Angle Orthodontist最新文献

Objectives: To analyze macrophage-colony-stimulating factor (M-CSF), a bone remodeling biomarker in the peri-miniscrew implant crevicular fluid (PMICF) after insertion and orthodontic loading.

Materials and methods: This prospective study included 40 miniscrew implant (MSI) sites in 10 subjects undergoing fixed orthodontic mechanotherapy utilizing miniscrew anchorage. After dental alignment, miniscrews were inserted between the second premolar and first molar roots. After 21 days of insertion, MSIs were direct loaded with closed-coil springs (200 g force) for en masse retraction of anterior teeth. PMICF was collected with Periopaper™ strips from the gingival crevice around MSIs at six time points (T1-T6: 1 hour, 1 day, 21 days postinsertion, and 7, 21, and 42 days postloading). PMICF was quantified for M-CSF by enzyme-linked immunosorbent assay. Paired comparison of mean M-CSF concentrations before and after loading stages (T1-T6) was made using the Wilcoxon signed-rank test.

Results: The mean M-CSF concentration showed a significant peak at T3 (21 days postinsertion; 12.646 pg/mL; T1 vs T3: P < .0001). After orthodontic loading of miniscrews, M-CSF levels increased to 13.570 pg/mL at T4 (7 days after loading; T1 vs T4: P < .001) and maintained at a plateau to T5 (21 days postloading; 11.994 pg/mL). However, the difference between preloading and postloading was not statistically significant (T3 vs T4).

Conclusions: The maximum M-CSF activity around MSIs was observed at around 3 weeks of miniscrew insertion, suggesting underlying bone remodeling after surgical injury. However, orthodontic force on MSIs did not cause any significant surge in M-CSF levels postloading.

A 25-year-old woman presented with left condylar hyperplasia, canting-type facial asymmetry, mandibular prognathism, and arch width discrepancy. Bone scintigraphy confirmed the inactive status of the condyle, and the temporomandibular joint functioned within the normal range; thus, orthognathic surgery without condylectomy was performed. To correct facial asymmetry successfully through orthognathic surgery, sufficient dentoalveolar decompensation must be achieved in the presurgical orthodontic phase. In cases of canting-type facial asymmetry, teeth on the nondeviated side are extruded as dentoalveolar compensation. Therefore, vertical decompensation is required for intrusion of the extruded teeth. A miniscrew and resin build-ups were used for the intrusion of teeth, and posterior segmental osteotomy was simultaneously performed with orthognathic surgery for further intrusion. The canting-type facial asymmetry was notably corrected through successful vertical decompensation and close cooperation between orthodontists and maxillofacial surgeons. After 2 years of retention, the treatment results remained stable.

Objectives: To identify predictors regarding the type and severity of malocclusion that affect total Invisalign treatment duration based on an intraoral digital scan.

Materials and methods: The subjects of this retrospective clinical cohort were 116 patients treated with Invisalign. A deep learning method was used for automated tooth segmentation and landmark identification of the initial and final digital models. The changes in the six degrees of freedom (DOF), representing types of malalignment, were measured. Linear regression was performed to find the contributing factors associated with treatment time. In addition, the Peer Assessment Rating (PAR) score and a composite score combining 6 DOF were correlated separately to the treatment time.

Results: The number of trays differed between sexes (P = .0015). The absolute maximum torque was marginally associated with the total number of trays (P = .0518), while the rest of the orthodontic tooth movement showed no correlation. The composite score showed a higher correlation with the total number of trays (P = .0045) than did individual tooth movement. Pretreatment upper and lower anterior segment PAR scores were positively associated with the treatment time (P < .001).

Conclusions: There is not enough evidence to conclude that certain types of tooth movement affect the total aligner treatment time. A composite score seems to be a better predictor for total treatment time than do individual malalignment factors in aligner treatment. Upper and lower anterior malalignment factors have a significant effect on the treatment duration.

Objectives: To characterize features of the current orthodontic literature.

