3D FEM comparison of lingual and labial orthodontics in en masse retraction.

BACKGROUND: The aim of this study was to compare displacements and stress after en masse retraction of mandibular dentition with lingual and labial orthodontics using three-dimensional (3D) finite element models (FEM). METHODS: A 3D FEM of each lower tooth was constructed and located as appropriate to Roth's prescription. The 0.018-in. GAC Roth Ovation labial and Ormco 7th Generation lingual brackets were virtually bonded to the lower teeth and threaded with 0.018 × 0.025- and 0.016 × 0.022-in. SS labial (Tru-Arch form, small size) and lingual (mushroom) archwires. En masse retraction was simulated by applying 300 g of distal force from the canine to the second premolar on the 0.016 × 0.022-in. SS labial and lingual archwires. The type of finite element used in the analysis was an eight-noded brick element. The Algor program (Algor Inc., Pittsburgh, PA, USA) was used to calculate the strains and displacements at each nodal point. RESULTS: Lingual tipping and extrusion of the anterior dentition occurred with both archwires. At the premolars and first molars, intrusion, lingual movements, and lingual tipping were seen with the labial archwire, while intrusion was accompanied by labial movements, mesial tipping, and buccal rotation with lingual mechanics. CONCLUSIONS: Lingual vs. labial bracket placement influences the pattern of tooth movement, but the stress that occurs around the teeth can be accurately mapped using a 3D FEM model.

Changes in the oral environment after placement of lingual and labial orthodontic appliances.

BACKGROUND: This study compared the oral hygiene and caries risk of patients treated with labial and lingual orthodontic appliances throughout a prospective evaluation of the status of the oral environment before and after bracket placement. METHODS: A total of 20 orthodontic patients aged 19 to 23 years were included in the study and were divided into two groups: 10 patients wore Roth labial appliance (American Orthodontics, Sheboygan, WI, USA) and 10 patients wore STb lingual appliance (Ormco Corporation, Glendora, CA, USA). Plaque index (PI), gingival bleeding index (GBI), salivary flow rate, saliva buffer capacity, salivary pH, and Streptococcus mutans and Lactobacillus counts in saliva were determined at three time points: before orthodontic appliance placement (T0), 4 weeks after bonding (T1), and 8 weeks after bonding (T2). After appliance placement, all patients were periodically educated to the oral hygiene procedures. Wilcoxon rank and Mann-Whitney U tests were used to determine intragroup and intergroup differences as regards qualitative data. To compare quantitative data between the groups, chi-square and Fisher's exact tests were undertaken, while intragroup differences were tested with McNemar test. The level of statistical significance was set at p<0.05. RESULTS: Statistical analysis of the data obtained revealed a statistically significant difference between the data of T0 and T1 and the data of T0 and T2 of the PI scores and between T0 and T2 of the GBI scores in the group treated with the lingual appliance. The GBI value increased significantly between T0 and T1 but decreased significantly between T1 and T2 (p<0.01) in the group treated with labial appliance. S. mutans counts increased significantly between T0 and T2 in the saliva samples of patients treated with lingual appliance. No statistically significant differences were found between S. mutans and Lactobacillus counts at the three terms of saliva collection in patients treated with labial appliance. No statistically significant differences were found between the two groups at the three time points as regards the salivary flow rate and saliva buffer capacity. CONCLUSIONS: Lingual and labial orthodontic appliances showed a different potential in modifying the investigated clinical parameters: patients wearing STb lingual orthodontic appliance had more plaque retention 4 and 8 weeks after bonding, while there were more gingival inflammation and more S. mutans counts 8 weeks after bonding. No differences were found between the two groups as regards the Lactobacillus counts, the salivary flow rate, and saliva buffer capacity.