Angle Orthodontist最新文献

Objectives: To investigate skeletal and dentoskeletal changes 20 years after bionator treatment.

Materials and methods: Analog lateral cephalograms of 18 subjects treated with a bionator appliance during growth were digitized with a transmitted light scanner. Inclusion criteria were: increased overjet (≥4 mm), skeletal Class II, available lateral cephalograms before (T0), after (T1), and 20 years after (T2) treatment with only a Bionator. To assess standard cephalometric parameters, the software ivoris analyze was used. Data were analyzed using Friedman's two-way analysis of variance by ranks followed by Dunn's post hoc tests (P ≤ .05).

Results: During therapy (T0-T1), ANB decreased significantly by 1.9° and remained unchanged long term. SNA slightly decreased (-0.6°) during treatment, SNB and SNPg increased (+1.4°, +1.7°). All three parameters showed a significant increase at T2 (+1.2°, +1.6°, +1.6°). Vertical measurements (ML-NL, ML-NSL, NL-NSL) remained almost unchanged during therapy. NL-NSL also was unchanged during the long-term interval; ML-NSL and ML-NL decreased significantly (-3.4°, -4.9°). During treatment, the maxillary incisors retroclined (OK1-NL: -1.6°, OK1-NA: -0.6°), the mandibular incisors proclined (UK1-ML: +3.5°, UK1-NB: +4.9°), neither significantly. Long term, there was a nonsignificant tendency toward proclination of upper (OK1-NL: +0.1°, OK1-NA: +0.7°) and retroclination of lower incisors (UK1-ML: -1.5°, UK1-NB: -5°).

Conclusions: Changes of ANB after bionator treatment without additional fixed appliances remained stable after 20 years. The observed long-term changes are probably consequences of well-known physiological and age-related processes.

Objectives: The objective of this study was to assess bone biomarkers and cytokines in patients with conventional labial appliances (CLAs) and aligners.

Materials and methods: Participants were recruited to undergo orthodontic treatment with CLAs and aligners according to predefined inclusion and exclusion criteria. Periodontal examination was accomplished at baseline and 4 weeks using the plaque index (PI), gingival index (GI), and bleeding on probing (BoP). Samples of gingival crevicular fluid (GCF) were collected at baseline (T0) before the start of treatment and at the 1-month follow-up (T1) to assess bone metabolic and inflammatory biomarkers. GCF from participants with CLAs and aligners was evaluated with enzyme-linked immunosorbent assay. Comparison between labial conventional orthodontic treatment and aligners were assessed using an unpaired t-test. The difference between T0 and T1 was measured using a paired t-test.

Results: BoP, PI, and GI demonstrated no significant difference between participants treated with aligners and subjects with CLAs at baseline and at 4 weeks (P > .05). Bone markers and other biomarkers (tumor necrosis factor α, interleukin [IL]-α, IL-2, IL-6, and IL-8) showed significant differences (P < .05). Also, a significant difference between CLAs and aligners was noted among all biomarkers (P < .05) except IL-β.

Conclusions: Aligners and CLAs increase the level of inflammatory and bone metabolic biomarkers after 1 month.

Objectives: To compare the perception of pain and discomfort of patients and guardians during treatment between miniscrew-anchored maxillary protraction (MAMP) therapy using Hybrid (HH) and Conventional Hyrax (CH) expanders.

Materials and methods: Group HH was composed of 18 subjects (8 female, 10 male; initial age: 10.80 years) with Class III malocclusion treated with a hybrid expander in the maxilla and two miniscrews in the anterior region of the mandible. Class III elastics were used from maxillary first molar to mandibular miniscrews. Group CH was composed of 14 subjects (6 female, 8 male; initial age: 11.44 years) treated with a similar protocol except for conventional Hyrax expander. Pain and discomfort of patients and guardians were assessed using a visual analog scale immediately after placement (T1), after 24 hours (T2), and 1 month after appliance installation (T3). Mean differences (MD) were obtained. Intergroup and intragroup timepoint comparisons were performed using independent t-tests, analysis of variance for repeated measures and Friedman test (P < 5%).

Results: Both groups demonstrated similar levels of pain and discomfort with a significant decrease after 1 month of appliance placement (MD: 4.21; P = .608). Compared to patient perceptions, guardians reported a higher level of pain and discomfort at all timepoints (MD, T1: 13.91, P < .001; T2: 23.15, P < .001; T3: 9.35, P = .008).

