A new concept of anatomic lingual arch form

3D-printed indirect bonding trays and transfer jigs for lingual brackets: Digital workflows and two case reports

With the advancement of 3-dimensionally (3D) printing technology, orthodontists can design and fabricate 3D-printed indirect bonding trays and transfer jigs for lingual brackets independently from the laboratory. The present article describes, in detail, the digital workflows for designing and fabricating 3D-printed lingual bracket indirect bonding trays and transfer jigs. Additionally, it aims to demonstrate the effectiveness of this approach in managing common orthodontic issues in adult patients. The first case report exemplifies the successful management of moderate crowding in a Class I adult patient using a non-extraction approach with lingual brackets and flexible 3D-printed indirect bonding trays. The second case illustrates the application of lingual brackets and rigid 3D-printed indirect bonding trays in managing a skeletal Class II adult patient with mouth protrusion requiring four-bicuspid extractions. The achieved good treatment results might demonstrate the high transfer accuracy of 3D-printed lingual bracket indirect bonding trays. Additional studies with large sample sizes should be conducted to compare the effectiveness and efficiency of 3D-printed trays with other tray types.

Three-dimensional of lingual arch form and creation of templates in Iraqi normal occlusion

OBJECTIVES

To evaluate the lingual dental arch form types in class I canine and molar relationship based on scanning dental cast models using three-dimensional laser scan and to give a new lingual arch form pattern created on this classification to be used for clinical submission by studying three-dimensional virtual models of the normal occlusion samples.

MATERIALS AND METHODS

Maxillary and mandibular casts of 120 young adults (18-24 ± 1.84 years) have normal occlusion that was scanned using a 3Shape E1 laser scanner, and then, the data were analyzed using SPSS software; then, we used K-means cluster to classify the arch form into clusters depending on the measurement of 10 landmarks designated on the lingual surface of the teeth.

RESULTS

Many dental arch patterns have been established for both the mandible and the maxilla.

CONCLUSION

The minimum sizes were found in the females, and the biggest sizes were found in the male subjects, and three sets were well defined for each sex; three categories for each mandible and maxilla are as follows: narrow, mid, and broad. The lingual arch form can be classified into three groups based on posterior and anterior dimensions, so a template of the three arch forms has been exemplified.

Accuracy of dental arch form in customized fixed labial orthodontic appliances

INTRODUCTION

This study evaluated arch form accuracy with or without premolar extraction in customized fixed labial orthodontic appliance treatment.

METHODS

Setup and posttreatment digital models of 27 samples (15 extractions and 12 nonextractions) were selected and superimposed by best-fit surface-based registration in both the maxilla and the mandible. The facial axis points were identified and converted into Cartesian coordinates. A sixth-order polynomial equation was used to fit dental arches. Arch discrepancies (the mean distance between 2 arch forms) and similarities were compared between extraction and nonextraction groups, maxilla and mandible, and anterior and posterior arches.

RESULTS

The arch discrepancy between extraction and nonextraction groups showed no statistically significant difference, but a statistically significant difference in arch similarity was found in the mandible. There were statistically significant differences between anterior and posterior arch discrepancies in the extraction (mandible) and the nonextraction (maxilla and mandible) groups. However, no statistically significant correlation was shown between anterior and posterior arch discrepancies. The arch similarities were 96.18% and 97.38% in the maxilla and 96.01% and 97.49% in the mandible between extraction and nonextraction groups. Arch form discrepancies and similarities showed a moderate correlation but no statistically significant differences between the maxilla and the mandible.

CONCLUSIONS

In customized fixed labial orthodontic appliance treatment, arch form setup can be accurately achieved with and without premolar extraction. Anterior arch form acquires fewer discrepancies than the posterior arch, and overcorrection should be added to the end of the customized archwire to reduce posterior arch discrepancies. The discrepancy of the maxillary and mandibular arches is interrelated, and adjustments should be made on both maxillary and mandibular archwires to correct single-jaw transverse malposition.

3D technology to measure dental arches and create a template for lingual brackets technique

Objective:

This study aims at identifying anatomical dimensions of dental arches, based on landmarks currently used in the lingual orthodontic technique, and create an archwire form template to be used in orthodontic clinics.

