Comparison of BALP, CTX-I, and IL-4 levels around miniscrew implants during orthodontic tooth movement between two different amounts of force

OBJECTIVES

To evaluate the Interleukin-4 (IL-4), bone-specific alkaline phosphatase (BALP), and C-telopeptide of type I collagen (CTX-I) levels in peri-miniscrew crevicular fluid (PMCF) during orthodontic tooth movement between 75 and 150 g of distalization force.

MATERIALS AND METHODS

Thirty miniscrews were placed bilaterally between the maxillary second premolars and first molars. The right and the left maxillary canines were moved distally using either 75 or 150 g of force. PMCF samples were collected before loading (T0); at 2 hours (T1) and 24 hours (T2) later; and on days 7 (T3), 14 (T4), 21 (T5), 30 (T6), and 90 (T7) after force application. Enzyme-linked immunosorbent assay kits were used to determine BALP, CTX-I, and IL-4 levels.

RESULTS

There was no significant difference between the force groups at all time points with respect to BALP, CTX-I, and IL-4 levels (P > .05). There was no significant difference among time points for the two force groups in terms of BALP and IL-4 levels (P > .05). The CTX-I level at T3 was significantly higher than at T0 for both force groups (P < .05).

CONCLUSIONS

Both 75 g and 150 g of orthodontic force are within optimal force limits, and there is no difference in biochemical markers of bone turnover.

En-masse Retraction of Upper Anterior Teeth in Adult Patients with Maxillary or Bimaxillary Dentoalveolar Protrusion: A Systematic Review and Meta-analysis

AIM

To evaluate the efficacy of accelerated and non-accelerated methods of en-masse retraction of the upper anterior teeth in terms of skeletal, dental, and soft-tissue variables, as well as the duration of retraction or overall orthodontic treatment.

MATERIALS AND METHODS

An electronic search of PubMed and nine other major databases for randomized controlled trials (RCTs) and clinical controlled trials (CCTs) was performed between January 1990 and April 2018. The bibliography in each identified article was reviewed. In addition, manual searching was performed in the same time frame in five major orthodontic journals.The participants were patients over 14 years old undergoing fixed orthodontic treatment with extraction of maxillary or bimaxillary premolars followed by en-masse retraction of maxillary anterior teeth in both groups. Cochrane's risk of bias tool for RCTs and methodological index for non-randomized studies (MINORS) for CCTs were used.

RESULTS

Eight articles (six RCTs and two CCTs) were included in this review, and only five articles were suitable for quantitative synthesis. The en-masse retraction caused a decrease in the SNA and ANB angles with no significant differences between the different en-masse retraction methods. Using temporary skeletal anchorage devices (TSADs) gave significantly better results in terms of posterior anchorage in comparison with conventional anchorage(standardized mean difference (SMD) = -3.03 mm, p < 0.001). No significant difference was found between en-masse/flapless corticotomy and en-masse/control groups in terms of anterior teeth retraction (p = 0.661); while there was a significantly greater anterior teeth retraction in corticotomy with flap elevation group compared to control group (p < 0.001).

CONCLUSION

There is a weak to moderate evidence that using accelerated and non-accelerated methods would improve the facial profile and lead to similar skeletal corrections. There is weak to moderate evidence that using TSADs would lead to better posterior anchorage than using conventional anchor-age.Moderate evidence was found regarding the benefit of using piezosurgery in achieving good incisors' inclination. Contradictory results were found regarding the amount of achieved anterior retraction and the retraction time in the studies that evaluated acceleration methods versus the traditional methods of retraction. According to the quality of evidence, there is a need for more well-conducted RCTs, and more work to be oriented towards en-masse retraction with the use of other acceleration methods.

CLINICAL SIGNIFICANCE

The correction of the maxillary or bimaxillary dentoalveolar protrusion by en-masse retraction of the upper anterior teeth with/without acceleration is accompanied by aesthetic results in the facial soft tissues as well as in the underlying skeletal and dental structures. The traditional corticotomy-assisted retraction is expected to reduce the retraction time significantly. However, the strength of evidence is not strong and requires additional research work.

Evaluation of the miniplate-anchored Forsus Fatigue Resistant Device in skeletal Class II growing subjects: A randomized controlled trial

OBJECTIVES

To evaluate the use of direct miniplate anchorage in conjunction with the Forsus Fatigue Resistant Device (FFRD) in treatment of skeletal Class II malocclusion.

