Adults seeking orthodontic treatment: expectations, periodontal and TMD issues

Age-related mitophagy regulates orthodontic tooth movement by affecting PDLSCs mitochondrial function and RANKL/OPG

A thorough comprehension of age-related variances in orthodontic tooth movement (OTM) and bone remodeling response to mechanical force holds significant implications for enhancing orthodontic treatment. Mitophagy plays a crucial role in bone metabolism and various age-related diseases. However, the impact of mitophagy on the bone remodeling process during OTM remains elusive. Using adolescent (6 weeks old) and adult (12 months old) rats, we established OTM models and observed that orthodontic force increased the expression of the mitophagy proteins PTEN-induced putative kinase 1 (PINK1) and Parkin, as well as the number of tartrate-resistant acid phosphatase-positive osteoclasts and osteocalcin-positive osteoblasts. These biological changes were found to be age-related. In vitro, compression force loading promoted PINK1/Parkin-dependent mitophagy in periodontal ligament stem cells (PDLSCs) derived from adolescents (12-16 years old) and adults (25-35 years old). Furthermore, adult PDLSCs exhibited lower levels of mitophagy, impaired mitochondrial function, and a decreased ratio of RANKL/OPG compared to young PDLSCs after compression. Transfection of siRNA confirmed that inhibition of mitophagy in PDLSC resulted in decreased mitochondrial function and reduced RANKL/OPG ratio. Application of mitophagy inducer Urolithin A enhanced bone remodeling and accelerated OTM in rats, while the mitophagy inhibitor Mdivi-1 had the opposite effect. These findings indicate that force-stimulated PDLSC mitophagy contributes to alveolar bone remodeling during OTM, and age-related impairment of mitophagy negatively impacts the PDLSC response to mechanical stimulus. Our findings enhance the understanding of mitochondrial mechanotransduction and offer new targets to tackle current clinical challenges in orthodontic therapy.

Patients' perceptions matter: Risk communication and psychosocial factors in orthodontics

INTRODUCTION

Effective risk communication is essential for achieving patient-centered oral health care, but the limited understanding of patients' subjective perceptions of orthodontic-related risks hinders this process. This study aimed to investigate adults' awareness, concerns, and risk-avoidance behaviors about long-term orthodontic risks, exploring their relationship with psychosocial factors.

METHODS

We included 498 adult patients (mean age, 27.3 ± 6.8 years; women, 75.5%) during their initial visits to the orthodontic department at a hospital in Chengdu, China. Participants' understanding of orthodontic risks was gauged before and after exposure to the Oral Health Education Comics (OHEC), a specifically designed digital tool. Concurrently, we used logistic regression models to investigate the associations between patients' depression, anxiety, self-esteem, perfectionism, and dentofacial esthetics with risk perceptions.

RESULTS

Approximately 79.5% of participants initially reported low awareness of orthodontic risks, with most knowledge from online sources. Notably, the percentage of participants with high awareness increased to 64.8% after OHEC. The negative facial soft-tissue change was most concerning for participants: 53.4% showed high concerns, and 28.1% showed high avoidance. Furthermore, linear regression indicated positive associations between depression (β = 0.42 [95% confidence interval {CI}, 0.07-0.77]) and anxiety (β = 0.76 [95% CI, 0.35-1.18]) with orthodontic risk concerns, whereas risk avoidance was positively associated with depression (β = 0.62 [95% CI, 0.27-0.97]), anxiety (β = 1.09 [95% CI, 0.68-1.50]), and perfectionism (β = 0.24 [95% CI, 0.02-0.46]).

CONCLUSIONS

Findings emphasize the imperative of streamlined risk communication in orthodontics. By incorporating comprehensible tools such as OHEC and integrating psychosocial evaluations, more refined patient-practitioner communication and psychosomatic-based dental care can be achieved.

Effect of autophagy on aging-related changes in orthodontic tooth movement in rats

BACKGROUND

The number of adult orthodontic patients is increasing, and studies have shown that autophagy is involved in regulating orthodontic tooth movement and plays an important role in aging-related changes. Therefore, we aimed to explore the role of autophagy in aging-related changes during orthodontic tooth movement by establishing a rat orthodontic tooth movement model.

METHODS

Forty-five 6-week-old and sixty-five 8-month-old male Sprague-Dawley rats were selected to represent adolescents and adults and establish orthodontic tooth movement model. They were sacrificed on days 0,1,3,7 and 14. Immunohistochemistry, immunofluorescence and tartrate resistant acid phosphatase (TRAP) staining were applied to measure the expression level of osteogenesis, autophagy, aging factors and osteoclast number in periodontal membrane of left upper first molar during orthodontic tooth movement. Then, we regulated the autophagy level by injecting autophagy activator rapamycin during orthodontic tooth movement and measured these factors and tooth movement distance by micro-computed tomography.

RESULTS

Aging factor levels in the periodontal membrane were higher in adult rats than in adolescent rats and the autophagy factor levels were lower. The levels of osteogenic factors were lower on the tension side in adult rats than in adolescent rats. The peak osteoclast number on the pressure side occurred later in adult rats than in adolescent rats. The injection of rapamycin increased autophagy, accelerated orthodontic tooth movement in adult rats, and reduced the levels of aging factors. The levels of osteogenic factors were higher and reached those in adolescent rats at some time points. The number of osteoclasts increased significantly in the early stage.

CONCLUSIONS

Autophagy may play a substantial role in regulating aging-related changes in orthodontic tooth movement.

Using a structured light scanner to evaluate 3-dimensional soft-tissue changes after extracting 4 premolars in young adult female patients

INTRODUCTION

Facial esthetics have always received much attention in orthodontic treatment, especially in young adult female patients. Three-dimensional (3D) soft-tissue changes after orthodontic extraction have not been fully explained. This study evaluated the 3D morphologic changes after orthodontic extraction in young female patients using a structured light scanner.

METHODS

Forty-five adult female patients aged 20-25 years were enrolled in our study. The treatment group consisted of patients who received orthodontic treatment with 4 premolar extractions, and the control group was composed of young female volunteers who had not undergone any orthodontic treatment. To monitor the soft-tissue changes, 9 morphologic regions and 12 landmarks were identified for the 3D deviation analyses. The spatial deviations of landmarks and regions in the x, y, and z directions were constructed for quantitative analysis. Color map images were constructed to visualize soft-tissue displacement as a qualitative evaluation. The paired sample test was used to compare differences at the beginning of the experiment (T0) and after 24 months (T1) in both groups. An independent t test with Bonferroni correction was performed to compare differences between the treatment and control groups. A linear regression test was performed between incisor retraction and changes in the perioral tissues.

