This case report presents a treatment approach which combines clear aligners and skeletal anchorage, mainly micro-implants, to address crowding and lip protrusion in a middle-aged adult who presented with multiple prosthetic restorations. Tooth movements were strategically staged in a virtual setup, beginning with canine retraction using micro-implants to resolve anterior crowding, followed by en-masse distalisation of the dentition. For refinement, additional in-house aligners were employed alongside fixed auxiliaries. The total treatment duration was 9 months, demonstrating high time efficiency. Cone beam computed tomography superimposition indicated posterior tooth distalisation, slight dental arch expansion, and predominantly tipping movements of the distalised teeth. This approach of total arch distalisation rather than conventional sequential distalisation, proved to be temporally efficient against equivalent treatment results. Further research is warranted to improve biomechanical predictability and develop standardised treatment protocols.
Introduction The bond strength of metal brackets to dental restorations directly affects the success of orthodontic treatment. In recent years, the clinical use of permanent restorations for adult patients and fabricated using three-dimensional (3D) printers has been increasing. Therefore, the present study aims to evaluate the shear bond strength (SBS) between orthodontic metal brackets and three different permanent restorative resins. Methods A total of 120 central incisor-shaped samples (n=40 per group) were fabricated from three different permanent restoration resins using a 3D printer: Saremco Print Crowntec (CR), VarseoSmile Crown Plus (VS), and P-Crown V3 (PC). The samples were polished, and the surface area for bracket bonding was roughened under standardised conditions using Al2O3 sandblasting. Following cleaning, metal brackets were bonded using a bis-acryl composite resin according to the adhesive protocol. To simulate intraoral conditions, all samples underwent thermocycling (10,000 cycles between 5 degrees C - 55 degrees C), followed by bond strength testing using a universal testing machine. SBS values and the Adhesive Remnant Index (ARI) scores were recorded. ANOVA was performed to assess the effect of the different resin types on SBS. A Fisher-Freeman-Halton exact test was applied for the comparison of ARI scores. Results The mean and standard deviation of SBS values were 13.28 +/- 2.85 MPa for the CR group, 13.92 +/- 1.60 MPa for the VS group, and 13.33 +/- 2.75 MPa for the PC group. Statistical analysis using the ANOVA test revealed no significant differences between the three resin groups (p = 0.738). In the comparison of the ARI scores between the different resin types, no statistically significant differences were observed (p >0.05). Conclusions The bond strength values between permanent restorative resins and metal brackets were found to be clinically acceptable, and the structural differences between the resins did not affect bond strength.
Objectives The present study aimed to identify factors predictive of increased treatment duration in patients presenting with impacted maxillary canines, and to assess the suitability of space opening as an alternative management technique compared to surgical exposure. Methods A retrospective investigation of case records and radiographs of 73 patients who presented with impacted maxillary canines was undertaken. A control group of 45 patients with matching age and gender profiles was also collected. Patient age, gender, treatment modality (orthodontic space opening and/or surgical exposure), and overall treatment duration were recorded. The variables describing canine location and orientation were assessed on two-dimensional orthopantomograms (OPGs). Results The treatment of labial/mid-alveolar sites of canine impaction took 32.1 weeks longer, and palatally-impacted canines 43.5 weeks longer, compared with conventional orthodontic cases. The assessment of multicollinearity found a significant correlation between the radiographic descriptors of canine impaction identified on OPGs. The group of variables was strongly associated with treatment time (p<0.001) and explained 24.03 per cent of the variability. Treatment by surgical exposure was associated with a statistically insignificant 32.3-week reduction in treatment time compared to space opening (p=0.07) while a change from space opening to surgical exposure was associated with a statistically insignificant 17.3-week reduction in treatment time compared to space opening (p=0.27). However, the case selection for surgical and non-surgical management of impacted canines differed significantly. All labial/mid-alveolar canines, and palatal canines in sectors I and II, or vertical (KPG) classification 1 were successfully treated by space opening. Most palatal impactions in sector IV, and all vertical (KPG) classification 4 canines required surgical exposure. For appropriately case-selected patients, treatment time did not differ significantly between space opening (128.9 weeks) or surgical exposure (136.0 weeks). Conclusions The increased total treatment duration for impacted maxillary canines is associated with worsening impaction as assessed on OPGs. Space opening is a valid treatment modality for all but the most severely impacted maxillary canines.
