Plane-to-plane analysis of mandibular misalignment in patients with facial asymmetry.

INTRODUCTION: Little is known regarding how the mandible rotates in facial asymmetry. The purpose of this study was to study mandibular misalignment with a new plane-to-plane analysis method in patients with facial asymmetry. METHODS: Optimal symmetry planes (OSPs) were generated by computing the greatest count of paired voxels on opposing sides of the computerized tomography image of the structure. The mandibular OSP was measured against the midfacial OSP for its alignment. The deviation angle formed by the 2 OSPs was broken down into a y-axis component (frontal deviation angle) and a z-axis component (horizontal deviation angle). Fifty-nine patients who sought correction for facial asymmetry were included for study. RESULTS: The new analysis method was feasible. Fifty patients (83%) had significant mandibular misalignment (deviation, ≥4° or 4 mm). The locations of the rotational axes exhibited significant variations that could explain the varied features of the asymmetry. The frontal deviation angle (mean, 3.80° ± 3.89°) was significantly larger than the horizontal deviation angle (mean, 2.77° ± 1.71°). There was no significant correlation between the horizontal deviation angle and the anterior deviation distance or the posterior deviation distance. CONCLUSIONS: Proper mandibular realignment was suggested to be the primary aim in surgical correction of most jawbone asymmetries. Because of the greatly varied rotational axes and the obscure z-axis rotation, realignment could be difficult with the traditional approach. The OSP-based analysis is advocated to guide planning.

Use of the matching optimal symmetry plane method in planning surgical correction of facial asymmetry--a preliminary report of 20 patients.

PURPOSE: A voxel-based median plane (optimal symmetry plane [OSP]) was developed to assess facial bone asymmetry. The purpose of the present study was to introduce a new method of planning surgical correction of facial asymmetry using the OSPs as guides and test its effectiveness. PATIENTS AND METHODS: A retrospective study was conducted of 20 facial asymmetry patients with a mandibular deviation of 4 mm or greater or 4° or more that required surgical correction. In the test group (n = 8), the plans for asymmetry correction were formulated using the matching OSP method, in which the OSPs of the facial bones are tracked and matched during the model surgery setup. In the control group (n = 12), traditional planning was conducted. The traditional plans were cross-checked for symmetry through tracking and revised as needed. The symmetry results of the plans were compared between the 2 groups and within the control group. The outcome measures were the deviation distances between the OSPs of the midface and mandible at the anterior or posterior mandible, the occlusal plane cant, and the angle formed by the 2 OSPs. Surgery was performed in accordance with the final plans, and the results were assessed for symmetry. RESULTS: The traditional plans left a major mandibular deviation in 5 of the 12 control subjects compared with none in the test group. The test group did significantly better than the control group. The revised plans were significantly better than the initial plans. Postoperatively, significant improvements in symmetry were observed. CONCLUSION: The new method resulted in surgical plans that brought about significantly less postoperative mandibular deviation while maintaining a reasonable occlusion.

Complex facial deformity reconstruction with a surgical guide incorporating a built-in occlusal stent as the positioning reference.

Computer-aided design has gained increasing popularity in clinical practice, and the advent of rapid prototyping technology has further enhanced the quality and predictability of surgical outcomes. It provides target guides for complex bony reconstruction during surgery. Therefore, surgeons can efficiently and precisely target fracture restorations. Based on three-dimensional models generated from a computed tomographic scan, precise preoperative planning simulation on a computer is possible. Combining the interdisciplinary knowledge of surgeons and engineers, this study proposes a novel surgical guidance method that incorporates a built-in occlusal wafer that serves as the positioning reference.Two patients with complex facial deformity suffering from severe facial asymmetry problems were recruited. In vitro facial reconstruction was first rehearsed on physical models, where a customized surgical guide incorporating a built-in occlusal stent as the positioning reference was designed to implement the surgery plan. This study is intended to present the authors' preliminary experience in a complex facial reconstruction procedure. It suggests that in regions with less information, where intraoperative computed tomographic scans or navigation systems are not available, our approach could be an effective, expedient, straightforward aid to enhance surgical outcome in a complex facial repair.

