Increased tooth mobility after fixed orthodontic appliance treatment can be selectively utilized for case refinement via positioner therapy - a pilot study.

BACKGROUND: Increased tooth mobility persists after fixed orthodontic appliance removal, which is therapeutically utilized for post-treatment finishing with positioners. As such a fine adjustment is only required for selected teeth, the aim of this pilot study was to investigate tooth mobility in vivo on corrected and uncorrected subgroups under positioner therapy. METHODS: Mobility was measured on upper teeth of 10 patients (mean age 16.8) by applying loadings for 0.1, 1.0 and 10.0 s with a novel device directly after multibracket appliance debonding as much as 2d, 1, 2 and 6 weeks later. Positioners were inserted at day 2. Specimens were divided into Group C (teeth corrected via positioner), Group N (uncorrected teeth adjacent to teeth from group C), and Group U (uncorrected teeth in an anchorage block). Untreated individuals served as controls (n = 10, mean age 22.4). Statistics were performed via Kolmogorov-Smirnov test and Welch's unequal variances t-test for comparisons between groups. P < 0.05 was considered statistically significant. RESULTS: After 1 week, tooth mobility in Group U almost resembled controls (13.0-15.7 N), and reached physiological values after 6 weeks (17.4 N vs. 17.3 N in controls). Group C (9.0-13.4 N) and Group N (9.2-14.7 N) maintained increased mobility after 6 weeks. Tooth mobility was generally higher by reason of long loading durations (10.0 s). CONCLUSIONS: Positioner therapy can selectively utilized increased tooth mobility upon orthodontic fixed appliance treatment for case refinements. Here, uncorrected teeth in anchorage blocks are not entailed by unwanted side effects and recover after 6 weeks post treatment. Corrected teeth and their neighbors exhibit enhanced mobility even after 6 weeks, which represents a necessity for the proper correction of tooth position, and concurrently arouses the requirement for an adequate retention protocol.

PEKK-made indirect temporary crowns and bridges: a clinical pilot study.

OBJECTIVES: The aim of the present study was to find out whether the high-performance polymer PEKK is an equivalent alternative compared to cobalt chrome (CoCr)-made restorations, regarding to biocompatibility, stability, and comfort. MATERIALS AND METHODS: Twenty-two patients (m, 10; f, 12) who were indicated for a long-term temporary-fixed restoration were included. They were randomized through a lottery procedure into two groups: the first group was restored with veneered PEKK-made crowns and bridges (Pekkton ivory), while the second group was restored with veneered CoCr crowns. Clinical parameters (plaque index (PI), probing depth (PD), fracture, and chipping) were documented in a period of 3-5 months from the insertion of restoration. Furthermore, every patient completed the OHIP-14 questionnaire. An exchange of the restorations from the first to the alternative material was performed after a period of 3-5 months. RESULTS: All patients showed an improvement of the oral hygiene and probing depth after insertion of the temporary restorations. However, there were no significant differences between PEKK and CoCr-made restorations (P > 0.05). There was no chipping after 5 months for both kinds of materials. There was a noticeable reduction of pain and discomfort of patients after insertion of temporary restorations. However, there were no significant differences between the two materials (P > 0.05). CONCLUSIONS: PEKK-made temporary restorations offer a good and stable alternative to CoCr-made restorations. They have a high aesthetical advantage over CoCr restoration. CLINICAL RELEVANCE: Esthetic and price-efficient temporary crowns can be offered for the patient during periodontal therapy to improve its success, in particular by improving the oral hygiene.

In vivo determination of tooth mobility after fixed orthodontic appliance therapy with a novel intraoral measurement device.

OBJECTIVE: Valid measurement systems recording tooth mobility upon displacement within the subtle range of physiological strains are missing. Here, we introduce a novel in vivo measurement device and demonstrate a first clinical application by monitoring tooth mobility changes during retention after fixed multibracket appliance therapy. MATERIALS AND METHODS: Tooth mobility was measured in vivo on 21 patients (11 female, 10 male; mean age 16.1 ± 3.1 years) by displacing the upper first incisor 0.2 mm lingually for 0.2, 0.5, 1, 2, 5, and 10 s with the novel intraoral device. Measurements were recorded directly after, as much as 2, 7, and 14 days and up to 6 months after appliance debonding. RESULTS: Device performance was precise and valid in clinical use. Data revealed significant interindividual varying tooth mobility, which was very high during the first 2 days after appliance removal. After 1 week, mobility values decreased, but were generally higher upon short loadings compared to long ones. After 3 months, tooth mobility was significantly lower than directly after debonding. Interestingly, males exhibited significantly less mobility than females. CONCLUSIONS: Our work is the first using an in vivo measurement device capable of performing and recording tooth displacements within this delicate range and in such precision. Furthermore, our findings elucidate tooth mobility changes after multibracket treatment, giving important information for retention periods. CLINICAL RELEVANCE: Establishment of this novel measurement device in clinical use is an important improvement when approaching the complexity of tooth mobility in vivo regarding different issues like orthodontics, periodontal disease, or bruxism.

