Anterior Open Bite Treated With Palatal Crib and Myofunctional Therapy: A Case Report.

The most prevalent oral habit and one of the most often habitual behavioral patterns in preschool-aged children is thumb-sucking. This behavior is crucial to the development of malocclusion and must be addressed carefully since it may cause a secondary tongue thrust that worsens the issue. Developing an effective treatment plan requires determining the underlying cause, which may include psychological, physiological, and or anatomical factors. Overall prevention of behavior needs to be planned for successful outcomes. One such device for treating tongue-thrusting and thumb-sucking habits is the palatal crib. The present case shows the possible effectiveness of palatal crib use in conjunction with myofunctional therapy for a child whose diagnosis involves habitually holding the tongue low and sucking the thumb that causes an anterior open bite (AOB). An 11-year-old boy with flared and spaced upper and lower incisors also had an AOB. Myofunctional therapy was combined with palatal cribs to help the tongue reposition itself and discourage the habit of sucking. The AOB was successfully corrected with an appropriate overjet and overbite after a total of three months of treatment.

Treatment of Vertical Maxillary Excess and Skeletal Class II Malocclusion: A Case Report.

Class II malocclusion is a recurrent problem that may occur at a young age. If treated initially, the malocclusion can be corrected by redirecting the growth without invasive modalities and avoiding orthognathic surgeries. A female patient aged 10 years three months came to the department of orthodontics having a complaint of upper front teeth placed forwardly, diagnosed with skeletal class II due to retrusive mandible and vertical maxillary excess with hyper divergent growth pattern with increased anterior facial height, with Angle's molar class II division 1 malocclusion, increased overjet of 13 mm and overbite of 7 mm, acute nasolabial angle, deep mentolabial sulcus, and hyperactive mentalis. It was treated using an activator with medium-high-pull headgear (modified Herren activator) passing through the maxillary center of resistance. A fixed mechanotherapy with high-pull headgear was given using the anterior inclined plane acrylic plate in the maxilla and McLaughlin, Bennett, and Trevisi (MBT). Begg's wrap was used for the retention plan. This case report shows the significance of proper treatment results obtained due to correct identification and planning in treating malocclusion. This case report shows the significance of proper treatment results obtained due to correct identification and planning in treating malocclusion.

Behind the Smile: Managing Class I Malocclusion and Protrusive Upper Incisors With Kalra Simultaneous Intrusion and Retraction (K-SIR) Mechanics.

Malocclusion is defined as any deviation from the ideal occlusal positions and the position of the specific teeth. Those that are common are numerous and affect a patient's stomatology and dental structures in appearance and utility. Class I is the most common type and favors the anterior relationship of both jaws, which lies between the second and third quartiles. Its cause is still unknown at the moment. It is even more frequent than usual occlusion. Class I malocclusion with an overjet of upper incisors less than 4 mm accompanied by type 2 of Dewey's modification also displays protruded upper incisors and a deep overbite. This case report's focus is to provide an extensive evaluation of the diagnostic process, management plan, and outcome for a patient who had presented with this specific dental abnormality and simultaneous intrusion and retraction mechanics for an anterior segment with Kalra Simultaneous Intrusion and Retraction (K-SIR) loops.

Effectiveness of removable anterior bite planes with varied mealtime protocols in correcting deep bites among growing patients: a randomized clinical trial.

