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Di Spirito F, Amato A, Di Palo MP, Ferraro R, Cannatà D, Galdi M, Sacco E, Amato M. Oral and Extra-Oral Manifestations of Hypersensitivity Reactions in Orthodontics: A Comprehensive Review. J Funct Biomater 2024; 15:175. [PMID: 39057297 PMCID: PMC11278158 DOI: 10.3390/jfb15070175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/24/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
Although rare, oral manifestations of hypersensitivity reactions in orthodontic patients pose a significant clinical challenge due to their heterogeneous presentations, and can cause discomfort and pain, possibly impacting patients' quality of life and orthodontic treatment duration and outcomes. This comprehensive review aimed to elucidate the oral, perioral, and systemic manifestations of hypersensitivity reactions in orthodontic subjects, focusing on patients with fixed appliances, removable appliances, and clear aligners, and detailing their epidemiology, macroscopic and microscopic features, allergy testing, clinical implications, and specific management strategies. Oral and extra-oral manifestations of (immediate and delayed) hypersensitivity reactions occur rarely and are due to the release of metal and non-metal ions from orthodontic appliances. They typically present as erythema, erosive-ulcerative lesions, and gingival hyperplasia, with histopathological findings showing inflammatory infiltrates. Nickel is a significant allergen, and diagnostic tests like patch tests are essential for managing these reactions. Likely due to prolonged contact with oral tissues, fixed orthodontic appliances pose a higher risk compared to removable appliances and clear aligners. Early identification and removal of allergenic materials, combined with effective treatments, can resolve symptoms and prevent recurrence. Keeping dental and medical records updated and knowing family and personal medical histories helps clinicians choose appropriate materials and counsel patients about potential risks. Proper patient education, regular monitoring, and using hypoallergenic materials are key strategies for managing these reactions.
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Affiliation(s)
- Federica Di Spirito
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (R.F.); (D.C.); (M.G.); (E.S.); (M.A.)
| | - Alessandra Amato
- Department of Neuroscience, Reproductive Science and Dentistry, University of Naples Federico II, 80131 Naples, NA, Italy;
| | - Maria Pia Di Palo
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (R.F.); (D.C.); (M.G.); (E.S.); (M.A.)
| | - Rahila Ferraro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (R.F.); (D.C.); (M.G.); (E.S.); (M.A.)
| | - Davide Cannatà
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (R.F.); (D.C.); (M.G.); (E.S.); (M.A.)
| | - Marzio Galdi
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (R.F.); (D.C.); (M.G.); (E.S.); (M.A.)
| | - Elettra Sacco
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (R.F.); (D.C.); (M.G.); (E.S.); (M.A.)
| | - Massimo Amato
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, SA, Italy; (R.F.); (D.C.); (M.G.); (E.S.); (M.A.)
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Di Carlo G, Biondi G, Gazzola I, Saccucci M. Biomechanical Multipurpose Miniscrew Strategy for Simultaneous Distalization in Class II Patients-The BiGa System. Biomimetics (Basel) 2024; 9:305. [PMID: 38786515 PMCID: PMC11117739 DOI: 10.3390/biomimetics9050305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024] Open
Abstract
An efficient treatment plan using a temporary anchorage device should be built following the principle of reducing the number of tads to obtain a multiple biomechanical advantage. The following case report concerns the Biga system, a strategy that supports orthodontists during class II corrections and vertical control through treatment. A 12-year-old girl with a high angle of skeletal class II was selected. A novel biomechanical strategy was effectively applied using two tads on the upper arch to obtain sequential distalization of the upper teeth and to correct the lower arch spee curve using third-class elastics. Eventually, on the same tads, a double cantilever was applied to control the overbite and intrusion during incisors' retraction. The Biga system is an easy biomechanical strategy that ensures the three-dimensional control of treatment mechanics in class II patients.
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Affiliation(s)
- Gabriele Di Carlo
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Viale Regina Elena 287a, 00161 Rome, Italy;
| | | | - Ivan Gazzola
- Private Practice, 31033 Castelfranco Veneto, Italy;
| | - Matteo Saccucci
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, Viale Regina Elena 287a, 00161 Rome, Italy;
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Song JH, Lee JH, Joo BH, Choi YJ, Chung CJ, Kim KH. Treatment outcome comparison of Invisalign vs fixed appliance treatment in first premolar extraction patients. Am J Orthod Dentofacial Orthop 2024; 165:399-413. [PMID: 38142394 DOI: 10.1016/j.ajodo.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 10/01/2023] [Accepted: 10/01/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION In this study, we compared the dentitional changes after Invisalign and conventional orthodontic treatment with 4 first premolar extractions. METHODS This retrospective study included 57 patients whose orthodontic treatment involved the extraction of 4 first premolars because of bialveolar protrusion. A total of 27 patients were treated with Invisalign (mean age, 25.5 ± 5.2 years) and 30 patients with the fixed appliance (mean age, 24.4 ± 5.8 years). The angular and linear changes of the maxillary and mandibular central incisors, second premolars, first molars, and second molars were measured from the recordings on the basis of the lateral cephalograms taken before and after treatment. The angular changes of the canines and second premolars were measured using panoramic radiographs. RESULTS The overbite and interincisal angle increased significantly in the Invisalign group compared with in the conventional fixed appliance group (P <0.05). The maxillary central incisors showed increased lingual tipping in the Invisalign group (P <0.05), whereas there was no statistically significant difference in the angular change of the mandibular incisors between groups (P >0.05). The maxillary first and second molars showed mesial tipping in the Invisalign group (P <0.05). The maxillary second premolars, first and second molars, and the mandibular second molars showed mesial movement in the Invisalign group (P <0.05). CONCLUSIONS The Invisalign group showed more statistically significant lingual tipping of the maxillary central incisors, distal tipping of the maxillary canines, and mesial tipping of the maxillary first and second molars after maximum retraction of the anterior teeth compared with the fixed appliance group.