RESULTS

Subtracting the effect of aging from the lip changes in the control group, the treatment group showed a statistically significant difference in the displacement of labrale superius (-1.37 mm), labrale inferius (-1.89 mm), the upper lip region (-0.98 mm), and the lower lip region (-1.36 mm) along the z-axis. No significant differences were found between the treatment and control groups in the temporal, parotideomasseteric, and buccal regions. Pearson correlation tests indicated a positive correlation between incisor tip retraction and changes in soft tissues (two-dimensional cephalometric analysis, 3D landmark measurements, and 3D regional measurements). The correlation coefficient ranged between 0.45 and 0.55.

CONCLUSIONS

Three-dimensional soft-tissue changes were mainly concentrated in the upper and lower lip regions in adult female patients after the 4 premolars were extracted. For female patients aged 20-25 years with 4 extracted premolars, soft-tissue changes in the temporal, parotideomasseteric, and buccal regions were not clinically significant.

Changes in alveolar bone structure during orthodontic tooth movement in adolescent and adult rats: A microcomputed tomography study

BACKGROUND

Increasing number of adults are willing to seek orthodontic treatment, but treatment duration for them is commonly longer. Although there have been studies on molecular biological changes during tooth movement, few have focused on microstructural changes in alveolar bone.

OBJECTIVE

This study aims to compare the microstructural changes in alveolar bone during orthodontic tooth movement in adolescent and adult rats.

METHODS

25 6-week-old and 25 8-month-old male Sprague-Dawley (SD) rats were used to build orthodontic tooth-movement models. On Days 0, 1, 3, 7 and 14, the rats were sacrificed. Microcomputed tomography was used to evaluate tooth movement, alveolar crest height loss and microstructural parameters of alveolar bone (bone volume fraction, trabecular thickness, trabecular separation and trabecular number).

RESULTS

Tooth movement in the adult group was slower than in the adolescent group. Alveolar bone crest height in adults was lower than it was in adolescents on Day 0. Under orthodontic force, the alveolar crest in both groups decreased and the degree of decrease are higher at early stage in adolescents. The microstructural parameters indicated that the alveolar bone was originally denser in the adult rats. With orthodontic force, it tended to be looser.

CONCLUSIONS

Under orthodontic force, changes in alveolar bone differ between adolescent and adult rats. Tooth movements in adults are slower, and the decrease in alveolar bone density are more severe.

Effects of Low-Level Laser Therapy on Dentin Hypersensitivity in Periodontally Compromised Patients Undergoing Orthodontic Treatment: A Randomised Controlled Trial

OBJECTIVES

This study aimed to assess the effects of low-level laser therapy (LLLT) on dentin hypersensitivity (DH) in periodontally compromised patients undergoing orthodontic treatment.

METHODS

This triple-blinded randomised controlled trial included 143 teeth with DH from 23 periodontally compromised patients. Teeth on one side of the dental arch were randomly assigned to the LLLT group (LG), while those on the contralateral side were allocated to the non-LLLT group (NG). After orthodontic treatment commenced, patients' orthodontic pain (OP) perceptions were documented in pain diaries. DH was assessed chairside by a visual analogue scale (VASDH) at fifteen timepoints across the orthodontic treatment and retention. VASDH scores were compared among timepoints by the Friedman test, among patients with varying OP perceptions using the Kruskal-Wallis tests, and between the LG and NG with the Mann-Whitney U test.

RESULTS

DH generally decreased over the observation (p < 0.001). The VASDH scores differed among patients with varying OP perceptions at multiple timepoints (p < 0.05). The generalized estimating equation model showed teeth in the LG had a significantly lower VASDH score than the NG at the 3rd month of treatment (p = 0.011).

CONCLUSION

LLLT could be potentially beneficial in managing DH in periodontally compromised patients undergoing orthodontic treatment.

CD301b+ Macrophages as Potential Target to Improve Orthodontic Treatment under Mild Inflammation

Due to improvements of quality of life and the demand for aesthetics, more and more people are choosing orthodontic treatments, resulting in a surge in adult orthodontic patients in recent years. However, a large amount of clinical evidence shows that many orthodontic patients have mild periodontitis in the periodontal tissues, which affects the efficacy of the orthodontic treatment or aggravates the periodontal condition. Therefore, it is important to identify the key factors that affect orthodontic treatments in this inflammatory environment. The aim of this study was to investigate the role of macrophages in orthodontic treatments under inflammatory environments. By analyzing the functional groups of macrophages in the orthodontic rat model of periodontitis, we found that macrophages with high expression levels of CD301b could improve the periodontal microenvironment and improve the efficiency of the orthodontic tooth movement. CD301b+ macrophages transplanted into the model can promote osteogenesis around orthodontic moving teeth, improve bone remodeling during orthodontic treatment, and accelerate orthodontic tooth movement. Considered together, these results suggest that CD301b+ macrophages may play an active role in orthodontic treatments in inflammatory environments and may serve as potential regulatory targets.

A comparison study of dental pulp stem cells derived from healthy and orthodontically intruded human permanent teeth for mesenchymal stem cell characterisation

The objective of this study was to compare the characteristics of Dental Pulp Stem Cells (DPSCs) derived from healthy human permanent teeth with those that were orthodontically-intruded to serve as potential Mesenchymal Stem Cells (MSC). Recruited subjects were treated with orthodontic intrusion on one side of the maxillary first premolar while the opposite side served as the control for a period of six weeks before the dental pulp was extracted. Isolated DPSCs from both the control and intruded samples were analyzed, looking at the morphology, growth kinetics, cell surface marker profile, and multilineage differentiation for MSC characterisation. Our study showed that cells isolated from both groups were able to attach to the cell culture flask, exhibited fibroblast-like morphology under light microscopy, able to differentiate into osteogenic, adipogenic and chondrogenic lineages as well as tested positive for MSCs cell surface markers CD90 and CD105 but negative for haematopoietic cell surface markers CD34 and HLA-DR. Both groups displayed a trend of gradually increasing population doubling time from passage 1 to passage 5. Viable DPSCs from both groups were successfully recovered from their cryopreserved state. In conclusion, DPSCs in the dental pulp of upper premolar not only remained viable after 6 weeks of orthodontic intrusion using fixed appliances but also able to develop into MSCs.

