Objectives:To investigate whether significant differences existed in the influence among factors considered during the selection process when ranking orthodontic programs and to understand how an individual's race or ethnic background might affect what factors were more important than others. Materials and Methods:A survey was distributed to orthodontic residents to assess overall preferences and differences in desirability of various factors between historically underrepresented racial and ethnic (HURE) and non-HURE applicants. Results:A total of 115 individuals initiated the survey, and 98 were included for analysis. Sixteen respondents were considered HURE applicants. "Clear aligner therapy training," "good quality of clinical faculty," and "high number of cases started" had the highest mean desirability overall. The most important factors influencing program rank order were "satisfied current residents," "low cost," and "having multiple techniques and treatment philosophies taught." HURE respondents rated "diversity of training of faculty" (P = .0154), "racial and ethnic diversity of current and former residents" (P = .0007), "racial and ethnic diversity of faculty" (P = .0002), "racial and ethnic diversity of patient population" (P = .0131), "male : female ratio of residents" (P = .0225), "participation in care of Medicaid patients" (P = .0251), and "dental school-based program" (P = .0493) higher than their non-HURE counterparts. Conclusions:Clinical factors are the most important to program applicants. However, HURE applicants place greater importance than non-HURE applicants on characteristics that promote inclusivity and representation of individuals of similar racial and ethnic backgrounds (peers, mentors, and patients).

Orthodontic microimplants have revolutionized anchorage in orthodontics but remain vulnerable to microbial colonization, potentially leading to infection and failure. Surface modifications incorporating silver nanoparticles (AgNPs) offer antimicrobial benefits, providing long-term protection against bacterial infections, while improving partial osseointegration. This study investigates hybrid coatings enriched with AgNPs, calcium (Ca), and phosphorus (P) to improve antimicrobial efficacy and reduce biofilm formation. Microimplants fabricated from the Ti6Al4V alloy were divided into six groups with varying surface treatments, including etching in hydrofluoric acid and hybrid layers containing 0.5 mol% AgNPs and CaP. Antibacterial activity was evaluated using agar diffusion and biofilm formation assays against S. aureus, E. coli, and S. mutans. Surface roughness was analyzed and correlated with biofilm formation. The model assessing the impact of biomaterials on S. aureus biofilm revealed a strong association (R2 = 0.94), with biomaterial choice significantly influencing biofilm formation. The model for E. coli biofilm exhibited exceptional predictability (R2 = 0.99). The model for S. mutans biofilm demonstrated an association (R2 = 0.68). Hybrid coatings exhibited a promising antimicrobial activity. Biofilm formation was higher on microimplants with rougher surfaces. Hybrid coatings enriched with AgNPs and CaP enhance antimicrobial properties and partially reduce biofilm formation. It is suggested that the optimization of microimplant surface areas varies according to function. An enhanced performance can be achieved by maintaining a smooth surface for soft tissue contact, while incorporating a rough surface enriched with bactericidal and bioactive modifiers for bone contact areas.

Integrating artificial intelligence (AI) and advanced three-dimensional (3D) imaging has revolutionised dentistry by enhancing diagnostics and treatment planning. Advanced algorithms and machine-learning techniques may enable orthodontists to analyse complex cases and predict treatment outcomes accurately. This technology facilitates the creation of customised treatment plans that consider individual tooth morphology and periodontal health, optimising force application and minimising treatment time. Since their introduction, clear aligners have gained popularity, with over 17 million people treated by 2023. Compared with fixed appliances, clear aligners offer advantages, such as better aesthetics, comfort and oral hygiene. Treating patients with a compromised periodontium requires accurate diagnosis and treatment planning. This paper reviews how AI-driven treatment planning software predicting root movement and visualising bone structures may impact treatment decisions and, ultimately, treatment outcomes. The technology behind machine learning and AI in designing clear aligners is discussed. Research shows that when viewing the cases in 3D, clinicians are more comfortable when treating crowding cases with a non-extraction approach using interproximal reduction (IPR) only. However, it was interesting to note that clinicians with extensive experience treating clear aligner patients were more comfortable using IPR to address severe crowding cases when viewed in 2D, compared with those less experienced with clear aligners. However, when the cases were visualised in 3D, both groups showed equal comfort in using IPR, as the roots were within the bone. AI-driven treatment planning software, utilising machine learning in conjunction with 3D modelling, may enhance the predictability of orthodontic movements while reducing treatment time and increasing patient satisfaction.

