Evaluation of Three-Dimensional Digital Models Formulated From Direct Intra-oral Scanning of Dental Arches in Comparison With Extra-oral Scanning of Poured Dental Models in Terms of Dimensional Accuracy and Reliability.

BACKGROUND: The study's objective was to assess the dimensional accuracy and reliability of dental digital models prepared by direct intraoral scanning and indirect scanning of the plaster models compared to the plaster models as the gold standard. MATERIALS AND METHODS: This study included 20 patients. Nine had a class I malocclusion, seven had a class II malocclusion, and four had a class III malocclusion. Intraoral scanning was done for the upper and lower arches of all the patients enrolled in this study using an intraoral scanner (i700; Medit, Seoul, Korea). The next step was preparing the plaster model for the control group. Addition-silicone impressions were taken for each patient's arches. The impressions were poured according to American Board of Orthodontics (ABO) standards. Finally, the digital models of the indirect scanning group were prepared using a 3D desktop scanner (T710; Medit). In total, 26 measurements were made on the plaster and digital models. Paired t-tests were used to test for significant differences between the studied groups. The reliability of the studied techniques was tested using intraclass correlation coefficients (ICCs). Because of the multiple comparisons, the ɑ level was adjusted and set at 0.002. RESULTS: No significant differences were found between the intraoral scanning group (20 patients) and the plaster models group (20 patients; P>0.002). The ICCs ranged from 0.814 to 0.993, indicating excellent agreement between the direct digital and traditional plaster models. There were no significant differences between the digital and original plaster models (P>0.002). ICCs ranged from 0.834 to 0.995, indicating excellent agreement between the indirect digital and original plaster models. No significant differences were detected between the direct and indirect digital models (P>0.002). ICCs ranged between 0.813 and 0.999, indicating excellent agreement between direct and indirect digital models. CONCLUSION: Both direct and indirect scanning techniques are accurate and reliable for digital model preparation and can be considered an alternative to traditional plaster models used in clinical orthodontics diagnostic applications. The intraoral scanning technique can be considered a valid alternative for indirect scanning of the plaster models to prepare digital working models during the digital design and fabrication of orthodontic appliances such as clear aligners.

Evaluation of Patient-Reported Outcome Measures (PROMs) Associated With the Acceleration of Canine Retraction by Piezosurgery in Comparison With Low-Level Laser Therapy: A Three-Arm Randomized Controlled Clinical Trial.

Background and objectives Recently, both surgical and non-surgical interventions have gained popularity in accelerating orthodontic tooth movement, but there is no randomized controlled trial (RCT) comparing both modalities in terms of patient-reported outcome measures (PROMs) during maxillary canine retraction. Therefore, this trial aimed to assess the PROMs associated with either low-level laser therapy (LLLT) or piezocision-assisted acceleration in the context of maxillary canine retraction. Materials and methods This was a single-blinded, single-center, three-arm RCT. A total of 54 patients (12 males, 42 females, mean age 20.65 ± 2.85) whose treatment needed upper-first-premolar extraction to facilitate canine retraction were enrolled and randomly divided into three groups: piezocision group (PG), LLLT group (LLLTG), and the control group (CG). Standardized questionnaires using a visual analog scale were distributed to patients at five assessment times: 1 (T1), 3 (T2), 7 (T3), 14 (T4), and 28 days following the canine retraction initiation (T5). The patients' pain, discomfort, swelling, chewing difficulty, satisfaction, and acceptance were recorded. Results Regarding pain and discomfort, the levels were significantly lower in the LLLTG during the first two weeks of canine retraction compared to the other two groups (p<0.017). At the same time, these levels were significantly greater in the PG than the CG in the first week of canine retraction (p<0.017). Patients in the PG had a "mild to moderate" perception of swelling at T1 and T2, which was significantly different than that of the other two groups (p<0.001). Regarding chewing difficulty, the levels in the LLLTG were significantly lower than those in PG at the first three assessment times (p<0.017). Patients' satisfaction with canine speed was significantly greater in the intervention groups compared to the CG (p<0.001). In contrast, no statistically significant differences were found between the three groups regarding satisfaction with gum appearance surrounding the canine (p=0.061) and acceptance (p=0.125). Conclusion The LLLT-assisted canine retraction was associated with significantly lower negative patient-reported outcomes during the first two weeks of retraction than piezocision-assisted retraction. However, the levels of pain and discomfort were significantly greater in the piezocision-assisted retraction group than those in the conventional canine retraction group, which in turn were greater than those with the LLLT-assisted canine retraction group during the first week of retraction. Patient satisfaction and acceptance were high with both piezocision and LLLT interventions.