Finite element analysis of miniscrew implants used for orthodontic anchorage.

INTRODUCTION: The miniscrew has been developed and effectively used as orthodontic anchorage, but current studies of its usage are insufficient to provide information about the underlying mechanical mechanisms. The aim of this study was to investigate the roles of bone quality, loading conditions, screw effects, and implanted depth on the biomechanics of an orthodontic miniscrew system by using finite element analysis. METHODS: A 3-dimensional model with a bone block integrated with a miniscrew was constructed to simulate various cortex thicknesses, cancellous bone densities, force magnitudes and directions, screw diameters and lengths, and implanted depths of miniscrews. RESULTS: Both stress and displacement increased with decreasing cortex thickness, whereas cancellous bone density played a minor role in the mechanical response. These 2 indexes were linearly proportional to the force magnitude and produced the highest values when the force was perpendicular to the long axis of the miniscrew. A wider screw provided superior mechanical advantages. The exposed length of the miniscrew was the real factor affecting mechanical performance. CONCLUSIONS: The screw diameter was the dominant factor for minscrew mechanical responses. Both bone stress and screw displacement decreased with increasing screw diameter and cortex thickness, and decreasing exposed length of the screw, force magnitude, and oblique loading direction.

Bone stress when miniplates are used for orthodontic anchorage: finite element analysis.

INTRODUCTION: The success rate of miniplates is superior to that of other temporary anchorage devices; nevertheless, the biomechanical behavior of miniplates during orthodontic use is not totally understood. The aim of this study was to investigate bone stress by finite element analysis when miniplates are used for orthodontic anchorage. METHODS: A 3-dimensional model consisting of a bone block integrated with a miniplate and fixation screw system was constructed to simulate various types of miniplates, screw numbers, screw lengths, cortex thicknesses, and force magnitudes and directions. RESULTS: The peak von Mises cortex stress values were highest with the I-type plates followed by the L-type, Y-type, and T-type plates. Bone stress decreased as the screw numbers increased but was not related to screw length. Bone stress increased as the cortex thickness decreased. Bone stress was linearly proportional to the force magnitude, and the highest values were produced when the force was in the forward direction. CONCLUSIONS: When a T- or Y-type plate is used, or when the force direction is in the tensile mode, bone stress decreases. Bone stress also decreases as the screw numbers increase and as the cortex thickness increases. Furthermore, it decreases as the force magnitude becomes less.

Effect of thermocycling-induced stress on properties of orthodontic NiTi wires.

Background/purpose: In orthodontic applications, NiTi wires are under continuous bending stress and exposed to fluctuations in temperature over long durations. The sensitivity of NiTi to temperature can have a considerable influence on its mechanical properties. This study investigated the effects of deflected NiTi wire, presented in stress-induced (detwinned) martensite microstructure, combined with thermal cycle on the microstructure and mechanical properties. Materials and methods: We tested four types of as-received orthodontic NiTi: (1) Nitinol Classic (3 M Unitek), (2) Sentalloy (Tomy), (3) 27 °C CuNiTi (Ormco) and (4) 40 °C CuNiTi (Ormco). Each group of specimens was subjected to three different testing conditions: (1) temperature fluctuations (5000 cycles) between 5 and 55 °C, (2) continuous three-point bending force and (3) combination of thermal cycling and bending stress. Results: The specimens that underwent thermocycling as well as loading exhibited a substantial narrowing in stress hysteresis, which may be attributed to crystallinity lower than that of as-received NiTi wires. Reduced crystallinity can manifest in a number of imperfections, such as dislocations and internal stress, as well as a less-organized structure. Micro X-ray diffraction (XRD) analysis revealed the existence of martensite phase in Sentalloy wires subject to thermal and stress conditions. Under loading conditions, stress-induced martensite of NiTi wires exposed to temperature fluctuations of 5-55 °C also induced cyclic changes in bending stress. In a simulated intra-oral environment, the stability of austenite↔martensite transformation decreased. Conclusion: This study determined that bending stress in conjunction with repeated temperature fluctuations can greatly affect the microstructure and mechanical properties of NiTi wires.

