Mandibular anterior intrusion using miniscrews for skeletal anchorage: A 3-dimensional finite element analysis

Biomechanical analysis of total arch maxillary distalization using infrazygomatic crest miniscrews: a finite element analysis study

AIM

To evaluate the maxillary incisors and canine's immediate movement tendency using three different power arms (PA) height levels during total arch maxillary distalization supported on infrazygomatic crest (IZC) miniscrews according to finite element analysis (FEA).

METHODS

Three finite element models of the maxilla were developed based on CBCT imaging of a teenage male patient presenting a Class II Division 1 malocclusion in the early permanent dentition. Maxillary complex, periodontium, orthodontic accessories, IZC miniscrews and an orthodontic wire were digitally created. The PAs were placed between canines and lateral incisors and projected at 4, 7, and 10 mm height distances. After that, distalization forces were simulated between PA and IZC miniscrews.

RESULTS

The anterior teeth deformation produced in the FEA models was assessed according to a Von Mises equivalent. The stress was measured, revealing tendencies of initial maxillary teeth movement. No differences were found between the right and left sides. However, there was a significant difference among models in the under-stress areas, especially the apical and cervical root areas of the maxillary anterior teeth. More significant extrusion and lingual tipping of incisors were observed with the 4 mm power arm compared to the 7 mm and 10 mm ones. The 10 mm power arm did not show any tendency for extrusion of maxillary central incisors but a tendency for buccal tipping and intrusion of lateral incisors.

CONCLUSION

The maxillary incisors and canines have different immediate movement tendencies according to the height of the anterior point of the en-masse distalization force application. Based on the PA height increase, a change from lingual to buccal tipping and less extrusion tendency was observed for the incisors, while the lingual tipping and extrusion trend for canines increased.

Maxillary molar distalization treated with clear aligners combined with mini-implants and angel button using different traction force: a finite element study

OBJECTIVES

To evaluate the biomechanical system of molar distalization with clear aligner therapy (CAT) combined with angel button using interradicular mini-implants (IRMIs) with varying elastic forces.

MATERIALS AND METHODS

FE models including maxilla, complete maxillary dentition, periodontal ligaments (PDL), composite attachments, mini-implants (MI), and dedicated orthodontic aligner, were constructed. Three groups were created in accordance with the sagittal position of MI. Elastic forces (0 N,1 N,1.5 N,2 N) were applied.

RESULTS

CAT without elastics caused labial tipping and intrusion of the anterior teeth. Initial labial tipping and the von Mises stress of the maxillary anterior teeth decreased as the elastic forces increased.

Orthodontic considerations in hypodivergent craniofacial patterns

This article examines the characteristics of hypodivergent craniofacial patterns and explores treatment modalities in response to these features. It discusses the impact of robust masticatory muscles, which produce heavy occlusal forces. In addition, it examines the use of Botox or splints to reduce gonial angles in individuals with a square face. A nonextraction treatment approach supported by temporary skeletal anchorage devices is recommended; however, if anatomical limitations persist, extraction may be necessary when arch expansion, molar distalization, incisor proclination, or interproximal reduction cannot create the necessary space. In hypodivergent cases where a nonextraction approach is impractical, a single-arch extraction strategy may be considered to prevent a reduction in the vertical dimension. Emphasizing esthetics, particularly maxillary incisor display, a protocol of total arch extrusion of the maxillary dentition assisted with temporary skeletal anchorage device, bite raisers, and interarch elastics is suggested.

Biomechanical and clinical considerations in deep bite treatment using temporary skeletal anchorage devices

Deep bite is usually treated by intrusion of the anterior teeth, extrusion of the posterior teeth, or a combination thereof. Various traditional methods have been used to correct deep bites, but they can cause negative side effects. Recently, temporary skeletal anchorage devices (TSADs) have been used to intrude the anterior teeth simply and efficiently without side effects. The amount of incisal exposure at rest should be considered as the first factor in determining which tooth segment should be intruded to correct a deep bite. The center of resistance of the anterior teeth should be considered to achieve the proper biomechanics when intruding them. The location of TSADs should be determined to ensure sufficient interradicular bone to achieve the desired tooth movement. Therefore, clinicians should understand the biomechanical and clinical considerations to correct a deep bite using TSADs.

Finite element analysis of two skeletally anchored maxillary molar distalisation methods

OBJECTIVE

To compare two methods of maxillary molar distalisation with skeletal anchorage using finite element analysis (FEA).

METHODS

Two digitised models were created: the miniscrew-anchored distaliser, which consisted of a distalisation method anchored in a buccal miniscrew between the first molar and second premolar (Model 1), and the miniscrew-anchored palatal appliance, which consisted of a distalisation method anchored in a miniscrew on the anterior region of the palate (Model 2). FEA was used to simulate both methods, assessing teeth displacements and stress concentration.

