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American Journal of Orthodontics and... Nov 2023Extrusion of maxillary lateral incisors during aligner treatment is a difficult movement to achieve accurately. Despite recommendations regarding attachment design, few... (Randomized Controlled Trial)
Randomized Controlled Trial
INTRODUCTION
Extrusion of maxillary lateral incisors during aligner treatment is a difficult movement to achieve accurately. Despite recommendations regarding attachment design, few studies and no prospective trials compare predictability among attachments. This study aimed to compare the efficacy between optimized and horizontal attachment designs for achieving maxillary lateral incisor extrusion during clear aligner treatment.
METHODS
The study included maxillary lateral incisors in 3 orthodontic practices requiring at least 0.3 mm of extrusion during the first series of 20-25 aligners in patients aged ≥16 years who were scheduled to begin clear aligner treatment (Invisalign; Align Technology, San Jose, Calif). Teeth were randomly assigned to receive optimized (O), rectangular horizontal nonbeveled (H), rectangular horizontal incisally-beveled (HIB), or rectangular horizontal gingivally-beveled (HGB) attachments. After the first series, a blinded evaluator measured extrusion using superimpositions with initial and predicted models. Linear models determined the difference in the predicted extrusion percentage achieved on the basis of attachment design. Other covariates were patient age, sex, number of trays, and self-reported compliance.
RESULTS
Forty patients (74 teeth) were enrolled, and 38 patients (71 teeth) completed the study. Intraexaminer and interexaminer reliability for extrusion measurements was high (intraclass correlation coefficient, 0.985 and 0.991, respectively). The achieved extrusion was significantly less than predicted (mean, 73%; P <0.0001). The average achieved extrusion was 62%, 79%, 78%, and 78% for O, H, HIB, and HGB attachments, respectively, with H significantly more effective than O (P = 0.0403). Horizontal attachments (H, HIB, and HGB combined) were significantly more effective than O attachments (P = 0.0060), with an average difference in achieved extrusion of 14% of the predicted amount (95% confidence interval, 4-23; estimated 76% vs 62%). Horizontal attachments were an estimated 22% more effective than O attachments for extruding maxillary lateral incisors.
CONCLUSIONS
Horizontal attachments are more effective than O attachments for predicted maxillary lateral incisor extrusion between 0.3 and 2.5 mm. The 3 horizontal attachment designs evaluated performed similarly for achieving predicted extrusion.
TRIAL REGISTRATION
This randomized clinical trial was registered and reported at clinicaltrials.gov (NCT04968353).
PROTOCOL
The protocol was not published before trial commencement.
FUNDING
This study was funded in part by the Alexander Fellowship of the Virginia Commonwealth University School of Dentistry, the Southern Association of Orthodontists, and the Virginia Orthodontic Education and Research Foundation. No funding source influenced the study design, the collection, analysis or interpretation of data, writing of the report, or the decision to submit the article for publication.
Topics: Adolescent; Adult; Humans; Incisor; Orthodontic Appliances, Removable; Reproducibility of Results; Single-Blind Method; Tooth Movement Techniques; Male; Female
PubMed: 37610383
DOI: 10.1016/j.ajodo.2023.07.011 -
Progress in Orthodontics Jun 2024Metallic and elastomeric ligatures are widely used in orthodontics to secure the archwire within the bracket slots, but elastomeric ligatures have traditionally been... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Metallic and elastomeric ligatures are widely used in orthodontics to secure the archwire within the bracket slots, but elastomeric ligatures have traditionally been associated with increased microbial colonization, which could adversely affect periodontal health.
AIM
This systematic review compares the periodontal effects of elastomeric and steel ligatures used for orthodontic fixed appliances.
METHODS
Unrestricted literature search of 7 databases (MEDLINE, Scopus, Web of Science, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Virtual Health Library) up to July 2023 were performed for randomized / non-randomized clinical studies on humans comparing the two ligation methods during fixed-appliance therapy. After duplicate study selection, data extraction, and risk-of-bias assessment with the Risk of Bias (RoB) 2 or the Risk Of Bias In Non-randomized Studies - of Interventions (ROBINS-I) tool, random-effects meta-analyses of Mean Differences (MD) or Standardized Mean Differences (SMD) and their 95% confidence intervals (CIs) were carried out, followed by assessment of certainty of existing evidence with the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach.
