Pub Date : 2025-12-08DOI: 10.1016/j.ortho.2025.101091
Yusi Ye, Congman Xie, Lina Bao, Hongzhen Xiong
This article illustrates the successful treatment of scissor bite correction using facemask, clear aligner appliances and miniscrew anchorage. An 11- and 3-month-old girl presented with crossbite as the main complaint. The patient was diagnosed with an Angle Class III malocclusion with severe unilateral scissor bite. An Anglebutton™ on the clear aligner appliance and a facemask were used to protract the maxilla during the first set of aligner treatments. Miniscrews were inserted into the posterior region to correct the scissor bite and to intrude posterior teeth, in combination with aligners and occlusal pads on the healthy occlusion side. Because of the attachments on the occlusal surface and the bite-plane effect of aligners, the scissor bite was unlocked and corrected effectively within a short time. The total active treatment period was 17 months. The treatment suggested that the combined use of miniscrew anchorage, clear aligner appliances, and facemask (FM) increased the efficiency of skeletal class III malocclusion with severe unilateral scissor bite correction.
{"title":"Combined use of miniscrews, facemask and clear aligner appliances for the treatment of an 11-year-old girl with unilateral posterior scissor bite and skeletal class III malocclusion: A case report","authors":"Yusi Ye, Congman Xie, Lina Bao, Hongzhen Xiong","doi":"10.1016/j.ortho.2025.101091","DOIUrl":"10.1016/j.ortho.2025.101091","url":null,"abstract":"<div><div>This article illustrates the successful treatment of scissor bite correction using facemask, clear aligner appliances and miniscrew anchorage. An 11- and 3-month-old girl presented with crossbite as the main complaint. The patient was diagnosed with an Angle Class III malocclusion with severe unilateral scissor bite. An Anglebutton™ on the clear aligner appliance and a facemask were used to protract the maxilla during the first set of aligner treatments. Miniscrews were inserted into the posterior region to correct the scissor bite and to intrude posterior teeth, in combination with aligners and occlusal pads on the healthy occlusion side. Because of the attachments on the occlusal surface and the bite-plane effect of aligners, the scissor bite was unlocked and corrected effectively within a short time. The total active treatment period was 17 months. The treatment suggested that the combined use of miniscrew anchorage, clear aligner appliances, and facemask (FM) increased the efficiency of skeletal class III malocclusion with severe unilateral scissor bite correction.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101091"},"PeriodicalIF":1.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716189","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This case report describes non-surgical camouflage treatment of a skeletal Class III malocclusion in a 28-year-old female using clear aligners, integrating orthodontics, restorative dentistry, and implantology. The patient presented with a full Class III molar relationship with borderline cephalometric values (Wits appraisal: −4.92 mm; Holdaway angle: 11°), and some functional issues. The orthodontic approach prioritized vertical and sagittal correction, including bite opening through intrusion and retroclination of mandibular incisors and proclination of maxillary incisors. The thickness of the aligner material with attachments on the occlusal surfaces of molars to open the bite, supplemented by Class III elastics contributing to favourable mandibular plane clockwise rotation and occlusal plane counterclockwise flattening. Substantial dental changes resulted, including maxillary incisor proclination (99.17° to 109.74°), mandibular incisor retroclination (96.37° to 88.08°), with roots maintained within basal bone. The soft tissue profile improved (NA-Apo: −5.31° to −2.51°), and normal overjet, overbite, and molar intercuspation were achieved. The multidisciplinary approach also involved restoring a discoloured UL1, initially managed with conservative observation before being extracted and replaced with an implant, along with aesthetic restoration of the anterior teeth. Seven-year follow-up showed stable results, highlighting the effectiveness of carefully planned clear aligner in camouflage treatment treating Class III malocclusions.
{"title":"Clear aligner-based multidisciplinary camouflage treatment for adult skeletal class III malocclusion: A 7-year follow-up","authors":"Menghan Zhang , Wenzhe Zhang , Xueyan Xia, Yan Lv, Yanfang Yu, Mengjie Wu","doi":"10.1016/j.ortho.2025.101110","DOIUrl":"10.1016/j.ortho.2025.101110","url":null,"abstract":"<div><div>This case report describes non-surgical camouflage treatment of a skeletal Class III malocclusion in a 28-year-old female using clear aligners, integrating orthodontics, restorative dentistry, and implantology. The patient presented with a full Class III molar relationship with borderline cephalometric values (Wits appraisal: −4.92<!--> <!-->mm; Holdaway angle: 11°), and some functional issues. The orthodontic approach prioritized vertical and sagittal correction, including bite opening through intrusion and retroclination of mandibular incisors and proclination of maxillary incisors. The thickness of the aligner material with attachments on the occlusal surfaces of molars to open the bite, supplemented by Class III elastics contributing to favourable mandibular plane clockwise rotation and occlusal plane counterclockwise flattening. Substantial dental changes resulted, including maxillary incisor proclination (99.17° to 109.74°), mandibular incisor retroclination (96.37° to 88.08°), with roots maintained within basal bone. The soft tissue profile improved (NA-Apo: −5.31° to −2.51°), and normal overjet, overbite, and molar intercuspation were achieved. The multidisciplinary approach also involved restoring a discoloured UL1, initially managed with conservative observation before being extracted and replaced with an implant, along with aesthetic restoration of the anterior teeth. Seven-year follow-up showed stable results, highlighting the effectiveness of carefully planned clear aligner in camouflage treatment treating Class III malocclusions.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101110"},"PeriodicalIF":1.9,"publicationDate":"2025-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145716152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate and compare the colour stability of direct-printed and thermoformed clear aligners after exposure to common staining agents.