Objective This study aimed to compare the validity of the mental foramen (MF) and gonion (Go) as landmarks for a mandibular horizontal plane by assessing their vertical positions and line angulations. Methods Ninety cone-beam computed tomography scans of skeletal Class III adult patients were included. The patients were divided into two main groups: symmetry (n=30) and asymmetry groups (n=60). The asymmetry group was subdivided into the roll (n=30) and non-roll types (n=30). A three-dimensional co-ordinate system was established using the best-fit mirroring superimposition of the mandibular body. Landmark positions of the MF and Go were analysed and line angulations were calculated using their coordinates. Results The Go line angulation relative to the x-axis in the mandibular co-ordinate system was significantly greater than the MF line angulation in both groups and asymmetry types (P<0.05). The difference between the Go line and the MF line angulations was significantly greater in the roll type than in the non-roll type. The bilateral vertical discrepancy in Go position was significantly greater than that of MF for both groups and asymmetry types. Conclusions The bilateral vertical discrepancy of the MF was significantly smaller than that of Go in symmetrically positioned mandibles. The mandibular roll may be assessed differently when using MF-based versus Go-based mandibular planes.
Objective The discrepancy between an anticipated digital configuration and the realised results poses a continual challenge during clear aligner therapy. The present study aims to examine the generated tooth movement achieved when upper molars are moved distally using clear aligners and Class II elastics.Materials and methods Thirty adult patients (13 males and 17 females) aged between 18 and 35 years-old were analysed. CBCT scans taken before and at the end of a distalisation phase were superimposed using a voxel-based registration. Molar distalisation efficiency, tipping and rotation angles, and changes in arch width were quantified to assess the achieved tooth movement. Pearson's correlation coefficients and multiple linear regression models were applied to examine the tooth changes, and how gender, attachments, and initial crowding affected the results.Results The study determined that the effectiveness of moving upper molars distally using clear aligners along with Class II elastics was 60% +/- 7% of the designed movement. Due to a counterforce, the upper incisors experienced labial tipping of 3.84 degrees +/- 1.1 degrees, the lower molar was mesialised by 0.64 mm +/- 0.27 mm, and the lower incisors underwent labial tipping of 2.61 degrees +/- 1.13 degrees. The upper archwidth displayed a non-significant increase, whereas the width of the lower arch exhibited a non-significant reduction. Furthermore, molars with attachments exhibited reduced distal tipping and rotation. The initial crowding was inversely related to the amount of upper molar distalisation and positively related to tipping.Conclusion This is the first CBCT superimposition study to reveal the achieved tooth movements during upper molar distalisation. The results suggest that multiple factors impact tooth movement.
Tooth fusion in the permanent dentition is exceedingly uncommon, particularly if involving a mandibular lateral incisor–canine pair. Bilateral fusion is even more rare. The present study describes a 27-year-old female who presented with severe maxillary anterior crowding and bilateral mandibular tooth fusion, which was complete on the right and incomplete on the left side. After discussion of alternative options, treatment comprised the extraction of both maxillary first premolars, conservative reduction of the right fused unit and a controlled 90° rotation of the left fused mandibular teeth, while applying a self-ligating fixed appliance system. Over 25 months of comprehensive orthodontic therapy, Class I molar and canine relationships were maintained, the mandibular midline was corrected, the maxillary incisors were uprighted and retracted, the mandibular incisor inclination was reduced, and overjet and overbite were normalised. At a three-year review, occlusal stability, periodontal health and patient satisfaction were upheld. This proof-of-concept demonstrates that rotational mechanics can effectively create space and harmonise tooth form in cases of rare fusion anomalies without compromising pulp vitality or periodontal integrity and further, highlights the need for larger cohort studies to confirm long-term predictability.
