[Voluntary and Adaptive Control Strategy for Ankle Rehabilitation Robot].

The control strategy of rehabilitation robots should not only adapt to patients with different levels of motor function but also encourage patients to participate voluntarily in rehabilitation training. However, existing control strategies usually consider only one of these aspects. This study proposes a voluntary and adaptive control strategy that solves both questions. Firstly, the controller switched to the corresponding working modes (including challenge, free, assistant, and robot-dominant modes) based on the trajectory tracking error of human-robot cooperative movement. To encourage patient participation, a musculoskeletal model was used to estimate the patient's active torque. The robot's output torque was designed as the product of the active torque and a coefficient, with the coefficient adaptively changing according to the working mode. Experiments were conducted on two healthy subjects and four hemiplegic patients using an ankle rehabilitation robot. The results showed that this controller not only provided adaptive the robot's output torque based on the movement performance of patients but also encouraged patients to complete movement tasks themselves. Therefore, the control strategy has high application value in the field of rehabilitation.

Handheld dynamometry: Validity and reliability of measuring hip joint rate of torque development and peak torque.

INTRODUCTION: Measuring rate of torque development (RTD) and peak torque (PT) for hip muscle performance presents challenges in clinical practice. This study investigated the construct validity of a handheld dynamometer (HHD) versus an isokinetic dynamometer (IKD), and intra-rater repeated reliability for RTD and PT and their relationship in hip joint movements. METHODS: Thirty healthy individuals (mean age = 30 ± 8 years, 13 males) underwent two test sessions in a single day. RTD (0-50, 0-100, 0-150, 0-200ms) and PT normalised to body mass in maximal voluntary isometric contractions were measured using a HHD and an IKD in hip flexion, extension, abduction, adduction, internal and external rotation. RESULTS: For validity between the devices, RTD0-50 exhibited the largest significant systematic bias in all hip movements (3.41-11.99 Nm·s-1 kg-1) and widest limits-of-agreement, while RTD0-200 had the lowest bias (-1.33-3.99 Nm·s-1 kg-1) and narrowest limits-of-agreement. For PT, agreement between dynamometers was observed for hip flexion (0.08 Nm·kg-1), abduction (-0.09 Nm·kg-1), internal (-0.01 Nm·kg-1), and external rotation (0.05 Nm·kg-1). For reliability, intra-rater intraclass correlation coefficient (ICC2,1) ranged from moderate to good in RTD0-50 and RTD0-100 (0.5-0.88), and good to excellent in RTD0-150 and RTD0-200 (0.87-0.95) in all movements. The HHD displayed excellent intra-rater, relative reliability values (ICC2,1) in all movements (0.85-0.95). Pearson's correlation revealed good linear correlation between PT and RTD0-150 and RTD0-200 in all movements (r = .7 to .87, p = < .001). CONCLUSION: Validity analysis demonstrated significant systematic bias and lack of agreement in RTD measures between the HHD and IKD. However, the HHD displays excellent to moderate intra-rater, relative reliability for RTD and PT measures in hip movements. Clinicians may use the HHD for hip muscle PT assessment but note, late phase RTD measures are more reliable, valid, and relate to PT than early phase RTD. Additionally, the correlation between RTD and PT at various time epochs was examined to better understand the relationship between these measures.

[Isometric muscle torque in Chilean children and adolescents evaluated by manual maintenance dynamometry: a reliability study]. / Torque muscular isométrico en niñas, niños, y adolescentes chilenos evaluado mediante dinamometría de mantención manual: un estudio de confiabilidad.

The measurement of isometric muscle torque with hand-held dynamometry is a technique little studied in the pediatric setting for the evaluation of maximal isometric muscle strength. OBJECTIVE: to determine the reliability of hand-held dynamometry to obtain the maximal isometric torque of upper and lower limb muscle groups in Chilean children and adolescents. PATIENTS AND METHODS: Crosssectional study. Seventy-two participants aged between 7 and 15 years were selected from a school in Talca. Maximal isometric torque was recorded in 15 muscle groups of upper and lower limbs through hand-held dynamometry. Intra- and inter-rater evaluation was used, applying the intraclass correlation coefficient (ICC) to determine the reliability of the tests and Bland-Altman plots to evaluate concordance. RESULTS: The results demonstrated good to excellent inter-rater reliability (ICC = 0.850.98) and intra-rater reliability (ICC = 0.87-0.98). Only two groups, hip extensors and abductors, showed good inter-rater reliability (ICC = 0.85 and ICC = 0.88, respectively); and one group, the ankle dorsiflexors, showed good intra-rater reliability (ICC = 0.87). 100% of the tests presented at least 95.8% inter- and intra-rater agreement on the Bland-Altman plots. CONCLUSION: The evaluation of isometric muscle torque using hand-held dynamometry is a reliable procedure for use in different growth periods.