Conclusions: MAMP therapy with HH and CH produced similar levels of pain and discomfort after appliance installation until 1 month after treatment. Pain and discomfort may not influence the choice between HH and CH expanders.

A patient with a Class II division 2 malocclusion is presented, illustrating the application of a modified double J retractor (DJR) and palatal miniscrews along with clear aligners to correct the malocclusion and normalize the incisor torque. In terms of incisor torque recovery, a nonextraction approach might be a good choice if the Class II correction could be successfully achieved with total arch distalization. When maxillary molar distalization was limited by anatomical boundaries, the treatment plan was changed to bilateral maxillary first premolar extractions, which led to even more retroclination of the maxillary incisors after space closure. Anterior interdental miniscrews were used to intrude the maxillary incisors. A modified DJR and palatal miniscrews were used to regain torque and achieve palatal root movement of the maxillary incisors. The treatment effects and biomechanical designs were evaluated for torque recovery of the retroclined maxillary incisors.

Objectives: To investigate the relationship between circummaxillary sutures and miniscrew-assisted rapid palatal expansion (MARPE) success in adult male patients and to evaluate the correlation between the width of the sutures and the maxilla expansion ratio.

Materials and methods: This retrospective study comprised 40 adult male patients treated with MARPE divided into a separation group (N = 20, mean age, 21.9 years) consisting of subjects with midpalatal suture opening and a nonseparation group (N = 20, mean age, 21.7 years) consisting of subjects with no midpalatal suture opening. Cone-beam computed tomography images were obtained before MARPE expansion for both groups and after expansion for the separation group. Vertical and horizontal skeletal relationships, palate length, and widths of 10 circummaxillary sutures before expansion were compared. The correlation between maxilla expansion ratio (jackscrew expansion to maxillary expansion ratio) and circummaxillary suture widths was also analyzed in the separation group.

Results: There were no significant differences in age, vertical and horizontal skeletal relationships, and palate length between the two groups. Zygomaticomaxillary, pterygomaxillary, midpalatal, and transverse palatine sutures showed significantly greater width in the separation group (P < .05). The zygomaticomaxillary suture showed the greatest difference (Δ = 0.36 mm) between the groups. The zygomaticomaxillary and pterygomaxillary sutures showed significant positive correlation with the maxilla expansion ratio (P < .01).

Conclusions: In adult male patients, greater circummaxillary suture widths before MARPE expansion, especially zygomaticomaxillary and pterygomaxillary sutures, resulted in a better chance of successful suture separation and more maxillary expansion.

Objectives: To perform an in vitro qualitative and quantitative evaluation of the enamel surface (by scanning electronic microscopy [SEM] and measuring polishing time and roughness analysis, respectively) among four methods to remove remaining orthodontic adhesive after bracket debonding.

Materials and methods: Forty-one human premolars were randomly divided into four groups (n = 10) according to the adhesive remnant removal method and one tooth was used as control: Group 1 (G1): Enhance (Dentsply, Milford, USA); Group 2 (G2): Fiberglass (TDV, Pomerode, Brazil); Group 3 (G3): DU10CA-Ortho (Dian Fong Industrial, Shenzhen, China); Group 4 (G4): Sof-Lex Pop-On (3M ESPE, Seefeld, Germany). Roughness was measured before bonding and after complete removal of the remaining adhesive (Ra2). SEM analysis was performed on one sample of each group after adhesive removal and polishing. The time required for adhesive remnant removal and polishing was measured in all groups. Analysis of variance and Tukey post hoc for pairwise comparison was applied to compare polishing times among groups and analysis of covariance was used to compare Ra2 means.

Results: Comparison between groups show that G4 presented the lowest Ra2 mean (0.43 μm)c followed by G3 (0.71 μm)ac, G1 (1.06 μm)ab, and G2 (1.21 μm)b - different letters, statistically different at P ≤ 0.05. In addition, Fiberglass was more time-consuming for adhesive remnant removal than other methods (P ≤ .05). SEM analysis showed that some enamel damage occurred for all methods.

Conclusions: All methods were able to remove the remaining adhesive and polish the enamel. The DU10CA-Ortho and Sof-Lex methods promoted better polishing of the enamel surface and exhibited a similar time-consuming process.

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 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 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.