Force profile assessment of direct-printed aligners versus thermoformed aligners and the effects of non-engaged surface patterns

Background

The purpose of the study was to measure the forces delivered by direct-printed aligners (DPA) in the vertical dimension and compare the force profile with traditional thermoformed aligners (TFA) and to investigate the impact of non-engaged surface patterns to the properties of DPA and TFA.

Methods

A force-measuring appliance was fabricated capable of displacing the aligner in 0.10 mm increments and measuring the resultant force. Polyethylene terephthalate glycol (ATMOS 0.030″ American Orthodontics) and TC-85DAC resin (Graphy Inc) were used to create TFA and DPA, respectively. Aligners were temperature-controlled prior to and during testing to simulate the oral environment. The resultant forces from displacements ranging from 0.10 to 0.30 mm were measured.

Results

At intraoral temperatures, DPA demonstrated significantly less force than TFA. TFA demonstrated a substantial statistically significant increase in force with each 0.10 mm increase in vertical displacement. DPA demonstrated a much more consistent force profile across the range of displacements. The effects of surface patterns in both DPA and TFA were generally a decrease in force. Statistical significance of surface patterns was detected for TFA at displacements of 0.30 mm and greater and significant for DPA only at a displacement of 0.10 mm. Surface patterns in both DPA and the TFA did not show any statistical difference when assessing force proprieties.

Conclusions

Forces delivered by aligners in the vertical dimension by DPA are more consistent and of lower magnitude than those of TFA aligners. Surface patterns were not capable of altering the force properties of both DPA and TFA.

Assessment of the Susceptibility of Aesthetic Orthodontic Brackets to Discoloration

The high aesthetic value of orthodontic appliance elements during treatment constitutes an important factor for an increasing number of adult patients. The aim of this study was to determine whether food dyes could significantly affect the color of both plastic and ceramic orthodontic brackets. Four brands of orthodontic brackets were investigated in the present study. Twenty-five samples of each kind were prepared. Five brackets of each series were stored in pure water, coffee, black tea and red wine for 1 h, 24 h, 7 days and 14 days. Total color change ∆E* of the samples was analyzed after storage with the use of the SpectroShade dental spectrophotometer (MHT, Verona, Italy) according to the CIE L*a*b* color scale. Correlations between bracket brand, kind of food dye and intensity of color change at the significance level p = 0.05 were investigated. After 1 and 24 h of incubation, water had the least influence on the color change of aesthetic orthodontic brackets, and tea had the greatest effect (p = 0.05). After 7 and 14 days of incubation of the samples, water still remained the environment influencing ∆E* change to the smallest extent, whereas storage in red wine changed the color of brackets to the significantly (p = 0.05) highest degree. The degree of discoloration of the assessed brackets depended on the type of material and the storage time in the environment of the individual food dyes (p = 0.05). The results of the present study show that, in the event of contact with food dyes, aesthetic orthodontic brackets discolor, the intensity of which can be influenced by the materials they are made of, the kind of food dye and the time of samples’ storage.

The value of adult orthodontics: Do the public's willingness-to-pay values reflect the profession's?

OBJECTIVE

To explore how the public and dental professionals would value an orthodontic service for adults by eliciting their willingness-to-pay (WTP), a standardised health economics technique which quantifies 'strength of preference' in monetary terms. Despite increasing demand, adults in the UK are only eligible for NHS orthodontic treatment if there is severe dental health or complex multidisciplinary need. Orthodontic services are provided to children aged under 18 years who are eligible by their Index of Orthodontic Treatment Need (IOTN) score. Consequently, many adults who may have a need for treatment as determined by IOTN are unable to access this service.

DESIGN

Cross-sectional survey.

SETTING

General dental practices in North East England and national specialists approached through the British Orthodontic Society (BOS).

PARTICIPANTS

Public participants were recruited from general dental practices. Dentists were recruited from local dental lists and members of the BOS.

METHODS

Participants were asked if they would be willing to pay to see an orthodontic service extended to all adults in England with a qualifying IOTN. Clinical photographs of three malocclusions were presented and maximum WTP in additional tax per household per year was elicited using shuffled payment cards.

RESULTS

A total of 205 dentists and 206 public participants were recruited. Pairwise tests showed a statistically significant difference in WTP between the public and professionals for all malocclusions, with the public giving higher valuations. In both groups, the Class III scenario elicited a higher WTP than the class I or II malocclusion. However, when all other factors were controlled for using a regression analysis, the group (public or profession) and the other variables did not significantly influence WTP.

CONCLUSION

The public and professionals were willing to pay for an adult orthodontic service. Due to this variability and unpredictability the allocation of healthcare resources will remain contentious.

Knowledge, attitudes and professional practices of ortho-periodontal care of adults: a cross-sectional survey in France

BACKGROUND

Due to increasing numbers of adult patients, orthodontists are being confronted more and more with periodontal problems. Coordination amongst orthodontists, periodontists and general dentists is useful in preventing and stopping periodontal disease. The main objectives of this survey were to evaluate the technical knowledge, techniques and attitudes employed by French orthodontists, periodontists and general dentists in adult dental care.

METHODS

A cross-sectional online survey was distributed to French dentists. The questionnaire, consisting of 30 questions, was divided into six sections covering treatment programs and the forensic environment.

RESULTS

One thousand one hundred twenty-two complete answers were recorded. Adults undergoing orthodontic treatment represented 19.9% of the orthodontists' patients, but only 2.67% of the general dentists' patients. Communication between clinicians was rated as good, greater than 3 out of 5. Before treatment, orthodontists were less alarmed than generalists regarding bleeding, recessions, increased probing depths, halitosis and hyperplasia. During treatment, orthodontists never or only occasionally performed palpation or probing in 54.2% and 84.6% of cases. Gingivitis and recessions were the main reasons for consultations for 22.0% and 20.1% of general dentists and periodontists after orthodontic treatment. Of the practitioners surveyed, 43% felt that they experienced a setback in the ortho-periodontal treatment.

CONCLUSIONS

This study revealed discrepancies in the knowledge and attitudes of practitioners. Therapeutic management remains one of the major challenges of multidisciplinary treatments. Continuing education needs to be further developed in this field.

