The Influence of Orthodontic Treatment on Periodontal Health between Challenge and Synergy: A Narrative Review

By correctly repositioning teeth, orthodontic therapy improves both the function and appearance of an occlusion. The relationship between teeth and the tissues that surround and support them significantly influences these alterations. With ever more adults seeking orthodontic care, orthodontists are increasingly seeing patients with periodontal issues. Concerns about the patient's appearance, such as uneven gingival margins or functional issues caused by inflammatory periodontal diseases, should be accounted for when designing orthodontic treatment plans. Furthermore, orthodontics may increase the chances of saving and recovering a degraded dentition in cases of severe periodontitis. Today, general dentists, dontists, and orthodontists play integrative roles that enable them to achieve the best possible results for their patients. This review will improve the results of interdisciplinary treatments and increase cooperation between dental specialists by drawing attention to the essential connection between orthodontics and periodontics in regular clinical practice.

Orthodontic treatment in children and adolescent patients with X-linked hypophosphatemia: A case-control study

OBJECTIVES

X-linked hypophosphatemia (XLH) is a rare genetic disease that disturbs bone and teeth mineralization. It also affects craniofacial growth and patients with XLH often require orthodontic treatment. The aim of this study was to describe changes in the dental health of XLH children during orthodontic treatment compared with those in matched controls undergoing similar orthodontic procedures.

MATERIALS AND METHODS

For this retrospective case-control study, we included all individuals less than 16 years old diagnosed with XLH, orthodontically treated in our centre from 2016 to 2022 and pair-matched them to patients with no chronic or genetic conditions. Clinical and radiological parameters concerning their malocclusion, craniofacial discrepancy and the characteristics and iatrogenic effects of their orthodontic treatment were analysed.

RESULTS

Fifteen XLH patients (mean age: 11.3 ± 2.1), pair-matched to 15 control patients were included. Orthodontic treatment was successfully conducted in XLH patients with slightly shorter duration and similar iatrogenic effects as in the control group, except for the occurrence of dental abscess during and after orthodontic tooth movement. XLH patients did not show more relapse than the controls.

CONCLUSION

Despite the presence of oral manifestations of XLH such as spontaneous abscesses, XLH patients can undergo orthodontic treatment with no obvious additional iatrogenic effects.

The Hydrostatic Pressure Distribution in the Periodontal Ligament and the Risk of Root Resorption-A Finite Element Method (FEM) Study on the Nonlinear Innovative Model

Excessive orthodontic force can induce inflammatory tooth root resorption due to sustained high stresses within the periodontal ligament (PDL). This study aimed to analyze the PDL pressures during upper incisor retraction using the en masse method with TISAD. The finite element method (FEM) ensured consistent conditions across cases. The models included bone geometry, adjacent teeth, PDL, and orthodontic hardware, analyzed with LS-Dyna. The pressure ranged from 0.37 to 2.5 kPa across the dental arch, with the central incisors bearing 55% of the load. The pressure distribution remained consistent regardless of the force or hook height. The critical pressure (4.7 kPa) was exceeded at 600-650 g force, with notable pressure (3.88 kPa) on the palatal root wall of the right central incisor. Utilizing 0.017 × 0.025 SS archwires in MBT 0.018 brackets provided good torque control and reduced the root resorption risk when forces of 180-200 g per side were applied, maintaining light to moderate stress. Triple forces may initiate resorption, highlighting the importance of nonlinear finite element analysis (FEA) for accurate oral cavity simulations.

Electromyographic Assessment of Muscle Activity in Children Undergoing Orthodontic Treatment-A Systematic Review

Background: Surface electromyography (sEMG) can provide an objective and quantitative image of the functional state of neuromuscular balance in the stomatognathic system. The objective of this systematic review is to examine current scientific evidence regarding the effects of orthodontic treatment on muscle electromyographic (EMG) activity in children. Methods: The search strategy included the PubMed, PubMed Central, Web of Science, Scopus, and Embase databases. The inclusion criteria were studies assessing EMG muscle activity in children undergoing orthodontic treatment compared with untreated children. The Cochrane risk-of-bias tool (RoB2) and the Newcastle-Ottawa Scale (NOS) were used to evaluate the quality of the studies. The quality of evidence assessment was performed using GRADE analysis. The PRISMA diagram visually represented the search strategy, as well as screening and inclusion process. Results: The search strategy identified 540 potential articles. Fourteen papers met the inclusion criteria. Six studies were judged at a low risk of bias. The certainty of evidence was rated as moderate to low, according to the GRADE criteria. Studies showed alterations in EMG muscle activity in children undergoing orthodontic treatment. Conclusions: Orthodontic treatment appears to affect muscle activity in children undergoing orthodontic treatment. However, the quality of evidence is low and, therefore, it is not possible to definitively state this effect. Further long-term studies are needed to confirm the findings of this review. Study protocol number in PROSPERO database: CRD42023491005.

Systematic review on effects of experimental orthodontic tooth displacement on brain activation assessed by fMRI

BACKGROUND

Orthodontic treatment is often accompanied by discomfort and pain in patients, which are believed to be a result of orthodontic tooth displacement caused by the mechanical forces exerted by the orthodontic appliances on the periodontal tissues. These lead to change blood oxygen level dependent response in related brain regions.

OBJECTIVE

This systematic review aims to assess the impact of experimental orthodontic tooth displacement on alterations in central nervous system activation assessed by tasked based and resting state fMRI.

MATERIALS AND METHODS

A literature search was conducted using online databases, following PRISMA guidelines and the PICO framework. Selected studies utilized magnetic resonance imaging to examine the brain activity changes in healthy participants after the insertion of orthodontic appliances.

RESULTS

The initial database screening resulted in 791 studies. Of these, 234 were duplicates and 547 were deemed irrelevant considering the inclusion and exclusion criteria. Of the ten remaining potential relevant studies, two were excluded during full-text screening. Eight prospective articles were eligible for further analysis. The included studies provided evidence of the intricate interplay between orthodontic treatment, pain perception, and brain function. All of the participants in the included studies employed orthodontic separators in short-term experiments to induce tooth displacement during the early stage of orthodontic treatment. Alterations in brain activation were observed in brain regions, functional connectivity and brain networks, predominantly affecting regions implicated in nociception (thalamus, insula), emotion (insula, frontal areas), and cognition (frontal areas, cerebellum, default mode network).

CONCLUSIONS

The results suggest that orthodontic treatment influences beyond the pain matrix and affects other brain regions including the limbic system. Furthermore, understanding the orthodontically induced brain activation can aid in development of targeted pain management strategies that do not adversely affect orthodontic tooth movement. Due to the moderate to serious risk of bias and the heterogeneity among the included studies, further clinical trials on this subject are recommended.

Does subsidized orthodontic treatment reduce inequalities in access? Evidence from Norway based on population register data

OBJECTIVE

An important part of Norwegian welfare policy is to provide subsidized orthodontic treatment for children and adolescents. The objective of this policy is that dental services should be allocated according to children's need for treatment, and not according to parents' ability to pay. The probability of receiving orthodontic treatment independent of parent's household income was examined.

METHODS

The study population encompassed children and adolescents aged 10-18 years in 2019 (n = 354 439). Information about whether they had started orthodontic treatment was obtained from the Norwegian Health Economics Administration. The key independent variable was net equalized household income. Inequalities were measured using concentration indices, which were estimated according to the severity of the malocclusion (very great need, great need, obvious need and no need). Two indices were used to measure relative inequality: the unstandardized concentration index and the partial concentration index. Absolute inequality was measured using the corrected concentration index. Relevant control variables were included in some of the analyses.

RESULTS

The unstandardized indices were in the range 0.04 (very great need) to 0.05 (obvious need). For all three groups of severity, the 95% confidence intervals overlapped. The values of the partial indices were significantly lower than the values of the unstandardized indices. The partial indices were in the range 0.008 (very great need) to 0.03 (obvious need). The 95% confidence intervals for the partial indices did not overlap with the 95% confidence intervals of the unstandardized indices. For all three groups of severity, the indices that measured absolute inequality were close to zero.

CONCLUSIONS

It is possible to achieve the egalitarian aim of equality in service provision by subsidizing orthodontic treatment. This is possible within a system where the cost of orthodontic treatment is reimbursed according to the criteria of need. These criteria function in such a way that patients with the greatest need for orthodontic treatment are given the highest priority.

Multivariate analysis of alveolar bone dehiscence and fenestration in anterior teeth after orthodontic treatment: A retrospective study

OBJECTIVE

To compare the prevalence of fenestration and dehiscence between pre- and post-orthodontic treatment and to explore the factors related to fenestration and dehiscence in the anterior teeth after treatment.

METHODS

This study included 1000 cone-beam computed tomography (CBCT) scans of 500 patients before (T1) and after (T2) orthodontic treatment. These images were imported into Dolphin 11.9 software to detect alveolar fenestration and dehiscence in the anterior teeth area. The chi-square test and Fisher's exact test were performed to compare the prevalence of alveolar bone defects between time points T1 and T2. A total of 499 patients were selected for logistic regression analysis to examine the correlation among age, sex, crowding, sagittal facial type, extraction, miniscrew use and fenestration or dehiscence post-treatment.

