Iatrogenic possibilities of orthodontic treatment and modalities of prevention

Retrospective Study on Orthodontic Gingival Recession Correction Using Clear Aligners

Background and Objectives: Our study aims to evaluate the effectiveness of ClearCorrect® clear aligners (The Straumann Group) in improving gingival recession, which developed following prior fixed orthodontic treatment. The specific objectives were to assess changes in recession severity in patients with orthodontic gingival recessions following aligner therapy and to determine whether the initial severity of recession influenced improvement rates across three categories-mild (RT1), moderate (RT2), and severe (RT3)-as defined by the Cairo classification. Materials and Methods: Fifty-six patients with gingival recession from previous orthodontic treatment received aligner therapy for seven to twelve months, focusing on 146 recession sites, primarily in the lower anterior region. Recession severity was classified and tracked as RT1, RT2, and RT3. Statistical analyses, including a Chi-square test, assessed improvement rates across these categories. Results: Among severe recessions (RT3), 52% showed no improvement, while 48% exhibited some improvement, with 16% improving to RT1. In the moderate group (RT2), 63% improved to RT1, and 16% resolved. The mild group (RT1) showed a 58% reduction in recession depth. Chi-square testing confirmed a statistically significant difference in improvement rates across the three groups (p = 1.44 × 10-7). Conclusions: Clear aligners may contribute to gingival recession improvement, particularly in mild and moderate cases (RT1 and RT2), though severe cases (RT3) show a more limited response.

Effectiveness of Platelet Rich Fibrin in Accelerating Canine Distal Movement: A Systematic Review of Randomized Controlled Trials

This review aimed at a systematic evaluation of the available literature on the effect of platelet-rich fibrin (PRF) in accelerating canine distal movement (CD). An elaborate search of the available literature on the effect of PRF on the acceleration of canine distal movement was conducted using appropriate search terms in PubMed, Scopus, Cochrane Central, and Google Scholar until April 2024. The risk of bias within the studies was assessed using the Cochrane risk of bias (RoB)-2 tool. Publication bias was assessed with a funnel plot, and a random effects model was used for quantitative synthesis. The certainty of the available evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Following the systematic search, a total of 11 studies were included for the qualitative analysis, and three studies were included for quantitative synthesis. Most of the studies reported an increased rate of canine distal movement following administration of PRF. The overall pooled CD at one, two, three, four, and five months showed a significantly increased mean CD in i-PRF (p<0.00001; MD = 0.23; 95% CI: 0.14 to 0.32), and a significantly increased rate of CD was noted during the first and second months. The available studies had a moderate to low risk of bias and a moderate certainty of evidence. Hence, with a moderate certainty of evidence and a risk of bias, it can be concluded that PRF accelerates orthodontic tooth movement during the first two months.

Orthodontic management of amelogenesis imperfecta: A case report

Key Clinical Message

Amelogenesis imperfecta (AI) is a rare developmental anomaly characterized by poorly developed or absent tooth enamel, which complicates orthodontic treatment due to weak enamel-bracket bond strength. This case report presents a successful management of AI using fixed orthodontic appliances and prosthodontic rehabilitation.

Abstract

Amelogenesis imperfecta (AI) causes enamel defects, complicating oral hygiene, reducing masticatory function and lowering self-esteem. This case report details an 18-year-old female with AI who underwent fixed orthodontic treatment followed by prosthodontic rehabilitation. The multidisciplinary approach restored function and aesthetics, significantly improving her quality of life.

Effects of Thermocycling with Two Different Curing Techniques on Enamel Micro-Cracks Formation, Debonding, and Failure Modes of Ceramic Brackets: An In Vitro Study

Despite the rise in popularity of ceramic braces for adults, the risk of enamel microcracks (EMCs) upon removal remains a significant drawback for both dental professionals and patients. Our study aimed to assess the effects of thermocycling, pre-curing, and co-curing techniques with different bonding agents on the enamel surface of teeth after the removal of ceramic brackets. We also examined the incidence, quantity, length, and direction of EMCs on tooth surfaces. Additionally, the adhesive remnant index (ARI) scores and orthodontic bracket bond failure modes were evaluated and compared. The study divided 40 extracted upper canine teeth into ten groups for further analysis. Two groups had intact enamel as the negative control, while the remaining groups had orthodontic ceramic brackets bonded using different bonding agents and curing techniques. Thermocycling was performed in five groups, and ARI was assessed after debonding. The study findings were statistically significant (p < 0.05) in demonstrating the impact of curing techniques on EMCs and debonding outcomes. Seventh-generation bonding agents resulted in complete adhesive removal (ARI = 0). The microcracks' incidence, number, and length showed insignificant results. Differences in ARI between thermocycler and non-thermocycler samples were insignificant. Both co-curing and pre-curing techniques yielded comparable ARI results. This study highlights the importance of using advanced bonding agents to minimize enamel damage during ceramic bracket debonding.

Interdisciplinary Approach in Periodontal Management of Orthodontic Patient: Long-Term Follow-up

Orthodontic therapy is becoming a mainstay for the correction of esthetic and functional disturbances in both young and older adults. Orthodontic forces act on the periodontium and can have wide-ranging effects, from beneficial to harmful, from being a hindrance to oral hygiene maintenance to causing irreversible periodontal breakdown. In some patients, the presence of periodontal conditions like gingival recession, before start of orthodontic therapy, raises many questions. Much controversy and confusion exist regarding the need for periodontal therapy, its sequencing, especially in case of recession in a young patient who needs orthodontic therapy. An interactive, interdisciplinary approach is essential in such cases for success. This case report illustrates the interdisciplinary management of a young patient with gingival recession with an eight-year follow-up of the case.

The Attitude and Perception of Dental and Medical Interns Toward Dental Smile Enhancing Treatments

Background:

Perception of beauty is different from one individual to another, and this may influence their desire for aesthetic treatment. There are many studies that compared dentists to the general population’s perception of smile treatments. However, only a few studies were carried out to compare the perception of fresh graduate dentists with a comparable group of another medical medical background.

