In Vitro Investigation Using a New Biomechanical Force-Torque Analysis System: Comparison of Conventional and CAD/CAM-Fixed Orthodontic Retainers.

(1) Background: After more than a decade since their first description, Inadvertent Tooth Movements (ITMs) remain an adverse effect of orthodontic retainers without a clear etiology. To further investigate the link between ITMs and the mechanical properties of different retainers, the response upon vertical loading was compared in three retainer types (two stainless steel and one nickel-titanium). The influence of different reference teeth was also considered. (2) Methods: Three retainers (R1, R2, R3) were tested in a newly developed biomechanical analysis system (FRANS). They were bonded to 3D-printed models of the lower anterior jaw and vertically displaced up to 0.3 mm. Developing forces and moments were recorded at the center of force. (3) Results: The vertical displacement caused vertical forces (Fz) and labiolingual moments (My) to arise. These were highest in the lateral incisors (up to 2.35 ± 0.59 N and 9.27 ± 5.86 Nmm for R1; 1.69 ± 1.06 N and 7.42 ± 2.65 Nmm for R2; 3.28 ± 1.73 N and 15.91 ± 9.71 Nmm for R3) for all analyzed retainers and with the R3 retainer for all analyzed reference teeth, while the lowest Fz and My values were recorded with the R1 retainer. (4) Conclusions: Displacements of 0.2 mm and larger provided forces and moments which could be sufficient to cause unwanted torque movements, such as ITMs, in all analyzed retainers. Clinicians must be mindful of these risks and perform post-treatment checkups on patients with retainers of all materials.

Biomechanical simulation of segmented intrusion of a mandibular canine using Robot Orthodontic Measurement & Simulation System (ROSS).

OBJECTIVE: Aim of this study was to investigate the forces and moments during segmented intrusion of a mandibular canine using Cantilever-Intrusion-Springs (CIS). METHODS: Three different CIS modifications were investigated using a robotic biomechanical simulation system: unmodified CIS (#1, control), CIS with a lingual directed 6° toe-in bend (#2), and CIS with an additional 20° twist bend (#3). Tooth movement was simulated by the apparative robotic stand, controlled by a force-control algorithm, recording the acting forces and moments with a force-torque sensor. Statistical analysis was performed using Shapiro-Wilk, Kolmogorov-Smirnov, Kruskal-Wallis ANOVA and post hoc tests with Bonferroni correction (α = 0.05). RESULTS: The initial intrusive force, which was uniformly generated by a 35° Tip-Back bend, decreased significantly (p < 0.05) from 0.31 N in group (#1) to 0.28 N in group (#3). Vestibular crown tipping reduced significantly (p < 0.05) from 2.11° in group (#1) and 1.72° in group (#2) to 0.05° in group (#3). Matching to that the direction of orovestibular force significantly (p < 0.05) shifted from 0.15 N to vestibular in group (#1) to 0.51 N to oral in group (#3) and the orovestibular tipping moment decreased also significantly (p < 0.05) from 4.63 Nmm to vestibular in group (#1) to 3.56 Nmm in group (#2) and reversed to 1.20 Nmm to oral in group (#3). Apart from that the orovestibular displacement changed significantly (p < 0.05) from 0.66 mm in buccal direction in group (#1) to 0.29 mm orally in group (#2) and 1.49 mm in oral direction as well in group (#3). SIGNIFICANCE: None of the modifications studied achieved pure mandibular canine intrusion without collateral effects. The significant lingual displacement caused by modification (#3) is, not least from an aesthetic perspective, considered much more severe than a slight tipping of the canine. Consequently, modification (#2) can be recommended for clinical application based on the biomechanical findings.

Torque expression of superelastic NiTi V-Slot and conventional stainless steel orthodontic bracket-archwire combinations - A finite element analysis.