An in vitro study into the efficacy of complex tooth alignment with conventional and self-ligating brackets.

OBJECTIVE: To evaluate the efficacy of tooth alignment achieved by various small cross-section archwire/bracket combinations using the orthodontic measurement and simulation system. MATERIALS AND METHODS: The study comprised three types of orthodontic brackets 1) conventional ligating (Victory Series and Mini-Taurus), 2) self-ligating (SmartClip a passive self-ligating bracket and Time3 an active self-ligating bracket), and 3) a conventional low-friction bracket (Synergy). All brackets had a nominal 0.022″ slot size. Brackets were combined with 1) 0.012″ stainless steel, 2) 0.012″ Orthonol, 3) 0.012″ Thermalloy, and 4) 0.0155″ coaxial archwires. Archwires were tied to the conventional brackets with stainless steel ligatures and elastomeric rings. The malocclusion simulated represented a central upper incisor displaced 2 mm gingivally (x-axis) and 2 mm labially (z-axis). RESULTS: The inciso-gingival correction achieved by the different archwire/bracket combinations ranged from 15 to 95%, while the labio-lingual correction ranged from 10 to 95%. The smallest correction was achieved by coaxial, Orthonol, and thermally archwires when ligated with the elastomeric rings to conventional brackets. Stainless steel archwires achieved from 65 to 90% of inciso-gingival correction and from 60 to 90% of labio-lingual correction. CONCLUSION: The resultant tooth alignment was the product of interaction between the archwire type, bracket type, and bracket design including ligature type. Small cross-sectional archwires might produce up to 95% correction if combined properly with the bracket system. Elastomeric rings when used with conventional brackets limit the efficacy of malalignment correction.

A systematic review and meta-analysis of experimental clinical evidence on initial aligning archwires and archwire sequences.

The aim of the study was to assess treatment effects and potential side effects of different archwires used on patients receiving orthodontic therapy. Electronic and manual unrestricted searches were conducted in 19 databases including MEDLINE, Cochrane Library, and Google Scholar until April 2012 to identify randomized controlled trials (RCTs) and quasi-RCTs. After duplicate study selection, data extraction, risk of bias assessment with the Cochrane risk of bias tool, and narrative analysis, mean differences (MDs) with confidence intervals (CIs) of similar studies were pooled using a random-effects model and evaluated with GRADE. A total of 16 RCTs were included assessing different archwire characteristics on 1108 patients. Regarding initial archwires, meta-analysis of two trials found slightly greater irregularity correction with an austenitic-active nickel-titanium (NiTi) compared with an martensitic-stabilized NiTi archwire (corresponding to MD: 1.11 mm, 95% CI: -0.38 to 2.61). Regarding archwire sequences, meta-analysis of two trials found it took patient treated with a sequence of martensitic-active copper-nickel-titanium (CuNiTi) slightly longer to reach the working archwire (MD: 0.54 months, 95% CI: -0.87 to 1.95) compared with a martensitic-stabilized NiTi sequence. However, patients treated with a sequence of martensitic-active CuNiTi archwires reported general greater pain intensity on the Likert scale 4 h and 1 day after placement of each archwire, compared with a martensitic-stabilized NiTi sequence. Although confidence in effect estimates ranged from moderate to high, meta-analyses could be performed only for limited comparisons, while inconsistency might pose a threat to some of them. At this point, there is insufficient data to make recommendations about the majority of initial archwires or for a specific archwire sequence.

3D analyses of interface voids in root canals filled with different sealer materials in combination with warm gutta-percha technique.

