A comparison of space closure rates between preactivated nickel-titanium and titanium-molybdenum alloy T-loops: a randomized controlled clinical trial

The osteoclastic activity in apical distal region of molar mesial roots affects orthodontic tooth movement and root resorption in rats

The utilization of optimal orthodontic force is crucial to prevent undesirable side effects and ensure efficient tooth movement during orthodontic treatment. However, the sensitivity of existing detection techniques is not sufficient, and the criteria for evaluating optimal force have not been yet established. Here, by employing 3D finite element analysis methodology, we found that the apical distal region (A-D region) of mesial roots is particularly sensitive to orthodontic force in rats. Tartrate-resistant acidic phosphatase (TRAP)-positive osteoclasts began accumulating in the A-D region under the force of 40 grams (g), leading to alveolar bone resorption and tooth movement. When the force reached 80 g, TRAP-positive osteoclasts started appearing on the root surface in the A-D region. Additionally, micro-computed tomography revealed a significant root resorption at 80 g. Notably, the A-D region was identified as a major contributor to whole root resorption. It was determined that 40 g is the minimum effective force for tooth movement with minimal side effects according to the analysis of tooth movement, inclination, and hyalinization. These findings suggest that the A-D region with its changes on the root surface is an important consideration and sensitive indicator when evaluating orthodontic forces for a rat model. Collectively, our investigations into this region would aid in offering valuable implications for preventing and minimizing root resorption during patients' orthodontic treatment.

What Is the Most Effective Frictionless Method for Retracting Anterior Teeth When Using Buccal Fixed-Appliance Therapy? A Systematic Review

There are various techniques and designs for springs used in orthodontic treatment, including frictionless methods for closing spaces. However, there is limited explicit evidence to support the superiority of one method over another. This review aims to investigate the available evidence and highlight the advantages of these different methods. This review contained six papers, and information such as study design, spring design, applied force systems, variables studied, follow-up period, and records were extracted. All of the studies focused on canine retraction with the Ladanyi spring showing the highest rate of movement (1.8 mm per month) among all springs for upper canine retraction. The Gjessing and T-loop springs outperformed the Reverse Closing Loop and Ricketts spring, respectively, substantially. In terms of tip control, the T-loop spring showed a clear advantage over the modified Marcotte spring with a difference of 1.2° vs. 6.6° per 3 months. Additionally, it was observed that the Reverse Closing Loop caused a significant loss of anchorage during canine retraction with a medial movement of 2.4 mm. When comparing wire types, no significant differences were found between TMA and Nitinol, while stainless steel was found to be less effective in terms of movement rate and tip control. However, the results indicated that there was no clear evidence that one specific technique was definitively preferable to another; therefore, there is an urgent need for more studies with proper study designs to produce more robust conclusions.

The scientific evidence for pre-adjusted edgewise attachments and mechanics

Introduction Fixed orthodontic appliance systems continue to evolve with a wealth of evidence emerging to underpin these refinements.Aims To present the evidence from comparative prospective research informing the selection of fixed appliance design and mechanics.Design Detailed literature review.Materials and methods An electronic search to identify randomised controlled trials and clinical controlled trials was undertaken using pre-defined search terms.Results Based on high-level evidence, no one bracket system has been proven superior in terms of efficiency or outcome. Similarly, a clear advantage associated with one wire type or dimension has not been shown. The effect of lacebacks in terms of anchorage management appears to be limited, while elastomeric chain and nickel titanium closing coils are associated with similar rates of space closure.Discussion A wealth of high-quality recent evidence to support the selection of fixed appliance attachments, archwires and auxiliaries, including lacebacks and space closing mechanics, was identified.Conclusions There has been a considerable increase in the amount of high-quality evidence informing the choice of pre-adjusted edgewise mechanics in recent years. This information can be used to make evidence-based decisions in the selection and manipulation of fixed appliances during daily practice.

Comparison of retraction efficacy of titanium-molybdenum and titanium-niobium alloy wires – A prospective split-mouth study

Objectives:

The study aimed to compare the efficacy of Titanium-Molybdenum (Ti-Mo) and Titanium-Niobium (Ti-Nb) alloy wires as retraction springs, by comparing: The amount and rate of canine retraction, the degree of canine rotation, the change in axial inclination of canines, and the associated anchorage loss.

Material and Methods:

All 17 participants (age: 18–25 years) to be treated with the first premolar extraction approach by canine retraction were assigned Ti-Mo and Ti-Nb alloy T-loop springs to either of the upper quadrants randomly. Digital intraoral 3-D scans and panoramic radiographs orthopantomagram (OPG) were taken before (T0) and after (T1) the study period (4 months). 3-D superimposition was performed and using the digital models and OPG, changes in canine position, angulation, and anchorage loss were compared between the two groups.