RESULTS

Except for the maxillary lingual fenestration and labial fenestration of mandibular canines, a significant change in the prevalence of fenestration and dehiscence was noted between time points T1 and T2 (P < .025). Multinomial logistic regression showed that age, miniscrew use and extraction highly influenced the prevalence of anterior lingual dehiscence (P < .05). Dehiscence of the mandibular labial side (skeletal Class III vs. I, OR = 2.368, P = .000) and fenestration of the mandibular lingual side (skeletal Class II vs. I, OR = 2.344, P = .044) were strongly correlated with the sagittal facial type. Dehiscence of the maxillary labial side (moderate vs. mild, OR = 1.468, P = .017) was significantly associated with crowding.

CONCLUSIONS

Older age, maxillary moderate crowding, skeletal Class III, extraction and miniscrew potentially significantly affect the prevalence of anterior teeth dehiscence. Adult females, skeletal Class III patients on the mandibular labial side and skeletal Class II patients on the mandibular lingual side should be monitored for anterior teeth fenestration.

Effects of orthopedic treatment (distraction splint) on dentofacial deformities in patients with juvenile idiopathic arthritis

BACKGROUND

Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joint (TMJ), which can alter mandibular growth and development and result in dentofacial deformities.

OBJECTIVE

To assess the outcomes of orthopedic treatment with distraction splint (DS) in patients with JIA-related dentofacial deformity.

METHODS

The retrospective study involved 30 patients with JIA and unilateral TMJ involvement, another study group of 20 patients with JIA and bilateral TMJ involvement, and a control group of 18 non-JIA orthodontic patients with Class II and III malocclusions. The inclusion criteria were DS treatment and cone-beam computed tomography (CBCT) scans before (T0) and 2 years after treatment (T1). Dentofacial morphology and deformity were evaluated based on a validated three-dimensional CBCT-based morphometric analysis. Intergroup differences in outcome measures were compared at T0 and T1, and intragroup changes between T0 and T1 were assessed using the Kruskal-Wallis test.

RESULTS

Initial evaluations at T0 revealed significant differences between the unilateral and bilateral JIA groups and the control group for three out of eight dentofacial deformity variables: inter-side difference in total posterior mandibular height, mandibular axial angle, and posterior/anterior face height (ratio). At follow-up (T1), significant inter-group differences were only observed in total posterior mandibular height indicating that intergroup differences were less pronounced after splint treatment. Assessing inter-group changes between T0 and T1 showed that all parameters remained constant except posterior/anterior face height ratio, which significantly decreased between T0 and T1.

CONCLUSIONS

The findings demonstrate the potential of DS treatment for patients with JIA and unilateral or bilateral TMJ involvement to generally support normal dentofacial growth or at least limit further deterioration of dentofacial deformities.

Bone Remodeling of Maxilla after Retraction of Incisors during Orthodontic Treatment with Extraction of Premolars Based on CBCT Study: A Systematic Review

Background: Incisor retraction is often a crucial phase in ongoing orthodontic treatment, with significant implications for alveolar remodeling mechanisms. There are two prevailing theories which seek to explain this. According to the first, teeth move with the bone, while according to the second, teeth move within the bone. This systematic review seeks to assess morphometric changes in the maxillary alveolar process resulting from incisor retraction following premolar extraction and to evaluate the potential for bone remodeling associated with orthodontic movement. Methods: The study was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The following electronic databases were searched: PubMed, Google Scholar, Web of Science EMBASE and the Cochrane Central Register of Controlled Trials. The databases were searched using the following keywords: "Bone remodeling and retraction of incisors", "Alveolar bone and incisor retraction", "Bone thickness and incisor retraction", and "Bone changes and orthodontic treatment". Search filters were utilized to identify relevant papers and articles written in English and published during the last 10 years. Based on the information provided in their abstracts, papers and articles were selected according to the following criteria: randomized clinical trials (RCTs), controlled clinical prospective trials (CCTs), and retrospective studies. Articles unrelated to the study's scope or failing to meet inclusion criteria were excluded. These generally comprised individual case reports, case series reports, literature reviews, experimental studies, studies with limited data (including conference abstracts and journal writings), studies involving an unrepresentative group of patients (less than 10 patients), studies concerning patients with syndromes, and animal experiments. The remaining articles which were deemed relevant underwent comprehensive reference review and such journals as the American Journal of Orthodontics, Dentofacial Orthopedics, International Orthodontics, Journal of Clinical Orthodontics, and Angle Orthodontist were manually searched. Results: Seven articles meeting the inclusion criteria articles were selected for final evaluation, with a total of 284 participants, including 233 women and 51 men. During the analysis of the results included in the publications, a lack of homogeneity was observed, rendering a reliable statistical analysis and heterogeneity assessment unobtainable. Noteworthy disparities in methodologies and measurements posed a risk of drawing inappropriate conclusions. Consequently, emphasis was placed on qualitative analysis, emphasizing the need for standardization in future studies of a similar nature, to enable valid and comparable analyses. Conclusions: The research findings incorporated in this review demonstrate that significant bone loss occurs because of incisor retraction, which diminishes distance between the bone surface and the root surface on the palatal aspect. The magnitude of this change may vary, contingent upon both the extent of incisor displacement and alterations in their inclination, thereby affecting the positioning of the root tips. This change is significantly higher in adults than in growing adolescents. The rationale behind this assertion lies in the widely recognized phenomenon of declining cellular activity with advancing age. The decrease in the speed and intensity of cellular changes may explain the diminished capacity for remodeling as patient age increases. There is ongoing discourse regarding alterations in the volume of bone on the labial aspect of the alveolar process. Further research is necessary to measure whether bone remodeling during orthodontic movement is contingent upon other factors, such as the speed and biomechanics of retraction, the level of applied orthodontic force, and the patient age.

The association between orthodontic treatment and temporomandibular disorders diagnosis and disease characteristics

BACKGROUND

The association between orthodontic treatment and temporomandibular disorders (TMD) has been contentious in the literature.

OBJECTIVES

To analyse the associations between orthodontic treatment and TMD diagnosis and diseases characteristics.

METHODS

This case-control study included 291 individuals, 192 TMDs and 99 controls. All patients underwent assessment based on a questionnaire and a clinical examination according to Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Differences in orthodontic treatment between TMDs and controls, as well as across different TMD diagnoses within the TMD group were analysed. Patients who underwent orthodontic treatment were compared to those who did not, regarding their trauma history, bruxism, aggressive teeth brushing, level of oral hygiene, pain scores, muscle tenderness scores and subjective sleep quality.

RESULTS

Of the 291 participants, 119 (40.9%) underwent orthodontic treatment and 172 (59.1%) had no orthodontics experience. Orthodontic treatment included: mandibular orthodontic treatment (102 subjects) and maxillary orthodontic treatment (113 subjects) of those 47 used a headgear. Following multivariate analysis among TMDs, orthodontic treatment was associated with a good level of oral hygiene versus poor (Odds ratio [OR]: 5.17 [1.04-25.59]), lower number of tender muscles [OR = 0.84 (0.74-0.96)] and lower (better) Pittsburgh Sleep Quality Index (PSQI) scores (OR = 0.86 [0.76-0.97]). None of the studied parameters maintained a statistically significant association with orthodontic treatment in the multivariate analysis among the entire study population.

CONCLUSIONS

Utilising a holistic approach, this study supports the main hypothesis that orthodontic treatment is not associated with TMD diagnosis and disease characteristics.

Impact of Orthodontic Treatment on the Incidence of Dental Caries in Adolescents: A Prospective Cohort Study

BACKGROUND

Orthodontic treatment is a widely embraced intervention aimed at enhancing dental aesthetics and correcting malocclusions among adolescents. However, concerns persist regarding its potential impact on oral health, particularly on the development of dental caries. This study aimed to systematically investigate the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents.

METHODS

A prospective cohort design involving adolescents aged 12-18 years was employed. A total of 82 patients met the inclusion criteria. In addition, an age-matched control group of 82 participants who did not undergo orthodontic treatment was included. The study included both a treatment group undergoing orthodontic treatment (braces or aligners) and an age-matched control group that did not undergo any orthodontic intervention. Demographic characteristics, orthodontic treatment details, and oral hygiene practices were documented at baseline and throughout the study period. Dental examinations at six-month intervals post-treatment were conducted to track the incidence and progression of carious lesions.

RESULTS

The demographic characteristics, baseline oral health status, orthodontic treatment details, and oral hygiene practices were comparable between the treatment and control groups. Post-orthodontic treatment assessment revealed a slightly higher incidence of new carious lesions in the treatment group (14.6%) than in the control group (9.8%), although this difference was not statistically significant (p = 0.15). Dental examinations at six-month intervals demonstrated a gradual increase in caries incidence over time in both groups, with no substantial disparities observed.