Effect of loading force on the dissolution behavior and surface properties of nickel-titanium orthodontic archwires in artificial saliva.

INTRODUCTION: For orthodontic applications, equiatomic nickel-titanium (NiTi) wires are used to level and align the teeth under bending conditions in the oral environment for long periods. The aim of study was to investigate the influence of bending stress on the nickel release of commercial NiTi orthodontic wires in vitro, simulating the intraoral environment as realistically as possible. METHODS: Two types of as-received orthodontic NiTi wires, free of performed internal stress, were immersed in artificial saliva. Half of the NiTi wires were exposed to continuous bending stress throughout the 14-day experimental period. RESULTS: The stressed NiTi wires exhibited substantial increases in the nickel release compared with the unstressed specimens during all experimental periods. The highest dissolution rate during the 0 to 1 day incubation period was observed for all stressed specimens. However, a slight increase of nickel released as a function of time was observed in the 3 groups of stressed specimens after 3 days of immersion. For the stressed specimens, it was hypothesized that the bending stress would induce buckling or cracking of the protective oxide film of the NiTi wires. In this study, the mechanism of nickel release was the underlying metal surface reacting with the surrounding environment. CONCLUSIONS: The results indicated that bending stress influences the nickel release of NiTi wires. The factor of loading condition with respect to corrosion behavior and passive film should be considered in view of the widespread use of NiTi wires for dental devices.

Three-dimensional analysis of biplanar cephalograms.

The aims of this study were to reconstruct a three-dimensional (3D) model, to provide a 3D analysis using biplanar cephalograms [postero-anterior (PA) and lateral] with orthogonal projection, and to compare the differences between the 3D and two-dimensional (2D) analyses. The procedures were as follows: (1) to identify landmarks from a dry skull and to construct the norms for the spatial information of the skull from the 3D reconstruction using computerized tomography (CT); (2) to reconstruct a 3D model using biplanar cephalograms (PA and lateral); and (3) to compare the differences between the 2D and 3D analyses. Fifteen clearly visible landmarks identified on both films were used in this study. By comparing the data from the CT and the biplanar cephalograms, it was found that the accuracy for the 3D linear measurements from biplanar cephalograms was 98.9 per cent. However, the accuracy for the linear measurements from 2D and CT data was only 89.2 per cent. If the measurement of gonion (Go) to menton (Me) was excluded, the accuracy for the linear measurements from 2D and CT data was 95.1 per cent. When using a t-test to compare the linear distances of 2D-CT and 3D-CT data (Go to Me excluded), the difference was statistically significant (P < 0.05). The findings indicate that biplanar cephalograms with orthogonal projection are able to provide a 3D analysis that is more accurate than 2D analysis.

The effect of microrough surface treatment on miniscrews used as orthodontic anchors.

OBJECTIVES: The aim of this study was to investigate the effects of two different microrough surface treatments on miniscrews with loading over different time periods in vivo. MATERIAL AND METHODS: Twenty-four New Zealand white rabbits were selected. One hundred and forty-four miniscrews with a machined (MA), sandblasted and acid-etched (SLA) or sandblasted and alkaline-etched (SL/NaOH) surface were implanted into the tibia of the rabbits. Then, orthodontic forces with Ni-Ti coils were applied immediately to two of the three miniscrews in each tibia, with the center one serving as the control. After 2, 4, 8 and 12 weeks, the rabbits were sacrificed. The removal torque value (RTV) was tested and bone-to-implant contact (BIC) was examined. RESULTS: In most groups, there were no differences between the RTV in the unloaded and loaded conditions at different time periods. In the loaded condition, the RTV of the SLA groups increased significantly after 4 weeks of healing. The RTV in the SL/NaOH groups increased after 8 weeks, and reached a significant difference with the SLA groups after 12 weeks. After 12 weeks, the BIC in the SLA and SL/NaOH groups was higher than in the MA groups. A regression test revealed a moderate correlation between the BIC and the RTV. CONCLUSIONS: There were no differences between the loaded and unloaded conditions in most groups. The RTV and BIC increased with time. In the loaded condition, the RTV of the SLA surface increased earlier, at 4 weeks, while the SL/NAOH group showed the highest RTV after 8 weeks.