Methods:

Maxillary and mandibular dental casts of 140 Caucasian individuals with natural and normal occlusion were digitized (3D), and the images were analyzed with Delcam Power Shape^TM 2010 software. The dental arch shapes and sizes were obtained from 14 landmarks selected on the lingual surface of the teeth. Points and segments defined by the software were used to create an archwire form template.

Results:

Various dental arch patterns were found for both maxilla and mandible. The smallest sizes were found in females, and the largest were found in male subjects. Six categories were defined for each gender, three for the maxilla and three for the mandible (Small, Medium and Large). A template was created with eighteen anatomic lingual archwire designs, nine for the maxilla and nine for the mandible, for both genders.

Conclusions:

Landmarks evaluated in this study showed dental arch differences between genders. This information enables making orthodontic lingual archwires that are more compatible with the anatomical forms and sizes of the maxilla and mandible. The findings also allowed the creation of a template for an anatomic lingual metallic archwire form to be used in the lingual technique.

<p>Analysis of Lingual Arch Form in Dental Students of Nepal with Normal Occlusion</p>

Background

The objectives of this study were to describe and classify lingual arch form in dental students with normal occlusion and explore the possibility to provide a lingual arch form template for Nepalese population.

Methods

The occlusion and arch form of 220 undergraduate dental students were analyzed and thirty-three subjects (14 males, 19 females) fulfilling the inclusion criteria were selected for the study. Reference points were drawn on the lingual surfaces of the teeth of study model using an indelible marker. A transparent ruled grid was used to obtain x and y coordinate values of the reference point. Following distances were measured with a digital caliper: inter-canine width, inter-molar width, inter-second molar width, canine depth, first molar depth, and second molar depth. Two-step cluster analysis was used to further classify the arch. The mean reference point values of each cluster were entered into the software (CurveExpert 1.4, Hymas developers). The curve finder tool of the software was used to obtain the curve which best described the arch forms.

Results

Two-step cluster analysis identified two distinguished clusters of lingual arch forms. Tenth degree polynomial was chosen as the best possible fit for lingual arch forms by using Curvefinder tool of the software CurveExpert 1.4.

Conclusion

Two types of anatomical lingual arch forms derived from Nepalese dental students with normal occlusion have been described and templates for the same have been generated.

Analysis of tooth anatomy in adults with ideal occlusion: A preliminary study

INTRODUCTION

The aim of this study was to investigate the vestibular anatomy of teeth in samples of adult Italian and Mozambican subjects in ideal occlusion and permanent dentition and identify any anatomic characteristics that may influence bonding in the straight-wire technique.

METHODS

Linear measurements and coordinates of each curve representing the clinical crown height and width of each tooth were acquired from digital models of each subject categorized to 1 of 2 groups: Italian (18 males, 22 females; mean age, 29.6 ± 5.7 years) or Mozambican (14 males, 15 females; mean age, 23.4 ± 5.9 years). All subjects had normal dentition and no previous orthodontic treatment, fillings, or prostheses. Method error and systematic error were calculated according to the Dahlberg formula (S² = ∑ d²/2n) and dependent Student t test (P <0.05), respectively. Tooth symmetry was investigated through a paired-samples t test (P <0.05) and sex difference via an independent-samples t test (P <0.05). After neither asymmetry nor sexual dimorphism was found, all data were pooled, inverting the signs of the X coordinates and then mirroring data. Subsequently, a 2-samples t test (P <0.05) and a multivariate cluster analysis were performed on the mirrored data to compare the 2 groups and to identify any within-group diversity for number of clusters for each tooth. Means of all linear measurements and coordinates (crown height and width) calculated for each cluster were reported and compared using a standard 2-samples t test (P <0.05).

RESULTS

Two clusters were identified for the maxillary second premolars and molars in Italian subjects, whereas in the Mozambican subjects, there were 2 clusters for the maxillary first premolars and lateral incisors and 3 clusters for the maxillary canines and central incisors. The mandibular arch was remarkably homogeneous, with only 1 cluster per tooth in each group. In the mandibular arch, statistical differences were recorded between ethnic groups in crown height at the central incisors and second molars and in crown width in the sector from the second premolar to the second molar.

CONCLUSIONS

There were considerable differences both between and within racial groups in crown height, crown width, and numbers of clusters, which should be taken into account during bonding. Although single-bracket placement guides specific for ethnicity may be feasible for the mandibular arch, the significant diversity in number of clusters in the maxillary arch indicates that more accurate bracket placement guides that take into account such heterogeneity are required.

