Orthodontic intrusion of maxillary incisors: a 3D finite element method study

Evaluation of dentoalveolar changes following maxillary incisor intrusion with one vs two anterior miniscrews in subjects with gummy smile: a randomized clinical trial

OBJECTIVES

To examine dentoalveolar changes following intrusion of maxillary incisors with one or two anterior miniscrews in subjects with gummy smile and deep bite.

MATERIALS AND METHODS

Forty-three subjects were selected and divided into two groups: group I (22 subjects: 15 women, 7 men; mean age 30 ± 10 years) received one miniscrew between the upper central incisors, and group II (21 subjects: 16 women, 5 men; mean age 30 ± 10 years) received two miniscrews between the canines and lateral incisors. Dentoalveolar parameters, including amount of intrusion, root resorption, incisor inclination, alveolar bone thickness, and buccal alveolar crest height (cementoenamel junction to labial alveolar crest), were evaluated using cone-beam computed tomography scans obtained before and after intrusion. The intergroup comparison was analyzed using a paired t-test and unpaired t-test to determine significant changes within and between groups.

RESULTS

The amount of intrusion was significantly greater in group II than in group I (P < .05). No statistically significant differences were found between groups I and II for changes in incisor inclination, labial bone thickness, and buccal alveolar crest height (P > .05).

CONCLUSIONS

Maxillary central and lateral incisor intrusion was significantly greater in subjects treated with two miniscrews. Root resorption of the maxillary central incisors was notably greater in subjects with one miniscrew, while maxillary lateral incisor resorption was greater in subjects treated with two miniscrews.

Investigating the Effectiveness of Low-Level Laser in Reducing Root Resorption of the Upper Incisors During Intrusion Movement Using Mini-Implants in Adult Patients With Deep Overbite: A Randomized Controlled Clinical Trial

BACKGROUND

Deep bite is a common characteristic of malocclusion, and many methods are used to treat it, including mini-implants used for the intrusion of the upper incisors. Orthodontically induced inflammatory root resorption (OIIRR) is an inevitable and unexpected side effect of orthodontic therapy. However, resorption of the root could be affected by the type of tooth movement, such as intrusion. Several studies have indicated the effectiveness of low-level laser therapy (LLLT) in accelerating orthodontic movement, but studies that have evaluated the role of this laser in reducing the risk of OIIRR have been limited. This trial aimed to investigate the effectiveness of LLLT in reducing the resorption of the roots of the upper incisors during their intrusion in the context of deep bite correction.

MATERIALS AND METHODS

Thirty patients (13 males, 17 females; mean age 22.4±3.37 years) with deep overbite were recruited and allocated to the laser or the control groups. Mini-implants were inserted between the roots of the upper central incisors and the lateral incisors from the labial aspect at the gingival-mucosal junction on both sides with a force of 40 g on each side through an NiTi coil spring. A low-level laser (Ga-Al-As) with 808 nm wavelength in a continuous mode, with the parameters 250 milliwatt power output, 4 Joules/point energy density, and 16 seconds irradiation per point, was applied to the root of each of the upper incisors. The laser was applied on the first day of the upper incisor intrusion (T1), then on days 3, 7, and 14 of the first month. In the second month, the laser was applied every 15 days, adjusting the spring strength every four weeks until the end of the intrusion stage (T2), which was determined by reaching a normal overbite. As for patients in the control group, the strength of the nickel-titanium springs was adjusted every four weeks to the required strength of 40 g on each end until reaching a normal overbite.

RESULTS

There was a volumetric decrease in both groups' upper central and lateral incisors roots, and this decrease was statistically significant (P<0.001). However, the difference between the two groups was not statistically significant in each central and lateral incisor volume root (P=0.345 and 0.263 for U1 and U2, respectively). Also, both groups had a linear decrease in upper central and lateral incisors roots, which was statistically significant (P<0.001). At the same time, the difference between the two groups was not statistically significant in each central and lateral incisor root length (P=0.343 and 0.461 for U1 and U2, respectively).

