Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis - Part 1.

This article explores the intersection of various systemic conditions with orthodontic treatment. Renal diseases, including chronic kidney disease and renal transplant, present challenges such as delayed tooth eruption and gingival overgrowth, necessitating careful orthodontic planning and collaboration with physicians. Liver diseases, particularly hepatitis, heighten the risk of periodontal disease and mandate strict infection control measures during orthodontic procedures. Ehlers-Danlos syndrome poses challenges related to collagen fragility, rapid tooth movement, and orthodontic relapse. Autoimmune diseases like diabetes mellitus and juvenile idiopathic arthritis require tailored orthodontic approaches considering oral complications and joint involvement.

Systemic Factors Affecting Orthodontic Treatment Outcomes and Prognosis-Part 2.

This article explores the various challenges systemic conditions can pose before and during orthodontic treatment. Cardiovascular conditions like infective endocarditis require antibiotic prophylaxis before certain orthodontic procedures are started. Patients with bleeding disorders require special considerations in regards to viral infection risk and maintenance of excellent atraumatic oral hygiene. Orthodontists play an important role in early identification of signs and symptoms of eating disorders and should deal with these patients sensitively. Congenital disorders, craniofacial anomalies, and nutritional deficiencies require special considerations and should be addressed appropriately before orthodontic treatment is started.

Is orthodontic research falling prey to obscure and predatory journals? A bibliometric study.

AIMS: To evaluate where orthodontic research papers are published and to explore potential relationships between the journal of publication and the characteristics of the research study and authorship. METHODS: An online literature search of seven research databases was undertaken to identify orthodontic articles published in English language over a 12-month period (1 January-31 December 2022) (last search: 12 June 2023). Data extracted included journal, article, and author characteristics. Journal legitimacy was assessed using a ternary classification scheme including available blacklists and whitelists, cross-checking of indexing claims and history of sending unsolicited emails. The level of evidence (LOE) of all included studies was assessed using a modified Oxford LOE classification scale. Univariable and multivariable ordinal logistic regression analyses were performed to examine possible associations between the level of evidence, journal discipline, and authorship characteristics. RESULTS: A total of 753 studies, published by 246 unique journal titles, were included and further assessed. Nearly two-thirds of orthodontic papers were published in non-orthodontic journals (62.8%) and over half (55.6%) of the articles were published in open-access policy journals. About a fifth of the articles (21.2%) were published either in presumed predatory journals or in journals of uncertain legitimacy. Journal discipline was significantly associated with the level of evidence. Higher-quality orthodontic studies were more likely published in established orthodontic journals (likelihood ratio test P < .001). LIMITATIONS: The identification and classification of predatory journals are challenging due to their covert nature. CONCLUSIONS: The majority of orthodontic articles were published in non-orthodontic journals. In addition, approximately one in five orthodontic studies were published in presumed predatory journals or in journals of uncertain legitimacy. Studies with higher levels of evidence were more likely to be published in established orthodontic journals.

Wilson curve modification in permanent dentition: a retrospective comparison between clear aligners and continuous archwire treatment.

OBJECTIVES: To evaluate leveling of the Curve of Wilson (COW) by two different treatment appliances (clear aligners [CA] and continuous archwire fixed appliances [FA]) in a permanent dentition sample of patients. MATERIALS AND METHODS: Digital casts of 40 patients (CA group = 20 patients; FA group = 20 patients) were collected. Angular values for COW, right and left vertical height difference of lower first molars, and linear distance between lower teeth and the WALA ridge were analyzed for pre- (T1), posttreatment (T2) and on final virtual (ClinCheck) models (T2-CC) of the CA group. An unpaired t-test was used to evaluate significant intergroup differences (P < .05), while a paired t-test was used for posttreatment CA intragroup comparison. RESULTS: FA group showed better control of second molar crown positions compared to CA group (47-WALA = -0.2 ± 0.1 mm, 37-WALA = -0.6 ± 0.3 mm). No significant difference was detected for linear distance of lower first molars and the WALA ridge or for vertical height difference. CA group showed a greater reduction of distance between lower premolars and the WALA ridge (mean difference: -0.5 mm for both 45-WALA and 35-WALA; mean difference: -0.5 mm for 44-WALA, -0.6 mm for 34-WALA). Predictability for the CA group was high for every measurement (87% Right COW, 89% Left COW, 88% 46 Vertical Diff, 87% 36 Vertical Diff). CONCLUSIONS: Clear aligner and continuous archwire mechanics were effective in leveling COW. FA was more effective in changing crown position of lower second molars with respect to the WALA ridge, while CA provided a greater distance reduction between lower premolars and WALA ridges compared to FA.

