PASS versus MBT™ for evaluation of anchorage control in three-dimensional measurements: a randomized controlled trial

A comparative study on anterior teeth retraction-related hard and soft tissue changes with physiologic anchorage control technique

Aim of this comparative cross-sectional study was to evaluate the effect of anterior teeth retraction and related hard and soft tissue change under physiologic anchorage control in patients with chief complain of protrusive teeth. 68 Class I or II orthodontic patients undergoing four-premolar extraction and requiring maximum or medium anchorage were included. Patients were treated with physiologic anchorage control technique (PASS group, n = 34, 18.6 ± 7.7 years, 10 male and 24 female) and self-ligation technique (Damon group, n = 34, 17.5 ± 5.4 years, 13 male and 21 female), respectively. TADs were used for anchorage reinforcement in Damon group. Pre- and post-treatment cephalograms were collected. Twenty-six skeletal, dental and soft tissue items were measured and analyzed using a blinded method. T test and paired rank-sum test were used for statistical analysis. The baseline characteristics were similar between groups (P > 0.05). After treatment, inter-group comparison showed statistically significant differences in the decrease of skeletal measurements ∠ANB (- 0.73 ± 1.05° in PASS group and - 0.25 ± 0.84° in the Damon group), Wits value (- 2.56 ± 2.29 mm in PASS group and - 0.47 ± 2.15 mm in Damon group) and soft tissue measurement UL-E (- 2.75 ± 1.36 mm in PASS group and - 2.03 ± 1.30 mm in Damon group) and the increase of FCA and Z angle, which was 2.03 ± 2.12°and 9.52 ± 4.78°in PASS group and 0.97 ± 2.12°and 6.96 ± 4.43°in Damon group, respectively (P < 0.05). Our results indicated that significant anterior teeth retraction and profile improvement could be achieved with PASS technique without additional anchorage devices. Appropriate application of physiologic anchorage control could reduce the dependence of TADs for anterior teeth retraction.

The predictability of orthodontic tooth movements through clear aligner among first-premolar extraction patients: a multivariate analysis

BACKGROUND

The purpose was to determine the predictability of tooth movements through clear aligner among premolar extraction patients and to explore the effects of various factors on tooth movements.

METHODS

A total of 31 extraction patients (10 males and 20 females; age 14-44) receiving clear aligner treatment (Invisalign) were enrolled in this study. The actual post-treatment models and pre-treatment models were superimposed using the palatal area as a reference and registered with virtual post-treatment models. A paired t test was used to compare the differences between actual and designed tooth movements of maxillary first molars, canines, and central incisors. A multivariate linear mixed model was performed to examine the influence of variables on actual tooth movements.

RESULTS

Compared to the designed tooth movements, the following undesirable tooth movements occurred: mesial movement (2.2 mm), mesial tipping (5.4°), and intrusion (0.45 mm) of first molars; distal tipping (11.0°), lingual tipping (4.4°), and distal rotation of canines (4.9°); lingual tipping (10.6°) and extrusion (1.5 mm) of incisors. Age, crowding, mini-implant, overbite, and attachments have differential effects on actual tooth movements. Moreover, vertical rectangular attachments on canines are beneficial in achieving more predictable canine and incisor tooth movements over optimized attachments. Lingual tipping and extrusion of incisors were significantly influenced by the interaction effects between incisor power ridge and different canine attachments (p < 0.05).

CONCLUSIONS

Incisors, canines, and first molars are subject to unwanted tooth movements with clear aligners among premolar extraction patients. Age, crowding, mini-implant, overbite, and attachments influence actual tooth movements. Moreover, vertical rectangular attachments on canines are beneficial in achieving more predictable incisor tooth movements over optimized canine attachments.

3D Finite Element Study of the Physiological Anchorage Control Concept on Anchorage Molars in Lingual Orthodontics

Objective. To study the effect of the physiological anchorage control concept on anchorage molars in lingual and labial orthodontic techniques. Methods. Three-dimensional finite element models, including the right maxillary first molar, periodontal ligament, alveolar bone, and buccal tube, were established. The models were divided into the McLaughlin–Bennett–Trevisi (MBT™) straight-wire model with 0-degree maxillary first molar axial inclination and the physiologic anchorage Speewire system (PASS) model with −7-degree maxillary first molar axial inclination. Simulated sliding retraction forces (1 N, 1.5 N, and 2 N) were loaded on the buccal side and lingual side, and retraction forces (0.5 N, 0.75 N, and 1 N) were loaded on the buccal and lingual sides simultaneously. The displacements, principal stresses, and von Mises stresses of the periodontal ligament under different conditions were derived. Results. The anchorage molars showed different degrees of rotation, tipping, intrusion, and extrusion. As the force increased, these displacement trends also increased. The mesial displacement of the buccal + lingual force loading was less than that of the other two groups. Under the same force load method, the mesial displacement of the PASS group was less than that of the MBT group. Tilt movement increases the tensile stress of the distal cervical margin and root mesial apical third and the compressive stress of the mesial cervical margin and root distal apical third. The maximum stress of the periodontal ligament was less than that of the other two groups when the lingual force was loaded. Conclusion. The physiological anchorage control concept in lingual orthodontics provides better sagittal anchorage control than in labial orthodontics, but there is no significant difference numerically. Attention should be given to the control of torsion, torque, and arch width. Tilt movement increases the PDL stress of the cervical margin and root apical third. The sliding retraction force should be loaded lingually to maintain the force value of 1∼1.5 N.

Methods of Anterior Torque Control during Retraction: A Systematic Review

Background: There are various methods of controlling the inclination of the incisors during retraction, but there is no evidence as to the advantages of some methods over others. The purpose of this systematic review and meta-analysis was to determine the effectiveness of the methods used to control torque during anterior teeth retraction. Methods: In accordance with the PRISMA guidelines, the main research question was defined in the PICO format [P: patients with complete permanent dentition; I: the maxillary incisor torque after (I) and before I retraction with straight-wire appliance and different modes of torque control; O: statistically significant differences in torque values of the upper incisors after orthodontic treatment]. The MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched for keywords combining: retraction orthodontics, torque control orthodontics, torque orthodontics, inclination orthodontics, torque control retraction. The articles were subjected to risk of bias and quality analyses with the ROBINS-I protocol and the modified Newcastle–Ottawa QAS, respectively. Meta-analyses were performed with both fixed- and random-effects models. Results: 13 articles were selected in which total number of 580 subjects took part. In all studies, incisors were retroclined during retraction by 2.46° (mean difference), which was statistically significant. Considering the articles separately, the differences in torque between the study group and the control group were statistically significant in six articles. The Q statistic was 36.25 with p = 0.0003 and I2 = 66.9%, which indicated a high level of study heterogeneity. Conclusion: Both properly performed corticotomy and en-masse retraction using orthodontic microimplants seem to be the most effective and scientifically validated methods of torque control. Further high-quality research is needed to perform better quality analyses and draw more reliable conclusions.