RESULTS
A total of 11 studies (3 randomized / 8 non-randomized) with 354 patients (mean age 14.7 years and 42% male) were included. No statistically significant differences were seen for plaque index (5 studies; SMD = 0.48; 95% CI = -0.03 to 1.00; P = 0.07), gingival index (2 studies; MD = 0.01; 95% CI = -0.14 to 0.16; P = 0.89), probing pocket depth (2 studies; MD = 0; 95% CI = -0.17 to 0.16; P = 0.97), or Streptococcus mutans counts (4 studies; SMD = 0.40; 95% CI=-0.41 to 1.20; P = 0.21). Elastomeric ligatures were associated with moderately increased total bacterial load (3 studies; SMD = 0.43; 95% CI = 0.10 to 0.76; P = 0.03). Confidence in these estimates was low in all instances due to the inclusion of non-randomized studies with high risk of bias.
CONCLUSIONS
Existing low quality evidence indicates that ligature method does not seem to influence the periodontal health during fixed treatment, even if elastomeric ligatures are associated with a moderate increase of bacterial load.
REGISTRATION
PROSPERO (CRD42023444383).
Topics: Humans; Elastomers; Orthodontic Appliances, Fixed; Steel; Periodontal Index; Orthodontic Brackets; Ligation
PubMed: 38880839
DOI: 10.1186/s40510-024-00520-8 -
Journal of Orofacial Orthopedics =... Oct 2023Fixed orthodontic appliances induce biofilm deposition, which harbors a microbial population harmful to the periodontal health of the individual. The present study...
PURPOSE
Fixed orthodontic appliances induce biofilm deposition, which harbors a microbial population harmful to the periodontal health of the individual. The present study evaluated the changes in thickness, live/dead bacterial ratio, and mineral content in dental biofilm over 6 months in patients with either stainless steel or ceramic orthodontic attachments.
METHODS
Eighty patients who require fixed orthodontic appliance treatment with first premolar extraction for correcting their malocclusion were selected and bonded with either stainless steel or ceramic orthodontic attachments on the buccal side. The attached buttons were retrieved at different periods-1 week, 1 month, 3 months, and 6 months. They were stained and visualized through confocal microscopy to detect biofilm thickness and the ratio of live/dead bacteria. X‑ray diffraction was used to identify the presence of calcium and phosphorous.
RESULTS
Ceramic attachments showed a greater increase in biofilm thickness in comparison to stainless steel attachments except in the initial 1‑week evaluation. A higher live/dead bacterial ratio was observed in stainless steel attachments than in their ceramic counterparts at all four evaluation periods. Both stainless steel and ceramic surfaces exhibited the presence of mineral deposition (calcium and phosphorous) at all periods.
CONCLUSIONS
More biofilm adhesion was observed over ceramic surfaces than over stainless steel orthodontic attachments. Stainless steel attachments exhibited biofilm with a higher live/dead bacterial ratio than their ceramic counterparts at all evaluation periods. The presence of calcium and phosphorous in the adhered biofilm, pointing toward its calcification process, was identified.
PubMed: 36820892
DOI: 10.1007/s00056-023-00452-8 -
American Journal of Orthodontics and... Aug 2023The objectives of this study were to investigate the biomechanical effects of clear aligners (CAs) with various thermoplastic material thicknesses and gingival-margin...
INTRODUCTION
The objectives of this study were to investigate the biomechanical effects of clear aligners (CAs) with various thermoplastic material thicknesses and gingival-margin designs for space closure in extraction treatment and to propose a computer-aided procedure to optimize CA design.
METHODS
The radiologic and intraoral scanning technology, in vitro mechanical experiment, viscoelastic modeling, and finite element analysis (FEA) were integrated to establish an orthodontic simulation model. Twelve FEA models of CA were created, comprising combinations of 2 kinds of thicknesses (0.75 and 0.50 mm), 2 forms of gingival-margin shape (scalloped and straight), and 3 types of margin height (-2, 0, and 2 mm). In vitro testing was carried out to determine the actual properties of material thickness.
RESULTS
A 0.75-mm-thick aligner resulted in greater periodontal ligament (PDL) stress than 0.50 mm, and there was no clear correlation between the control ability of tooth movement and the thickness. For different margin designs, PDL stress at -2 mm height was significantly lower than those with a higher border. Aligners with straight margins had higher stress than the scalloped aligners, whereas the differences were unnoticeable at 2 mm height. The optimized aligner with differential margin designs was recommended on the basis of biomechanical calculations, which facilitated the efficiency and control of tooth movement for multiple teeth.
CONCLUSIONS
The effect of material thickness and margin design of CA on the force and movement differed in different teeth. Preferable CA designs of each tooth during different movement stages should be presented personalized under the guidance of precise biomechanics instead of pure morphologic analysis.
