Forced eruption in impacted teeth: analysis of failed cases and outcome of re-operation.

BACKGROUND: Forced eruption of an impacted tooth usually requires surgical and orthodontic interventions to successfully bring the tooth into the dental arch. The clinical time required for a forced eruption is difficult to predict before treatment begins and success rates are affected by several factors before and after an eruption. This study was conducted to identify factors that affect the success of forced eruption, the duration of orthodontic treatment of impacted teeth, and the reasons for re-operation and forced eruption failure in a various teeth and cases. METHODS: In this retrospective study, the records regarding the forced eruption of 468 teeth in 371 patients from June 2006 to May 2020 at the Advanced General Dentistry Department of Yonsei University Dental Hospital were initially examined. The records of 214 teeth in 178 patients who completed orthodontic treatment were included in the analysis. Data on patient demographics, tooth characteristics, orthodontic treatment duration, re-operations, and failures were collected from electronic medical records. RESULTS: There was a significant difference in age between the success and failure forced eruption. Factors significantly affecting treatment duration were apex formation, position, rotation, and re-operation. Re-operation had a 96% success rate. The average orthodontic treatment duration was 29.99 ± 16.93 months, but the average orthodontic treatment duration for teeth that undergone re-operation was 20.36 ± 11.05 months, which was approximately 9 months shorter. Additionally, there was an interaction effect between rotation and re-operation on the duration of orthodontic treatment. The causes for failure of forced eruption in 6 cases were ankyloses (3 cases), incomplete alignment with the normal dental arch (2 cases), and a significant deviation in the impacted tooth's location (1 case). CONCLUSIONS: To increase the success rate of forced eruption, age should be considered as a priority, and in order to predict the treatment period, the apex formation status, position in the arch, and rotation should be considered in addition to age. When determining re-operation, considering factors such as ankylosis, root curvature, and apex formation can help in the success of orthodontic treatment.

Effect of strontium substitution on functional activity of phosphate-based glass.

Phosphate-based glass (PBG) is a bioactive agent, composed of a glass network with phosphate as the primary component and can be substituted with various therapeutic ions for functional enhancement. Strontium (Sr) has been shown to stimulate osteogenic activity and inhibit pro-inflammatory responses. Despite this potential, there are limited studies that focus on the proportion of Sr substituted and its impact on the functional activity of resulting Sr-substituted PBG (PSr). In this study, focusing on the cellular biological response we synthesized and investigated the functional activity of PSr by characterizing its properties and comparing the effect of Sr substitution on cellular bioactivity. Moreover, we benchmarked the optimal composition against 45S5 bioactive glass (BG). Our results showed that PSr groups exhibited a glass structure and phosphate network like that of PBG. The release of Sr and P was most stable for PSr6, which showed favorable cell viability. Furthermore, PSr6 elicited excellent early osteogenic marker expression and inhibition of pro-inflammatory cytokine expression, which was significant compared to BG. In addition, compared to BG, PSr6 had markedly higher expression of osteopontin in immunocytochemistry, higher ALP expression in osteogenic media, and denser alizarin red staining in vitro. We also observed a comparable in vivo regenerative response in a 4-week rabbit calvaria defect model. Therefore, based on the results of this study, PSr6 could be identified as the functionally optimized composition with the potential to be applied as a valuable bioactive component of existing biomaterials used for bone regeneration.

Comparison of translucency, thickness, and gap width of thermoformed and 3D-printed clear aligners using micro-CT and spectrophotometer.

The present study compared the thickness and gap width of thermoformed and 3D-printed clear aligners (CAs) using micro-computed tomography (micro-CT) and evaluated their translucency using spectrophotometer. Four groups of CAs were tested: thermoformed with polyethylene terephthalate glycol (TS) or copolyester-elastomer combination (TM), and 3D-printed TC-85 cleaned with alcohol (PA) or with centrifuge (PC). CIELab coordinates were measured (n = 10) to evaluate translucency. CAs (n = 10) were fitted onto respective models and micro-CT was performed to evaluate the thickness and gap width. Thickness and gap width were measured for different tooth type and location in sagittal sections on all sides. The PC group showed significantly higher translucency than the PA group, which was similar to the TS and TM groups (p < 0.01). After the manufacturing process, thickness reduction was observed in the thermoformed groups, whereas thickness increase was observed in the 3D printed-groups. The TM group showed the least gap width amongst the groups (p < 0.01). Thermoformed and 3D-printed CAs had significantly varied thicknesses and regions of best fit depending on the tooth type and location. Differences in the translucency and thickness of the 3D-printed CAs were observed depending on the cleaning methods.

