Progress in Orthodontics最新文献

Background: The aims of this study were to gather expert agreement about essential aspects of clear aligner therapy (CAT) and to determine what research areas need further investigation.

Materials and methods: A steering committee performed literature selection and compiled a list of 25 statements. This study used a modified Delphi method involving a panel of 23 international orthodontic experts. Six essential areas of CAT were investigated: treatment efficacy, quality of life, side effects, management of growing patients, treatment with extraction, and treatment of periodontal patients. A panel of experts assessed 25 statements using a 5-point Likert scale throughout 3 rounds of the study. A steering committee adjusted statements that failed to achieve consensus through either revision, splitting, merging, or complete removal.

Results: After the third round, 22 statements achieved consensus while 3 statements were rejected. The panel agreed that aligners could be used effectively in some types of malocclusions, such as those with mild or moderate crowding or open bite cases. The experts reached a consensus on the biomechanical limits of clear aligners. However, they agreed on the benefits in terms of improved quality of life during treatment and easier maintenance of oral hygiene maneuvers. Regarding specific patient categories, the panelists supported the use of aligners in periodontal patients with tooth migration requiring tipping movements. They also agreed on the advantages of using a rapid palatal expander over aligners in growing patients.

Conclusions: The panel members reached agreement on most topics. However, they acknowledged limitations in the current literature regarding root resorption and orthodontic relapse with CAT compared to fixed appliances. The absence of agreement on treatment duration, effects on skeletal growth, and the management of periodontally compromised patients highlights significant evidence gaps that warrant further research.

Objective: There is a lack of studies on patient-reported outcomes in orthodontics. The aim of this study was to evaluate the changes in patient-reported chief complaints during orthognathic surgery treatment.

Materials and methods: Patients undergoing orthognathic surgery at the University Hospital Münster between 2019 and 2023 were eligible for inclusion in this prospective cohort study. Patient-reported chief complaints were recorded on visual analogue scale (VAS) forms before treatment ([Formula: see text]), and reevaluated after presurgical orthodontic treatment ([Formula: see text]), and 6-9 months after surgery ([Formula: see text]). Chief complaints were grouped into three main categories (pain, function, aesthetics) and ten subcategories, and their intensity was quantified over time.

Results: A total of 217 out of 386 recruited patients (56%) completed all study assessments and were included in the final analysis (female/male = 126/91, median age 24.1 years). Dental function, facial aesthetics, and dental aesthetics were the most frequently reported complaints at [Formula: see text]. At [Formula: see text], there was a statistically significant improvement in dental aesthetics. There was a statistically significant reduction in the intensity of each of the 10 subcategories from [Formula: see text] to [Formula: see text].

Conclusion: Orthognathic surgery patients most frequently report dental function, facial aesthetics, and dental aesthetics as their chief complaints, and these complaints were improved significantly after treatment.

Clinical relevance: The improvement in patient-reported chief complaints can be used to inform patients prior to treatment.

Background: The angulation of third molars is a critical factor influencing the likelihood of impaction. Orthodontic premolar extractions have been hypothesized to affect the eruption path of developing third molars by modifying available space and mesial drift patterns.

Objective: This systematic review and meta-analysis aimed to assess whether premolar extraction during orthodontic treatment alters the angulation of developing third molars compared to non-extraction protocols.

Eligibility criteria: Observational studies comparing angular measurements of third molars between extraction and non-extraction orthodontic treatments were included. Studies without a control group or adequate cephalometric data were excluded.

Information sources: A comprehensive literature search was conducted across two electronic databases (MEDLINE, Scopus) up to November 2024, following PRISMA 2020 guidelines.

Risk of bias and synthesis of results: Risk of bias was evaluated independently by two reviewers using the ROBINS-I tool. A random-effects meta-analysis was conducted, and the certainty of the evidence was assessed using the GRADE approach.

Results: Nine studies (865 participants) were included. For mandibular third molars, extraction was significantly associated with improved angulation (SMD = - 0.37; 95% CI: - 0.59 to - 0.15; p = 0.004). Significant differences were found in M3L/M2L (MD = - 1.31; 95% CI: - 1.76 to - 0.85; p = 0.003) and M3L/PP (MD = - 4.85; 95% CI: - 8.50 to - 1.21; p = 0.02). No statistically significant difference was observed in the M3L/MP angle. In the maxilla, only the M3U-PP angle showed a significant change (MD = - 5.79; 95% CI: - 11.53 to - 0.04; p = 0.049). Meta-regression revealed no association with age, sex, or premolar type. Certainty of evidence ranged from low to moderate.

Background: Skeletal Class II malocclusion is commonly treated using mandibular advancement appliances during growth. Evaluating the comparative effectiveness of different appliances can help optimize treatment outcomes.

Objectives: This study aimed to compare dental and skeletal outcomes of Class II malocclusion treatment using Herbst and PowerScope appliances in conjunction with fixed orthodontic therapy.

Methods: This retrospective comparative study included 46 consecutively treated patients in two university clinics: 26 with PowerScope and 20 with Herbst MiniScope. CBCT scans were obtained before and after treatment. Skeletal and dental changes were analyzed using maxillary and mandibular voxel-based regional superimpositions and cranial base registrations, aided by AI-based landmark detection. Measurement bias was minimized through the use of a calibrated, blinded examiner. No patients were excluded from the analysis. Due to the study's retrospective nature, no prospective registration was performed; the institutional review board granted ethical approval.