BACKGROUND: To investigate the torque expression of conventional stainless steel (SS) brackets in combination with rectangular SS archwires and nickel-titanium (NiTi) V-slot brackets in combination with V-shaped NiTi archwires using finite element analysis (FEA). METHODS: CAD models were created for a conventional bracket and rectangular archwires with dimensions of 0.018″x0.025″ and 0.019″x0.025″, and for a V-slot bracket and V-shaped archwires with heights of 0.55 mm, 0.60 mm and 0.70 mm. FEA was performed using Ansys 2022R2 software to assess the forces and moments during simulated torsion of the archwires in the brackets between 0° and 25° with varying interbracket distances and free path lengths. RESULTS: The V-slot bracket-archwire combination exhibited force transmission and moment generation within 1° of torsion. The transmissible force increased with the torsion angle, but showed an upper limit of about 13-14 Nmm. The SS bracket-archwire combination showed negligible forces and moments for simulated torsion between 0° and 15°. At torsions of 25°, moments of 12 Nmm and 14 Nmm occurred for the 0.018″x0.025″ and 0.019″x0.025″ archwire dimensions, respectively. CONCLUSIONS: The V-slot bracket-archwire combination is effective in expressing torque and preventing both over- and under-activation. Conventional bracket-archwire combinations showed torsional losses due to play between 10 and 15°, depending on the dimensions of the respective archwire, and no upper torsional moment limit.

Comparing Torque Transmission of Different Bracket Systems in Combination with Various Archwires Considering Play in the Bracket Slot: An In Vitro Study.

This study aims to examine the play between various archwires and bracket systems, exploring potential variations in angle values for specific torque and torque values for a given angle along different bracket systems. Therefore, seven brackets systems were evaluated in conjunction with different stainless steel archwires of varying dimensions (0.016″ × 0.022″, 0.018″ × 0.025″, and 0.019″ × 0.025″). Biomechanical behavior during torque development and transmission was assessed using a six-component force/torque sensor. Torque angles (5-45°) were specified with subsequent torque measurement, and the sequence was reversed by setting the torque (5-30 Nmm) and measuring the angle. A reference measurement with 0 Nmm torque served to evaluate bracket slot play. Bracket play (0 Nmm) during palatal load ranged between 20.06° and 32.50° for 0.016″ × 0.022″ wire, 12.83° and 21.11° for 0.018″ × 0.025″ wire, and 8.39° and 18.73° for 0.019″ × 0.025″ wire. The BioQuick® bracket exhibited the highest play, while Wave SL® and Damon® Q brackets demonstrated the lowest play (p < 0.001). Significant differences (p < 0.001) between the brackets were observed in the torque angles required to achieve torques of 5-20 Nmm. In summary, each bracket system has a different torque transmission, which is of great clinical importance in order to achieve correct torque transmission and avoid complications such as root resorption.

Biomechanical Simulation of Orthodontic En-Bloc Retraction Comparing Compound Technique and Sliding Mechanics Using a HOSEA Robotic Device.

En-bloc retraction is a common procedure in orthodontic therapy. The application of palatal root torque moments is required to control incisor inclination during retraction, yet studies comparing forces and moments with respect to different mechanics are lacking. This study aimed to investigate the forces and moments during orthodontic en-bloc retraction using a robotic biomechanical simulation system, comparing two distinct approaches: (I) compound technique [stainless steel (SS) combined with nickel-titanium (NiTi)] using industrially pretorqued retraction-torque-archwires (RTA) in combination with NiTi closed coil springs; (II) conventional sliding mechanics using SS archwires with manually applied anterior twist bends in combination with elastic chains. Two dimensions (0.017" × 0.025" and 0.018" × 0.025") and ten archwires per group were investigated using 0.022" slot self-ligating brackets. Kruskal-Wallis tests with a significance level of α = 0.05 were conducted. The biomechanical simulation showed that en-bloc retraction was characterized by a series of tipping and uprighting movements, differing significantly regarding the examined mechanics. Collateral forces and moments occurred in all groups. Notably, RTA exhibited fewer extrusive forces. The most bodily movement was achieved with the compound technique and the 0.018" × 0.025" RTA. Sliding mechanics exhibited maximum palatal root torque moments of more than 20 Nmm, exceeding recommended values.

Influence of the design of 3D-printed indirect bonding trays and experience of the clinician on the accuracy of bracket placement.