CONCLUSIONS

This study provides a comprehensive examination of the relationship between orthodontic treatment and the incidence of new carious lesions among adolescents. While a trend towards higher caries incidence in the treatment group was observed, the difference was not statistically significant. These findings contribute to the existing body of knowledge and emphasize the need for ongoing research to guide clinical practice.

Robotic Archwire Bending in Orthodontics: A Review of the Literature

Malocclusion is a widespread oral health issue that adversely affects individuals' health and well-being. Currently, fixed orthodontics is considered the most efficient treatment for correcting malocclusion, with archwire bending playing a key role in orthodontic treatment. Traditionally, orthodontists manually performed archwire bending using various handheld pliers and other mechanical tools, requiring a significant amount of time, precision, and specialized training yet being unable to guarantee appliance accuracy. The process of shaping orthodontic wire is challenging due to its high stiffness and superelasticity, resulting in a time-consuming, laborious process that is prone to human errors. With advancements in orthodontics, traditional methods have taken a backseat, making way for innovative technologies that provide more accurate and personalized treatment options. The continuous efforts to enhance treatment efficiency, accuracy, efficacy, and patient experience have led to the integration of robotics into various orthodontic procedures. The use of robotics in archwire bending represents a breakthrough in orthodontics, offering unparalleled precision, consistency, and efficiency. This technology reduces treatment time and patient discomfort, overcoming the limitations of manual bending and enhancing orthodontic treatment overall. Hence, the present study aims to review the literature on robotic archwire bending in orthodontics, including their drawbacks and their impact on orthodontic treatment.

Management Strategies for Open Bite Relapse: A Systematic Review and Meta-Analysis

The purpose of orthodontic therapy is to correct malocclusion and produce a stable outcome that endures over time. Long-term stability can be difficult to achieve, and many patients relapse after treatment, particularly in instances of open bite relapse (OBR). This systematic review aimed to analyze different types of management strategies for OBR and conduct a meta-analysis to find the best method of dealing with relapse. A comprehensive search was carried out across six major online databases using relevant keywords pertaining to our study, including "open bite relapse," "orthodontic retention," "orthodontic surgery," "orthodontic appliance," "orthodontic management," "orthodontic treatment," "orofacial myofunctional therapy (OMT)," "skeletal anchorage," and "treatment follow-up period." Eleven studies were selected after the application of relevant inclusion and exclusion strategies. The mean follow-up period of treatment for the studies ranged from six months to 4.5 years. Of all the management strategies assessed, OMT was found to be the least effective for OBR management. Surgical management modalities, such as mandibular repositioning and molar intrusion using skeletal anchorage, in conjunction with the usage of orthodontic appliances, were found to be noticeably effective, especially in the cases of participants who were <18 years of age. However, when utilized on a singular basis, either of them was found to be lacking the desired effect. The overall odds ratio (OR) of 0.48 (0.37, 0.64) and risk ratio (RR) of 0.62 (0.51, 0.74) were obtained after the meta-analysis of the different interventions for OBR, indicating statistical significance. There were only 11 studies included in the study, so it's possible that not all management strategies for OBR were fully understood. The limited number of studies may also have affected the generalizability of the findings. Although statistical differences were obtained to a certain degree, more clinical trials are needed to assess the effect of such surgical modalities as a viable management tool for OBR, since these represent a significant limiting factor in terms of the overall cost of the treatment placed upon the patient. Prior to the start of the research, registration was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The research protocol was created to meet the goals and was properly filed with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023401991).

Long-term stability of curve of Spee depth among orthodontically treated patients: A retrospective longitudinal study

OBJECTIVE

The curve of Spee is deemed important characteristic of the dentition for a balanced occlusion and distribution of masticatory forces, while orthodontic levelling of an accentuated curve of Spee is generally included as a treatment goal for deepbite correction. However, relapse is often seen and can be problematic.

METHODS

A retrospective longitudinal study of predominantly young patients with a deep curve of Spee, who had been treated orthodontically with 0.018"-slot Edgewise fixed appliances, was performed. The depth of the curve of Spee was digitally measured before treatment (T1), at debond (T2), and an average of 7 years post-debond (T3) and analysed statistically at 5%.

RESULTS

A total of 157 patients were included (56.7% female; 11.6-year-old at T1), 16.6% of which were treated with premolars extractions. Non-extraction treatment reduced the curve of Spee at the first premolar from 1.87 mm (T1) to 0.22 mm (T2), which relapsed 0.12 mm (T3; P = .04). The respective depths for the second premolar were 2.0 mm (T1), reduced to 0.80 mm (T2). No significant relapse was seen for the second premolar (0.08 mm; P > .05) or the first permanent molar (0.06 mm; P > .05). No overall significant differences in absolute relapse were seen between extraction and non-extraction patients, but premolar extractions were associated with less clinically relevant relapse at the first molar (odds ratio 0.27; 95%-confidence interval 0.08-0.88; P = .003).

CONCLUSION

Steep curves of Spee can be satisfactorily levelled orthodontically with satisfactory stability in the long term, while premolar extractions might be associated with less relapse.

Diagnostic Accuracy of Cone Beam Computed Tomography and Periapical Radiography for Detecting Apical Root Resorption in Retention Phase of Orthodontic Patients: A Cross-Sectional Study

Objectives: This clinical study aimed to evaluate and compare the diagnostic accuracy of intraoral periapical radiography (PR) and cone beam computed tomography (CBCT) in detecting external apical root resorption (EARR) in orthodontic patients during the retention phase. Methods: The research involved 41 Caucasian patients who had undergone comprehensive orthodontic treatment, with a total of 328 teeth analyzed. The Kappa values for inter- and intra-examiner agreement were high for both PR and CBCT, indicating a robust level of agreement among examiners. The study used a four-point scale for classifying EARR. Results: This study showed comparable accuracy, sensitivity, and specificity between PR and CBCT when using the most stringent criterion of "Definitely present". The data suggested that CBCT outperformed PR when using a less stringent criterion ("Definitely present" or "Probably present"), particularly for maxillary incisors. However, overall diagnostic performance, as measured by the area under the ROC curve, showed only a slight advantage for CBCT over PR. Areas under the ROC curve range between 0.85 and 0.90 for PR and between 0.89 and 0.92 for CBCT. According to DeLong's test, there is no evidence to conclude that the area under the ROC curve is different for PR and CBCT. Conclusions: Both PR and CBCT are accurate diagnostic tools for identifying EARR, with PR being deemed more suitable for routine clinical use due to its cost-effectiveness and lower radiation exposure. The findings emphasize the importance of considering the risk-benefit ratio when deciding on imaging modalities for monitoring EARR in orthodontic patients.

Masticatory performance and oral health related to quality of life before and after orthodontic treatment: a systematic review and meta-analysis

Masticatory performance is considered an important step in the beginning of the digestive process and considering the patient's aesthetic and functional factors, it is necessary to choose appropriate treatments. Based on the evidence during orthodontic treatment, the restoration of the physiological function of masticatory performance should not be neglected. The present study aimed to evaluate the association between orthodontic treatment and improved masticatory performance and oral health related to quality of life. In the present study, all articles published till the end of August 2023 were extracted by two trained researchers independently through a search in databases like PubMed, Scopus, Science Direct, ISI, Web of Knowledge, Elsevier, Wiley, and Embase, and Google Scholar search engine using keywords and their combinations. Data analysis was done using the fixed effects model in a meta-analysis, by STATA (version 17); a P-value of less than 0.05 was considered significant. Based on the results, the mean difference in masticatory performance between pre-treatment and post-treatment was 2.23 (MD: 2.23; 95CI, 2.17, 2.29. p<0.01; I2= 99.98%; p<0.01). The mean difference in oral health related to quality of life between pre-treatment and post-treatment was -32.23 (MD: -32.23; 95CI, -33.35, -31.11. p<0.01; I2= 97%; p<0.01). Orthodontic treatment had a positive effect on masticatory performance and improved the quality of life of patients after treatment.

Effectiveness of Invisalign Treatment on Open Bite Correction

Background

Open bite is a common orthodontic malocclusion that can have functional and aesthetic implications. Traditional orthodontic treatments have been used to correct open bites, but the effectiveness of Invisalign, a clear aligner therapy, in open bite correction remains a topic of interest.

Materials and Methods

A retrospective analysis was conducted on a cohort of 50 patients with open bites who underwent Invisalign treatment. Pre-treatment and post-treatment records, including cephalometric radiographs, dental models, and clinical photographs, were assessed. The open bite was defined as a negative overbite greater than 2 mm. Treatment duration, number of aligners used, and patient compliance were also recorded. Statistical analysis, including paired t-tests and subjective patient feedback, was employed to evaluate the treatment outcomes.

Results

The mean pre-treatment open bite was -3.5 mm (SD = 1.2), and the mean treatment duration was 18 months (SD = 2.5). On average, patients received 24 sets of aligners (SD = 4.1) during the treatment. Post-treatment evaluation showed that the mean overbite improved to + 1.5 mm (SD = 0.8), indicating successful open bite correction. The paired t-test revealed a statistically significant difference between pre-treatment and post-treatment open bite measurements (P < 0.001). Patient satisfaction was high, with 90% of participants reporting improved aesthetics and comfort.