Objective:

This study aimed to compare how medical and dental interns perceive dental smiles and how much they ask for dental enhancement treatments.

Methods:

A cross-sectional study targeting dental and medical interns in the kingdom of Saudi Arabia using an online survey. An online questionnaire was formulated and distributed through social media. Comparisons between groups were made using the Chi-square test with a p-value of significance kept under 0.05.

Results:

204 participants responded to the survey, 107 dental and 97 medical interns (52.5%, 47.5%), respectively. When the participants were asked to rate their satisfaction with their smiles, almost 60% of the dental interns rated their smiles 8/10 or more on a scale of (1-10). When they were asked about the cause of the dissatisfaction, their responses were varying. About 84% of dental interns reported having complications of varying sources because of the smile-enhancing treatment, compared to only 50% of the medical interns.

Conclusion:

Dental and medical interns interacted in the same manner toward smile-enhancing treatments. Dental interns seem to show more satisfaction with their smiles. They also showed more ability to spot and identify the harmful effects of those procedures.

A Comprehensive Review on Drug Therapies and Nanomaterials used in Orthodontic Treatment

Orthodontic treatment typically requires an extended duration of 1-2 years to complete the treatment. Accelerating the rate of tooth movement during orthodontic treatment is essential for shortening the overall treatment duration. After the completion of orthodontic treatment, a prominent concern arises in the form of orthodontic relapse, where the teeth tend to revert to their original positions. This issue affects approximately 60% of the global population, underscoring the importance of implementing effective measures to address orthodontic relapse. An approach in this regard involves the targeted administration of herbal and synthetic drugs applied directly to the specific area of interest to facilitate tooth movement and prevent orthodontic relapse. Apart from this, researchers are investigating the feasibility of utilizing different types of nanoparticles to improve the process of orthodontic tooth movement. In recent years, there has been a noticeable increase in the number of studies examining the effects of various drugs on orthodontics. However, the currently available literature does not provide significant evidence relating to orthodontic tooth movement. In this review, the authors provide valuable information about the drugs and nanomaterials that are capable of further enhancing the rate of orthodontic tooth movement and reducing the risk of orthodontic relapse. However, a notable hurdle remains, i.e., there is no marketed formulation available that can enhance orthodontic tooth movement and reduce treatment time. Therefore, researchers should try herbal-synthetic approaches to achieve a synergistic effect that can enhance orthodontic tooth movement. In this nutshell, there is an urgent need to develop a non-invasive, patient-compliant, and cost-effective formulation that will provide quality treatment and ultimately reduce the treatment time. Another critical issue is orthodontic relapse, which can be addressed by employing drugs that slow down osteoclastogenesis, thereby preventing tooth movement after treatment. Nevertheless, extensive research is still required to overcome this challenge in the future.

Immune System Acts on Orthodontic Tooth Movement: Cellular and Molecular Mechanisms

Orthodontic tooth movement (OTM) is a tissue remodeling process based on orthodontic force loading. Compressed periodontal tissues have a complicated aseptic inflammatory cascade, which are considered the initial factor of alveolar bone remodeling. Since skeletal and immune systems shared a wide variety of molecules, osteoimmunology has been generally accepted as an interdisciplinary field to investigate their interactions. Unsurprisingly, OTM is considered a good mirror of osteoimmunology since it involves immune reaction and bone remolding. In fact, besides bone remodeling, OTM involves cementum resorption, soft tissue remodeling, orthodontic pain, and relapse, all correlated with immune cells and/or immunologically active substance. The aim of this paper is to review the interaction of immune system with orthodontic tooth movement, which helps gain insights into mechanisms of OTM and search novel method to short treatment period and control complications.

MH cortical screws, a revolutionary orthodontic TADs design

OBJECTIVE

MH cortical screws were designed to combine the advantages of thick mini-implants with the versatility of micro-screws while avoiding the disadvantages of both.

MATERIALS AND METHODS

An MH cortical screw (MH is an abbreviation for the author's name) was made from titanium material. The screw has a 3 mm-long amphora-shaped shank of 2 mm thickness at its thinnest and 3 mm at its thickest part. Uniform 4 mm diameter threads blend into a 1 mm cutting tip. An external hexagonal head with side retentive ligature holes and a central hole for attachments was fabricated on a saucer-shaped gingival collar. Multiple attachments have been prepared for amending to the central hole.

RESULTS

The shank design allowed cortical plate retention. The uniform threads and the amphora design provided maximum primary and secondary stability, respectively. The self-drilling tip allowed for a flapless technique, while the hexagonal head with side holes facilitated screwdriver control and allows for ligature wire anchorage. Cleats and buttons facilitated the use of elastics and springs, together with bracket-heads and eyelets for titanium molybdenum alloy and nickel-titanium wires inclusion. Adjustable hooks and chains provided versatility of line of action. Cover screws to retain extra-tissue mini-plates applied skeletal anchorage and long-term retention with flapless manipulations.

CONCLUSION

MH cortical screws are a novel and important introduction to orthodontic anchorage. They combine primary and secondary stability with avoidance of root damage together with insertions into attached gingiva only. Multiple and versatile attachments allow for the application of biomechanical techniques according to the clinician's preferences. Extra-tissue mini-plates facilitate maximum anchorage for skeletal control and long-term retention without surgery.

Updated Guidelines for the Orthodontic Management of Traumatized and Endodontically Treated Teeth: A Review Study

Traumatic dental injuries (TDIs) are injuries affecting the teeth, periodontium, and surrounding soft tissues. A significant percentage of candidates for orthodontic treatment suffer from previous TDIs to their permanent incisors that mostly remained untreated. Orthodontic treatment of such teeth might be associated with an increased risk of further pulpal and periodontal consequences, especially in teeth with a previous onset of root resorption that has occurred following the trauma. Orthodontic treatment planning can also be challenging for previously endodontically treated teeth. Clinicians should be aware of the techniques and the appropriate time to proceed with orthodontic tooth movement of traumatized and endodontically treated teeth, whether it was secondary to deep carious lesions or TDIs, and about the risks involved.