Methods
Clear aligners fabricated using two direct-printed resins, TC85 and TA28 (Graphy Inc., Seoul, Republic of Korea), and one thermoformed aligner, Erkodur (Erkodent, Germany), were tested for colour stability in coffee, curcumin, and 0.2% chlorhexidine mouthwash, with distilled water as control. A total of 132 specimens (n = 11 per group) were immersed in the respective solutions at 37 °C for 7 days. Colour variation (ΔE*) was measured using a spectrophotometer, while molecular and surface changes were analysed using attenuated total reflectance–Fourier transform infrared (ATR-FTIR) spectroscopy and scanning electron microscopy (SEM). Data were analysed using two-way ANOVA with Tukey's post hoc test (P < 0.001).
Results
Thermoformed aligners demonstrated significantly greater colour stability (ΔE* = 2.56; 95% CI: 2.27–2.85; P < 0.001), smoother surface morphology, and superior chemical integrity compared to direct-printed aligners — TC85 (ΔE* = 9.82; 95% CI: 9.53–10.11) and TA28 (ΔE* = 3.59; 95% CI: 3.30–3.88).
Conclusions
Direct-printed aligners exhibited inferior optical and surface properties, influenced by material composition and printing technology. PETG-based thermoformed aligners showed enhanced colour and structural stability, suggesting superior long-term aesthetics performance.
Clinical significance
Discolouration and increased surface roughness in clear aligners can compromise aesthetics, patient compliance, and biomechanical efficiency, underscoring the importance of material selection in aesthetics orthodontic therapy.
{"title":"Assessing colour stability of direct printed and thermoformed aligners: An in vitro study on aesthetics longevity","authors":"Bhavani Priya Perumalla, Pradeep Kandikatla, Arun Bhupathi, Anoosha Manda, Praveen Kumar Varma, Hari Babu","doi":"10.1016/j.ortho.2025.101105","DOIUrl":"10.1016/j.ortho.2025.101105","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate and compare the colour stability of direct-printed and thermoformed clear aligners after exposure to common staining agents.</div></div><div><h3>Methods</h3><div>Clear aligners fabricated using two direct-printed resins, TC85 and TA28 (Graphy Inc., Seoul, Republic of Korea), and one thermoformed aligner, Erkodur (Erkodent, Germany), were tested for colour stability in coffee, curcumin, and 0.2% chlorhexidine mouthwash, with distilled water as control. A total of 132 specimens (<em>n</em> <!-->=<!--> <!-->11 per group) were immersed in the respective solutions at 37<!--> <!-->°C for 7 days. Colour variation (ΔE*) was measured using a spectrophotometer, while molecular and surface changes were analysed using attenuated total reflectance–Fourier transform infrared (ATR-FTIR) spectroscopy and scanning electron microscopy (SEM). Data were analysed using two-way ANOVA with Tukey's post hoc test (<em>P</em> <!--><<!--> <!-->0.001).</div></div><div><h3>Results</h3><div>Thermoformed aligners demonstrated significantly greater colour stability (ΔE*<!--> <!-->=<!--> <!-->2.56; 95% CI: 2.27–2.85; <em>P</em> <!--><<!--> <!-->0.001), smoother surface morphology, and superior chemical integrity compared to direct-printed aligners — TC85 (ΔE*<!--> <!-->=<!--> <!-->9.82; 95% CI: 9.53–10.11) and TA28 (ΔE*<!--> <!-->=<!--> <!-->3.59; 95% CI: 3.30–3.88).</div></div><div><h3>Conclusions</h3><div>Direct-printed aligners exhibited inferior optical and surface properties, influenced by material composition and printing technology. PETG-based thermoformed aligners showed enhanced colour and structural stability, suggesting superior long-term aesthetics performance.</div></div><div><h3>Clinical significance</h3><div>Discolouration and increased surface roughness in clear aligners can compromise aesthetics, patient compliance, and biomechanical efficiency, underscoring the importance of material selection in aesthetics orthodontic therapy.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101105"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Understanding the behaviour of different printable resins under clinical simulation is essential for optimal material selection. The study aims to evaluate and compare the optical behaviour of aligners printed using directed printed resins, TA 28 and TC 85.