RESULTS

The miniscrew-anchored distaliser showed greater buccal than distal displacement of the first molar, while the opposite was observed in the miniscrew-anchored palatal appliance. The second molar responded similarly in the transverse and anteroposterior perspectives with both appliances. Greater displacements were observed at crown level than in apical regions. Greater stress concentration was observed at the buccal and cervical regions of the crown in the miniscrew-anchored distaliser and the palatal and cervical regions in the palatal appliance. The stress progressively spread in the buccal side of the alveolar bone for the miniscrew-anchored distaliser and in the palatal root and alveolar bone for the palatal appliance.

CONCLUSION

FEA assumes that both appliances would promote maxillary molar distalisation. A skeletally anchored palatal distalisation force seems to provide a greater molar bodily movement with less undesirable effects. Greater stress is expected at the crown and cervical regions during distalisation, and the stress concentration in the roots and alveolar bone depends directly on the region the force was applied.

Temporary anchorage devices and the forces and effects on the dentition and surrounding structures during orthodontic treatment: a scoping review

BACKGROUND

Temporary anchorage devices (TADs) offer the clinician an immediate temporary source of skeletal anchorage for a range of orthodontic interventions. It is important to understand forces involved in using TADs and the effects on the dentition and surrounding structures, to improve clinical outcomes.

OBJECTIVE

To examine and qualitatively synthesize literature on the forces involved with the use of TADs and the effects on the dentition and surrounding structures in orthodontic tooth movement, to provide better understanding of the complex interactions and the clinical implications.

SEARCH METHODS

Electronic databases searched included: Cochrane Library [including Central Register of Controlled Trials (CENTRAL)], Embase via OVID, Pubmed, and Scopus. Study screening and selection were conducted in duplicate.

SELECTION CRITERIA

Studies selected were clinical studies, simulation studies (computer or laboratory-based), or animal studies with no restriction over gender, age, study type (excluding case reports), or setting. Studies focusing on the forces involved with the use of TADs in orthodontic treatment and their effects on the dentition and surrounding structures were included.

DATA COLLECTION AND ANALYSIS

A data charting form was piloted and refined. Data charting was performed independently and in duplicate. This consisted of key fields with predetermined options and free text. The extracted data were collated, and a narrative synthesis conducted.

RESULTS

The results from 203 included studies were grouped into seven TAD based interventions combining the clinical, simulation, and animal studies. They were: En masse retraction of anterior teeth, intrusion, movement of a single tooth, orthopaedic interventions, distalisation, maxillary expansion and other types. The forces involved with the use of TADs, and their effects on the dentition and surrounding structures, were presented in descriptive and tabular formats.

LIMITATIONS

This review restricted study language to English. Formal appraisal of the quality of evidence is not a required feature of scoping reviews, as per the PRISMA-ScR guidelines, however it was evident that a proportion of clinical studies were of high risk of bias and low quality and therefore any proposed changes the reader may consider to their clinical practice should be contextualized in light of this.

CONCLUSIONS

Across the seven types of TAD based interventions the effects on the dentition and surrounding structures are described providing a better understanding of the complex interactions. A guide to the level and direction of forces in each type of intervention is provided to aid clinicians in achieving high quality outcomes.

IMPLICATIONS

There is a need to validate future FEA simulation studies by comparing to clinical data. It is also recommended that future scoping reviews incorporate a formal critical appraisal of studies to facilitate the translation of the results into clinical practice. Development of a standard set of terms for TADs is recommended to facilitate future research.

REGISTRATION

Registration of a scoping review is not possible with PROSPERO.

FUNDING

None to declare.

Conservative orthodontic treatment for severe pathologic migration following total glossectomy: A case report

Glossectomy combined with radiotherapy causes different levels of tongue function disorders and leads to severe malocclusion, with poor periodontal status in cancer survivors. Although affected patients require regular access to orthodontic care, special considerations are crucial for treatment planning. This case report describes the satisfactory orthodontic management for the correction of severe dental crowding in a 43-year-old female 6 years after treatment for tongue cancer with total glossectomy combined with radiotherapy, to envision the possibility of orthodontic care for oral cancer survivors. Extraction was performed to correct dental crowding and establish proper occlusion following alignment, after considering the possibility of osteoradionecrosis. Orthodontic mini-implants were used to provide skeletal anchorage required for closure of the extraction space and intrusion of the anterior teeth. The dental crowding was corrected, and Class I occlusal relationship was established after 36 months of treatment. The treatment outcome was sustained after 15 months of retention, and long-term follow-up was recommended.