OBJECTIVES: The aim of the present study was to analyze the formation of voids and gaps in root canals obturated with different sealer materials in combination with warm gutta-percha vertical compaction technique by using BeeFill® 2in1. MATERIALS AND METHODS: Twenty-four single-rooted teeth were collected, and root canals were prepared by using rotary files. All teeth were randomly allocated into three groups. Each group was obturated by using the BeeFill® 2in1 system in combination with Sealapex (non-eugenol, calcium hydroxide polymeric root canal sealer; Kerr Sybron, USA), RoekoSeal (polydimethylsiloxane-based sealer; Roeko, Germany), or 2Seal (epoxy-amine resin-based sealer; VDW, Germany). Following preparation, all teeth were scanned with a micro-computed tomography (CT) scanner, and a three-dimensional reconstruction of the obturated root canals was performed to analyze the volume of interface voids and gaps in the obturated teeth. RESULTS: Statistical analysis demonstrated that the silicon-based sealer RoekoSeal induced significantly less voids and gaps than other tested materials. The amount of voids and gaps significantly was higher in the apical region. CONCLUSIONS: These data indicate that none of the root canal-filled teeth were free of gaps. Teeth obturated with RoekoSeal demonstrated to have the highest quality in terms of voids and gaps formation in combination with the BeeFill® 2in1 obturation system. CLINICAL RELEVANCE: These findings point to the potential benefit of micro-CT analyses for in vitro evaluation of root canal obturation systems and provide further information about sealer materials used in combination with a warm gutta-percha vertical compaction technique.

Changes in the distribution of occlusal forces in the course of the orthodontic retention phase : A prospective cohort study.

PURPOSE: Aim of the present study was to assess the relative distribution of occlusal forces after orthodontic treatment and during the first 3 months of the retention phase using a computerized occlusal analysis system (T-Scan, Tekscan Inc., Norwood, MA, USA). MATERIALS AND METHODS: A total of 52 patients were included in this prospective cohort study and underwent analysis of occlusal forces on the level of tooth, jaw-half, and -quadrant during a 3-month period. Furthermore, differences between three retention protocols (group I: removable appliances in both jaws; group II: fixed 3-3 lingual retainers in both jaws; group III: removable appliance in the maxilla and fixed 3-3 lingual retainer in mandible) were assessed with Wilcoxon signed-rank tests at 5%. RESULTS: Directly after debonding, measured forces distribution were similar to published references for untreated samples. In the following, no significant difference was found between retention protocols II and III with regard to the asymmetry of the anterior occlusal forces. Both groups maintained an asymmetric force distribution in the anterior segment during the study period. There was also no difference between groups II and III in the distribution of occlusal forces for the posterior segments. Both retention concepts kept the symmetrical distribution of occlusal forces stable over the observation period. The retention concept of group I demonstrated a symmetrical distribution of occlusal forces in the anterior segment after debonding and this remained stable during the 3­month period. In the posterior segment, no improvement of the initially asymmetric masticatory force distribution could be observed. CONCLUSIONS: All three studied retention protocols showed stability in retaining their original symmetrical or asymmetrical occlusal force distribution posteriorly/anteriorly during the 3­month observation period. Therefore, an even distribution of occlusal forces should be the aim of the finishing phase, as no relative benefit of any single retention scheme in terms of post-debond improvement during the retention phase was seen.

Torque capabilities of self-ligating and conventional brackets under the effect of bracket width and free wire length.

OBJECTIVES: To numerically investigate the torque capacity of conventional and self-ligating brackets under the effect of varying bracket width and free wire length. MATERIAL AND METHODS: Finite element models of three kinds of orthodontic brackets in the 0.022-inch slot size were investigated: Discovery, Damon 3MX, Speed. Additionally, finite element (FE) models of Speed and Damon brackets were generated with the same width as the Discovery. From the left upper incisor to the right upper canine, four brackets each were modelled. The total wire length at the upper right incisor was kept constant at 12 mm for all brackets types. For the Discovery brackets, the wire length was increased from 12 to 16 mm in 2-mm steps. A torque of 20° was applied to the upper right incisor with 0.46 × 0.64 mm(2) (0.018″ × 0.025″) and 0.48 × 0.64 mm(2) (0.019″ × 0.025″) wires. Wires made of stainless steel, titanium molybdenum and nickel titanium were studied. Torque angle/moment characteristics were recorded. RESULTS: Wider brackets showed more torque control capability (e.g. Discovery: 10.6 Nmm, Damon: 9.2 Nmm, Speed: 4.0 Nmm for the NiTi wire). Even with the same width as the Discovery bracket, Damon and Speed brackets showed lower torque capability than the Discovery bracket. Increasing the free wire length decreased the torsional stiffness of the wire and thus decreased the torque capability. CONCLUSION: The results showed that the bracket design has less influence on the torquing moment than other parameters, such as bracket width, free wire length, wire/slot play or misalignment.