PURPOSE: The aim was to investigate the influence of three different three-dimensional (3D)-printed bonding tray designs and professional experience on accuracy of indirect bracket placement. METHODS: Virtual bracket placement was performed on a scanned dental model using OnyxCeph software (Image Instruments, Chemnitz, Germany). Three different designs for indirect bonding trays (open, semi-open, and closed design) were created and produced using a 3D printer. To analyze the influence of professional experience, one of the three tray designs was produced twice. In this case, bracket placement was performed by an inexperienced dentist. Bracket positions were scanned after the indirect bonding procedure. Linear and angular transfer errors were measured. Significant differences between the target and actual situation were analyzed using the Kruskal-Wallis and χ2 test. RESULTS: All bonding tray designs resulted in comparable results. The results of the unexperienced dentist showed significantly higher deviations than those for the experienced orthodontist in the torque direction. However, the mean values were comparable. The open tray design exceeded the clinically acceptable limits of 0.25 mm and 1° more often. The inexperienced dentist exceeded these limits significantly more often than the experienced orthodontist in the vertical and torque direction. The immediate bracket loss rate showed no significant differences between the different tray designs. Significantly more bracket losses were observed for the inexperienced dentist during the procedure compared to the experienced orthodontist. CONCLUSIONS: The bonding tray design and professional experience had an influence on the exceedance of clinically relevant limits of positioning accuracy and on the bracket loss rate.

Load Deflection Characteristics of Orthodontic Gummetal® Wires in Comparison with Nickel-Titanium Wires: An In Vitro Study.

The aim of this study was to investigate the load deflection characteristics of Gummetal® wires in comparison to nickel-titanium (NiTi) wires. Four different NiTi wires and one Gummetal® archwire were analyzed in two dimensions (0.014″ (0.36 mm) and 0.016″ × 0.022″ (0.41 mm × 0.56 mm)) and in two different orientations (edgewise and ribbonwise) using three-point bending tests at T = 37 °C. Force-displacement curves were recorded and analyzed. The Gummetal® 0.014″ wires exhibited higher forces compared to the NiTi wires at 2.0 mm deflection. At 1.0 mm deflection, the opposite pattern was observed. For the 0.016″ × 0.022″ Gummetal® wires, the forces were within the force interval of the NiTi wires at 2.0 mm deflection. At a deflection of 1.0 mm, no residual force was measurable for the Gummetal® wires. All the NiTi wires investigated showed hysteresis and a superelastic plateau. However, the Gummetal® did not form a plateau, but hysteresis was present. An easier plastic deformability compared to the NiTi wires was observed for all the tested geometries.

Investigation of Forces and Moments during Orthodontic Tooth Intrusion Using Robot Orthodontic Measurement and Simulation System (ROSS).

The Robot Orthodontic Measurement and Simulation System (ROSS) is a novel biomechanical, dynamic, self-regulating setup for the simulation of tooth movement. The intrusion of the front teeth with forces greater than 0.5 N poses a risk for orthodontic-induced inflammatory root resorption (OIIRR). The aim was to investigate forces and moments during simulated tooth intrusion using ROSS. Five specimens of sixteen unmodified NiTi archwires and seven NiTi archwires with intrusion steps from different manufacturers (Forestadent, Ormco, Dentsply Sirona) with a 0.012″/0.014″/0.016″ wire dimension were tested. Overall, a higher wire dimension correlated with greater intrusive forces Fz (0.012″: 0.561-0.690 N; 0.014″: 0.996-1.321 N; 0.016″: 1.44-2.254 N) and protruding moments Mx (0.012″: -2.65 to -3.922 Nmm; 0.014″: -4.753 to -7.384 Nmm; 0.016″: -5.556 to -11.466 Nmm) during the simulated intrusion of a 1.6 mm-extruded upper incisor. However, the 'intrusion efficiency' parameter was greater for smaller wire dimensions. Modification with intrusion steps led to an overcompensation of the intrusion distance; however, it led to a severe increase in Fz and Mx, e.g., the Sentalloy 0.016″ medium (Dentsply Sirona) exerted 2.891 N and -19.437 Nmm. To reduce the risk for OIIRR, 0.014″ NiTi archwires can be applied for initial aligning (without vertical challenges), and intrusion steps for the vertical levelling of extruded teeth should be bent in the initial archwire, i.e., 0.012″ NiTi.

Fluid flow shear stress and tissue remodeling-an orthodontic perspective: evidence synthesis and differential gene expression network analysis.