Stability of vertical dimension following total arch intrusion.

BACKGROUND: The purpose of this study is to evaluate stability of vertical dimension following total arch intrusion using miniscrews by measuring the change during treatment and relapse amount after more than one year of retention. METHODS: Thirty patients (6 men, 24 women) were included in this study. Lateral cephalographs were taken with conventional radiography at the start of treatment (T0), after treatment (T1), and at least one year after treatment (T2). The evaluation was performed by measuring changes of selected parameters during treatment and the extent of relapse after more than one year. RESULTS: During total arch intrusion treatment (T1-T0), anterior and posterior teeth intruded significantly. The mean vertical distance between the maxillary posterior teeth and palatal plane was reduced by 2.30 mm (P < 0.001). The mean vertical distance between the maxillary anterior teeth and palatal plane was reduced by 2.04 mm (P < 0.001). The anterior facial height was also reduced by 2.70 mm (P < 0.001). During retention period (T2-T1), the vertical distance between the maxillary anterior teeth and the palatal plane significantly increased by 0.92 mm (P < 0.001). The anterior facial height increased by 0.81 mm (P < 0.01). CONCLUSIONS: Anterior facial height significantly decreases after treatment. During retention period, relapse of AFH and maxillary anterior teeth observed. There was no correlation between initial amount of AFH, mandibular plane angle, or SNPog and posttreatment AFH relapse. However, there was a significant correlation between the amount of intrusion of anterior and posterior teeth achieved by the treatment and the extent of relapse.

Cerium oxide nanozymes confer a cytoprotective and bio-friendly surface micro-environment to methacrylate based oro-facial prostheses.

Poly-(methyl methacrylate) (PMMA) is the preferred biomaterial for orofacial prostheses used for the rehabilitation of naso-palatal defects. However, conventional PMMA has limitations determined by the complexity of the local microbiota and the friability of oral mucosa adjacent to these defects. Our purpose was to develop a new type of PMMA, i-PMMA, with good biocompatibility and better biological effects such as higher resistance to microbial adhesion of multiple species and enhanced antioxidant effect. The addition of cerium oxide nanoparticles to PMMA using a mesoporous nano-silica carrier and polybetaine conditioning, resulted in an increased release of cerium ions and enzyme mimetic activity, without tangible loss of mechanical properties. Ex vivo experiments confirmed these observations. In stressed human gingival fibroblasts, i-PMMA reduced the levels of reactive oxygen species and increased the expression of homeostasis-related proteins (PPARg, ATG5, LCI/III). Furthermore, i-PMMA increased the levels of expression of superoxide dismutase and mitogen-activated protein kinases (ERK and Akt), and cellular migration. Lastly, we demonstrated the biosafety of i-PMMA using two in vivo models: skin sensitization assay and oral mucosa irritation test, respectively. Therefore, i-PMMA offers a cytoprotective interface that prevents microbial adhesion and attenuates oxidative stress, thus supporting physiological recovery of the oral mucosa.

Reorientation methodology for reproducible head posture in serial cone beam computed tomography images.

