Progress in Orthodontics最新文献

Aims: The aim of this retrospective cohort study is to calculate the accuracy of dental movement in consecutively treated patients treated with thermoformed and direct printed aligners.

Methodology: Two patient groups were included in the analysis. The first group consisted of 34 consecutively treated patients (23 females, 11 males; mean age 26.3 ± 13.7 years; age range 9-63), who were treated using 3D-printed aligners and a second group included 40 consecutively treated patients (28 females, 12 males; mean age 27.5 ± 12.5 years; age range 12-57), who received treatment with thermoformed aligners made of polyethylene terephthalate glycol (PETG). Digital analysis were performed to evaluate for every tooth torque, tip and rotational movements for each tooth as well as accuracy of planned movement. (Delta-Dent software, Outside Format, Milano, Italy) as well as accuracy of planned movement. The differences between groups in the toothwise movement accuracy were tested using the Mann-Whitney U test The Kruskall-Wallis test was used to evaluate the difference among teeth values. The differences were considered statistically significant at P < 0.05.

Results: 1018 teeth were measured. The overall accuracy of the torque was 60% for the DPA group and 66% for the TFA group; was 52% for the DPA group and 61% for the TFA group for the tip and the overall accuracy for rotations was 58% for the DPA group and 69% for the TFA group; none of the differences resulted statistically significant.

Conclusions: All treatments were successfully completed with similar amounts of refinement stages. No statistically significant differences were found between the two groups in respect of rotation, tip and torque movements.

Background: Disruption of iron homeostasis is closely associated with ferroptosis and inflammation-related diseases. Nuclear receptor coactivator 4 (NCOA4)-mediated ferritinophagy plays a central role in regulating intracellular iron levels and inducing ferroptosis. However, its involvement in orthodontically induced inflammatory root resorption (OIIRR) remains largely unexplored. METHODS : In vitro, a compressive force (CF) loading model was established using human periodontal ligament cells (hPDLCs). Western blotting and immunofluorescence staining were performed to detect the expression of ferroptosis-related proteins, including NCOA4, FTH1, and GPX4. Intracellular levels of malondialdehyde (MDA), Fe²⁺, and reactive oxygen species (ROS) were measured using a ferroptosis assay kit. JC-1 staining was used to evaluate mitochondrial membrane potential. NCOA4 was silenced via lentiviral transfection, and the small-molecule inhibitor 9a was used to further assess its functional role in ferroptosis. In vivo, an OIIRR mouse model was established. Hematoxylin and eosin (H&E) staining, tartrate-resistant acid phosphatase (TRAP) staining, and micro-computed tomography (micro-CT) were used to assess root resorption. The expression of NCOA4, FTH1, and GPX4 in periodontal tissues was evaluated via immunohistochemistry and immunofluorescence. Ferrostatin-1 (Fer-1), a ferroptosis inhibitor, was administered intraperitoneally to investigate its therapeutic effect on OIIRR.

Results: CF and IL-1β stimulation induced ferroptosis in hPDLCs, as indicated by increased intracellular Fe²⁺, ROS, and MDA levels, decreased GPX4 expression, and mitochondrial damage. NCOA4 expression was markedly upregulated in both in vitro and in vivo models, leading to ferritin degradation and iron overload. Fer-1 treatment effectively reduced oxidative stress and iron accumulation in vitro and alleviated OIIRR in vivo. Compound 9a suppressed NCOA4 expression and mitigated ferritinophagy-mediated ferroptosis.

Conclusions: NCOA4/FTH1-mediated ferritinophagy promotes ferroptosis under compressive and inflammatory conditions, contributing to OIIRR pathogenesis. Targeting the NCOA4/FTH1 axis may represent a promising therapeutic strategy for preventing orthodontically induced root resorption.