Material and methods
Study consisted of two groups Group 1 – aligners printed using TC 85 and Group 2 – aligners printed using TA 28 resin. Aligners were designed using Direct Aligner Designer (DAD) software and fabricated with a uniform 0.5 mm thickness. Patients with Class I molar relationships, mild crowding, minimal rotation, and no history of periodontal disease were included in this study. Maxillary intraoral scans were performed using the Aoralscan 3 scanner. Aligners were printed using TA-28 and TC-85 resins and post-cured for 24 minutes with the Tera Harz Cure THC unit (405 nm UV LED). Aligners were air-dried and patients were instructed to wear the aligner for 14 days for 20–22 hrs. Control (unused) samples were fabricated alongside for comparison.
Results
Shapiro–Wilk test confirmed normal data distribution; thus, paired and independent t-tests were applied. Intragroup comparisons showed statistically significant changes (p < 0.001) in all colour parameters (L*, a*, b*) after 14 days of wear in both groups. Intergroup analysis revealed no significant difference in L* values for unused (p = 0.07) or used aligners (p = 0.89). However, a* and b* values differed significantly between the groups (p < 0.001). The mean colour difference (ΔE) between groups was not statistically significant in either condition (p = 0.592).
Conclusion
Aligners printed with TC-85 and TA-28 resins exhibited clinically acceptable colour stability after intraoral use, with ΔE values within aesthetic thresholds. TA-28 showed slightly greater colour change, which may reflect differences in material composition and could inform clinical material selection.
{"title":"Comparative evaluation of optical property changes in direct printed aligners using two resins: An in vivo investigation","authors":"Subashree Rohinikumar, Shanthini Priya Arumugam, Balaji Krishnan, TM Parameswaran, Krishnakumar Mahalakshmi, Aswini Soundharya Sekar","doi":"10.1016/j.ortho.2025.101106","DOIUrl":"10.1016/j.ortho.2025.101106","url":null,"abstract":"<div><h3>Objective</h3><div>Understanding the behaviour of different printable resins under clinical simulation is essential for optimal material selection. The study aims to evaluate and compare the optical behaviour of aligners printed using directed printed resins, TA 28 and TC 85.</div></div><div><h3>Material and methods</h3><div>Study consisted of two groups Group 1 – aligners printed using TC 85 and Group 2 – aligners printed using TA 28 resin. Aligners were designed using Direct Aligner Designer (DAD) software and fabricated with a uniform 0.5<!--> <!-->mm thickness. Patients with Class I molar relationships, mild crowding, minimal rotation, and no history of periodontal disease were included in this study. Maxillary intraoral scans were performed using the Aoralscan 3 scanner. Aligners were printed using TA-28 and TC-85 resins and post-cured for 24<!--> <!-->minutes with the Tera Harz Cure THC unit (405<!--> <!-->nm UV LED). Aligners were air-dried and patients were instructed to wear the aligner for 14<!--> <!-->days for 20–22<!--> <!-->hrs. Control (unused) samples were fabricated alongside for comparison.</div></div><div><h3>Results</h3><div>Shapiro–Wilk test confirmed normal data distribution; thus, paired and independent <em>t</em>-tests were applied. Intragroup comparisons showed statistically significant changes (p<!--> <!--><<!--> <!-->0.001) in all colour parameters (L*, a*, b*) after 14<!--> <!-->days of wear in both groups. Intergroup analysis revealed no significant difference in L* values for unused (p<!--> <!-->=<!--> <!-->0.07) or used aligners (p<!--> <!-->=<!--> <!-->0.89). However, a* and b* values differed significantly between the groups (p<!--> <!--><<!--> <!-->0.001). The mean colour difference (ΔE) between groups was not statistically significant in either condition (p<!--> <!-->=<!--> <!-->0.592).</div></div><div><h3>Conclusion</h3><div>Aligners printed with TC-85 and TA-28 resins exhibited clinically acceptable colour stability after intraoral use, with ΔE values within aesthetic thresholds. TA-28 showed slightly greater colour change, which may reflect differences in material composition and could inform clinical material selection.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101106"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.ortho.2025.101103
Maria Doughan, David Greene, Flavio Copello, Dina Stappert
Objective
To evaluate the shear bond strength (SBS) of orthodontic brackets bonded with Assure Plus® alone and in combination with Pro Seal®, and to assess the adhesive remnant index (ARI) scores following bracket debonding.
Material and methods
This in vitro experimental study included forty-two extracted human premolar teeth, randomly assigned to two bonding groups: the control group (Assure Plus®) and the test group (Assure Plus® with Pro Seal®). After bonding, all specimens were stored at 37 ̊C for 24 h before SBS testing. The Shapiro–Wilk test was used to assess normality, and group comparisons were performed using the Mann–Whitney U test (α = 0.05).