OBJECTIVES: To compare effectiveness of two protocols for correcting deep bite in growing patients using a removable anterior bite plane (RABP): full-time wear with appliance on during meals (F + M) vs off during meals (F - M) and to explore the relationship between average daily duration of wear and overbite (OB) correction rate, stratified by the wear protocol. MATERIALS AND METHODS: Thirty-two growing patients with deep bite (mean age = 10.94 ± 2.17 years) were randomly assigned to the F + M (n = 16) or F - M (n = 16) group. Cephalometric radiographs were taken at baseline (T0) and when normal OB was achieved (T1). Duration of wear was recorded by a TheraMon microsensor within the appliance. A best-fit regression model for the relationship between daily duration of wear and OB correction rate was determined (α = 0.05). RESULTS: Both groups exhibited similar baseline characteristics and cephalometric changes, ie, molar extrusion, and incisor intrusion and proclination in both arches (P < .05), and intergroup differences were not significant. Here, F + M exhibited significantly faster rates of deep bite correction (1.83 ± 1.18 vs 1.08 ± 0.62 mm/month; P < .05) and mandibular molar extrusion (0.46 ± 0.25 vs 0.30 ± 0.18 mm/month, P < .05) compared with F - M. Best-fit regression models for relationship between daily duration of wear and OB correction rate were exponential for both F + M (R2 = 0.53) and F - M (R2 = 0.74). CONCLUSIONS: Here, F + M and F - M protocols resulted in comparable cephalometric changes among deep bite growing patients. However, the F + M group exhibited a faster correction rate. Daily duration of wear positively correlated with OB correction rate in an exponential manner.

Effect of Early Orthodontic Treatment on Long-Term Stability of Class II Malocclusions.

Background: Class II malocclusions are a common orthodontic problem, often requiring comprehensive treatment to achieve proper occlusion and facial harmony. Early orthodontic intervention in the mixed dentition phase has been advocated to address these issues. Materials and Methods: A retrospective analysis was conducted on a cohort of 150 patients with class II malocclusions who underwent early orthodontic treatment between the ages of 7 and 10 years. The treatment included fixed or removable appliances, headgear, and functional appliances, depending on individual needs. Records of their initial malocclusion severity, treatment modalities, and long-term follow-up data (mean follow-up duration of 10 years) were collected and analyzed. Stability was assessed by evaluating overjet and overbite changes from post-treatment to the long-term follow-up. Results: The initial mean overjet and overbite values were 8.5 mm and 4.0 mm, respectively. Following early orthodontic intervention, these values were significantly reduced to 3.0 mm and 1.5 mm, respectively (P < 0.001). At the long-term follow-up, the mean overjet and overbite remained stable at 3.2 mm and 1.6 mm, respectively. Analysis revealed that 85% of patients maintained their corrected class II occlusion within clinically acceptable limits, while 15% experienced minor relapse requiring minimal additional treatment. Conclusion: Early orthodontic treatment in class II malocclusions can lead to significant improvements in overjet and overbite, and these corrections tend to remain stable over the long term.

Planned and achieved overjet and overbite changes following an initial series of Invisalign® aligners: A retrospective study of adolescent patients.

OBJECTIVE: The aim of the present study was to compare the changes in overjet and overbite measurements achieved in adolescent patients following an initial series of Invisalign® aligners (Align Technology, San Jose, California) with those planned by orthodontists via its ClinCheck® digital treatment planning facility. METHODS: Data provided by Align regarding patients who had completed an initial series of Invisalign® aligner treatment and were less than 18-years old were assessed in relation to pre-treatment, planned and achieved overjet and overbite measurements. Descriptive statistics, Wilcoxon rank-sum, Mann Whitney calculations were computed. RESULTS: A total of 290 patients satisfied inclusion criteria. The median (interquartile range (IQR)) age was 14.17 (13,15.42) years. The median achieved overjet and overbite changes were less than those planned (p<0.01) with 53.33% of the planned median overjet increase achieved and 52.94% of planned median overjet reduction achieved. Additionally, 58.33% of the planned median overbite increase was achieved and 55.55% of the planned median overbite reduction was achieved. A total of 21.52% patients recorded no change or an increase from pre-treatment to the achieved overjet where reduction was planned, whereas 41.67% recorded no change or a reduction in overjet where increase was planned. A total of 18.72% recorded no change or an increase in overbite where reduction was planned, whereas 20.75% recorded no change or a reduction in overbite where increase was planned. CONCLUSIONS: Less than 60% of the planned overjet and overbite changes per patient were achieved. Between 18.72 and 41.67% of patients experienced no change or changes in overjet and overbite in the opposite direction to that planned. This is likely to be clinically significant.

Correlation between Depth of the Curve of Spee and Some Specific Malocclusion Characteristics in a Population from Sibiu County, Romania-A Cross-Sectional Study.