Multidisciplinary non-surgical treatment of advanced periodontitis: A case report

BACKGROUND

Patients with severe periodontitis often require multidisciplinary treatment to achieve healthy periodontal tissue, normal occlusion, and optimal aesthetics. In the present study, we aimed to evaluate the efficacy of multidisciplinary non-surgical treatment in a patient with stage IV/ grade C periodontitis, malocclusion, and dentition defects.

CASE SUMMARY

A 47-year-old woman visited our periodontology department due to teeth mobility problems and difficulties chewing food. The patient had no history of drug allergies or systemic disease. Initial therapy involved scaling and root planning with a Gracey scaler and periodontal ultrasonic therapeutic apparatus using a periodontal endoscope (Perioscopy, Zest Dental Solutions, United States) to control the periodontal inflammation prior to treatment. Five months later, orthodontic treatment was then performed to treat occlusion and overall aesthetics. After completion, a Maryland bridge was used to restore Nos. 22, 31, and 41 teeth. Florida probing (Florida probe, United States) was performed every 2-3 mo to evaluate the periodontal condition throughout treatment. Overall, multidisciplinary non-surgical treatment resulted in satisfactory aesthetic results with healthy periodontal tissue and stable occlusion.

CONCLUSION

In some patients with stage IV/grade C periodontitis, systematic and sequential non-surgical treatment can provide excellent therapeutic results.

The influence of malocclusion on social aspects in adults: study via eye tracking technology and questionnaire

BACKGROUND

Smile esthetics has a strong influence on perception, attractiveness, and personal characteristics. It is unknown how malocclusions may influence the appearance of the individual's smile. This study aimed to investigate whether malocclusion affects the visual perception of esthetics, age, employability, honesty, intelligence and to meet its obligation in time in middle-aged adults. Facial frontal smiling photographs of a male and a female middle-aged adult with 3 different malocclusions were shown to and evaluated by 90 laypeople (non-dentists), divided into groups: young adults (14-44 years), middle-aged adults (45-59 years), and elders (over 60 years). The index of treatment need (IOTN) was used, and IOTN 1, 5, and 8 images were created in Photoshop using the male and female photographs. In total, 6 photographs were evaluated, 3 areas of interest (AOI)-eyes, nose, and mouth-were created for statistical comparison. The Ogama and Eye Tribe tracker were used in conjunction to measure eye tracking. A visual analog scale (VAS) was employed with a questionnaire surveying individuals' perception of age, employability, honesty, intelligence, and ability to meet obligations. Kruskal-Wallis, one-way analysis of variance, Pearson's-chi-squared, and Pearson correlation test were applied.

RESULTS

No statistical difference was found in complete fixation time and time until the first fixation for each AOI for eye-tracking. VAS showed statistical differences in the male and female IOTN 1 images when compared with the IOTN 5 and 8 for both models, and there was no difference between genders in the IOTN 1. As the perceived age of the model increased, the chances of getting hired decreased. Employability, honesty, intelligence, and ability to meet obligations showed higher values for IOTN 1. There were significant differences between age ranges; perception of intelligence in the female IOTN 1 model (p = 0.002) and IOTN 8 model (p < 0.001) and honesty between young adults and middle-aged adults in the male IOTN 1 and 8 images (p < 0.001).

CONCLUSIONS

There was a difference between age groups in the perception of honesty and intelligence. A well-balanced and attractive was perceived as more youthful and attractive in both genders and may increase the chance of being selected for a job interview or being hired.

Accelerated orthodontic tooth movement: surgical techniques and the regional acceleratory phenomenon

BACKGROUND

Techniques to accelerate tooth movement have been a topic of interest in orthodontics over the past decade. As orthodontic treatment time is linked to potential detrimental effects, such as increased decalcification, dental caries, root resorption, and gingival inflammation, the possibility of reducing treatment time in orthodontics may provide multiple benefits to the patient. Another reason for the surge in interest in accelerated tooth movement has been the increased interest in adult orthodontics.

REVIEW

This review summarizes the different methods for surgical acceleration of orthodontic tooth movement. It also describes the advantages and limitations of these techniques, including guidance for future investigations.

CONCLUSIONS

Optimization of the described techniques is still required, but some of the techniques appear to offer the potential for accelerating orthodontic tooth movement and improving outcomes in well-selected cases.

Knowledge and Attitude towards Orthodontic Treatment among Non-Orthodontic Specialists: An Online Survey in Croatia

Objectives: The aim of this study was to examine the knowledge and attitudes towards orthodontic treatment among non-orthodontic specialists. Methods: A web-based survey was formulated for non-orthodontic dental specialists to respond to statements regarding an orthodontic treatment. It contained 20 multiple-choice questions with three or more possible answers. Two hundred and fifty questionnaires were sent via email, with explanatory letters, to randomly selected non-orthodontic Croatian dental specialists. Data were assessed using IBAM SPSS 23.0. and p < 0.01 was considered significant. Results: The results indicate that the majority of respondents were well informed about principles and practices in orthodontics. All the respondents (100%) were aware that malocclusions can affect a patient’s facial aesthetic and masticatory function. The results also showed statistically significant differences in answers about contraindications for orthodontics therapy among different non-orthodontic specialists (p < 0.01). Private health practitioners were better informed about the ideal time for the first orthodontic appointment (74.2%) and that implants and periodontal problems are not contraindications for orthodontic treatment (over 70%), in comparison with public health practitioners. Conclusion: Non-orthodontic specialists in this sample exhibit encouraging awareness and knowledge of the principals and practices of orthodontic treatment. Additional improving of practitioners’ knowledge and awareness can help patients with malocclusion to decide upon orthodontic treatment at earlier stages and avoid later complications in the future.

Associations among Orthodontic History, Psychological Status, and Temporomandibular-Related Quality of Life: A Cross-Sectional Study

OBJECTIVES

This cross-sectional study aimed to evaluate the associations among orthodontic history, psychological status, and temporomandibular-related quality of life.

METHODS

A questionnaire was developed and distributed to students in a local college, containing questions about demographic information, the Patient Health Questionnaire-4 (PHQ-4), the Fonseca anamnestic index, and the Oral Health Impact Profile for Temporomandibular Disorders (OHIP-TMD). The respondents were divided into with orthodontic history (OS) group and without OS group. Binary logistic regression and multiple linear regression were performed for statistical analysis.