Results:

There was no significant difference between the two treatment groups for all the parameters pertaining to maxillary canine retraction, that is, canine retraction (P = 0.72), change in axial inclination of canines (P = 0.71), rotation of canines (P = 0.74), and anchorage loss (P = 0.13) as well as extraction space closure (P = 0.74).

Conclusion:

Ti-Nb and Ti-Mo alloy wires show a similar potency for use in retraction mechanics for orthodontic space closure.

Evaluation of the Effect of Micro-osteoperforations versus Piezopuncture on the Rate of Orthodontic Tooth Movement Associated with Canine Retraction

AIM: The aim of the study was to investigate the effectiveness of using micro-osteoperforations (MOPs) or piezocision in accelerating tooth movement, during canine retraction, compared to standard canine retraction. PATIENTS AND METHODS: A split-mouth study design was carried out with two Groups A and B. Each group contained 10 patients; in each patient, one side was used as a control side and the contralateral side received either MOPs (Group A) or piezocision (Group B). The assessment data were collected by direct intraoral measurements, every 2 weeks, over a 3 months retraction period. RESULTS: Independent t-test, paired t-test, and ANOVA were used to analyze the results. In Group A, there was a statistically significant difference between the study and control sides (p < 0.001) with a total of 4.2 ± 0.5 mm canine retraction in the MOPs assisted canine retraction side versus a 2.8 ± 0.2 mm total canine retraction in the control side. For Group B, there was a statistically significant difference between the study and control sides (p < 0.001) with a total of 3.6 ± 0.4 mm canine retraction in the piezocision-assisted canine retraction side versus a 2.8 ± 0.2 mm total canine retraction in the control. CONCLUSION: MOPs and piezocision techniques accelerated the rate of canine retraction during orthodontic treatment, with the MOPs being slightly more effective.

Orthodontic force prediction model of T-loop closing spring based on dynamic resistance model

Malocclusion has been seriously endangering human oral function. The most effective and mature therapy is orthodontic treatment. But the relationship between the shape of the T-loop and the orthodontic force is unclear, and the precise mathematical model has not been established. In this article, the dynamic orthodontic force prediction model of the T-loop was established by analyzing the treatment process of the T-loop. The model was based on the dynamic resistance model of waxy dental jaw, the theory of beam deformation, and the deformation characteristics of the T-loop. In the experimental process, 11 kinds of orthodontic archwires were used as experimental samples, including 2 kinds of common archwire materials, 7 kinds of cross-sectional sizes, and 10 kinds of clearance distances. The T-loop was put into the extraction space and immersed in 75°C constant temperature water for 2 min. And the experimental data were measured and collected by the dynamic force measuring device. The experimental results show that the cross-sectional size and the clearance distance are positively correlated with the orthodontic force. The influence of the clearance distance on the orthodontic force is greater than that of the cross-section size. The deviation rates between the experimental values of orthodontic force and the theoretical values are between 1.10% and 9.09%, which verifies the accuracy of the dynamic orthodontic force prediction model. The model can predict the orthodontic force, improve the treatment effect, shorten the treatment cycle, and provide reference and guidance for orthodontists to carry out orthodontic treatment safely and effectively.

Comparison of dual-dimensional and rectangular wires in terms of space closure and anchorage loss during retraction with miniimplants: A prospective clinical study

Background. In sliding mechanics, archwires should slide easily during the retraction of anteriors. Round wires slide well, but the torque control is a significant problem. Rectangular wires produce effective torque expression but pose a challenge to free sliding due to factors like friction and force used to overcome friction, etc. To utilize the properties of both wires, the wire should be bi-dimensional. Dual-dimensional wire is one such wire with different dimensions in the anterior and posterior sections. This study aimed to compare the amount of space closure and anchorage loss of molars between the rectangular and dual-dimensional wire groups during retraction with mini-implants. Methods. Forty patients were randomly allocated to two groups (n=20). Patients with rectangular wires formed the control group, and those with dual-dimensional wires formed the experimental group. Mini-implants and NiTi coil springs were used for retraction. Model and cephalometric analyses were carried out to calculate the amount of space closure and anchor loss, before and four months after the study. Statistical significance was set at P<0.05. Results. The average amount of space closure was higher with DDW (3.98 mm) than rectangular wire (3.22 mm). The difference was statistically significant. No significant difference was found with anchorage loss. Conclusion. DDW can be used as an alternative to rectangular wires during retraction with mini-implants; however, it cannot replace the rectangular wires completely. Anchorage control was effective with both wires.