Background: This study aimed to investigate the relationship between the Curve of Spee (COS) depth and malocclusion characteristics in a population from Sibiu County, Romania. The research sought to understand how the COS's anatomical dimensions correlate with different classes of malocclusion and the position of the frontal teeth. Methods: A total of 265 participants from the Dentistry Ambulatory of the Military Hospital of Sibiu were included in this study. It employed digital intraoral scanning technology to measure the COS, overjet, and overbite, with malocclusion classification. Statistical analyses, including correlation and regression, were conducted to examine the relationships between COS depth, frontal teeth position, and malocclusion characteristics. Results: The average COS depth measured was 1.0564 mm, presenting variability when compared to existing literature. Most of the study participants had Class I malocclusion. A significant positive correlation between COS depth and overjet was identified, with no notable gender-based differences in these occlusal parameters. Conclusions: The findings affirm the integral role of COS in occlusal dynamics and malocclusion diagnosis. The COS measurement of a mean of 1.0564 mm, when compared to other results emphasizes the differences in occlusal curvature among various populations. The results contribute to a refined understanding of occlusal relationships, supporting the need for personalized orthodontic and prosthetic treatments based on precise anatomical measurements.

Effectiveness of Invisalign Treatment on Open Bite Correction.

Background: Open bite is a common orthodontic malocclusion that can have functional and aesthetic implications. Traditional orthodontic treatments have been used to correct open bites, but the effectiveness of Invisalign, a clear aligner therapy, in open bite correction remains a topic of interest. Materials and Methods: A retrospective analysis was conducted on a cohort of 50 patients with open bites who underwent Invisalign treatment. Pre-treatment and post-treatment records, including cephalometric radiographs, dental models, and clinical photographs, were assessed. The open bite was defined as a negative overbite greater than 2 mm. Treatment duration, number of aligners used, and patient compliance were also recorded. Statistical analysis, including paired t-tests and subjective patient feedback, was employed to evaluate the treatment outcomes. Results: The mean pre-treatment open bite was -3.5 mm (SD = 1.2), and the mean treatment duration was 18 months (SD = 2.5). On average, patients received 24 sets of aligners (SD = 4.1) during the treatment. Post-treatment evaluation showed that the mean overbite improved to + 1.5 mm (SD = 0.8), indicating successful open bite correction. The paired t-test revealed a statistically significant difference between pre-treatment and post-treatment open bite measurements (P < 0.001). Patient satisfaction was high, with 90% of participants reporting improved aesthetics and comfort. Conclusion: Invisalign treatment demonstrates effectiveness in correcting open bites, with statistically significant improvements in overbite measurements.

An evaluation of cephalometric predictors of anterior open bite; An assessment of dental and skeletal parameters in an orthodontic population.

BACKGROUND: Anterior open bite (AOB) malocclusion is one of the highly challenging malocclusions. Cephalometric radiographs have been used for the diagnosis of occlusal anomalies in the vertical and anteroposterior directions. This study aims to compare skeletal and dental features in open and non-open bite subjects to identify factors that help predict and categorize open bites in a Nigerian population. MATERIALS AND METHODS: Pretreatment cephalometric radiographs of 82 patients were recruited into this study. This study comprised 41 AOB patients and 41 (Class 1 malocclusion) patients (control group). The radiographs were obtained from the orthodontic unit, Department of Child Dental Health of the Lagos University Teaching Hospital, Idi-Araba Lagos. Cephalometric tracing and analysis of the obtained radiographs were used to identify and compare the skeletal and dental differences between the two groups. RESULTS: The mean age of the participants was 20.47 ± 8.05 years. The patients consisted of 26 (31.7%) males and 56 (68.3%) females. There was a significant difference in the open bite depth indicator (ODI) of the open bite (P value < 0.001). There was a statistically significant increase in the vertical skeletal parameters - lower facial height (LFH), total facial height (TFH), posterior facial height (PFH), Frankfort-mandibular plane angle (FMA), mandibular-maxillary angle (MMA), and gonial angle in the AOB group compared to the control group. The vertical height of the dentoalveolar segments measured was all significantly increased in the open bite group compared to the control group. CONCLUSION: The results suggest that the skeletal and dental vertical parameters, including ODI of the open bite subjects, varied compared with the non-open bite subjects in the Nigerian population studied and could be used to predict AOB tendency.