RESULTS

A total of 531 valid questionnaires were collected, covering 161 participants with OS and 370 participants without OS. No statistically significant differences were observed in the scores of PHQ-4 between the two groups. There was statistical difference in the prevalence of TMD (with OS group, 54.66%; without OS group, 40.81%) and the mean value ( ± standard deviations) of the scores of OHIP-TMD (with OS group, 9.64 ± 12.36; without OS group, 6.64 ± 10.79) (p < 0.05). After adjusting confounding factors, participants with OS have worse temporomandibular-related quality of life and a higher risk of having TMD than the participants without OS.

CONCLUSIONS

Orthodontic history was related with the higher prevalence of TMD and worse temporomandibular-related quality of life, but not related with psychological distress, and the cause-and-effect relationship needs further exploration.

Structural, Mechanical, and Decorative Properties of Sputtered TiN and Ti (N, C) Films for Orthodontic Applications; an In Vitro Study

In this paper, we explore and modify the structural, mechanical, and decorative properties of films composed by TiN and Ti (N, C) with a wide range of N₂ gas flow during the deposition in order to be used on orthodontic systems. The films were grown using reactive DC magnetron sputtering from a pure Ti target and customized with C pellets onto Si and stainless steel 316L substrates. The structural properties were studied using X-ray diffraction and scanning electron microscopy, while the mechanical ones were obtained through hardness, elastic modulus, and friction coefficient. Moreover, the wear rate has been measured under an artificial saliva medium to simulate the oral cavity. The color of the films deposited onto stainless steel 316 L substrate was characterized through CIELab color code. Our findings show that the addition of N₂ and C in the Ti matrix improves the mechanical properties of the films. With the increase in the amount of N₂ and C, the hardness reaches a value of 739 HV, higher than the one reported in the literature (600 HV), a low value of the coefficient of elasticity (8.0 GPa), and also a low friction coefficient (0.30). Moreover, with the addition of N₂ and C in the Ti films, the color of the films changes from metallic aspect until “with” gold, which means that our coatings exhibit versatile mechanical and color characteristics to be used in orthodontic wires applications.

Interaction of periodontitis and orthodontic tooth movement-an in vitro and in vivo study

OBJECTIVES

The aim of this in vitro and in vivo study was to investigate the interaction of periodontitis and orthodontic tooth movement on interleukin (IL)-6 and C-X-C motif chemokine 2 (CXCL2).

MATERIALS AND METHODS

The effect of periodontitis and/or orthodontic tooth movement (OTM) on alveolar bone and gingival IL-6 and CXCL2 expressions was studied in rats by histology and RT-PCR, respectively. The animals were assigned to four groups (control, periodontitis, OTM, and combination of periodontitis and OTM). The IL-6 and CXCL2 levels were also studied in human gingival biopsies from periodontally healthy and periodontitis subjects by RT-PCR and immunohistochemistry. Additionally, the synthesis of IL-6 and CXCL2 in response to the periodontopathogen Fusobacterium nucleatum and/or mechanical strain was studied in periodontal fibroblasts by RT-PCR and ELISA.

RESULTS

Periodontitis caused an increase in gingival levels of IL-6 and CXCL2 in the animal model. Moreover, orthodontic tooth movement further enhanced the bacteria-induced periodontal destruction and gingival IL-6 gene expression. Elevated IL-6 and CXCL2 gingival levels were also found in human periodontitis. Furthermore, mechanical strain increased the stimulatory effect of F. nucleatum on IL-6 protein in vitro.

CONCLUSIONS

Our study suggests that orthodontic tooth movement can enhance bacteria-induced periodontal inflammation and thus destruction and that IL-6 may play a pivotal role in this process.

CLINICAL RELEVANCE

Orthodontic tooth movement should only be performed after periodontal therapy. In case of periodontitis relapse, orthodontic therapy should be suspended until the periodontal inflammation has been successfully treated and thus the periodontal disease is controlled again.

Parathyroid hormone increases alveolar bone homoeostasis during orthodontic tooth movement in rats with periodontitis via crosstalk between STAT3 and β-catenin

Periodontitis patients are at risk of alveolar bone loss during orthodontic treatment. The aim of this study was to investigate whether intermittent parathyroid hormone (1–34) treatment (iPTH) could reduce alveolar bone loss during orthodontic tooth movement (OTM) in individuals with periodontitis and the underlying mechanism. A rat model of OTM in the context of periodontitis was established and alveolar bone loss was observed. The control, iPTH and iPTH + stattic groups received injections of vehicle, PTH and vehicle, or PTH and the signal transducer and activator of transcription 3 (STAT3) inhibitor stattic, respectively. iPTH prevented alveolar bone loss by enhancing osteogenesis and suppressing bone resorption in the alveolar bone during OTM in rats with periodontitis. This effect of iPTH was along with STAT3 activation and reduced by a local injection of stattic. iPTH promoted osteoblastic differentiation and might further regulate the Wnt/β-catenin pathway in a STAT3-dependent manner. The findings of this study suggest that iPTH might reduce alveolar bone loss during OTM in rats with periodontitis through STAT3/β-catenin crosstalk.

Characterisation of mechanical and surface properties of novel biomimetic interpenetrating alumina-polycarbonate composite materials

OBJECTIVE

To determine the mechanical and surface characteristics of two novel biomimetic interpenetrating phase alumina-polycarbonate (Al₂O₃-PC) composite materials, comprising aligned honeycomb-like porous ceramic preforms infiltrated with polycarbonate polymer.

METHOD

Two composite materials were produced and characterised. Each comprised a porous structure with a ceramic-rich (polymer-poor) top layer, graduated through to a more porous ceramic-poor (polymer-rich) bottom layer. In addition, pure polycarbonate and dense alumina specimens were subjected to the same characterisation namely: density, compression, three-point bend, hardness, surface loss and surface roughness testing. Scanning electron microscopy and micro computerised tomography were employed for structural examination.

RESULTS

Three-dimensional aligned honeycomb-like ceramic structures were produced and full interpenetration of the polymer phase was observed using MicroCT. Depending on the ceramic volume in the initial aqueous ceramic suspension, the density of the final interpenetrating composites ranged from 2.64 to 3.01g/cm³, compressive strength ranged from 192.43 to 274.91MPa, flexural strength from 105.54 to 148.47MPa, fracture toughness from 2.17 to 3.11MPa.m^½, hardness from 0.82 to 1.52GPa, surface loss from 0.71 to 1.40μm and surface roughness, following tooth brushing, from 0.70 to 0.99μm. Composite specimens showed characteristic properties part way between enamel and polycarbonate.