Optimal force magnitude for bodily orthodontic tooth movement with fixed appliances: A systematic review

INTRODUCTION

There is a high degree of uncertainty regarding the appropriate force level that should be applied during orthodontic tooth movement (OTM). As a result, orthodontic treatments may take longer than necessary, leading to unwanted side effects. This review aimed to identify an optimal force range with the rate of OTM as the primary outcome. External apical root resorption and pain were evaluated as secondary outcomes, and the influence of growth was examined.

METHODS

Five electronic databases were searched (MEDLINE [via PubMed], Embase [via OVID], Cochrane Library, CINAHL, and Web of Science) with no publication date or language restrictions. Inclusion eligibility screening, quality assessment, and data extraction were performed by 3 investigators. Each retrieved record was assessed by 2 observers independently. Only randomized controlled trials and randomized split-mouth studies were included.

RESULTS

A total of 12 articles satisfied the inclusion criteria-two randomized controlled trials and 10 randomized split-mouth studies. Only 1 study showed a low risk of bias, whereas the remaining 11 were unclear. The qualitative analysis showed that forces between 50 cN and 250 cN produced a similar OTM rate; forces >250 cN yielded a slightly higher rate but were accompanied by adverse effects. Because of considerable heterogeneity in methodology, clinical diversity with varying forces between 18 cN and 360 cN, and poor statistical reporting, a meta-analysis was deemed inappropriate.

CONCLUSIONS

Forces between 50 cN and 100 cN seem optimal for OTM, patient comfort and potentially exhibit fewer side effects. Nevertheless, careful data interpretation is necessary because of the lack of strong evidence. Protocol registration: PROSPERO CRD42016039985.

Evaluation of the Effect of Combined Low Energy Laser Application and Micro-Osteoperforations versus the Effect of Application of Each Technique Separately On the Rate of Orthodontic Tooth Movement

AIM

The study was conducted to evaluate the effect of combined low energy laser application and Micro-Osteoperforations versus the effect of the application of each technique separately on the rate of orthodontic tooth movement.

PATIENTS AND METHODS

Three parallel groups (each group contained 10 patients) were performed; Group A: In which one side was controlled side, and the other side received micro-osteoperforations (MOPs), Group B: In which one side was controlled side, and the other side received low-level laser therapy (LLLT), Group C: In which one side was controlled side, and the other side received both MOPs and LLLT.

RESULTS

Significant statistical differences were obvious in the rate of canine retraction between each intervention and the control sides as following; the MOPs increased the rate of canine retraction by 1.6 fold more than the control side, LLLT increased the rate of canine retraction by 1.3 fold than the control side, and combination of both techniques resulted in an increase in the rate of canine retraction by 1.8 fold more than the control side.

CONCLUSION

Combination of MOPs and LLLT proved to be more efficient regarding increasing the rate of canine retraction than the application of each technique separately.

Evaluating the Amount of Tooth Movement and Root Resorption during Canine Retraction with Friction versus Frictionless Mechanics Using Cone Beam Computed Tomography

BACKGROUND

The current study was carried out to compare the amount of tooth movement during canine retraction comparing two different retraction mechanics; friction mechanics represented by a NiTi closed coil spring versus frictionless mechanics represented by T - loop, and their effect on root resorption using Cone Beam Computed Tomography (CBCT).

METHOD

Ten patients were selected in a split-mouth study design that had a malocclusion that necessitates the extraction of maxillary first premolars and retraction of maxillary canines. The right maxillary canines were retracted using T - loops fabricated from 0.017 X 0.025 TMA wires. The left maxillary canines received NiTi coil spring with 150 gm of retraction force. Pre retraction and post retraction Cone Beam Computed Tomography were taken to evaluate the amount of tooth movement and root resorption using three-dimensional planes.

RESULTS

T - loop side showed statistically significant higher mean anteroposterior measurement than NiTi coil spring side, indicating a lower amount of canine movement pre and post a canine retraction. Concerning the root resorption, there was no statistically significant change in the mean measurements of canine root length post retraction.

CONCLUSION

The NiTi coil spring side showed more distal movement more than the T-loop side. Both retraction mechanics with controlled retraction force, do not cause root resorption.

The T-loop in details

INTRODUCTION

The T-loop as designed by Burstone is a space closure spring used in the rational application of orthodontic biomechanics. Despite the diversity of studies, there is still no consensus on the optimal parametric characteristics for its conformation.

OBJECTIVE

This study aimed at reviewing the literature on the force systems released by different conformations of the T-loop, according to the type of anchorage and the main characteristics and factors that influence them.

RESULTS

Comparing the studies, the need for standardization was perceived in the methodology to shape the loops, regarding the variables that influence the force system. Most of the experimental studies with this loop do not report the vertical movement, nor the steps and angles that occur in the brackets. Clinical studies have obtained more variable results in relation to vertical acting forces, considering the influence of chewing.

CONCLUSION

There is great potential for future studies with this type of loop, especially using nickel-titanium alloys, in order to achieve a pure translational movement without friction, with optimal and constant levels of force.