Low dose and accessibility have increased the application of cone beam computed tomography (CBCT). Often serial images are captured for patients to diagnose and plan treatment in the craniofacial region. However, CBCT images are highly variable and lack harmonious reproduction, especially in the head's orientation. Though user-defined orientation methods have been suggested, the reproducibility remains controversial. Here, we propose a landmark-free reorientation methodology based on principal component analysis (PCA) for harmonious orientation of serially captured CBCTs. We analyzed three serial CBCT scans collected for 29 individuals who underwent orthognathic surgery. We first defined a region of interest with the proposed protocol by combining 2D rendering and 3D convex hull method, and identified an intermediary arrangement point. PCA identified the y-axis (anterioposterior) followed by the secondary x-axis (transverse). Finally, by defining the perpendicular z-axis, a new global orientation was assigned. The goodness of alignment (Hausdorff distance) showed a marked improvement (> 50%). Furthermore, we clustered cases based on clinical asymmetry and validated that the protocol was unaffected by the severity of the skeletal deformity. Therefore, it could be suggested that integrating the proposed algorithm as the preliminary step in CBCT evaluation will address a fundamental step towards harmonizing the craniofacial imaging records.

Three-dimensional soft tissue landmark detection with marching cube algorithm.

Current method of analyzing three-dimensional soft tissue data, especially in the frontal view, is subjective and has poor reliability. To overcome this limitation, the present study aimed to introduce a new method of analyzing soft tissue data reconstructed by marching cube algorithm (Program S) and compare it with a commercially available program (Program A). Cone-beam computed tomography images of 42 patients were included. Two orthodontists digitized six landmarks (pronasale, columella, upper and lower lip, right and left cheek) twice using both programs in two-week intervals, and the reliability was compared. Furthermore, computer-calculated point (CC point) was developed to evaluate whether human error could be reduced. The results showed that the intra- and inter-examiner reliability of Program S (99.7-100% and 99.9-100%, respectively) were higher than that of Program A (64.0-99.9% and 76.1-99.9%, respectively). Moreover, the inter-examiner difference of coordinate values and distances for all six landmarks in Program S was lower than Program A. Lastly, CC point was provided as a consistent single point. Therefore, it was validated that this new methodology can increase the intra- and inter-examiner reliability of soft tissue landmark digitation and CC point can be used as a landmark to reduce human error.

Changes in mechanical and bacterial properties of denture base resin following nanoceria incorporation with and without SBA-15 carriers.

Poly (methyl methacrylate) (PMMA) is a commonly used material for the fabrication of biomedical appliances. Although PMMA has several advantages, it is susceptible to microbial insults with practical use. Therefore, different bioactive nanomaterials, such as nanoceria (CeN), have been proposed to enhance the properties of PMMA. In this study, we investigated the effect of the incorporation of CeN into PMMA with and without the use of mesoporous silica nanoparticle (SBA-15) carriers. The unmodified PMMA specimens (control, CTRL) were compared to groups containing SBA-15, CeN, and the synthesized SBA-15 impregnated with CeN (SBA-15@CeN) at different loading percentages. The mechanical and physical properties of the different SBA-15@CeN groups and their effects on cell viability were investigated, and the optimal CeN concentration was identified accordingly. Our results revealed that flexural strength was significantly (P < 0.01) reduced in the SBA-15@CeN3× group (containing 3-fold the CeN wt. %). Although the surface microhardness increased with the increase in the wt. % of SBA-15@CeN, cell viability was significantly reduced (P < 0.001). The SBA-15@CeN1× group had the optimal concentration and displayed significant resistance to single-and multispecies microbial colonization. Finally, the enzymatic activity of CeN was significantly high in the SBA-15@CeN1× group. The proinflammatory markers (IL-6, IL-1ß, TNF-α, CD80, and CD86) showed a significant (P < 0.001) multifold reduction in lipopolysaccharide-induced RAW cells treated with a 5-day eluate of the SBA-15@CeN1× group. These results indicate that the addition of SBA-15@CeN at 1.5 wt % improves the biological response of PMMA without compromising its mechanical properties.

Changes in masticatory performance during the retention period following 4-premolar extraction and non-extraction orthodontic treatment.