Bacterial infections are a common cause of clinical complications associated with the use of orthodontic microimplants. Biofilm formation on their surfaces and subsequent infection of peri-implant tissues can result in either exfoliation or surgical removal of these medical devices. In order to improve the properties of microimplants, hybrid coatings enriched with silver nanoparticles, calcium, and phosphorus were investigated. The present study aimed to assess the microstructure of commercially available microimplants composed of a medical TiAlV (Ti6Al4V) alloy covered with organic–inorganic layers obtained by the sol–gel method using the dip-coating technique. The microstructures and elemental surface compositions of the sterile, etched, and layer-modified microimplants were characterized by scanning electron microscopy with X-ray energy-dispersive spectroscopy (SEM-EDS). Elements such as silver (Ag), calcium (Ca), phosphorus (P), silicon (Si), oxygen (O), and carbon (C) were detected on the microimplant’s surface layer. The SEM observations revealed that control microimplants (unetched) had smooth surfaces with only manufacturing-related embossing, while etching in hydrofluoric acid increased the surface roughness and introduced fluoride onto the microimplants. Layers with only silver nanoparticles reduced the roughness of the implant surface, and no extrusion was observed, while increased roughness and emerging porosity were observed when the layers were enriched with calcium and phosphorus. The highest roughness was observed in the microimplants etched with AgNPs and CaP, while the AgNPs-only layer showed a reduction in the roughness average parameter due to lower porosity. Enhancing the effectiveness of microimplants can be achieved by applying selective surface treatments to different parts. By keeping the outer tissue contact area smooth while making the bone contact area rough to promote stronger integration with bone tissue, the overall performance of the implants can be significantly improved.

The aim of this study was to determine the influence of age and gender on the incidence of calcification in laryngeal cartilage diagnosed on lateral cephalometric radiographs routinely taken for orthodontic diagnosis. The lateral cephalometric radiographs of 957 patients who met the study criteria were analyzed from among the 1000 lateral radiographs originally collected. The images were evaluated independently by two investigators. Given the dichotomous dependent variable (calcification or no calcification), a mixed logistic regression model was used to test how age and gender affected calcification. The effect of age and gender reliably determined the likelihood of laryngeal cartilage calcification. The greatest differences in the degree of calcification by gender were found at ages 20–25 years. The degree of calcification increased with age, reaching 100% in women at age 30 and in men at age 50. In women, the degree of calcification was higher than in men from the age of 13 years and levelled off at the age of 50 years. The interrater agreement was strong k = 0.97, z = 30.0, p < .001. Calcification can be detected by orthodontists trained in lateral cephalogram analysis and can be used as a screening or diagnostic tool to detect calcified areas in the larynx.

INTRODUCTION:This prospective study compared pain perception, intensity, and analgesic use among patients treated with fixed appliances (FAs) and clear aligners (CAs) over 6 months. METHODS:Digital surveys were collected from 87 adult patients treated with CA or FA from 2 orthodontic offices. The 7-item survey was sent at 3-time points (preappointment, 2-day postappointment, and 7-day postappointment) for each appointment. Wilcoxon, t test, and Fisher exact chi-square tests were performed with significance set at 0.05. RESULTS:The FA group had a higher rate and intensity of pain 2 days after the second, third, and fifth appointments (P <0.030). At 7 days postappointment, the FA group had a higher rate and intensity of pain for the first and fifth appointments. Dull pain was reported the most in both groups, with a proportion of FA patients reporting throbbing (31%) or sharp (20%) pain (P = 0.035) at 2 days postappointment. The CA group reported the most pain at rest, whereas the FA group reported chewing as the most painful (P = 0.002). The FA group had a higher rate of analgesic consumption after the first appointment (P = 0.037). CONCLUSIONS:Both the FA and CA groups experienced similar rates and intensities of pain 2 days after the delivery of appliances at the first appointment. Although CA pain intensity remained minimal, FA pain peaked 2 days postappointment whenever a new orthodontic stimulus was introduced and remained elevated 7 days postappointment when that stimulus was a new archwire material.