Effect of fluoridated carbamide peroxide gels on enamel microtensile bond strength.

The aim of this study was to examine the resin bond strength on enamel treated with different fluoridated bleaching agents. Forty-eight bovine incisors were divided into four groups to receive bleaching treatments, over a 14-d period, as follows: no treatment; 10% carbamide peroxide (CP) bleaching; 10% CP containing 0.11% fluoride; and 10% CP containing 0.37% fluoride. Immediately, and 7 and 14 d after bleaching, the enamel surfaces were respectively bonded with composite and sectioned to create resin-enamel beams. These beams were subjected to the microtensile bond strength (microTBS) test, then assessed for failure mode under scanning electron microscopy. The results showed that the 0.37% fluoridated group demonstrated a microTBS equivalent to that of the unbleached group at all stages. Non-fluoridated and 0.11% fluoridated groups showed a weaker microTBS after bleaching but regained the bond strength after 14 or 7 d of storage, respectively. In the non-fluoridated group, adhesive failure was the predominant fracture pattern that comprised the enamel prism demineralization change and widely dispersed voids on the resin-enamel interfaces. No evident enamel erosion and fewer microporosities were found in the 0.37% fluoridated group. Accordingly, treatment with 0.37% fluoridated CP maintained the microTBS as effectively as the unbleached enamel. Additional fluoride in the bleaching agents may facilitate subsequent restorative treatment by inhibiting enamel demineralization.

Effect of fluoride containing bleaching agents on enamel surface properties.

OBJECTIVES: To evaluate the effects of fluoridated bleaching agents and post-bleaching fluoridation treatment on the whitening efficiency and microhardness of bovine enamel. METHODS: Twenty five freshly extracted bovine incisors were cut into halves, embedded and then divided into the following five groups: Group 1, untreated controls; Group 2, treatment with 10% carbamide peroxide (CP) bleaching agent; Group 3, treatment with 10% CP followed by a 0.9% sodium fluoride gel application, Group 4, treatment with 10% CP containing 0.11% fluoride; Group 5, treatment with an experimental bleaching agent consisting of 10% CP and 0.37% fluoride. Groups 2-5 were treated 8h per day for 14 days then immersed in saliva for 2 weeks. Enamel morphology changes were evaluated under SEM on Day 14. Changes in enamel color and microhardness were evaluated on Days 7 and 14, and compared with the baseline data. Additionally, microhardness was determined on post-bleaching Days 21 and 28. RESULTS: After 2 weeks, an erosion pattern was noted on the specimens in Groups 2 and 3. Groups 4 and 5 showed a milder demineralized pattern. All the bleached enamel specimens revealed increased whiteness and overall color value. Groups 2 and 3 showed significantly decreased enamel microhardness compared to their baseline data. The specimens treated with fluoridated bleaching agents showed relatively less reduction in enamel microhardness than those treated with nonfluoridated agents during the bleaching treatment. CONCLUSIONS: The fluoridated bleaching agents produced less demineralization of surface morphology and microhardness. The addition of fluoride did not impede the whitening effect.

Model-Based Orthodontic Assessments for Dental Panoramic Radiographs.

For better treatment outcomes, dentists usually use a set of parameters for orthodontic evaluation. In this study, a new method is proposed to assist dentists in obtaining reliable assessment of these parameters. The proposed method is based on dental panoramic radiographs and can be divided into four stages: image preprocessing, model training, tooth segmentation, and assessment of orthodontic parameters. The image is first normalized and enhanced. Then, the model training stage consists of shape and image model training, energy function training, and weight training. Next, we automatically segment the tooth contours in an energy-minimized manner. Finally, the automatic assessment of orthodontic parameters is carried out. The experimental results show that the average of absolute distance, the Dice similarity coefficient, and the average qualitative score ranged between 4.17 and 6.03, 0.87 and 0.90, as well as 2.58 and 3.12, respectively. The orthodontic assessment also is close to the evaluation of orthodontists. It has been shown that the proposed method can obtain accurate and consistent measurement in helping dentists to obtain an objective treatment evaluation.

