A comparison of CAD/CAM-based fixed retainers versus conventional fixed retainers in orthodontic patients: a systematic review and network meta-analysis.

OBJECTIVE: Comparing computer-aided design and computer-aided manufacturing (CAD/CAM) fixed retainers and conventional fixed retainers for their effectiveness in orthodontic patients using systematic review and meta-analysis of literature. SEARCH METHODS: A comprehensive search was conducted in MEDLINE, Web of Science, EMBASE, Scopus, Cochrane's CENTRAL, Google Scholar, Ovid, and LILACS up to May 2023, with no language or date restrictions. SELECTION CRITERIA: Only randomized clinical trials (RCTs) that complied with PICO questions were included, and the Cochrane Risk of Bias 2.0 (RoB 2) tool was used to assess the risk of bias in the included studies. DATA COLLECTION AND ANALYSIS: Using custom-piloted forms, relevant data were retrieved from the included studies. Then a random-effects inverse variance meta-analysis was used to pool the results. Primary outcomes were stability of treatment results measured through dental cast measurements and periodontal status, while secondary outcomes were failure rates and patient-reported outcomes. RESULTS: Seven RCTs with 601 participants were included in the review. In the short term (≤6 months), the meta-analysis showed no significant differences in inter-canine distance or arch length between CAD/CAM and conventional fixed retainers in mandibular retainers. However, for Little's irregularity index, single-stranded stainless-steel retainers were notably worse than Ni-Ti CAD/CAM retainers at 3 and 6 months, while multi-stranded stainless-steel retainers only diverged from CAD/CAM at the 6-month milestone, despite the overall clinical inconsequence of these changes. CAD/CAM retainers were associated with a lower plaque index than traditional retainers but no significant difference in gingival index. Failure rates did not differ significantly between CAD/CAM and other types of retainers in mandibular retainers. Nonetheless, one study had a high amount of CAD/CAM retainer failures leading to the study being stopped. CONCLUSIONS: In the short term, CAD/CAM fixed retainers show promise as an alternative to traditional retainers. They may enhance periodontal health, as indicated by lower plaque index scores than conventional retainers. However, extensive research is needed to determine the long-term durability and effectiveness of CAD/CAM retainers in orthodontic treatment, particularly regarding their failure rate. Until comprehensive evidence is available, the use of CAD/CAM retainers should be tailored for each case. REGISTRATION: The protocol for this systematic review was registered at PROSPERO with the ID CRD42023412741.

Mathematical beta function formulation for maxillary arch form prediction in normal occlusion population.

The aim of this study was to assess the dental arch curvature in subjects with normal occlusion in an Iranian population and propose a beta function formula to predict maxillary arch form using the mandibular intermolar widths (IMW) and intermolar depths (IMD). The materials used were study casts of 54 adolescents with normal occlusion and mean age of 14.1 years (25 males, 29 females, age range 12-16 years). Curve-fitting analyses were carried out and the curves passing through the facial-axis point of the canines, premolars, first molars, and the incisal edges of the anterior teeth were studied using a 3D laser scanner. Using the measured IMW and IMD of the dental arches at the maxillary and mandibular first molar region, a beta function formula proposed for predicting maxillary arch form. The accuracy of the proposed formula was assessed on 10 randomly selected dental casts. The mean (SD) of the maxillary and mandibular IMW and IMD were 57.92 (4.75), 54.19 (5.31), and 31.59 (2.90) and 28.10 (2.59) mm, respectively. There was no gender dimorphism (P > 0.05) for both variables (IMW, IMD). There was a strong positive association (n = 10, Pearson r = 0.98, P < 0.05) between the measured (actual) maxillary arch length and proposed arch length derived from generated formula. The goodness of fit (whole arch) for the proposed beta function formula, using adjusted r square measure and root mean square in 10 patients averaged 0.97 and 1.49 mm, respectively. The corresponding figures for the maxillary anterior arch (canine to canine) were 0.90 and 0.92 mm, respectively. The proposed beta function formula used for predicting maxillary arch form based on two mandibular measures (IMW, IMD) was found to have a high accuracy for maxillary arch prediction in the Iranian population and may be used as a guide to fabricate customized arch wires or as an aid in maxillary reconstructive surgery.

Bipolar Disorder: Review of Orthodontic and Orthognathic Surgical Considerations.