Topics: Humans; Incisor; Maxilla; Computer Simulation; Mechanical Phenomena; Biomechanical Phenomena; Tooth Movement Techniques; Finite Element Analysis; Orthodontic Appliances, Removable; Orthodontic Appliance Design
PubMed: 36935221
DOI: 10.1016/j.ajodo.2022.12.014 -
British Dental Journal Nov 2023
Topics: Orthodontic Appliance Design; Orthodontic Appliances, Removable; Tooth Movement Techniques
PubMed: 38001178
DOI: 10.1038/s41415-023-6573-3 -
International Journal of Dental Hygiene Apr 2024This study aimed to determine the overall oral health statuses of patients with fixed orthodontic appliance and clear aligner, as well as their oral hygiene management...
Comparison of oral health status, oral hygiene management behaviours and satisfaction of patients with fixed orthodontic appliance and clear aligner: A quasi-experimental design.
OBJECTIVES
This study aimed to determine the overall oral health statuses of patients with fixed orthodontic appliance and clear aligner, as well as their oral hygiene management behaviours and satisfaction.
METHODS
We selected 40 participants (20 each with fixed orthodontic devices and clear aligners) who visited a dental clinic. We conducted a survey to determine the oral hygiene management behaviours of the subjects and their satisfaction with their orthodontic treatment. Three measurements were also conducted at 4-week intervals to determine the oral health statuses of the subjects.
RESULTS
The Löe and Silness gingival index of patients with fixed orthodontic appliances indicated moderate gingivitis (1.1 ± 0.3), and those with clear aligners had mild gingivitis (0.6 ± 0.4) (p < 0.001). The modified O'Leary index also indicated that the degree of dental plaque deposition in the oral cavity was lower in patients treated with a clear aligner (43.0 ± 18.2 points) than in those treated with a fixed orthodontic (28.1 ± 10.9 points) (p = 0.004). Regarding oral hygiene management, the fixed orthodontic group received scaling more frequently (p = 0.006), received more oral health education (p < 0.001) and had a longer brushing time (p = 0.008) than the clear aligner group. No significant difference was observed in satisfaction between the fixed orthodontic appliance and the clear aligner.
CONCLUSIONS
Regarding the oral health status by orthodontic appliance type, the clear aligner group had the advantages of reduction in dental plaque attachment and gingival health. The fixed orthodontic group exhibited better oral hygiene management behaviours. Satisfaction with orthodontic treatment was found to be similar for the two device types.
PubMed: 38659166
DOI: 10.1111/idh.12813 -
European Journal of Orthodontics Sep 2023To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment.
TRIAL DESIGN
Three-armed parallel-group randomized controlled trial.
METHODS
The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis.
RECRUITMENT
October 2010 to December 2012.
RESULTS
In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01.
CONCLUSIONS
To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended.
LIMITATIONS
The protocol was not registered, and the present study did not use a double-blinded design.
Topics: Adolescent; Humans; Child; Young Adult; Adult; Fluorides; Toothpastes; Mouthwashes; Reproducibility of Results; Esthetics, Dental; Dental Caries; Sodium Fluoride; Cariostatic Agents
PubMed: 37524332
DOI: 10.1093/ejo/cjad044 -
American Journal of Orthodontics and... Apr 2024In this study, we compared the dentitional changes after Invisalign and conventional orthodontic treatment with 4 first premolar extractions.
INTRODUCTION
In this study, we compared the dentitional changes after Invisalign and conventional orthodontic treatment with 4 first premolar extractions.
METHODS
This retrospective study included 57 patients whose orthodontic treatment involved the extraction of 4 first premolars because of bialveolar protrusion. A total of 27 patients were treated with Invisalign (mean age, 25.5 ± 5.2 years) and 30 patients with the fixed appliance (mean age, 24.4 ± 5.8 years). The angular and linear changes of the maxillary and mandibular central incisors, second premolars, first molars, and second molars were measured from the recordings on the basis of the lateral cephalograms taken before and after treatment. The angular changes of the canines and second premolars were measured using panoramic radiographs.
RESULTS
The overbite and interincisal angle increased significantly in the Invisalign group compared with in the conventional fixed appliance group (P <0.05). The maxillary central incisors showed increased lingual tipping in the Invisalign group (P <0.05), whereas there was no statistically significant difference in the angular change of the mandibular incisors between groups (P >0.05). The maxillary first and second molars showed mesial tipping in the Invisalign group (P <0.05). The maxillary second premolars, first and second molars, and the mandibular second molars showed mesial movement in the Invisalign group (P <0.05).