Interactions of regenerative, inflammatory and biomechanical signals on bone morphogenetic protein-2 in periodontal ligament cells.

BACKGROUND AND OBJECTIVE: Regeneration of periodontal tissues by EMD remains a major challenge because a number of modifying factors are as yet unknown. The effects of EMD seem to be mediated, at least in part, by bone morphogenetic protein-2 (BMP-2). This in vitro study was performed to examine whether the effects of EMD on BMP-2 activity are modulated by inflammatory and/or biomechanical signals. MATERIAL AND METHODS: Periodontal ligament cells were seeded on BioFlex(®) plates and exposed to EMD under normal, inflammatory or biomechanical loading conditions for 1 and 6 d. In order to mimic proinflammatory or biomechanical loading conditions in vitro, cells were stimulated with interleukin-1ß (IL-1ß), which is increased at inflamed periodontal sites, and cyclic tensile strain of various magnitudes, respectively. The synthesis of BMP-2, its receptors (BMPR-1A, BMPR-1B and BMPR-2) and its inhibitors (follistatin, matrix gla protein and noggin) were analyzed using real-time RT-PCR and ELISA. RESULTS: In EMD-treated cells, BMP-2 synthesis was increased significantly at 1 d. EMD also induced the expression of all BMP receptors, and of the BMP inhibitors follistatin and noggin. In general, IL-1ß and biomechanical loading neither down-regulated BMP-2 nor up-regulated BMP inhibitors in EMD-stimulated cells. However, IL-1ß and biomechanical loading, when applied for a longer time period, caused a down-regulation of EMD-induced BMP receptors. CONCLUSION: EMD induces not only BMP-2, but also its receptors and inhibitors, in PDL cells. IL-1ß and biomechanical forces may counteract the beneficial effects of EMD on BMP-2 activity via the down-regulation of BMP receptors.

A method to calibrate fetal µCT scans using histological sections from the same specimens.

Craniofacial morphogenesis is an intricate developmental process in 3D, which therefore merits visualization and investigation in 3D. To better understand the process, we utilize µCT imaging, and describe a method to calibrate each cone beam µCT individually. Calibration is necessary, because during development, fetuses undergo tissue differentiation, which affects the acquisition process for radiographic images. Additionally, tissue fixation and conservation agents may influence the physical properties of the specimens and may affect image acquisition. After taking a µCT scan from each specimen, we separated a horizontal slice from each neck (which is inconsequential to our question with relation to the whole head). These neck specimens were prepared as horizontal histological serial sections and stained. With these as a reference, the µCT visualization parameters could be adjusted until they matched the selected virtual section planes, which correspond exactly to the planes of the histological sections with a precision (pixel size) of 0.69µm.

Definition of a drilling protocol for mini dental implants in different bone qualities.

Mini dental implants (MDI) have proven to be a good alternative of the conventional implants to support lower overdentures in elderly edentulous patients with narrow residual ridge. The aim of the present study was to define drilling protocols for each diameter of the MDI in each bone quality. The number and the diameter of the drilling bur and the drilling depth was investigated. A total of 48 MDIs with a ball head and transgingival collar were used to the drilling protocol in four different bone qualities (Q1-Q4). All available four diameters of the implants were included: 1.8mm, 2.1mm, 2.4mm, and 2.9mm. The length of all implants was 15mm. Three different protocols were prepared for each of the four bone qualities and for each implant diameter. The insertion torques and the primary stability of the implants were measured in their final position. Regardless of implant diameter and bone quality, the insertion torque was significantly higher using drilling protocol 1 than 3 and using drilling protocol 2 than 3 as well. The insertion torque was significantly higher in bone quality Q1 than in Q2-Q4. The unscrewing resulted in considerably increase in the torque, which exceeded the insertion torques by up to two times. This repeatedly led to the bending and fractures of implants.

Forces and moments on posterior teeth generated by incisor intrusion biomechanics.