This review was done in order to provide an evidence-based approach regarding the orthodontic management of traumatized and endodontically treated teeth and the current recommendations for orthodontic tooth movement of such teeth.

A novel removable appliance for canine retraction: a case report

This case report outlines the use of a modified Leighton's retractor as a method for canine retraction in a patient with severe hypodontia, a history of aggressive periodontitis with tooth loss and idiopathic root resorption affecting multiple teeth. Treatment involved an upper removable appliance in combination with a lower sectional fixed appliance with the aim of improving aesthetics and function for the patient, whilst balancing the need to minimise treatment duration and modify treatment mechanics to reduce the orthodontic risks.

Clear Aligners in Patients with Amelogenesis and Dentinogenesis Imperfecta

Dentinogenesis imperfecta (DI) and amelogenesis imperfecta (AI) are hereditary abnormalities of dental hard tissues. Dental abnormalities may also be accompanied by symptoms of disorders such as osteogenesis imperfecta. AI and DI have a significant burden on socializing, function, and comfort; therefore, frequent screening and accurate diagnosis is the cornerstone of managing such conditions. Both AI and DI could be treated with many strategies, including restorative, prosthetic, periodontal, surgical, and orthodontics treatment. The interdisciplinary combination of orthodontic, prosthodontic, and periodontic treatment has been proven to improve the prognosis of AI and DI. Regarding orthodontic treatment, the most difficult element of orthodontic therapy may be maintaining a high level of motivation for what might be a prolonged form of treatment spanning several years. There are many forms of orthodontic management for AI and DI, including removable appliances, functional appliances, and fixed appliances. Clear aligner therapy (CAT) contains a broad range of equipment that works in different ways, has different construction processes, and is compatible with different malocclusion procedures. The application of CAT in patients with AI and DI is favorable over the fixed applicants. However, the available evidence regarding the application of CAT in AI is weak and heterogeneous. In this review, we discussed the current evidence regarding the application of clear CAT in patients with AI and DI.

The MH-WIRE, a novel coil-springe wire system: A prototype design

OBJACTIVE:

The authors introduced a novel wire system aiming to achieve optimal goals of tooth movement without multiple wire changes or sophisticated wire bending.

MATERIALS AND METHODS:

The system was composed of a single wire for all phases of treatment. The archwire was composed of NiTi coil springs connecting delta-shaped segments of 0.018˝ × 0.025˝ Titanium Molybdenum Alloy (TMA) segments to fit the 0.018˝ × 0.025˝ bracket slot, or 0.022˝ × 0.028˝ TMA segments to fit the 0.022˝ × 0.028˝ bracket slot. The coil spring was closed and packed in design. The coil-spring loops were constructed with 3 mm lumen. The wires were designed in three sagittal forms and the system provided nine forms of archwires.

RESULTS:

The wire systems have been an important component of treatment since the development of orthodontic science. Over time, the philosophy has evolved from endorsing wire bending to straight-wire treatment and then to custom-made archwires.

CONCLUSION:

This wire system was designed to be used as a “single-wire for the case” across all stages of treatment to achieve the ideal goals without any biological damage.

Role of the general dental practitioner in managing the risks of orthodontic treatment

The aim of this article is to outline the potential risks in orthodontic treatment and the general dental practitioner's role in reducing and managing such risks. The success of orthodontic treatment largely depends on patient understanding of the risk/benefit implications of the orthodontic treatment and all of the potential consequences involved in such treatment. A perfect blend of good case selection, sound clinical judgement and, more importantly, a patient's clear understanding of the potential risks involved and the treatment implications help minimise and manage potential hazards that occur during the course of the treatment.

An Instrument for Seating Orthodontic Archwires

Full engagement of orthodontic archwires to permit gate closure in self-ligating brackets can be challenging in both the initial stages of alignment with crowded or rotated teeth and also during the later treatment stages with use of heavy rectangular wires.

A handy, reliable tool has been developed to ensure complete seating of any archwire in slots of both conventional and self-ligating bracket (SLB) systems to overcome this problem.

Effect of antimicrobial agents on the oral microflora in patients undergoing fixed orthodontic therapy-An ex vivo comparative analysis

Aim:

To evaluate and compare the efficacy of Ozonated Olive Oil Gel, Chlorhexidine gel, and Amflor (Fluoridated) mouthwash on reducing the count of Streptococcus mutans and Lactobacillus in patients undergoing fixed orthodontic therapy evaluated at different time intervals.

Methods:

Sixty patients undergoing orthodontic treatment were randomly divided into three groups (n = 20) based on antimicrobial agents used (Group 1: Ozonated olive oil gel; Group 2: Chlorhexidine gel; Group 3: Fluoridated mouthwash). Elastomeric modules from brackets were collected at T₀ (Fresh samples) and T₁ (2^nd week) and T₂ (4^th week) for assessment of the microbial growth. These collected modules were cultured and evaluated for the presence of Streptococcus Mutans and Lactobacilli and numbers of colonies were counted at each interval. Data obtained was subjected to statistical analysis using SPSS software (Version 20.0). Level of significance was kept at 5%. Intra-group and inter-group comparison between pretreatment, 2^nd week and 4^th week was done for each group using Wilcoxon signed rank test and Mann–Whitney U test.

Results:

There was presence of Streptococcus Mutans and Lactobacilli during orthodontic treatment which progressively increased from T_o to T₁ and then declined from T₁ to T_2. The colony counts were maximum for Fluoridated mouthwash and least for Chlorhexidine and the results were statistically significant (P < 0.05).