Similar to many other fields, developments in digital technology and artificial intelligence have reached exciting levels within the orthodontic profession. However, it is predicted that certain branches of medicine, such as radiology, pathology and dermatology, may either 'fall victim' to the rapid advancements in artificial intelligence or undergo significant transformations. In this context, how will the digital transformations that excite orthodontists and the increasing integration of artificial intelligence in orthodontics impact the future of the profession? What long-term effects will these rapid advancements in artificial intelligence, in particular, have on orthodontics? This article seeks to stimulate a range of perspectives among orthodontists regarding the future of their profession by examining the recent developments in digital technologies, aligners, and artificial intelligence.
Aim The objective of this bibliometric analysis was to provide an overview of the current literature status of myofunctional therapy and to assist practitioners and researchers to make clinically relevant decisions and to foster collaborations by mapping out bibliographic information.Methods A literature search was conducted using the Web of Science Core Collection through the electronic library of Ege University by applying the query "(TS = (myofunctional therapy OR dental myofunctional therapy OR myofunctional treatment OR myofunctional appliance))." The 50 most-cited articles were analysed in September 2024 using VOSviewer software to assess parameters associated with authorship, the country of origin, academic institutions, and keywords, so that the interrelationships could be mapped.Results The 50 most-cited articles, authored by a total of 227 researchers, were published between 1998 and 2022, and attracted a cumulative total of 2483 citations. According to the Web of Science (WoS) categories, most of the publications were classified under Dentistry, Oral Surgery & Medicine, followed by Clinical Neurology. The United States was the country with the highest number of citations, while Stanford University emerged as the institution with the greatest number of frequently cited works.Conclusion This bibliometric analysis highlights the increasing research interest in myofunctional therapy and its role in addressing a malocclusion, obstructive sleep apnoea, and other orofacial conditions. While international collaboration is growing, limited cross-specialty integration remains, emphasising the need for more interdisciplinary studies and randomised controlled trials to strengthen evidence-based practices.
Objective To investigate the clinical effect of the Myobrace appliance and traditional functional appliances in treating Class II malocclusions. Methods Six databases (PubMed, Web of Science, Cochrane Library, ClinicalTrials.gov, CNKI, and Embase) were searched to collect and compare articles regarding the effect of the Myobrace appliance and traditional functional appliances for treating Class II malocclusions in children. The literature in both the English and Chinese languages was systematically searched. Randomised controlled trials, non-randomised controlled trials, and retrospective studies were included. A meta-analysis was performed using the RevMan5.4.1 software. Results A total of 12 trials involving 577 patients were included in the quantitative synthesis analysis. The results indicated that, compared to a Twin-block group, the Myobrace group showed significantly smaller reductions in the SNA angle, smaller increases in Ar-Go and Go-Me (mm), and smaller decreases in overbite and overjet (mm) (p < 0.05 for all). Additionally, compared to an Activator group, the Myobrace group demonstrated a significantly smaller increase in the SNB angle (p < 0.05). Conclusions Moderate evidence suggests that the Myobrace appliance and traditional functional appliances were effective in correcting a Class II malocclusion, but the Twin-block appliance was more effective than the Myobrace appliance in inhibiting maxillary growth and reducing overjet and overbite, while the Activator was more effective in promoting mandibular growth.