Occlusal characteristics in modern humans with tooth agenesis.

Non-syndromic permanent tooth agenesis affects a significant proportion of the population, especially if third molars are considered. Although tooth agenesis has been linked to a smaller craniofacial size, reduced facial convexity and a shorter skeletal face, the occlusal characteristics of individuals with tooth agenesis remain largely unexplored. Therefore, this study investigated potential associations between tooth agenesis and metric occlusal traits in 806 individuals (491 with 4.1 missing teeth per subject, including third molars, and 315 without any tooth agenesis). Dentoskeletal morphology was defined through anatomical landmarks on pre-treatment cephalometric radiographs. Multivariate regression models, adjusted for sex and age, showed that tooth agenesis was significantly associated with a reduced overjet, an increased interincisal angle, and shorter upper and lower dental arch lengths, but not with overbite. Moreover, apart from reduced tooth length and dentoalveolar effects, as the number of missing teeth increased the upper front teeth were progressively retruded according to the craniofacial complex and to the face. Thus, tooth agenesis has a substantial influence on dental and occlusal characteristics, as well as on the sagittal position and inclination of anterior teeth. These findings emphasize the necessity for personalized, multidisciplinary approaches in individuals with multiple agenesis to successfully meet treatment goals.

Hybrid treatment of varied orthodontic appliances for a patient with skeletal class II and temporomandibular joint disorders: A case report and review of literature.

BACKGROUND: The relation between orthodontic treatment and temporomandibular disorders (TMDs) is under debate; the management of TMD during orthodontic treatment has always been a challenge. If TMD symptoms occur during orthodontic treatment, an immediate pause of orthodontic adjustments is recommended; the treatment can resume when the symptoms are managed and stabilized. CASE SUMMARY: This case report presents a patient (26-year-old, female) with angle class I, skeletal class II and TMDs. The treatment was a hybrid of clear aligners, fixed appliances and temporary anchorage devices (TADs). After 3 mo resting and treatment on her TMD, the patient's TMD symptom alleviated, but her anterior occlusion displayed deep overbite. Therefore, the fixed appliances with TAD were used to correct the anterior deep-bite and level maxillary and mandibular deep curves. After the levelling, the patient showed dual bite with centric relation and maximum intercuspation discrepancy on her occlusion. After careful examination of temporomandibular joints (TMJ) position, the stable bite splint and Invisible Mandibular Advancement appliance were used to reconstruct her occlusion. Eventually, the improved facial appearance and relatively stable occlusion were achieved. The 1-year follow-up records showed there was no obvious change in TMJ morphology, and her occlusion was stable. CONCLUSION: TMD screening and monitoring is of great clinical importance in the TMD susceptible patients. Hybrid treatment with clear aligners and fixed appliances and TADs is an effective treatment modality for the complex cases.

Predicted and achieved overjet and overbite measurements with the Invisalign appliance: a retrospective study.

OBJECTIVES: To determine whether achieved outcome regarding overjet and overbite matched the predicted outcome following treatment with Invisalign (Align Technology, San Jose, Calif) aligner appliances. MATERIALS AND METHODS: Data including pretreatment, predicted and achieved overjet, and overbite measurements provided by Align's digital treatment facility, ClinCheck Pro, were evaluated. Descriptive statistics, Mann-Whitney U-test, and Wilcoxon rank-sum intraclass correlation (ICC) test results were calculated. RESULTS: From an initial sample of 600, 355 adult patients satisfied the inclusion and exclusion criteria. ICC scores for data input were excellent. Median (interquartile range [IQR]) age was 30.14 (23.33, 39.92) years and most (n = 259; 72.95%) were women. Almost one-third (n = 101; 28.45%) had undergone extraction as part of their treatment. More aligners were prescribed in the initial digital treatment plan for patients (median, 44; IQR: 35, 51.5; minimum, 17; maximum, 92) undergoing extractions as part of their orthodontic treatment than those who were not (median, 24; IQR: 18.25, 32; minimum, 13; maximum, 85) (P < .0001). Planned changes in overjet differed significantly from achieved outcomes (P < .001). Planned increases in overbite resulted in up to more than twice (222.72%) as much increase than predicted. Planned reduction of overbite achieved 8.69% of its predicted reduction in extraction cases. CONCLUSIONS: Achieved overjet and overbite measurements differed significantly from the predicted outcomes at the end of an initial sequence of aligners. Planned increases in overbite resulted in greater overbite correction than predicted, particularly in extraction cases. Planned overbite reduction was challenging, especially in patients with extractions.