Eccentric exercise-induced delayed onset trunk muscle soreness alters high-density surface EMG-torque relationships and lumbar kinematics.

We aimed to assess high-density surface electromyography (HDsEMG)-torque relationships in the presence of delayed onset trunk muscle soreness (DOMS) and the effect of these relationships on torque steadiness (TS) and lumbar movement during concentric/eccentric submaximal trunk extension contractions. Twenty healthy individuals attended three laboratory sessions (24 h apart). HDsEMG signals were recorded unilaterally from the thoracolumbar erector spinae with two 64-electrode grids. HDsEMG-torque signal relationships were explored via coherence (0-5 Hz) and cross-correlation analyses. Principal component analysis was used for HDsEMG-data dimensionality reduction and improvement of HDsEMG-torque-based estimations. DOMS did not reduce either concentric or eccentric trunk extensor muscle strength. However, in the presence of DOMS, improved TS, alongside an altered HDsEMG-torque relationship and kinematic changes were observed, in a contraction-dependent manner. For eccentric trunk extension, improved TS was observed, with greater lumbar flexion movement and a reduction in δ-band HDsEMG-torque coherence and cross-correlation. For concentric trunk extensions, TS improvements were observed alongside reduced thoracolumbar sagittal movement. DOMS does not seem to impair the ability to control trunk muscle force, however, perceived soreness induced changes in lumbar movement and muscle recruitment strategies, which could alter motor performance if the exposure to pain is maintained in the long term.

Evaluation of the effect of different attachment configurations on molar teeth in maxillary expansion with clear aligners - a finite element analysis.

OBJECTIVE: To evaluate the effects of different attachment configurations with and without buccal root torque on expansion movements achieved with aligners through finite element analysis (FEA). METHODS: FEA modelling was done with 0.25 mm buccal expansion force application to the maxillary molars with different attachment configurations: Eight models were tested (1) no attachment (NA), (2) horizontal attachment (HA), (3) gingivally beveled horizontal attachment (GHA), and (4) occlusally beveled horizontal attachment (OHA), as well as models with 6obuccal root torque, (5) no attachment (TNA), (6) horizontal attachment (THA), (7) gingivally beveled horizontal attachment (TGHA), and (8) occlusally beveled horizontal attachment (TOHA). RESULTS: The first and second molars exhibited buccal tipping in all models. The highest amount of buccal tipping for the molars was observed in the NA (6CMB, 0.232 mm; 6CMP, 0.246 mm; 7CMB, 0.281 mm; 7CMP, 0.312 mm) and GHA (6CMB, 0.230; 6CMP, 0.245; 7CMB, 0.279 mm; 7CMP, 0.311 mm) models, respectively, while the least tipping was observed in the TOHA model (6CMB, 0.155 mm; 6CMP, 0.168 mm; 7CMB, 0.216 mm; 7CMP, 0.240 mm). In all groups, the buccal tipping of the second molars was higher than that of the first molars. CONCLUSION: This FEA study showed that expansion with aligners tip maxillary molars buccally and the use of occlusally beveled attachments and addition of buccal root torque reduces uncontrolled buccal tipping.

Effects of shoe heel height on ankle dynamics in running.

Shoes affect the evolved biomechanics of the foot, potentially affecting running kinematics and kinetics that can in turn influence injury and performance. An important feature of conventional running shoes is heel height, whose effects on foot and ankle biomechanics remain understudied. Here, we investigate the effects of 6-26 mm increases in heel height on ankle dynamics in 8 rearfoot strike runners who ran barefoot and in minimal shoes with added heels. We predicted higher heels would lead to greater frontal plane ankle torques due to the increased vertical moment arm of the mediolateral ground reaction force. Surprisingly, the torque increased in minimal shoes with no heel elevation, but then decreased with further increases in heel height due to changes in foot posture. We also found that increasing heel height caused a large increase in the ankle plantarflexion velocity at heel strike, which we explain using a passive collision model. Our results highlight how running in minimal shoes may be significantly different from barefoot running due to complex interactions between proprioception and biomechanics that also permit runners to compensate for modifications to shoe design, more in the frontal than sagittal planes.