SIGNIFICANCE

There was a correlation between the initial solid ceramic loading in the aqueous suspension, used to produce the porous ceramic scaffolds, and the subsequent characteristic properties of the composite materials. These novel composites show potential as aesthetic orthodontic bracket materials, as their properties fit part way between those of ceramic, enamel and polycarbonate.

Adult orthodontic retreatment: A survey of patient profiles and original treatment failings

INTRODUCTION

A growing number of adult patients are seeking orthodontic treatment. This research aimed to analyze the particulars of patients seeking retreatment and identify the causes of their original treatment failure.

METHODS

An online questionnaire survey of adults seeking first-time orthodontic treatment (control) and retreatment (study) was conducted. Index of complexity, outcome, and need (ICON) scores were determined. Appraisal of treatment records was carried out to identify the causes of original treatment failure.

RESULTS

No significant differences were found between retreatment adult patients and first-timers regarding reasons for seeking orthodontic treatment, malocclusion type, self-perception of malocclusion, level of self-motivation, willingness for surgery, expectations of treatment improvement and duration. The predominant reason for seeking treatment in both groups was for aesthetic concerns. Retreatment patients presented with lower ICON scores (39.4; standard error, 0.26) than the first-time patients (54.3; standard error, 0.23), P ≤0.001. The predominant reasons for original treatment failings were poor treatment, maturational changes, inadequate retention, shortcomings in diagnosis and treatment planning, and unfavorable growth. Other causes were related to transverse deficiency, secondary malocclusion (after periodontal breakdown), poor retention compliance, and temporomandibular joint degeneration.

CONCLUSIONS

Adult orthodontic retreatment and first-time seekers' profiles are remarkably similar. Aesthetic concerns were the leading reasons patients sought treatment. ICON was not a useful proxy of patient profiles. Poor treatment was the chief reason for the failure of the original treatment. In terms of clinical significance, clinicians should be mindful of the patient profiles of retreatment seekers and vigilant about the possible causes of failings of orthodontic treatment to avoid suboptimal outcomes.

Wish-fulfilling medicine and wish-fulfilling dentistry

OBJECTIVES

to explain the practice of wish-fulfilling medicine and how it relates to dentistry.

SOURCES

Relevant papers, and reports from authoritative institutions were identified in Pubmed and Google Scholar.

RESULTS

Wish-fulfilling medicine refers to services provided by professionals using medical methods in a medical setting to address non-medical wishes of patients. Care-providers, medical industries, and health-insurance companies also contribute to wish-fulfilling in medicine and dentistry. Various concepts of health and illness compounded by blurred borders between health and illness offer an unstable foundation for wish-fulfilling medicine, and growing demands for these services where healthcare resources are limited can displace medically necessary treatments. Moreover, treatments without a medical or a dental necessity, can be harmful and bear the risk of futile or excessive treatments not in patients' long-term interest. Examples in dentistry are found in the field of cosmetic interventions, prosthodontics and orthodontics, where perceptions of small 'deviations' from normality prompt wishes or recommendations for intervention. Ethically, wish-fulfilling services confront the principles of the common morality if the autonomy of a patient is compromised, beneficence is unclear, harm is foreseeable, or distributive justice is compromised. Wish-fulfilling dental treatment can be restricted by legislation if it conflicts with safe, effective and efficient care, or if it interferes with patient's real needs or undermines established professional standards.

CONCLUSIONS

The general understanding of wish-fulfilling medicine including its ethical and legal themes is relevant to dentistry.

CLINICAL RELEVANCE

Ethical considerations and legislation can guide a dentist to reflect critically on clinical decisions regarding wish-fulfilling dentistry.

Age effect on orthodontic tooth movement rate and the composition of gingival crevicular fluid : A literature review

PURPOSE

To evaluate and form a comprehensive understanding of the effect of patient age on bone remodeling and consequently on the rate of orthodontic tooth movement (OTM).

METHODS

A systematic search in PubMed and Embase from 1990 to December 2017 was performed and completed by a hand search. Prospective clinical trials which investigated the rate of OTM and/or studies assessing age-related changes in the composition of gingival crevicular fluid (GCF) in older compared to younger study groups were included. Study selection, data extraction and risk of bias were assessed by two authors.

RESULTS

Eight studies fulfilled the inclusion criteria. Among them, four evaluated the rate of OTM and six investigated mediators in the GCF (prostaglandin E₂, interleukin [IL]-1β, IL‑6, IL‑1 receptor antagonist, receptor activator of nuclear factor kappa‑Β ligand, osteoprotegerin, granulocyte-macrophage colony-stimulating factor, pentraxin 3). Patient age ranged between 16 and 43 years for older and <16 years for younger groups. In most of the studies, the younger patients showed faster OTM in the first phase of treatment and more pronounced cytokine levels. Older patients had a delayed reaction to orthodontic forces.

CONCLUSION

The small number of included studies and large heterogeneity in study design give limited clinical evidence that the older patients are less responsive to orthodontic force in comparison to younger patients. The initial cellular response to orthodontic force is expected to be delayed in older patients. Control intervals during orthodontic treatment should be adjusted to the individual's treatment response.

Influence of orthodontic appliance design on employment hiring preferences

INTRODUCTION

The objective of this study was to evaluate the extent to which different types of orthodontic appliances influence the hiring process of an individual applying for a customer service position.

METHODS

A total of 7 images were created for 2 adult models: 1 male and 1 female. One image was produced without orthodontic appliances, and 6 simulated the use of orthodontic appliances, including a conventional metallic appliance with a gray elastic ligature, a conventional metallic appliance with blue elastic ligature, a conventional appliance with a transparent elastic ligature, a self-ligating metal appliance, a self-ligating esthetic appliance, and a clear aligner. A photo album was designed for each model and delivered, along with a questionnaire, to individuals in charge of job interviews and hiring. These evaluators included 236 individuals, divided into 4 groups according to age and gender: males between 18-35 years (M), males over 35 years (M > 35), females between 18-35 years (F), and females over 35 years (F > 35). The evaluators quantified the chance of hiring the models using a Visual Analogue Scale. The Mann-Whitney test was used to compare the evaluators according to gender and age. The Wilcoxon test was used to compare the models according to gender. The Kruskal-Wallis and Dunn post hoc tests were used to compare the appliances according to design. A 5% significance level was used for all tests.