The effect of vertical skeletal proportions on overbite changes in untreated adolescents: a longitudinal evaluation.

OBJECTIVES: To evaluate the change in overbite within an untreated cohort from 9 to 18 years of age and to compare age-related changes in overbite depth based on vertical skeletal proportion. MATERIALS AND METHODS: Lateral cephalograms were obtained from the American Association of Orthodontists Foundation (AAOF) Craniofacial Growth Legacy Collection Project. All cephalometric outcome measures were assessed at ages 9-11 (T1), 13-15 (T2), and 17-19 (T3) years. Generalized estimating equation (GEE) regression models were fit to examine the effect of MP-SN on overbite adjusted for age and gender. RESULTS: A total of 130 subjects from the Denver, Bolton Brush, and Oregon Growth Studies were included. Overbite was relatively constant from T1 to T3 irrespective of facial type, with a minor decrease (0.15 mm) being observed overall. There was a transient increase between T1 and T2 (0.31 mm) that was canceled out by changes during later adolescence. Based on the GEE regression model adjusted for time and gender, a minor but statistically significantly greater reduction in overbite arose as MP-SN increased (coefficient = -0.080; 95% confidence interval -0.12, -0.04; P < .01). CONCLUSIONS: In hyperdivergent subjects, a marginal decrease in overbite was observed from 9 to 18 years of age, with a transient increase from the period spanning 9-11 years to 13-15 years, which was negated in later adolescence. There are limited data to suggest that observation of vertical growth is required in most patients with marginally increased vertical facial proportions in the juvenile and pubertal phases.

Predicted overbite and overjet changes with the Invisalign appliance: a validation study.

OBJECTIVES: To investigate whether the predicted changes in overbite (OB) and overjet (OJ) in Align Technology's (Santa Jose, Calif) digital treatment plan for the prescribed course of treatment with the Invisalign appliance were consistent with those same changes in OB and OJ measured with the Geomagic Control X (Geomagic US, Research, Triangle Park, NC) metrology software system. MATERIALS AND METHODS: Geomagic Control X software was used to determine OB and OJ differences between the pretreatment and predicted outcome. STL files for patients satisfying inclusion criteria and undergoing nonextraction orthodontic treatment with the Invisalign appliance. The differences were compared, using the Bland-Altman analysis, to the corresponding data provided by Align Technology's digital treatment-planning interface, ClinCheck. RESULTS: Data regarding 76 adult patients who satisfied strict inclusion criteria were assessed. The Shapiro-Wilks test indicated normality (P > .05). The Bland-Altman analysis showed high levels of agreement between the two measurements, with a bias range of -0.131 to 0.111 for OB and -0.393 to 0.03 for OJ recorded. CONCLUSIONS: Clinicians and researchers can be confident that measurement data provided by Invisalign's ClinCheck digital treatment-planning facility concerning OB and OJ changes from the initial to the predicted treatment outcome are valid.

Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults.