Gauging force by tapping tendons? Inaccurately in the human patellar tendon.

Accurately estimating in vivo tendon load non-invasively remains a major challenge in biomechanics, which might be overcome by shear-wave tensiometry. Shear-wave tensiometry measures the speed of mechanically induced tendon shear waves by skin-mounted accelerometers. To gauge the feasibility and accuracy of this novel technique, we obtained patellar tendon shear wave speeds via shear-wave tensiometry during sustained or ramp voluntary contractions of the knee extensors in two experiments (n = 8 in both). In experiment one, participants produced a constant knee extension torque of âˆ¼ 50 Nm at five different knee joint angles (i.e. variable tendon load), which resulted in estimated patellar tendon forces between 1005 ± 6N and 1182 ± 16 N. However, wave speed squared did not correlate with estimated tendon force within participants (rrm(31) = -0.19, p = 0.278). In experiment two, averaged correlation coefficients between normalized wave speed squared and torque of maximal and submaximal voluntary contractions across participants ranged between r = 0.43 and r = 0.94, while the time-varying correlation between these normalized signals ranged from r = -0.99 to r = 1.00. Further, the mean absolute errors (MAEs) between normalized wave speed squared and normalized torque across participants ranged between 0.03 and 0.54, which were larger than the MAEs between normalized torque and normalized summed EMG amplitude from the superficial quadriceps muscles (0.03-0.54 versus 0.06-0.26, respectively). In conclusion, there was no simple relation between shear wave speed squared and patellar tendon load, which severely limits the feasibility of shear-wave tensiometry for accurately estimating in vivo tendon load at the knee joint.

Comparative study of axial displacement in digital and conventional implant prosthetic components.

Axial displacement of prosthetic components is a major concern in implant dentistry, particularly during screw tightening. However, implant manufacturers provide different recommended torques for tightening implant prosthetic components, which can lead to errors in prosthesis fit before and after impression making. Implant-abutment connection angle or abutment geometries can affect axial displacement. This study aimed to compare the axial displacement between conventional and digital components based on the tightening torque and differences in the implant-abutment connection angles and geometries. The results showed that scan bodies with different implant-abutment connection geometries exhibited smaller axial displacement with increasing tightening torque than other prosthetic components. Except for the scan bodies, there was no difference in the axial displacement of prosthetic components when tightened with the same torque. However, regardless of the use of digital or conventional method of impression making, the axial displacement between the impression making component and the abutment when tightened to the recommended torques were significantly different. In addition, axial displacement was affected by the internal connection angle. The results of this study indicate that the tightening torque and geometry of prosthetic components should be considered to prevent possible misfits which can occur before and after impression making.

Delayed reinforcement learning converges to intermittent control for human quiet stance.

The neural control of human quiet stance remains controversial, with classic views suggesting a limited role of the brain and recent findings conversely indicating direct cortical control of muscles during upright posture. Conceptual neural feedback control models have been proposed and tested against experimental evidence. The most renowned model is the continuous impedance control model. However, when time delays are included in this model to simulate neural transmission, the continuous controller becomes unstable. Another model, the intermittent control model, assumes that the central nervous system (CNS) activates muscles intermittently, and not continuously, to counteract gravitational torque. In this study, a delayed reinforcement learning algorithm was developed to seek optimal control policy to balance a one-segment inverted pendulum model representing the human body. According to this approach, there was no a-priori strategy imposed on the controller but rather the optimal strategy emerged from the reward-based learning. The simulation results indicated that the optimal neural controller exhibits intermittent, and not continuous, characteristics, in agreement with the possibility that the CNS intermittently provides neural feedback torque to maintain an upright posture.

Assessing the Effect of Cervical Transcutaneous Spinal Stimulation With an Upper Limb Robotic Exoskeleton and Surface Electromyography.