CONCLUSIONS
The Invisalign group showed more statistically significant lingual tipping of the maxillary central incisors, distal tipping of the maxillary canines, and mesial tipping of the maxillary first and second molars after maximum retraction of the anterior teeth compared with the fixed appliance group.
Topics: Humans; Young Adult; Adult; Adolescent; Bicuspid; Retrospective Studies; Tooth Movement Techniques; Orthodontic Appliances, Removable; Treatment Outcome; Maxilla; Orthodontic Appliances, Fixed; Cephalometry
PubMed: 38142394
DOI: 10.1016/j.ajodo.2023.10.014 -
Dental Research Journal 2024The objective is to compare the impact of clear aligner treatment (CAT) versus conventional fixed appliance treatment (FAT) on oral health-related quality of life... (Review)
Review
BACKGROUND
The objective is to compare the impact of clear aligner treatment (CAT) versus conventional fixed appliance treatment (FAT) on oral health-related quality of life (OHRQoL) among adults at five-time points: pretreatment (T0), 1 week (T1), 1 month after (T2), and 6 months after (T3) treatment initiation, and in the long-term follow-up (T4).
MATERIALS AND METHODS
Search terms were based on Medical Subject Headings (MeSH) and non-MeSH. Potentially eligible studies compared OHRQoL in clear aligner (CA) and fixed appliance (FA) patients. In February 2023, Scopus, Web of Science, Cochrane, and PubMed were searched for published studies. Nine out of 94 shortlisted papers were eligible for a systematic review. Of these nine papers, five studies were considered for a meta-analysis.
RESULTS
At T0, CA and FA patients had similar oral health impact profile (OHIP)-14 questionnaire scores with a standard mean difference (SMD) of 0.105 (confidence interval [CI]: -1.029-1.48). The SMD of the OHRQoL related to T1, T2, and T3 was -3.119 (CI: -0.145, 0.355), -1.527 (CI: -5.597, -0.64), and - 2.331 (CI: -1.906, -1.148). T4 showed no difference between groups (SMD = 0.007, CI: CI: -4.286, -0.376). Regarding the OHIP-14 domains, functional limitations remained consistent in both groups across all time intervals. Psychological discomfort exhibited a notable difference only at T2. Throughout the treatment, CAT showed significantly lower levels of physical, psychological, and social disability, as well as handicap, though these differences did not persist beyond T4. Notably, physical pain was the sole domain that remained elevated in the FAT group up to T4.
CONCLUSION
During the 1 day of the orthodontic treatment, both the CA and FA groups had comparable OHRQoL statuses. However, as time passed, the CA group notably improved their OHRQoL compared to the FA group. Interestingly, after a year or the completion of treatment, both groups eventually reached similar OHRQoL levels. Nevertheless, it is worth noting that FA patients continued to experience more physical pain even a year later.
PubMed: 38425319
DOI: No ID Found -
The Relationship between Personality Profiles and the Esthetic Perception of Orthodontic Appliances.International Journal of Dentistry 2024In orthodontics, patients' esthetic expectations involve the final esthetic result as well as the treatment's appliance choice. Personality traits can influence...
INTRODUCTION
In orthodontics, patients' esthetic expectations involve the final esthetic result as well as the treatment's appliance choice. Personality traits can influence patients' perception, treatment modality selection, expectations, compliance, and satisfaction with the treatment outcome, although there are very few studies on this interconnection between personality and orthodontic appliances.
OBJECTIVE
The aim of this study is to evaluate the relationship between personality traits and the esthetic perception of different orthodontic appliances.
MATERIALS AND METHODS
The online questionnaire is composed of three parts: (1) sociodemographic variables; (2) questions on the esthetic perception of different orthodontic appliances; (3) general personality assessment via the NEO-FFI. A total of 461 questionnaires were accepted.
RESULTS
There were statistically significant differences between laypeople and professionals related to assessing smiles and the need for orthodontic treatment. Laypeople identified a statistically significant relationship between personality traits and orthodontic appliances, in which esthetic perception is associated with high traits of agreeableness and openness. Neuroticism is most associated with orthodontic treatment with fixed appliances, which are the most conventional.
CONCLUSIONS
Professionals tend to have a more critical judgment than laypeople as far as esthetics is concerned. Personality traits play an important role in esthetic perception and may influence orthodontic treatment.
PubMed: 38715870
DOI: 10.1155/2024/8827652