Do gender and age influence hard palate dimensions? A systematic review

PURPOSE

Analyze the influence of gender and age on hard palate dimensions and verify the reference parameters available in the literature.

RESEARCH STRATEGIES

Two reviewers independently performed a search at the Cochrane Library, PubMed-Medline and Web of Knowledge databases using descriptors according to the syntax rules of each database.

SELECTION CRITERIA

Observational or experimental human studies evaluating the dimensions of the hard palate or maxillary dental arch, with at least one transverse, vertical or sagittal plane measurement, in normal occlusions or class I malocclusions, and comparisons of the dimensions between genders and/or ages.

DATA ANALYSIS

Descriptive analysis with the following subdivisions: design, sample, evaluation instruments, measurements in millimeters, and statistical analysis. Quality of the included studies was verified by the Newcastle - Ottawa Quality scale.

RESULTS

Eighteen studies were selected and 11 presented results for hard palate or maxillary dental arch dimensions according to gender, six in age and gender and one in age only.

CONCLUSION

The dimensions were larger in males and progressive increase in the measurements was observed from birth to the permanent dentition period.

The effect of occlusogingival placement of clinical bracket points on the adaptation of a straight wire to the lingual arch form

Objective

The aim of this study is to compare the adaptation of a straight wire between brackets positioned at the mid-lingual surface and those placed gingivally by using a three-dimensional simulation software.

Methods

This cross-sectional study was performed using OrthoAid, an in-house software. The subjects were 36 adolescents with normal Class I occlusion. For each dental cast, two bracket positioning approaches, namely the middle and gingival, were examined. In the middle group, the reference points were placed on the mid-lingual surface of each tooth, while in the gingival group, the reference points were positioned lingually on the anterior teeth. A 4th degree polynomial was adopted, and the in-plane and off-plane root mean squares (RMSs) of the distances between the reference points and the fitted polynomial curve were calculated using the software. Statistical analysis was performed using the paired-samples t-test (α = 0.05).

Results

The mean in-plane RMS of the polynomial curve to the bracket distance in the gingival group was significantly lower than that in the middle group (p < 0.001). The off-plane RMS was higher in the gingivally positioned brackets in the maxilla than in the middle group (p < 0.001). However, the off-plane RMS in mandible was not statistically significantly different between the two groups (p = 0.274).

Conclusions

The results demonstrated that the gingival placement of lingual brackets on the anterior teeth could decrease the distance between a tooth and the straight wire.

Computer-guided technique evaluation of the bony palate for planning individual implant placement

OBJECTIVE

Different clinical problems may require a surgical approach to the dental arch, such as dentofacial orthopedics, implant-supported dental prothesis, maxillary orthodontics protraction, removable appliances, and posttraumatic dental reconstruction. The aim of this study is to analyze the dental arch size and type for supporting individual dental protheses.

MATERIALS AND METHODS

In this study, the reference measurements on the length of the bony palate, maxillary intercanine width, maxillary intermolar width, and the ratio of the maxillary to the palatinal surface were studied in 120 bony palates using a computer software program.

RESULTS

The average length of the bony palate, maxilla, and palatine was measured as 104.4 ± 30.3, 40.05 ± 4.05, and 15.00 ± 3.03 mm, respectively. The right and left sides of average width of intermaxillary distances were measured as 13.75 ± 1.50 and 12.51 ± 1.50 mm, respectively. The average width of intermolar distance was calculated as 19.82 ± 1.61 mm (right side) and 18.89 ± 1.69 mm (left side), respectively. The maxillary dentitions were classified as square (17%), round-square (63.5%), round (14.4%), and round V-shaped arches (5.1%). The round-square ones showed no prominent principal component. Among the maxillary arches, the round arches were characterized by small values and round V-shaped ones with the largest values. Asymmetry between the right and the left bony palate was observed. The areas with equal bony palate on both sides were present in 64.4% of the cases, and in 33.1% of the cases, bony palate was dominant on the right.