An increasing number of patients with psychological conditions with or without drug regimens are seeking orthodontic treatment and orthognathic surgery to address jaws dysmorphology. Depression and bipolar affective disorders are relatively common. These disorders may interfere with the presurgical orthodontics, surgical intervention and postsurgical treatments and thus requires careful considerations. The aim of this article is to report of a case with bipolar disorder and review the orthodontics and orthognathic surgery considerations of patients with bipolar disorder.

Oro-facial characteristics and the surgical correction of patients affected by beta-thalassaemia: a review of the literature and report of a case.

Despite the fact that recent medical advances have improved the quality of life and increased the life expectancy of patients suffering from thalassaemia, no standard strategy or clinical guidelines are available for the correction of the presenting craniofacial anomalies. The aim of the present study is to review the craniofacial features of affected patients, and to discuss the orthodontic and orthognathic surgical treatment options available to manage the associated and characteristic facial deformity.

Stabilization of premaxilla repositioned during secondary bone grafting in complete bilateral cleft lip and palate patients.

Secondary bone grafting simultaneous to premaxillary repositioning is a well-recognized surgical procedure for the management of bilateral cleft lip and palate patients. Proper stabilization of the repositioned premaxilla is considered as a key factor for the success of secondary bone grafting because the mobility of the premaxillary segment jeopardizes graft integration. This case series reports a reliable method of premaxillary stabilization that incorporated the intrasurgical application of resin bone cement to cover and reinforce the arch bars or orthodontic brackets applied on the maxillary teeth. Occlusal loads were reduced by application of posterior bite blocks on the mandibular teeth. The stabilization method was performed on 7 patients (5 women and 2 men) with a mean age of 12.4 years. During postsurgery follow-ups, the repositioned premaxillary segments did not show mobility in any of the patients. The palatal fistulae were completely closed. Panoramic radiographies taken 2 months after surgery demonstrated acceptable graft integration. The patients have now been followed up to 5 years. No evidence of relapse has been observed. This technique seemed to be undemanding, included minimal laboratory procedure, and maintained the labial mucosa overlying the repositioned segment intact.

Outcomes of revascularization treatment in immature dog's teeth.

AIM: The purpose of the current study was to examine the success rate of a revascularization treatment protocol involving canal space disinfection using copious irrigation, a triantibiotic dressing, and induction of a blood clot matrix in immature dog's teeth. MATERIALS AND METHODS: Thirty-six immature mongrel dog's teeth were divided into two experimental and two control groups. The experimental groups included a necrotic-infected group (n = 20) and a vital group (n = 10). In the group with the necrotic-infected teeth, periapical lesions were induced, and disinfection of the canals was carried out using copious irrigation and a triple antibiotic medication (metronidazole, ciprofloxacin, and tetracycline). Subsequently, the periapical tissues were irritated to initiate bleeding, producing a blood clot. A double seal of the coronal access was then placed. In the vital group, the pulp was aseptically removed before the canal was irrigated and periapical tissues irritated to induce bleeding. The same protocol as that used for the necrotic-infected group was used to seal the coronal access. In the positive control group (n = 3), after pulp removal, sterile sponges soaked in plaque suspension were placed in the pulp chambers of the teeth, after which the chambers were sealed. In the negative control group (n = 3), one untouched 1st premolar tooth in each dog was assigned and left to develop naturally. Radiographic and histological findings were evaluated at 3 and 6 months. Data analysis was performed using Fisher's exact test. RESULTS: The necrotic-infected group radiographically demonstrated apical healing and apical closure in 70% of the cases and thickening of the walls in 40% after 6 months. The vital group showed apical closure in 77% and thickened walls in 44% of the cases after 3 months. Histological findings confirmed the radiographic findings. No significant difference was observed between the two groups (P > 0.05). CONCLUSIONS: If necrotic-infected canals are effectively disinfected and treated according to the protocol, the ensuing revascularization response is similar to that of vital immature teeth.

The effect of an Er,Cr:YSGG laser on the micro-shear bond strength of composite to the enamel and dentin of human permanent teeth.