Methods and materials: All research articles published in 2020 (N = 350) in the American Journal of Orthodontics and Dentofacial Orthopedics, The Angle Orthodontist, and the European Journal of Orthodontics were categorized on 48 features such as type of study (domain of generalization, subjects, and research design), analytical tools (statistical tests, power and normality of data, consistency of measurement, management of covariables, and corrections of multiple independent tests), and reporting characteristics. Consistency of the coding was high (κ > .990).

Results: The "most typical" article was a cohort study reporting multiple patient outcomes at a single treatment location. Soundness of analyses was uneven, with about half providing information on power or normality of the data and consistency of measurement. Few articles addressed covariables or adjusted for multiple tests of independent outcomes. Photos and flow charts were commonly used to explain methods, and results were presented in multiple formats. There was a clear association between design and reporting characteristics and type of study for systematic reviews, meta-analyses, and case reports. There were small but consistent differences across the three journals.

Conclusions: The quality of the orthodontic research literature has advanced at an uneven pace, and this review identifies areas that could be strengthened. Substantial gaps remain in achieving accepted standards for randomized controlled trials and opportunities exist for better understanding measures of effect through design and analysis using regression techniques to identify sources of variance.

Objectives: To compare patient-reported experience between a Penn expander activated every other day vs twice daily.

Materials and methods: A total of 30 patients aged 12-16 years with transverse maxillary deficiency were recruited from the outpatient clinic, Faculty of Dentistry, Alexandria University (February 2019-December 2020). They were randomly allocated to two groups using block randomization (block size of six) and an allocation ratio of 1:1, which was concealed using opaque, sealed, sequentially numbered envelopes. Both groups received Penn expanders anchored by four palatal miniscrews. The slow maxillary expansion (SME) group activated the appliance once every other day. The rapid maxillary expansion (RME) group activated the appliance twice daily. Outcome measures were pain, pressure, headache, dizziness, speech difficulty, chewing difficulty, and swallowing difficulty scores rated by the participants on an 11-point numeric rating scale (NRS) at the following four time points: before appliance insertion (t1), after first activation (t2), after 1 week of activation (t3), and after last activation (t4).

Results: Data of 24 patients in the SME group (n = 12, mean age = 14.30 ± 1.37 years) and RME group (n = 12, mean age = 15.07 ± 1.59 years) were analyzed. Median scores for all outcomes were in the bottom quartiles of the NRS. No difference was found between the two groups at t1 or t2. Significantly higher scores for all variables, except dizziness and headache, were reported in the RME group at t4.

Conclusions: Activation of miniscrew-supported expanders resulted in mild to moderate discomfort and functional limitation. Slow activation resulted in a better overall patient experience compared with rapid activation.

Objectives: To evaluate the angular and positional changes of the maxillary second (M2) and third molars (M3) after orthodontic premolar extraction treatment according to patient skeletal classification and growth pattern.

Materials and methods: Panoramic radiographs of patients treated with extraction of the first or second premolars (n = 116) and patients treated without extraction (n = 92), taken before orthodontic treatment (T0) and after completion of multibracket appliance therapy (T1) were analyzed. Angle classification, growth pattern, crowding, and incisor inclination were recorded. The palatal (PP) and interorbital planes (IOP) were used as reference lines. Changes in the M3 angulation relative to PP and IOP (T0-T1) within the same group were evaluated with paired t-tests. One-way analysis of variance (ANOVA) and Kruskal-Wallis tests were used for comparisons between the groups. Accordingly, pairwise comparisons were performed with Mann-Whitney U-tests or independent t-tests (P < .05).

Results: The M3 angulation related to the PP and the IOP did not differ significantly between the extraction and nonextraction groups. The M2 angulation improved in the premolar extraction group between T0 and T1 (M2/PP, P < .001). According to Archer's classification, the change in the vertical position of M3 differed significantly between the extraction and nonextraction groups (P < .001).

Conclusions: The angulation of M3 improved over time regardless of the extraction decision. The vertical eruption pattern of M3 was positively influenced only in the extraction group. M2 became significantly more upright in the orthodontic extraction treatment groups.

Objectives: To investigate the association between three-dimensional (3D) skeletal variables and self-recognition of facial asymmetry in skeletal Class III patients.