MATERIALS AND METHODS

Forty-eight females with skeletal Class II were randomly allocated to the Forsus plus miniplates (FMP) group (16 patients, age 12.5 ± 0.9 years), Forsus alone (FFRD; 16 patients, age 12.1 ± 0.9 years), or the untreated control group (16 subjects, age 12.1 ± 0.9 years). After leveling and alignment, miniplates were inserted in the mandibular symphysis in the FMP group. The FFRD was inserted directly on the miniplates in the FMP group and onto the mandibular archwires in the FFRD group. The appliances were removed after reaching an edge-to-edge incisor relationship.

RESULTS

Data from 46 subjects were analyzed. The effective mandibular length significantly increased in the FMP group only (4.05 ± 0.78). The mandibular incisors showed a significant proclination in the FFRD group (9.17 ± 2.42) and a nonsignificant retroclination in the FMP group (-1.49 ± 4.70). The failure rate of the miniplates was reported to be 13.3%.

CONCLUSIONS

The use of miniplates with the FFRD was successful in increasing the effective mandibular length in Class II malocclusion subjects in the short term. The miniplate-anchored FFRD eliminated the unfavorable mandibular incisor proclination in contrast to the conventional FFRD.

A prospective, split-mouth, clinical study of orthodontic titanium miniscrews with machined and acid-etched surfaces

OBJECTIVES

To determine whether the success rate and primary stability of surface-treated miniscrews differ from those of nontreated miniscrews.

MATERIALS AND METHODS

Patients who required one or more miniscrews for the same reason in each quadrant were recruited into a single-blinded, split-mouth, randomized, controlled trial with a 1:1 allocation ratio. Self-drilling miniscrews with two surface types were used: those with no surface treatment, and those with an acid-etched surface treatment. The cumulative success rate and primary stability of each type of miniscrew were examined, and factors potentially affecting the success and failure of miniscrews were investigated.

RESULTS

Forty patients were included in the study, with a total of 98 orthodontic miniscrews. The overall success rate was 88.8%, and the respective success rates for acid-etched and machined surface miniscrews were 91.8% and 85.7%. The respective mean insertion torques were 13.62 ± 5.95 N·cm and 13.38 ± 4 N·cm, and periotest values measured immediately after insertion were -0.50 ± 2.77 for acid-etched miniscrews and -0.28 ± 3.36 for machined surface miniscrews. There was no significant difference in the mean insertion torques and periotest values according to surface treatment and jaw.

CONCLUSIONS

Neither the success rate nor the primary stability of acid-etched surface miniscrews and machined surface miniscrews differed significantly. There is a high possibility that miniscrews will fall out in patients who have an open bite or those who require total distalization.

[Clinical study on upper molar mesial movement with miniscrews in the palatal suture and casting frame]

PURPOSE

To study the clinical effect of the upper first molar space closure by mesial traction of the second and the third molar with palatal miniscrew and casting frame.

METHODS

Twelve cases with the upper first molar lost and only accepting regional orthodontic treatment were chosen. Two miniscrews were inserted beside the palatal suture, individual casting frames were manufactured to help stabilize the miniscrew and the upper premolars on the same side. The force was exerted on both the buccal and lingual side. Graphpad Prism 6.0 software was used for Student's t test.

RESULTS

All the spaces were closed, the average mesial movement was 5.7 mm, the tipping of the second molar and the third molar was almost normal and the occlusion of other teeth kept intact.

CONCLUSIONS

Miniscrew and casting frame can accomplish the effective mesial movement of the upper second and third molar to close the first molar space.

Comparison of anterior retraction and anchorage control between en masse retraction and two-step retraction: A randomized prospective clinical trial

OBJECTIVES

The purpose of this two-arm parallel trial was to compare en masse (ER) and two-step retraction (TSR) during space closure.

MATERIALS AND METHODS

Forty-eight adult patients with bimaxillary protrusion who were planned for treatment with extraction of four first premolars were enrolled. All patients were randomly allocated in a 1:1 ratio to either the ER (n = 24) group or the TSR (n = 24) group. The main outcome was the amount of posterior anchorage loss in the molars and the retraction of the incisors between ER and TSR; the difference in incisor and molar inclination was a secondary outcome. Lateral cephalometric radiographs and oblique cephalometric radiographs at 45° were taken before retraction (T1) and after space closure (T2). Cephalograms were digitized and superimposed on the anatomic best fit of the maxilla and mandible by one operator who was blinded to the treatment group.

RESULTS

Neither incisor nor molar crown movements showed any significant differences between the ER and TSR. There were no significant differences in the tipping of incisors and molars between the two groups.