IntroductionClear aligner technology based on a machine learning algorithm is currently available for orthodontic treatment. Treatment planning on the basis of 3-dimensional crown, root, and bone imaging is claimed to provide accurate diagnosis and better treatment outcomes for adult patients with complex needs. This study aimed to answer the following questions: (1) would practitioners modify their original treatment plan once provided with the crown, root, and bone view? and (2) does practitioner satisfaction regarding treatment outcomes change once the crown, root, and bone view is provided?MethodsAn online questionnaire was emailed to members of the American Association of Orthodontists (n = 2300) and the Virginia Orthodontic Education and Research Foundation (n = 211). The survey consisted of videos of 4 patients shown in 2 presentations: crown-only and crown, root, and bone views, generated by artificial intelligence-driven treatment planning software (3D Predict aligner system; 3D Predict, New York, NY). Respondents were asked to answer treatment-related questions and rate the treatment outcomes using a visual analog scale. Statistical analyses were completed to determine the significance of crown, root, and bone view on treatment planning with clear aligners.ResultsA total of 70 orthodontists participated in the survey. There were significant differences in responses when viewing patients in crown-only and crown, root, and bone presentations. Across the 4 patients, 33%-43% of practitioners changed their sentiment toward the treatment plan (P <0.001). When rating satisfaction on the 100-point scale, average ratings changed by 10.6 to 21.0 points; both increases and decreases in satisfaction were seen across the patients (P <0.001).ConclusionsWhen given 3-dimensional information on the position of a patient’s crowns, root, and bone coverage, orthodontists are likely to change their clear aligner treatment plan. This study showed that a confirmation of dehiscence and fenestrations using the root and bone view resulted in practitioner dissatisfaction despite an initial satisfaction with the crown-only view.

OBJECTIVES:To determine recognition ability and the levels of esthetic tolerance of deep bite and anterior open bite (AOB) among laypeople and investigate the factors affecting levels of tolerance. MATERIALS AND METHODS:Using a questionnaire, laypeople (N = 100) were examined, and overbite was measured. They were tested for whether they recognized deep bite and AOB. Esthetic tolerance thresholds for deep bite and AOB were selected by incremental depiction in grayscale images. Stepwise logistic regression analyses were used to quantify the effect of recognition and other factors (age, sex, education level, occupation, history of orthodontic treatment, interest in orthodontic treatment or retreatment, and overbite presence) affecting the tolerance of overbite problems (α = 0.05). RESULTS:Of the participants, 55% and 94% recognized deep bite and AOB, respectively. Participants with a deep bite were significantly more likely to esthetically tolerate deep bite compared with those without a deep bite (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.29-9.89). Participants who recognized a deep bite problem had significantly lower esthetic tolerance to deep bite compared with participants who did not recognize a deep bite (OR, 0.17; 95% CI, 0.06-0.45). None of the other eight chosen factors significantly affected the tolerance level of AOB (P > .05). CONCLUSIONS:Participants with a deep bite or those who did not recognize a deep bite had significantly higher esthetic tolerance of deep bite than those without or those who recognized the problem (P < .05).

INTRODUCTION:Extrusion of maxillary lateral incisors during aligner treatment is a difficult movement to achieve accurately. Despite recommendations regarding attachment design, few studies and no prospective trials compare predictability among attachments. This study aimed to compare the efficacy between optimized and horizontal attachment designs for achieving maxillary lateral incisor extrusion during clear aligner treatment. METHODS:The study included maxillary lateral incisors in 3 orthodontic practices requiring at least 0.3 mm of extrusion during the first series of 20-25 aligners in patients aged ≥16 years who were scheduled to begin clear aligner treatment (Invisalign; Align Technology, San Jose, Calif). Teeth were randomly assigned to receive optimized (O), rectangular horizontal nonbeveled (H), rectangular horizontal incisally-beveled (HIB), or rectangular horizontal gingivally-beveled (HGB) attachments. After the first series, a blinded evaluator measured extrusion using superimpositions with initial and predicted models. Linear models determined the difference in the predicted extrusion percentage achieved on the basis of attachment design. Other covariates were patient age, sex, number of trays, and self-reported compliance. RESULTS:Forty patients (74 teeth) were enrolled, and 38 patients (71 teeth) completed the study. Intraexaminer and interexaminer reliability for extrusion measurements was high (intraclass correlation coefficient, 0.985 and 0.991, respectively). The achieved extrusion was significantly less than predicted (mean, 73%; P <0.0001). The average achieved extrusion was 62%, 79%, 78%, and 78% for O, H, HIB, and HGB attachments, respectively, with H significantly more effective than O (P = 0.0403). Horizontal attachments (H, HIB, and HGB combined) were significantly more effective than O attachments (P = 0.0060), with an average difference in achieved extrusion of 14% of the predicted amount (95% confidence interval, 4-23; estimated 76% vs 62%). Horizontal attachments were an estimated 22% more effective than O attachments for extruding maxillary lateral incisors. CONCLUSIONS:Horizontal attachments are more effective than O attachments for predicted maxillary lateral incisor extrusion between 0.3 and 2.5 mm. The 3 horizontal attachment designs evaluated performed similarly for achieving predicted extrusion. TRIAL REGISTRATION:This randomized clinical trial was registered and reported at clinicaltrials.gov (NCT04968353). PROTOCOL:The protocol was not published before trial commencement. FUNDING:This study was funded in part by the Alexander Fellowship of the Virginia Commonwealth University School of Dentistry, the Southern Association of Orthodontists, and the Virginia Orthodontic Education and Research Foundation. No funding source influenced the study design, the collection, analysis or interpretation of data, writing of the report, or the decision to submit the article for publication.

