European journal of orthodontics最新文献

Objective: This retrospective study aimed to compare the three-dimensional (3D) outcomes of the novel miniscrew-anchored maxillary protraction (MAMP) therapy and the bone-anchored maxillary protraction (BAMP) therapy.

Methods: The sample comprised growing patients with skeletal Class III malocclusion treated with two skeletal anchored maxillary protraction protocols. The MAMP group comprised 22 patients (9 female, 13 male; 10.9 ± 0.9 years of age at baseline) treated with Class III elastics anchored on a hybrid hyrax expander in the maxilla and two mandibular miniscrews distally to the permanent canines. The BAMP group comprised 24 patients (14 female, 10 male; 11.6 ± 1.1 years of age at baseline) treated with Class III elastic anchored in two titanium miniplates in the infra-zygomatic crest and two miniplates in the mesial of the mandibular permanent canines. Three-dimensional displacements were measured in the pre- and post-treatment cone-beam computed tomography scans superimposed on the cranial base using the Slicer Automated Dental Tools module of 3D Slicer software (www.slicer.org). Mean differences (MD) between groups and 95% confidence interval (CI) were obtained for all variables. Intergroup comparison was performed using the Analysis of Covariance (P < .05).

Results: Both groups showed improvements after treatment. The MAMP group showed a smaller anterior (MD: -1.09 mm; 95% CI, -2.07 to -0.56) and 3D (MD: -1.27 mm; 95% CI, -2.16 to -0.74) displacements of the maxilla after treatment when compared with BAMP. Both groups showed negligible and similar anteroposterior changes in the mandible (MD: 0.33 mm; 95% CI, -2.15 to 1.34). A greater increase in the nasal cavity width (MD of 2.36; 95% CI, 1.97-3.05) was observed in the MAMP group when compared with BAMP.

Limitations: The absence of an untreated control group to assess the possible growth impact in these findings is a limitation of this study.

Conclusion: Both BAMP and MAMP therapies showed adequate 3D outcomes after treatment. However, BAMP therapy produced a greater maxillary advancement with treatment, while MAMP therapy showed greater transversal increases in the nasal cavity.

Objectives: This study aimed to quantitatively investigate the intractable 'roller coaster effect' (RCE) that occurs in premolar extraction cases treated with clear aligner therapy (CAT) or straight-wire appliance (SWA).

Methods: Protrusion cases treated with extraction of bilateral first premolars were included. Pre- and post-treatment cephalograms were obtained to measure the bending angle of occlusal plane (BAOP), namely the occlusal intersection angle between the anterior occlusal plane (AOP) and posterior occlusal plane (POP). BAOP is proposed as the indicator for quantifying RCE in this study.

Results: In the maxillary dentition, BAOP significantly decreased from 177.50 ± 5.57° to 171.10 ± 3.32° in the SWA group (n = 30), and from 178.00 ± 4.66° to 168.10 ± 5.63° in the CAT group (n = 36). In the mandibular dentition, BAOP had no significant change (from 164.90 ± 5.00° to 164.30 ± 6.40°) in the SWA group (n = 29), while significantly decreased from 163.40 ± 6.36° to 155.90 ± 7.48° in the CAT group (n = 37). In the both dentitions, the post-treatment BAOP was significantly smaller in the CAT compared to SWA group. Decrease of BAOP in the CAT group resulted from bending of the AOP rather than POP. Multiple linear regression analysis revealed that the mandibular canine crown length had a positive correlation with the mandibular post-treatment BAOP.

Limitations: Only two-dimensional cephalometric measurements were conducted.

Conclusions: In premolar extraction cases, CAT undergoes more severe RCE at completion of its first-phase treatment compared to SWA at the end of treatment. Longer mandibular canine crown may mitigate mandibular RCE in CAT.