Introduction: This study aimed to identify and analyze in vitro studies investigating the biological effect of fluid-flow shear stress (FSS) on cells found in the periodontal ligament and bone tissue. Method: We followed the PRISMA guideline for systematic reviews. A PubMed search strategy was developed, studies were selected according to predefined eligibility criteria, and the risk of bias was assessed. Relevant data related to cell source, applied FSS, and locus-specific expression were extracted. Based on this evidence synthesis and, as an original part of this work, analysis of differential gene expression using over-representation and network-analysis was performed. Five relevant publicly available gene expression datasets were analyzed using gene set enrichment analysis (GSEA). Result: A total of 6,974 articles were identified. Titles and abstracts were screened, and 218 articles were selected for full-text assessment. Finally, 120 articles were included in this study. Sample size determination and statistical analysis related to methodological quality and the ethical statement item in reporting quality were most frequently identified as high risk of bias. The analyzed studies mostly used custom-made fluid-flow apparatuses (61.7%). FSS was most frequently applied for 0.5 h, 1 h, or 2 h, whereas FSS magnitudes ranged from 6 to 20 dyn/cm2 depending on cell type and flow profile. Fluid-flow frequencies of 1 Hz in human cells and 1 and 5 Hz in mouse cells were mostly applied. FSS upregulated genes/metabolites responsible for tissue formation (AKT1, alkaline phosphatase, BGLAP, BMP2, Ca2+, COL1A1, CTNNB1, GJA1, MAPK1/MAPK3, PDPN, RUNX2, SPP1, TNFRSF11B, VEGFA, WNT3A) and inflammation (nitric oxide, PGE-2, PGI-2, PTGS1, PTGS2). Protein-protein interaction networks were constructed and analyzed using over-representation analysis and GSEA to identify shared signaling pathways. Conclusion: To our knowledge, this is the first review giving a comprehensive overview and discussion of methodological technical details regarding fluid flow application in 2D cell culture in vitro experimental conditions. Therefore, it is not only providing valuable information about cellular molecular events and their quantitative and qualitative analysis, but also confirming the reproducibility of previously published results.

Force-Controlled Biomechanical Simulation of Orthodontic Tooth Movement with Torque Archwires Using HOSEA (Hexapod for Orthodontic Simulation, Evaluation and Analysis).

This study aimed to investigate the dynamic behavior of different torque archwires for fixed orthodontic treatment using an automated, force-controlled biomechanical simulation system. A novel biomechanical simulation system (HOSEA) was used to simulate dynamic tooth movements and measure torque expression of four different archwire groups: 0.017″ x 0.025″ torque segmented archwires (TSA) with 30° torque bending, 0.018″ x 0.025″ TSA with 45° torque bending, 0.017″ x 0.025″ stainless steel (SS) archwires with 30° torque bending and 0.018″ x 0.025″ SS with 30° torque bending (n = 10/group) used with 0.022″ self-ligating brackets. The Kruskal-Wallis test was used for statistical analysis (p < 0.050). The 0.018″ x 0.025″ SS archwires produced the highest initial rotational torque moment (My) of -9.835 Nmm. The reduction in rotational moment per degree (My/Ry) was significantly lower for TSA compared to SS archwires (p < 0.001). TSA 0.018″ x 0.025″ was the only group in which all archwires induced a min. 10° rotation in the simulation. Collateral forces and moments, especially Fx, Fz and Mx, occurred during torque application. The measured forces and moments were within a suitable range for the application of palatal root torque to incisors for the 0.018″ x 0.025″ archwires. The 0.018″ x 0.025″ TSA reliably achieved at least 10° incisal rotation without reactivation.

Biomechanical simulation of forces and moments of initial orthodontic tooth movement in dependence on the used archwire system by ROSS (Robot Orthodontic Measurement & Simulation System).

OBJECTIVES: Aim of this study was to determine the forces and moments during simulated initial orthodontic tooth movements using a novel biomechanical test setup. METHODS: The test setup consisted of an industrial precision robot with a force-torque sensor, a maxillary model and a control computer and software. Forces and moments acting on the corresponding experimental tooth during the motion simulations were dynamically measured for two 0.016" NiTi round archwires (Sentalloy Light/Sentalloy Medium). Intrusive (#1), rotational (#2) and angular (#3) tooth movements were simulated by a control program based on the principle of force control and executed by the robot. The results were statistically analysed using K-S-test and Mann-Whitney U test with a significance level of α = 5%. RESULTS: Sentalloy Medium archwires generated higher forces and moments than the Sentalloy Light archwires in all simulations. In simulation #1 the mean initial forces/moments reached 1.442 N/6.781 Nmm for the Light archwires and 1.637 N/9.609 Nmm for the Medium archwires. In movement #2 Light archwires generated mean initial forces/moments of 0.302 N/-8.271 Nmm whereas Medium archwires generated 0.432 N/-9.653 Nmm. Simulation #3 showed mean initial forces/moments of -0.122 N/8.477 Nmm from the Light archwires compared to -0.300 N/11.486 Nmm for the Medium archwires. SIGNIFICANCE: The measured forces and moments were suitable for initial orthodontic tooth movement in simulations #2 and #3, however inadequate in simulation #1. Reduced archwire dimensions (<0.016″) should be selected for initial leveling of vertical malocclusions.

