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:To introduce and validate newly designed computer software to aid in the diagnosis of anterior open bite (AOB). MATERIALS AND METHODS:The software was constructed based on the algorithm of a standardized open bite checklist, which considered skeletal, dental, and soft tissue components, as well as smile characteristics. Feeding the software with this input yielded a digital form output (DFO) in the guise of a diagnostic report characterizing the AOB phenotype, contributing components, severity, associated problems, and functional factors. For validation, DFO was compared to a conventional form output (CFO), created in a standardized manner according to expert opinions. Agreement between the DFO and CFO in terms of AOB phenotype was the primary outcome, while the secondary outcome was the number of missing diagnostic components in either method. RESULTS:Percentage of agreement between CFO and DFO was 82.2%, with a kappa coefficient of 0.78, which is considered a good level of agreement. There was a statistically significant relationship between the number of missing diagnostic components in CFO and level of disagreement, which rendered the DFO more reliable. CONCLUSIONS:Newly constructed software represents an efficient and valid diagnostic tool for AOB and its contributing components. There was good agreement between CFO and DFO, with the latter being more comprehensive and reliable. The algorithm built in the software can be used as the basis for a future artificial intelligence model to aid in the diagnosis of AOB.

AIM:To evaluate the three-dimensional position and root resorption of incisors after anterior segment retraction (ASR) using friction versus frictionless mechanics. PARTICIPANTS AND METHODS:Thirty female patients (13-18 years) with bimaxillary protrusion were randomly allocated into two groups. In the intervention group, ASR was undertaken using an elastomeric chain rendering 160 g/side extending between mini-screw implant and a hook crimped on 0.017 × 0.025-inch stainless-steel wire distal to the lateral incisor. In the comparison group, ASR was undertaken using closing T-loops fabricated from 0.017 × 0.025-inch titanium molybdenum alloy (TMA) wire rendering comparable retraction force. In both groups, the canine brackets were ligated after retraction to the mini-screw implants that were inserted in both the upper and lower arches bilaterally. The primary outcome was the three-dimensional changes in the position of the incisors. The secondary outcome was root resorption. These were measured from cone-beam computed tomography scans. RESULTS:Statistically significant decreases in the upper (UI) and lower incisors (LI) crown torque were seen in both groups; however, the difference between groups was not statistically or clinically significant (UI MD -2.04°; 95% confidence interval [CI] = -8.02-3.95; LI MD -0.49°; 95% CI = -7.06-6.08). Significant tipping of upper (MD -1.17°; 95% CI = -2.06--0.27) and lower (MD -1.13°; 95% CI = -1.66--0.60) incisors was found in the friction, but not the frictionless group after retraction; however, the changes were not clinically significant. Significant lower incisor intrusion was found in both groups after retraction; however, the difference between groups was not statistically or clinically significant (MD -0.61°; 95% CI = -1.99-0.77). Statistically significant decreases in the UI and LI root length were seen in both groups. The difference between groups for UI changes was statistically significant (MD 0.54 mm; 95% CI = -0.02-1.07) but probably not clinically significant. CONCLUSION:Considering the limitations in the current study, there was no advantage of either mechanics over the other regarding the final position of incisors. The likelihood of root resorption should be considered when frictionless mechanics are used for retraction of incisors.Registry:Clinicaltrials.gov (NCT04878939).