Background: Adolescents' lack of adherence to intra-oral removable appliances (IORAs) can lead to poor treatment outcomes. Available literature on this topic hasn't been comprehensively summarized. Existing reviews often combine data from various age groups, lack a standardized conceptual definition of adherence to IORAs, and offer limited evaluation of interventions aimed at improving adherence among adolescents. This scoping review aims to map the breadth and depth of the literature on adolescents' adherence to IORAs and identify research gaps for developing tailored interventions.

Methods: In accordance with Arksey and O'Malley's framework and PRISMA-ScR guidelines, a comprehensive search strategy was implemented across MEDLINE, CINAHL, Web of Science, and ProQuest Theses and Dissertations. Two researchers independently screened titles, abstracts, and full texts. A pilot-tested form facilitated data extraction. Risk of bias was evaluated using RoB 2, ROBINS-I, and JBI tools. Extracted data then underwent both descriptive and content analysis.

Results: The 14 included studies focused on adherence to wear-time recommendations (n = 13), with only one examining appointment adherence. Only seven studies (50%) were deemed high-quality. Adherence rates varied across IORAs: vacuum-formed retainers showed wear-time of less than 24 h/day, Hawley retainers averaged 12-15 h/day, Twin Blocks averaged 21 h/day, and Activators averaged 11.5 h/day. Studies pursued various aims: four explored patient perspectives and experiences; one assessed designed interventions; two evaluated treatment adherence and assessed adherence to both recommendations and appointments; and five identified associated factors. Several studies pursued multiple aims. Patient perspectives highlighted challenges like discomfort and social pressures, and enablers such as parental support. Limited intervention studies indicated potential benefits of digital and image-based monitoring. Adherence consistently fell short of recommended daily wear time (DWT), often influenced by motivation, parental involvement, and psychosocial factors.

Conclusion: Adherence among adolescents to the DWT for intraoral removable appliances is frequently suboptimal, displaying considerable variability depending on appliance type. Both individual and social determinants influence adherence. Robust study designs and a standardized conceptualization of adherence are imperative to generate high-quality, comparable evidence. Evidence-based interventions must be developed and tested to enhance adherence and ultimately optimize treatment outcomes within this patient population.

Background: Orthodontic tooth movement requires synchronized mechanoadaptive and osteoimmune interactions, yet molecular pathways linking mechanical forces to immune-mediated bone remodeling remain incompletely characterized. This study aimed to elucidate molecular drivers and dissect cell crosstalk under orthodontic force, with a focus on their immunoregulatory consequences.

Methods: This study combined in vitro compressive loading of human periodontal ligament (PDL) cells with transcriptomic/proteomic profiling, and in vivo single-cell RNA sequencing of alveolar bone macrophages from murine orthodontic models. Mendelian randomization (MR) analysis leveraged genetic instruments from transcriptome-wide (n = 31,684), proteome-wide (n = 35,559), and immune trait genome-wide association studies (n = 3,757). The two-phase framework first identified mechanoresponsive molecular signatures across omics layers, then established causal links to immune cell dynamics through MR.

Results: Transcriptomic and proteomic analyses of PDL cells under compressive force revealed LBH upregulation and TGF-β pathway activation and collagen disassembly, evidenced by COL1A1/COL2A1 downregulation. Single-cell RNA sequencing identified Cd40⁺ macrophages enriched in IL-17 signaling. MR causally linked PDL-derived molecular changes to CD40⁺ monocyte dynamics: LBH (OR = 0.860, P = 0.019) reduced CD40⁺ monocyte prevalence, while COL2A1 (OR = 1.115-1.133, P = 0.010) elevated CD40 expression in monocytes.

Conclusions: Orthodontic forces induce transcriptional reprogramming and proteomic remodeling in PDL cells, which drive CD40 signaling in monocytes through mechano-immunological coupling. These adaptations activate Cd40⁺ macrophages, ultimately redefining orthodontic bone remodeling as a mechano-driven stromal-immune partnership essential for tooth movement.