Optimization of three-dimensional printing parameters for orthodontic applications.

OBJECTIVES: To determine the impact of build orientation, increased layer thickness, and dental crowding on the trueness of three-dimensional (3D)-printed models, and to evaluate how these parameters affect the fit of thermoformed appliances. MATERIALS AND METHODS: Ninety-six dental models were printed horizontally and vertically on the building platform using different 3D-printing technologies: (1) a stereolithography (SLA) printer with layer thicknesses of 160 µm and 300 µm and (2) a digital light processing (DLP) printer with layer thicknesses of 100 µm and 200 µm. Each printed model was digitalized and superimposed on the corresponding source file using 3D rendering software, and deviations were quantified by the root mean square values. Subsequently, a total of 32 thermoformed appliances were fabricated on top of the most accurate 3D-printed models, and their fit was evaluated by digital superimposition and inspection by three blinded orthodontists. Paired t-tests were used to analyze the data. RESULTS: Significant differences (P < .05) between printing technologies used were identified for models printed horizontally, with the SLA system achieving better trueness, especially in crowded dentitions. No significant differences between technology were found when models were printed vertically. The highest values of deviation were recorded in appliances fabricated on top of DLP-printed models. The results of the qualitative evaluation indicated that appliances fabricated on top of SLA models outperformed the DLP-modeled appliances. CONCLUSIONS: Three-dimensional printing with increased layer height seems to produce accurate working models for orthodontic applications.

Lower incisor position in skeletal Class III malocclusion patients: a comparative study of orthodontic camouflage and orthognathic surgery.

OBJECTIVES: To determine the difference between orthodontic camouflage and orthodontic-orthognathic surgery using the traditional cephalometric measurement IMPA and the newly proposed IA/PAMD, the angle between the long axis of the lower incisor (IA) and the principal axis of the mandibular alveolus (PAMD). MATERIALS AND METHODS: This study included 40 cases each in the orthodontic camouflage group (OG) and orthodontic-orthognathic surgery group (SG). The differences between the IMPA and IA/PAMD before and after treatment were compared between the two groups. T0 lateral cephalometric images of the 10 cases with the highest and lowest increase in the IA/PAMD were analyzed to identify characteristics associated with a higher risk of overdecompensation of the lower incisors during presurgical orthodontic treatment. RESULTS: Both the OG and SG showed a significant improvement in hard- and soft-tissue measurements. However, in the OG, there was significant lingual inclination of the lower incisor but only a small change in the IA/PAMD. In the surgical group, the IMPA was close to 90° after treatment, but the IA/PAMD significantly increased. CONCLUSIONS: In orthodontic camouflage, the lower anterior teeth were significantly moved lingually with a better root-bone relationship. However, this relationship deteriorated in some surgical patients. Therefore, it is important to conduct cephalometric or cone-beam computed tomography examinations during preoperative orthodontics to identify and prevent possible periodontal risks.

Orthodontic treatment outcome predictive performance differences between artificial intelligence and conventional methods.