Molar incisor hypomineralisation (MIH) is a developmental, qualitative enamel irregularity associated with a reduction of inorganic and mineralised components, leading to tooth discolouration and weakening of tooth structure. Patients presenting with one or more teeth affected by MIH are common in dental practice. With a broad range of clinical manifestations, MIH can be difficult to diagnose. The condition may have a deleterious impact on the general health, psychosocial well-being and the quality of life of children who are affected. Teeth with MIH can result in hypersensitivity, sub-optimal aesthetics, and a rapid increase of dental caries. It also presents additional challenges for the orthodontist in relation to the management of affected patients. The present paper provides an evidence-based overview of the prevalence and aetiology of the condition, with specific emphasis on the orthodontic implications. The paper summarises the clinical characteristics of MIH and the range of potential management options. An accurate and timely diagnosis can enable effective planning and appropriate management that is tailored for the individual child patient.
Aim To investigate and compare patient perceptions and satisfaction regarding traditional braces and clear aligners.Materials and methods In this qualitative, interpretive study, a total of 40 participants were recruited from a public institution and a private clinic. Participants were over the age of 18 years and categorised into six groups, dependent on treatment type and stage. A qualitative questionnaire, asking 16 open-ended questions was distributed by email and was hosted online using XM Qualtrics. All responses to the questionnaire were organised into themes using NVIVO and were then analysed using the Braun and Clarke reflexive thematic analysis approach.Results Patient perceptions towards braces were primarily influenced by family, friends and research on the internet, while clear aligner consumers' perceptions appeared to be greatly influenced by social media. Patients generally perceived braces to be unaesthetic, painful and inconvenient. Clear aligners were considered aesthetic, but also associated with possible pain, increased oral hygiene practices and reported clinical limitations. Throughout treatment, braces users were less concerned regarding the aesthetics of their appliances when compared to the pain and other faced inconvenience. Clear aligner patients were mostly satisfied with the aesthetics of their appliance and least satisfied with the inconvenience of having to insert and remove them before and after meals.Conclusion Braces users relied on dentists and family for information, while aligner users sought online sources and social media. Braces were associated with poor visible aesthetics and discomfort, while aligners were preferred for their discrete appearance and convenience. Braces affected eating and oral hygiene to a greater extent, while aligners required frequent removal for meals, which posed challenges. Negative experience perceptions continued post-treatment for wearers of braces but did not for users of aligners. Treatment choice should consider patient priorities and case complexity, but also the manner by which consumers seek information and evaluate experience expectations related to pain and aesthetics.
Background and aim To establish a smartphone-based application (App) for orthodontic soft-tissue analysis and to compare the derived soft-tissue linear and angular measurements to those acquired from conventional lateral cephalometric and digital photogrammetric analyses.Methodology A pilot study was conducted on 26 participants aged between 14 and 30 years who intended to undergo orthodontic treatment. Each participant was subjected to three methods of soft tissue measurement: lateral cephalometric tracing measurements using Dolphin Imaging software, digital photogrammetric tracing measurements using WebCeph Website (webceph.com), and Smartphone App tracing measurements (SOFTBLINK). The applied linear and angular measurements were: Profile facial third, Profile angle, Nasiolabial angle, Mentolabial angle, and Mandibular plane angle. The values obtained from the Dolphin imaging software, WebCeph, and SOFTBLINK application were compared using the repeated measures MANOVA test.Results Despite the mild variation obtained in the mean values between the three methods of soft tissue analyses, the MANOVA and the subsequent multiple pairwise comparison tests revealed a statistically non-significant difference between the three methods of soft tissue measurement regarding all of the tested linear and angular measurements.Conclusions The results obtained by the SOFTBLINK App showed comparable measurements with the Dolphin Imaging software. User-friendly mobile Apps can be utilised with sufficient accuracy for the soft tissue analysis required in daily clinical orthodontic practice
Objectives This meta-analysis aims to evaluate the effects of occlusal therapy, specifically the use of occlusal splints, on psychosocial outcomes in patients with temporomandibular joint disorders (TMDs). While occlusal splints are commonly used to manage TMD symptoms, their impact on psychological and quality-of-life outcomes, such as anxiety, depression, oral health-related quality of life, sleep quality, and overall quality of life remains unclear.Methods A systematic search was conducted across databases including PubMed, Google scholar, Scopus, and Web of Science, focusing on studies which assessed the psychosocial impacts of occlusal splint therapy in adult TMD patients. Eligible studies, published between 2000 and 2024, included quantitative measurements of the specified psychosocial outcomes. A total of 17 studies met the inclusion criteria and were subjected to meta-analytic review. Effect sizes were calculated using a random-effects model, with subgroup analyses conducted to explore potential moderators.Results The overall findings suggest that occlusal splint therapy does not significantly improve anxiety, overall quality of life, nor sleep quality in patients presenting with temporomandibular joint disorders (TMDs). The significant improvement observed in depression symptoms, while small, could imply a potential mental health benefit of splint therapy. Similarly, the improvement in oral health-related quality of life with occlusal splints indicates a specific benefit for oral health perceptions and related quality of life.Conclusions The meta-analysis suggests that occlusal splint therapy has a limited and variable impact on the psychosocial and quality of life outcomes for patients presenting with temporomandibular disorders (TMDs).