Conclusion:

All three antimicrobial agents used were effective against Streptococcus mutans and Lactobacillus. Chlorhexidine proved to be more efficacious whereas Fluoridated mouthwash proved to be least effective against both Streptococcus mutans and Lactobacillus bacteria.

Orthodontic management of severe iatrogenic biprotrusion and resorptions with miniscrews and corticotomies

BACKGROUND

This case report describes a patient with severe iatrogenic dental biprotrusion who visited for a second assessment. The patient presented first premolar maxillary extractions, resorbed maxillary incisors and dehiscences in the anterior buccal and palatal cortical bone diagnosed with cone-beam computed tomography (CBCT).

MATERIAL AND METHODS

At the beginning of treatment, fixed appliances were bonded on all teeth except on the upper incisors to prevent further root resorption. Mandibular first premolar extractions, miniscrews and corticotomies were scheduled for gaining distalization of the teeth in the four quadrants. When this was achieved, an occlusal splint was placed to extrude the posterior teeth with interarch elastics for increasing the vertical dimension. Next, brackets were placed on the maxillary incisors and a comprehensive orthodontic treatment was performed.

RESULTS

After treatment, changes in incisor positioning were evident, varying the interincisal angle by 57.6 degrees. Nevertheless, slight root resorption of the upper incisors was observed.

CONCLUSIONS

Correct diagnosis is necessary to design an adequate treatment plan and make orthodontists aware of possible severe unwanted tooth movements before they occur. In dental biprotrusion without overjet, the first objective should be to distalize mandibular teeth prior to maxillary teeth retraction.

Comparison of microbial adhesion and biofilm formation on orthodontic wax materials; an in vitro study

Background/purpose

Orthodontic wax materials are available on the dental market and are given by orthodontists due to pain, sores and irritation caused by treatment. The aim of the study was to compare biofilm formation and microbial adhesion at different time points on different protective materials used against orthodontic wounds in vitro.

Materials and methods

Microbial adhesion and biofilm formation were evaluated against Streptococcus mutans ATCC 25175 and Lactobacillus acidophilus ATCC 4356 standard strains on orthodontic wax materials at the 0, 24th, 48th, 72nd, 96th and 120th hour. The Kruskal Wallis test and Bonferroni test were used for statistical evaluations. Statistical significance was set at p < 0.05.

Results

It was observed that S. mutans formed statistically significantly more biofilm on OrthoDots®CLEAR (OrVance) than Ora-Aid (TBM Corporation) at the 48th hour (p < 0.05). Furthermore, L. acidophilus formed statistically significantly more biofilm on OrthoDots®CLEAR (OrVance) than Brace Gard®(Infa-Lab Inc.) at the 72nd, 96th and 120th hours (p < 0.05).

Conclusion

Significant differences were noted among the different orthodontic wax materials and both S. mutans and L. acidophilus created biofilm on all waxes at different time points in vitro. To prevent biofilm formation, these waxes need to be refreshed and should not be used for more than 24 h. According to our study, biofilm production performances of pathogens on Brace Gard®(Infa-Lab Inc.) are minimal and therefore it may be a better option to use in clinics. However, to our knowledge, this is the first study investigating biofilm formation on waxes and more studies are needed in this field.

[Effect of orthodontic traction on the microstructure of dental enamel]

OBJECTIVE

To investigate the effect of orthodontic traction on the microstructure of dental enamel.

METHODS

Forty-eight isolated premolars were randomly divided into 6 groups (n=8), including Group A (blank control group), in which the teeth were bonded with the orthodontic brackets without any loading force; Groups B1, B2, and B3 where the teeth were bonded with the orthodontic brackets using clinical adhesives and loaded with 50 g force for 6 months, 200 g force for 6 months, and 200 g force for 1 month, respectively; and Groups C1 and C2, where the teeth were bonded with straight wire brackets using light curing bonding and chemical curing bonding techniques, respectively. All the teeth were embedded with non-decalcified epoxy resin. Scanning electron microscope (SEM), atomic force microscope (AFM), and energy spectrometer (EDS) were used to analyze interface morphology and elemental composition of the teeth sliced with a hard tissue microtome.

RESULTS

Compared with those in Group A, the teeth in the other 5 groups showed increased adhesive residue index with microcracks and void structures on the enamel surface under SEM; AFM revealed microcracks on the enamel surface with angles to the grinding direction. A larger loading force on the bracket resulted in more microcracks on the enamel interface. The interface roughness differed significantly between Groups A and C2, and the peak-to-valley distance differed significantly between Groups A, C, and C2.

CONCLUSIONS

Orthodontic traction can cause changes in the microstructure of normal dental enamel.

Comparative assessment of mouse models for experimental orthodontic tooth movement

Animal experiments are essential for the elucidation of biological-cellular mechanisms in the context of orthodontic tooth movement (OTM). So far, however, no studies comparatively assess available mouse models regarding their suitability. OTM of first upper molars was induced in C57BL/6 mice either via an elastic band or a NiTi coil spring for three, seven or 12 days. We assessed appliance survival rate, OTM and periodontal bone loss (µCT), root resorptions, osteoclastogenesis (TRAP⁺ area) and local expression of OTM-related genes (RT-qPCR). Seven days after the elastic bands were inserted, 87% were still in situ, but only 27% after 12 days. Survival rate for the NiTi coil springs was 100% throughout, but 8.9% of the animals did not survive. Both methods induced significant OTM, which was highest after 12 (NiTi spring) and 7 days (band), with a corresponding increase in local gene expression of OTM-related genes and osteoclastogenesis. Periodontal bone loss and root resorptions were not induced at a relevant extent by neither of the two procedures within the experimental periods. To induce reliable OTM in mice beyond 7 days, a NiTi coil spring is the method of choice. The elastic band method is recommended only for short-term yes/no-questions regarding OTM.

Do various degrees of tooth decalcification affect orthodontists', general dentists' and laypersons' ratings of smile esthetics?

OBJECTIVES

To compare the effect of various degrees of decalcification after orthodontic treatment (white spot lesions) on orthodontists', general dentists', and laypersons' ratings of smile esthetics.