OBJECTIVES: To comparatively evaluate the extrusive forces and torquing moments on the posterior dentition generated during anterior intrusion with different intrusion techniques in the maxillary and mandibular dental arch. MATERIAL AND METHODS: Seven wire specimens were used for each of the following intrusive arches: Utility arch 0.016 x 0.016' Blue Elgiloy, Utility arch 0.017 x 0.025' TMA and Burstone Intrusion arch 0.017 x 0.025' TMA. The wires were inserted on bracketed dental arches constructed on maxillary Frasaco models, segmented mesially to the maxillary canines. Simulated intrusion from 0.0-3.0 mm was performed on the Orthodontic Measurement and Simulation System (OMSS). The forces and moments were recorded in all three planes of space at 0.1 mm increments and the values at 3.0 mm for all wires were used for all statistical evaluations. The data were analyzed, separately for the forces and moments, by means of two-way analysis of variance (ANOVA) with forces and moments serving as the dependent variables and intrusion technique and jaw (maxilla or mandible) as the independent variable. Post hoc multiple comparisons were performed using the Tukey test at .05 error rate. RESULTS: The 0.016 x 0.016' Blue Elgiloy utility arch exerted the highest posterior extrusive forces, 15% higher than the 0.017 x 0.025' TMA utility and 40% higher in comparison with the 0.017 x 0.025' TMA Burstone intrusion arch.The lowest posterior moment in the sagittal plane was generated by the 0.017 x 0.025' TMA Burstone intrusion arch. The 0.016 x 0.016' Blue Elgiloy utility arch exerted 15% higher posterior moments and the 0.017 x 0.025' TMA utility 25% higher. Forces and moments were consistently larger for the mandible compared to the maxilla for the same intrusion technique. CONCLUSIONS: The upper Burstone 0.017 x 0.025' TMA intrusion arch exerted the lowest forces/moments on posterior teeth. The highest forces were generated by the 0.016 x 0.016-inch Blue Elgiloy utility arch and the highest moments by the lower 0.017 x 0.025-inch TMA utility arch.

Time-related PDL: viscoelastic response during initial orthodontic tooth movement of a tooth with functioning interproximal contact-a mathematical model.

Most anteroposterior orthodontic movements of posterior teeth have to overcome the "resistance" of adjacent teeth with functioning interproximal contacts. The aim of this study was to develop a mathematical model describing initial posterior tooth movement associated with functioning interproximal contacts in relation to the viscoelastic mechanical behavior of the human periodontal ligament (PDL). A linear viscoelastic 2D mathematical model was modified to depict tipping movement around the center of rotation (C(rot)) of a premolar where tipping is restrained by adjacent teeth. Equilibrium equations were applied taking into account the sagittal moment developed around the C(rot). The constants of the model were analyzed and applied to a numerical model that can simulate short-term tooth creep movement caused by a tipping force. Changes in force magnitude (0.5-3N) and crown length (6-10mm) were analyzed until no movement was observed (steady state). Premolar displacement in contact with adjacent teeth showed a non-linear progression over time with an initial sharp tipping movement followed by a transient period of 2.6-7.1min. As tipping force increased the transient period increased. A similar but smaller effect was observed with an increase in crown length. The premolar initial displacement within the arch (3.2-19.5microm) is about seven-fold smaller than retraction/protraction movement of an incisor. These suggest reduction in tooth displacement when functioning interproximal contact is present and clinically recommend establishing a space in the direction of tooth displacement before tooth movement.

Fatigue failure of as-received and retrieved NiTi orthodontic archwires.