OBJECTIVES: To evaluate changes in masticatory performance (MP) during the retention period after extraction and non-extraction treatment and compare it with MP in individuals with normal occlusion. MATERIALS AND METHODS: Adult patients who had completed orthodontic fixed appliance treatment comprised the extraction and non-extraction treatment groups, and those with normal occlusion comprised the control group. Their mixing ability (MA), maximum bite force (MBF), and occlusal contact area (OCA) were recorded immediately after the fixed appliance was removed and at 1 month, 6 months, and 1 year post-treatment. The MA was measured via the two-color chewing gum MA test using ViewGum software, and the MBF and OCA were measured using Dental Prescale II system. RESULTS: MA immediately after orthodontic treatment was lower than that in the normal group but showed a time-dependent gradual increase during a 1-year retention period (P < 0.01). The MA at 1 month post-treatment was not significantly different between the three groups (P > 0.05). The MA revealed a significant correlation with the MBF and OCA (P < 0.01). CONCLUSIONS: The MP immediately after orthodontic treatment was lower than that in the normal group but increased gradually, with levels comparable to those of the normal occlusion group at 1 month post-treatment. Further, extraction did not affect the recovery of the MP after orthodontic treatment. CLINICAL RELEVANCE: No other study has evaluated the changes in MP during the retention period after orthodontic treatment. The findings show that compared with MBF and OCA, the patients' MP improved faster to levels found in normal occlusion.

Polybetaine-enhanced hybrid ionomer cement shows improved total biological effect with bacterial resistance and cellular stimulation.

Hybrid ionomer cements (HICs) are aesthetic polyelectrolyte cements that have been modified with a resin. The setting of HICs occurs by both monomer polymerization and an acid-base reaction. In addition, HICs contain a resin, which is substituted for water. Thus, the competition between the setting reactions and reduced water content inherently limits polysalt formation and, consequently the bioactive interactions. In this study, we explored the effects of polybetaine zwitterionic derivatives (mZMs) on the augmentation of the bioactive response of HICs. The polybetaines were homogenized into an HIC in different proportions (α, ß, and γ) at 3% w/v. Following basic characterization, the bioactive response of human dental pulp stem cells (hDPSCs) was evaluated. The augmented release of the principal constituent ions (strontium, silica, and fluoride) from the HIC was observed with the addition of the mZMs. Modification with α-mZM elicited the most favorable bioactive response, namely, increased ion elution, in vitro calcium phosphate precipitation, and excellent biofouling resistance, which deterred the growth of the bridging species of Veillonella. Moreover, α-mZM resulted in a significant increase in the hDPSC response, as confirmed by a significant increase (p < 0.05) in alizarin red staining. The results of mRNA expression tests, performed using periodically refreshed media, showed increased and early peak expression levels for RUNX2, OCN, and OPN in the case of α-mZM. Based on the results of the in vitro experiments, it can be concluded that modification of HICs with polybetaine α-mZM can augment the overall biological response.

Evaluation of miniscrew-assisted rapid palatal expansion success by comparing width of circummaxillary sutures before expansion in adult male patients.

OBJECTIVES: To investigate the relationship between circummaxillary sutures and miniscrew-assisted rapid palatal expansion (MARPE) success in adult male patients and to evaluate the correlation between the width of the sutures and the maxilla expansion ratio. MATERIALS AND METHODS: This retrospective study comprised 40 adult male patients treated with MARPE divided into a separation group (N = 20, mean age, 21.9 years) consisting of subjects with midpalatal suture opening and a nonseparation group (N = 20, mean age, 21.7 years) consisting of subjects with no midpalatal suture opening. Cone-beam computed tomography images were obtained before MARPE expansion for both groups and after expansion for the separation group. Vertical and horizontal skeletal relationships, palate length, and widths of 10 circummaxillary sutures before expansion were compared. The correlation between maxilla expansion ratio (jackscrew expansion to maxillary expansion ratio) and circummaxillary suture widths was also analyzed in the separation group. RESULTS: There were no significant differences in age, vertical and horizontal skeletal relationships, and palate length between the two groups. Zygomaticomaxillary, pterygomaxillary, midpalatal, and transverse palatine sutures showed significantly greater width in the separation group (P < .05). The zygomaticomaxillary suture showed the greatest difference (Δ = 0.36 mm) between the groups. The zygomaticomaxillary and pterygomaxillary sutures showed significant positive correlation with the maxilla expansion ratio (P < .01). CONCLUSIONS: In adult male patients, greater circummaxillary suture widths before MARPE expansion, especially zygomaticomaxillary and pterygomaxillary sutures, resulted in a better chance of successful suture separation and more maxillary expansion.