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Affiliation(s)
- Ji-Hye Song
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Ji-Hyun Lee
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Bo-Hoon Joo
- The Institute of Clear Aligner Center of The STAR 28 Dental Group, Seoul, South Korea
| | - Yoon Jeong Choi
- Department of Orthodontics, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Chooryung J Chung
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea
| | - Kyung-Ho Kim
- Department of Orthodontics, Gangnam Severance Dental Hospital, The Institute of Craniofacial Deformity, Yonsei University College of Dentistry, Seoul, South Korea.
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Hodecker LD, Kühle R, Weichel F, Roser CJ, Lux CJ, Bauer CAJ. Concept for the Treatment of Class III Anomalies with a Skeletally Anchored Appliance Fabricated in the CAD/CAM Process-The MIRA Appliance. Bioengineering (Basel) 2023; 10:616. [PMID: 37237686 PMCID: PMC10215846 DOI: 10.3390/bioengineering10050616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
OBJECTIVE Intermaxillary elastics, anchored skeletally, represent a promising concept for treatment in adolescent patients with skeletal Class III anomalies. A challenge in existing concepts is the survival rate of the miniscrews in the mandible or the invasiveness of the bone anchors. A novel concept, the mandibular interradicular anchor (MIRA) appliance, for improving skeletal anchorage in the mandible, will be presented and discussed. CLINICAL CASE In a ten-year-old female patient with a moderate skeletal Class III, the novel MIRA concept, combined with maxillary protraction, was applied. This involved the use of a CAD/CAM-fabricated indirect skeletal anchorage appliance in the mandible, with interradicularly placed miniscrews distal to each canine (MIRA appliance), and a hybrid hyrax in the maxilla with paramedian placed miniscrews. The modified alt-RAMEC protocol involved an intermittent weekly activation for five weeks. Class III elastics were worn for a period of seven months. This was followed by alignment with a multi-bracket appliance. DISCUSSION The cephalometric analysis before and after therapy shows an improvement of the Wits value (+3.8 mm), SNA (+5°), and ANB (+3°). Dentally, a transversal postdevelopment in the maxilla (+4 mm) and a labial tip of the maxillary (+3.4°) and mandibular anterior teeth (+4.7°) with gap formation is observed. CONCLUSION The MIRA appliance represents a less invasive and esthetic alternative to the existing concepts, especially with two miniscrews in the mandible per side. In addition, MIRA can be selected for complex orthodontic tasks, such as molar uprighting and mesialization.
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Affiliation(s)
- Lutz D. Hodecker
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Reinald Kühle
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (R.K.); (F.W.)
| | - Frederic Weichel
- Department of Oral and Maxillofacial Surgery, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (R.K.); (F.W.)
| | - Christoph J. Roser
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Christopher J. Lux
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
| | - Carolien A. J. Bauer
- Department of Orthodontics and Dentofacial Orthopedics, University of Heidelberg, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany; (L.D.H.); (C.J.R.); (C.J.L.)
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Abstract
The objective of this study was to evaluate the effect of bone–miniscrew contact percentage (BMC%) and bone quality and quantity on orthodontic miniscrew stability and the maximum insertion torque value (ITV). Orthodontic miniscrews of five different dimensions and several bovine iliac bone specimens were used in the evaluation. Miniscrews of each dimension group were inserted into 20 positions in bovine iliac bone specimens. The experiment was divided into three parts: (1) Bone quality and quantity were evaluated using cone-beam computed tomography (CBCT) and microcomputed tomography. (2) The 3D BMC% was calculated. (3) The ITVs during miniscrew insertion were recorded to evaluate the stability of the orthodontic miniscrews. The results indicated that longer and thicker miniscrews enabled higher ITVs. CBCT was used to accurately measure cortical bone thickness (r = 0.939, P < 0.05) and to predict the bone volume fraction of cancellous bone (r = 0.752, P < 0.05). BMC% was significantly influenced by miniscrew length. The contribution of cortical bone thickness to the ITV is greater than that of cancellous bone structure, and the contribution of cortical bone thickness to BMC% is greater than that of cancellous bone structure. Finally, the higher is BMC%, the greater is the ITV. This study concludes that use of CBCT may predict the mechanical stability of orthodontic miniscrews.