Objective: To evaluate the prevalence of bullying among schoolchildren and to study the correlation between bullying and a specific type of malocclusion, self-esteem, oral health-related quality of life (OHRQoL), the need for orthodontic treatment and socioeconomic status.Design: A cross-sectional study.Setting: Low, middle and high socioeconomic-class schools in the same educational district in Cairo, Egypt.Participants: A total of 324 Egyptian schoolchildren aged 11-14 years.Methods: Validated questionnaires were used to assess self-reported bullying frequency and intensity, self-esteem and OHRQoL. The Index of Orthodontic Treatment Need (IOTN) was used to assess the orthodontic treatment need and the participants' occlusion was classified according to the British Standard Incisors (BSI) classification.Results: Bullying was found to be prevalent in 61.7% of the sample. Regression analysis revealed that participants with a Class II division 1 incisor relationship had the highest odds ratio (OR) for predicting bullying (OR = 1.86, 95% confidence interval [CI] = 1.38-2.15). Being bullied was significantly associated with lower self-esteem (OR = 0.47, 95% CI = 0.13-0.78), worse OHRQoL (OR = 2.73, 95% CI = 1.95-3.15) and a high need for orthodontic treatment, as determined by the IOTN Dental Health Component score (OR = 1.33, 95% CI = 1.05-1.95) and IOTN Aesthetic Component score (OR = 1.52, 95% CI = 1.12-1.88). Moreover, participants in high and middle socioeconomic-class groups had a lower OR for predicting bullying than those in the low socioeconomic-class group (OR = 0.27, 95% CI = 0.13-0.54).Conclusion: The bullying prevalence among Egyptian schoolchildren aged 11-14 years was very high. The prevalence of bullying was higher in schoolchildren with higher orthodontic treatment need and Class II division 1 incisor relationship. Bullying was correlated to poor self-esteem as well as poor OHRQoL. In addition, low socioeconomic status was found to be a potential predictor for bullying.

OBJECTIVES:To evaluate anchorage loss after en masse retraction in bimaxillary dentoalveolar protrusion patients using friction vs frictionless mechanics. MATERIALS AND METHODS:Thirty patients with bimaxillary dentoalveolar protrusion needing extraction of upper first premolars and en masse retraction with maximum anchorage were included in this two-arm, parallel, single-center, single-blinded randomized clinical trial with a 1:1 allocation ratio using fully sealed opaque envelopes. Friction group retraction utilized elastomeric power chain between miniscrews and hooks crimped mesial to upper canines on 17 × 25 stainless steel archwire. Frictionless group used customized T-loop springs loading upper first molars indirectly anchored to miniscrews. Activation was every 4 weeks until full retraction. The primary outcome assessed was anchorage loss evaluated at cusp tip and root apex of the first molar. First molar rotation, incisor tip and torque, and root resorption of anterior teeth were evaluated on digital models and cone beam computed tomography taken before and after space closure. RESULTS:Anchorage loss at crown of first molar was significantly more in frictionless group by 2.1 mm (95% CI = -0.4 to 3.5), (P = .014), while there was no significant difference in anchorage loss at root apex between groups. Significant mesial in molar rotation of 6.672° (95% CI = 12.2-21.2), (P = 0.02) was greater in the frictionless group. Both groups showed comparable tip, torque, and root resorption values. No severe harms were reported. There was mild gingival overgrowth and inflammation in the frictionless group due to T-loop irritation. CONCLUSIONS:Extra anchorage considerations are needed during en masse retraction when frictionless mechanics is implemented as higher anchorage loss and molar rotation were detected. No difference in tip, torque, and root resorption was observed.

Acceleration of tooth movement has gained remarkable attention during the last decade. The aim of this study was to evaluate the effect of low-level laser therapy (LLLT) on en masse retraction of upper anterior teeth in adult women with bimaxillary dentoalveolar protrusion. In this two-arm parallel trial, 36 women with bimaxillary dentoalveolar protrusion were randomly divided into two equal groups. Eligibility criteria included class I Angle molar relationship, good general and oral health as well as no systemic disease or syndrome. Four temporary anchorage devices (TADs) were used in the upper and lower arches for anchorage purposes. A 0.019×0.025-inch stainless steel wire with crimped hooks just distal to the maxillary canines was inserted. Nickle titanium (NiTi) closed coil springs (200 g/side) were employed for en masse retraction following extraction of the first premolars. In the laser group (LG), retraction of the upper anterior teeth was done along with the application of LLLT on days 0, 3, 7, and 14 after extraction and then repeated biweekly until the end of retraction. Retraction was completed without LLLT application in the nonlaser group (NLG). Data concerning the rate of retraction as well as first molars and anterior positional changes were gained from digitized models and cone beam computed tomography (CBCT) scans taken just before extraction and at the end of retraction. Treatment-associated pain and root resorption were evaluated using visual analogue scale (VAS) and CBCT scans, respectively. Four patients dropped out prior to follow-up. The duration of retraction was 10.125 ± 2.876 and 13.643 ± 3.455 months in the LG and NLG, respectively. The LG showed a statistically significant faster rate of en masse retraction (0.833 ± 0.371 mm/month) compared to the NLG (0.526 ± 0.268 mm/month; P ≤ 0.035). The observed root resorption was significantly less in the LG (P ≤ 0.05) with comparable pain scores in both groups. Within the constraints of the parameters of the LLLT used in the current study and despite the statistically significant results on the rate of en masse retraction and the associated root resorption, LLLT did not demonstrate a clinically relevant effect that justifies its use to enhance en masse retraction. Clinicaltrials.gov NCT05183451 January 10, 2022, “Retrospectively registered” https://www.clinicaltrials.gov/study/NCT05183451