Influence of enamel wetness on composite restorations using various dentine bonding agents: part II-effects on shear bond strength.

OBJECTIVES: To investigate the bond strength and fracture characteristics of various dentine bonding agents (DBAs) on wet or dry enamel. METHODS: Forty molar halves with enamel flattened were divided into 5 groups. Groups 1-4, teeth were acid-etched and treated separately with either an ethanol-based adhesive (Single Bond) or an acetone-based adhesive (Prime & Bond NT) on dry or wet enamel. Group 5 was treated with a self-etching adhesive (Clearfil SE Bond). The treated enamel surfaces were bonded with Z 250 composite with metal rings. The composite-ring assemblies were subjected to shear bond test until failure. Failure patterns on the debonded surfaces were inspected under a scanning electron microscope. The bonded enamel thickness was measured on sectioned specimens to investigate their statistical evidence. Results of open margin and enamel microcrack ratios from Part I of this study were compared with these fracture characteristics. Data was analyzed statistically. RESULTS: There was no difference in the bond strength between paired groups using the same DBA on wet or dry enamel. The teeth restored with self-etching adhesive exhibited lower bond strength and higher adhesive-enamel failure rate than the other groups. No correlation between enamel thickness, microcrack, bond strength, and failure patterns was revealed. CONCLUSION: The self-etching adhesive had a lower enamel bond strength than the other bonding systems. The difference in the failure patterns of groups with ethanol- and acetone-based DBAs on wet or dry enamel was indistinct. The frequently observed enamel microcrack cannot be directly correlated with the bond strength of bonding systems.

Influence of flowable composite lining thickness on Class II composite restorations.

This in vitro study aimed to investigate the influence of flowable composite lining with different thicknesses on the marginal quality and internal porosity of Class II composite restorations. Thirty-two intact molars, each prepared with two box-only Class II cavities, were randomly divided into four groups: Group 1, P60 filling alone; Group 2, ultrathin flowable composite lining/co-cured with overlaying composite; Group 3, thin lining/pre-cured and Group 4, thick lining/pre-cured. The teeth were then thermocycled for 1500 cycles (between 5 degrees C and 60 degrees C) and dye immersed for 24 hours. Exterior surface replicas of these restorations were fabricated before and after thermocycling and examined by SEM to evaluate percentages of the five marginal patterns. Data was statistically evaluated using one-way ANOVA test. The teeth were subsequently sectioned longitudinally. The interface microleakage of cervical margin was measured as to the extent of dye penetration. Internal voids were separately recorded in the cervical interface and the cervical and occlusal halves of the restorations. Mann-Whitney test was applied to analyze the interface microleakage and internal voids. Results revealed that replicas of Group 4 presented the highest percentage of marginal openings both before and after thermocycling in SEM examination. Group 2 exhibited superior marginal quality in interface microleakage evaluation compared to the other groups, while Group 4 exhibited the worst. The pre-cured groups (Group 3 and 4) showed significant reduction in interface and cervical voids. Despite the reduction in interface voids, a thick lining may impair the marginal sealing, especially after thermocycling. It was concluded that a minimally thin flowable composite lining improved cavity adaptation and marginal sealing.

Shear bond strengths of plastic brackets with a mechanical base.

This study compares the shear bond strengths of plastic brackets with a mechanical base and metal brackets using two different adhesives, and examines the modes of failure using a scanning electron microscope (SEM). Forty extracted human premolars were selected for bonding. Two types of brackets: metal and plastic-Spirit MB, and two orthodontic adhesives: System 1 + and Enlight, were used. After bonding, all samples were put into a 37 degrees C distilled water bath for 24 hours before shear bond strengths were tested. The bond strengths of the plastic brackets were significantly lower than those of the metal brackets (P < .0001). There was a statistically significant difference in bond strengths between System 1 + and Enlight for plastic brackets (P < .05), but not for metal brackets. The modes of failure predominantly occurred at the enamel/adhesive interface in the metal bracket-System 1 + group, within the adhesive in the metal bracket-Enlight and plastic bracket-System 1 + groups, and at the bracket/adhesive interface in the plastic bracket-Enlight group.