MATERIALS AND METHODS

Eight photographs representing incrementally altered tooth decalcification lesions of maxillary anterior teeth ranging from mild to severe were shown randomly to the study participants. Photographs were rated by a matched sample of orthodontists (N = 42), general dentists (N = 52), and laypeople (N = 58). A visual analogue scale (VAS) was used to assess perceptions of smile esthetics.

RESULTS

The three groups of raters could distinguish between different decalcification levels. Raters gave more negative scores as the decalcification level increased.

CONCLUSIONS

The three groups of raters were able to distinguish between various degrees of decalcification lesions. General dentists were the most critical of all groups when rating decalcification lesions.

A Novel Temporary Anchorage Device Aided Sectional Mechanics for Simultaneous Orthodontic Retraction and Intrusion

Closing spaces on light wires with inadequate knowledge and inappropriate mechanics can cause a "roller coaster" effect leading to an improper occlusion. Current knowledge of biomechanics, along with the incorporation of TADs, has made this process less challenging and more predictable. Resistance to sliding is considered the most prominent inhibitor of space closure in archwire-guided space closure or sliding mechanics, in turn delaying treatment duration considerably. In our case, resistance to sliding, primarily binding of the wire in the bracket slot, was nullified with the use of loop and sectional mechanics. This case report is aimed at showcasing the successful treatment of a young lady with a novel clinical setup to retract the canines into the premolar extraction space and simultaneously retract and intrude the anterior segment using sectional archwires and TADs in just under nine months. The current setup with sectional wires and TADs produced an uprighting, and an intrusive effect on the upper incisors during space closure. Additionally, the anchorage design avoided any significant change in the vertical dimension during sagittal correction of the Class II malocclusion. The occlusal plane remained almost stable with good amount of uprighting of the lower incisors following lower space closure too. The use of good biomechanical principles helped us achieve all the treatment goals and objectives in a very short period of time.

Self-Reported Changes in Oral Hygiene Habits among Adolescents Receiving Orthodontic Treatment

The prevalence of malocclusion and a need for orthodontic treatment is high. Orthodontic appliances increase biofilm accumulation by expanding plaque retention sites. The aim of this study was to investigate the self-reported changes in oral hygiene habits among adolescents receiving orthodontic treatment. A cross-sectional study of 291 patients aged 10–17 years (mean (M) = 12.98; standard deviation (SD) = 2.36) was conducted in the Department of Orthodontics, Lithuanian University of Medical Sciences (LSMU) Hospital (Kaunas, Lithuania) during the fall semester (October–January) of the 2017/2018 study year. An anonymous self-administered questionnaire covered background information, experience of orthodontic treatment, oral hygiene habits and the seeking of professional dental care. Statistical data analysis was performed using SPSS version 22. To establish relationships between categorical variables, Chi-squared tests (χ2) were used. A p-value ≤ 0.05 was set to indicate statistically significant difference. The univariate logistic regression analysis evaluated the probability of an event given a certain risk indicator, including odds ratio (OR) and its confidence interval (95% CI). Associations were found between the usage of auxiliary measures (OR = 1.797 (1.118–2.887), p = 0.015), tongue cleaning (OR = 1.712 (1.059–2.767), p = 0.028), mouth rinsing after meals (OR = 1.707 (1.048–2.781), p = 0.032) and experience of orthodontic treatment, respectively. More orthodontic patients underwent professional oral hygiene regularly than non-orthodontic patients (p = 0.024). More patients with fixed orthodontic appliances reported significantly changed oral hygiene habits, while more orthodontic patients with removable appliances did not change their oral hygiene habits.

Valid consent and orthodontic treatment

Valid patient consent is a legal and ethical principle that is fundamental to healthcare provision. Oral health practitioners (OHPs) must understand the principles that need to be addressed to ensure that the consent given by a patient is valid. Failure to obtain consent may result in a negligence claim or a complaint of professional misconduct against the OHP. Orthodontic treatment is mostly elective but is not without risk to the patient. Obtaining and maintaining valid consent for orthodontic treatment presents additional challenges in comparison with other dental procedures as the treatment lasts over a longer time and is most commonly performed in adolescents. In addition, prospective patients need to be informed regarding ‘lifelong’ management in the retention phase to minimise the risk of relapse. The present paper outlines the principles of valid consent with particular regard to orthodontic treatment in the adolescent patient. OHPs must ensure that they are satisfied that the competent patient has the capacity to voluntarily consent. Clinicians must also recognise that valid consent is not a one-off ‘tick the box’ procedural exercise but an ongoing process of effective information sharing in light of changing laws and an ever-changing scientific evidence base within a patient-centred model of healthcare.

[Relationship of orthodontic treatment and periodontal soft tissue health]

With the increasing number of the orthodontic patients, the relationship between periodontal and orthodontic becomes increasingly close. Orthodontic treatment can improve periodontal status, but the adverse clinical problems of periodontal tissue during orthodontic treatment are relatively common. In this paper, we discuss the problems of soft tissue, including causes, prevention, and treatment of gingivitis, gingival enlargement, gingival recession, and gingival invagination in orthodontic treatment.

Orthodontic Fixed Appliance and Periodontal Status: An Updated Systematic Review

Background:

Periodontal implications of orthodontic therapy are frequent, gingival and periodontal conditions need to be evaluated for every appointment. Several studies have analyzed the effects of fixed appliance on periodontal health.

Objective:

To evaluate whether there is updated scientific evidence on the relationship between fixed orthodontic therapy and periodontal health.