OBJECTIVE: To compare the accuracy of mandibular incisor intrusion with Invisalign (Align Technology, Santa Clara, Calif) in adolescents to that in adults. MATERIALS AND METHODS: This prospective clinical study included 58 patients treated with either Invisalign Teen or Invisalign Full. Mandibular central and lateral incisors were measured on digital models created from intraoral scans. Predicted values were determined by superimposing the initial and final ClinCheck models, and achieved values were determined by superimposing the initial ClinCheck models and the digital models from the final scans. Individual teeth were superimposed with a best-fit analysis and measured using Compare software (version 8.1; GeoDigm, Falcon Heights, Minn). RESULTS: The mean accuracies of mandibular incisor intrusion were 63.5% in adolescents and 45.3% in adults, and this difference was statistically significant. The amounts of achieved intrusion were 1.7 mm in adolescents and 0.9 mm in adults, and this difference was also statistically significant. Overall, there was a weak negative correlation between age and accuracy; as age advanced, the accuracy of mandibular incisor intrusion diminished slightly. CONCLUSIONS: Mandibular incisor intrusion with Invisalign is significantly more accurate in adolescents than in adults. Orthodontists could contemplate reducing the degree of overcorrection for mandibular incisor intrusion in adolescents with deep overbites undergoing Invisalign Teen but still implementing the reverse curve of Spee mechanics.

Clear aligner treatment assisted by mini screw for an adult with Class II division 2 malocclusion and a right upper canine completely outside of the dental arch: A case report.

This case report describes a 19-year-old man presented with a 5.7-mm deep overbite, Class II division 2 malocclusion with the right upper maxillary canine completely buccal ectopia, deviated midline in the upper arch, severe crowding and retroclination of the maxillary and mandibular incisors. The patient was treated with clear aligners to correct the Class II relationship and the deep overbite. A series of clear aligners were used to move bilateral maxillary molars distally with unilateral mini-screw anchorage. The final results showed that clear aligners with mini-screws could effectively achieve the required upper distal molar movement thanks to a reasonable design of the stages and anchorage. The treatment was completed in 19 months and the patient was satisfied with the treatment outcome in this context of mild to moderate Class II division 2 malocclusion.

Alinhadores ortodônticos para finalização de tratamentos ortodônticos e recidiva - relato de caso / Orthodontic aligners in the completion of orthodontic treatments and recurrence - case report

Nos últimos anos, os avanços na Odontologia têm proporcionado novas abordagens para o alinhamento dentário, visando não apenas a correção eficaz das más oclusões, mas também o conforto e a estética para os pacientes. Entre essas inovações, os alinhadores ortodônticos do tipo bolha e abaulamento emergiram como uma alternativa promissora aos aparelhos tradicionais. Este artigo visa explorar o histórico, as indicações clínicas, as vantagens estéticas e o conforto oferecido por esses dispositivos, destacando evidências tanto da literatura antiga quanto de estudos recentes.(AU)

In recent years, advances in dentistry have provided new approaches to dental alignment, aiming not only for effective correction of malocclusions but also for patient comfort and aesthetics. Among these innovations, bubble and bump orthodontic aligners have emerged as a promising alternative to traditional braces. This article aims to explore the history, clinical indications, aesthetic advantages, and comfort offered by these devices, highlighting evidence from both old literature and recent studies (AU)

The Stability of Anterior Open Bite Closure After Bimaxillary Osteotomy.

Introduction: The aim of this study was to evaluate the long-term success rate of combined surgical-orthodontic therapy of skeletal anterior open bite. Materials and Methods: A total of 11 patients with an anterior open bite treated with a combined surgical-orthodontic therapy were retrospectively analysed via lateral cephalometric radiographs and models before treatment, 7-10 days after surgery (T1), one year post-operatively (T2) and two years post-operatively (T3). Results: Ten patients continued to experience a positive overbite at T2. This decreased to 8 at T3. Three patients experienced relapse and had a negative overbite at T3. The average pre-treatment overbite was greater in the positive overbite group compared to the relapse group. Spearman's correlation analysis revealed a correlation between preoperative maxilla-mandibular plane angle (MMPA) with the overall change in overbite. Friedman's test followed by Bonferroni post-hoc analysis was carried out to identify any statistical significance. Conclusion: In conclusion, combined surgical-orthodontic treatment achieves good results for anterior open bite. Patients with a high pre-operative MMPA have a higher risk of relapse. Lower anterior facial height ratio to total anterior facial height (LAFH/TAFH) and the amount of impaction do not significantly contribute to the risk of relapse. Long-term stability of overbite for anterior open bite patients should be around 75%.