Accuracy and efficiency of automatic tooth segmentation in digital dental models using deep learning.

This study evaluates the accuracy and efficiency of automatic tooth segmentation in digital dental models using deep learning. We developed a dynamic graph convolutional neural network (DGCNN)-based algorithm for automatic tooth segmentation and classification using 516 digital dental models. We segmented 30 digital dental models using three methods for comparison: (1) automatic tooth segmentation (AS) using the DGCNN-based algorithm from LaonSetup software, (2) landmark-based tooth segmentation (LS) using OrthoAnalyzer software, and (3) tooth designation and segmentation (DS) using Autolign software. We evaluated the segmentation success rate, mesiodistal (MD) width, clinical crown height (CCH), and segmentation time. For the AS, LS, and DS, the tooth segmentation success rates were 97.26%, 97.14%, and 87.86%, respectively (p < 0.001, post-hoc; AS, LS > DS), the means of MD widths were 8.51, 8.28, and 8.63 mm, respectively (p < 0.001, post hoc; DS > AS > LS), the means of CCHs were 7.58, 7.65, and 7.52 mm, respectively (p < 0.001, post-hoc; LS > DS, AS), and the means of segmentation times were 57.73, 424.17, and 150.73 s, respectively (p < 0.001, post-hoc; AS < DS < LS). Automatic tooth segmentation of a digital dental model using deep learning showed high segmentation success rate, accuracy, and efficiency; thus, it can be used for orthodontic diagnosis and appliance fabrication.

Comparison of soft tissue changes between incisor tipping and translation after premolar extraction.

OBJECTIVE: This study compared soft tissue changes after extraction of the four premolars followed by maximum retraction of the anterior teeth according to the type of anterior teeth movement: tipping and translation. METHODS: Patients who had undergone orthodontic treatment involving the extraction of four premolars were retrospectively selected and divided into either the tipping (n = 27) or translation (n = 26) groups based on the retraction of the incisor root apex and the axis changes of the incisors during the treatment period. Lateral pre- and post-treatment cephalograms were analyzed. RESULTS: There were no significant differences between the tipping and translation groups before treatment. The retraction amounts of the root apex of the upper and lower incisors in the tipping group were 0.33 and 0.26 mm, respectively, and 5.02 and 5.31 mm, respectively, in the translation group (p < 0.001). The posterior movements of soft tissue points A and B in the tipping group were 0.61 and 1.25 mm, respectively, and 1.10 and 3.25 mm, respectively, in the translation group (p < 0.01). The mentolabial sulcus angle increased by 5.89° in the tipping group, whereas it decreased by 8.13° in the translation group (p < 0.001). CONCLUSIONS: An increased amount of retraction of the incisor root apex led to the increased posterior movement of soft tissue points A and B, and this appeared more distinct in cases involving the lower incisor and lower lip.

Correlation Analysis between Three-Dimensional Changes in Pharyngeal Airway Space and Skeletal Changes in Patients with Skeletal Class II Malocclusion following Orthognathic Surgery.

INTRODUCTION: Studies on the pharyngeal airway space (PAS) changes using three-dimensional computed tomography (CT) have shed more light on patients with Class III than Class II malocclusion. This paper focuses on analyzing the long-term changes in the PAS and evaluating the postoperative association between these PAS and skeletal changes in patients with skeletal Class II malocclusion who have undergone orthognathic surgery. METHODS: The records of 21 patients with skeletal Class II malocclusion who had undergone orthognathic surgery were included. The anatomical modifications in both jaws, changes in volume, sectional area (SA), minimum sectional area (MSA), and anterior-posterior (AP) and transverse (TV) width in the airway at one month before surgery (T0), and one month (T1) and one year (T2) after surgery were analyzed using CT images. The association between the skeletal and airway changes was evaluated between T0, T1, and T2. RESULTS: After surgery, the ANS, A point, and PNS demonstrated significant posterior and superior movement. The B point and the pogonion exhibited substantial anterior and superior movement. The total and inferior oropharyngeal volumes (vol 3, vol 4) notably increased, while the nasopharyngeal volume (vol 1) decreased. The anterior-posterior movement at the ANS and PNS after surgery was significantly associated with the total volume, vol 2, vol 3, SA 1, MSA, and TV width 1, while substantial association with the total volume was found at the pogonion. CONCLUSION: Thus, an ideal treatment plan can be formulated for patients with skeletal Class II malocclusion by considering the postoperative PAS changes.