Results: The Herbst group showed greater anterior displacement at B-point and Pogonion than PowerScope (2.4 mm and 2.6 mm, respectively). Both groups exhibited improved maxillomandibular relationships, with PowerScope's SNA angle reduced and Herbst's SNB increased. Vertical skeletal changes were observed at points A, B, and Pog in both groups. Herbst also resulted in less lower incisor proclination and more pronounced distal movement of upper incisors.

Conclusion: Both appliances effectively corrected Class II malocclusion. Herbst promoted more pronounced skeletal advancement, while PowerScope induced greater dental compensation. These findings may be generalizable to similarly aged Class II patients in CVM stages 3-4.

Background: This cross-sectional observational study seeks to determine the clinical differences in eruption failure of permanent first molars presenting in cases of ankylosis, failure due to mechanical obstruction (MFE), and failure due to genetic causes (PFE). A total of 34 patients between 7 and 12 years old (mean ± SD: 9.3 ± 1.28 years), with anomalies in the eruption of the first permanent molars, were selected based on clinical observation, the evaluation of orthopanoramic radiographs, and intra- and extra-oral photographs. Genetic testing was also conducted to identify variants of the PTH1R gene in 27 patients with clinical signs of PFE. The familial nature of the condition was investigated through anamnesis of the first-degree relatives.

Results: Out of the 34 patients, 3 were diagnosed with PFE, confirmed by the presence of PTH1R variants. Twelve patients showed clinical signs suggestive of MFE diagnosis. The remaining 19 cases, in which no variants of the PTH1R gene were found, were considered cases of ankylosis. Roots in ankylosed teeth were located in the basal bone and often dilacerated. The reduction of vertical growth of the alveolar bone was present in both PFE and ankylosis cases, but teeth were nearer to the basal bone in ankylosis cases. Infraocclusion of deciduous teeth was present in PFE and MFE cases. Asymmetry due to bilaterally unbalanced eruption of the teeth was present in six cases with ankylosis. Bilateral affection was noticed in one PFE case and 6 MFE cases. A descriptive statistical analysis using Fisher's exact test was employed to evaluate the significant association between variables.

Conclusions: The study highlighted some characteristic signs that help in early diagnosis of cases of PFE, MFE, and ankylosis. However, genetic testing remains necessary to understand the nature of the most dubious cases.

Background: The aim of this study was to investigate if there is a significant difference in the incidence of buccal gingival recession after non-surgical transversal dentoalveolar compensation with completely customized lingual appliances (DC-CCLA) versus surgically assisted rapid palatal expansion (SARPE).

Methods: This cohort study included 81 adult patients with posterior crossbite. The DC-CCLA group (n = 38; f/m 25/13; mean age 30.3 ± 13.0 years) was treated with dentoalveolar compensation using completely customized lingual appliances. The SARPE-group (n = 43; f/m 19/24; mean age 28.2 ± 9.4 years) was treated with SARPE and buccal straight wire appliances. The number of buccal gingival recessions was recorded on digital models before treatment (T0) and after removal of fixed appliances (T1). Statistical analyses included Fisher's exact tests, Chi-squared tests, Mann-Whitney U tests and mixed-effects logistic regression to evaluate the influence of various variables on the incidence of gingival recession.

Results: In 3976 teeth evaluated, the incidence of developing gingival recessions was 8.1% with DC-CCLA (n = 77) and 5.8% with SARPE (n = 60). This difference was not statistically significant (p > 0.05). Age was a significant factor for the incidence of gingival recession and recessions were more likely to occur in males and in the maxillary posterior region.

Conclusions: There was no statistically significant difference in the incidence of gingival recessions between dentoalveolar compensation with CCLAs and SARPE after debonding, with some degree of gingival recession being inevitable with both treatment approaches.

Objectives: This study aimed to compare the designed and achieved maxillary teeth movements in patients undergoing first premolar extraction after the initial series of Invisalign^® treatment using a 3D whole-tooth (crown with root) model and research the related influencing factors.

Materials and methods: Thirty-three consecutive adult patients (Class I with crowding or bimaxillary protrusion) from a single clinical division who completed the first series of aligners after first premolar extractions were included in this retrospective study. The pretreatment, designed, and post-first series treatment teeth (crowns, roots, and bone) models were exported from ClinCheck^® software (Align Technology). The superimposition of the models and 3D tooth movement measurements were constructed using Geomagic Studio Software 2014 (Raindrop Geomagic Inc., USA). Descriptive and analytical statistics were performed, and a P-value < 0.05 was considered statistically significant.

Results: Significant discrepancies were observed between the designed and achieved maxillary tooth movements, particularly in mesiodistal (except U1) and buccolingual (except U6) angular tooth movements (P < 0.05). In contrast, non-significant discrepancies were observed in linear buccolingual movements (P > 0.05). Significant discrepancies in mesiodistal (all teeth) and vertical (U1, U5, U6) tooth movements were more pronounced (P < 0.05). Key influencing factors included the usage of TADs, aligner generation (G6), attachment design, overbite, and gender (P < 0.05).

Conclusions: This study highlights significant deviations between the designed and achieved maxillary teeth (crowns with roots) movements following the first premolar extractions in the initial series of Invisalign^®treatment. Key findings demonstrate significant mesiodistal (except U1) and buccolingual (except U6) angular movement deviations. While linear buccolingual movements were well-controlled, mesiodistal and vertical (U1, U5, U6) discrepancies were more pronounced, influenced by factors such as TADs usage, aligner generation (G6), attachment design, overbite, and gender. These findings may provide further evidence for virtual design during clear aligner treatment.