CONCLUSIONS

No significant differences existed in the amount of retraction of incisors and anchorage loss of molars between ER and TSR. Changes in incisor and molar tipping were similar, with the crowns showing more movement than the apex.

Evaluation of miniscrew stability using an automatic embedding auxiliary skeletal anchorage device

OBJECTIVE

To clarify the in vivo effect of an automatic embedding device on miniscrew stability.

MATERIALS AND METHODS

42 miniscrews were implanted into rabbit femurs. The miniscrews with the novel auxiliary device formed the auxiliary group (n = 11 at 4 weeks; n = 11 at 8 weeks) and the miniscrews without the auxiliary device formed the nonauxiliary control group (n = 9 at 4 weeks; n = 11 at 8 weeks). Cortical bone thickness, distance from the cortical bone surface to the miniscrew head, and implantation depth of the spike were measured using micro-computed tomography. The mechanical retention force was evaluated by measuring the displacement of the miniscrew head after it was loaded perpendicular to its long axis. In the lateral displacement test, effects of the auxiliary (with vs without auxiliary), and time (4 vs 8 weeks) were assessed using the Brunner-Langer nonparametric analysis of longitudinal data in factorial experiments.

RESULTS

The mean implantation depth of the spike in the auxiliary group at 4 and 8 weeks was 0.28 mm (median: 0.33; SD: 0.12) and 0.37 mm (median: 0.33; SD: 0.19), respectively. The retention force was approximately 2.0 to 2.8 and 1.6 to 1.8 times greater in the auxiliary group than in the nonauxiliary group at 4 and 8 weeks, respectively.

CONCLUSIONS

The auxiliary device improved the mechanical retention force without the need to increase miniscrew length or diameter. This may enable the safe use of miniscrews in difficult areas.

A Technique for Utilizing Ankylosed Teeth for Anchorage

We present a novel method of reinforcing anchorage by utilizing ankylosed teeth. This technique provides simple solutions in otherwise challenging and complex cases.

Nonsurgical and nonprosthetic camouflage treatment of skeletal Class II open bite with bilaterally missing lower first molars

This report illustrates the successful nonsurgical and nonprosthetic camouflage treatment of a skeletal Class II open bite malocclusion combined with missing mandibular first molars bilaterally. In the mandible, the second and third molars were uprighted and protracted, substituting for the missing first molars. In the maxilla, anterior bodily retraction and full-arch intrusion were achieved following premolar and second molar extraction, which also induced autorotation of the mandible. The treatment outcome and prognosis were confirmed with three-dimensional superimposition techniques, along with long-term stability.

Evaluation of miniscrew-supported rapid maxillary expansion in adolescents: A prospective randomized clinical trial

OBJECTIVES:

To evaluate and compare the dental and skeletal changes with conventional and miniscrew-supported maxillary expansion appliances in adolescents.

MATERIALS AND METHODS:

Forty patients were divided into two groups, with one group receiving a tooth-borne expander and the other group receiving an expander supported by four miniscrews (bone-borne). Multiplanar coronal and axial slices obtained from cone-beam computed tomography images were used to measure the changes in transverse skeletal widths, buccal bone thickness, tooth inclination, and root length. Paired t-tests and independent-sample t-tests were used to compare the two expansion methods.

RESULTS:

Bone-borne expansion increased the maxillary suture opening more than 2.5 times than tooth-borne expansion both anteriorly and posteriorly. Between the maxillary first premolars, sutural expansion accounted for 28% and 70% of the total transverse width increase in the tooth-borne and bone-borne expander groups, respectively. Similarly, 26% and 68% of the total expansion was of skeletal nature in the tooth-borne and bone-borne expander groups between the maxillary first molars. The pattern of expansion was variable, with most of the patients in both groups demonstrating a triangular-shaped sutural opening that was wider anteriorly. Subjects in the conventional group experienced significantly more buccal bone reduction and greater buccal inclination of the teeth. No significant differences were observed for root length measurements between the two groups.

CONCLUSION:

Use of bone-borne expansion in the adolescent population increased the extent of skeletal changes in the range of 1.5 to 2.8 times that of tooth-borne expansion and did not result in any dental side effects.