The bond strength of resin composite to Er,Cr:YSGG laser-irradiated enamel and dentin has been evaluated in only a few studies. Therefore, we measured and compared the micro-shear bond strength of composite restorations to enamel and dentin using two different cavity-preparation tools and conditioning methods. One hundred and seventy-five caries-free human third molars were sectioned longitudinally into two different thicknesses and randomly assigned to seven subgroups (n = 25). Enamel groups included laser-cut without etching (LO), laser-cut and laser-etched (LL), laser-cut and acid-etched (LA), bur-cut and laser-etched (BL1), and bur-cut and acid-etched (BA1-comparison group). Dentinal groups included bur-cut and laser-etched (BL2) and bur-cut and acid-etched (BA2-comparison group). The specimens were bonded by Single Bond and Tygon tubes and were restored with Z100 composite. Failure patterns were evaluated using a stereomicroscope, and a shear bond test was performed at 0.5 mm/min. The mean shear bond strength values (MPa) for the LO, LL, LA, BL1 and BA1 enamel groups were 23.14, 23.77, 23.51, 19.30, and 28.99, respectively, whereas for the BL and BA dentinal groups, these values were 22.44 and 26.15, respectively. In enamel specimens, BA1 and LL groups presented the highest shear bond strength values, and the bur-cut and laser-etched (BL1) group showed the lowest values. In the laser-etched groups, bond strength values for bur-cut surfaces were significantly higher than those for laser-cut surfaces. Moreover, there was a significant difference between the BL2 and BA2 dentinal groups. The results of this study indicate that re-etching with acid phosphoric would be recommended if an Er,Cr:YSGG laser is used for tooth preparation or surface treatment.

Prioritized Commitment-Based Clinical Assessment: A New Method for Assessment of Orthodontic Treatment Outcomes.

OBJECTIVE: Quality assessment is an essential part of orthodontic treatment. Most of the current indices are essentially based on occlusal assessment. However, an ideal occlusion is only one aspect of an ideal treatment. The aim of this article is to introduce a new prioritized commitment-based clinical assessment (PCCA) method and present its reliability and linear correlation test in comparison with the comprehensive clinical outcome assessment (CCA). METHODS: One hundred treated cases were scored with the conventional assessment tool--the CCA--and the newly developed assessment tool--the PCCA--with 2 calibrated examiners at 2 different time intervals. These cases were randomly selected including equal numbers of the main malocclusions managed with fixed conventional edgewise appliances within the past 3 years and had complete pre-treatment and post-treatment routine records. The intraclass correlation coefficient (ICC) was used to assess the intra- examiner repeatability of the total scores of both methods. Pearson's correlation coefficients were computed to assess the linear relationships between the CCA and PCCA scores. RESULTS: The intra-examiner reliability assessed for CCA and PCCA showed high repeatability for both examiners (ICC: 0.93 and 0.945, respectively). The inter-examiner reliability values for CCA and PCCA, assessed by ICC, were 0.84 and 0.96, respectively. The linear correlation between the 2 methods, assessed by comparing the mean score of each case by the 2 examiners was significant, at 0.01. CONCLUSION: The PCCA method can be used for quality assessment in treated orthodontic patients. The preliminary test of the new method presented good inter- and intra-observer agreements and a significant linear correlation with the CCA method.

The impact of platelet-rich fibrin (PRF) on delayed tooth replantation: A preliminary animal study.

The aim of this study was to evaluate the effect of platelet-rich fibrin (PRF) placed in delayed replantation of mature extracted teeth. Sixteen intentionally extracted teeth in two mature beagle dogs were selected. In one quadrant of each jaw, the extraction sockets were filled with PRF prior to replantation, and the other quadrant served as control without PRF. All extracted teeth underwent endodontic treatment and dried for 60 min. Thereafter, they were replanted with a flexible splint. After 8 weeks, the animals were euthanised, and the histological sections examined. Less inflammatory root resorption was noted in the PRF group compared to the control (P = 0.031). However, there was no significant difference between the two groups with regard to new bone formation, inflammatory status, connective tissue healing and replacement resorption (P > 0.05). Using PRF in the extracted socket before delayed replantation did not provide any significant benefit other than reduced inflammatory root resorption.

The correlation between external apical root resorption and electric pulp test responses: a prospective clinical trial.