Introduction: Teledentistry in orthodontics is growing, yet patient preferences for its use is unknown. This study aimed to determine the perceived value of doctor-to-patient face-to-face interaction, convenience, and attitudes toward specific uses of teledentistry among orthodontic patients. Methods: Private practice orthodontists emailed an electronic survey to active patients. Patients aged $18 years completed the survey regarding their treatment. Parents of patients aged \18 years completed a separate survey regarding their child's treatment. Responses were compared on the basis of patient characteristics (adult vs child, braces vs clear aligners, etc). Results: Three hundred and seventy-seven respondents from 8 orthodontic practices participated in the survey. Eighty-five percent of parents considered face-to-face interaction important, and 85% said that their child's treatment fit conveniently into their schedule. Adult responses were 86% and 89%, respectively. Adult preference for face-to-face was significantly higher than parents of adolescent patients (83% vs 78%; P = 0.038). Adults treated with clear aligners were less likely to strongly agree that their treatment fitted conveniently in their schedule (51% vs 76% in braces; P = 0.0490) and were more likely to be interested in using teledentistry (27% vs 18% in braces; P = 0.0429). Conclusions: Most orthodontic patients prefer to be seen face-to-face. This is due to the high value placed on face-to-face interaction with the orthodontist. Most patients do not consider their treatment inconvenient. Patients prefer that teledentistry be used to enhance communication as opposed to replacing face-to-face interaction. Implementing teledentistry in orthodontics should be applied on a patient-to-patient basis with continued emphasis on the doctor-patient relationship. (Am J Orthod Dentofacial Orthop 2023;163:328-37)

Introduction: This study aimed to determine adaptations orthodontists made during the coronavirus disease 2019 pandemic to maintain safety and determine which adaptations will remain after the pandemic. Methods: An original 34-question survey was sent by mail to a randomized selection of practicing orthodontic specialists (n = 1000). Questions included the changes made during the pandemic in 4 categories (infection control, social distancing, appliance type, and teleorthodontics) and whether those changes will remain postpandemic. Results: The use of personal protective equipment increased during the pandemic, with a significant decrease anticipated after the pandemic. The most common aerosol modification during the pandemic and predicted after the pandemic was using an assistant with high-volume suction (61% and 49%, respectively; P = 0.0013). Ninety-six percent of orthodontists changed their waiting room protocol during the pandemic, but only 23% plan to continue that practice (P \0.0001). Forty-two percent of orthodontists increased clear aligners during the pandemic in response to patient demand (91%). The use of teleorthodontics increased from 8% to 68% during the pandemic and is expected to decrease significantly postpandemic. Virtual appointments are anticipated to be used for screening and consultations of new patients and monitoring active patients in clear aligners but not fixed appliances. Conclusions: The specialty recommended patient safety modifications during the coronavirus disease 2019 pandemic. Postpandemic, enhanced personal protective equipment is expected to decrease, and high-volume suction will likely be continued for aerosol-producing procedures. Teleorthodontics will likely remain in limited use. (Am J Orthod Dentofacial Orthop 2023;164:45-56)