Methods:

A literature search was performed using the Pubmed and Cochrane databases and manual search; the search was carried out using the keywords “orthodontic” and “periodontal”. Articles published only in the English language from January 1997 to April 2017 were included. The inclusion criteria were: RCTs, cohort studies, cross-sectional studies and case-control studies only in English language; only studies on humans, with a minimum sample size of 20 patients and no restriction in terms of patient ages; orthodontic fixed appliances placed into the buccal tooth surface; standardization and training in oral hygiene; Periodontal Index (PI), Gingival Index (GI), Bleeding on Probing (BOP), Pocket Probing Depth (PPD), at least at baseline (before appliance was placed) and after follow up (with a minimum period of 3 months). The exclusion criteria were as follows: absence of baseline data before fixed appliances was placed; patients with systemic diseases, periodontal disease or craniofacial anomalies; removable appliances or orthodontic appliance on the lingual dental surface; and no standardization or training in oral hygiene.

Studies were selected by abstract and title; then, inclusion and exclusion criteria were applied. The studies that satisfied the inclusion criteria were evaluated and classified as having low, moderate or high methodology quality.

Results:

Fifty-five records were reviewed on the basis of title and abstract. After full-text reading, 47 full texts were excluded, and 3 articles were classified as having low methodological quality and 5 as having moderate methodological quality.

Conclusions:

The present systematic analysis suggests that there is moderate scientific evidence that a fixed appliance influences periodontal status; no article reported a high score.

Polymeric materials and films in dentistry: An overview

The use of polymeric materials (PMs) and polymeric films (PMFs) has increased in medicine and dentistry. This increasing interest is attributed to not only the excellent surfaces of PMs and PMFs but also their desired mechanical and biological properties, low production cost, and ease in processing, allowing them to be tailored for a wide range of applications. Specifically, PMs and PMFs are used in dentistry for their antimicrobial, drug delivery properties; in preventive, restorative and regenerative therapies; and for corrosion and friction reduction. PMFs such as acrylic acid copolymers are used as a dental adhesive; polylactic acids are used for dental pulp and dentin regeneration, and bioactive polymers are used as advanced drug delivery systems. The objective of this article was to review the literatures on the latest advancements in the use of PMs and PMFs in medicine and dentistry. Published literature (1990–2017) on PMs and PMFs for use in medicine and dentistry was reviewed using MEDLINE/PubMed and ScienceDirect resources. Furthermore, this review also explores the diversity of latest PMs and PMFs that have been utilized in dental applications, and analyzes the benefits and limitations of PMs and PMFs. Most of the PMs and PMFs have shown to improve the biomechanical properties of dental materials, but in future, more clinical studies are needed to create better treatment guidelines for patients.

An Evaluation of Shear Bond Strength of Admira (Ormocer) as an Alternative Material for Bonding Orthodontic Brackets: An In vitro Study

Objective:

To evaluate shear bond strength (SBS) of Ormocer-bonded orthodontic brackets with self-etching primer (SEP) and conventional adhesive system and also to assess the amount of adhesive remaining on the tooth surface after debonding using adhesive remnant index (ARI).

Materials and Methods:

The study was done on 90 extracted human upper first permanent maxillary premolars. The study sample was categorized into three groups of 30 each to assess the SBS using three adhesives, Ormocer, SEP, and conventional adhesive system. Following debonding, the surfaces of teeth were examined for residual adhesive remaining by means of the optical stereomicroscope at ×50 magnification. ARI (Artun and Bergland) was used to classify the amount of residual adhesive. Obtained data were expressed as mean ± standard deviation, and obtained data was expressed as mean ± standard deviation (SD) and statistical analysis was done using one way ANOVA and Mann-Whitney U-test [SPSS version 17 statistical package (SPSS Inc., Chicago, IL)].

Results:

The mean SBS was maximum in Group I followed by Group II and Group III. The difference in the mean SBS among Group I (8.67 ± 1.84 Mpa), Group II (7.72 ± 1.82 MPa) and Group III (6.42 ± 1.55 MPa) was statistically significant. ARI was maximum in Group I followed by Group II and minimum Group III.

Conclusion:

Ormocer may be utilized as a substitute to generally used bisphenol A-glycidyl methacrylate-based adhesives; however, its effectiveness should be determined clinically by in vivo studies.

Fibrotic encapsulation of orthodontic appliance in palate

Iatrogenic trauma though not serious is very common in dental practice. Orthodontic treatment can inflict such injuries as they are prolonged over a long period of time. Ill-fabricated orthodontic appliances, such as wires and brackets, or the patients' habits such as application of constant pressure over the appliance can traumatize the adjacent oral soft tissues. In rare cases, these appliances can get embedded into the mucosa and gingival tissues. This case report describes one such case of iatrogenic trauma to the palatal mucosa due to entrapment of a tongue spike appliance and its surgical management.

Sleeve Push Technique: A Novel Method of Space Gaining

Space gaining is frequently required in orthodontics. Multiple loops were initially used for space gaining and alignment. The most common used mechanics for space gaining is the use of nickel-titanium open coil springs. The disadvantage of nickel-titanium coil spring is that they cannot be used until the arches are well aligned to receive the stiffer stainless steel wires. Therefore, a new method of gaining space during initial alignment and leveling has been developed and named as sleeve push technique (SPT). The nickel-titanium wires, i.e. 0.012 inches and 0.014 inches along with archwire sleeve (protective tubing) can be used in a modified way to gain space along with alignment. This method helps in gaining space right from day 1 of treatment. The archwire sleeve and nickel-titanium wire in this new SPT act as a mutually synergistic combination and provide the orthodontist with a completely new technique for space opening.

Effect of Surface Treatment on Enamel Cracks After Orthodontic Bracket Debonding: Er,Cr:YSGG Laser-Etching Versus Acid-Etching

OBJECTIVES

This study sought to compare enamel cracks after orthodontic bracket debonding in the surfaces prepared with erbium, chromium: yttrium-scandium-galliumgarnet (Er,Cr:YSGG) laser and the conventional acid-etching technique.

