A comparison of orthodontic elastic forces: Focus on reduced inventory

Coupling biomechanical models of implants with biodegradation models: A case study for biodegradable mandibular bone fixation plates

In fracture fixation, biodegradable implant materials are an interesting alternative to conventional non-biodegradable materials as the latter often require a second implant removal surgery to avoid long-term complications. In this study, we present an in silico strategy to design/study biodegradable metal implants focusing on mandibular fracture fixation plates of WE43 (Mg alloy). The in silico strategy is composed of an orchestrated interaction between three separate computational models. The first model simulates the mass loss of the degradable implant based on the chemistry of Mg biodegradation. A second model estimates the loading on the jaw plate in the physiological environment, incorporating a phenomenological dynamic bone regeneration process. The third model characterizes the mechanical behavior of the jaw plate and the influence of material degradation on the mechanical behavior. A sensitivity analysis was performed on parameters related to choices regarding numerical implementation and parameter dependencies were implemented to guarantee robust and correct results. Different clinical scenarios were tested, related to the amount of screws used to fix the plate. The results showed a lower initial strength when more screw holes were left open, as well as a faster decrease over time in strength due to the increased area available for surface degradation. The obtained degradation results were found to be in accordance with previously reported data of in vivo studies with biodegradable plates. The combination of these three models allows for the design of patient-specific biodegradable fixation implants able to deliver the desired mechanical behavior tuned to the bone regeneration process.

Evaluation of the Loss of Strength, Resistance, and Elasticity in the Different Types of Intraoral Orthodontic Elastics (IOE): A Systematic Review of the Literature of In Vitro Studies

BACKGROUND

Intraoral orthodontic elastics (IOE), typically referred to as rubber bands, are important tools for correcting malocclusion, and they are classified into latex and synthetic (elastomeric-based) elastics. They have different strengths and sizes, depending on their intended use, that provide clinicians with the ability to correct both anteroposterior and vertical discrepancies. Clinical use, together with saliva, alters the physical characteristics of both latex and synthetic elastics, causing declines in strength over time.

AIM

The aim of the study was to assess, through a systematic review of in vitro studies, the properties of intraoral elastics. The primary goal was to evaluate how IOEs behave in terms of tension strength and duration. The secondary goal was to investigate the force loss during the first hours of wear. The tertiary goal was to assess how these forces decayed.

MATERIALS AND METHODS

The following electronic databases were searched from December 2020 to April 2021: Medline Full Text, PubMed, Cochrane Clinical Trials Register, Science Direct, and Literature Review. Out of 8505 initial articles, 10 were selected for the systematic review.

RESULTS

The force-degradation property was found in all types of IOEs. The loss of strength was directly proportional to time, with the highest value during the first 3 h after extension, regardless of the elastic band size and manufacturer. The forces generated by the latex bands were higher than in those of the elastomeric-based elastics, but they did not consistently correspond to the loads specified by the manufacturers. The retention forces in the latex IOEs were significantly higher than those in the nonlatex bands, suggesting that elastomeric-based bands need to be changed more frequently and at regular intervals throughout a 24 h period.

CONCLUSION

This systematic review indicates that intraoral orthodontic elastics have the greatest loss of force during the first 3 h, that latex rubber bands have the highest strength during the first hour, that the forces generated are not always consistent with the manufacturer's specifications, and that nonlatex (elastomeric-based) IOEs need to be changed frequently and regularly during a 24-h cycle.

Pain Perception during Orthodontic Treatment with Fixed Appliances

The present study aimed to determine the intensity of pain perception in patients undergoing fixed orthodontic treatment. We analyzed the severity of pain concerning four routine procedures: the placement of separating elastics, ring cementations, arch activations, and elastic tractions. Our study consisted of a sample of 100 patients between 12 and 35 years old during the initial months of orthodontic treatment with fixed appliances. The patients completed a questionnaire meant to assess their pain sensation perception. The study sample was divided according to age and sex. By determining the intensity of pain felt during the four orthodontic procedures, we found that the most painful one was the ring cementation in all four age groups. The therapeutic-arch-activation procedure ranked second, with a higher mean value (2.66) in the 18–24 age group; the least painful was considered the elastic traction procedure, with a higher value (1.33) in the group over 30 years old. The most painful period was during the first 3–4 days after procedures. Most patients showed moderate pain after following the studied orthodontic interventions and required analgesic medication, the most frequently used being Nurofen, ketonal or paracetamol. The level of pain felt was significantly higher in men than in women. Patients suffer differently from the intensity of perceived pain as they grow older.

Analysis of Class II Intermaxillary Elastics Applied Forces: An in-vitro Study

Objectives

The aims of this study were: (1) to assess the average inter-arch distances characterizing Class II malocclusions, (2) to analyze the applied forces at those distances by different elastics, and (3) to compare measured forces with those declared by manufacturers, both in dry and wet environments.