OBJECTIVE: The current study investigated the correlation between pulpal sensitivity to the electric pulp tester (EPT) and external apical root resorption (EARR) in four types of maxillary anterior teeth of fixed orthodontic treatment patients. METHODS: In this prospective cohort study, 232 anterior teeth of 58 patients (mean age 18.96 ± 6.13 years) treated with fixed orthodontic treatment were examined. The EPT readings were recorded at twelve time points immediately before archwire insertion. Root resorption of four maxillary incisors were measured by means of parallel periapical radiographs at three time intervals (six months interval from the start) through design-to-purpose software to optimize data collection. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of EPT values and observed EARR (p< 0.05). RESULTS: The highest level of EPT measurement was recorded at initial visit, and then there was a decreasing trend in EPT level during treatment for the next six and twelve months. There was another increasing trend after six months till the finishing time of the treatment. There was a significant correlation between changes in root length and time of recording the root length (p< 0.001). There was significant positive correlation between changes in EPT level and amount of observed root resorption (p< 0.001). CONCLUSION: The relative decrease in electric pulp test level could be a diagnostic sign of root resorption during orthodontic treatment. Further studies with longer follow up are needed to confirm the current results.

The effect of autologous leukocyte platelet rich fibrin on the rate of orthodontic tooth movement: A prospective randomized clinical trial.

OBJECTIVE: The aim of this study was to evaluate the effect of LPRF, placed in extraction sockets, on orthodontic tooth movement (OTM). MATERIALS AND METHODS: Thirty extraction sockets from eight patients (five males, three females, with a mean age of 17.37 years; range 12-25 years) requiring extraction of first premolars based on their orthodontic treatment plan participated in this split-mouth clinical trial. In one randomly selected quadrant of each jaw, the extraction socket was preserved as the experimental group by immediate placement of LPRF in the extraction socket. The other quadrant served as the control group for secondary healing. Immediately, the teeth adjacent to the defects were pulled together by a NiTi closed-coil spring with constant force. A piece of 0.016 × 0.022-inch stainless steel wire was used as the main arch wire. The amount of OTM was measured on the study casts at eight time points with 2-week intervals for 3 months. Analysis of random effect model was performed for the purpose of comparison between the experimental and control groups. RESULTS: According to the random effect model, a statistically significant difference was found between the experimental and control group in rate of OTM (P = 0.006). CONCLUSION: According to the results, application of LPRF, as an interdisciplinary approach combining orthodontics and surgery, may accelerate OTM, particularly in extraction cases.

The Effect of Methylphenidate on Cervical Vertebral Maturation and Dental Age in Patients with Attention Deficit Hyperactivity Disorder.

STATEMENT OF THE PROBLEM: It is postulated that attention deficit/hyperactivity disorder (ADHD) with or without medication has an inhibitory effect on the children's growth and development. PURPOSE: This study aimed to assess the dental age and cervical vertebral maturation (CVM) stage in ADHD patients with or without medication. MATERIALS AND METHOD: This cross-sectional study evaluated the pretreatment panoramic and lateral cephalograms of 129 patients (70 males, 59 females aged 8-14 years). Demirjian index and Baccetti's CVM index were used to determine the dental age and CVM stage, respectively. The subjects were evaluated in two groups of ADHD (case, n=59) and healthy individuals (control, n=70). The ADHD patients were divided into two groups of AWT (ADHD with Treatment, n=43) and AW (ADHD without treatment, n=16) based on the use of methylphenidate. Paired t-test was used to compare the mean dental age between the groups. Linear and ordered logistic regression models were used to detect differences between the groups. The association between dental and chronological age was assessed by using Pearson correlation coefficient (p< 0.05). RESULTS: After age and sex adjustment, the skeletal maturity stage was found to be similar to the control group based on the presence of the disorder or use of medication (p= 0.711 and p= 0.436, respectively). Similarly, the patients' dental age was similar to the controls in AW and AWT groups (p= 0.180 and p= 0.421, respectively). The correlation between dental age and chronological age was 0.79 in AWT, 0.88 in AW, and 0.88 in control group (p< 0.001 for all the three). CONCLUSION: After age and sex adjustment, the dental and skeletal age of ADHD patients with or without Methylphenidate treatment do no manifest a significant delay compared with the controls.

Effect of Low-intensity Pulsed Ultrasound on Postorthognathic Surgery Healing Process.