An analysis of the optimal intrusion force of the maxillary central incisor with root horizontal resorption using the finite element method and curve fitting

There are no studies on the optimal intrusion force in orthodontic patients with the existing root resorption (RR). The study aimed to analyze the optimal intrusion force for central incisors with existing horizontal root resorption using the finite element method (FEM). We calculated the optimal intrusion force using the finite element method and curve fitting. We found that with the increase of the maxillary central incisor's root horizontal resorption length, the optimal intrusion force interval's median gradually increases. If the resorption length is more significant than 1/2 of the root length, it is not recommended to use intrusion force theoretically.

The effects of cortical bone thickness and miniscrew implant root proximity on the success rate of miniscrew implant: A retrospective study

OBJECTIVE

To investigate the effects of cortical bone thickness (CBT), miniscrew implant root proximity (MRP) and other related factors on the success rate of miniscrew implant (MSI).

MATERIALS AND METHODS

Four hundred and five MSIs placed in 171 patients were analysed in this retrospective study. The primary predictor variables were CBT and MRP at MSI insertion sites. The predictor variables also included patient, location, MSI design and procedure related factors. The outcome variable was the survival of MSI. The differences in measurement data between success group and failed group were evaluated by the analysis of variance and independent samples t tests. Patient, location, MSI design and procedure related factors associated with the MSI prognosis were analysed by survival analysis with Cox proportional hazard regression model. The P value was set at .05. And the survival curves of independent factors were plotted.

RESULTS

The overall success rate of MSI was 82.7%. The age of MSI host, CBT, interdental root distance (IRD) and MRP at MSI sites showed no significant differences between failed group and success group. CBT and insertion jaws were independent prognosis factors screened out by Cox proportional hazard regression model. Failure risk (hazard ratio) of MSI with CBT <1 mm was 4.72. The failure risk in the mandible was 3.80 times as high as that in the maxilla.

CONCLUSION

Inadequate CBT (<1 mm) contributed to the failure of MSI. MSI placed in the maxilla showed better prognosis compared to the mandible. MRP had no significant effect on the prognosis.

Critical issues concerning biocreative strategy in contemporary temporary skeletal anchorage device orthodontics: A narrative review

Biocreative Orthodontic Strategy (BOS) is designed to establish a physiologically stable occlusion in harmony with masticatory and TMJ function and healthy supporting tissues with strategic use of temporary skeletal anchorage devices (TSADs). This narrative review surveys current research that demonstrates how BOS with TSADs uses a target approach to overcome the limitations experienced with conventional orthodontic treatment. A narrative review article including research on TSADs orthodontics in the permanent dentition. This review is a brief survey of five BOS principles for contemporary TSAD orthodontics: elegant selection of TSADs, bracket prescription to enhance TSAD orthodontics, antero-posterior dimension control, transverse dimension control and airway control issues. Severe malocclusion and craniofacial dysmorphology can be treated with Biocreative Orthodontic Strategy with a minimum number of TSADs. In order to achieve successful treatment outcome using TSADs, it is critical to understand the key diagnosis and treatment principles of BOS and how to develop a target approach for the tooth and bone movement.

Miniscrew mechanics for molar distalization and incisor intrusion in a patient with a Class II brachyfacial pattern and gummy smile

A gummy smile is one of the most problematic characteristics in patients with a Class II Division 2 malocclusion, and the correction of vertical position and incisor torque is often challenging for the orthodontist. This case report describes the orthodontic treatment of a 31-year-old woman, assisted by miniscrew mechanics for maxillary arch distalization and correction of a gummy smile with a brachyfacial pattern. Two different mechanics were used. Miniscrews were placed in both maxillary tuberosities, and the maxillary arch was successfully distalized, correcting the Class II relationship. Interradicular miniscrews were placed for maxillary and mandibular incisor intrusion to correct the gummy smile, overbite, and torque. Finally, periodontal surgery was performed to lengthen the maxillary incisor crowns. Satisfactory smile esthetics and good occlusion were achieved. Follow-up after 24 months confirmed that the outcome was stable.

Concentrated growth factor promotes gingival regeneration through the AKT/Wnt/β-catenin and YAP signaling pathways

Although concentrated growth factor (CGF) is known to promote gingival regeneration and improve the outcomes of clinical treatment, the mechanisms underlying its effects remain unknown. Therefore, this study aimed to elucidate the effects of CGF on gingival thickening. To this end, gingival mesenchymal stem cells (GMSCs) were treated with different concentrations of CGF, and the effects of CGF on cell proliferation and migration; collagen-1 (Col-1), fibronectin (FN), vascular endothelial growth factor (VEGF), and angiopoietin-1 (Ang-1) expression; and the AKT, Wnt/β-catenin, and Yes-associated protein (YAP) signalling pathways were investigated. The effects of CGF in vivo were also investigated in a rat buccal gingival injection model. GMSCs cultured with CGF showed improved cell proliferation and migration. Moreover, CGF treatment improved the levels of FN, Col-1, VEGF, and ANG-1. These effects of CGF were mediated by the AKT/Wnt and YAP pathways, with the AKT pathway possibly functioning upstream of the Wnt/β-catenin and YAP pathways. YAP was also shown to be overexpressed in the in vivo model. Thus, CGF can promote gingival regeneration, and YAP transport into the nucleus may be a key factor underlying this activity, which provides a novel perspective for gingival regeneration and further promotion of the clinical application of CGF.