Results
The control group demonstrated a mean SBS of 11.20 ± 2.51 MPa and a mean peak load of 90.09 ± 20.21 N, while the test group (Assure Plus® with Pro Seal®) showed a mean SBS of 10.62 ± 3.56 MPa and a mean peak load of 85.47 ± 32.61 N. The Mann-Whitney U test revealed no statistically significant differences between the groups for either SBS (P = 0.094) or peak load (P = 0.134). Both groups exceeded the clinically acceptable SBS threshold of 6–8 MPa. ARI scores were identical between groups, with 95% of samples scoring 2 and 5% scoring 1, indicating adhesive failures with more than 50% of the adhesive remaining on the tooth surface.
Conclusion
The combination of Pro Seal® and Assure Plus®, as recommended for bonding to atypical enamel surfaces, produced bond strengths comparable to Assure Plus® alone. These findings support its use as a clinically acceptable bonding protocol in orthodontic practice.
{"title":"Shear bond strength of orthodontic metal brackets using Assure® Plus with and without Pro Seal®: An in vitro study","authors":"Maria Doughan, David Greene, Flavio Copello, Dina Stappert","doi":"10.1016/j.ortho.2025.101103","DOIUrl":"10.1016/j.ortho.2025.101103","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the shear bond strength (SBS) of orthodontic brackets bonded with Assure Plus® alone and in combination with Pro Seal®, and to assess the adhesive remnant index (ARI) scores following bracket debonding.</div></div><div><h3>Material and methods</h3><div>This in vitro experimental study included forty-two extracted human premolar teeth, randomly assigned to two bonding groups: the control group (Assure Plus®) and the test group (Assure Plus® with Pro Seal®). After bonding, all specimens were stored at 37<!--> <!-->̊C for 24<!--> <!-->h before SBS testing. The Shapiro–Wilk test was used to assess normality, and group comparisons were performed using the Mann–Whitney U test (α<!--> <!-->=<!--> <!-->0.05).</div></div><div><h3>Results</h3><div>The control group demonstrated a mean SBS of 11.20<!--> <!-->±<!--> <!-->2.51<!--> <!-->MPa and a mean peak load of 90.09<!--> <!-->±<!--> <!-->20.21<!--> <!-->N, while the test group (Assure Plus® with Pro Seal®) showed a mean SBS of 10.62<!--> <!-->±<!--> <!-->3.56<!--> <!-->MPa and a mean peak load of 85.47<!--> <!-->±<!--> <!-->32.61<!--> <!-->N. The Mann-Whitney U test revealed no statistically significant differences between the groups for either SBS (<em>P</em> <!-->=<!--> <!-->0.094) or peak load (<em>P</em> <!-->=<!--> <!-->0.134). Both groups exceeded the clinically acceptable SBS threshold of 6–8<!--> <!-->MPa. ARI scores were identical between groups, with 95% of samples scoring 2 and 5% scoring 1, indicating adhesive failures with more than 50% of the adhesive remaining on the tooth surface.</div></div><div><h3>Conclusion</h3><div>The combination of Pro Seal® and Assure Plus®, as recommended for bonding to atypical enamel surfaces, produced bond strengths comparable to Assure Plus® alone. These findings support its use as a clinically acceptable bonding protocol in orthodontic practice.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101103"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-05DOI: 10.1016/j.ortho.2025.101107
Nafisa Marium Molla , Raisa Queiroz Catunda , Karla Carpio Horta , Heesoo Oh , Manuel O. Lagravère
Background
Non-surgical rapid maxillary expansion (RME) has been widely investigated regarding skeletal effects, although fewer studies have assessed the associated soft tissue changes, which is an important factor to consider, as orthodontic treatment aims to achieve occlusal harmony and an aesthetically pleasing soft tissue balance. This systematic review examines the existing literature on facial soft tissue changes following rapid maxillary expansion (RME) in children with a maxillary transverse deficiency.
Material and methods
A systematic search was conducted up to July 2025 in four major databases, including Embase (via Ovid), Medline (via Ovid), PubMed, Cochrane Library, and Google Scholar. Studies focused on children receiving RME were included. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials and the ROBINS-I tool for the Risk of Bias in Non-randomized Studies of Interventions. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines.
Results
Of the 1379 articles found, 15 included PICOS-based inclusion criteria: five randomized controlled trials, four cohort studies, and six controlled clinical trials. Alar width (0.5 to 2.21 mm), alar base width (0.17 to 2.81 mm), and nasolabial angle (0.9 degrees) increased significantly after RME treatment. Five studies were found to have a low risk of bias, seven had a moderate risk of bias, one had a serious risk of bias, and two had some concerns.
Conclusions
Our findings suggest that RME results in variable soft tissue facial changes over time. The findings resulted statistically significant for alar width, alar base width, and nasolabial angle, showing changes in the facial soft tissues after non-surgical rapid maxillary expansion, especially in the nasal area. These results, which are directly related to the anatomical effects of the rapid maxillary expansion, need careful consideration by clinicians as the skeletal and the consequent soft tissue changes may be influenced by different factors, i.e. patient age, appliance activation and follow-up duration.