Thermal Programming of Commercially Available Orthodontic NiTi Archwires.

The shape of superelastic Nickel-Titanium (NiTi) archwires can be adjusted with thermal treatments using devices such as the Memory-MakerTM (Forestadent), which potentially affects their mechanical properties. The effect of such treatments on these mechanical properties was simulated by means of a laboratory furnace. Fourteen commercially available NiTi wires (0.018″ × 0.025″) were selected from the manufacturers American Orthodontics, Dentaurum, Forestadent, GAC, Ormco, Rocky Mountain Orthodontics and 3M Unitek. Specimens were heat treated using different combinations of annealing duration (1/5/10 min) and annealing temperature (250-800 °C) and investigated using angle measurements and three-point bending tests. Complete shape adaptation was found at distinct annealing durations/temperatures for each wire ranging between ~650-750 °C (1 min), ~550-700 °C (5 min) and ~450-650 °C (10 min), followed by a loss of superelastic properties shortly afterwards at ~750 °C (1 min), ~600-650 °C (5 min) and ~550-600 °C (10 min). Wire-specific working ranges (complete shaping without loss of superelasticity) were defined and a numerical score (e.g., stable forces) was developed for the three-point bending test. Overall, the wires Titanol Superelastic (Forestadent), Tensic (Dentaurum), FLI CuNiTi27 (Rocky Mountain Orthodontics) and Nitinol Classic (3M Unitek) proved to be the most user-friendly. Thermal shape adjustment requires wire-specific working ranges to allow complete shape acceptance and high scores in bending test performance to ensure permanence of the superelastic behaviour.

Influence of growth structures and fixed appliances on automated cephalometric landmark recognition with a customized convolutional neural network.

BACKGROUND: One of the main uses of artificial intelligence in the field of orthodontics is automated cephalometric analysis. Aim of the present study was to evaluate whether developmental stages of a dentition, fixed orthodontic appliances or other dental appliances may affect detection of cephalometric landmarks. METHODS: For the purposes of this study a Convolutional Neural Network (CNN) for automated detection of cephalometric landmarks was developed. The model was trained on 430 cephalometric radiographs and its performance was then tested on 460 new radiographs. The accuracy of landmark detection in patients with permanent dentition was compared with that in patients with mixed dentition. Furthermore, the influence of fixed orthodontic appliances and orthodontic brackets and/or bands was investigated only in patients with permanent dentition. A t-test was performed to evaluate the mean radial errors (MREs) against the corresponding SDs for each landmark in the two categories, of which the significance was set at p < 0.05. RESULTS: The study showed significant differences in the recognition accuracy of the Ap-Inferior point and the Is-Superior point between patients with permanent dentition and mixed dentition, and no significant differences in the recognition process between patients without fixed orthodontic appliances and patients with orthodontic brackets and/or bands and other fixed orthodontic appliances. CONCLUSIONS: The results indicated that growth structures and developmental stages of a dentition had an impact on the performance of the customized CNN model by dental cephalometric landmarks. Fixed orthodontic appliances such as brackets, bands, and other fixed orthodontic appliances, had no significant effect on the performance of the CNN model.

Influence of the force magnitude of fixed functional appliances for class II subdivision 1 treatment-a cephalometric study.

