Effects of variable attachment shapes and aligner material on aligner retention.

OBJECTIVE: To evaluate the retention of four types of aligners on a dental arch with various attachments. MATERIALS AND METHODS: For this study, three casts were manufactured, two of which contained attachments (ellipsoid and beveled), and one without any attachments to serve as a control. Four types of aligners were thermoformed: Clear-Aligner (CA)-soft, CA-medium, and CA-hard, with various thicknesses, and Essix ACE. Measurements of vertical displacement force during aligner removal were performed with the Gabo Qualimeter Eplexor. Means and standard deviations were next compared between different aligner thicknesses and attachment shapes. RESULTS: CA-soft, CA-medium, and CA-hard did not present a significant increase in retention, except when used in the presence of attachments. Additionally, CA-medium and CA-hard required significantly more force for removal. Essix ACE demonstrated a significant decrease in retention when used with ellipsoid attachments. The force value for Essix ACE removal from the cast with beveled attachments was comparable to that of CA-medium. Forces for aligner removal from the model without attachments showed a linear trend. Essix ACE did not show a continuous increase in retention for each model. Overall, ellipsoid attachments did not present a significant change in retention. In contrast, beveled attachments improved retention. CONCLUSIONS: Ellipsoid attachments had no significant influence on the force required for aligner removal and hence on aligner retention. Essix ACE showed significantly less retention than CA-hard on the models with attachments. Furthermore, beveled attachments were observed to increase retention significantly, compared with ellipsoid attachments and when using no attachments.

Cephalometric evaluation of the craniofacial complex in patients treated with an intraoral distraction osteogenesis device: a long-term study.

INTRODUCTION: Distraction osteogenesis has gained popularity because of the hypothesized concurrent soft-tissue expansion, which is believed to reduce postoperative relapse. Although many articles describe the immediate success of mandibular distraction, little research has been done on its long-term stability. Our goal was to examine the long-term craniofacial changes after distraction. METHODS: Four hemifacial microsomic patients treated with unilateral mandibular distraction were recalled. Changes in maxillary width and height, occlusal height, ramus height, mandibular length, and chin position were quantified by using the posteroanterior and 45 degrees lateral oblique cephalographs. Predistraction and postdistraction measurements were taken over a 5-year period. The data were analyzed by using paired t tests and ANOVA. RESULTS: Maxillary height, ramus height, mandibular length, and chin point deviation all experienced moderate improvement after distraction. Although the growth patterns between the control side and the treated side were comparable until 2 years after removal of the device, the normal side outgrew the affected side thereafter until 5 years after distraction. CONCLUSIONS: Because of the greater inherent growth potential of the unaffected side, more overcorrection than originally believed is needed to offset the persistent asymmetry in growing hemifacial microsomia patients who undergo unilateral distraction osteogenesis.

Damping effects on the response of maxillary incisor subjected to a traumatic impact force: a nonlinear finite element analysis.

OBJECTIVES: The aim of this study was to evaluate the effects of damping on stress concentration in an impacted incisor. METHODS: Damping ratios of maxillary incisors were tested using an in vivo modal testing method. A finite element model of the upper central incisor was established for dental trauma analysis. To assess the effect of damping properties on induced stresses in the traumatized incisors, equivalent stresses in the finite element model with various damping ratios were calculated for comparison. The mechanisms of cushioning properties of the upper incisors on traumatic injuries were assessed by profiling the stress distributions in the incisor model sequentially with time. RESULTS: The measured damping ratio of maxillary incisors was 0.146+/-0.037. When the incisor was subjected to an impact force, high stresses were concentrated at the labial and lingual incisor edges, cervical ridge, and the area around root apex. When the damping ratios of the incisor model were set at 10- and 50-fold of the measured values, the peak stresses induced near the impact site of the incisor model were reduced from 24.0 to 23.2 and 15.9 MPa, respectively. On the other hand, the peak stress lagged and the stress existence period increased when the damping properties were taken into consideration. CONCLUSIONS: Damping properties of teeth provide protection to the tooth during traumatic injury by decreasing the peak stress magnitude due to release of strain energy over a longer period.

Cephalometric evaluation of the craniofacial complex in patients treated with an intraoral distraction osteogenesis device: a preliminary report.

The purpose of this pilot study was to evaluate cephalometrically the efficacy of an intraoral distraction osteogenesis device in treating patients with unilateral mandibular hypoplasia. Six patients with hemifacial microsomia underwent unilateral mandibular distraction. Posteroanterior and 45 degrees lateral oblique cephalograms were measured, and changes in maxillary width and height, occlusal height, ramus height, mandibular length, and chin position were quantified. Measurements were taken preoperatively and postoperatively at 7 time points (T1-T7) over 2 years. Calculations for statistical significance were done to T6 for all patients and through T7 for 4 patients. The means and variances were calculated for the 6 cephalometric variables for each time point. The mean differences between treatment and control were calculated as well as analysis of variance. Mean differences between specific time periods were measured by pairwise comparison with significance determined at the 0.05 level of confidence. Statistical analysis was used for descriptive purposes only. The cephalometric data suggest that the intraoral distractor is as capable of lengthening hypoplastic mandibles as the initial extroral appliances. The bone lengthening appears stable, with the distracted side of the mandible maintaining a growth rate similar to the normal side. Immediately after distraction, transient improvements were noted in maxillary height, ramal height, and maxillary width. All patients demonstrated an immediate improvement in chin position toward the skeletal midline; however, after T4, menton appeared to be moving away from the midline over time.