Conclusion

Invisalign treatment demonstrates effectiveness in correcting open bites, with statistically significant improvements in overbite measurements.

Alveolar bone morphology in patients with palatally-displaced maxillary lateral incisors before and after orthodontic treatment: A cone-beam computed tomography study

INTRODUCTION

Palatal displacement of maxillary anterior teeth is common in clinical practice. Previous studies have reported that the labial bone around palatally-displaced incisors is thinner than that around normally-placed teeth. Therefore, it is necessary to elucidate alveolar bone changes after alignment to guide orthodontic treatment. In this study, we investigated the alveolar bone changes around palatally-displaced maxillary lateral incisors before and after treatment, and the effects of extraction and age using cone-beam computed tomography.

METHODS

In this retrospective study, 55 patients with unilateral palatally-displaced maxillary lateral incisors were included. Three-dimensional alveolar bone changes were measured at three levels (25%, 50% and 75% of the root length) using cone-beam computed tomography. Group comparisons were made between displaced and control teeth, extraction and non-extraction groups, and adult and minor groups.

RESULTS

After orthodontic treatment, labiopalatal and palatal alveolar bone widths decreased at all measured levels. Labial alveolar bone width increased significantly at P25, but decreased at P75. Concavity decreased, while tooth-axis angle, tooth length, B-CEJ and P-CEJ increased. Changes in LB and LP at P75, B-CEJ and P-CEJ were statistically significant. After treatment, the tooth-axis angle on the PD side increased by 9.46°. The change in tooth-axis angle on the PD side was significantly smaller, and LB and LP decreased more at P75, in the extraction group.

CONCLUSIONS

Compared to the control teeth, alveolar bone thickness and height for the displaced teeth decreased more significantly after treatment. Tooth extraction and age also influenced alveolar bone changes.

Effectiveness of Different Retention Protocols in Preventing Posttreatment Relapse After Comprehensive Orthodontic Treatment

Background

After undergoing comprehensive orthodontic treatment, maintaining the achieved results and preventing relapse remains a significant concern. Various retention protocols have been proposed to address this issue, but their comparative effectiveness is not well-established.

Materials and Methods

This study aimed to evaluate the effectiveness of different retention protocols in preventing posttreatment relapse following comprehensive orthodontic treatment. A sample of 150 orthodontic patients who had completed their treatment was included in the study. The patients were divided into three groups based on the retention protocol they received: Group A (Hawley retainers), Group B (Essix retainers), and Group C (permanent retainers). Patients' dental casts were obtained at the end of the treatment (T0) and six months after treatment (T1). Various measurements, including anterior and posterior occlusal changes, were recorded.

Results

The results revealed that Group C (permanent retainers) showed the least amount of relapse compared to Groups A and B. In Group C, the mean anterior relapse was 0.2 mm, while in Groups A and B, it was 1.0 mm and 0.8 mm, respectively. Similarly, the mean posterior relapse in Group C was 0.1 mm, whereas in Groups A and B, it was 0.8 mm and 0.6 mm, respectively. These findings indicate that permanent retainers were more effective in preventing relapse compared to removable retainers.

Conclusion

In preventing posttreatment relapse after comprehensive orthodontic treatment, permanent retainers demonstrated superior effectiveness compared to Hawley and Essix retainers.

Evaluation of Patient Acceptance and Compliance with Clear Aligners vs. Lingual Braces: A Randomized Trial

Background

The efficacy of orthodontic treatments is often influenced by patient acceptance and compliance. This study aims to compare patient acceptance and compliance between clear aligners and lingual braces in a randomized clinical trial.

Materials and Methods

A total of 100 patients requiring orthodontic treatment were randomly allocated into two groups: clear aligners (n = 50) and lingual braces (n = 50). Data on patient acceptance and compliance were collected through self-reported questionnaires and clinical observations over a period of 12 months.

Results

Patient acceptance was significantly higher in the clear aligner group, with 80% reporting high levels of comfort, compared to 60% in the lingual braces group (P < 0.05). Compliance rates were 92% for clear aligners and 85% for lingual braces (P = 0.1).

Conclusion

Clear aligners showed a higher level of patient acceptance and a slightly better compliance rate, although the difference was not statistically significant. These findings suggest that clear aligners may be a preferable option for patients prioritizing comfort.

Influence of Orthodontic Treatment on Changes in the Maxillary Sinus Dimensions

Objective This study aimed to investigate the correlation of craniofacial morphology with maxillary sinus morphology and to evaluate whether orthodontic treatment facilitates maxillary sinus enlargement in adults. Materials and methods A total of 45 adult women underwent cephalography and computed tomography before and after orthodontic treatment. All participants were classified into three groups: skeletal class I, II, and III. The average dimensions and volume of the maxillary sinus were calculated in each subgroup. Furthermore, multiple regression analysis was used to analyze the correlations of maxillary sinus dimensions with 20 cephalometric variables. Results Before treatment, the maxillary sinus width, height, depth, and volume were 32.2 ± 3.9 mm, 39.5 ± 3.8 mm, 38.6 ± 1.8 mm, and 36,179.3 ± 5,454.0 mm3 in skeletal class I, 33.9 ± 6.2 mm, 37.3 ± 3.5 mm, 38.6 ± 2.4 mm, and 34,729.8 ± 6,686.6 mm3 in skeletal class II, and 32.0 ± 4.3 mm, 41.8 ± 5.0 mm, 38.0 ± 2.8 mm, and 35,592.3 ± 10,334.3 mm3 in skeletal class III, respectively. Despite no significant differences in maxillary sinus width, depth, or volume, the height was significantly lower in the skeletal class II than in the other two. Regardless of the skeletal pattern, maxillary sinus height and volume increased considerably after treatment. Moreover, the maxillary sinus width was substantially involved in pretreatment U1 to SN and overbite and posttreatment U1 to NA and overjet. Conclusion Except for the height, the maxillary sinus dimensions were almost similar, irrespective of the skeletal classification. The posttreatment sinus height and volume were significantly greater than the pretreatment values, although the sinus width and length showed no significant changes during orthodontic treatment. This implies that orthodontic treatment may facilitate the enlargement of the maxillary sinus even after physical growth.

The Impact of Early Orthodontic Intervention on Dental and Skeletal Development in Children with Mixed Dentition

Background

The mixed dentition stage in children is a critical period for orthodontic assessment and intervention. This study investigates the effects of interceptive orthodontics on dental and skeletal development in children with mixed dentition, aiming to evaluate the potential benefits of early orthodontic treatment.

Materials and Methods

A retrospective analysis was conducted on a cohort of 150 children with mixed dentition (aged 7-11 years), who received interceptive orthodontic treatment. Dental and skeletal records, including cephalometric radiographs and dental cast models, were collected before and after treatment. A control group of 150 untreated children with mixed dentition was also assessed for comparison. Various dental and skeletal parameters, such as dental alignment, overjet (OJ), overbite (OB), and cephalometric measurements, were recorded and analyzed.

Results

The results of this study indicate significant improvements in dental alignment and occlusion in the group of children who received interceptive orthodontic treatment. The average reduction in OJ was 3.5 mm, and the OB correction averaged 2.1 mm. Cephalometric analysis showed positive changes in skeletal relationships, with a mean reduction in the angle formed by point A, nasion (N) and point B. (ANB) angle of 2.8 degrees. These improvements were statistically significant compared to the control group (P < 0.05).

Conclusion

Early orthodontic intervention, such as interceptive orthodontics, has a positive impact on dental and skeletal development in children with mixed dentition.

Comparing the Efficacy of Different Archwire Materials in Accelerating Orthodontic Tooth Movement

Background

Orthodontic treatment is commonly used to correct misaligned teeth and improve dental aesthetics and function. Archwires play a crucial role in this treatment by exerting forces on teeth, prompting them to shift into desired positions.

Materials and Methods

For this experimental study, 60 participants requiring orthodontic treatment were selected and divided into three groups: Group A, treated with stainless steel archwires; Group B, treated with nickel-titanium archwires; and Group C, treated with beta-titanium archwires. Standardized orthodontic procedures were followed for all participants. The rate of tooth movement was measured over a period of 6 months using digital models and a calibrated measurement technique.

Results

The study revealed notable differences in the rate of orthodontic tooth movement among the three groups. Group B (nickel-titanium archwires) demonstrated the highest mean rate of tooth movement, with an average of 1.5 mm per month. Group A (stainless steel archwires) exhibited a mean rate of 1.2 mm per month, while Group C (beta-titanium archwires) showed the lowest mean rate at 0.9 mm per month.

Conclusion

In conclusion, this study highlights the varying efficacy of different archwire materials in accelerating orthodontic tooth movement. Nickel-titanium archwires exhibited the highest rate of tooth movement compared to stainless steel and beta-titanium archwires.