{"title":"Facial soft tissue changes in patients following rapid maxillary expansion in children: A systematic review","authors":"Nafisa Marium Molla , Raisa Queiroz Catunda , Karla Carpio Horta , Heesoo Oh , Manuel O. Lagravère","doi":"10.1016/j.ortho.2025.101107","DOIUrl":"10.1016/j.ortho.2025.101107","url":null,"abstract":"<div><h3>Background</h3><div>Non-surgical rapid maxillary expansion (RME) has been widely investigated regarding skeletal effects, although fewer studies have assessed the associated soft tissue changes, which is an important factor to consider, as orthodontic treatment aims to achieve occlusal harmony and an aesthetically pleasing soft tissue balance. This systematic review examines the existing literature on facial soft tissue changes following rapid maxillary expansion (RME) in children with a maxillary transverse deficiency.</div></div><div><h3>Material and methods</h3><div>A systematic search was conducted up to July 2025 in four major databases, including Embase (via Ovid), Medline (via Ovid), PubMed, Cochrane Library, and Google Scholar. Studies focused on children receiving RME were included. The risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomized trials and the ROBINS-I tool for the Risk of Bias in Non-randomized Studies of Interventions. This review followed the protocols recommended by the Preferred Reporting Items for a Systematic Review and Meta-analysis (PRISMA) guidelines.</div></div><div><h3>Results</h3><div>Of the 1379 articles found, 15 included PICOS-based inclusion criteria: five randomized controlled trials, four cohort studies, and six controlled clinical trials. Alar width (0.5 to 2.21<!--> <!-->mm), alar base width (0.17 to 2.81<!--> <!-->mm), and nasolabial angle (0.9 degrees) increased significantly after RME treatment. Five studies were found to have a low risk of bias, seven had a moderate risk of bias, one had a serious risk of bias, and two had some concerns.</div></div><div><h3>Conclusions</h3><div>Our findings suggest that RME results in variable soft tissue facial changes over time. The findings resulted statistically significant for alar width, alar base width, and nasolabial angle, showing changes in the facial soft tissues after non-surgical rapid maxillary expansion, especially in the nasal area. These results, which are directly related to the anatomical effects of the rapid maxillary expansion, need careful consideration by clinicians as the skeletal and the consequent soft tissue changes may be influenced by different factors, i.e. patient age, appliance activation and follow-up duration.</div><div>PROSPERO reference number: CRD42024505738.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101107"},"PeriodicalIF":1.9,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145684806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.ortho.2025.101108
Sara Saeid Parizi , Rashin Bahrami , Maryam Pourhajibagher , Abbas Bahador
Background and objectives
White spot lesions are common complications around orthodontic brackets, caused by Streptococcus mutans. The main aim of this study was to evaluate the antimicrobial properties of orthodontic light-cured resin-modified glass ionomer cement (RMGIC) containing silibinin against S.mutans biofilm. Secondary objectives included assessing the physicomechanical properties (such as shear bond strength and fluoride release) and the cytotoxicity of the modified RMGIC.
Material and methods
The liquid component of the RMGIC was combined with varying concentrations of silibinin (0%, 1%, 2%, and 5%). The antimicrobial effect was assessed using the biofilm inhibition test, measuring colony-forming units (CFU)/mL. Shear bond strength (SBS) was determined using a universal testing machine, while adhesive remnant index (ARI) scores were evaluated under a stereomicroscope. Fluoride release was measured at 1, 7, 15, and 30 days using the pH/ion meter. Cytotoxicity was assessed using an indirect MTT assay on human gingival fibroblast (HGF) cells.
Results
The lowest bacterial colony count was observed in the chlorhexidine group (2.50 ± 1.60 × 105 CFU/mL; CI:95%), followed by the RMGIC containing 5% silibinin (2.87 ± 5.11 × 106 CFU/mL; CI:95%). Although the addition of silibinin at different concentrations reduced the SBS in a dose-dependent manner, there were no significant differences between the SBS of composite resin – the gold standard adhesive for bracket bonding – and that of RMGIC containing silibinin at any concentration (P = 0.70). The most common ARI scores in all groups were 1 and 2, and cohesive failure was the predominant mode of failure. The incorporation of silibinin into RMGIC did not alter the fluoride release pattern, and none of the silibinin concentrations exhibited cytotoxic effects on HGF cells.
Conclusion
RMGIC containing 5% silibinin effectively reduced S.mutans biofilm around orthodontic brackets without adversely affecting its physical-mechanical properties and showed no toxicity to HGF cells.