Patient-Reported Outcome Measures of Flapless Corticotomy with Low-Level Laser Therapy in En Masse Retraction of Upper Anterior Teeth: A Three-Arm Randomized Controlled Trial.

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review.

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

Radiographic evaluation of alveolar ridge preservation using a chitosan/polyvinyl alcohol nanofibrous matrix: A randomized clinical study.

The objective of this randomized clinical trial (RCT) was to assess the effectiveness of electrospun chitosan/polyvinyl alcohol (CS/PVA) nanofibrous scaffolds in preserving the alveolar ridge and enhancing bone remodeling following tooth extraction when compared to a control group. In this split RCT, 24 human alveolar sockets were randomly assigned to two groups, with 12 sockets receiving CS/PVA nanofibrous scaffold grafts (test group) and 12 left to heal by secondary intention as the control group. Cone-beam computed tomography (CBCT) was performed at two different time points: immediately after extraction (T0) and 4 months post-extraction (T4). After 4 months, linear vertical and horizontal radiographic changes and bone density of extraction sockets were assessed in both the test and control groups. The RCT included 12 patients (4 male and 8 female) with a mean age of 24 ± 3.37 years. The test group had a significantly lower mean vertical resorption vs the control group, with a mean difference of 1.1 mm (P < 0.05). Similarly, the control group's mean horizontal bone resorption was -2.01 ± 1.04 mm, while the test group had a significantly lower mean of -0.69 ± 0.41 mm, resulting in a mean difference of 1.35 mm (P < 0.05). Furthermore, the study group exhibited a significant increase in bone density (722.03 ± 131.17 HU) after 4 months compared to the control group (448.73 ± 93.23 HU). In conclusion, we demonstrated within the limitations of this study that CS/PVA nanofibrous scaffold significantly limited alveolar bone resorption horizontally and vertically and enhanced bone density in alveolar sockets after 4 months when compared to results in the control group (TCTR20230526005).

Effectiveness of Flapless Cortico-Alveolar Perforations Using Mechanical Drills Versus Traditional Corticotomy on the Retraction of Maxillary Canines in Class II Division 1 Malocclusion: A Three-Arm Randomized Controlled Clinical Trial.

BACKGROUND AND OBJECTIVES: Both invasive and minimally invasive surgical methods have recently gained popularity in accelerating orthodontic tooth movement. Traditional corticotomy (TC) was one of the first effective invasive surgical techniques in shortening orthodontic treatment time, whereas the flapless cortico-alveolar perforations (FCAPs) technique is a modern minimally invasive method that has recently shown good results in different types of orthodontic tooth movement. Therefore, this study aimed to compare the effectiveness of TC versus FCAPs in maxillary canine retraction when treating Class II division 1 malocclusion patients. MATERIALS AND METHODS: This was a single-blinded, single-center, three-arm randomized controlled trial. A total of 51 patients (22 males, 29 females, mean age 20.98 ± 1.95) whose treatment planning included the extraction of maxillary first premolars were enrolled and randomly divided into three groups: the TC group, the FCAPs group, and the control group. The assessed outcomes were the amount of canine retraction, anchorage loss, and canines' rotation, which was evaluated at five-time points till the completion of canine retraction. RESULTS: There were statistically significant differences in the amount of canine retraction between the three groups in the first two months (p < 0.001), with greater mean values in the TC group (p < 0.001) in the first month. However, the amount of canine retraction in the FCAPs group was significantly greater in the second month compared to the TC group (p = 0.003) and the control group (p < 0.001). In the first month of canine retraction, anchorage loss, and canine rotation were significantly lesser in the TC and FCAPs groups than in the control group (p < 0.001). On the contrary, the canines' rotation amount after the completion of retraction was greater in the TC group than in the other two groups (p < 0.001). CONCLUSION: TC and FCAPs are efficient adjunctive surgical methods for accelerating canine retraction. At the end of the first month, the TC accelerated canine retraction by 59.85% and FCAPs by 44% compared to the conventional retraction. At the end of the second month, the acceleration was less than recorded in the first month (35.44% and 50.20%, respectively). The acceleration effect of the surgical interventions appeared transient and did not last in the following observation period.

Bilateral ossifying fibroma affecting the jaws: Literature review, rare case report.

BACKGROUND: Ossifying fibroma (OF) is a benign lesion could occur in different areas of the body and contain fibers, cells and non-organic materials in non specific amounts. It is growing could be slow or rapid and according to this an array of treatment options must be considered to avoid future complications. CASE PRESENTATION: In this article, we present a case report of a 40-year-old female patient who visited the dentist with the intention of having a normal check up. Bilateral lesion was observed in the mandible, the patient had no medical history of trauma. The lesion was removed surgically and analyzed histologically and the result was ossifying fibroma in both sides. DISCUSSION: Ossifying fibroma is a rare tumor to be found in the oral cavity, and the family of fibro-osseous lesions (FOLs) has in general the same pathologic features and differ from each other in clinical view so the definitive diagnosis is based on mixture of all these elements. The treatment is complete surgical excision. CONCLUSIONS AND LITERATURE REVIEW: 11 cases were discovered and archived since 1968 until now, the distribution of cases is nearly equal in the oral cavity, and the infection of females is higher than males.