PURPOSE: To investigate the skeletal and dental effects of a hybrid fixed functional appliance (FFA) used with different force magnitudes for class II subdivision 1 treatment. METHODS: Treatment records from 70 patients were evaluated: 35 patients were treated with a FFA with standard activation (SUS group) and 35 with a FFA with an additional force-generating spring (TSUS group). Two control groups were matched from the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collection for comparison with the two treatment groups to determine skeletal and dental treatment effects. The cephalometric parameters at T0 (before treatment) and T1 (before debonding) were assessed using the Munich standard cephalometric analysis and by the sagittal occlusal analysis (SO) according to Pancherz. Data were analyzed statistically using SPSS. RESULTS: No statistically significant difference for any cephalometric parameter was observed between the SUS and TSUS groups concerning the measurements at T0 and T1. Both treatment groups exhibited an effective class II therapy mainly due to a significant reduction in SNA, and ANB and an increase in SNB. In contrast to the control group, as the result of treatment a skeletal class I was achieved. CONCLUSION: No significant statistical differences were observed between the patient group treated with the FFA with standard activation (SUS) and those treated with an additional spring (TSUS) regarding the cephalometric parameters investigated. Both variants were equally effective in treating class II division 1 malocclusions.

Force behaviour of elastic chains during a simulated gap closure in extraction therapy cases.

OBJECTIVE: Tooth movement with elastic chains requires defined force magnitudes. This study assessed the force behaviour of different elastic chains at different configurations of gap width. METHODS: Self-ligating brackets of teeth 5 & 6 and 2 & 3 were bonded to two movable aluminium plates. The plates were positioned on a joint basis with varying distances of 0.5, 2.0, 4.0, 6.0, and 8.0 mm. Reset forces of open and closed chains from four different manufacturers were investigated in four different configurations. Configurations differed in either having an additional intermediate ring within the gap (#1, #3) and/or having intermediate rings between teeth adjacent to the gap (#1, #2), or by no intermediate rings (#4). Forces were measured with a universal testing machine. The results were statistically analysed using U-test, H-test and (if applicable) post-hoc tests with a significance level of .05. RESULTS: Configurations #1 and #3, and #2 and #4 formed homogenous subgroups (P < .001). Initial forces in configuration #4 were significantly higher than in configuration #3 (P = .029). Initial forces in closed chains were significantly higher than for open chains (P = .029). CONCLUSIONS: Intermediate chain rings adjacent to the gap are not required to modulate the force. In contrast, leaving a ring unapplied in the tooth gap can help modulate the force. Open thermoset chains with an additional ring within the gap (#3) seem to produce suitable initial forces for a gap closure of 4 mm. With a residual gap width of <2 mm, open thermoset chains and closed thermoset chains (#4) seem suitable.

Functional Orthodontic Treatment of Mandibular Condyle Fractures in Children and Adolescent Patients: An MRI Follow-Up.

BACKGROUND: The purpose of this study was to retrospectively evaluate and follow up a conservative treatment approach with functional orthodontic appliances for the management of mandibular condyle fractures in children and adolescent patients. METHODS: Between 2020 and 2022, the treatment records of patients with mandibular condyle fractures receiving a functional orthodontic treatment (FOT) were evaluated. In addition to the clinical and functional findings, magnetic resonance images of the mandibular condyles and surrounding structures were assessed. RESULTS: Out of 61 patients, 8 met the inclusion criteria. The follow-up examination records showed no functional limitations. In 75% of cases, mild midline deviations persisted (mean 1.1 mm) without significant alterations to the occlusal relationships. Magnetic resonance imaging (MRI) showed the remodeling of the condyles and the restitution of the ramus heights, even in dislocated and displaced fractures. In three cases, a partial displacement of the articular disc was observed at the follow-up. No differences in the remodeling patterns were noted depending on age, sex, or fracture location. CONCLUSIONS: A FOT led to favorable functional and morphologic outcomes, supporting the concept of a conservative functional approach in children and adolescent patients. Functional adjunctive therapy should be considered in the conservative treatment of mandibular condyle fractures in growing patients.

Accuracy of 3D Tooth Movements in the Fabrication of Manual Setup Models for Aligner Therapy.

Background: The clinical outcome of aligner therapy is closely related to the precision of its setup, which can be manually or digitally fabricated. The aim of the study is to investigate the suitability of manual setups made for aligner therapy in terms of the precision of tooth movements. Methods: Six dental technicians were instructed to adjust each of eleven duplicate plaster casts of a patient models as follows: a 1 mm pure vestibular translation of tooth 11 and a 15° pure mesial rotation of tooth 23. The processed setup models were 3D scanned and matched with the reference model. The one-sample Wilcoxon signed-rank test (p < 0.05) was used for evaluation. Results: The overall precision of the translational movement covers a wide range of values from 0.25 to 2.26 mm (median: 1.09 mm). The target value for the rotation of tooth 23 was achieved with a median rotation of 9.76° in the apical-occlusal direction. Unwanted movements in the other planes also accompanied the rotation. Conclusions: A manual setup can only be fabricated with limited precision. Besides the very high variability between technicians, additional unwanted movements in other spatial planes occurred. Manually fabricated setups should not be favored for aligner therapy due to limited precision.