AIM: To investigate the fracture resistance of as-received and retrieved NiTi archwires. MATERIALS AND METHODS: NiTi archwires (German Orthodontics, CA, USA) of various cross-sections were retrieved from orthodontic patients and brand-, type- and size-matched wires were included as controls. Specimens prepared from the selected wires were subjected to bending deformation at a loading frequency of 2 Hz and cyclic loading was applied either until fatigue failure or with a maximum number of loading cycles of 2 x 10(6). For each wire cross-section a minimum of five specimens were loaded; the cycle number of the fatigue fracture was recorded and the mean of the cycles was calculated from the five specimens to provide the corresponding point in the Wöhler diagram. Scanning electron microscopy was used to assess the fracture pattern of broken wires. The results of the fracture cycles of as-received and retrieved wires were analyzed with a general linear regression model with state (as-received vs. retrieved) and wire size serving as discriminating variables and Tukey's test at the 0.05 level of significance. RESULTS: Retrieved wires fractured at a significantly lower number of cycles compared to their as-received matches. The size of the wire played a role in determining fracture with larger cross-sections showing reduced fatigue failure properties and 0.30 and 0.035-mm specimens showing no fracture at the selected strain and number of cycles. The SEM investigations revealed evidence of smoother fractured surfaces in large-sized, rectangular cross-sectioned retrieved wires. Kaplan-Meier survival analysis with log rank test demonstrated the effect of aging and size in predicting survival of NiTi wires. SIGNIFICANCE: The extended life expectancy of NiTi archwires proposed in current treatment trends is associated with higher probability of fatigue fracture of wires. Large diameter and square or rectangular cross-sections possess an increased chance of failure relative to smaller diameter wires. A necessity may emerge to monitor patients to identify wire failures despite the commonly employed practice of increased time intervals between appointments in patients treated with NiTi wires.

Experimental-numerical analysis of minipig's multi-rooted teeth.

The paper pertains to the analysis of the biomechanical behaviour of the periodontal ligament (PDL) by using a combined experimental and numerical approach. Experimental analysis provides information about a two-rooted pig premolar tooth in its socket with regard to morphological configuration and deformational response. The numerical analysis developed for the present investigation adopts a specific anisotropic hyperelastic formulation, accounting for tissue structural arrangement. The parameters to be adopted for the PDL constitutive model are evaluated with reference to data deducted from experimental in vitro tests on different specimens taken from literature. According to morphometric data relieved, solid models are provided as basis for the development of numerical models that adopt the constitutive formulation proposed. A reciprocal validation of experimental and numerical data allows for the evaluation of reliability of results obtained. The work is intended as preliminary investigation to study the correlation between mechanical status of PDL and induction to cellular activity in orthodontic treatments.

Computer-aided analysis of the biomechanics of tooth movements.

Orthodontic biomechanics started in the early 1960s with the work of Burstone and later Nikolai. Experimental and theoretical studies using finite element methods (FEM) focused on the determination of the position of the center of resistance of single and multi-rooted teeth. Due to the complex structure of the system tooth/periodontal ligament/alveolar bone and because of the limited power of computers, the first numerical models were quite simple. Improved FE software, sophisticated programs for model generation and the explosion of computer power in the last decade resulted in more complex tooth-periodontium models and model assumptions. This paper describes the application of finite element methods in orthodontic biomechanics with the help of several typical examples. The examples cover aspects from basic orthodontic biomechanics to possible future applications in treatment planning using bone remodelling theories: determination of the mechanical properties of the periodontal ligament in a combined numerical and experimental study, calculation of the centers of resistance of different teeth, and simulation of orthodontic tooth movements. The examples show that nowadays finite element methods are a useful and easy-to-handle tool for the solution of a larger number of structure-mechanical and biomechanical problems. Nevertheless, in spite of the enormous technical progress in the last decade, many problems in orthodontic biomechanics remain to be solved.

Finite element analysis of different loading conditions for implant-supported overdentures supported by conventional or mini implants.

The effect of implants' number on overdenture stability and stress distribution in edentulous mandible, implants and overdenture was numerically investigated for implant-supported overdentures. Three models were constructed. Overdentures were connected to implants by means of ball head abutments and rubber ring. In model 1, the overdenture was retained by two conventional implants; in model 2, by four conventional implants; and in model 3, by five mini implants. The overdenture was subjected to a symmetrical load at an angle of 20 degrees to the overdenture at the canine regions and vertically at the first molars. Four different loading conditions with two total forces (120, 300 N) were considered for the numerical analysis. The overdenture displacement was about 2.2 times higher when five mini implants were used rather than four conventional implants. The lowest stress in bone bed was observed with four conventional implants. Stresses in bone were reduced by 61% in model 2 and by 6% in model 3 in comparison to model 1. The highest stress was observed with five mini implants. Stresses in implants were reduced by 76% in model 2 and 89% increased in model 3 compared to model 1. The highest implant displacement was observed with five mini implants. Implant displacements were reduced by 29% in model 2, and increased by 273% in model 3 compared to model 1. Conventional implants proved better stability for overdenture than mini implants. Regardless the type and number of implants, the stress within the bone and implants are below the critical limits.

Changes in biting forces with implant-supported overdenture in the lower jaw: A comparison between conventional and mini implants in a pilot study.