BACKGROUND: Orthognathic surgery can cause discomforts such as pain, inflammation, and edema. One of the challenges is bone regeneration at surgery area. The aim of this study is to evaluate the effect of low-intensity pulsed ultrasound (LIPUS) therapy on bone regeneration and pain relief after surgery. MATERIALS AND METHODS: Following mandibular surgery of nine patients, LIPUS treatment was applied to the left or right side for 3 weeks and 20 min/day. The other side was treated with sham-LIPUS as the control group. Digital panoramic radiographies were obtained immediately after surgery and 3 weeks later. Bone density at surgery site was assessed using Digora version 2.8 software. The data were analyzed with one-sample Kolmogorov-Smirnov and t-paired test. Postoperation pain was evaluated by means of visual analog scale. RESULTS: Increase in bone density at border and medulla was 23 and 28.33 for experimental group and 13 and 13.55 units in control group, respectively. The differences are statistically significant (P < 0.01). Variance analysis showed that decrease in experienced pain during 3 weeks after surgery was significantly different between groups (P < 0.01). CONCLUSION: LIPUS can be an effective way to increase bone modeling and decrease pain following orthognathic surgeries.

Correlation of Vitamin D status and orthodontic-induced external apical root resorption.

BACKGROUND: Adequate Vitamin D is essential for dental and skeletal health in children and adult. The purpose of this study was to assess the correlation of serum Vitamin D level with external-induced apical root resorption (EARR) following fixed orthodontic treatment. MATERIALS AND METHODS: In this cross-sectional study, the prevalence of Vitamin D deficiency (defined by25-hydroxyvitamin-D) was determined in 34 patients (23.5% male; age range 12-23 years; mean age 16.63 ± 2.84) treated with fixed orthodontic treatment. Root resorption of four maxillary incisors was measured using before and after periapical radiographs (136 measured teeth) by means of a design-to-purpose software to optimize data collection. Teeth with a maximum percentage of root resorption (%EARR) were indicated as representative root resorption for each patient. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of Vitamin D status and observed EARR. P < 0.05 was considered statistically significant. RESULTS: The Pearson coefficient between these two variables was determined about 0.15 (P = 0.38). Regression analysis revealed that Vitamin D status of the patients demonstrated no significant statistical correlation with EARR, after adjustment of confounding variables using linear regression model (P > 0.05). CONCLUSION: This study suggests that Vitamin D level is not among the clinical variables that are potential contributors for EARR. The prevalence of Vitamin D deficiency does not differ in patients with higher EARR. These data suggest the possibility that Vitamin D insufficiency may not contribute to the development of more apical root resorption although this remains to be confirmed by further longitudinal cohort studies.

The correlation between external apical root resorption and electric pulp test responses: a prospective clinical trial

ABSTRACT Objective: The current study investigated the correlation between pulpal sensitivity to the electric pulp tester (EPT) and external apical root resorption (EARR) in four types of maxillary anterior teeth of fixed orthodontic treatment patients. Methods: In this prospective cohort study, 232 anterior teeth of 58 patients (mean age 18.96 ± 6.13 years) treated with fixed orthodontic treatment were examined. The EPT readings were recorded at twelve time points immediately before archwire insertion. Root resorption of four maxillary incisors were measured by means of parallel periapical radiographs at three time intervals (six months interval from the start) through design-to-purpose software to optimize data collection. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of EPT values and observed EARR (p< 0.05). Results: The highest level of EPT measurement was recorded at initial visit, and then there was a decreasing trend in EPT level during treatment for the next six and twelve months. There was another increasing trend after six months till the finishing time of the treatment. There was a significant correlation between changes in root length and time of recording the root length (p< 0.001). There was significant positive correlation between changes in EPT level and amount of observed root resorption (p< 0.001). Conclusion: The relative decrease in electric pulp test level could be a diagnostic sign of root resorption during orthodontic treatment. Further studies with longer follow up are needed to confirm the current results.