Background: Orthodontic treatment is one of the longest and most common medical interventions in adolescence. There are certain inequalities in care leading to risk factors associated with higher rates of untreated tooth malocclusion, resulting in a significant burden on oral health. Little is known about that certain psychosocial and personal risk factors influence the uptake of orthodontic treatment. Therefore, the aim was to explore factors that might influence orthodontic treatment and psychosocial and personal factors in a representative sample in Germany.

Methods: The data are based on the KiGGS Survey Wave 2, a representative cross-sectional study of children and adolescents in Germany. Sociodemographic data, uptake of orthodontic treatment, parental socioeconomic status, social support, self-efficacy, and perceived health status were collected through a self-reported questionnaire.

Results: A total of 6599 children and adolescents between 11 and 17 years were included in the analysis. Girls, non-immigrants, children, and adolescents with higher levels of social support, and children and adolescents who have visited a dentist or orthodontist more often in the past 12 months are more likely to have received orthodontic treatment. Among 14- to 17-year-olds, the likelihood of seeking orthodontic treatment is also associated with an increasing parental socioeconomic status (odds ratio 1.07 [95% CI 1.02; 1.14] P = .013).

Conclusions: Certain protective and risk factors as well as personal and psychosocial factors are associated with orthodontic treatment. This knowledge can be used to determine which individuals should be targeted for need-based care to ensure that health care is provided without over- or undertreatment.

Background: Recent advancements in computer-aided design and computer-aided manufacturing (CAD/CAM) technology have led to the development of customized brackets for personalized treatment.

Objective: Comparing customized CAD/CAM brackets for their efficacy and effectiveness in orthodontic patients using systematic review and meta-analysis of the literature.

Search methods: A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to June 2024, with no language or date restrictions.

Selection criteria: Studies that complied with PICO (population, intervention, comparison, outcome) questions were included, and the Cochrane Risk of Bias 2.0 and Newcastle-Ottawa Scale tools were used to assess the risk of bias in the included studies.

Data collection and analysis: Using custom piloted forms, relevant data was retrieved from the included studies. Then a random-effects inverse variance meta-analysis was used to pool the results. The primary outcome was the effectiveness of orthodontic treatment measured by the American Board of Orthodontics cast-radiographic examination (ABO-CRE). Secondary outcomes were overall treatment time and mean number of appointments for CAD/CAM and conventional brackets.

Results: Six studies were included in our final review and meta-analysis. Based on the results of meta-analysis, no significant differences between CAD/CAM and conventional brackets for ABO-CRE score (Mean Difference (MD) = -0.49, Confidence Interval (CI)95% = -4.67, 3.68; P = .82) or number of appointments (MD = -1.88, CI95% = -5.91, 2.16; P = .36) could be found. However, significantly shorter overall treatment time for CAD/CAM brackets were reported (MD = -4.07, CI95% = -7.16, -0.99; P = .010).

Conclusions: The findings of our meta-analysis indicate that both bracket types perform comparably in terms of treatment results and the number of clinical appointments required during treatment. Nevertheless, a distinct advantage of CAD/CAM brackets emerged concerning overall treatment duration. Notably, patients using CAD/CAM brackets experienced an average treatment period reduction of approximately 4 months, a clinically significant result.

Registration: The protocol for this systematic review was registered at PROSPERO with the ID CRD42024605257.

Background: Maxillary lateral incisor agenesis is often managed with orthodontic space closure and canine substitution. Anatomic gingival margin heights associated with the maxillary anterior teeth are considered important for achieving aesthetic excellence with space closure, but evidence relating to the perceptions of lay people is poor.

Objectives: This study investigated the influence of gingival margin height variation in the maxillary anterior teeth following orthodontic space closure and canine substitution in the absence of maxillary lateral incisor teeth on perceived aesthetics judged by a lay population.

Material and methods: Images of a case treated with space closure and bilateral canine substitution were digitally modified to create gingival margin height variation for the substituted lateral incisors and canines. Six variations were created, including one conforming to accepted norms for anatomic gingival margin heights. Lay people represented by parents of orthodontic patients ranked the images based on aesthetics, with data analysed statistically using linear models at 5%.