OBJECTIVES: To evaluate an artificial intelligence (AI) model in predicting soft tissue and alveolar bone changes following orthodontic treatment and compare the predictive performance of the AI model with conventional prediction models. MATERIALS AND METHODS: A total of 1774 lateral cephalograms of 887 adult patients who had undergone orthodontic treatment were collected. Patients who had orthognathic surgery were excluded. On each cephalogram, 78 landmarks were detected using PIPNet-based AI. Prediction models consisted of 132 predictor variables and 88 outcome variables. Predictor variables were demographics (age, sex), clinical (treatment time, premolar extraction), and Cartesian coordinates of the 64 anatomic landmarks. Outcome variables were Cartesian coordinates of the 22 soft tissue and 22 hard tissue landmarks after orthodontic treatment. The AI prediction model was based on the TabNet deep neural network. Two conventional statistical methods, multivariate multiple linear regression (MMLR) and partial least squares regression (PLSR), were each implemented for comparison. Prediction accuracy among the methods was compared. RESULTS: Overall, MMLR demonstrated the most accurate results, while AI was least accurate. AI showed superior predictions in only 5 of the 44 anatomic landmarks, all of which were soft tissue landmarks inferior to menton to the terminal point of the neck. CONCLUSIONS: When predicting changes following orthodontic treatment, AI was not as effective as conventional statistical methods. However, AI had an outstanding advantage in predicting soft tissue landmarks with substantial variability. Overall, results may indicate the need for a hybrid prediction model that combines conventional and AI methods.

Influence of Invisalign precision bite ramp utilization on deep bite correction and root length in adults.

OBJECTIVES: To assess the influence of Invisalign precision bite ramp use on skeletal deep overbite correction and root length and volume of maxillary anterior teeth. MATERIALS AND METHODS: This was a retrospective study of 60 adults with skeletal deep overbite. Patients were divided into three groups: Invisalign (Align Technology, San Jose, Calif) with precision bite ramps (Invisalign with Bite Ramps [IBR] = 12), Invisalign with no bite ramps (INBR = 22), and full-fixed appliances (FFA = 26). Cone beam computed tomography records at T1 (pretreatment) and T2 (posttreatment) were used to measure eight skeletal, nine dental, and three soft-tissue cephalometric variables. Maxillary anterior teeth root length (mm), root volume (mm3), and percent root volume loss between T1 and T2 (%) were also recorded. RESULTS: Significant changes from T1 to T2 among the three groups were seen in ANB(o), lower face height (%), ODI (overbite depth indicator) (o), and U1-SN (o). Reduction in root length was significantly less (P < .001) in the INBR and IBR groups compared to the FFA group. Reduction in root volume and percent volume loss were significantly higher in the INBR group compared to the IBR group (P < .001), but the difference between the two Invisalign groups and the FFA group was not significant. CONCLUSIONS: Skeletal deep overbite correction using Invisalign with or without bite ramps is comparable to FFA. Reduction in root length was significantly less with Invisalign compared to FFA. Bite ramps influenced root volume and volume loss but not root length.

Vertical and transverse treatment effects of Invisalign First system compared to Hyrax maxillary expanders with fixed appliances in mixed dentition patients.

OBJECTIVES: To compare vertical and transverse changes in mixed dentition patients treated with the Invisalign First System (IFS) to those treated with a banded hyrax expander with fixed appliances (Hyrax) and control groups, and to assess the efficiency rate of dental arch expansion with IFS. MATERIALS AND METHODS: The study included 80 mixed dentition patients, with 40 in each group (IFS and Hyrax) and 40 controls from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection. Skeletal and dental vertical dimension changes and arch width changes between pretreatment (T1) and posttreatment (T2) were evaluated. RESULTS: Age at T1, time interval (T1-T2), sex, and Angle class did not significantly differ among the groups. Mandibular plane angle changes showed a similar reduction for the control and IFS groups, with no changes in the Hyrax group. However, the differences among the three groups did not reach statistical significance (P = .06). The Hyrax group showed significantly greater expansion in maxillary intermolar width compared to the IFS group, 4.4 vs 2.5 mm, respectively. The efficiency of maxillary expansion using IFS ranged from 52.3% to 76.87%. CONCLUSIONS: During the mixed dentition stage, no significant changes occurred in vertical dimensions among the control, Hyrax, and IFS groups. Although there was a trend suggesting a greater reduction in mandibular plane angle in the IFS group compared to the Hyrax group, this may not be clinically significant given the less than 1° difference. IFS can be a viable option for addressing mild arch width deficiencies, with a predictable increase in intermolar width of approximately 2.5 mm.