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Sobouti F, Chiniforush N, Saravani HJ, Noroozian M, Cronshaw M, Navaei RA, Rakhshan V, Dadgar S. Efficacy of compound topical anesthesia combined with photobiomodulation therapy in pain control for placement of orthodontic miniscrew: a double-blind, randomized clinical trial. Lasers Med Sci 2022; 37:589-594. [PMID: 33796965 DOI: 10.1007/s10103-021-03307-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 03/28/2021] [Indexed: 02/05/2023]
Abstract
This study aims to investigate the effect of compound topical anesthetic (CTA) application combined with photobiomodulation therapy (PBMT) on the level of pain perceived during placement of miniscrews and 24 h post the procedure in the buccal side of the maxillary bone. This randomized, prospective, single-center, split-mouth, double-blinded study included 25 subjects (12 males and 13 females, aged 16 to 35). Two anesthetic techniques before implantation were performed including Profound gel +PBM with 980 nm diode laser and local anesthesia with 2% lidocaine hydrochloride. Then, the miniscrews with the size of 1.6 mm in diameter and 8 mm in length were placed with a hand driver in the buccal side of the maxillary bone. The pain immediately after miniscrew placement (T1), also 12 h (T2), and 24 h (T3) post the procedure were collected by visual analog scale (VAS). Data were analyzed by SPSS version 22. There were no statistically significant differences in mean VAS scores within or between CTA combined with PBMT or injection applications, immediately after miniscrew placement (P = 0.75), 12 h after miniscrew placement (P = 0.4), and 24 h after miniscrew placement (P = 1.0). Compound topical anesthetic combined with PBMT provided adequate local anesthesia for the placement of miniscrews in the buccal side of the maxillary bone.
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Affiliation(s)
- Farhad Sobouti
- Dental Sciences Research Center, Department of Orthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Nasim Chiniforush
- Dental Implant Research Center, Dentistry Research Institute, Tehran University of Medical Sciences, Qouds Ave, Tehran, 1441987566, Iran.
| | - Hamid Jaahed Saravani
- Student Research Committee, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Noroozian
- Department of Orthodontics, Student Research Committee, School of dentistry, Ilam University of Medical Sciences, Ilam, Iran
| | - Mark Cronshaw
- School of Dentistry, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Leicester School of Pharmacy, De Montfort University, Leicester, UK
| | - Reza Alizadeh Navaei
- Gastrointestinal Cancer Research Center, Non-Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Sepideh Dadgar
- Dental Sciences Research Center, Department of Orthodontics, Faculty of Dentistry, Mazandaran University of Medical Sciences, Sari, Iran.
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Choi JY, Cho J, Oh SH, Kim SH, Chung KR, Nelson G. Effect of Different Surface Designs on the Rotational Resistance and Stability of Orthodontic Miniscrews: A Three-Dimensional Finite Element Study. SENSORS 2021; 21:s21061964. [PMID: 33799632 PMCID: PMC8001794 DOI: 10.3390/s21061964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/05/2021] [Accepted: 03/08/2021] [Indexed: 01/03/2023]
Abstract
High orthodontic forces and various directions of applied forces can be associated with loosening of the screw anchorage in the bone. Screw designs have been modified to increase the stability of the miniscrews. This research evaluates the influence of three-designs on the stability of orthodontic miniscrews. A conventionally cylinder-type miniscrew design (Bio-Action screw, Jin-Biomed co., Bucheon, Korea) was set as a control, and three conditions were studied based on modifications of this control design. Condition-1 has narrowed threads in the upper part of the screw; Condition-2 has a notch at the middle part; and Condition-3 has the combination of Condition-1 and Condition-2. The moment required to unwind the miniscrew to five degrees is tested, and the moment generated at the cortical bone and the trabecular bone were calculated with finite element analysis. Compared to the control, all three conditions showed a higher moment required to unwind the miniscrew and a higher moment generated at the cortical bone. At the trabecular bone, condition-2 and -3 showed higher moment than the control, and condition-1 showed similar moment to the control. Condition-3 required a higher overall moment to unwind the miniscrew. These findings validate the design modifications used to increase the rotational resistance.
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Affiliation(s)
- Jin-Young Choi
- Department of Orthodontics, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (J.-Y.C.); (K.-R.C.)
| | - Jaehee Cho
- Department of Orthodontics, Graduate School of Medicine, Korea University, Seoul 02841, Korea;
| | - Song Hee Oh
- Department of Oral and Maxillofacial Radiology, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea;
| | - Seong-Hun Kim
- Department of Orthodontics, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (J.-Y.C.); (K.-R.C.)
- Correspondence:
| | - Kyu-Rhim Chung
- Department of Orthodontics, Graduate School of Dentistry, Kyung Hee University, Seoul 02447, Korea; (J.-Y.C.); (K.-R.C.)
| | - Gerald Nelson
- Division of Orthodontics, Department of Orofacial Science, University of California, San Francisco, CA 94143, USA;
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