Friction Force Adjustment by an Innovative Covering System Applied with Superelastic NiTi Brackets and Wires-An In-Vitro Study.

The aim of this study was the investigation of polymeric coverings to adjust frictional forces between V-shaped wires and brackets, both made of superelastic NiTi. Adjustment of frictional forces is relevant for certain stages during orthodontic therapy. Coverings able to generate frictional forces when assembled to such brackets are additively manufactured. Six different internal widths of coverings were examined in three different environments: dry condition at room temperature (RT) or body temperature (BT), or artificial saliva (AS) at RT. The different coverings significantly affected the frictional forces for all media (p < 0.001). A correlation between internal width of the covering and resulting frictional forces was found. BT and dry environment showed the lowest friction forces for all samples. The highest force was found for two covering types at RT in AS, while the remaining four covering types showed the highest values in dry environment (p < 0.001). Friction could, therefore, be adjusted by variation of bracket covering clipped onto brackets, which is useful for orthodontic therapy. Coverings delivering higher friction provide dental anchorage, while coverings with lower friction can be used for tooth movement or purely esthetic reasons. It was shown that the variation of covering width may be used for adjustment of frictional forces.

Bracket Transfer Accuracy with the Indirect Bonding Technique-A Systematic Review and Meta-Analysis.

PURPOSE: To investigate the bracket transfer accuracy of the indirect bonding technique (IDB). METHODS: Systematic search of the literature was conducted in PubMed MEDLINE, Web of Science, Embase, and Scopus through November 2021. SELECTION CRITERIA: In vivo and ex vivo studies investigating bracket transfer accuracy by comparing the planned and achieved bracket positions using the IDB technique were considered. Information concerning patients, samples, and applied methodology was collected. Measured mean transfer errors (MTE) for angular and linear directions were extracted. Risk of bias (RoB) in the studies was assessed using a tailored RoB tool. Meta-analysis of ex vivo studies was performed for overall linear and angular bracket transfer accuracy and for subgroup analyses by type of tray, tooth groups, jaw-related, side-related, and by assessment method. RESULTS: A total of 16 studies met the eligibility criteria for this systematic review. The overall linear mean transfer errors (MTE) in mesiodistal, vertical and buccolingual direction were 0.08 mm (95% CI 0.05; 0.10), 0.09 mm (0.06; 0.11), 0.14 mm (0.10; 0.17), respectively. The overall angular mean transfer errors (MTE) regarding angulation, rotation, torque were 1.13° (0.75; 1.52), 0.93° (0.49; 1.37), and 1.11° (0.68; 1.53), respectively. Silicone trays showed the highest accuracy, followed by vacuum-formed trays and 3D printed trays. Subgroup analyses between tooth groups, right and left sides, and upper and lower jaw showed minor differences. CONCLUSIONS AND IMPLICATIONS: The overall accuracy of the indirect bonding technique can be considered clinically acceptable. Future studies should address the validation of the accuracy assessment methods used.

Influence of normal forces on the frictional behavior in tribological systems made of different bracket types and wire dimensions.

The aim of the present work was measuring the effect of varying normal forces on frictional forces applied to different bracket types in combination with archwires made of NiTi and stainless steel of variable cross section. The measurements were carried out in artificial saliva. Three-way ANOVA and Bonferroni post-hoc tests (α=0.05) were applied. Except for one subgroup the combination of normal force, bracket system and wire dimension had significant effect on friction (p<0.001) as friction increased with increasing normal forces. Only moderately tied ligatures or passive self-ligating brackets generate low friction forces. There was a statistically significant order (0.016"×0.022"<0.018"×0.025"<0.019"×0.025") for stainless steel wire material. Finite element modeling simulation showed the increasing effect of active clip force on friction especially for 0.025" wire profiles. If compared to NiTi wires, stainless steel archwires delivered higher friction. Combinations between wire-type and ligation should be chosen carefully for the intended treatment step.