Nonsurgical orthodontic treatment of a hypodivergent adult patient with bilateral posterior scissors bite and excessive overjet

This report illustrates successful nonsurgical orthodontic treatment of a hypodivergent adult patient with bilateral posterior scissors bite (Brodie bite) and excessive overjet. A 26-year-old woman primarily reported maxillary incisor protrusion. She was diagnosed with Class ll division 1 malocclusion with skeletal Class I, short face, low mandibular plane angle and bilateral posterior scissors bite. A lingual arch with anterior bite block and posterior miniscrews with preadjusted edgewise appliances were used to improve the bilateral scissors bite. After achieving molar occlusion, the maxillary first premolars were extracted, and six miniscrews were used to improve the anterior-posterior and vertical discrepancies. After active treatment for 56 months, the convex facial profile with excessively protruded lips was improved and good interdigitation with ideal incisor relationship was achieved. Additionally, the irregular movements of the incisal path and the bilateral condyles during lateral excursion were improved. At 13 months of retention, a satisfactory facial profile, occlusion, and jaw movements were maintained. The treatment results suggest that miniscrews and fixed bite blocks were effective and efficient to facilitate correction of the bilateral scissors bite, excessive overjet, and vertical relationship correction in this nonsurgical orthodontic treatment.

[Long-term effect of intruded upper molars and dental implant restoration in 24 patients]

PURPOSE

To evaluate the long-term effectiveness of intruded upper molar with orthodontic mini-screw and the long-term stability of the lower molar restored with dental implant.

METHODS

Twenty-four patients with excessive growing upper molar were chosen. The upper molars were intruded by orthodontic mini-screw to increase the bite distance, and then restored with dental implant. The height of molar and the height of bone around the implant were measured on the lateral cephalometric films and panoramic films to analyze the long-term effect of molar intrusion and implantation. The data were analyzed with SPSS18.0 software package.

RESULTS

There was significant difference between the length of upper molar before and after intrusion, the upper molars were intruded (2.7±0.3)mm 3.5 months after orthodontic mini-screw; there was no significant difference after 1 year with retainer and implant restoration. The height of bone around the implant decreased 1.2 mm but without significant difference.

CONCLUSIONS

With the upper molar intruded by orthodontic mini-screw , more bite space can be obtained to restore lower molar with dental implant, and the long-term effect of upper molar intrusion and lower molar implant are stable.

Comparison of orthodontic tooth movement between adolescents and adults based on implant superimposition

OBJECTIVE

We compared tooth movement under maximum anchorage control with mini-screw implants in growing and non-growing patients.

METHODS

In total, 15 adolescent (G1) and 19 adult (G2) patients with prognathic profiles were selected. All patients underwent first premolar extraction treatment with mini-screw implants for maximum anchorage control. Cone-beam computed tomography (CBCT) data were obtained immediately after implant placement (T1) and at the end of anterior tooth retraction (T2). Tooth movement and root length changes of the maxillary first molar, canine, and incisors were evaluated with three-dimensional models constructed using CBCT data obtained before and after orthodontic retraction through the superimposition of stable implants.

RESULTS

Distal movement of the molar crown was observed in G2, but mesial movement was observed in G1. Mesial tipping of the first molar (1.82 ± 6.76°) was seen in G1 and distal tipping (4.44 ± 3.77°) was observed in G2. For the canines, mesial crown tipping (0.33 ± 4.99°) was noted in G1 and distal crown tipping (8.00 ± 5.57°) was observed in G2. In adults, the lingual inclinations of the lateral and central incisors were 11.91 ± 7.01° and 11.47 ± 6.70°, with 0.99 ± 1.22 mm and 1.08 ± 1.20 mm root retraction, respectively. In adolescents, the torque changes were smaller (lateral incisors, 8.25 ± 10.15°; central incisors, 9.82 ± 8.97°) and the root retractions were 0.31 ± 1.81 mm and 0.77 ± 1.59 mm, respectively. Less shortening of the central incisor roots occurred in adolescents than in adults.

CONCLUSIONS

Tooth movements, such as anchor molar angular change, the canine tipping pattern, and the amount of incisor retraction, differed between adolescents and adults treated using the same anchorage with mini-screw implants, bracket prescription, and en masse retraction method. Anchorage strength of the first molars, canine movement patterns, and incisor retraction ranges are not determined by the anchorage device alone; growth and alveolar limitations also play roles.

Prediction of mandibular movement and its center of rotation for nonsurgical correction of anterior open bite via maxillary molar intrusion

OBJECTIVES

To evaluate quantitatively the relationship between molar intrusion (change [Δ] maxillary first molar [U6]-palatal plane [PP]) and changes in vertical and sagittal cephalometric parameters and to determine the center of mandibular autorotation.