{"title":"Ex vivo evaluation of the antimicrobial properties, physical and mechanical characteristics, and cytotoxicity of orthodontic cement containing silibinin against Streptococcus mutans biofilm","authors":"Sara Saeid Parizi , Rashin Bahrami , Maryam Pourhajibagher , Abbas Bahador","doi":"10.1016/j.ortho.2025.101108","DOIUrl":"10.1016/j.ortho.2025.101108","url":null,"abstract":"<div><h3>Background and objectives</h3><div>White spot lesions are common complications around orthodontic brackets, caused by <em>Streptococcus mutans</em>. The main aim of this study was to evaluate the antimicrobial properties of orthodontic light-cured resin-modified glass ionomer cement (RMGIC) containing silibinin against <em>S.</em> <em>mutans</em> biofilm. Secondary objectives included assessing the physicomechanical properties (such as shear bond strength and fluoride release) and the cytotoxicity of the modified RMGIC.</div></div><div><h3>Material and methods</h3><div>The liquid component of the RMGIC was combined with varying concentrations of silibinin (0%, 1%, 2%, and 5%). The antimicrobial effect was assessed using the biofilm inhibition test, measuring colony-forming units (CFU)/mL. Shear bond strength (SBS) was determined using a universal testing machine, while adhesive remnant index (ARI) scores were evaluated under a stereomicroscope. Fluoride release was measured at 1, 7, 15, and 30 days using the pH/ion meter. Cytotoxicity was assessed using an indirect MTT assay on human gingival fibroblast (HGF) cells.</div></div><div><h3>Results</h3><div>The lowest bacterial colony count was observed in the chlorhexidine group (2.50<!--> <!-->±<!--> <!-->1.60<!--> <!-->×<!--> <!-->10<sup>5</sup> CFU/mL; CI:95%), followed by the RMGIC containing 5% silibinin (2.87<!--> <!-->±<!--> <!-->5.11<!--> <!-->×<!--> <!-->10<sup>6</sup> CFU/mL; CI:95%). Although the addition of silibinin at different concentrations reduced the SBS in a dose-dependent manner, there were no significant differences between the SBS of composite resin – the gold standard adhesive for bracket bonding – and that of RMGIC containing silibinin at any concentration (<em>P</em> <!-->=<!--> <!-->0.70). The most common ARI scores in all groups were 1 and 2, and cohesive failure was the predominant mode of failure. The incorporation of silibinin into RMGIC did not alter the fluoride release pattern, and none of the silibinin concentrations exhibited cytotoxic effects on HGF cells.</div></div><div><h3>Conclusion</h3><div>RMGIC containing 5% silibinin effectively reduced <em>S.</em> <em>mutans</em> biofilm around orthodontic brackets without adversely affecting its physical-mechanical properties and showed no toxicity to HGF cells.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101108"},"PeriodicalIF":1.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-02DOI: 10.1016/j.ortho.2025.101104
Margitha Björksved , Bei Yang , Lars Hjalmarsson , Rune Lindsten , Anders Magnusson , Farhan Bazargani
Background
The multidisciplinary treatment of palatally displaced canines (PDCs) involves choosing between open and closed surgical exposure.
Aim
To compare post-treatment aesthetic outcomes between PDC exposed by open and by closed surgical exposure.
Methods
A digital survey was distributed to two respondent groups — orthodontists and laypeople — to evaluate PDC post-treatment appearance outcomes. The survey featured 62 series of three intra-oral post-treatment images taken at debonding and four years later, with 31 PDC cases per surgical exposure group. Patients were on average 13 years old at time of surgical exposure and were part of a multicentre RCT comparing clinical outcomes between the two exposure techniques. Both surgical exposure methods involved mucoperiosteal flaps and bone removal above the PDCs.
Results
The respondent groups’ ability to identify surgically exposed canines, as well as the ratings of “unexposed looking better than exposed canine,” achieved proportions below chance. Orthodontists demonstrated better identification ability than laypeople (P = 0.013), with higher odds of correctly identifying exposed canines, odds ratio (OR) of 3.2 (95% CI 1.5–7.1, P = 0.003) and rating “better-looking unexposed contralateral canines” in open exposure compared to closed exposure technique, OR of 4.3 (95% CI 1.8–10.2, P = 0.001).
Conclusions
The results support free preference in choosing surgical exposure methods, indicating that aesthetic factors are not the main consideration in clinical practice. However, orthodontists found the PDCs treated with the closed technique more appealing.
Clinical trial registration
Researchweb.org, ID: 278893.