Advancements in Clear Aligner Fabrication: A Comprehensive Review of Direct-3D Printing Technologies

Clear aligners have revolutionized orthodontic treatment by offering an esthetically driven treatment modality to patients of all ages. Over the past two decades, aligners have been used to treat malocclusions in millions of patients worldwide. The inception of aligner therapy goes back to the 1940s, yet the protocols to fabricate aligners have been continuously evolved. CAD/CAM driven protocol was the latest approach which drastically changed the scalability of aligner fabrication-i.e., aligner mass production manufacturing. 3D printing technology has been adopted in various sectors including dentistry mostly because of the ability to create complex geometric structures at high accuracy while reducing labor and material costs-for the most part. The integration of 3D printing in dentistry has been across, starting in orthodontics and oral surgery and expanding in periodontics, prosthodontics, and oral implantology. Continuous progress in material development has led to improved mechanical properties, biocompatibility, and overall quality of aligners. Consequently, aligners have become less invasive, more cost-effective, and deliver outcomes comparable to existing treatment options. The promise of 3D printed aligners lies in their ability to treat malocclusions effectively while providing esthetic benefits to patients by remaining virtually invisible throughout the treatment process. Herein, this review aims to provide a comprehensive summary of studies regarding direct-3D printing of clear aligners up to the present, outlining all essential properties required in 3D-printed clear aligners and the challenges that need to be addressed. Additionally, the review proposes implementation methods to further enhance the effectiveness of the treatment outcome.

Diagnosis and Orthodontic Treatment of Obstructive Sleep Apnea Syndrome Children-A Systematic Review

Obstructive sleep apnea syndrome (OSAS) is a respiratory illness that is associated with recurrent episodes of either partial or full obstruction of the upper airways, or apnea, among other sleep disorders. This study aims to analyze, through a literature review, whether orthodontic treatment can be a good treatment strategy for this type of disorder. We performed a database search on Scopus, Web of Science, and Pubmed with the keywords OSA(S) and orthodontics to select the papers under evaluation. The criteria for inclusion were articles related to OSA(S) children undergoing an orthodontic treatment and clinical studies or case series, excluding systematic reviews, narrative reviews, meta-analyses, adult studies, animal models, and in vitro studies. The screening phase ended with the selection of 16 publications for this work. RME, or rapid maxillary expansion, turned out to be the preferred orthodontic treatment in cases of pediatric OSAS. The goal of this orthodontic procedure is to increase the hard palate's transverse diameter by reopening the mid-palatal suture. Children with maxillary contraction and dental malocclusion typically undergo such a procedure and have excellent results. However, OSAS is a multifactorial disorder; it does not seem related to the morphology of the oral cavity, and therefore, it is not always possible to cope with this problem exclusively through orthodontic treatment.

Vertical Dentofacial Skeletal Divergency Is Not Linked with Oral Health-Related Quality of Life

The aim of this study is to assess how vertical skeletal malocclusion affects oral health-related quality of life (OHRQoL) among a sample of individuals comprising adolescents, young adults, and adults seeking orthodontic treatment. From January 2019 to March 2020, participants were consecutively enrolled. The assessment of OHRQoL involved measurement using the oral health impact profile (OHIP-14). Lateral cephalograms were performed to measure the vertical skeletal divergency with four cephalometric measurements. Descriptive and inferential statistical analyses were performed. The Mann-Whitney test was applied to compare OHRQoL scores according to the vertical dimension category. The mean age of the participants ranged between 30.3 ± 14.9 and 29.9 ± 14.4 and there was a majority of female participants, between 64.1% and 65.9%. There were no statistically significant differences observed between hyperdivergent and normodivergent groups in either the total score or any domain of the OHIP-14 questionnaire. Individuals with hyperdivergent facial morphology did not show a reduced OHRQoL compared with a normodivergent facial type.

Periodontal indexes of two types of 3 x 3 retainers: 0.032-in SS V-loop versus 0.0215-in SS coaxial - a randomized crossover trial

OBJECTIVE

This randomized crossover trial evaluated periodontal indexes of two types of 3 x 3 retainers (a modified 0.032-in SS V-loop retainer and a conventional 0.0215-in SS coaxial wire retainer) after bonded for six months. Also, bonded failure rate, and a questionnaire about comfort, ease of cleaning and overall preference were recorded.

MATERIAL AND METHODS

15 patients were enrolled in this study who used both retainers for six months each, having a 15-day wash-out interval between each bonded retainer usage. The following periodontal index were recorded: Plaque Index (PI), Calculus Index (CI) and Gingival Index (GI). Patients answered a questionnaire to assess comfort, ease of cleaning and overall retainer-type preference. Rate of bonding failure was also evaluated.

RESULTS

V-Loop retainer showed higher PI (P<0.05) as compared to conventional 0.0215-in coaxial wire retainer. However, CI and GI presented no statistically significant differences between both types of retainers. The conventional 0.0215-in coaxial wire retainer was chosen as the most comfortable (p<0.05), although no statistically significant differences were found for all other questionnaire answers. Bonding failure events were more observed in the 3x3 V-Loop retainer (p<0.002), as compared to the conventional 0.0215-in coaxial retainer.

CONCLUSION

V-Loop retainer showed higher PI (p<0.05), higher bonding failure rate and less comfortable, as compared to conventional 0.0215-in coaxial wire.

Cone-Beam Computerized Tomography Evaluation of the Relationship between Orthodontic Vertical Direction Parameters and the Distance from the Apex of the Upper Central Tooth to the Nasal Floor and Anterior Nasal Spine

The aim of this study was to examine the relationship between the vertical cephalometric values and the distance from the apex tip of the upper central tooth (U1A) to the anterior nasal spine (ANS) and nasal floor (NF) using cone-beam computerized tomography (CBCT). One hundred and twenty-two patients who applied to the Department of Orthodontics between January 2011 and June 2019 were included. The distances between the U1A and the NF and ANS were measured using CBCT. Statistical significance was considered as p < 0.05. Of the 122 individuals, 73.8% (n = 90) were female and 26.2% (n = 32) were male, with a mean age of 22.8 ± 3.3 years. A statistically significant moderate positive correlation was found between the mean NF-U1A values and the N-Me, ANS-Me, ANS-Gn, S-Go, and N-ANS measurements (p < 0.01). A statistically significant positive correlation was found between the mean ANS-U1A values and the Ar-Go-Me, total posterior angles, N-Me, SN/GoGn and Y-axis angle, ANS-Me, and ANS-Gn measurements (p < 0.01). The distance from the U1A to the ANS and NF was related to the orthodontic vertical direction parameters. The ANS-U1A and NF-U1A distances can serve as reference points for identifying the orthodontic vertical growth pattern from CBCT scans.

Influence of casein phosphopeptide-amorphous calcium phosphate on the surface topography and composition of nickel-titanium archwires during orthodontic treatment with fixed appliances

PURPOSE

To investigate the surface topography and nickel content of nickel-titanium (NiTi) archwires exposed to either routine oral hygiene or a prophylactic regimen with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) during orthodontic treatment.

METHODS

This in vivo study involved 40 orthodontic patients with fixed appliances, who were randomly assigned to either a routine oral hygiene group or a CPP-ACP supplementary regimen group. Twenty new NiTi archwires served as controls. All archwires underwent scanning electron microscopy and energy-dispersive spectroscopy to evaluate their surface topography and elemental composition. The nickel content was quantified as a percentage of total weight and the Ni/Ti ratio, and statistical comparisons were made using pairwise tests.

RESULTS

Wires exposed to fluoride toothpaste showed signs of pitting corrosion, deep grooves, and corrosion debris. In contrast, wires exposed to supplementary CPP-ACP exhibited smooth surface areas interspersed with microdefects and deposits. Statistically significant differences in nickel content were found between the new and retrieved archwires, as well as between wires exposed to routine oral hygiene and CPP-ACP (P < 0.001). The archwires exposed to CPP-ACP had the lowest nickel content (P < 0.001).

CONCLUSION

The use of CPP-ACP holds promise for application as a safe anticariogenic agent with possible protective properties during orthodontic treatment.

Orthodontic Treatment for Borderline Class III Malocclusion in Adults: Nonextraction Treatment with Anterior Bite Turbo: A Case Report

Retrusive upper lips, retroclined upper incisors, a shorter midface, and a larger maxillary-mandibular difference are the characteristics of borderline Class III malocclusion. Individuals with borderline Class III malocclusion frequently exhibit certain morphologic, dental, and skeletal traits, which should aid in the diagnosis of the condition. To report the case of a 22-year-old Vietnamese woman who complained of having tense front teeth and lacking confidence when smiling. Medical history did not find anything strange, there was root canal treatment of the first premolar on the left of the upper jaw, asymmetrical concave chin, and right deviation. Orthodontic camouflage treatment using anterior bite turbos in combination with early light short Class III elastics and box elastics was proposed since the patient declined to have orthognathic surgery. In just 10 months of treatment, a Class I molar and canine relationship was created, an anterior crossbite was corrected via mandibular retraction, and severe skeletal malocclusions were successfully treated without orthognathic surgery. Smiling currently showcases the patient's maxillary incisors more prominently, and her lower lip fullness has diminished, giving her a more attractive smile and a significant improvement to her facial profile.

White spot lesions after fixed appliance treatment-Can we expect spontaneous long-term (≥15 years) improvement?