CONCLUSION

The low-level laser irradiation using the current protocol did not significantly affect the amount of root resorption induced by incisor intrusion in the experimental group compared to the control group.

Dynamics, Efficacies, and Adverse Effects of Maxillary Full-Arch Intrusion Using Temporary Anchorage Devices (Miniscrews): A Finite Element Analysis

Introduction

Absolute anchorages obtained from temporary anchorage devices (TADs, miniscrews) considerably facilitate dental movements and make some very difficult movements such as full-arch intrusions possible. Despite the significance of assessing strategies to fully intrude the arch using mini-implants, there is no study in this regard except a few case reports. Therefore, we simulated/tested 4 scenarios.

Methods

Four maxilla models were created with different miniscrews/appliances: (1) two miniscrews were placed distal to laterals and one in the mid sagittal region. (2) Two mini-implants were inserted in mesial of canines and 2 others between bilateral first and second molars, plus another TAD in the midpalatal area, plus a transpalatal arch (TPA). (3) Two mini-implants were inserted between bilateral canines and first premolars and 2 others between bilateral first and second molars + TPA. (4) Two mini-implants were installed between lateral-and-canine and 2 miniscrews between second premolars and first molars + TPA. Intrusive forces (80 g anterior, 150 g posterior) were exerted using stainless-steel coil springs. Stresses/displacements were measured. Risk of external root resorption was evaluated.

Results

The highest amounts of incisor/molar intrusion were seen in model 1. Model 2 had fewer intrusions, but its control over undesired movements was greater. Model 4 drastically reduced molar intrusion and considerably increased premolar intrusion. Overall amounts of intrusion were highest in the first 2 models, marking them as proper candidates for cases needing greater intrusion extents. Model 2 may be useful when miniscrew loosening/failure is a concern, while model 1 is recommended when fewer miniscrews are allowed. Overall, the highest and lowest root resorptions might occur in models 1 and 4, respectively.

Conclusions

Each model showed certain efficacies/drawbacks and thus is recommended for a particular set of cases. Therefore, depending on the diagnosis and treatment plan, one or more of these scenarios might be desirable.

Effect of the bracketless orthodontics technique and resin composite material on the biomechanical response of the upper central incisor: 3D finite element analysis

Objectives:

The bracketless orthodontic treatment (BOT) is an alternative technique which indicates using an orthodontic appliance composed of wires and composite resin assisted by 3D technology. However, the biomechanical response of central incisor orthodontic movement has yet to be investigated. Thus, the aim of the present investigation was to calculate the stress magnitude in central incisor movement through 3D finite element analysis using different wire diameters (0.012”, 0.014”, and 0.016”) of nickel–titanium wire and two different resin composites (Opallis and Filtek).

Materials and Methods:

A 3D volume composed of enamel, dentin, cortical bone, cancellous bone, periodontal ligament, composite resin, and different orthodontic wire diameters was designed. After the modeling process, the models were exported to computer-aided engineering software divided into a finite number of elements, and a mechanical structural static analysis was conducted.

Results:

The stress results were plotted on colorimetric maps and in tables for comparison between the different models. The results showed that the central incisor orthodontic movement with BOT does not induce damage to the periodontal ligament, dental root, or bone tissue, regardless of the simulated orthodontic wire diameter and resin composite materials. The palatal composite resin and orthodontic wire also presented acceptable stress magnitude during orthodontic movement.

Conclusion:

Thus, the BOT technique promoted a suitable biomechanical response during central incisor movement regardless the resin composite.

Negligible tooth resorptions after anterior open bite treatment using skeletal anchorage with miniplates

Introduction:

When miniplates are used as anchoring for orthodontic mechanics for anterior open bite correction by retraction of anterior teeth and posterior teeth intrusion and retraction, orthodontically induced inflammatory external apical root resorption is clinically negligible.

Methods:

A homogeneous sample of 32 patients was used, and the roots of the teeth were compared on CT scans performed before and after orthodontic treatment.