Results: One hundred and twenty responders were included (median age 48.0 years), 50% male and 81.7% Caucasian, with 87% able to provide specific preferences. In absolute terms, the highest-ranking [image C] had substituted lateral incisor gingival margins below the central incisors (considered normal) but substituted canine margins symmetrically below the substituted lateral incisors (considered to be too low); followed by [image D] with symmetrically level gingival margins; and [image F] with asymmetric substituted lateral incisor margins and substituted canine margins symmetrically too low. The lowest-ranked [image E] had normal substituted lateral incisor margins but asymmetric substituted canine margins. Image C was most often ranked first (29.8% of responders) and image E last (22.1%). After adjusting for potential confounding effects, image E received the worse scores.

Conclusions: Anatomic norms for gingival margin height in absent maxillary lateral incisor-canine substitution do not correlate with the highest-ranking aesthetic choices of a lay population. Lateral incisor gingival margins symmetrically below the central incisors and substituted canine margins symmetrically below these ranked highest. Vertical asymmetry in the substituted canine position was considered the least aesthetic.

Background: Periodontal ligament cells (PDLCs) possess mechanotransduction capability, vital in orthodontic tooth movement (OTM) and maintaining periodontal homeostasis. The study aims to elucidate the expression profiles of mechanosensitive ion channel (MIC) families in PDLCs and how the inflammatory mediator alters their expression and function, advancing the understanding of the biological process of OTM.

Methods and methods: Human PDLCs were cultured and exposed to TNF-α. RNA sequencing was conducted to explore the mRNA transcriptome of both normal and TNF-α-treated PDLCs. Differentially expressed MICs were identified and analyzed. The functional expressions of TRPA1 and TRPM8 were further validated by RT-qPCR, Western blot, and calcium influx assays.

Results: All 10 identified MIC families or subfamilies were expressed in PDLCs, with the TRP family being the most abundant. KCNK2, PIEZO1, TMEM87A, and PKD2 were the most expressed ion channels in PDLCs. TNF-α altered the expression of the MIC families, resulting in increased expression of PIEZO, K2P, TRP, TMEM63, and TMEM87 families and decreased expression of ENaC/ASIC, TMC/TMHS/TMIE, TMEM150, TMEM120, and L/T/N-Type calcium channel families. Furthermore, 17 DEMICs were identified (false discovery rate < 0.05), with the top five (fold change ≥ 2), including upregulated TRPA1 and TRPM8. The functional expressions of TRPA1 and TRPM8 were verified, suggesting that TNF-α significantly increased their expression and sensitized their activities.

Conclusions: The study provides comprehensive expression profiles of the MICs in PDLCs and reveals how inflammation alters the expression and activities of the MICs. Treatments targeting these MICs may offer promising strategies for improving OTM and preventing complications in inflammatory environments, ultimately leading to more effective and safer orthodontic practices.

Objectives: To develop a reproducible, reliable clinical index of alveolar bone grafting (ABG) outcome based on the eruption position of the cleft canine tooth and determine the association between eruption position and radiographic outcome at 6 months post-grafting.

Methods: Children with complete, non-syndromic, unilateral/bilateral cleft lip and palate in the West of Scotland were identified. Post-ABG radiographic outcome (Kindelan index) and canine eruption position in children with a cleft of the alveolus who had undergone ABG were documented. A Kindelan score was assigned to the 6-month post-bone-graft radiograph. Following canine tooth eruption, four-point clinical index scale (CIS) scores were assigned to maxillary occlusal images taken prior to commencement of definitive orthodontics; 1-canine eruption in alveolar crest, 2-canine eruption buccal to alveolar crest, 3-canine eruption palatal to alveolar crest, and 4-canine impaction. Intra and inter-rater reliability was assessed using Cohen and Fleiss kappa's, respectively. Duration of orthodontics treatment, number of orthodontic clinic visits, and clinical management of the cleft site space were noted.