OBJECTIVE

To investigate the extent to which post-orthodontic white spot lesions (WSLs) change in appearance over a period of ≥15 years and whether an association with caries data exists.

SUBJECTS AND METHODS

Seventy-two patients treated with a Herbst-Multibracket appliance at age 14.0 ± 2.7 years for 20.1 ± 5.1 months who attended a recall 18.3 ± 2.9 years post-treatment. Post-treatment (T1) intraoral photographs were assessed by a panel of five dentists using a modified version of the WSL-Index by Gorelick. For affected incisors, photographs from before treatment (T0) and recall (T3) were evaluated. In addition, the WSL-Change Index by Pancherz and Muehlich was assessed for all adequately visible incisors considering T1, T2 (if available), and T3. Radiographic (T0, T1, and T2-if available) and clinical (T3) MFT data were used.

RESULTS

37.5% of the patients exhibited WSLs on ≥ 1 incisor at T1; in total, 81 incisors (14.9%) were affected. At T3, 48% of the WSLs had improved. The modified WSL-Index decreased from 1.2 ± 0.4 to 0.8 ± 0.6 (P < .001), with a score 0 in 28% of the previously affected incisors. When comparing T2 vs. T3, additional improvement after T2 occurred in 11% of the teeth. While no difference existed at T0, the MFT values at T1, T2, and T3 were higher (P ≤ .05) in patients with WSLs at T1 than in those without.

LIMITATIONS

The homogeneity of the subjects was limited and no patient-reported outcome was assessed.

CONCLUSIONS

Long-term, post-orthodontic WSLs showed spontaneous full recovery in 28% and improvement in 48% of the teeth. Patients affected with WSLs exhibited higher post-treatment MFT values.

External apical root resorption in African American orthodontic patients

OBJECTIVE

External apical root resorption (EARR) is a side effect of orthodontic treatment that results in root shortening. However, this condition has yet to be evaluated in African Americans. The aim of this study was to determine the EARR prevalence within this ethnicity and investigate how patient and treatment-related factors contribute to root resorption.

METHODS

The records of 336 African Americans treated at the University of Alabama at Birmingham School of Dentistry Department of Orthodontics were retrospectively analyzed with Dolphin Imaging software. Pre-treatment and post-treatment panoramic radiographs were used to measure EARR. Resorption was recorded when final roots were at least 2 mm shorter after orthodontic treatment. Additionally, moderate and severe EARR was reported when 20% and 50% or more of the root structure was lost for any of the four maxillary incisors, respectively. The Pearson chi-square test was used to evaluate the associations of individual patient and treatment-related factors with EARR.

RESULTS

The prevalence of root resorption with 2 mm or greater of root structure loss was 51.8%. The prevalence of ≥ 20% EARR was 29.8%. Only one patient displayed severe resorption (0.3%). The associations between the patient-specific and treatment-specific variables and EARR were not statistically significant (P > .05).

CONCLUSIONS

More than half of the African American patients exhibit at least 2 mm of root resorption with orthodontic treatment. However, in this ethnicity, patient-related factors such as age, gender, dental malocclusion, and skeletal classifications, as well as treatment-related factors do not indicate a significant correlation with the risk of developing EARR.

Evaluation of different aesthetic indices for planning orthodontic treatment

Three aesthetic indices namely aesthetic component of index of orthodontic treatment needs (IOTN -AC), dental aesthetic index (DAI) and dental aesthetics screening index (DESI) were compared in orthodontic treatment. 242 participants (160 female and 82 male) who were interested in orthodontic treatment participated. The individuals' ages ranged from 16-25 years. Three aesthetic indices namely IOTN -AC, DAI and DESI were evaluated for each participant. The overall accuracy of DAI, AC-IOTN and DESI in assessment of dental aesthetics in orthodontic treatment was 62%, 68% and 64% respectively. The Negative predictive value (NPV) was higher than Positive predictive value (PPV) for all indices. The sensitivity was greater than specificity for all indices. It was observed that values of sensitivity, specificity, PPV and NPV were high for AC-IOTN. The findings were significant statistically (p<0.05).

Digital treatment planning and clear aligner therapy: A retrospective cohort study

OBJECTIVE

To investigate the total number of digital treatment plan (DTPs) and aligners manufactured for clear aligner therapy (CAT) by Invisalign® from initial treatment planning to the completion of CAT.

DESIGN

A retrospective cohort study.

MATERIAL AND METHODS

A total of 30 patients, from each of 11 experienced orthodontists, who commenced treatment over a 12-month period, were assessed regarding the number of DTPs and aligners prescribed from initial planning to completion of CAT. Patients were categorised according to the number of aligners prescribed by the initial DTP into mild (<15), moderate (15-29) or severe (>29).

RESULTS

After the application of inclusion/exclusion criteria, 324 patients (71.9% women; median age = 28.5 years) undergoing non-extraction treatment with the Invisalign® appliance were assessed. The median number of initial DTPs was 3 (interquartile range [IQR] = 2, 1-9) per patient before acceptance by the orthodontist. Most (99.4%) patients required a refinement phase with a median of 2 (IQR = 2, 2-7) refinement plans recorded. A total of 9135 aligners per dental arch, was prescribed in the initial DTP of the 324 patients assessed and 8452 in the refinement phase. The median number of aligners per dental arch prescribed from the initial DTP was 26 (IQR = 12, 6-78) and from the refinement plans was 20.5 (IQR = 17, 0-132).

CONCLUSION

A median of three initial DTPs and two refinement plans were required for patients undergoing non-extraction treatment with the Invisalign® appliance. Patients were prescribed almost double the number of aligners initially predicted to manage their malocclusion.

Impact of Invisalign G-series Updates on Improving Predicted Outcomes: A Retrospective Study

BACKGROUND

Understanding the real-world implications of periodic changes to orthodontic appliances can provide valuable insights for future treatment strategies and patient outcomes. This study aimed to investigate the impact of the latest updates added to the G7 and G8 Invisalign series on actual versus predicted outcomes and the percentage accuracy of the treatment.

METHOD

This retrospective study was conducted in private orthodontic practices in Riyadh, Saudi Arabia. Orthodontists carried out Invisalign® treatment using the latest updates added to the G7 and G8 Invisalign series. The study group comprised patients with different malocclusion types who received non-extraction Invisalign treatment. The Invisalign treatment plan was provided by the ClinChecks program (Invisalign, San Jose, United States) for patients treated throughout the years (2016-2022). Different dimensions were assessed to record predicted and actual treatment outcomes with the aid of iTero® (Align Technology, San Jose, United States) and ClinCheck® (Invisalign, San Jose, United States). The percentage accuracy was determined using the formula (100%-((Predicted-Actual)/Predicted) *100%).

RESULTS

A total of 108 patients (male = 34 (31.5%) and female = 74 (68.5%)) treated with Invisalign G7 and G8 series were considered in this study. The overall mean and standard deviation values of vertical distance (2.91±1.42), intermolar distance in the lower arch (52.68±3.15), overjet (2.71±1.06), and inter-incisal angle (138.24±12.18) were higher than the predicted model. However, the predicted model showed higher mean and standard deviation values for intercanine distances in the upper (36.94±1.57) and lower arches (28.48±1.40) and upper intermolar distances (57.21±2.91). The G7 versus G8 intercanine distance in lower (61.28±47.67 vs. 80.51±38.32), intermolar distance in upper (61.72±47.67 vs. 69.95±44.11), and intermolar distance in lower (100.68±3.80 vs. 100.89±2.52) were relatively higher in the G8 series than the G7. The accuracy percentage was higher with the G8 series than with the G7 regarding the intercanine distance in the upper arch. In contrast, the G7 series showed a higher mean percentage accuracy of vertical distance (91.11±84.83 vs. 76.76±65.45), overjet (58.44±35.17 vs. 53.71±45.87), and inter-incisal angle (34.47±44.06 vs. 27.53±37.98) than the G8 series.

CONCLUSION

The percentage accuracy of aligner therapy administered using the Invisalign G7 and G8 series demonstrated no significant variation.

Multidisciplinary approach involving strategic implant placement before orthodontic (SIMBO) treatment for generalized stage IV grade C periodontitis: A case report with 10-year follow-up

OBJECTIVE

The aim of this case report was to demonstrate the long-term effects of a multidisciplinary approach involving periodontal reconstructive surgery and strategic implant placement before orthodontic (SIMBO) treatment in a patient with severe periodontitis (e.g., stage IV/grade C).

CLINICAL CONSIDERATIONS

The patient presented with severe periodontitis and pathologic tooth migration (PTM) without stable occlusion or occlusal support. After performing cause-related therapy, periodontal regenerative surgery, pre-orthodontic posterior implant placement, and orthodontic treatment involving anterior implant placement with papilla reconstruction, the patient achieved full-mouth rehabilitation and improvement of dental and smile esthetics. The clinical and radiographic results obtained were maintained over a 10-year period.