Efficacy of different designs of mandibular expanders: A 3-dimensional finite element study

INTRODUCTION

Nonsurgical mandibular expansion has been increasingly performed in recent years because it can effectively expand the mandibular dental arch. However, many types of mandibular expanders have been used in previous studies. No relevant studies have compared the biomechanical responses of different designs of mandibular expansion appliances with screws. Therefore, the purpose of this study was to analyze the stress distribution and displacement of the dentoalveolar structures according to different designs of mandibular screw expanders.

METHODS

Cone-beam computed tomography scans were used for 3-dimensional reconstruction of the mandibular finite element model. Four different designs of mandibular expanders, 1 removable expander (type A) and 3 fixed expanders (types B, C, and D), were added to the finite element models. Expanders were activated transversely for 0.2 mm. The initial tooth displacement and von Mises stress distribution were evaluated.

RESULTS

All the expanders enlarged the arch dimensions. In types A and B, the stress was mainly concentrated in the region of the anterior teeth, along with greater tooth displacement, whereas in types C and D, greater stress and displacement occurred in the region of the posterior teeth. Type A showed the greatest amount of transverse displacement. Type D was more efficient in the region of the posterior teeth.

CONCLUSIONS

Types A and B should be used with great caution in the clinic because of their incompatible expansion pattern. Type D is the recommended mandibular expansion appliance because of its appropriate expansion pattern.

An Umbrella Review of the Effectiveness of Temporary Anchorage Devices and the Factors That Contribute to Their Success or Failure

OBJECTIVES

New methodological approaches, such as the umbrella review, constitute an important pathway for synthesizing the scientific evidence provided from studies with a high level of evidence. This study aims to summarize the results on the effectiveness of temporary anchorage devices (TADs) and the factors that contribute to their success or failure during orthodontic treatment in patients of different age groups and to identify the gaps in knowledge based on analysis of the scientific literature.

METHODS

An umbrella review of systematic reviews and meta-analyses was performed. A quality evaluation and a descriptive analysis of the included studies were conducted. The study protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO: CRD42018094463).

RESULTS

Seventeen systematic reviews and meta-analyses were considered (10 descriptive and 7 with meta-analysis; 12 of high quality and 5 of moderate quality). Variability was observed in the type of intervention and the type of system (TADs). Most of the studies reported high success rates (≥90%), and just one systematic review indicated a low rate of success (≤56%) for the mini-screws. All the studies discussed several factors related to the success of the TADs. These factors were classified as device-related factors, patient-related factors, procedure-related factors, and orthodontic treatment-related factors. Conceptual and methodological gaps were observed when considering the data analysis, the terminology used, and the orthodontic protocols.

CONCLUSIONS

The results should be analysed cautiously because of several research gaps related to the methodological quality and the high heterogeneity of the original studies and because of the necessity to add several clinical and sociodemographic variables to enrich the data analysis.

Pure Mandibular Incisor Intrusion: A Finite Element Study to Evaluate the Segmented Arch Technique

Leveling the curve of Spee is a commonly-used strategy to correct deep bites. Although several techniques have been proposed to intrude mandibular incisors (MI), flaring of these teeth is often observed and in many instances undesired. A three-dimensional (3D) finite element model (FEM) was used to locate the ideal point of force application (PFA) to achieve pure MI intrusion with the three-piece arches' technique. It comprised (1) a 0.021 × 0.025 in. stainless steel (SS) wire that passively filled the slots of the canine and premolar brackets and the first and second molar tubes, bilaterally; (2) a 0.0215 × 0.0275 in. SS intrusion base arch (IBA) inserted into the MI brackets, that presented a step down distal to the lateral incisors brackets and a posterior extension arm; (3) titanium-molybdenum tip-back springs designed to apply the intrusion force, fitted inside the first molar gingival tube. Four PFA on the IBA were simulated (FEM 1, 2, 3, and 4). FEM 3 resulted in pure MI and was considered the ideal PFA. FEM1 and 2 showed intrusion and buccal crown flaring of the MI, whereas FEM4 resulted in intrusion and lingual crown flaring of those teeth. Clinicians may consider three-piece arch mechanics to achieve pure MI intrusion. However, they must be aware that when force was applied anteriorly or posteriorly to the ideal PFA, the incisors would incline labially or lingually, respectively.