Accuracy of bracket position using thermoplastic and 3D-printed indirect bonding trays.

AIM: The positional accuracy of bracket placement planned through tooth setup vs actual placement was evaluated by means of conventional thermoplastic indirect bonding trays and customized 3D-printed indirect bonding trays. MATERIALS AND METHODS: A total of 280 bracket positions placed on the crowns of 10 dental plaster models were evaluated. The manual setup method and a thermoplastic indirect bonding tray were used for the manual group. For the CAD/CAM group, the bracket was positioned using a digital setup and a corresponding 3D-printed tray. The positional accuracy of the bracket placement on the duplicated gypsum model using the trays was evaluated by means of 3D software. Six errors of bracket position (height, depth, mesiodistal, torque, rotation, and tip errors), including linear and angular errors, were measured. Differences in variables were compared across subgroups using the independent t test or the Mann-Whitney U test. RESULTS: Only the height error differed significantly (P < 0.05) between groups (manual: 0.2 mm; CAD/CAM: 0.12 mm). For both incisors and molars, the manual group showed significantly greater height errors than the CAD/CAM group (P < 0.05). The analysis of variance of the position error to the whole bracket showed statistically significant differences between tooth positions, linear measurements, and angular measurements (P < 0.05). CONCLUSION: A 3D-printed indirect bonding tray showed accuracy similar to that of conventional methods for bracket placement, with slightly greater bracket height accuracy. Further studies should strive to improve accuracy in terms of tooth positions.

Stability and success rate of dual-thread miniscrews.

OBJECTIVES: To date, the clinical stability of dual-thread orthodontic miniscrews has not been studied. This study aimed to compare the primary stability and long-term clinical success rate of dual-thread and cylindrical orthodontic miniscrews and to examine the association between various clinical factors and the success rate of miniscrews. MATERIALS AND METHODS: A total of 145 cylindrical and 135 dual-thread miniscrews were inserted in the maxillary and mandibular buccal alveolar areas of 142 patients. The torque and Periotest (Siemens, Bensheim, Germany) values were recorded during insertion and removal. The effect of clinical variables such as sex, age, screw design, jaw, side of placement, root proximity, and site of placement on the success rate was examined using logistic regression analysis. RESULTS: There was no statistically significant difference (P = .595) in the overall clinical success rate between the two designs, with an overall success rate of 82.1% and 84.4% for the cylindrical and dual-thread miniscrews, respectively. Age and screw-root proximity were significantly associated with failure (P < .05). CONCLUSIONS: The dual-thread miniscrews did not show superior long-term stability and clinical success rate as compared with the cylindrical miniscrews. The results of this study suggest that patient age and screw-root proximity influence the clinical success rate of miniscrews.

Tomographic similarity scan with a computed modified absolute mandibular midsagittal plane for precise and objective localization of mandibular asymmetry.