RESULTS

The clear aligner group showed the highest likelihood of being hired, followed by the group without orthodontic appliances, the groups with esthetic appliances (ie, conventional appliance with a transparent elastic ligature, and self-ligating esthetic appliance), and the groups with metallic appliances (ie, self-ligating metal appliance, conventional metallic appliance with gray elastic ligature, and conventional metallic appliance with blue elastic ligature).

CONCLUSIONS

Assuming all other qualifications of the applicants are equivalent, the use of an orthodontic appliance may influence job interviews. The better the esthetics of the appliance, the higher the likelihood of the individual being hired.

Biomechanical analysis of initial incisor crowding alignment in the periodontally reduced mandible using the finite element method

AIMS

To reduce remaining plaque niches due to dental malocclusion after periodontal treatment and to avoid reinflammation of periodontitis, severe anterior crowding can be treated orthodontically. The treatment indication is motivated by aesthetic and functional needs. In this study the biomechanical behaviour of crowded lower front teeth in reduced periodontium is analysed.

METHODS

Using the finite element (FE) method, a model of the mandible was constructed with an anterior crowding of 4 mm and a vertical bone loss of 4 mm in the front tooth area. A 0.3 mm (0.012″) round superelastic nickel titanium (NiTi) arch wire was fitted to an ideal positioned teeth set-up and was inserted into the brackets of teeth 34 to 44 in the crowded model. The premolars were used as the anchorage unit. Material parameters were adopted from previous investigations, including bone (homogenous, isotropic, E = 2 GPa), teeth (E = 20 GPa) and healthy periodontal ligament (PDL, bilinear elastic; E₁ = 0.05 MPa; E₂ = 0.2 MPa; ε₁₂ = 7%). All simulations were compared to simulations with a physiological periodontal model to assess the effect of bone loss at teeth 42 to 32. Additionally, the influence of three arch wire materials (nonsuperelastic NiTi, superelastic NiTi and stainless steel) were analysed in a reduced model, including only brackets in position of the crowded front teeth, wire and ligatures. Wire force levels and stresses were determined to assess the influence of material variation.

RESULTS

Initial tooth mobility is increased by a factor of 2.5 in case of a moderate periodontal defect. Front teeth with reduced attachment display increased strains in the periodontal ligament up to a factor of 2. Forces in the model with reduced periodontium were decreased by a factor of 2. Comparing different aligning arch wires, stainless steel appears to have the highest force and stress levels. Force levels of this alloy were 7.5 times higher than with the superelastic NiTi wire. Force levels of nonsuperelastic NiTi appeared to be 1.8 times higher than superelastic NiTi. Calculated stresses with stainless steel were 5 times higher than with the nonsuperelastic NiTi and 10 times higher than with superelastic NiTi.

CONCLUSION

Periodontally reduced incisors 42 to 32 are associated with an increased load on periodontal tissue and increased level of tooth mobility during fixed orthodontic treatment. This has to be considered by reducing orthodontic force levels and by selecting mechanics that reduce the load to the tissue.

Pain perception among patients treated with passive self-ligating fixed appliances and Invisalign® aligners during the first week of orthodontic treatment

Objective

This study was performed to compare the perception of pain between patients treated with passive self-ligating fixed appliances and those treated with Invisalign aligners.

Methods

This prospective study conducted in Saudi Arabia used an estimated sample of 64 patients from a private dental clinic. After obtaining written informed consent, the patients were divided into two groups; one group (n = 32) was treated using passive self-ligating fixed appliances and the other group (n = 32) using Invisalign^® aligners. Immediately after fitting the appliances, the patients' perception of pain was evaluated through a close-ended and coded self-administrated questionnaire by using a visual analog scale (VAS). Their responses were recorded at 4 hours, 24 hours, day 3, and day 7. Mann-Whitney U-test, Kruskal-Wallis test, and Pearson's chi-square test were performed for statistical analysis.

Results

A lower percentage of patients treated with Invisalign aligners reported pain than did patients treated with passive self-ligating fixed appliances, and these differences were statistically significant (p = 0.001). Similarly, the mean VAS score for the Invisalign group was significantly lower than that for the passive self-ligating fixed appliance group at different intervals during the first week of treatment. The intensity of pain with both appliances peaked at 24 hours (mean VAS score, 3.87) and was lowest (mean VAS score, 1.62) on day 7.

Conclusions

During the first week of orthodontic treatment, patients treated with Invisalign aligners reported lower pain than did those treated with passive self-ligating fixed appliances.

Fabrication and characterisation of a novel biomimetic anisotropic ceramic/polymer-infiltrated composite material

OBJECTIVE

To fabricate and characterise a novel biomimetic composite material consisting of aligned porous ceramic preforms infiltrated with polymer.

METHOD

Freeze-casting was used to fabricate and control the microstructure and porosity of ceramic preforms, which were subsequently infiltrated with 40-50% by volume UDMA-TEGDMA polymer. The composite materials were then subjected to characterisation, namely density, compression, three-point bend, hardness and fracture toughness testing. Samples were also subjected to scanning electron microscopy and computerised tomography (Micro-CT).

RESULTS

Three-dimensional aligned honeycomb-like ceramic structures were produced and full interpenetration of the polymer phase was observed using micro-CT. Depending on the volume fraction of the ceramic preform, the density of the final composite ranged from 2.92 to 3.36g/cm³, compressive strength ranged from 206.26 to 253.97MPa, flexural strength from 97.73 to 145.65MPa, hardness ranged from 1.46 to 1.62GPa, and fracture toughness from 3.91 to 4.86MPam^1/2.

SIGNIFICANCE

Freeze-casting provides a novel method to engineer composite materials with a unique aligned honeycomb-like interpenetrating structure, consisting of two continuous phases, inorganic and organic. There was a correlation between the ceramic fraction and the subsequent, density, strength, hardness and fracture toughness of the composite material.

Pain experience in adults undergoing treatment: A longitudinal evaluation

OBJECTIVES

To quantify the intensity and duration of pain experience in adults over the initial three visits of fixed appliance-based orthodontic treatment. A secondary objective was to assess the relationship between pain experience and analgesic use, dental irregularity, gender, and age.