背景：腭移位犬（PDCs）的多学科治疗涉及开放式和闭合性手术暴露的选择。目的：比较开放式和闭式PDC手术暴露后的美观效果。方法：一份数字调查分发给两组受访者-正畸医生和外行人-评估PDC治疗后的外观效果。该调查包括62组在脱粘时和四年后拍摄的三组口腔内治疗后图像，每个手术暴露组有31例PDC病例。手术暴露时患者的平均年龄为13岁，这是比较两种暴露技术临床结果的多中心随机对照试验的一部分。这两种手术暴露方法都涉及粘骨膜瓣和PDCs上方的骨切除。结果：受访者群体识别手术暴露的狗的能力，以及“未暴露的狗看起来比暴露的狗更好”的评级，达到了低于概率的比例。正畸医师的识别能力优于非专业人员（P=0.013），正确识别暴露犬的几率更高，优势比（OR）为3.2 (95% CI 1.5-7.1， P=0.003)，与封闭暴露技术相比，开放暴露技术的“未暴露的对侧犬更漂亮”评分，OR为4.3 （95% CI 1.8-10.2， P=0.001）。结论：结果支持自由选择手术暴露方式，表明美观因素不是临床实践的主要考虑因素。然而，正畸医生发现封闭技术治疗PDCs更有吸引力。临床试验注册：Researchweb.org, ID: 278893。
{"title":"Post-treatment aesthetic outcomes in palatally displaced canines exposed by open versus closed surgical technique: A prospective cohort study and a survey","authors":"Margitha Björksved , Bei Yang , Lars Hjalmarsson , Rune Lindsten , Anders Magnusson , Farhan Bazargani","doi":"10.1016/j.ortho.2025.101104","DOIUrl":"10.1016/j.ortho.2025.101104","url":null,"abstract":"<div><h3>Background</h3><div>The multidisciplinary treatment of palatally displaced canines (PDCs) involves choosing between open and closed surgical exposure.</div></div><div><h3>Aim</h3><div>To compare post-treatment aesthetic outcomes between PDC exposed by open and by closed surgical exposure.</div></div><div><h3>Methods</h3><div>A digital survey was distributed to two respondent groups — orthodontists and laypeople — to evaluate PDC post-treatment appearance outcomes. The survey featured 62 series of three intra-oral post-treatment images taken at debonding and four years later, with 31 PDC cases per surgical exposure group. Patients were on average 13 years old at time of surgical exposure and were part of a multicentre RCT comparing clinical outcomes between the two exposure techniques. Both surgical exposure methods involved mucoperiosteal flaps and bone removal above the PDCs.</div></div><div><h3>Results</h3><div>The respondent groups’ ability to identify surgically exposed canines, as well as the ratings of “unexposed looking better than exposed canine,” achieved proportions below chance. Orthodontists demonstrated better identification ability than laypeople (<em>P</em> <!-->=<!--> <!-->0.013), with higher odds of correctly identifying exposed canines, odds ratio (OR) of 3.2 (95% CI 1.5–7.1, <em>P</em> <!-->=<!--> <!-->0.003) and rating “better-looking unexposed contralateral canines” in open exposure compared to closed exposure technique, OR of 4.3 (95% CI 1.8–10.2, <em>P</em> <!-->=<!--> <!-->0.001).</div></div><div><h3>Conclusions</h3><div>The results support free preference in choosing surgical exposure methods, indicating that aesthetic factors are not the main consideration in clinical practice. However, orthodontists found the PDCs treated with the closed technique more appealing.</div></div><div><h3>Clinical trial registration</h3><div>Researchweb.org, ID: 278893.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101104"},"PeriodicalIF":1.9,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145670257","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Accurate prediction of unerupted teeth widths significantly contributes to formulating optimal treatment plan during mixed dentition phase. The ability of artificial intelligence to identify hidden patterns and both linear and non-linear relationships can be particularly advantageous in this context.
Methods
In this retrospective observational study, pre-treatment dental casts of 336 orthodontic patients were scanned using a 3D scanner. The mesiodistal dimensions of each tooth were measured digitally, and the values for the left and right sides were averaged. These measurements, along with the patients’ sex, were then used to train machine learning and regression models with various architectures. The dimensions of teeth #1, #2, #6 and a binary value representing patients’ sex were used as input features to predict the sum of widths of teeth #3, #4, and #5 during the model training phase. The performance of the model was evaluated by calculating the mean absolute error (MAE) between the predicted values and the actual measurements obtained from the casts. Model performance was compared with Tanaka–Johnston equation and Moyers prediction tables.
Results
Among the tested models, the Support Vector Machine showed the highest accuracy in predicting lower arch tooth sizes, achieving a MAE of 0.65 mm and Standard Deviation (SD) of 0.82 mm. For the upper arch, the Linear Regression model performed best with a MAE of 0.64 mm and a SD of 0.80 mm.
Conclusion
Our findings demonstrate that machine learning-based regression techniques offer superior accuracy in predicting the dimensions of unerupted teeth compared to traditional methods, making them a valuable tool for treatment planning in mixed dentition.