The biting ability of patients improves noticeably after receiving implant-supported overdentures in comparison to conventional complete dentures. However, the change of biting with such treatment concepts has been quantitatively investigated in only a limited number of studies. The aim of the present study has been to measure the biting forces of edentulous patients with complete dentures and after receiving implant-supported overdentures. A total of 26 edentulous patients were included. Ten patients received two to four conventional implants (control group, Ø3.3-3.7mm, L11-13mm) and 16 patients received four to five mini implants (study group, Ø1.8-2.4mm, L13-15mm) inserted in the mandibular interforaminal region. All patients received a lower overdenture with ball/rubber ring attachments and a complete denture for the maxilla. The biting forces were measured using Prescale pressure sheets type low before the insertion of implants and after receiving implant-supported overdenture. The measured sheets were later scanned and analysed using FPD-8010E software. The range of biting forces before the insertion of implants was 80N-122N for the control group and 66-88N for the study group. After the insertion of implants, the range of biting forces increased to 167N-235N for the control group and to 81N-138N for the study group. However, the increase in biting forces after the insertion of implants was not significant for either group. No significant difference was obtained between the two implant systems. The biting forces improved after insertion of implants regardless of which implant system was used. However, the degree of improvement is noticeably related to the original bone quality of the mandible at the insertion regions of implants.

In vivo measurements and numerical analysis of the biomechanical characteristics of the human periodontal ligament.

The periodontal ligament is a complex tissue with respect to its biomechanical behaviour. It is important to understand the mechanical behaviour of the periodontal ligament during physiological loading in healthy patients as well as during the movement of the tooth in orthodontic treatment or in patients with periodontal disease, as these might affect the mechanical properties of the periodontal ligament (PDL). Up to now, only a limited amount of in vivo data is available concerning this issue. The aim of this study has been to determine the time dependent material properties of the PDL in an experimental in vivo study, using a novel device that is able to measure tooth displacement intraorally. Using the intraoral loading device, tooth deflections at various velocities were realised in vivo on human teeth. The in vivo investigations were performed on the upper left central incisors of five volunteers aged 21-33 years with healthy periodontal tissue. A deflection, applied at the centre of the crown, was linearly increased from 0 to 0.15mm in a loading period of between 0.1 and 5.0s. Individual numerical models were developed based on the experimental results to simulate the relationship between the applied force and tooth displacement. The numerical force/displacement curves were fitted to the experimental ones to obtain the material properties of the human PDL. For the shortest loading time of 0.1s, the experimentally determined forces were between 7.0 and 16.2N. The numerically calculated Young's modulus varied between 0.9MPa (5.0s) and 1.2MPa (0.1s). By considering the experimentally and numerically obtained force curves, forces decreased with increasing loading time. The experimental data gained in this study can be used for the further development and verification of a multiphasic constitutive law of the PDL.

Post-treatment changes in permanent retention.

OBJECTIVES: While permanent retention is today the method of choice to stabilize orthodontic treatment outcomes, recent studies have increasingly reported posttreatment changes in tooth position during permanent retention. We conducted this study to analyze changes in the anterior mandible, whether the changes follow an underlying movement pattern, and, aiming for a preventive strategy, whether any risk factors could be identified comparing findings with the pretreatment situations. METHODS: We included 30 patients who had worn fixed Twistflex retainers (UK 3-3) extending from canine to canine in the mandible. Casts reflecting the intraoral situations before orthodontic treatment (T0), directly after completion of active therapy (T1), and 6 months later (T2) were scanned and superimposed using Imageware Surfacer software. Posttreatment changes (T2-T1) of tooth position within the retainer block were analyzed on 3D virtual models and were compared to pretreatment (T0) and treatment-related (T1-T0) findings to identify potential risk factors. RESULTS: Almost all analyzed patients revealed three-dimensional changes in tooth position within the retainer block. Comparing these movements, we repeatedly found rotated retainer blocks in labio-oral direction, while the center of rotation was located at the first incisors. This pattern was associated with intercanine expansion and excessive overjet correction during orthodontic treatment. The canines underwent the most pronounced (rotational and translational) movements. CONCLUSIONS: In general permanent lingual retainers are safe but in special clinical cases retainers can induce undesired tooth movement. Risk factors seem to be intercanine expansion and excessive overjet correction during orthodontic treatment. In specific cases an additional retention device might be needed.