CONCLUSION

Within the limits of this as a single case, multidisciplinary treatment involving the SIMBO approach appeared to allow long-term improvement of periodontal condition, stability of the dental arches and occlusion, and esthetics in a patient with severe periodontitis, PTM and posterior bite collapse. Future studies with more subjects are needed to evaluate and validate this approach.

CLINICAL SIGNIFICANCE

When addressing periodontal disease, SIMBO approach-based multidisciplinary treatment appears safe and effective as a clinical protocol for establishing esthetic and functional rehabilitation in generalized stage IV/grade C periodontitis.

Rescuing the Hidden Canine: A Case Report of Successful Surgical Exposure and Orthodontic Management

Canine impaction, a recognized dental condition, particularly in the maxillary region, poses both functional and esthetic challenges. This case report explores the management of impacted maxillary canines coexisting with missing upper third molars in the same patient, showcasing the complexity of dental anomalies. Its multifaceted etiology includes complex eruption pathways and potential genetic factors. Addressing the impacted canine (upper left), particularly in the anterior region, is essential for oral health and aesthetics. Surgical-orthodontic techniques, guided eruption, and interdisciplinary collaboration have revolutionized management. This report emphasizes early diagnosis, personalized treatment, and the transformative potential of surgical exposure and orthodontic intervention in enhancing oral health, function, and aesthetics.

Genetic and other factors contributing to external apical root resorption in orthodontic patients

OBJECTIVE

External apical root resorption (EARR) is a multifactorial disorder with adverse clinical outcomes in orthodontic practices often resulting in significant root shortening. This study examined the effect that specific single nucleotide polymorphisms (SNPs) have on the risk of developing EARR in orthodontic patients in X. We also evaluated how other selected patient- and treatment-related factors may contribute to root resorption in these patients.

SETTING/SAMPLE

Patients included in this case-control study were treated at the University of Alabama at Birmingham School of Dentistry, Department of Orthodontics.

METHODS

Panoramic radiographs were used to measure root resorption of the maxillary incisors. EARR was recorded when at least 20% of the root length had been lost with orthodontic treatment. Factors evaluated for association with EARR included ethnicity, sex, age, dental and skeletal classifications, ANB, U1-SN, overjet, treatment type and time, and SNPs in IL-1A (rs1800587), IL-1B (rs1143634), IL-1RN (rs419598), P2RX7 (rs1718119 and rs2230912), IRAK1 (rs1059703) and CASP1 (rs530537, rs580253 and rs554344). Chi-square test, Student's t test, Wilcoxon test, Benjamin-Hochberg false discovery rate (FDR) adjustment and logistic regression were used to analyse the data. The significance level was defined as P < .05.

RESULTS

We found that extraction treatment protocol and dental classification displayed significant association with root resorption. Furthermore, the GG genotype of IL-1A rs1800587 variant (in individuals with an increased overjet) predisposed Caucasians to EARR. While CASP1 (rs530537) variant may contribute to the risk of root resorption, it was not statistically significant after FDR adjustment (P = .09).

CONCLUSIONS

Both patient- and treatment-related factors contributed to EARR.

Orthodontic treatment in patients with periodontitis - a narrative literature review

Patients with periodontitis often require an inter-disciplinary approach, including orthodontic treatment, for effective rehabilitation of masticatory function, aesthetics and quality of life. The aim of this narrative review was to comprehensively discuss literature focusing on the biology, indications and inter-disciplinary connections related to the orthodontic approach in patients with periodontitis and to present clinical concepts in accordance with valid guidelines. The outcomes of the experimental studies indicate that orthodontic tooth movement (OTM) can be performed safely for teeth with reduced periodontium, provided infection and inflammation are controlled. Orthodontic treatment can correct pathological tooth migration, is not associated with deterioration of clinical periodontal parameters and improves aesthetics. Intrusion is safe when performed with light forces and under a strict oral hygiene regimen. Teeth can be moved either towards or away from the intrabony defect previously subjected to regenerative procedures, and research suggests that OTM has the potential to enhance bone formation after regenerative therapy. The data on orthodontic movement of teeth with furcation involvement are very scarce. The improvement in furcation involvement following either combined periodontal and orthodontic treatment was only documented in animal model studies. Due to bone and tooth loss, special consideration should be given to orthodontic treatment mechanics. © 2023 Australian Dental Association.

A Systematic Review and Meta-Analysis of the Impact of Cancer and Its Treatment Protocol on the Success of Orthodontic Treatment

BACKGROUND

There are several significant gaps in current studies of the relationship between anti-cancer medications and orthodontic care that call for more investigation. As a result, the main goals of this systematic review and meta-analysis were to summarise and assess the information that was available regarding the effect of radiotherapy and anti-cancer medications on the overall successful completion of an orthodontic treatment plan.

METHODS

A standardised data extraction form was devised in accordance with the PRISMA guidelines to conduct a systematic review and meta-analysis, with specific criteria implemented for selecting studies with low to moderate risk of bias.

RESULTS

Five studies involving different methodologies were selected at the conclusion of the search strategy. The statistical analysis revealed an estimated odds ratio (OR) of 0.31 and relative risk (RR) of 0.48, indicating a statistically significant association between the use of radiotherapy and anti-neoplastic drugs and a noticeable reduction in the successful completion of orthodontic treatment. The heterogeneity analysis showed significant heterogeneity among the studies.

CONCLUSIONS

This review emphasises that, although orthodontic therapies can still be beneficial for children receiving chemotherapy, the effectiveness of the therapy may be diminished in older populations. The findings further highlight how crucial it is to take cancer therapies into account when planning and managing orthodontic treatment in order to optimise results and reduce problems.

Does leukocyte-platelet-rich fibrin (L-PRF) cause long term acceleration in the rate of canine retraction? A split-mouth, two-arm parallel group, randomized control trial

OBJECTIVE

The present study was conducted to investigate the effects of leukocyte-platelet-rich fibrin (L-PRF) on the rate of maxillary canine retraction for a period of 5 months.

METHODS

A split-mouth study was conducted on 16 subjects (9 males and 7 females; age range 17-25 years; mean age, 21.85±2.45 years) who required therapeutic extraction of bilateral maxillary first premolars. After the initial leveling and alignment, L-PRF plugs were placed in a randomly selected extraction socket (Experimental Group), and the other side served as a control (Control Group). Canine retraction was carried out by the activation of nickel-titanium (NiTi) closed-coil springs delivering 150 g of force. The rates of canine movement, canine rotation, tipping, root resorption, and molar movement were assessed at monthly intervals for five months (T0-T5). Pain, swelling and discomfort accompanying the procedure were assessed using a Likert scale.

RESULTS

The study revealed a significant increase in the rate of canine movement on the experimental side in the first two months, and significant molar anchorage loss was observed only in the first month for control side. There were no statistically significant differences between the groups regarding canine rotation, tipping, probing depth, root resorption, and pain perception.

CONCLUSIONS

The use of L-PRF plugs in extraction sockets considerably enhanced the rate of canine movement only in the first two months, and long-term efficacy was not observed in this study.

Safe sites for buccal shelf bone screw placement in various skeletal malocclusions: A CBCT study

INTRODUCTION

The mandibular buccal shelf area is an extra-alveolar anchorage site that has high quality and quantity of bone, provides biomechanical benefits and has low failure rates. It is essential to place the implant in the region of bone with optimal thickness. The aim of this study was to determine the suitable site of the mandibular buccal shelf for bone screw insertion at 90 degrees and 30 degrees angles of insertion and various heights, angulations, areas of the buccal shelf in prognathic and retrognathic mandibles, and vertical and horizontal growth patterns.

METHODS

In this retrospective study, we evaluated the cone-beam computed tomography (CBCT) images of 48 patients in the age range of 18-30 years, divided into four groups. Seven sectional sites were examined at 3, 5, and 7 mm from the alveolar crest at 90 degrees and 30 degrees. The angulation and area of the buccal shelf were examined.

RESULTS

Cortical bone thickness increased distally from the first to the second molar in all four groups.

CONCLUSIONS

The preferred site for buccal shelf implant placement was distal to the mandibular second molar. The maximum amount of cortical bone was observed distal to the second molar, 7 mm vertically from the alveolar crest, when the buccal shelf implant was placed at 30 degrees angulation to the long axis of the tooth.

The Correlation between Mandibular Arch Shape and Vertical Skeletal Pattern

Background and Objectives: The aim of this study was to evaluate the correlation between the mandibular arch shape and the vertical skeletal pattern in growing patients. Materials and Methods: A total of 73 Caucasian patients (33 males and 40 females; mean age 9.4) were retrospectively enrolled from a pool of patients treated in chronological order at the Department of Orthodontics, University of Foggia, Italy, from April 2018 to December 2021. Each patient received a laterolateral radiograph and a digital scan of the dental arch. Eight cephalometric parameters (lower gonial angle, intermaxillary angle, divergence angle, Wits index, Jarabak ratio, OP-MP angle, PP-OP angle, and ANB) and five dental measurements (posterior mandibular arch width, anterior mandibular arch width, mandibular occlusal angle, posterior width on distobuccal molar cusps, and molar angle) were analyzed and then compared. A Spearman's rho correlation test between the cephalometric measurements and the dental measurements was performed. Statistical significance was set at p < 0.05. Results: A negative statistically significant correlation was found between the Jarabak ratio and the intermolar angle; a statistically significant correlation was also observed between the Wits index, the posterior mandibular width, and the occlusal mandibular angle; the ANB angle and the occlusal mandibular angle; the intermaxillary angle (PP-PM) and the mandibular occlusal angle, posterior mandibular width on the disto-vestibular cusp, and the intermolar angle; and the OP-MP angle and mandibular occlusal angle and the posterior mandibular width on the disto-vestibular cusp. Conclusions: The mandibular arch form may be related to certain predisposing features in craniofacial morphology, such as jaw divergence, the Jarabak ratio, and the intermaxillary angle.