MATERIALS AND METHODS

Twenty-one patients diagnosed with anterior open bite and successfully treated with molar intrusion (overbite [OB] > 0 mm) were retrospectively enrolled. Lateral cephalograms taken before and after molar intrusion were used to measure changes in vertical and sagittal cephalometric parameters. The center of mandibular autorotation was calculated by measuring displacement of gonion (Go) and pogonion (Pog). Paired t-tests were used to compare variables, and linear regression analysis was used to examine the relationship between ΔU6-PP and other variables.

RESULTS

The mandible exhibited counterclockwise rotation after maxillary molar intrusion, which led to closure of anterior open bite. Strong linear relationships, in descending order, between ΔU6-PP and ΔOB, Δanterior facial height (AFH), Δvertical reference plane (Pog), and Δsella-nasion to Go-menton (SN-GoMe), were observed. When the maxillary molar was intruded 1 mm, OB increased by 2.6 mm, AFH decreased by 1.7 mm, Pog moved forward by 2.3 mm, and SN-GoMe decreased by 2°. The center of mandibular autorotation was located 7.4 mm behind and 16.9 mm below condylion after molar intrusion.

CONCLUSIONS

The mandible exhibited counterclockwise rotation after maxillary molar intrusion; the center of mandibular autorotation was located behind and below condylion with individual variations.

[Influence of the arch-wire deformation on movement of the maxillary anterior teeth in the lingual retraction force system with micro-implant anchorage using 3-D finite element analysis]

PURPOSE

To evaluate the biomechanical effect of arch wire deformation, height of micro-implant and lever-arm on movement of the maxillary anterior teeth in the lingual retraction force system.

METHODS

Nonlinear 3-D finite element model of lingual orthodontic force system with micro-implant was constructed. When the arch-wire was set to be flexible body and rigid body, lingual retraction force system using sliding mechanism, the height of micro-implant and lever-arm was 0, 3, 5, 7 mm to alveolar ridge crest of the middle point of maxillary second premolars and maxillary first molars. The initial movement and hydrostatic pressure of anterior teeth were calculated.

RESULTS

In the lingual retraction force system with micro-implant using sliding mechanism, when the wire was set to be flexible body, retroclination primary displacements of maxillary anterior teeth were found because of wire deformation. The maxillary lateral incisor's primary displacement became larger with the height of micro-implant increased. When the wire was set to be rigid body, the teeth tended to be slightly tipping, and with the increase of height of micro-implant, the change of movement tendency was not obvious. High value of periodontal ligament hydrostatic pressure was observed in the lingual retraction force system of maxillary anterior teeth with micro-implant when the wire was flexible, exceeding the capillary pressure. When the wire was rigid, the value of periodontal ligament hydrostatic pressure was small within the upper limit value of capillary pressure.

CONCLUSIONS

Deformation of wire has a great influence on initial teeth movement and periodontal hydrostatic pressure. In clinic, using more rigid wire and reducing the initial force may reduce the risk of orthodontic root absorption.

Assessment of changes in the nasal airway after nonsurgical miniscrew-assisted rapid maxillary expansion in young adults

OBJECTIVES

To evaluate changes in the volume and cross-sectional area of the nasal airway before and 1 year after nonsurgical miniscrew-assisted rapid maxillary expansion (MARME) in young adults.

MATERIALS AND METHODS

Fourteen patients (mean age, 22.7 years; 10 women, four men) with a transverse discrepancy who underwent cone beam computed tomography before (T0), immediately after (T1), and 1 year after (T2) expansion were retrospectively included in this study. The volume of the nasal cavity and nasopharynx and the cross-sectional area of the anterior, middle, and posterior segments of the nasal airway were measured and compared among the three timepoints using paired t-tests.

RESULTS

The volume of the nasal cavity showed a significant increase at T1 and T2 ( P < .05), while that of the nasopharynx increased only at T2 ( P < .05). The anterior and middle cross-sectional areas significantly increased at T1 and T2 ( P < .05), while the posterior cross-sectional area showed no significant change throughout the observation period ( P > .05).

CONCLUSIONS

The results demonstrate that the volume and cross-sectional area of the nasal cavity increased after MARME and were maintained at 1 year after expansion. Therefore, MARME may be helpful in expanding the nasal airway.

[Three-dimensional printed miniplate used for maxillary protraction]

The miniplate was designed and three-dimensional (3D) printed according to the positions of roots and tooth germs and then it was used as skeletal anchorage to protract the maxilla. The maxilla moved forward obviously after treatment. Custom designed and 3D printed miniplate could be used for maxillary protraction.