Introduction: This study aimed to assess the perceived efficacy of aligners (Invisalign; Align Technology, Santa Clara, Calif) at performing extrusive movements of maxillary lateral incisors and to evaluate and compare differ-ences in treatment planning protocols and other interventions used when required between orthodontists and general dentists with various degrees of experience. Methods: An original 18-question survey was sent by mail to a randomized and geographically proportionate selection of orthodontic specialists (N = 400) and general dentists (N = 400) listed as providers on the Invisalign Web site. The data were analyzed using analysis of variance and chi-square tests. Results: One hundred twenty-six providers responded to the survey (15.8% response rate), including 36 general dentists and 90 orthodontists. Overall, the average perceived efficacy was 4.71 out of 10 (95% confidence interval, 4.28-5.14). The threshold for identification of tracking issues was significantly associated with provider type (P = 0.0305). General dentists were significantly more likely to prefer an optimized attachment (P = 0.0001), whereas orthodontists were significantly more likely to prefer a gingivally-beveled horizontal rectangular attachment (P \0.0001). A refinement scan was the most common intervention method, followed by the bootstrap technique. Conclusions: The average perceived efficacy for extruding maxillary lateral incisors with aligners was 4.71 out of 10. Orthodontists had a lower tolerance than general dentists for tracking issues. A refinement scan was the most common method of intervention. General dentists and orthodontists differed in their treatment plan-ning preferences and timing of intervention. (Am J Orthod Dentofacial Orthop 2023;163:252-9)

Introduction: This study evaluated current trends and perspectives among orthodontists regarding clear aligner therapy in the mixed dentition (CAMD), including insights into perceived indications, compliance, oral hygiene, and other factors. Methods: An original, 22-item survey was mailed to a randomized, nationally representative sample of practicing orthodontists (n = 800) and a specific, randomized subsample of high-aligner-prescribing orthodontists (n = 200). Questions assessed respondents' demographic information, experience with clear aligner therapy, and perceived advantages and disadvantages of CAMD compared with fixed appliances (FAs). Responses were compared using McNemar's chi-square and paired t tests to assess CAMD vs FAs. Results: One thousand orthodontists were surveyed, and 181 (18.1%) responded over 12 weeks. CAMD use was less common than mixed dentition FAs, but most respondents predicted an increase in their future CAMD use (57.9%). Among respondents using CAMD, the number of patients with mixed dentition treated with clear aligners was significantly lower than the number of total patients with clear aligners (23.7% vs 43.8%; P <0.0001). Fewer respondents considered skeletal expansion, growth modification, sagittal correction, and habit cessation feasible indications for CAMD compared with FAs (P <0.0001). Perceived compliance was similar for CAMD and FAs (P = 0.5841), but perceived oral hygiene was significantly better with CAMD (P <0.0001). Conclusions: CAMD is an increasingly common treatment modality for children. Most surveyed orthodontists reported limited indications for CAMD compared with FAs but perceived noticeable benefits for oral hygiene with CAMD. (Am J Orthod Dentofacial Orthop 2023;164:172-82)

Aligners are an example of how advances in dentistry can develop from innovative combinations of 3D technologies in imaging, planning and printing to provide new treatment modalities. With increasing demand for esthetic orthodontic treatment, aligners have grown in popularity because they are esthetically more pleasing and less obstructive to oral hygiene and other oral functions compared to fixed orthodontic appliances. To observe and estimate aligner treatment interest among Google Search users, Google Trends data were obtained and analyzed for the search term, “Invisalign”. A prediction of interest for the year 2022 for three European Union countries with the highest GDP was developed. “Invisalign” was chosen to represent all orthodontic aligners as the most searched term in Google Trends for aligners. This is the first study to predict interest in the query “Invisalign” in a Google search engine. The Prophet algorithm, which depends on advanced statistical analysis methods, positions itself as an automatic prediction procedure and was used to predict Google Trends data. Seasonality modeling was based on the standard Fourier series to provide a flexible model of periodic effects. The results predict an increase in “Invisalign” in Google Trends queries in the coming year, increasing by around 6%, 9% and 13% by the end of 2022 compared to 2021 for France, Italy and Germany, respectively. Forecasting allows practitioners to plan for growing demand for particular treatments, consider taking continuing education, specifically, aligner certification courses, or introduce modern scanning technology into offices. The oral health community can use similar prediction tools and methods to remain alert to future changes in patient demand to improve the responses of professional organizations as a whole, work more effectively with governments if needed, and provide better coordination of care for patients.