Orthodontic finishing errors detected in board-approved cases: common types and prediction.

OBJECTIVE: To report and rank orthodontic finishing errors recorded in the clinical phase of the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) examination and correlate pretreatment case complexity with orthodontic treatment outcomes. MATERIALS AND METHODS: This single-center cross-sectional survey collected retrospective data from the clinical phase of BBO examinations between 2016 and 2023. The quality of orthodontic clinical outcomes of each case was assessed by means of the Cast-Radiograph Evaluation (CRE), while case complexity was evaluated using the Discrepancy Index (DI), both tools provided by the American Board of Orthodontics. Survey items were analyzed using descriptive statistics, and a correlation analysis between total CRE and DI scores (p<0.05) was also performed. RESULTS: A total of 447 orthodontic records was included. Orthodontic finishing errors were often observed, and no case was completely perfect. In the total CRE score, an average of 15 points was discounted for each case. Most frequently found issues involved problems with alignment, buccolingual inclination, marginal ridge, and occlusal relationship. The median DI score for initial case complexity was 22.0 (range 10.0 - 67.0). There was no significant correlation between the DI and CRE scores (p=0.106). CONCLUSION: Orthodontic finishing errors are inevitable, even in well-finished board-approved cases. Rotation, excessive buccolingual inclination, and discrepancies in marginal ridges are the most frequently observed areas of concern, in that order. Moreover, while case complexity, determined by DI, can impact orthodontic planning and pose challenges for clinicians, the study did not consider it a determining factor in predicting treatment outcomes.

Shared decision making for patients needing dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance therapy: a comparison between Pakistani patients' and clinicians' perspective.

INTRODUCTION: Shared decision making (SDM) involves presenting patients with relevant information about a health issue and reaching a clinical decision based on their preferences. However, its application in orthodontics lacks documentation. OBJECTIVE: This study aimed to assess and compare the perspectives of patients and clinicians on SDM in different cases. METHODS: A cross-sectional study was conducted at a tertiary care hospital in Pakistan, involving 90 patients categorized into three groups (dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance treatment). Following clinical assessment and treatment plan discussions, patients and clinicians completed a 12-item dyadic observing patient involvement in decision making (OPTION) questionnaire, to gauge their perspectives on SDM. Mean OPTION scale scores were compared using paired sample t-tests between clinicians and patients, and intergroup comparisons utilized paired sample t-tests and Pearson correlation coefficients. RESULTS: OPTION scores were similar between patients/parents and clinicians. However, statistically significant differences were found regarding the questions about "different sources of information", "different options (including the possibility of doing nothing)" and "concerns regarding management", with the patients giving overall lower OPTION scores. Patients gave lower SDM OPTION scores for conventional orthodontic treatment, but higher scores for orthopedic and orthognathic surgery, as compared to the clinicians. CONCLUSIONS: The current study revealed an overall consensus in the mean total scores of OPTION scales between patients and clinicians. However, when stratified, patients showed higher SDM scores for orthopedic and orthognathic cases, and lower scores for conventional orthodontic treatment.

Digital Platform Facilitates Successful Facially Driven Orthodontic-Restorative Treatment.

This case report presents a novel digital technique for prosthetically driven orthodontic treatment. A 28-year-old patient who had undergone orthodontics as a teenager experienced a relapse and presented with esthetic concerns. The author utilized state-of-the-art software to create a virtual orthodontic-restorative treatment outcome with virtual restorations. This approach helped guide tooth movement, improve team communication, and optimize treatment outcomes while allowing for minimally invasive restorative treatment.