ABSTRACT Introduction: Orthodontists attempt to maximize treatment efficiency regarding time, tooth position and adverse effects. A new approach, not yet explored, is the activation frequency. Objective: The aim of this split-mouth randomized controlled trial was to evaluate the effect of reactivation intervals on the efficiency of tooth movement. Methods: Thirty eight patients having a Class I malocclusion with bimaxillary dentoalveolar protrusion or severe crowding, Class II with mandibular deficiency or Class III, requiring first premolar extraction and canine retraction were recruited. Elastomeric chains producing 150g were replaced every two, four, six or eight weeks. There were 36, 37, 36, and 36 quadrants randomly allocated to these groups, respectively. The canine retraction rate was the primary outcome. Canine tipping, rotation, and root resorption and pain were the secondary outcomes. Only the outcome assessors were blinded to group assignment. Results: The average total movement for the 6 months was 5.14, 5.31, 2.79 and 3.85 mm for the two-week, four-week, six-week and eight-week reactivation intervals, respectively. Root resorption was significantly higher in the two-week and four-week groups. No adverse events were observed. Conclusion: The canine retraction rate, tipping, rotation and pain were similar in 2, 4, 6 and 8-week activation intervals groups. Longer reactivation intervals show less root resorption. The trial protocol was not pre-registered. The study was self-funded.

Abstract Background The purpose of this 2-arm parallel study was to compare the rate of en-masse retraction using friction versus frictionless mechanics. Anchorage loss, molar rotation, changes in the incisor position, and pain was additionally assessed. Methods Twenty-eight patients were randomly allocated into two en-masse retraction groups using friction or frictionless mechanics. Eligibility criteria included maxillary dentoalveolar protrusion requiring maxillary 1st premolars extraction with maximum anchorage. Randomization was done in a 1:1 allocation ratio into either friction (A) or frictionless (B) groups. In group A, power-chains of 200 g retraction force on 0.017” x 0.025” st.st archwire were utilized. Group B comprised of T-loops using the same gauge TMA archwires and comparable force. Measurements were made on scanned 3D models, superimposed on one another, as well as pre-treatment and post-retraction cephalograms. Results It was a single-blinded study where the outcome assessors were blinded. For the friction group, the rate of retraction was 0.63 ± 0.18 mm per month, with a total retraction of 4.04 ± 1.41 mm spanning over 6.42 ± 1.08 months. The frictionless group was 0.75 ± 0.23 mm per month with a total retraction of 4.13 ± 1.44 mm, over 5.67 ± 1.5 months. Conclusion Frictionless mechanics was only slightly faster than friction mechanics regarding the rate of retraction, not enough to make a significant difference between the two groups. Frictionless mechanics is not recommended in cases with great anchorage needs, as the molars tend to move and rotate mesially during retraction, regardless of the presence of miniscrews. Trial registration: Trial was registered on clinicaltrials.org, with the reference number NCT04902430.

OrthodonticsAim: The aim of the study is to evaluate the effect of en-masse retraction with maximum anchorage on the lip length, lip strain, and interlabial gap in adult female patients with bimaxillary protrusion.Materials and Methods: Thirteen patients underwent initial records including photographs, study casts, and cephalometric x-rays.En-masse retraction was performed using friction mechanics, with the use of temporary anchorage devices and power chains after the extraction of first premolars.The soft tissue was analyzed using lateral cephalometric radiographs before and after retraction.Results: The results showed that en-masse retraction had a significant effect on reducing lip strain, increasing lip length, and reducing interlabial gap. Conclusion:The findings suggest that en-masse retraction can be an effective tool in improving the soft tissue profile in patients with bimaxillary protrusion