Purpose To investigate the changes of mandibular incisors in position and alveolar bone thickness and height after retraction with intrusion in adults.Materials and Methods Cephalometric radiograph tracings were evaluated before and after retraction and divided into two groups: pure retraction (PR) and retraction with intrusion (RI). Distances of tooth movements and alveolar bone changes were recorded in cephalograms. Tooth movements in anteroposterior and vertical directions were measured at the incisal edge (IE) and root apex(AXE). Changes of labial bone thickness (LaBT), lingual bone thickness (LiBT) and bone height (BH) were assessed at crestal (S1), mid-root (S2), and apical (S3) levels from 86 Cephalograms (46PR/40RI) and 33 CBCT (17PR/16RI). T-tests were applied for cephalometric group (Ceph-M) and non-parametric tests for CBCT groups (CBCT-M).Results Retraction distances at IE were not different between PR and RI but significant intrusion was observed in RI. Amount of retraction and intrusion at AXE was greater in RI. In PR, LaBT was maintained at S1 and S2 in Ceph-M but only S2 in CBCT-M, whereas S3 exhibited significant bone gain. In RI, LaBT was maintained at S1 in Ceph-M but at S2 in CBCT-M, significant bone gain occurred at S2 and S3 in Ceph-M but at only S3 in CBCT-M. LiBT in both groups showed significant bone thinning at all three levels. LaBH and LiBH in both groups exhibited BH loss. RI showed significantly greater bone gain in LaBT at S3.Conclusions RI provided more lingual and apical movement at AXE with comparable labial and lingual bone response to PR with more apical labial bone gain in RI.

INTRODUCTIONThe aims of this study were to (1) investigate and compare the educational value of the most popular YouTube (www.youtube.com; Google, San Bruno, Calif) orthodontic patient testimonials between braces, in-office aligners (IOA), and direct-to-consumer aligners (DTCA), and (2) classify the emotional response of the viewers through sentiment analysis of the video comments.METHODSThree different phrases relevant to braces, IOA, and DTCA were searched on YouTube. The 20 most popular patient testimonial videos meeting the criteria for each group were selected for a total of 60 videos. Using the YouTube application program interface for each video, 13 video metrics were extracted. An information completeness score was assigned, and the video comments were analyzed using sentiment analysis software.RESULTSThe 60 videos included were viewed 34.4 million times by internet users. Braces videos had significantly more likes, comments, and a higher viewer interaction score than the IOA and DTCA videos. IOA videos had a higher median information completeness score than braces and DTCA videos. Of the 5149 video comments with polarity, 53.6% were positive, and 46.4% were negative (P <0.0001). There was no significant association between the treatment modality and positive or negative comments (P = 0.5679).CONCLUSIONSThere is high user engagement on YouTube with orthodontic patient testimonials. YouTube users interact with braces patient testimonials the most. YouTube viewers' comments on orthodontic patient testimonials express more positive sentiment than negative sentiment. There was no significant difference in positive and negative sentiment between the video comments for the 3 different treatment modalities.

ABSTRACT Objective: To determine whether separating the alignment and leveling phases can reduce proclination of the mandibular incisors. Methods: Eligibility criteria included Class I subjects with an irregularity index of 3-5 mm, 3-4 mm curve-of-Spee (COS), and non-extraction treatment. Thirty adults were randomly allocated into two groups: (1) Control group was leveled and aligned simultaneously with flat archwires progressively to 0.016x0.022-in stainless-steel; (2) Experimental group was aligned first with 0.014-in-superelastic NiTi with mild accentuated COS, then leveled using 0.016x0.022-in beta-titanium accentuated COS archwires and gradually reduced the curve until flat. Mandibular incisor position and inclination were evaluated by cephalometric analysis. COS and irregularity index were evaluated in study models. Assessment was conducted twice after 0.016-in NiTi and after 0.016x0.022-in stainless-steel archwire placements. Dental changes from cephalograms and models were compared within group using paired t-test and between groups using independent t-test. Results: Control group: Round-wire-phase, mandibular incisors tipped labially (4.38° and 1 mm) with intrusion (-1.13 mm); Rectangular-wire-phase, mandibular incisors further intruded and proclined (-0.63 mm and 1.38°). Experimental group: During aligning with round accentuated COS archwires, mandibular incisors tipped very slightly labially (0.75° and 0.50 mm) with no significant intrusion; during leveling with rectangular archwires, incisors majorly intruded (1.75 mm) with slight proclination (1.81°). The experimental group had significant less incisor proclination (control: 5.76°, experimental: 2.56°) with more incisor intrusion (control: -1.75 mm, experimental: -2.13 mm). The COS in experimental group showed significant greater reduction (-2.88 mm) than that of the control group (-1.69 mm). Conclusion: In control group, mandibular incisor proclination was markedly observed in round archwires, with further proclination caused by rectangular archwires. In experimental group, minimal proclination was exhibited when accentuated COS round archwires were used for aligning. Leveling with rectangular archwires caused less proclination with more COS reduction.