Objective: To develop a machine-learning-based model and construct a nomogram that integrates ClinCheck features and clinical risk factors for accurately predicting open gingival embrasures (OGE) between mandibular central incisors after clear aligner treatment (CAT).

Methods: A total of 297 patients (163 normal and 134 with OGE) who underwent Invisalign^® treatment were enrolled. A ClinCheck model was developed based on predicted OGE-area in the final step from initial ClinCheck treatment plan. Twenty-three clinical features were extracted from electronic medical records and ClinCheck tooth movement metrics. Predictors were selected through Least Absolute Shrinkage and Selection Operator (LASSO) regression to establish a clinical model. Additionally, a nomogram incorporating ClinCheck features and clinical predictors was constructed via logistic regression and validated with bootstrap resampling. The performances of these models were evaluated through receiver operating characteristic (ROC) curves, area under curves (AUC), and decision curve analyses (DCA).

Results: Six clinical features, including age, gingival papilla angle, interproximal reduction, crown morphology and two types of tooth movement, were selected through LASSO regression. The combined model that consisted of OGE-area and clinical features demonstrated superior predictive capacity (AUC: 0.880; 95% CI: 0.840-0.916), outperforming both clinical model (AUC: 0.815; 95% CI: 0.767-0.861; P < 0.001) and ClinCheck model (AUC: 0.860; 95% CI: 0.817-0.900; P < 0.05). The corrected C-statistic of the combined nomogram was 0.888, and the calibration curve exhibited great performance with a mean absolute error of 0.012. In the DCA curve, the combined model showed higher net benefit than the clinical model when the threshold probability exceeded 0.13, and higher than the ClinCheck model between 0.13 and 0.63.

Conclusion: The integration of clinical features and ClinCheck in the machine-learning-based model demonstrated favorable predictive capabilities for OGE between lower central incisors. This comprehensive nomogram may contribute to precisely prediction and prevention of OGE in clinical practice.

Background: A deep bite is a prevalent malocclusion, and its treatment remains one of the most debated topics in orthodontics due to the variety of underlying causes and the diverse orthodontic approaches employed to address it.

Objective: This systematic review aimed to assess the evidence on the most effective approach for treating deep bites in adult and adolescent patients.

Search methods: A thorough search was performed up to January 2025 among these databases: PubMed^®, the Cochrane Library, Scopus^®, Web of Science™, Embase^®, and Google™ Scholar.

Selection criteria: Only randomized controlled trials (RCTs) were included in this review on adult and adolescent patients with deep bite malocclusion who underwent any orthodontic treatment to correct this malocclusion.

Data collection and analysis: The Cochrane tool (ROB2) was employed to assess the risk of bias, while the GRADE approach was used to evaluate the quality of evidence.

Results: Eight RCTs were included in this review. Five of the eight studies were suitable for qualitatively synthesizing the data. The meta-analysis showed that the miniscrew-supported intrusion (MSI) caused a statistically significant amount of overbite reduction (mean difference (MD) = - 0.36 mm), upper incisor intrusion (MD = - 0.77 mm), and upper incisor proclination (MD = 0.63^o) compared to the Connecticut intrusion arch (CIA), and the quality of evidence was low to moderate. Moderate-quality evidence indicated that there was no statistically significant difference between the anterior bite turbos (ABT) and the lower reversed curve of Spee (RCS) regarding overbite reduction (MD= - 4.07 mm, MD = - 3.27 mm, respectively). A low-quality evidence indicated that the MSI and the utility arch (UA) caused more overbite reduction than the J-Hook headgear (J-Hg) (MD = -2.33 mm, MD = - 2 mm, MD = - 0.8 mm, respectively). However, the MSI was superior regarding upper incisor intrusion than the UA and the J-Hg (MD = - 2.08 mm, MD = - 1.33 mm, MD= - 0.1 mm, respectively).