BackgroundThe aim of the study was to assess the accuracy and efficiency of a new artificial intelligence (AI) method in performing lateral cephalometric radiographic measurements.Materials and methodsA total of 200 lateral cephalometric radiographs were assessed for quality and included. Three methods were used to perform the cephalometric measurements: (1) the AI method using WebCeph software (AssembleCircle Corp., Gyeonggi-do, Republic of Korea), (2) the modified AI method using WebCeph software after manual modification of the landmarks' position, and (3) using OnyxCeph software (Image Instruments GmbH, Chemnitz, Germany) by manual landmark identification and digital measurements generation. The results of the measurements produced by the three methods were compared, in addition to comparing the time required for the measurements' generation required for each method.ResultsStatistically significant differences were detected between the measurements resulting from the three used methods. Fewer differences were detected between the modified AI method and the OnyxCeph method. The AI method produced the measurements the fastest followed by the modified AI method and then the OnyxCeph method.ConclusionsConsidering the used AI software, AI followed by manual tuning of the landmarks' position might be an accurate method in lateral cephalometric analysis. AI alone is still not fully reliable at locating the different landmarks on the lateral cephalometric radiographs.

The dentigerous cyst is a developmental odontogenic asymptomatic cyst, that is associated with the crown of an unerupted or impacted tooth. Early diagnosis is important to avoid any future complications and choose the best treatment option. The purpose of this case report is to describe the management of a dentigerous cyst related to lower second molar in a young female patient using orthodontic traction as a conservative treatment approach. This procedure helps to spare the patient an unnecessary surgical excision procedure and the associated excessive bone removal for a safety margin, stimulates bone healing and promotes the eruption of the cyst-associated tooth.

Objectives: To evaluate the effects of one versus four weeks reactivation of the elastomeric chain on the rate of orthodontic tooth movement (OTM) and supporting structures. Methods: The 3rd maxillary premolars of 8 male mongrel dogs were extracted. Custom made appliance was constructed so that the 2nd premolars were allowed to slide bodily. An elastomeric chain with calibrated force of 150g was attached to the hooks of soldered tubes on the 2nd premolar’s crowns. The sample was divided into two groups based on the interval of reactivation of the elastomeric chains used for tooth movement where in group I activation was scheduled every one week versus four weeks in group II. Measurements of the amount and rate of OTM were performed every week for 12 weeks using digital caliper. The animals were then sacrificed and specimens were prepared for decalcified histological examination using Hematoxylin and Eosin stains under light microscope. Results: No remarkable difference in the rate of OTM between the two groups was reported. The total amount of tooth movement in group I was 1.44mm ± 0.5 compared to 1.46mm ± 0.6 in group II. Histological examination revealed a more favorable tissue reaction associated with 4 weeks reactivation as regards the new formed bone, root resorption and periodontal ligament structure. Conclusion: Altering the reactivation interval of the elastomeric chains from four to one week doesn’t have a significant impact on the rate of OTM. However, four weeks reactivation interval showed a more favorable tissue reaction associated with orthodontic tooth movement.

Background Maxillary expansion (ME) might be beneficial in improving airway dimensions and obstructive sleep apnoea syndrome (OSAS) in patients with constricted maxillae. The aim of this overview is to present clinicians with a summary of the evidence. Data from systematic reviews and meta-analyses were evaluated to investigate the effect of ME on OSAS.Methods An electronic search was commenced in five databases, in addition to a manual search until July 2021. Screening of articles started with title and abstract followed by full-text assessment. Systematic reviews with/without meta-analyses were included. Critical appraisal was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2, Level of Research Design scoring and criteria of body of evidence scores. The search, study selection and critical appraisal were completed by three reviewers.Results In total, 14 systematic reviews with/without meta-analyses were included. The quality of available evidence ranged between low to high, based on the overall quality evaluation.Conclusions Based on the available evidence, maxillary expansion might be able to improve the nasal airway volume and OSAS in both growing and adult patients in the short term. ME can be considered as one of the treatment options in cases with OSAS.