RESUMO Objetivo: O presente estudo investigou a correlação entre a sensibilidade pulpar ao teste pulpar elétrico (TPE) e a reabsorção radicular apical externa (RRAE) nos quatro dentes anteriores superiores de pacientes em tratamento ortodôntico com aparelho fixo. Métodos: Nesse estudo de coorte prospectivo, foram avaliados 232 dentes anteriores de 58 pacientes (idade média 18,96 ± 6,13 anos) tratados com aparelho ortodôntico fixo. As leituras do TPE foram registradas em doze tempos de avaliação, imediatamente antes da inserção dos arcos. As reabsorções radiculares dos quatro incisivos superiores foram aferidas por meio da média das radiografias periapicais, em três intervalos de tempo (em intervalos de seis meses desde o início) por um software desenvolvido para essa finalidade, com o intuito de otimizar a coleta de dados. Para aferir a associação entre os valores de TPE e as RRAE observadas (p< 0,05), foram utilizados o modelo de regressão linear múltiplo e o coeficiente de correlação de Pearson. Resultados: O nível mais alto das medidas do TPE foi registrado na primeira visita e, daí em diante, houve uma tendência de diminuição no nível do TPE durante o tratamento, nos seis a doze meses seguintes. Houve, também, outra tendência de aumento após os seis meses até o término do tratamento, além de uma correlação significativa entre as mudanças no comprimento radicular e o tempo de registro do comprimento radicular (p< 0,001), bem como uma correlação positiva significativa entre as mudanças no nível do TPE e a quantidade de reabsorção radicular observada (p< 0,001). Conclusão: Uma diminuição relativa no nível de sensibilidade ao teste pulpar elétrico pode ser um sinal diagnóstico de reabsorção radicular durante o tratamento ortodôntico. Estudos futuros com acompanhamentos mais longos são necessários para confirmar os presentes resultados.

The Effect of Orthodontic Forces on Tooth Response to Electric Pulp Test.

INTRODUCTION: The current study investigated the pulp response to electric pulp testing (EPT), before, upon initiation and one month after the start of orthodontic tooth movement. METHODS AND MATERIALS: A total of 402 anterior teeth from 39 patients (mean age of 16.8±2.7 years) were examined in this non-controlled prospective study. The aligning forces were administered using initial NiTi archwires ligated on fixed appliances by using the MBT straight wire technique. The electrical stimulation was provided by the EPT. The EPT readings were recorded at three time points: before bonding (EPT0), immediately upon initiation (EPT1) and 1 month post-treatment (EPT2). The data were statistically analyzed by the ANOVA and Bonferroni tests (P<0.05). RESULTS: Prior to bonding of the orthodontic brackets, the mean EPT value for all the experimental teeth was 3.42 EPT units. Upon initiation, the mean value of EPT1 for each tooth increased to 7.62 units. One month later, the mean EPT2 values dropped to 6.27 units. At this time point, 64 teeth (16%) of the experimental teeth failed to respond. The differences among EPT values at different time points were significant. There was no association between the EPT values and the location or the type of teeth. CONCLUSION: The physiological changes in the pulp affect the nerve fibers in the early stages of the orthodontic force application. As a result, thresholds to electrical stimulation would increase and the EPT may not initiate a response. Therefore results obtained by electrical pulp testing should be interpreted accordingly.

Correlation between cervical vertebral maturation and chronological age in a group of Iranian females.

BACKGROUND: Correlation between chronological age at different stages of cervical vertebral maturation (CVM) is important in clinical orthodontic practice. The objective of this study was to evaluate the correlation between CVM stage and chronological age in a group of Iranian female patients. MATERIALS AND METHODS: This study was conducted on 196 digital lateral cephalometry of female patients with the age ranged 9-14 years. The CVM stage was determined with two calibrated examiners, using the method developed by Baccetti and its correlation with mean chronological age was assessed by the Spearman rank-order. The intra and inter-agreements were evaluated by weighted Kappa statistics in overall diagnosis of stages, in addition to determination of presence or absent of concavities at the lower border of second, third and fourth cervical vertebrae and the shapes of the third and fourth vertebrae. P < 0.05 was considered as significant. RESULTS: The correlation coefficient between CVM stages and chronological age was relatively low (r = 0.62). The least amount of inter-observer agreement was determined to be at the clinical decision of the shape of the fourth vertebra. CONCLUSION: Regarding the low reported correlation, the concomitant usage of other skeletal indicators seems necessary for precise determination of physiological age of the patients.

Acid and Alkaline Phosphatase Levels in GCF during Orthodontic Tooth Movement.