Objectives: To assess using CBCT, the mandibular buccal shelf (MBS) bone thickness asymmetry and its relationship with cortical and cancellous bone density in Vietnamese adults presenting with Class I bimaxillary protrusion (Class I BP) and skeletal Class III malocclusions. Materials and Methods: CBCT scans of 60 Vietnamese adults (30 Class I BP: 7 males, 23 females, mean age 27.63 years; 30 Class III: 15 males, 15 females, mean age 23.63 years) were analysed. Total bone thickness (dTB) was measured at 6, 9, and 12 mm below the cementoenamel junction at the mandibular first and second molars (R6G, R6X, R7G, R7X). Cortical (M & Dstrok;V) and cancellous (M & Dstrok;X) bone density were evaluated. Left-right asymmetry was tested using Wilcoxon or t-tests, and correlations were assessed using Spearman's rho coefficient (P<0.05). Results: Class I BP cases showed significant left-right asymmetry in dTB at R6G and R6X (e.g., R6G 6 mm: 1.57 +/- 0.93 mm vs. 2.25 +/- 1.38 mm, P=0.004). The Class III group showed no asymmetry (P>0.05). No significant correlations were found between dTB and M & Dstrok;V or M & Dstrok;X (e.g., Class I BP, R7X 12 mm: r=-0.087, P=0.646 for M & Dstrok;V). No intergroup differences in dTB were observed (P>0.05). Conclusions: A Class I BP malocclusion exhibited MBS asymmetry at R6G and R6X, unlike a symmetrical Class III malocclusion. No correlation between bone thickness and density suggested independent adaptations, aiding miniscrew placement in Vietnamese adults.
Background: To evaluate the responses given by ChatGPT 4.0, Google Gemini 1.5 and Claude 3.5 Sonnet chatbots to questions about impacted canines in relation to reliability, accuracy and readability. Methods: Thirty-five questions were posed to 3 different chatbots and 105 responses were received. The answers were evaluated in relation to reliability (Modified DISCERN), accuracy (Likert scale and Accuracy of Information Index (AOI)) and readability (Flesch-Kincaid Reading Ease Score (FRES) and Flesch-Kincaid grade level (FKGL)). Statistical significance was set at p<0.05. Results: Gemini had the highest modified DISCERN score (33.66 +/- 2.64), followed by Claude (29.70 +/- 3.08) and ChatGPT (28.13 +/- 2.83). ChatGPT had the highest mean Likert score (4.76 +/- 0.43), while Claude and Gemini had 4.71 +/- 0.47 and 4.66 +/- 0.47, respectively. For the AOI index, ChatGPT had the highest mean score (8.67 +/- 0.55), which was statistically significant when compared to others (ChatGPT vs Claude: p=0.042, ChatGPT vs Gemini: p=0.036). All chatbots showed similar readability FRES and FKGL scores without any significant differences (p=0.121 and p=0.377, respectively). Claude expressed responses with significantly fewer words than the other chatbots (Claude vs ChatGPT: p=0.019, Claude vs Gemini: p=0.001) and ChatGPT was the AI service that used the most words (239.74 +/- 114.21). Conclusion: In answering questions about impacted canines, Gemini showed good, while ChatGPT and Claude provided moderate reliability. All chatbots achieved high scores for accuracy. However, the responses were difficult to understand for anyone below a college reading level. Chatbots can serve as a resource for patients seeking general information about impacted canines, potentially enhancing and expediting clinician-patient communication. However, it should be noted that the readability of chatbot-generated texts may pose challenges, thereby affecting overall comprehension. Moreover, due to patient-specific, case-based variations, the most accurate interpretation should be provided by the patient's healthcare professional. In the future, improved outcomes across all parameters may be achieved through advancements in chatbot technology and increased integration between healthcare providers.