Transcutaneous spinal stimulation (TSS) is a promising rehabilitative intervention to restore motor function and coordination for individuals with spinal cord injury (SCI). The effects of TSS are most commonly assessed by evaluating muscle response to stimulation using surface electromyography (sEMG). Given the increasing use of robotic devices to deliver therapy and the emerging potential of hybrid rehabilitation interventions that combine neuromodulation with robotic devices, there is an opportunity to leverage the on-board sensors of the robots to measure kinematic and torque changes of joints in the presence of stimulation. This paper explores the potential for robotic assessment of the effects of TSS delivered to the cervical spinal cord. We used a four degree-of-freedom exoskeleton to measure the torque response of upper limb (UL) joints during stimulation, while simultaneously recording sEMG. We analyzed joint torque and electromyography data generated during TSS delivered over individual sites of the cervical spinal cord in neurologically intact participants. We show that site-specific effects of TSS are manifested not only by modulation of the amplitude of spinally evoked motor potentials in UL muscles, but also by changes in torque generated by individual UL joints. We observed preferential resultant action of proximal muscles and joints with stimulation at the rostral site, and of proximal joints with rostral-lateral stimulation. Robotic assessment can be used to measure the effects of TSS, and could be integrated into complex control algorithms that govern the behavior of hybrid neuromodulation-robotic systems.

A hop testing alternative for functional performance following anterior cruciate ligament reconstruction.

The purpose of this work was to provide a simple method to determine reactive strength during the 6-meter timed hop test (6mTH) and evaluate its association with isokinetic peak torque in patients following anterior cruciate ligament reconstruction (ACLR). Twenty-nine ACLR patients who were at least four months from surgery were included in this analysis. Participants were brought into the laboratory on one occasion to complete functional testing. Quadriceps and hamstring isokinetic testing was completed bilaterally at 60, 180, and 300 deg∙s-1, using extension peak torque from each speed as the outcome measure. The 6mTH was completed bilaterally using a marker-based motion capture system, and reactive strength ratio (RSR) was calculated from the vertical velocity of the pelvis during the test. An adjustment in RSR was made using the velocity of the 6mTH test to account for different strategies employed across participants. Repeated measures correlations were used to determine associations among isokinetic and hop testing variables. A two-way mixed analysis of variance was used to determine differences in isokinetic and hop testing variables between operated and non-operated legs and across male and female participants. Moderate positive associations were found between RSR (and adjusted RSR) and isokinetic peak torque at all speeds (r = .527 to .577). Mean comparisons showed significant main effects for leg and sex. Patients showed significant deficits in their operated versus non-operated legs in all isokinetic and hop testing variables, yet only isokinetic peak torque and timed hop time showed significant differences across male and female groups. Preliminary results are promising but further development is needed to validate other accessible technologies available to calculate reactive strength during functional testing after ACLR. Pending these developments, the effects of movement strategies, demographics, and levels of participation on RSR can then be explored to translate this simple method to clinical environments.

Force reserve predicts compensation in reaching movement with induced shoulder strength deficit.

Following events such as fatigue or stroke, individuals often move their trunks forward during reaching, leveraging a broader muscle group even when only arm movement would suffice. In previous work, we showed the existence of a "force reserve": a phenomenon where individuals, when challenged with a heavy weight, adjusted their motor coordination to preserve approximately 40% of their shoulder's force. Here, we investigated if such reserve can predict hip, shoulder, and elbow movements and torques resulting from an induced shoulder strength deficit. We engaged 20 healthy participants in a reaching task with incrementally heavier dumbbells, analyzing arm and trunk movements via motion capture and joint torques through inverse dynamics. We simulated these movements using an optimal control model of a 3-degree-of-freedom upper body, contrasting three cost functions: traditional sum of squared torques, a force reserve function incorporating a nonlinear penalty, and a normalized torque function. Our results demonstrate a clear increase in trunk movement correlated with heavier dumbbell weights, with participants employing compensatory movements to maintain a shoulder force reserve of approximately 40% of maximum torque. Simulations showed that while traditional and reserve functions accurately predicted trunk compensation, only the reserve function effectively predicted joint torques under heavier weights. These findings suggest that compensatory movements are strategically employed to minimize shoulder effort and distribute load across multiple joints in response to weakness. We discuss the implications of the force reserve cost function in the context of optimal control of human movements and its relevance for understanding compensatory movements poststroke.NEW & NOTEWORTHY Our study reveals key findings on compensatory movements during upper limb reaching tasks under shoulder strength deficits, as observed poststroke. Using heavy dumbbells with healthy volunteers, we demonstrate how forward trunk displacement conserves around 40% of shoulder strength reserve during reaching. We show that an optimal controller employing a cost function combining squared motor torque and a nonlinear penalty for excessive muscle activation outperforms traditional controllers in predicting torques and compensatory movements in these scenarios.