STATEMENT OF THE PROBLEM: The present constituents of gingival crevicular fluid (GCF) can reflect the changes occurring in underlying tissues. Considering variety of biologic bone markers, alkaline phosphatase and acid phosphatase have been examined as bone turn over markers in orthodontic tooth movement. PURPOSE: The current study designed in a longitudinal pattern to determine the changes of acid and alkaline phosphatase (ACP & ALP) in GCF during orthodontic tooth movement. MATERIALS AND METHOD: An upper canines from twelve patients (mean age: 14±2 years) undergoing extraction orthodontic treatment for distal movement served as the test tooth (DC), and its contralateral (CC) and antagonist (AC) canines were used as controls. The CC was included in orthodontic appliance without orthodontic force; the AC was free from any orthodontic appliance. The GCF around the experimental teeth was harvested from mesial and distal tooth sites immediately before appliance placement (T0), and 14 (T2) and 28 days (T3) after it and ALP and ACP concentration were determined spectrophotometrically. RESULTS: ALP concentration was elevated significantly in DC and CC groups at days 14 and 28 compared with the AC. In DC group, the ALP was significantly greater in mesial sites than distal site, while no significant changes were found between both sites of CC. The peak level of ALP was observed in mesial sites of DC at T2. Regarding ACP, significant elevation of this enzyme was seen in DC group both in mesial and distal sites at T2 and T3. The peak level of this enzyme was seen at T2. CONCLUSION: Monitoring simultaneous changes of ALP and ACP levels in GCF can reflect the tissue responses occur in periodontium during bone formation and bone resorption during orthodontic tooth movement, respectively.

Rapid, conservative, multidisciplinary miniscrew-assisted approach for treatment of mandibular fractures following plane crash.

Mandibular fractures are among the most common facial injuries. This case report demonstrates the efficacy of simultaneous usage of miniscrews and direct bonding techniques without open reduction in an extensive traumatized patient. A 25-year-old girl with multiple injuries in the head and facial region 1 month after a plane crash accident was referred to manage the mandibular fractures. Due to the presence of multiple injuries, a conservative treatment of symphysiseal fracture was performed. In order to keep the fractured fragments of the mandible close together, the anterior teeth of the lower arch were tied by means of the orthodontic wire. Ten miniscrews were used to improve the anchorage units and also, settling the occlusion by means of light intermaxillary elastics. Following the active treatment, clinical and radiographic analysis showed satisfactory healing without any periodontal involvement of the teeth in the fracture line.

The 808 nm Laser-Assisted Surgery as an Adjunct to Orthodontic Treatment of Delayed Tooth Eruption.

INTRODUCTION: Failure of teeth to erupt from gingival tissues at usual developmental time is called delayed tooth eruption (DTE). Delayed tooth eruption lead to prolonged fixed orthodontic treatment and its eventual complications. The purpose of the present study was to evaluate the effect of laser-assisted (808 nm) surgical uncovering, on the tooth emergence and orthodontic treatment of DTE. METHODS: A total of 16 orthodontic patients were included in this study and were equally assigned to an experimental and a control group. Subjects for experiment consisted of eight patients (6 girls and 2 boys) with a mean age of 14±0.9 years. All patients exhibited delayed second premolar eruption. The laser wavelength was 810 nm and it was set in a continuous wave mode at a power output of 1.6 watt with a 0.3-mm diameter fiber tip. When the target tissue was sufficiently anesthetized, the tip was directed at an angle of 10 to 20 degrees to the tissue (light contact mode); and was applied continuously for approximately 12 Seconds until an acceptable tooth exposure area was visible. The facial axis of the clinical crown (FACC) line represents the most prominent portion of the facial central lobe for premolars. All orthodontic brackets are aligned along this reference and are located on FA (Facial Axis) point. The standard for adequate tooth eruption was the accessibility of facial axis of the clinical crown (FACC) for bonding the brackets. Data gathered from the patients were statistically surveyed and compared by means of Tukey's Test and Analysis of Variance (ANOVA). RESULTS: All patients showed good gingival status, no significant bleeding during or immediately after the surgery, and acceptable level of healing after laser surgery. The biologic width of the teeth was preserved and no violation of this important periodontal parameter was observed. The average time for accessing the FA point in experimental group was 11±1.1 weeks and the mentioned period was increased to 25±1.8 weeks in control group. The data analysis showed that in patients with DTE, laser intervention significantly accelerated tooth eruption (P < 0.05). CONCLUSION: Laser-assisted surgical removal of the fibrous tissue over erupting premolars (DTE) with appropriate irradiation parameters appears to be a promising adjunct to orthodontic treatment for bringing the premolar to the aligned and leveled dental arch.