The application of 3D imaging is at its cusp in craniofacial diagnosis and treatment planning. However, most applications are limited to simple subjective superimposition-based analysis. As the diagnostic accuracy dictates the precision in operability, we propose a novel method that enables objective clinical decision making for patients with mandibular asymmetry. We analyzed cone-beam computed tomography (CBCT) scans of 34 patients who underwent surgical correction for mandibular asymmetry using a high-throughput computing algorithm. Radiomic segmentation of quantitative features of surface and volume followed by exploration resulted in identification of a computed modified absolute mandibular midsagittal plane (cmAMP). Tomographic similarity scan (ToSS) curves were generated via bilateral equidistant scanning in an antero-posterior direction with cmAMP as the reference. ToSS comprised of a comprehensive similarity index (SI) score curve and a segment-wise volume curve. The SI score was computed using the Sørensen-Dice similarity coefficient ranging from 0 to 1. The volumetric analysis was represented as the non-overlapping volume (NOV) and overlapping volume (OV) for each segment, with two segmentation lines, at the mental foramen anteriorly and the intraoral vertical ramus osteotomy region posteriorly. Statistical analysis showed strong negative correlation between the NOV and SI scores for the anterior, middle, and total mandible (P < 0.001). Additionally, a significant correlation was observed between the change in the SI scores for anterior (P = 0.044) and middle segments (P < 0.001) to the total mandible when comparing the data before and after the surgery. This work demonstrated the potential of incorporating ToSS curves in surgical simulation software to improve precision in the clinical decision-making process.

Scanning Accuracy of Bracket Features and Slot Base Angle in Different Bracket Materials by Four Intraoral Scanners: An In Vitro Study.

The accurate expression of bracket prescription is important for successful orthodontic treatment. The aim of this study was to evaluate the accuracy of digital scan images of brackets produced by four intraoral scanners (IOSs) when scanning the surface of the dental model attached with different bracket materials. Brackets made from stainless steel, polycrystalline alumina, composite, and composite/stainless steel slot were considered, which have been scanned from four different IOSs (Primescan, Trios, CS3600, and i500). SEM images were used as references. Each bracket axis was set in the reference scan image, and the axis was set identically by superimposing with the IOS image, and then only the brackets were divided and analyzed. One-way analysis of variance (ANOVA) was used to compare the differences. The difference between the manufacturer's nominal torque and bracket slot base angle was 0.39 in SEM, 1.96 in Primescan, 2.04 in Trios, and 5.21 in CS3600 (p < 0.001). The parallelism, which is the difference between the upper and lower angles of the slot wall, was 0.48 in SEM, 7.00 in Primescan, 5.52 in Trios, 6.34 in CS3600, and 23.74 in i500 (p < 0.001). This study evaluated the accuracy of the bracket only, and it must be admitted that there is some error in recognizing slots through scanning in general.

Stability of bimaxillary surgery involving intraoral vertical ramus osteotomy with or without presurgical miniscrew-assisted rapid palatal expansion in adult patients with skeletal Class III malocclusion.

OBJECTIVE: The aim of this study was to evaluate the stability of bimaxillary surgery involving bilateral intraoral vertical ramus osteotomy performed with or without presurgical miniscrew-assisted rapid palatal expansion (MARPE) in adult patients with skeletal Class III malocclusion. METHODS: A total of 40 adult patients with skeletal Class III malocclusion were retrospectively divided into two groups (n = 20 each) according to the use of MARPE for the correction of transverse maxillomandibular discrepancy during presurgical orthodontic treatment. Serial lateral cephalograms and dental casts were analyzed until 6 months after surgery. RESULTS: Before presurgical orthodontic treatment, there was no significant differences in terms of sex and age between groups. However, the difference of approximately 3.1 mm in the maxillomandibular intermolar width was statistically significant (p < 0.001). Two days after surgery, the mandible had moved backward and upward without any significant intergroup difference. Six months after surgery, the maxillary intercanine (2.7 ± 2.1 mm), interpremolar (3.6 ± 2.4 mm), and intermolar (2.0 ± 1.3 mm) arch widths were significantly increased (p < 0.001) relative to the values before presurgical orthodontic treatment in the MARPE group; these widths were maintained or decreased in the control group. However, there was no significant difference in surgical changes and the postsurgical stability between the two groups. No significant correlations existed between the amount of maxillary expansion and postsurgical mandibular movement. CONCLUSIONS: MARPE is useful for stable and nonsurgical expansion of the maxilla in adult patients with skeletal Class III malocclusion who are scheduled for bimaxillary surgery.