MATERIALS AND METHODS

This in-vitro experimental study was conducted on 60 sound human premolars extracted for orthodontic purposes. The teeth were randomly divided into two groups (n=30). The teeth in group A were etched with 37% phosphoric acid gel, while the teeth in group B were subjected to Er,Cr:YSGG laser irradiation (gold handpiece, MZ8 tip, 50Hz, 4.5W, 60μs, 80% water and 60% air). Orthodontic brackets were bonded to the enamel surfaces and were then debonded in both groups. The samples were inspected under a stereomicroscope at ×38 magnification to assess the number and length of enamel cracks before bonding and after debonding. Independent-samples t-test was used to compare the frequency of enamel cracks in the two groups. Levene's test was applied to assess the equality of variances.

RESULTS

No significant difference was noted in the frequency or length of enamel cracks between the two groups after debonding (P>0.05).

CONCLUSIONS

Despite the same results of the frequency and length of enamel cracks in the two groups and by considering the side effects of acid-etching (demineralization and formation of white spot lesions), Er,Cr:YSGG laser may be used as an alternative to acid-etching for enamel surface preparation prior to bracket bonding.

Wire Roughness Assessment of 0.016'' × 0.022'' the Technique Lingual Orthodontics

OBJECTIVE

To evaluate the difference in surface roughness of stainless steel archwires of different commercial brands used in lingual orthodontics.

MATERIALS AND METHODS

Precontoured arches measuring 0.016'' × 0.022'' were selected of the following brands: Tecnident, Adenta, G&H, Highland Metals Inc., Ormco, Incognito, and Ebraces. Quantitative evaluation of the surface roughness of archwires was performed by means of an atomic force microscope in contact mode. Three surface readouts were taken of each sample, analyzing areas of 20 × 20 μm. Each scan of the samples produced a readout of 512 lines, generating three-dimensional images of the wires. The analysis of variance statistical test was applied to prove significant variables (p > 0.05), with H₀ being rejected and H₁ accepted.

RESULTS

The Incognito brand showed the lowest surface roughness. The archwires of brands Adenta, Tecnident, Highland, and Ormco showed similar values among them, and all close to these obtained by the Incognito brand. The archwires of the Ebraces brand showed the highest surface roughness, with values being close to those of the G&H Brand.

CONCLUSION

There was a statistical difference in surface roughness of orthodontic archwires among the brands studied.

CLINICAL SIGNIFICANCE

Companies should pay attention to the quality control of their materials, as these may directly affect the quality of orthodontic treatment.

Alveolar bone level changes in maxillary expansion treatments assessed through CBCT

OBJECTIVES

Determine changes in alveolar bone levels during expansion treatments as assessed through cone-beam computer tomography (CBCT).

METHODS

Sixty-one patients from Edmonton, Canada, with maxillary transverse deficiencies were split into three groups. One group was treated with a bone-anchored expander, another group was treated with a tooth-borne maxillary expander (Hyrax) and one group was untreated. CBCTs were obtained from each patient at two time points (initialT₁ and at removal of appliance after 6 months T₂). CBCTs were analyzed using AVIZO software and landmarks were placed on different dental and skeletal structures. Intra-examiner reliability for landmarks was done by randomly selecting 10 images and measuring each landmark 3 times, 1 week apart. Descriptive statistics, intraclass correlation coefficients (ICC) and ANOVA analysis were used to determine if there were changes to the alveolar bone levels and if these changes were statistically significant within each group.

RESULTS

Landmarks reliability showed an ICC of at least 0.99 with a 95% confidence interval and a mean measurement error of at least 0.2067mm. Descriptive statistics show that changes in alveolar bone levels were less than 1mm for all three groups and therefore clinically insignificant. Changes between groups were not statistically different (P<0.05) from one another with the exception of 8 distances. However, since the distances were small, they were not considered clinically significant.

CONCLUSION

Alveolar bone level changes were similar in maxillary expansion treatments and in the control group. The effects of maxillary expansion treatments on alveolar bone levels are not clinically significant.

Incidence of pulp sensibility loss of anterior teeth after paramedian insertion of orthodontic mini-implants in the anterior maxilla

BACKGROUND

The aim of this retrospective investigation was to evaluate the incidence of loss to pulp sensibility testing (PST) of maxillary front teeth after paramedian (3 to 5 mm away from the suture) orthodontic mini-implant (OMI) insertion in the anterior palate.

METHODS

A total of 284 patients (102 males, 182 females; mean age was 14.4 years (±8.8) years at time of OMI-Insertion) with a total of 568 OMIs (1.7 mm diameter, length 8 mm) were retrospectively investigated. A binomial regression analysis was performed to explore covariates, such as age, gender, inclination of upper central incisors, dentition status and insertion position of OMIs that could have contributed to loss of sensibility. Statistical significance was set at p < 0.05.

RESULTS

Loss of response to PST was encountered during retention in 3 out of 284 patients and the respective OMIs had been placed at height of the second rugae (R-2). Affected teeth were a right canine, a left lateral and a left central incisor. Subsequent root canal treatment was successful. Results of the binomial regression analysis revealed that the covariate insertion position (R-2) of OMIs (p = 0.008) had statistically significant influence on loss of response to PST.

CONCLUSIONS

(1) Although there was no radiographic evidence for direct root injury, the proximity of the implants to the anterior teeth was nevertheless statistically related to loss of PST. (2) In all cases of PST loss OMIs were inserted at the second rugae. Therefore OMIs should be placed either more posteriorly, at the third rugae or in the median plane. (3). Loss of PST was not increased for patients with palatal OMI (0.18%) compared to samples without OMI (0.25%).

[Effectiveness of Paradontax toothpaste in patients undergoing orthodontic treatment]

The purpose of this study was to determine the effectiveness of toothpaste Parodontax in patients undergoing orthodontic treatment. The results showed that fixed orthodontic appliances deteriorated oral hygiene, increased the viscosity of saliva and reduced mineralizing capacity of saliva (MCS). Use of Parodontax toothpaste based on sodium bicarbonate improved OHI-S, reduced the viscosity of saliva, increased MCS and normalized oral microbiota.