CONCLUSIONS

The primary principle in reconstructive treatment should be describing geometrical forms and mathematical details of the bony palate. Three-dimensional reference values relative to the dental arch may increase the success of individual treatment of surgical procedures and reduce possible complications. With the help of certain software, this research has made possible to investigate the variability of the dental arch and calculate the variety in measurements and thereby determining the most appropriate implant position, optimizing the implant axis and defining the best surgical and prosthetic solution for the patient.

Stiffness comparison of mushroom and straight SS and TMA lingual archwires

Background

The aim of this study is to investigate the relative stiffness of straight and mushroom lingual archwires of different diameters, cross sections and alloys, plotting their load/deflection graphs and using a modified three-point bending test.

Methods

Fujita’s mushroom archwires and straight lingual archwires of different diameters, cross sections and alloys were derived by a virtual set-up of an equal malocclusion and were cut at their straight distal portion. These distal portions were tested using a modified three-point bending test by an Instron 4467 dynamometer and the forces, were exerted at 1-mm deflection and were compared on each resulting load/deflection curve by means of ANOVA (p < 0.05).

Results

All upper lingual mushroom wires exerted significantly lower forces than the straight wire. Lower mushroom archwires were stiffer than their upper counterparts, which were longer and featured inset bends. In the lower arch, similar levels of forces were recorded for the two types of wire. Load-deflection curves were higher for the straight wires, and stiffness increased proportionally with their diameter.

Conclusions

The stiffness of an archwire is a function of its diameter, length and the alloy it is made from. In lower lingual wires, there is little difference in stiffness between mushroom and straight wires, but in upper wires, the straight version is considerably stiffer. The greater bearing effect exhibited by the straight wire in the working and finishing phases makes it less susceptible to bowing effect and therefore preferable for sliding mechanics during en masse retraction, particularly in the upper arch.

Shape variation and covariation of upper and lower dental arches of an orthodontic population

OBJECTIVES

This study aimed to quantify the patterns of shape variability and the extent and patterns of shape covariation between the upper and lower dental arch in an orthodontic population.

METHODS

Dental casts of 133 white subjects (61 males, 72 females; ages 10.6-26.6) were scanned and digitized in three dimensions. Landmarks were placed on the incisal margins and on the cusps of canines, premolars, and molars. Geometric morphometric methods were applied (Procrustes superimposition and principal component analysis). Sexual dimorphism and allometry were evaluated with permutation tests and age-size and age-shape correlations were computed. Two-block partial least squares analysis was used to assess covariation of shape.

RESULTS

The first four principal components represented shape patterns that are often encountered and recognized in clinical practice, accounting for 6-31 per cent of total variance. No shape sexual dimorphism was found, nevertheless, there was statistically significant size difference between males and females. Allometry was statistically significant, but low (upper: R(2) = 0.0528, P < 0.000, lower: R (2) = 0.0587, P < 0.000). Age and shape were weakly correlated (upper: R(2) = 0.0370, P = 0.0001, lower: R (2) = 0.0587, P = 0.0046). Upper and lower arches covaried significantly (RV coefficient: 33 per cent). The main pattern of covariation between the dental arches was arch width (80 per cent of total covariance); the second component related the maxillary canine vertical position to the mandibular canine labiolingual position (11 per cent of total covariance).

LIMITATIONS

Results may not be applicable to the general population. Age range was wide and age-related findings are limited by the cross-sectional design. Aetiology of malocclusion was also not considered.

CONCLUSIONS

Covariation patterns showed that the dental arches were integrated in width and depth. Integration in the vertical dimension was weak, mainly restricted to maxillary canine position.

Comparison of dental and alveolar arch forms between different ethnic groups

OBJECTIVE

The aims of this study were to evaluate, by means of 3D software, any correlation between ethnic group and the shape and size of the dental arcade and its bony support, and to investigate the correspondence between the latter two variables within each ethnic group. The data gathered were also compared with the measurements of commercially available pre-formed archwires to determine which provide the best fit for each arch in each group.

MATERIALS AND METHODS

The shape and size of the dental and alveolar arches of 29 subjects of African origin and 37 Caucasian subjects were compared in terms of linear inter-canine, inter-premolar and inter-molar measurements, overall arch length, and the distance between each tooth and the reference occlusal plane. To determine which pre-formed archwires are best suited to each of the two ethnic groups, the in-out of the brackets was considered, simulating their presence in the oral cavity.