Low-frequency sounds combined with motor imagery elicits a transient disruption of force performance: A path to neuromotor reprogramming?

The effectiveness of motor imagery (MI) training on sports performance is now well-documented. Recently, it has been proposed that a single session of MI combined with low frequency sound (LFS) might enhance muscle activation. However, the neural mechanisms underlying this effect remain unknown. We set up a test-retest intervention over the course of 2 consecutive days to evaluate the effect of (i) MI training (MI, n = 20), (ii) MI combined with LFS (MI + LFS, n = 20), and (iii) a control condition (CTRL, n = 20) on force torque produced across repeated maximal voluntary contractions of the quadriceps before (Pretest), after (Posttest) and at +12 h (Retention) post-intervention. We collected the integrated electromyograms of the quadriceps muscles, as well as brain electrical potentials during each experimental intervention. In the CTRL group, total force torque decreased from Pretest to Retention and from Posttest to Retention. By contrast, there was an increase between Posttest and Retention in both MI + LFS and MI groups (both ηP2 = 0.03, p < 0.05). Regression analyses further revealed a negative relationship between force performance and EEG activity in the MI + LFS group only. The data support a transient interference of LFS on cortical activity underlying the priming effects of MI practice on force performance. Findings are discussed in relation to the potential for motor reprogramming through MI combined with LFS.

The effect of individualised post-exercise blood flow restriction on recovery following strenuous resistance exercise: A randomised controlled trial.

The purpose was to clarify the effect of individualised post-exercise blood flow restriction (PE-BFR) on measures of recovery following strenuous resistance exercise. Twenty resistance-trained adults were randomised to a PE-BFR or control (CON) group and completed a fatigue protocol of five sets of 10 repetitions of maximal intensity concentric and eccentric seated knee extension exercise. Participants then lied supine with cuffs applied to the upper thigh and intermittently inflated to 80% limb occlusion pressure (PE-BFR) or 20 mmHg (CON) for 30 min (3 × 5 min per leg). Peak torque (PT), time-to-peak torque (TTP), countermovement jump height (CMJ), muscle soreness (DOMS) and perceived recovery (PR) were measured pre-fatigue, immediately post-fatigue and at 1, 24, 48 and 72 h post-fatigue. Using a linear mixed-effect model, PE-BFR was found to have greater recovery of CMJ at 48 h (mean difference [MD]=-2.8, 95% confidence interval [CI] -5.1, 0.5, p = 0.019), lower DOMS at 48 (MD = 3.0, 95% CI 1.2, 4.9, p = 0.001) and 72 h (MD = 1.95, 95% CI -1.2, 1.5, p = 0.038) and higher PR scores at 24 (MD = -1.7, 95% CI -3.4, -0.1, p = 0.038), 48 (MD = -3.1, 95% CI -4.8, -1.5, p < 0.001) and 72 h (MD = -2.2, 95% CI -3.8, -0.5, p = 0.011). These findings suggest that individualised PE-BFR accelerates recovery after strenuous exercise.

Impact of different landing heights on the contact force in the medial tibiofemoral compartment and the surrounding muscle force characteristics in drop jumps.

This study explored the impact of landing height on the tibiofemoral joint's medial compartment force (MCF) during drop jumps to help athletes prevent knee injury. Experienced male participants (N = 16) performed drop jumps with landing heights from 0.15 m to 0.75 m. Kinematic/kinetic parameters were collected using a motion capture system and a three-dimensional force platform. The Med-Lat Knee model was used to calculate biomechanical indicators of the knee joint, and data were analyzed using one-way analysis of variance and one-dimensional statistical parametric mapping (SPM1d). Findings indicated that landing height significantly affected the anterior-posterior and vertical MCF, flexion-extension torque, internal-external rotation torque, and vertical ground reaction force (p<0.05)-all increasing with elevated landing height-and significantly impacted the generated force of the vastus medialis, vastus lateralis, and vastus intermedius (p<0.05). SPM1d analysis confirmed these results within specific time intervals. Thus, both the knee moment and the MCF exhibited similar coordinated changes during drop jumps, indicating that these may be adaptive movement strategy. The impact of varying drop jump heights on muscle groups around the knee joint varied suggests that different heights induce specific muscular responses and improve muscle coordination to prevent knee joint injuries.