Results: Eighty-three patients representing 98 bone graft sites were identified. CIS scoring intra- and inter-rater reliability was 0.69-0.99 and 0.63-0.75, respectively. CIS score was associated with reduced visits (P = .015), months in orthodontics (P = .009), and likelihood of space closure (P = .006).

Limitations: This is a retrospective study with small numbers but is comparative to other similar studies in the literature.

Conclusions: The CIS presented appears to be a reliable index of ABG outcome. It also demonstrates an association with the burden of orthodontic care post-cleft alveolar bone graft.

Background/objectives: To adapt and estimate the psychometric properties of Utrecht Questionnaire for esthetic outcome assessment in rhinoplasty (OAR) to assess concern about smile appearance and to estimate the influence of demographic characteristics on this concern in adults.

Material/methods: This was a cross-sectional observational study. Individuals aged between 18 and 40 years participated in the study. The Portuguese version of OAR was adapted for smile assessment in dental practice and was named Questionnaire for Outcome Assessment of Smile Aesthetic (OA-Smile). Data validity was estimated using factorial validity [confirmatory factor analysis (CFA)-CFI, Tucker-Lewis index (TLI), SRMR)] and convergent validity (average variance extracted). Reliability was assessed using the alpha ordinal coefficient (αordinal) and the omega coefficient (ω). A structural model was elaborated to assess the contribution of demographic characteristics to smile appearance concerns. Model fit was evaluated, and the z-test (α = 5%) was used to estimate the significance of the path estimates (β).

Results: 2.523 subjects participated in the study [mean age = 32.86 (SD = 11.39) years, 68.1% female]. The factor model of orofacial appearance (OA)-Smile presented an adequate fit to the data [CFA: comparative fit index (CFI) = 0.99, TLI = 0.99, SRMR ≤ 0.05]. Convergent validity (AVE ≥ 0.80) and reliability (αordinal and ω ≥ 0.85) were adequate. The structural model presented an acceptable fit (CFI = 0.974; TLI = 0.991 and SRMR = 0.053). Women, younger people, single people, people with lower income, people using dental prostheses, undergoing dental treatment, and those who do not like their smile were more concerned about their smile appearance.

Limitations: Nonprobability sampling, online data collection, and cross-sectional design are considered limitations of the study.

Conclusions/implications: OA-Smile is a suitable scale to assess smile appearance concerns, and the data obtained with this scale were valid and reliable. Demographic characteristics should be considered when measuring concerns about smile appearance.

Background: The facial landmark annotation of 3D facial images is crucial in clinical orthodontics and orthognathic surgeries for accurate diagnosis and treatment planning. While manual landmarking has traditionally been the gold standard, it is labour-intensive and prone to variability.

Objective: This study presents a framework for automated landmark detection in 3D facial images within a clinical context, using convolutional neural networks (CNNs), and it assesses its accuracy in comparison to that of ground-truth data.

Material and methods: Initially, an in-house dataset of 408 3D facial images, each annotated with 37 landmarks by an expert, was constructed. Subsequently, a 2.5D patch-based CNN architecture was trained using this dataset to detect the same set of landmarks automatically.

Results: The developed CNN model demonstrated high accuracy, with an overall mean localization error of 0.83 ± 0.49 mm. The majority of the landmarks had low localization errors, with 95% exhibiting a mean error of less than 1 mm across all axes. Moreover, the method achieved a high success detection rate, with 88% of detections having an error below 1.5 mm and 94% below 2 mm.

Conclusion: The automated method used in this study demonstrated accuracy comparable to that achieved with manual annotations within clinical settings. In addition, the proposed framework for automatic landmark localization exhibited improved accuracy over existing models in the literature. Despite these advancements, it is important to acknowledge the limitations of this research, such as that it was based on a single-centre study and a single annotator. Future work should address computational time challenges to achieve further enhancements. This approach has significant potential to improve the efficiency and accuracy of orthodontic and orthognathic procedures.