Conclusion: Low-quality evidence suggests that MSI is superior to CIA for reducing overbite, and causing more upper incisor proclination. Moderate -quality evidence indicates that MSI is superior to CIA for intruding the upper incisors. Moderate-quality evidence indicates that the ABT and the RCS effectively reduce overbite. Low-quality evidence suggests that the MSI and the UA cause more overbite reduction and upper incisor intrusion than the J-Hook headgear, and the MSI causes more upper incisor intrusion than the UA.

Registration: The protocol was registered in the PROSPERO database (CRD42025633739) during the first stages of the review.

Objective: This retrospective clinical study, using cone-beam computed tomography (CBCT), examined the presence of fenestration and dehiscence in anterior teeth following non-extraction clear aligner therapy, along with the associated risk factors.

Methods: The study included 224 adult patients who underwent non-extraction clear aligner treatment. CBCT scans taken before (T1) and after treatment (T2) were analyzed to detect the presence of fenestration and dehiscence. Patient-related and treatment design-related variables were collected, with the latter from the planned tooth movements specified in the aligner software. The exact McNemar test was used to compare the occurrence of alveolar bone defects between T1 and T2. Univariate and multivariate logistic regression analyses were performed to evaluate the associations between posttreatment alveolar bone defects and various factors.

Results: From T1 to T2, the occurrence of fenestration and dehiscence increased on most maxillary and mandibular anterior root surfaces. At T2, the presence of alveolar bone defects at different tooth positions was influenced by multiple factors, including crowding, curve of Spee depth, alveolar bone thickness, gingival thickness, sagittal skeletal pattern, magnitude and type of intrusion, amount of retraction, molar distalization, and number of attachments. Specifically, labial fenestration of the maxillary lateral incisors and canines, as well as the mandibular central incisors and canines, and lingual dehiscence of the mandibular central incisors were significantly associated with the amount of intrusion (P < 0.05). Labial dehiscence of the mandibular central and lateral incisors was significantly associated with the number of attachments (P < 0.05). No significant associations were found between alveolar bone defects and factors such as age, gender, vertical skeletal pattern, changes in arch width, use of miniscrews, the amount of interproximal enamel reduction, attachment type, or treatment duration.

Conclusions: In patients undergoing non-extraction clear aligner therapy, factors such as crowding, curve of Spee depth, alveolar bone thickness, gingival thickness, sagittal skeletal pattern, amount and type of intrusion, amount of retraction, molar distalization, and number of attachments were significantly associated with the presence of fenestration and dehiscence at T2. Orthodontists should assess these factors, conduct thorough pretreatment evaluations of individual oral conditions, and develop tailored treatment plans accordingly.

Background: It is generally accepted that the ideal time to benefit from functional therapy in Class II patients is during the circumpubertal growth period (CVM 3-4). However, in severe cases, early intervention during the mixed dentition phase may be indicated, particularly to reduce the risk of dental trauma and to protect the child from potential bullying. The aim of this study was to evaluate the effects of the Manni Telescopic Herbst (MTH) appliance in young patients with mixed dentition, comparing the outcomes with two control groups: one treated with Class II elastics and a Wilson arch, and the other with a removable functional appliance (Paolone-Kaitsas, PK).

Methods: Following statistical matching for age, sex and pre-treatment overjet, lateral cephalograms taken at beginning (T0) and at appliance removal (T1) from 30 patients treated with the MTH appliance were compared with those of 15 patients treated with Class II elastics and 15 treated with the PK appliance.

Results: Regarding skeletal parameters, significant differences were observed in the mandibular sagittal position (SNB (T1-T0), p = 0.01) and in the relationships between skeletal bases (ANB (T1-T0), p = 0.03; Wits (T1-T0), p < 0.01), when comparing MTH and PK groups to the Class II elastics group. The Herbst group exhibited the most substantial skeletal changes. For dental variables, better incisor control was achieved with the removable PK appliance (Ii/GoGn T1-T0 1.513 ± 5.739, and Is/PP (T1-T0) 2.507 ± 6.482). No statistically significant difference was found regarding skeletal divergence (SN/GoGn (T1-T0), p = 0.38) when focusing on younger patients in mixed dentition phase.