Materials and methods: Questionnaires and cone beam computed tomography of 74 patients (42 men and 32 women; mean age: 22.8 ± 4.5 years) with skeletal Class III and facial asymmetry were collected retrospectively. Patients were classified into three groups: group Sy (recognition of symmetry), group NS (not sure), and group Asy (recognition of asymmetry), according to their responses to the questionnaires. To assess 3D anatomic differences in the maxillomandibular region, six 3D hard tissue variables: maxillary height, ramal length, frontal ramal inclination (FRI), lateral ramal inclination (LRI), mandibular body length (Mn BL), and mandibular body height (Mn BH) were compared among the three self-recognition groups. Six 3D hard tissue variables and Menton deviation were reduced into three factors and their association with the self-recognition of facial asymmetry was investigated.

Results: Maxillary height, FRI, LRI, Mn BH, and Menton deviation demonstrated significant differences among the three self-recognition groups. The reduced factors, which consisted of transverse and vertical parameters, and vertical parameter of the mandibular corpus, demonstrated significant differences among the three self-recognition groups. The difference in Mn BH influenced the self-recognition of facial asymmetry.

Conclusions: Both the transverse and vertical parameter of the skeleton were determinant in self-recognition of facial asymmetry. Identification of the skeletal difference in the lateral view involving LRI and Mn BH should be included for assessment of facial asymmetry.

Objectives: To examine whether optimal calculations of the sample size are being used in longitudinal orthodontic trials.

Materials and methods: Longitudinal orthodontic trials with a minimum of three time points of outcome assessment published between January 1, 2017, and December 30, 2020, were sourced from a single electronic database. Study characteristics at the level of each trial were undertaken independently and in duplicate. Descriptive statistics and summary values were calculated. Inferential statistics (Fisher's exact test and logistic regression) were applied to detect associations between reporting of a sample size calculation and the study characteristics.

Results: A total of 147 trials were analyzed; 75.5% of these trials reported a sample size calculation with none reporting optimal sample size calculation for longitudinal trials. Most of the longitudinal orthodontic trials did not report the correlation and the number of longitudinal measurements in calculating the sample size. An association between reporting of a sample size calculation (yes or no) and the type of journal (orthodontic and non-orthodontic) was detected with higher odds of reporting a sample size calculation in orthodontic journals than in non-orthodontic journals (3.04; 95% confidence interval, 1.4-6.59; P < .01).

Conclusions: The findings of this study highlighted that the undertaking of optimal sample size calculations in longitudinal orthodontic trials is being underused. Greater awareness of the variables required for undertaking the correct sample size calculation in these trials is required to reduce suboptimal research practices.

Objectives: To investigate long-term outcomes of dentoskeletal changes induced by facemask therapy using skeletal anchorage in Class III patients and compare them to those of conventional tooth-borne anchorage.

Materials and methods: This retrospective study included 20 patients who received facemask (FM) therapy with miniplates as anchorage for maxillary protraction (Miniplate/FM group, 10.6 ± 1.1 years old [mean ± SD]) and 23 patients who were treated with facemask with rapid maxillary expander (RME/FM group, 10.0 ± 1.5 years old [mean ± SD]). Dentoskeletal changes were evaluated using lateral cephalograms at pretreatment (T1), after facemask therapy (T2), and at the post-pubertal stage (T3). Cephalometric changes were compared between groups and clinical success rates at T3 were evaluated.

Results: SNA and A to N perpendicular to FH increased significantly more in the Miniplate/FM group than in the RME/FM group when comparing short-term effects of facemask therapy (T1-T2). ANB, Wits appraisal, Angle of convexity, mandibular plane angle, and overjet decreased significantly more in the RME/FM group than in the Miniplate/FM group after facemask therapy (T2-T3). A more favorable intermaxillary relationship was observed in the Miniplate/FM group than in the RME/FM group in long-term observations (T1-T3). Clinical success rate at T3 was 95% in the Miniplate/FM group and 85% in the RME/FM group.

Conclusions: Facemask therapy with skeletal anchorage showed a greater advancement of the maxilla and more favorable stability for correction of Class III malocclusion in the long-term than conventional facemask therapy with tooth-borne anchorage.