The aim of the present work was to study the sequence of skeletal maturation in the various anteroposterior and vertical skeletal growth patterns and to detect whether differences existed between them. Cephalograms of 861 growing and adolescent female patients were traced to categorize the subjects into 9 skeletal patterns. Each subject was assigned a skeletal maturational stage. Analysis of variance (ANOVA) followed by Bonferroni test were used to detect differences in the onset of the three growth stages (prepubertal, pubertal and postpubertal) between the 9 groups. The same statistical methods were used to detect differences between the mean ages at the three growth stages within each group. No statistically significant differences were found between the mean ages of pubertal and postpubertal growth stages between the 9 skeletal patterns. However, class III growers had a significantly earlier onset of prepubertal growth (10.25 ± 1.56 years) when compared to that of class II high angle cases (11.11 ± 1.67 years; P < 0.01). Also, significant differences were found between the mean ages at the three growth stages within the groups. A map was created defining the sequence of skeletal maturation for each skeletal growth pattern. This map defines clinically relevant differences in the starting time points and the optimum intervals of growth modification for each skeletal growth pattern.

•In patients requiring premolar extraction and maxillary incisor retraction with maximum anchorage, absolute bodily retraction and intrusion of the incisors could be achieved via incisor retraction using the temporary skeletal anchorage device–supported accentuated curve of Spee archwire.•The method of ligation of the first molar to the temporary skeletal anchorage device posteriorly changed the configuration of the regular accentuated curve of Spee archwire. It prevented any undesirable molar movements while exaggerating the incisor intrusive force creating a greater moment of couple that was able to balance the moment of force resulting from the distal retracting force applied at the level of the incisor brackets, enabling absolute bodily retraction and intrusion of the incisors.

OBJECTIVESTo compare canine retraction using NiTi closed coil springs vs elastomeric chains comprehensively in a split-mouth randomized controlled trial.MATERIALS AND METHODSThe canines in 64 quadrants were randomly retracted into the first premolar extraction spaces using NiTi closed coil springs or elastomeric chains, in the maxilla and mandible. The retraction force was 150 g. Cone beam computed tomography scans and study models were obtained before the start of canine retraction and 6 months later. The rate and total amount of canine retraction, canine rotation, tipping, and root resorption were evaluated. A visual analogue scale was used to evaluate patients' pain experience.RESULTSThe two methods were statistically similar for dental changes, rate of canine retraction, and root resorption. However, patients reported significantly more days of pain with the elastomeric chain compared to the NiTi closed coil springs.CONCLUSIONSWithin the constraints of the current study, using either NiTi closed coil springs or elastomeric chains as force delivery systems for canine retraction results in no significant difference in the rate of canine retraction, tipping, rotation, or root resorption. Pain experience during retraction using elastomeric chains is more significant yet needs further investigation.

Background Excessive proclination of lower incisors and other undesirable consequences usually result from the use of class II elastics during orthodontic treatment. The purpose of this study was to attempt to limit the adverse effects of class II elastics by the use of mini implants placed in the mandibular arch in adolescent class II female patients. Methods The sample comprised 28 patients, (a mean age of 15.66 ± 2 years for intervention group and 15.1 ± 2.2 years for conventional group) with one-fourth or one-half unit class II canine relationship. The sample was divided into two equal groups. Randomization was carried out by a computer sequence generator with a 1:1 allocation ratio. In the intervention group, the mini implants were inserted between the lower second premolar and first molar, while the conventional group underwent regular class II elastics therapy. The active elastics treatment time was 8 months for both groups. Results were assessed by measurements from pre- and post-elastics lateral cephalometric radiographs. Results The change in L1 inclination (0.97 ± 0.92°) and L1 AP position (0.31 ± 0.63 mm) did not show a statistically significant difference between the two groups, but a statistically significant difference was found in the U1 retroclination (5.23 ± 1.92°) and U1 distal movement (4.05 ± 1.4 mm) [P ˂ 0.001] and [P ˂ 0.05] respectively in favor of the intervention group. Conclusion Mini-implants in conjunction with class II elastics had no skeletal effect, mainly dentoalveolar and it did not prevent the proclination of lower incisors. There was more distal movement in the upper incisors in the skeletal anchorage group which helped in enhancing the camouflaging of class II malocclusion. Trial registration Trial registered “FUE.REC (10)/10-2018” at the FUE registration council for clinical trials/IOP Orthodontic Program October 2018.