Torque and power of knee extensor muscles at individualized isokinetic angular velocities.

OBJECTIVE: Existing isokinetic contractions are characterized using standardized angular velocities, which can induce differing adaptations. Here, we characterized the variation in the isokinetic parameters of knee extensors according to individualized angular velocity (IAV). METHODS: We performed a cross-sectional study of 19 young, healthy men. We measured the maximum angular velocity (MAV) of concentric knee extension using the isotonic mode of an isokinetic dynamometer. Isometric and isokinetic (at angular velocities corresponding to 100%, 70%, 40%, and 10% of each individual's MAV) knee extensor contractions were performed, and the peak torque and mean power were recorded. RESULTS: Peak torque significantly decreased with increasing IAV (129.42 ± 25.04, 84.37 ± 20.97, and 56.42 ± 16.18 Nm at 40%, 70%, and 100%, respectively), except for isometric contraction (233.36 ± 47.85) and at 10% of MAV (208 ± 48.55). At the mean power, 10% of MAV (74.52 ± 20.84 W) was significantly lower than the faster IAV (176.32 ± 49.64, 161.53 ± 56.55, and 145.95 ± 50.64 W at 40%, 70%, and 100%, respectively), and 100% was significantly lower than 40%. CONCLUSION: The optimized IAV for isokinetic contraction to improve power output while maintaining torque is 10% to 40% of MAV. IAV may reflect both the velocity and force components of power because individuals do not have the same angular velocity.

Isokinetic Peak Torque Improvement and Shoulder Muscle Ratios Imbalance Correction After Specific Strength Training on a New Ballistic Throwing Device: A Randomized Controlled Trial.

CONTEXT: The aim of this study was to investigate the effects of 8-week ballistic-strength-training program using a validated specific throwing device (ie, Arm/Shoulder Specific Strength Device), on isokinetic shoulders' rotation muscle-torques and ratios as well as range of motion in team handball players. DESIGN: A repeated-measures experimental design with a randomized controlled trial was used. METHODS: Twenty-six high-level competitive male U-19 team handball players were randomly assigned into training (TG, n = 15) and control (n = 11) groups. The TG undertook a twice a week for 8-week periodized throws program with an individually predetermined optimal load. The program incorporated shackled eccentric and concentric exercises using the Arm/Shoulder Specific Strength Device. Peak torques, functional, and conventional ratios for both arms at different angular velocities (60°·s-1, 180°·s-1, and 300°·s-1) were assessed over time and between groups, using an isokinetic dynamometer. RESULTS: A significant improvement for TG (P < .01; d = 1.13 [moderate]; +20.2%) of the concentric peak torques for dominant arm in external rotation was observed at 300°·s-1. Significant (P < .05-.01) increases were also noted for nondominant arm at the 3 studied angular velocities. In addition, 300°·s-1 eccentric peak torques of the dominant arm and nondominant arm have significantly improved for both external and internal rotations (P < .05; d = .99 [moderate] and d = 1.21 [large]; +15.7% and + 17.9%, respectively) with small changes at the other angular assessed velocities. Posttraining, TG's dominant arm showed significant improvements (P < .05-.01) in functional and conventional ratios at all velocities. Notably, significant differences (P < .05-.01) were observed at 60°·s-1 and across all velocities when comparing the TG with the control group. TG showed significant increase for internal rotation and external rotation shoulder range of motions (P < .05; d = 1.22-1.27 [large]), +5.0% and +7.7%, respectively). CONCLUSIONS: The specific 8-week throwing training program on the Arm/Shoulder Specific Strength Device showed significant performance improvements in almost all assessed isokinetic concentric and eccentric peak torques as well as internal and external range of motion increase for both arms while ensuring rotator cuff torque ratios and shoulder mobility in team handball real sport-specific condition.

Tip, torque and rotation of maxillary molars during distalization using Invisalign: a CBCT study.