Initial forces experienced by the anterior and posterior teeth during dental-anchored or skeletal-anchored en masse retraction in vitro

OBJECTIVE

To investigate initial forces acting on teeth around the arch during en masse retraction using an in vitro Orthodontic SIMulator (OSIM).

MATERIALS AND METHODS

The OSIM was used to represent the full maxillary arch in a case wherein both first premolars had been extracted. Dental and skeletal anchorage to a posted archwire and skeletal anchorage to a 10-mm power arm were all simulated. A 0.019 × 0.025-inch stainless steel archwire was used in all cases, and 15-mm light nickel-titanium springs were activated to approximately 150 g on both sides of the arch. A sample size of n = 40 springs were tested for each of the three groups. Multivariate analysis of variance (α = 0.05) was used to determine differences between treatment groups.

RESULTS

In the anterior segment, it was found that skeletal anchorage with power arms generated the largest retraction force (P < .001). The largest vertical forces on the unit were generated using skeletal anchorage, followed by skeletal anchorage with power arms, and finally dental anchorage. Power arms were found to generate larger intrusive forces on the lateral incisors and extrusive forces on the canines than on other groups. For the posterior anchorage unit, dental anchorage generated the largest protraction and palatal forces. Negligible forces were measured for both skeletal anchorage groups. Vertical forces on the posterior unit were minimal in all cases (<0.1 N).

CONCLUSIONS

All retraction methods produced sufficient forces to retract the anterior teeth during en masse retraction. Skeletal anchorage reduced forces on the posterior teeth but introduced greater vertical forces on the anterior teeth.

Nickel titanium T-loop wire dimensions for en masse retraction

OBJECTIVE

To compare the force system produced by nickel-titanium T-loop springs made with wires of different dimensions.

MATERIAL AND METHODS

Thirty compound T-loop springs were divided into three groups according to the dimensions of the nickel-titanium wire used for its design: 0.016" × 0.022", 0.017" × 0.025", and 0.018" × 0.025". The loops were tested on the Orthodontic Force Tester machine at an interbracket distance of 23 mm and activated 9 mm. The force in the y-axis and the moment in the x-axis were registered while the calculated moment to force ratio was recorded at each .5 mm of deactivation. The data were analyzed by three analyses of variance of repeated measures to detect differences and interactions between deactivation and wire size on force, moment, and moment-force ratios (M/F).

RESULTS

All groups had significantly different forces (P < .001). The 0.016" × 0.022" wire produced 1.78N of force while the 0.017" × 0.025" and the 0.018" × 0.025" produced 2.81 N and 3.25 N, respectively. The 0.016" × 0.022" wire produced lower moments (11.6 Nmm) than the 0.017" × 0.025" and 0.018" × 0.025" wires, which produced similar moments (13.9 Nmm and 14.4Nmm, respectively). The M/F produced was different for all groups; 0.016" × 0.022" T-loops produced 6.7 mm while the 0.017" × 0.025" and 0.018" × 0.025" T-loops produced 5.0 mm and 4.5 mm, respectively. An interaction was detected for all variables between deactivation and groups.

CONCLUSION

The larger wires tested produced higher forces with slight increase on the moments, but the M/F produced by the 0.016" × 0.022" wire was the highest found.

Effects of stress relaxation in beta-titanium orthodontic loops: Part II

OBJECTIVE

To determine which regions of beta-titanium T-loop springs (TLSs) are more affected by the stress relaxation over a 12-week period.

MATERIALS AND METHODS

Fifty TLS were previously activated by concentrated bends and divided into five groups of 10 each according to their evaluation periods: immediate assessment (G0), 24 hours (G1), 48 hours (G2), 1 week (G3), and 12 weeks (G4). Groups 1 to 4 were mounted into a structure simulating a clinical situation. After the experimental periods, the springs were scanned for measurement of their angles and numbered from 1 to 9. A two-way analysis of variance was used to detect differences among the angles measured and differences caused by time and also to detect interactions between those two factors. Tukey's test was used to find differences among the groups.

RESULTS

Time influenced the angulations of the TLSs (P < .001). Tukey post hoc test showed that G0 (84.1°) presented a different profile, whereas G1 (90.2°), G2 (90.7°), and G3 (91.1°) had similar profiles among each other, with G4 (92.6°) showing a mean value different from all other groups. A significant interaction was detected between activation time and angular deformation in the TLSs (P < .01).

CONCLUSION

Stress relaxation was observed in the TLSs. It was greatest within 24 hours and gradually increased up to 12 weeks. Two regions were identified as responsible for the relaxation of the TLSs: one at the bend between the vertical extensions of the springs and the base arch and the other at the preactivation bends made in the base arch.