Results:

The observed root resorption was minimal, and this can be explained by the uniform distribution of forces in several teeth, simultaneously, in the set of the dental arch and in the bone that supports the teeth.

Conclusion:

The most important thing to prevent root resorption in orthodontic practice, besides being concerned with the intensity of the applied forces, is to be careful with its distribution along the roots of each tooth, in the dental arch and in the bone that supports the teeth.

Volumetric evaluation of root resorption on the upper incisors using cone beam computed tomography after 1 year of orthodontic treatment in adult patients with marginal bone loss

OBJECTIVES:

To determine upper incisor root resorption, volume loss, and the relationship between root volume loss and tooth movement after 1 year of orthodontic treatment in patients with marginal bone loss.

MATERIALS AND METHODS:

A total of 30 women (46.3 ± 5.4 years old) with moderate upper incisor bone loss who required intrusion during orthodontic treatment were recruited. Pre- and post-treatment cone beam computed tomography images were reconstructed. Upper incisors at pre- and post-treatment were superimposed; labio- and palato-apical, middle, and coronal third root volumes were assessed. Tooth movement and alveolar bone height were measured from lateral cephalometric radiographs and cone beam computed tomography. Changes in root volume/alveolar bone height were compared using paired-sample t-tests, percentage root volume loss for each tooth/segment was evaluated by one-way analysis of variance, and the relationship between percentage root loss and degree of tooth movement was assessed by linear regression.

RESULTS:

Mean root volume significantly decreased on the labio- and palato-apical aspects of 12 and labio-apical aspects of 21 and 22 ( P ≤ .024). Palato-apical segment volume loss was greater on lateral than central incisors ( P ≤ .016). Two-dimensional root length and cementoenamel junction-bone crest distance did not change between T0 and T1, with no significant relationship between tooth movement amount and percentage root volume loss.

CONCLUSIONS:

Delivery of 40 g intrusive force to the four upper incisors using a T-loop and the leveling phase lead to more apical root volume loss on lateral than central incisors. There was no relationship between extent of tooth movement and upper incisor root volume loss.

Evaluation of the load system produced by a single intrusion bend in a maxillary lateral incisor bracket with different alloys

OBJECTIVES

To evaluate if a 0.5-mm vertical bend applied on an incisor bracket produces movements in other planes and if different wires influence these effects.

MATERIALS AND METHODS

An acrylic model of a treated patient with brackets passively bonded was attached to an Orthodontic Force Tester, and a load cell was attached to the left lateral incisor. Thirty 0.019 × 0.025-inch archwires were divided into three groups according to their alloy: SS (stainless steel), B-Ti (beta-titanium), and MF (beta-titanium wire coated with nickel-titanium). Step-bends of 0.5 mm high were placed on the lateral incisor bracket using a universal plier, and the forces and moments in three dimensions were statistically analyzed by analysis of variance and Tukey post hoc test.

RESULTS

SS produced a larger force (3.4 N) than the B-Ti (1.41 N) and the MF (0.53 N; P < .001). Lingual forces were produced by the SS (0.82 N) and B-Ti (0.31 N) groups, while in the MF group, the force was insignificant. SS produced a mesial force of 0.24 N, while the B-Ti force was insignificant and MF produced 0.09 N. Groups produced different crown-distal tipping moments (SS = 31.48 N-mm, B-Ti = 11.7 N-mm, and MF = 4.55 N-mm) and different crown-buccal tipping moments. SS produced larger moments (3.63 N-mm) than B-Ti (1.02 N-mm) and MF (0.36 N-mm) wires. A mesial-out rotational moment was observed in all groups (SS = 7.17 N-mm, B-Ti = 3.46 N-mm, and MF = 0.86 N-mm).

CONCLUSIONS

A 0.5-mm intrusion bend produced lingual and mesial side effects. In addition to the distal and buccal crown-tipping moments, there was a mesial-out moment. Compared with SS, B-Ti and MF wires produced lower forces. These more flexible wires showed side effects with lesser intensity.