be of value for the early mixed dentition period in patients with maxillary deficiency.
Purpose: Significance of analysing collum angle in class II malocclusions with respect to lip position may lend greater credibility to variable torque brackets (mainly in the anteriors) that are fast gaining traction. Determine the magnitude of collum angle of maxillary central incisors in Class II division 1, division 2 malocclusions and changes in measurement brought about by variations in lower lip position and incisal contact. Materials and methods: 154 lateral cephalograms were divided into three groups- 55(Angle's class I), 52 (Angle's class II division 1) and 47 (Angle's class II division 2). The collum angle was measured along with lower lip line (in Class II division 2) and lower lip contact (in Class II division 1) malocclusions. Results: The mean collum angles were 2.12 +/- 1.43 degrees, -0.84 +/- 0.87 degrees and 4.67 +/- 2.23 degrees in Groups 1, 2, and 3, respectively. Mean collum angle is significantly increased when the lower lip was found to contact the middle-third of the central incisor(in Group 3)and significantly decreased when the anterior one-third of the lower lip was in contact with the incisal edge of the central incisor (in Group 2). ANOVA followed by Tukey HSD test was carried out to determine statistically significant differences (p < 0.05). Conclusion: Collum angle is significantly decreased in Class II division 1 malocclusions necessitating variable torque prescriptions and segmental mechanics of maxillary anteriors. Appropriate alveolar bone support must be assessed prior to en-masse retraction and intrusion respecting the cortical boundaries. KEY MESSAGES: Variable torque brackets are rapidly gaining credence for their ability to provide sufficient alveolar bone support in different clinical scenarios. In this study, we have emphasized upon utilizing similar mechanics to treat class II malocclusions by utilizing the lower lip position as a reference guide.
ABSTRACT Purpose : In children, snoring and apnoea cause impairments in growth, cognitive function, attention, and school performance. In this study, we aimed to identify the association between craniofacial disharmony and paediatric sleep-disordered breathing. Materials and Methods : Forty-one patients with malocclusion (19 boys; 22 girls; mean age, 10.0 ± 2.1 years) were selected from our hospital. The relationship between maxillofacial morphology, pharyngeal airway form, and nasal respiratory function was examined using cephalometric analysis and skeletal patterns. All patients underwent portable monitoring with an overnight out-of-centre sleep testing protocol that could be performed at home using a portable computerized monitoring system. Results : The respiratory disturbance index was significantly greater in patients with mandibular retrusion than those with malocclusion. Arterial oxygen saturation and nasopharyngeal area were significantly smaller in participants with Class II malocclusion than in those with other types of malocclusion. Moreover, dental cast model analyses confirmed that patients with reduced transverse maxillary dimensions had a higher obstructive sleep apnoea syndrome (OSAS) risk than those with malocclusion. Therefore, patients with mandibular retrusion have a higher OSAS risk than those with other types of malocclusion. Conclusion : Childhood maxillofacial morphology may influence adult OSAS, and early treatment for children with OSAS may help prevent adult OSAS.