Objective To evaluate the effects of different lingual retainers on mandibular anterior tooth stability one-year follow-up period.Materials and methods A total of 140 patients who had undergone non-extraction orthodontic treatment were included in the investigation. For lower incisor retention, Group 1 received a bonded 0.0175-inch seven-strand stainless steel wire (Ortho Technology, Tampa, FL, USA), Group 2 received a 0.022 x 0.016-inch eight-strand dead-soft wire (Bond-A-Braid, Reliance Orthodontic Products, IL, USA), Group 3 received a 0.038 x 0.016-inch prefabricated stainless steel wire (Ortho FlexTech (R), Reliance Orthodontic Products, Itasca, IL, USA), and Group 4 received a fibre-reinforced composite wire (StickTech, Turku, Finland). Tooth stability was assessed using Little's Irregularity Index, intercanine width, and arch length measurements taken at five different time points.Results After one year, changes in Little's Irregularity Index were statistically greater in Groups 2 and 4 than in Groups 1 and 3. Reductions in intercanine width were also significantly greater in Groups 2 and 4. No significant differences in arch length changes were found between the groups. Wire breakages were statistically more frequent in Group 4, and bonding failures were higher in Group 2. Using a 0.0175-inch seven-strand stainless steel wire or a 0.038 x 0.016-inch prefabricated stainless steel wire for lingual retainers is recommended.Conclusion Stainless steel retainers are recommended for 1-year stability due to their durability and lower failure rate, whereas fibre-reinforced composite retainers may be less reliable.
Objective Recent advancements in technology have promoted artificial intelligence (AI) to automatically detect landmarks on lateral cephalograms. This study aimed to evaluate the reliability of an AI-assisted cephalometric analysis program (Webceph, Gyeonggi-do, Republic of Korea) in the assessment of cephalometric measurements involving bilateral landmarks. Materials and methods Fifty-one high-quality cephalograms were used and inclusion/exclusion criteria were applied. Two researchers manually traced the cephalograms after which an AI-assisted cephalometric analysis program (Webceph) was applied. Both intra-and inter-operator reliability were tested. Independent Sample t-tests were used to compare the means of measurements. Results The inter- and intra-class correlation coefficients were 0.80 which indicated ‘good’ reliability. Statistically significant differences were found in the gonial angle and effective mandibular length measurements ( p <0.05), but not in the articular angle and FMA angle ( p >0.05). The results suggest that, while AI-assisted programs provide reliable measurements, differences in certain measurements may be attributed to inherent AI algorithm limitations. Clinicians should verify and, if needed, correct bilateral landmark locations after the initial AI digitisation. Conclusion AI-driven cephalometric analysis holds promise for improving diagnostic efficiency and precision. However, limitations and further AI advancements require consideration to ensure appropriate clinical use.