Conclusion: Both the fixed MTH appliance and the removable PK appliance produced greater skeletal effects compared to Class II intermaxillary elastics, even when applied during the mixed dentition phase. Although the PK group demonstrated better dentoalveolar control, when significant skeletal modifications are required in young patients with mixed dentition, the use of a fixed functional appliance - such as the Herbst - is preferable.

Background: This study aimed to screen favorable and unfavorable profile outcomes in orthodontic camouflage treatment of skeletal Class II cases, based on which to identify the reference line and the associated value for the optimal incisor position objective (IPO) in such cases.

Methods: A total of 140 Chinese adult skeletal Class II cases were included, who finished orthodontic camouflage treatment with anterior retraction following premolars extraction. Post-treatment lateral cephalograms were trimmed and converted into silhouettes, rated by a panel of orthodontists. The top 30% and bottom 30% ranked cases were included as the favorable and unfavorable profile group respectively. The distances of U1 anterior to the GALL line (U1-GALL), point A vertical (U1-Av), and ANS-Pog line (U1-ANPo) were measured as IPO indicators.

Results: U1-ANPo in the favorable profile group was 4.74 ± 1.65 mm, significantly different from that in the unfavorable profile group (6.02 ± 3.61 mm). U1-GALL was -2.68 ± 2.30 mm and -1.12 ± 2.02 mm, and U1-Av was 4.49 ± 3.97 mm and 6.22 ± 4.42 mm, in the favorable and unfavorable profile group respectively, neither showing significant difference. Among three indicators, only U1-ANPo had a significant discriminatory capacity (AUC = 0.74, P = 0.007) for differentiating between the favorable and unfavorable profile group.

Conclusions: In skeletal Class II orthodontic camouflage treatment, the relatively favorable post-treatment profiles are associated with the U1 position anterior to the ANS-Pog line. U1-ANPo of around 4.7 mm could be tentatively proposed as a practical IPO reference in treatment planning for such cases.

Primary failure of eruption (PFE) is an uncommon autosomal dominant disorder predominantly defined by an impaired tooth eruption mechanism. It is characterized by a unilateral or bilateral open bite in the posterior area and incomplete or absent tooth eruption. Nonetheless, its etiology remains unclear. Current studies indicate that PFE may be directly associated with mutations in several genes, including parathyroid hormone receptor 1 (PTH1R), lysine (K)-specific methyltransferase 2 C (KMT2C), and transmembrane protein 119 (TMEM119). Despite the growing research on PFE genetics, no cohesive conceptual framework exists to integrate the known genetic information. This review seeks to address this gap and introduce a novel pathogenic model. The model posits that the normal eruption of teeth relies on the precise equilibrium between "The Pro-Eruptive Axis" and "The Anti-Resistance Axis," with the Dental Follicle (DF) serving as the central regulatory hub of this mechanism. This research will systematically categorize PFE-related genes and classify their pathogenic mechanisms as "insufficient motivation" or "excessive resistance" in eruption. On this basis, this review will analyze in depth the crosstalk of key signaling pathways (such as PTH, Wnt, TGF-β, and RANKL/OPG), investigate the complexity of genetic influences and temporal factors in elucidating phenotypic variability, enhance the existing classification framework into a dynamic, multi-dimensional comprehensive network, and ultimately suggest precise diagnostic approaches and prospective therapeutic targets based on pathogenic mechanisms from a translational medicine perspective. By constructing this integrated pathophysiological model, we aim to establish a robust theoretical framework for investigating molecular mechanisms and clinical diagnosis and formulating novel individualized treatment options for PFE.