Quantifying the efficacy of overbite reduction in patients treated with clear aligners using optimized versus conventional attachments.

BACKGROUND: Deep overbite has been shown to be difficult to correct with clear aligners. Optimized deep bite attachments are reported to facilitate deep bite correction with aligners. The aim of this retrospective study was to quantify the efficacy of deep bite correction with aligners when using optimized versus conventional attachments. METHODS: This was a retrospective cohort study. The pretreatment and post-treatment intraoral scans of patients with deep overbite treated with Invisalign clear aligners were accessed. Patients were divided into two groups: group A, patients treated with conventional attachments, and group B, patients treated with optimized attachments. Pre and post-treatment overbite and the planned overbite reduction were measured and compared between groups. Descriptive statistics were computed, and statistical significance was set at P < 0.05. RESULTS: Seventy-eight patients were included. There was no statistically significant difference in overbite reduction between patients who had conventional versus optimized attachments. The amount of overbite reduction observed post-treatment was found to be no more than 33-40% of the planned amount of overbite reduction across all patients and groups. CONCLUSIONS: Deep overbite correction with aligners remains difficult regardless of the type of attachment used. Optimized attachments are no more effective than using conventional attachments in reducing deep overbite. The amount of overbite reduction expected with clear aligners is significantly lower than the planned overbite reduction. PRACTICAL IMPLICATIONS: When correcting deep bite with clear aligners, the attachment type does not improve the success rate. Clinicians should plan to overcorrect deep bite reduction to expect only 33% to 40% of their planned final overbite to be actually expressed.

Investigating the Effectiveness of Low-Level Laser in Reducing Root Resorption of the Upper Incisors During Intrusion Movement Using Mini-Implants in Adult Patients With Deep Overbite: A Randomized Controlled Clinical Trial.

BACKGROUND: Deep bite is a common characteristic of malocclusion, and many methods are used to treat it, including mini-implants used for the intrusion of the upper incisors. Orthodontically induced inflammatory root resorption (OIIRR) is an inevitable and unexpected side effect of orthodontic therapy. However, resorption of the root could be affected by the type of tooth movement, such as intrusion. Several studies have indicated the effectiveness of low-level laser therapy (LLLT) in accelerating orthodontic movement, but studies that have evaluated the role of this laser in reducing the risk of OIIRR have been limited. This trial aimed to investigate the effectiveness of LLLT in reducing the resorption of the roots of the upper incisors during their intrusion in the context of deep bite correction. MATERIALS AND METHODS: Thirty patients (13 males, 17 females; mean age 22.4±3.37 years) with deep overbite were recruited and allocated to the laser or the control groups. Mini-implants were inserted between the roots of the upper central incisors and the lateral incisors from the labial aspect at the gingival-mucosal junction on both sides with a force of 40 g on each side through an NiTi coil spring. A low-level laser (Ga-Al-As) with 808 nm wavelength in a continuous mode, with the parameters 250 milliwatt power output, 4 Joules/point energy density, and 16 seconds irradiation per point, was applied to the root of each of the upper incisors. The laser was applied on the first day of the upper incisor intrusion (T1), then on days 3, 7, and 14 of the first month. In the second month, the laser was applied every 15 days, adjusting the spring strength every four weeks until the end of the intrusion stage (T2), which was determined by reaching a normal overbite. As for patients in the control group, the strength of the nickel-titanium springs was adjusted every four weeks to the required strength of 40 g on each end until reaching a normal overbite. RESULTS: There was a volumetric decrease in both groups' upper central and lateral incisors roots, and this decrease was statistically significant (P<0.001). However, the difference between the two groups was not statistically significant in each central and lateral incisor volume root (P=0.345 and 0.263 for U1 and U2, respectively). Also, both groups had a linear decrease in upper central and lateral incisors roots, which was statistically significant (P<0.001). At the same time, the difference between the two groups was not statistically significant in each central and lateral incisor root length (P=0.343 and 0.461 for U1 and U2, respectively). CONCLUSION: The low-level laser irradiation using the current protocol did not significantly affect the amount of root resorption induced by incisor intrusion in the experimental group compared to the control group.