RESULTS

The upper and lower dental and alveolar arches were all wider and longer in African with respect to Caucasian subjects (P<0.05). In general, "Roth small" (index value 1.556) and "Ideal Form Medium" (index value 0.645) archwires were better suited to both upper and lower arcades in the latter group, while "Damon" (index value 1.447) and "Ideal Form Large" (index value 1.695) conformed better to the size and shape of both arcades in the former.

CONCLUSIONS

There are very significant differences in arch form between the two ethnic groups considered, and the range of pre-formed archwires on the market does not provide for the anatomical variability of patients.

New classification of lingual arch form in normal occlusion using three dimensional virtual models

Objective

The purposes of this study were 1) to classify lingual dental arch form types based on the lingual bracket points and 2) to provide a new lingual arch form template based on this classification for clinical application through the analysis of three-dimensional virtual models of normal occlusion sample.

Methods

Maxillary and mandibular casts of 115 young adults with normal occlusion were scanned in their occluded positions and lingual bracket points were digitized on the virtual models by using Rapidform 2006 software. Sixty-eight cases (dataset 1) were used in K-means cluster analysis to classify arch forms with intercanine, interpremolar and intermolar widths and width/depth ratios as determinants. The best-fit curves of the mean arch forms were generated. The remaining cases (dataset 2) were mapped into the obtained clusters and a multivariate test was performed to assess the differences between the clusters.

Results

Four-cluster classification demonstrated maximum intercluster distance. Wide, narrow, tapering, and ovoid types were described according to the intercanine and intermolar widths and their best-fit curves were depicted. No significant differences in arch depths existed among the clusters. Strong to moderate correlations were found between maxillary and mandibular arch widths.

Conclusions

Lingual arch forms have been classified into 4 types based on their anterior and posterior dimensions. A template of the 4 arch forms has been depicted. Three-dimensional analysis of the lingual bracket points provides more accurate identification of arch form and, consequently, archwire selection.

Determining shapes and dimensions of dental arches for the use of straight-wire arches in lingual technique

INTRODUCTION:

This study aims to determine the shape and dimension of dental arches from a lingual perspective, and determine shape and size of a straight archwire used for lingual Orthodontics.

METHODS:

The study sample comprised 70 Caucasian Brazilian individuals with normal occlusion and at least four of Andrew's six keys. Maxillary and mandibular dental casts were digitized (3D) and the images were analyzed by Delcam Power SHAPET 2010 software. Landmarks on the lingual surface of teeth were selected and 14 measurements were calculated to determine the shape and size of dental arches.

RESULTS:

Shapiro-Wilk test determined small arch shape by means of 25^th percentile (P25%) - an average percentile for the medium arch; and a large one determined by means of 75^th percentile (P75%). T-test revealed differences between males and females in the size of 12 dental arches.

CONCLUSION:

The straight-wire arch shape used in the lingual straight wire technique is a parabolic-shaped arch, slightly flattened on its anterior portion. Due to similarity among dental arch sizes shown by males and females, a more simplified diagram chart was designed.

Dental and alveolar arch forms in a Caucasian population compared with commercially available archwires

INTRODUCTION

The aim of this study was to identify an arch form, comprising dentition and alveolus, representative of the Caucasian population, and to compare it with the shape of the main archwires on the market.

MATERIALS AND METHODS

The study sample comprised 35 pairs of dental casts, taken from the arches of 35 Southern Europeans with ideal natural occlusion. After the dental casts were scanned, the reference points of the dental arches (FA points) and alveolar bone (WALA ridges) were identified with 3D software. Cartesian coordinates and intercanine and intermolar diameters were calculated for each patient, and curves representing the upper and lower dentition, as well as those showing the shape of the lower supporting bone, were traced and compared with those pertaining to different types of commonly used orthodontic archwires.

RESULTS

Ideal shapes of the mandibular alveolus and of the upper and lower archwires were calculated and compared with those actually on the market. Statistical analysis showed significant differences between the two, particularly at the upper and lower molars and canines. Likewise, there were significant differences between the shapes of the available archwires and the WALA ridge, except for the intercanine width.

CONCLUSIONS

None of the commercial archwires examined faithfully represented the shape of the 'ideal' dentition we calculated, particularly at the molars and canines. The bone structure of the mandibular support cannot be used as a guide to the shape of the arch form during orthodontic treatment.