An In Vivo Study Using T-scan III Occlusal Analysis System: Does the Extraction Pattern Affect the Final Occlusion in Orthodontics?

BACKGROUND

The assessment of an orthodontic patient's occlusion throughout the treatment and after debonding permits the orthodontist to improve functional occlusion through interventional tooth movements, thus rendering the overall treatment more efficient in terms of stability and masticatory efficiency. This study aimed to evaluate the effect of four first premolar extractions during orthodontic treatment on the distribution of bite force using the T-scan III system (Tekscan Inc., Boston, MA).

OBJECTIVE

We aim to evaluate the effect of four first premolar extractions during orthodontic treatment on bite force distribution.

METHODS

Ten patients (mean age: 16 ± 2.72 years), who would be treated orthodontically with four first premolar extractions to treat their teeth crowding, were selected for this study. The T-scan III system was utilized to measure the occlusal bite force of the patients before and after treatment, and the findings were compared.

RESULTS

There was a non-statistically significant decrease in the occlusal bite force's mean in the arch's anterior segment from 24.45% (± 8.50%) to 14.25% (± 12.93%) after the orthodontic treatment. A non-statistically significant increase in the occlusal bite force in the posterior right segment of the arch from 37.64% (± 18.13%) to 41.65% (± 11.52%) was found after the treatment. The occlusal bite force in the posterior left segment of the arch increased insignificantly from 30.53% (± 20.00%) to 43.95% (± 13.22%). There was an even distribution of bite force on both sides of the arch by the end of the treatment.

CONCLUSIONS

Orthodontic treatment helps to achieve a functional occlusal balance by assisting in the uniform distribution of biting force on both sides of the arch. There was no statistically significant change in the distribution of bite force recordings collected before and after orthodontic treatment, indicating that the removal of the four first premolar teeth does not impact the functional aspect of occlusion. The T-scan III system serves as an essential guide during orthodontic treatment to monitor occlusal changes.

Impact of Portraiture Photography on Orthodontic Treatment: A Systematic Review and Meta-Analysis

Due to the clear depiction of facial aesthetics and other craniofacial parameters, portraiture photography (PP) is becoming more and more necessary in modern clinical practice. The studies chosen for this review's inclusion looked at how PP affected the orthodontic treatment and diagnostic procedure on the subjects who were watched in the studies. Studies published within the last decade precisely from 2013 were searched for across major online databases after devising a proper search strategy. Multiple reviewers created a specific data extraction form that was used for the investigation, followed by the evaluation of bias and the variables found in each of the chosen papers. This form was meant for the assessment for various variables encountered in this study. According to the meta-analysis, using PP was related with a statistically significant decrease in the risk of orthodontic treatment and diagnostic modalities, with odds ratios (OR) of 0.52 with a 95% confidence interval (CI) of (0.28, 0.96), and a relative risk (RR) of 0.66 with a CI of (0.45, 0.96). In orthodontics, PP is an important tool that offers useful data for diagnosis, treatment planning, and tracking treatment success. To validate the results of studies like ours, a sizable evidence sample is required due to the limited number of trials that have been performed in this area.

Combined orthodontic and prosthodontic treatment in an adolescent patient with traumatically ankylosed incisors: A case report

Symmetric extraction of premolars is a frequently used orthodontic treatment for dental crowding and protrusion. However, when a patient has incisors with ankylosis, the establishment of a treatment protocol often plagues orthodontists. An adolescent patient with a history of incisor trauma sought treatment for dental protrusion and crowding. Upon percussion of his infrapositioned maxillary central incisors, characteristic dull metallic sounds were noted, and a lack of normal mobility of these teeth under the application of external forces was detected. Follow-up radiographs after the trauma showed replacement root resorption of the maxillary central incisors. Based on clinical and radiological findings, ankylosis of the maxillary central incisors was tentatively diagnosed. A combination of orthodontic and prosthodontic treatment options involving extraction of the maxillary central incisors and mandibular first premolars was chosen to resolve the functional and esthetic problems. After treatment, well-aligned dentition, improved smile esthetics, and a more harmonious facial profile were achieved, and these outcomes remained stable during the follow-up period. This case report illustrates a viable treatment strategy for tackling predicaments caused by ankylosed incisors, which is unusual in the literature.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

Orthodontic Management of Severe Hypodontia and Impacted Maxillary Second Molars in a Patient with Sotos Syndrome

Sotos syndrome is a genetic disorder characterized by distinct craniofacial features, overgrowth in childhood, and impaired intellectual development. We herein report the successful orthodontic treatment of a 14-year-old boy with Sotos syndrome caused by a heterozygous mutation in the NSD1 gene. He showed severe hypodontia, impaction of the maxillary second molars and a skeletal Class III jaw-base relationship. Orthodontic management, including space control by protraction of the maxillary first molars and traction of the impacted molars, was performed using fixed appliances and miniscrews. As a result, acceptable occlusion was obtained without any discernible relapse 18 months postretention.

Effects of probiotics on the oral health of patients undergoing orthodontic treatment: a systematic review and meta-analysis

BACKGROUND AND OBJECTIVE

The effect of probiotics on oral health maintenance in orthodontic patients remains controversial. The aim of the study is to systematically review and assess the effects of probiotics on the oral health and microbiome of patients undergoing orthodontic treatment.

SEARCH METHODS AND SELECTION CRITERIA

Databases including PubMed, Web of Science, Cochrane Library, ClinicalTrials.gov, and ProQuest Dissertations & Theses Global databases were searched from their inception until June 2022. Randomised controlled trials that assessed the effects of probiotics on clinical and microbial outcomes in patients undergoing orthodontic treatment were included.

DATA COLLECTION AND ANALYSIS

Data screening and collection were performed, and the risk of bias (RoB) was assessed using the Cochrane RoB 2 tool. The meta-analysis evaluated the effects of probiotics on Streptococcus mutans (S. mutans) and Lactobacillus counts. The quality of the evidence from the meta-analyses was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE).

RESULTS

A total of 405 records were identified, of which 15 studies were included in the qualitative synthesis and 4 in the meta-analysis. The patients in all the included studies were treated with fixed orthodontic appliances. Results regarding clinical outcomes were controversial; four out of five studies reported no significant changes in plaque in the probiotic group (P > .05), and two out of three studies reported no significant changes in the gingival index (P > .05). Regarding microbial outcomes, the meta-analysis results revealed that probiotics significantly increased the likelihood of reducing the abundance of S. mutans to below 105 CFU/ml (risk ratio: 2.05 [1.54, 2.72], P < .001) and reduced the likelihood of increasing the abundance of S. mutans to beyond 106 CFU/ml (risk ratio: 0.48 [0.28, 0.83], P = .009). However, the quality of evidence according to the GRADE was moderate.

CONCLUSIONS AND IMPLICATIONS

There is insufficient evidence to determine the clinical benefits of probiotics as a supplement for the oral health of patients undergoing orthodontic treatment. However, probiotics may have benefits in reducing the salivary S. mutans counts in orthodontic patients.

REGISTRATION

PROSPERO (CRD42022366650).

Prevalence of Taurodontism in Contemporary and Historical Populations from Radom: A Biometric Analysis of Radiological Data

Taurodontism is a morphological anomaly of multirooted molars characterized by apical displacement of the pulp chamber, shortened roots, and the absence of constriction at the dentoenamel junction. It can negatively impact the outcome of dental treatment plans. This study aimed to compare the prevalence of taurodontism among contemporary and historical populations from Radom, Poland. Five hundred eighty-two panoramic radiographs of contemporary patients and 600 radiographs of historical individuals were analyzed using the Shifman and Chanannel index. Group differences were determined with Pearson's chi-square tests according to sex, site, tooth group, and historical period. The study also evaluated the degree of severity of taurodontism in relation to dental groups, gender, and the periods from which contemporary patients as well as historical individuals originated. In the contemporary population, taurodontism was observed in 34% of individuals. In the historical data, the highest prevalence of taurodontism (31%) was observed among individuals from the 18th and 19th centuries, while earlier periods exhibited considerably lower prevalence rates. Across contemporary and historical populations, the maxillary molars were the most commonly affected teeth. Hypotaurodontism was the most prevalent form of taurodontism. The prevalence of taurodontism has gradually increased from the 11th century to the current day. The results of the research are of great importance for the clinician in terms of planning comprehensive dental treatment.