{"title":"Prediction of unerupted canine and premolars width using artificial intelligence compared with Tanaka–Johnston and Moyers methods: A retrospective observational analytical study on Iranian population","authors":"Majid Mahmoudzadeh , Shabnam Yousefi , Maryam Farhadian , Ali Ashkan","doi":"10.1016/j.ortho.2025.101094","DOIUrl":"10.1016/j.ortho.2025.101094","url":null,"abstract":"<div><h3>Introduction</h3><div>Accurate prediction of unerupted teeth widths significantly contributes to formulating optimal treatment plan during mixed dentition phase. The ability of artificial intelligence to identify hidden patterns and both linear and non-linear relationships can be particularly advantageous in this context.</div></div><div><h3>Methods</h3><div>In this retrospective observational study, pre-treatment dental casts of 336 orthodontic patients were scanned using a 3D scanner. The mesiodistal dimensions of each tooth were measured digitally, and the values for the left and right sides were averaged. These measurements, along with the patients’ sex, were then used to train machine learning and regression models with various architectures. The dimensions of teeth #1, #2, #6 and a binary value representing patients’ sex were used as input features to predict the sum of widths of teeth #3, #4, and #5 during the model training phase. The performance of the model was evaluated by calculating the mean absolute error (MAE) between the predicted values and the actual measurements obtained from the casts. Model performance was compared with Tanaka–Johnston equation and Moyers prediction tables.</div></div><div><h3>Results</h3><div>Among the tested models, the Support Vector Machine showed the highest accuracy in predicting lower arch tooth sizes, achieving a MAE of 0.65<!--> <!-->mm and Standard Deviation (SD) of 0.82<!--> <!-->mm. For the upper arch, the Linear Regression model performed best with a MAE of 0.64<!--> <!-->mm and a SD of 0.80<!--> <!-->mm.</div></div><div><h3>Conclusion</h3><div>Our findings demonstrate that machine learning-based regression techniques offer superior accuracy in predicting the dimensions of unerupted teeth compared to traditional methods, making them a valuable tool for treatment planning in mixed dentition.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101094"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objective of this study is to assess the biomechanical efficacy of different attachment systems in facilitating the lower canine retraction using clear aligners by means of a finite element method (FEM) analysis.
Methods
A FEM was developed by utilizing intraoral scan data and CBCT data from an 18-year-old female with ideal occlusion. Four experimental groups were assessed: group 1 (unattached), group 2 (single vertical rectangular attachment), group 3 (double vertical rectangular attachments), and group 4 (optimized quarter-ellipsoid attachments). The study evaluated the stress distribution, plastic deformation and displacement of the crown and root during simulated canine retraction.
Results
Highest bodily translation (85–90%) was observed with optimized attachments (group 4) attaining nearly equal crown and root displacement. Tipping was observed in group 1, less of bodily movement was seen (60–65%) compared to group 2, which demonstrated better physiological translation (70–75%), while group 3 further enhanced efficiency to 75–80%. Group 4 exhibited the most uniform stress distribution, and plastic deformation was minimal (0.01 mm), suggesting superior force application and aligner stability.
Conclusion
The efficiency of canine retraction was considerably improved by optimized quarter-ellipsoid attachments, which resulted in minimal stress concentration and deformation. These findings substantiate the use of optimized attachments to improve the results of clear aligner treatment. Further clinical research is advised to verify these findings and investigate alternative attachment designs and materials to optimize aligner therapy.
{"title":"Optimization of the effectiveness of lower canine retraction: A FEM comparison of different attachment systems with no attachments in clear aligners","authors":"Muskan Chanduka, Srirengalakshmi Muthuswamy Pandian, Aravind Kumar Subramanian, Nikhillesh Vaiid","doi":"10.1016/j.ortho.2025.101090","DOIUrl":"10.1016/j.ortho.2025.101090","url":null,"abstract":"<div><h3>Objective</h3><div>The objective of this study is to assess the biomechanical efficacy of different attachment systems in facilitating the lower canine retraction using clear aligners by means of a finite element method (FEM) analysis.</div></div><div><h3>Methods</h3><div>A FEM was developed by utilizing intraoral scan data and CBCT data from an 18-year-old female with ideal occlusion. Four experimental groups were assessed: group 1 (unattached), group 2 (single vertical rectangular attachment), group 3 (double vertical rectangular attachments), and group 4 (optimized quarter-ellipsoid attachments). The study evaluated the stress distribution, plastic deformation and displacement of the crown and root during simulated canine retraction.</div></div><div><h3>Results</h3><div>Highest bodily translation (85–90%) was observed with optimized attachments (group 4) attaining nearly equal crown and root displacement. Tipping was observed in group 1, less of bodily movement was seen (60–65%) compared to group 2, which demonstrated better physiological translation (70–75%), while group 3 further enhanced efficiency to 75–80%. Group 4 exhibited the most uniform stress distribution, and plastic deformation was minimal (0.01<!--> <!-->mm), suggesting superior force application and aligner stability.</div></div><div><h3>Conclusion</h3><div>The efficiency of canine retraction was considerably improved by optimized quarter-ellipsoid attachments, which resulted in minimal stress concentration and deformation. These findings substantiate the use of optimized attachments to improve the results of clear aligner treatment. Further clinical research is advised to verify these findings and investigate alternative attachment designs and materials to optimize aligner therapy.</div></div>","PeriodicalId":45449,"journal":{"name":"International Orthodontics","volume":"24 2","pages":"Article 101090"},"PeriodicalIF":1.9,"publicationDate":"2025-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145574479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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