Effect of bracket bevel design and oral environmental factors on frictional resistance.

OBJECTIVE: To investigate the effects of bracket bevel design and oral environmental factors (saliva, temperature) on frictional resistance. MATERIALS AND METHODS: Five types of brackets, namely a conventional bracket (Omni-arch), an active self-ligating bracket (Clippy), and three passive self-ligating brackets (Carriere, Damon, and Tenbrook T1) coupled with a 0.014-inch austenitic nickel-titanium archwire were tested. In the experimental model, which used a group of five identical brackets, the center bracket was displaced 3 mm to mimic the binding effects. The friction experiments were performed at three temperatures (20°C, 37°C, 55°C) in a dry or a wet (artificial saliva) state. Finally, the surfaces of the bracket slots were observed using scanning electron microscopy (SEM) before and after the friction tests. RESULTS: The sliding frictional force was significantly influenced by the bracket slot bevel and saliva whether in the active or passive configuration (P < .05). The frictional force significantly increased as the temperature increased in the active configuration (P < .01). Based on the SEM observations, a correlation was found among the level of frictional force, the bevel angle, and the depth of scratches on bracket bevels. CONCLUSION: Frictional force can be reduced by increasing the bevel angle and by lowering the oral temperature, whereas the presence of saliva increases frictional resistance.

Bond strength and debonding characteristics of a new ceramic bracket.

INTRODUCTION: The purposes of this study were to evaluate the shear bond strength of a new collapsible monocrystalline bracket (Inspire, Ormco, Orange, Calif) and compare it with another collapsible ceramic bracket (Clarity, 3M Unitek, Monrovia, Calif) and a metal bracket; to examine the modes of failure after shear bond strength testing; and to observe the tooth surface after debonding the ceramic brackets with pliers. METHODS: One hundred extracted human premolars were selected for bonding. Three types of brackets and 2 orthodontic adhesives (Transbond XT, 3M Unitek; and Enlight, Ormco) were used. After bonding, all samples were placed in a distilled water bath at 37 degrees C for 24 hours. The shear bond strength of 60 samples was measured, and the remaining 40 samples with ceramic brackets were debonded with pliers. RESULTS: No statistically significant differences in bond strengths among the different combinations of brackets and adhesives were found (P > .05). The mode of failure after debonding by either shear bond strength testing or with pliers was predominantly at the bracket/adhesive interface in all groups. Enamel and bracket fractures were noted in 2 and 5 of 20 samples for Inspire, and 1 and 0 of 20 samples for Clarity after debonding with pliers. CONCLUSIONS: Bond strength and mode of failure of Inspire were similar to those of Clarity, but the risk of bracket fracture after debonding for Inspire was greater.

Comparison of initial shear bond strengths of plastic and metal brackets.

The aims of this study were to compare initial and 24 hour shear bond strengths of plastic brackets with a mechanical base (Spirit MB) and metal brackets, using two different adhesives (System 1+ and Enlight), and to examine the modes of failure after debonding. Eighty extracted human premolars were used. After bonding, shear bond strengths in half the sample were tested within 30 minutes. The remaining 50 per cent were placed in a 37 degrees C distilled water bath for 24 hours before testing. The results showed that the effects of the two adhesives and the interaction of the two time intervals and the two bracket types on shear bond strength were significantly different (P < 0.05 and P < 0.0001, respectively). Six of the 10 groups were found to have less than 50 per cent of the adhesive remaining on the tooth surface after debonding in the 24 hour metal bracket-System 1+ group, but most specimens in the other seven groups had more than 50 per cent of the adhesive left. It is concluded that System 1+ cannot provide sufficient initial bond strengthfor Spirit MB and may increase the risk of enamel fracture for metal brackets.