BACKGROUND: Desirable molar distalization by bodily movement is challenging and can be difficult to achieve. This study investigated changes in molar angulation (mesiodistal tipping), molar inclination (buccolingual torque) and rotation during distalization using clear aligner therapy (CAT). MATERIALS AND METHODS: This retrospective study included 38 cone beam computed tomographic images (CBCTs) taken for patients treated with molar distalization using CAT. The study evaluated pre- (T0) and post-treatment (T1) CBCTs of 19 adult patients (36.68 ± 13.50 years) who underwent maxillary molar distalization using Invisalign® aligners (Align Technology, Inc., San José, CA, USA) with a minimum of 2 mm distalization. Changes in maxillary molar tip, torque and rotation were measured for 61 molars (183 roots). Paired t-test was used to evaluate the differences between pre- and post-treatment readings. The level of significance was set at p ≤ 0.05. The reproducibility of measurements was assessed by the intraclass correlation coefficient (ICC). RESULTS: Molar angulation did not show significant change after distalization (p = 0.158) however, there was significant increase in buccal molar inclination (p = 0.034) and mesiobuccal molar rotation (p < 0.001). CONCLUSION: Molar distalization of 2 mm did not cause significant molar tipping. Maxillary molars showed significant buccal inclination (increased torque) and mesiobuccal rotation after distalization.

Clinical study on freehand of bicortical sacral screw fixation with the assistance of torque measurement device.

BACKGROUND: Sacral screw loosening is a typical complication after internal fixation surgery through the vertebral arch system. Bicortical fixation can successfully prevent screw loosening, and how improving the rate of bicortical fixation is a challenging clinical investigation. OBJECTIVE: To investigate the feasibility of improving the double corticality of sacral screws and the optimal fixation depth to achieve double cortical fixation by combining the torque measurement method with bare hands. METHODS: Ninety-seven cases of posterior lumbar internal fixation with pedicle root system were included in this study. Based on the tactile feedback of the surgeon indicating the expected penetration of the screw into the contralateral cortex of the sacrum, the screws were further rotated by 180°, 360°, or 720°, categorized into the bicortical 180° group, bicortical 360° group, and bicortical 720° group, respectively. Intraoperatively, the torque during screw insertion was recorded. Postoperatively, the rate of double-cortex engagement was evaluated at 7 days, and screw loosening was assessed at 1 year follow-up. RESULTS: The bicortical rates of the 180° group, 360° group, and 720° group were 66.13%, 91.18% and 93.75%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05).The rates of loosening of sacral screws in the 180° group, 360° group, and 720° group were 20.97%, 7.35% and 7.81%, respectively. There were statistically significant differences between the 180° group and both the 360° and 720° groups (P < 0.05). However, there was no statistically significant difference between the 360° group and the 720° group (P > 0.05). The bicortical 360° group achieved a relatively satisfactory rate of dual cortical purchase while maintaining a lower rate of screw loosening. CONCLUSION: Manual insertion of sacral screws with the assistance of a torque measurement device can achieve a relatively satisfactory dual cortical purchase rate while reducing patient hospitalization costs.

Impact of Invisalign® first system on molar width and incisor torque in malocclusion during the mixed dentition period.

In orthodontic treatment of patients during the mixed dentition period, arch expansion and opening deep overbite are one of the objectives to achieve proper alignment of the teeth and correction of sagittal and vertical discrepancies. However, the expected outcomes of most therapeutic regimens are not clear, making it impossible to standardize early treatment effects. Therefore, this study was designed to evaluate the impact of the Invisalign® First System on the dental arch circumference and incisor inclination in patients during the mixed dentition period. A total of 21 children during the mixed dentition period (10 females and 11 males, with an average age of 8.76 years) were included in this study. The patients received non-extraction treatment through Invisalign® First System clear aligners, and no other auxiliary devices were used except Invisalign® accessories. Subsequently, the cooperation degree of patients during treatment and the oral measurement parameters at the beginning (T1) and the end (T2) of treatment were collected. All patients showed moderate/good cooperation degree during treatment. Besides, horizontal width of the maxillary first molar increased significantly; the designed arch expansion was 4.1 mm (±1.4 mm), while the actual arch expansion was 3.0 mm (±1.7 mm). Furthermore, the torque expression rate of upper anterior teeth reached 56.53%. Invisalign® First System clear aligners can effectively correct the teeth of patients during the mixed dentition period, widen the circumference of dental arch, and control the torque of incisors.