Materials and Methods

Settings and sample population: Class II models of 167 adult subjects (96 women and 71 men, age: 28 ± 3 years) referred to the Orthodontic Department of the University of Turin, Turin, Italy, between January 2018 and January 2020, were collected. Distances between facial axes (FA) points of upper canines and lower first molars (A), upper first premolar and lower first molar (B), upper second premolar and lower first molar (C), upper canine and lower first premolar (D), and upper canine and lower second premolar (E), were measured using 3Shape Ortho® Viewer program. Different elastics' diameters and forces were tested at those distances. The MTS Insight® Electromechanical Testing System was used to measure the tensile forces of elastics. The applied forces were measured in dry (T0) and wet conditions, after 1 (T1), 6 (T2), and 12 h (T3).

Results

Average distances were calculated: A = 24.64 mm (SD 2.10), B = 16.3 mm (SD 1.94), C = 9.78 mm (SD 1.77), D = 9.8 mm (SD 1.88), and E = 15.99 mm (SD 2.06). Significant differences (p < 0.05) were highlighted between the measured force and the force declared by manufacturers, and all elastics had a significant force decay (p < 0.05).

Conclusion

The results showed that 3/16" 4.5 oz are the most reliable elastics in terms of applied force with respect to the declared one and in terms of force degradation.

Do we know how much force we apply with latex intermaxillary elastics?

Objectives:

The aim of our study was to evaluate the variation of the forces provided by different branded elastics and to compare the force diminution that occurs after 24-h of use in wet environment.

Materials and Methods:

Elastics from four different manufacturer (American Orthodontics [AO], USA; Dentaurum [DENT], Germany; Ormco, USA; RMO, USA) with 3/16-inch (4.8 mm) lumen diameter, and two different force degrees (medium/heavy) were included in the study with a total of eight groups of elastics. First force measurements were performed with 50 elastics of each group at various stretching distances; lumen diameter ×2 (9.52 mm), ×3 (14.28 mm), the average canine-first molar length (22.3 mm), and the canine-second molar length (38.7 mm) under room temperature and dry air conditions. In addition, ten the elastics from each group were stretched at 22.3 mm distance in a custom-made plate and kept in 37°C distilled water. Twenty-four hours later, the force measurements were repeated.

Results:

Regardless of the brand and type (medium-heavy), all the tested elastics showed variations in matter of generated forces at different stretching distances. The variation amount increased as the length of elongation increased. The lowest standard deviation values were observed for both medium and heavy DENT elastic groups. When stretched to 3 times of their lumen size, the medium and heavy elastics both produced either lower or higher forces compared to the levels of force indicated by the manufacturers. The closest mean force to the force level stated by the manufacturer was provided with medium AO (3.6 g difference) elastics and heavy RMO counterparts (7.9 g difference). A significant 20–23% reduction of force was observed in all brands, both in medium and heavy elastics after passing 24-h in aqueous environment. No significant difference was observed in matter of force degradation between groups for both medium and heavy elastics (P < 0.05).

Conclusion:

The forces exerted by intermaxillary elastics were not found to be standard and the force stated on the package is not always provided precisely. A significant force loss around 20% was observed with all the elastics after 24-h of use in wet environment at 37°C.

Force degradation of orthodontic latex elastics analyzed in vivo and in vitro

INTRODUCTION

The objective of this study was to evaluate the characteristics of force degradation of latex elastics of 10 kinds of elastics over 48 hours, both in vivo and in vitro.

METHODS

For the in vivo study, 10 different kinds of elastics were randomly chosen for investigation: 1/8-inch (2 oz); 1/8-inch (3.5 oz); 3/16-inch (2 oz); 3/16-inch (3.5 oz); 1/4-inch (2 oz); 1/4-inch (3.5 oz); 5/16-inch (2 oz); 5/16-inch (3.5 oz); 3/8-inch (2 oz); and 3/8-inch (3.5 oz). Ten volunteers (aged 22-24 years) were selected to wear personalized clear retainers, which were made to hold the elastics in the mouth and stretched to a specific length. Control samples of 1/4-inch (2 oz) and 1/4-inch (3.5 oz) latex elastics were stretched to the same length and held in dry air conditions (temperature = 25°C) and in artificial saliva (temperature = 37°C, pH = 6.7). Force value and percentage of force degradation were estimated 10 times over a 48-hour period in both the in vivo and in vitro groups. A 1-way ANOVA and t test were used to identify statistical significance (P <0.05).

RESULTS

The force degradation of the latex elastic in vivo is greater than in vitro. In the in vivo groups, during the first hour, the extension rate of all elastics decreased sharply about 13.16%-18.79%, then the rate of force degradation declined. The degradation of initial force was about 29.35%-39.94% after 48 hours. The extension range of 2.0-oz elastics reduced less than that of the 3.5-oz elastics in vivo. At the same time, with the same initial force, elastics with larger inner diameters decreased more slowly than the smaller elastics (P <0.05).

CONCLUSIONS

The force degradation of latex elastic in vivo is much greater than that in both air and artificial saliva. In vivo, the force value of the orthodontic latex elastics decreased sharply in the first hour. The larger the inner diameter and smaller the setting force value were, the slower the force decay.