Objectives The aim of this study was to compare the accuracy and reproducibility of linear measurements on photographs taken using a smartphone and a DSLR camera, using the DSLR camera as the gold standard for comparison.Materials and methods A total of 120 clinical photographs were taken of 30 participants who met the inclusion and exclusion criteria. Each participant had four standardised photographs captured: one extraoral and one intraoral view using a smartphone (Xiaomi) and repeated using a DSLR camera. Five linear measurements from the extraoral photographs and four linear measurements from the intraoral photographs were recorded. Measurements were analysed using an image software program with a precision of 0.01mm. Accuracy was assessed using the paired t-test/Wilcoxon signed ranks test while reproducibility was assessed using the paired t-test/Wilcoxon signed ranks test and ICC.Results The mean differences in measurements for the photographs captured with a DSLR camera and a smartphone were statistically significant, with the smartphone measurements consistently smaller. The reproducibility was excellent for the extraoral measurements and good to excellent for the intraoral measurements while the paired t-test showed no identified statistical differences.Conclusion Linear measurements taken from the tested android smartphone (Xiaomi Mi 10T Pro) were consistently underestimated compared to a DSLR gold standard, but intraoral discrepancies were clinically acceptable and measurement reproducibility rated good to excellent. These findings apply only to the device evaluated and should not be generalised to other smartphone models.
Aim The increased risk of caries during orthodontic treatment is a significant prevention challenge. This in vitro study aimed to evaluate the caries-preventive potential of bioactive composites used in clear aligner attachments. Methods A bioactive composite group consisted of Activa Bioactive Restorative (Pulpdent, USA), while a traditional flowable composite group included G-Aenial Universal Flo (GC, Japan). A total of 24 sound extracted human teeth were cleaned using pumice, and all surfaces except for a 3 x 3 mm area on the buccal crown were coated with acid resistant varnish. Standard acid etching and bonding protocols were applied to the exposed area, after which clear aligner attachments were created using a mould. The specimens underwent pH cycling, consisting of immersion in a demineralising solution for 48 hours followed by immersion in a remineralising solution for 24 hours, repeated three times. Sections were obtained from the attachment areas, and demineralisation depths were measured using a digital microscope. Statistical analysis was performed using an independent samples t-test. Results The mean lesion depth for the bioactive composite (Activa Bioactive Restorative) was 120 +/- 29 mu m, while the traditional flowable composite (G-Aenial Universal Flo) exhibited a mean lesion depth of 150 +/- 41 mu m. According to the t-test results, significantly less demineralisation depth was observed in the bioactive composite group (p < 0.05). Conclusion Under in vitro conditions, bioactive composites exhibited lower demineralisation depths compared to traditional flowable composites. The findings suggest that bioactive composites may offer caries-preventive benefits when used in clear aligner attachments, although further studies are needed to confirm the effects.
Objective Mandibular advancement appliances (MAAs) are used to treat primary snoring and obstructive sleep apnoea (OSA) by advancing the mandible to maintain upper airway patency during sleep. The conventional fabrication of custom-made MAAs requires skilled technicians and specialised laboratories, resulting in longer processing times and higher outsourcing costs. Advancements in 3D-printing technology offer an efficient in-office alternative. The present paper aims to demonstrate the potential of digital technology in fabricating in-office, 3D-printed, non-adjustable monobloc MAAs.Methods The fabrication and refinement processes of non-adjustable monobloc MAAs were carried out on three patients of whom two presented with primary snoring and one with mild OSA. The appliances were designed using Appliance Designer (TM) software (3Shape, Copenhagen, Denmark) and 3D-printed with a stereolithography printer (Uniz 3D printer, San Diego, US) using Ortho Flex resin (NextDent, The Netherlands).Results One MAA was made for each patient and incorporated specific refinement strategies to optimise fit and retention. Improvements in snoring were noted in all patients. The Apnoea-Hypopnoea index (AHI) was normalised from 11.2 to 4.6 for the patient with mild OSA.Conclusion 3D-printed MAAs were successfully employed to manage patients presenting with primary snoring and mild OSA. The digital workflow for fabricating 3D-printed MAAs, including refinement strategies to enhance fit and retention was presented, thereby laying the groundwork for future investigations and the development of in-office 3D-printed MAAs.