Prevention and Treatment of White Spot Lesions in Orthodontic Patients

Decalcification of enamel, appearing as white spot lesions (WSLs), around fixed orthodontic appliances is a major challenge during and after fixed orthodontic treatment by considering the fact that the goal of orthodontic treatment is to enhance facial and dental esthetic appearance. Banded or bonded teeth exhibit a significantly higher rate of WSLs compared to the controls with no braces as fixed appliances and the bonding materials promote retention of biofilms. These lesions are managed in the first step by establishing good oral hygiene habits and prophylaxis with topical fluorides, including high-fluoride toothpastes, fluoride mouthwashes, gels, varnishes, fluoride-containing bonding materials, and elastic ligatures. Recently, other materials and methods have been recommended, including the application of casein phosphopeptides-amorphous calcium phosphate, antiseptics, probiotics, polyols, sealants, laser, tooth bleaching agents, resin infiltration, and microabrasion. This article reviews the currently used methods to manage enamel demineralization during and after orthodontic treatment and the risk factors and preventive measures based on the latest evidence.

Impact of dental neglect score on oral health among patients receiving fixed orthodontic treatment: A cross-sectional study

Objective:

Maintenance of meticulous oral health practices is critical for patients who are under orthodontic treatment as failure to do so can result in deterioration of periodontal health. Thus, the present study was commenced to assess dental negligence and oral health status among patients undergoing orthodontic treatment using dental neglect scale (DNS) questionnaire.

Materials and Methods:

The present cross-sectional study was planned and carried out among the 40 patients undergoing fixed orthodontic treatment. The study comprised of two questionnaires, one was close-ended questionnaire which consisted of questions regarding patient practice in maintenance of oral health and other questionnaire comprised of DNS followed by examination of oral hygiene status using Oral Hygiene Index Simplified. Data so obtained were subjected to analysis using SPSS version 20 and Chi-square test was used to statistically analyze data with P < 0.05 regarded as a statistically significant value.

Results:

The present study revealed that 63% among the studied orthodontic patients brushed once daily, 26% brushed twice daily, and 11% brushed thrice. About one-fourth was using brush with soft bristles and only 9% among the respondents used interdental aids. Data revealed positive correlation between DNS and oral hygiene index-simplified score with P < 0.05.

Conclusion:

The present study found that less frequency of brushing, rinsing mouth, and eating sticky and hard food can be attributed to self-neglect of the orthodontic patients.

Comparative evaluation and influence on shear bond strength of incorporating silver, zinc oxide, and titanium dioxide nanoparticles in orthodontic adhesive

OBJECTIVE

To investigate the influence of silver (Ag), zinc oxide (ZnO), and titanium dioxide (TiO₂) nanoparticles on shear bond strength (SBS).

MATERIALS AND METHODS

One hundred and twenty extracted premolars divided into four groups with thirty specimens in each group. Group 1 (control): brackets (American Orthodontics) were bonded with Transbond XT primer. Groups 2, 3, and 4: brackets (American Orthodontics) were bonded with adhesives incorporated with Ag, ZnO, and TiO₂ nanoparticles in the concentration of 1.0% nanoparticles of Ag, 1.0% TiO₂, and 1.0% ZnO weight/weight, respectively. An Instron universal testing machine AGS-10k NG (SHIMADZU) was used to measure the SBS. The data were analyzed by SPSS software and then, the normal distribution of the data was confirmed by Kolmogorov-Smirnov test. One-way ANOVA test and Tukey's multiple post hoc procedures were used to compare between groups. In all statistical tests, the significance level was set at 5% (P < 0.05).

RESULTS

A significant difference was observed between control (mean [standard deviation (SD)] 9.43 [3.03], confidence interval [CI]: 8.30-10.56), Ag (mean [SD]: 7.55 [1.29], CI: 7.07-8.03), ZnO (mean [SD]: 6.50 [1.15], CI: 6.07-6.93), and TiO₂ (mean [SD]: 6.33 [1.51], CI: 5.77-0.89) with SBS (F = 16.8453, P < 0.05) at 5% level of significance.

CONCLUSION

Incorporation of various nanoparticles into adhesive materials in minimal amounts may decrease SBS and may lead to the failure of bracket or adhesive. The limitation of this study is that it is an in vitro research and these results may not be comparable to what the expected bond strengths observed in vivo. Further clinical studies are needed to evaluate biological effects of adding such amounts of nanoparticles and approve such adhesives as clinically sustainable.

Iatrogenic Damage to the Periodontium Caused by Orthodontic Treatment Procedures: An Overview

In orthodontic treatment, teeth are moved in to new positions and relationships and the soft tissue and underlying bone are altered to accommodate changes in esthetics and function. Function is more important than esthetics. The speciality of orthodontics has in addition to its benefits, complications as well as risks associated with its procedures. However the benefits outweigh the risks & complications in most of the treatment cases. Few of the unwanted side effects associated with treatment are tooth discolorations, enamel decalcification, periodontal complications like open gingival embrasures, root resorption, allergic reactions to nickel & chromium as well as treatment failure in the form of relapse.

The effect of orthodontic therapy on periodontal health: a review of the literature

Objectives. This review aims to evaluate the effect of orthodontic therapy on periodontal health. Data. Original articles that reported on the effect of orthodontic therapy on periodontal health were included. The reference lists of potentially relevant review articles were also sought. Sources. A literature search was conducted using the databases, Medline, EMBASE, Cochrane Library, Web of Science, Google Scholar, and Scopus databases for relevant studies. The search was carried out by using a combined text and the MeSH search strategies: using the key words in different combinations: “periodontal disease,” “orthodontics” and “root resorption.” This was supplemented by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed. Articles published only in English language were included. Letters to the Editor, historical reviews and unpublished articles were not sought. Conclusions. Within the limitations of the present literature review, it was observed that there is a very close inter-relationship between the periodontal health and the outcome of orthodontic therapy.