MATERIALS AND METHODS

A prospective longitudinal study design was adopted. Fifty-eight adults undergoing fixed appliance treatment in five orthodontic practices recorded pain experience at four time points (4 hours, 24 hours, 3 days, and 7 days) following the initial bond-up appointment (T0) and first (T1) and second (T2) routine follow-up adjustment appointments using a visual analogue scale. In addition, subjects recorded the dosage and frequency of analgesic use.

RESULTS

A slightly greater proportion of women (57%) were recruited, with a mean sample age of 34.69 (SD 12.11) years. Peak pain was experienced between 24 hours and 3 days following appliance placement (T0) and subsequent adjustments (T1 and T2). The highest mean pain score arose at T0 followed by T2 and T1 adjustments, with the difference between pain levels at these appointment intervals being statistically significant ( P < .001). The use of analgesics following each appointment mirrored pain experience, with pain score, appointment, and time point all being significant predictors of analgesic consumption. The level of dental irregularity, gender, or age did not predict pain levels reported.

CONCLUSIONS

Adults undergoing fixed orthodontic therapy should be advised that they are most likely to experience increased levels of pain for 1 to 3 days following placement of their appliance and subsequent adjustment visits.

Potential risks of orthodontic therapy: a critical review and conceptual framework

This review examines some of the potential risks of orthodontic therapy along with their evidence base. The risks of orthodontic treatment include periodontal damage, pain, root resorption, tooth devitalization, temporomandibular disorder, caries, speech problems and enamel damage. These risks can be understood to arise from a synergy between treatment and patient factors. In general terms, treatment factors that can influence risk include appliance type, force vectors and duration of treatment whilst relevant patient factors are both biological and behavioural. Hence, the natural variation between orthodontic treatment plans and patients gives rise to variations in risk. A good understanding of these risks is required for clinicians to obtain informed consent before starting treatment as well as to reduce the potential for harm during treatment. After considering each of these risks, a conceptual framework is presented to help clinicians better understand how orthodontic risks arise and may therefore be mitigated.

Relationship between orthodontics and temporomandibular disorders

Since the end of the 20th century, the problems of the temporomandibular disorders (TMDs) have aroused interest to the orthodontists. The aim of this literature review is to present the contemporary evidence concerning the association between the presence of malocclusions and the occurrence of signs and symptoms of the TMJ. In addition, additional variables, which may affect the TMJs of a patient during the orthodontic treatment are pointed out. It is evident that there is an increased number of patients who are seeking for orthodontic treatment, not only in order to enhance their facial aesthetics and the function of mastication system, but also to relieve the symptoms of the temporomandibular joint (TMJ). There are multiple etiological factors that have been associated with the TMDs and they may be manifested by pain and/or sounds of TMJ. In addition, during the clinical examination it can be detected a deviation from the normal function of the mandible.

Temporomandibular pain

Temporomandibular joint pain has various medical and dental etiological factors. The etiology of the temporomandibular joint pain is enigmatic, no single etiological factor is regarded as the cause. Its distribution is also not confined to a single area. This article presents the basic etiologic factors, its epidemiology, distribution of pain, classification of patients and the psychosocial behavior of patients suffering with temporomandibular pain. As overwhelming majority of medical and dental conditions/issues related to etiology of temporomandibular pain in patients have traditionally been presented and interpreted from the clinician's point of view.

Prevalence and risk factors of periodontitis among adults with or without diabetes mellitus

BACKGROUND/AIMS

This study examined prevalence and risk factors of periodontitis in representative samples of Korean adults, with and without diabetes mellitus (DM).

METHODS

Data from the 2012 Korean National Health and Nutritional Examination Survey were analyzed. A total of 4,477 adults (≥ 30 years old) were selected from 8,057 individuals who completed a nutrition survey, a self-reported general health behavior questionnaire, an oral examination, an oral hygiene behaviors survey, and laboratory tests. DM was defined as a fasting plasma glucose ≥ 126 mg/dL, or self-reported diagnosed diabetes, or current use of oral hypoglycemic agents and/or insulin. The community periodontal index was used to assess periodontitis status and comparisons between the periodontitis and the non-periodontitis group, were performed, according to the presence of DM. Risk factors for periodontitis in adults with DM and without DM were evaluated by multiple logistic regression analysis.

RESULTS

The prevalence of periodontitis was significantly higher in adults with DM (43.7%) than in those without DM (25%, p < 0.001). In adults without DM, risk factors for periodontitis were older age, male, urban habitation, waist circumference, smoking, oral pain, and less frequent tooth brushing. Significant risk factors for periodontitis in adults with DM were the smoking, oral pain, and not-using an oral hygiene product.

CONCLUSIONS

Adults with DM have an increased risk of periodontitis than those without DM. Current smoking and oral pain increase this risk. Using an oral hygiene product can reduce risk of periodontal disease in adults with DM.

What are patients' expectations of orthodontic treatment: a systematic review

Background

What patients expect to happen during treatment or benefit from the treatment might influence the subsequent factors such as treatment outcome, patient satisfaction, patient’s cooperation as well as compliance. The aim of this systematic review is to assess the role of patients’ expectations from orthodontic treatment.

Methods

A systematic literature search of four databases Pubmed, Cochrane, Web of Science and PsychINFO was conducted following PRISMA guidelines. Studies reporting expectations regarding orthodontic treatment were selected and a narrative review was conducted. The quality of study was rated according to STROBE statements and the methodology as well as key findings were summarized.

Results

Thirteen studies (14 papers) were finally included for analysis. Among them, only one was a randomized control trial, while the rest included one cohort study, two questionnaire-developments and ten cross-sectional studies. The STROBE quality of reporting scores of the studies ranged from 12 to 18. Seven papers described expectations of the treatment experiences, along with seven talking about benefit expectations from the treatment. Dental appearance and function improvement were most expected in studies relate to the treatment benefits.

Conclusions

Orthodontics appears to have adopted various standardized questionnaires. However, most of them are poor in the quality of methodology and results analyses, which prohibit synthesizing sufficient evidence to help identify which factors influence patient expectations. The evidence of “expectations” affecting treatment outcomes is not found in current research. Future studies are needed to better understand the impact of “expectation” on the treatment both theoretically and experimentally.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0182-3) contains supplementary material, which is available to authorized users.