The effect of hyaluronic acid addition to collagen in reducing the trismus and swelling after surgical extraction of impacted lower third molars: a split-mouth, randomized controlled study.

BACKGROUND: Removal of impacted third molars is associated with postoperative complications such as pain, swelling, ecchymosis, trismus, infection, and hematoma. Thus, contemporary surgery aims to reduce complications by applying collagen or hyaluronic acid in the socket after extracting the impacted mandibular third molars. This study aimed to study the efficacy of hyaluronic acid (HA) addition to collagen, compared to collagen application alone, on the magnitude of swelling and trismus following impacted mandibular third molar surgery. METHODS AND MATERIALS: A total of 40 impacted molars of 20 participants who had completely bilateral impacted lower third molars were enrolled in this split-mouth, randomized, clinical trial. Randomization was carried out by two opaque envelops; two materials were applied topically in the socket collagen alone or with hyaluronic. The postoperative mouth-opening limitation and swelling rate were assessed on the third and seventh days after the extraction. RESULTS: The mean age was 22.7 ± 3.079 years (75% female and 25% male). Regarding the rate of trismus, the test sides had less values than the control sides on 3rd days (44.03 ± 12.8 vs. 52.14 ± 13.7) and 7th days (19.22 ± 12.8 vs. 32.45 ± 15.3) postoperatively but the difference is only significant on the seventh day (P = 0.005). The swelling scores of the hyaluronic acid addition group were significantly lesser than those of the collagen alone group on the third and the seventh day (P < 0.05) except for the lateral canthus to the angulus mandibulae on the third day (P = 0.133). CONCLUSION: Adding hyaluronic acid to collagen could effectively reduce the severity of facial swelling and trismus following surgical extraction of impacted lower third molars. STATEMENT OF CLINICAL RELEVANCE: Swelling and trismus are the most sequela following impacted third molar surgical extraction. This study showed that applying hyaluronic acid with collagen can reduce the severity of facial swelling and trismus which could be useful in surgeons' daily practice. We should mention that this original article has a preprint edition (44).

The transparency of reporting 'harms' encountered with the surgically assisted acceleration of orthodontic tooth movement in the published randomized controlled trials: a meta-epidemiological study.

BACKGROUND: Surgical-assisted accelerated orthodontics (SAAO) has become very popular recently. Therefore, this study aimed to investigate the extent to which researchers adhere to Item 19 (harms) of the Consolidated Standards of Reporting Trials (CONSORT) in the published studies in the field of SAAO. In addition, the study evaluated the possible association between harm reporting and the human development index (HDI) of the recruited research sample country, CiteScore-based quartile (CSBQ) of the publishing journal, invasiveness of the surgical intervention (ISI), and the type of orthodontic tooth movement (TOTM). Moreover, it aimed to summarize the different possible harms and complications that maybe encountered in the course of SAAO. MATERIALS AND METHODS: Electronic searching of six databases was conducted for SAAO-related English RCTs published between January 2000 and April 2022. For the RCTs that did not report harms, information was sought by contacting the corresponding authors. Descriptive statistics of the evaluated variables were performed. The association between 'harm reporting' and the HDI of the research team, the BDRQ of the publication journal, the ISI, and the TOTM were investigated. Binary logistic regression was used, and the odds ratios (ORs) with 95% confidence interval (CIs) of the evaluated variables were obtained. Moreover, the risk of bias of the included RCTs was assessed using the RoB2 tool. RESULTS: Among the 91 included RCTs, 54 RCTs (59.3%) did not adhere to reporting harm associated with the SAAO. The non-adherence was significantly associated with the ISI (OR 0.16; CI 0.03-0.73; p < 0.018) for invasive methods compared with minimally invasive ones). There was a significant positive correlation between harm reporting and both the CSBQ of the publishing journal and the HDI of the recruited research sample country (p = 0.001, p = 0.003, respectively). On the contrary, a non-significant association was found between harm reporting and the type of OTM (p = 0.695). The incidence of harms associated with SAAO was approximately 17.5%. LIMITATIONS: Assessment was restricted to English RCTs related to SAAO. CONCLUSION AND IMPLICATIONS: The adherence to reporting harms in the field of SAAO was deficient. Efforts should be made by authors, peer reviewers, and editors to improve compliance with the CONSORT guidelines regarding harms reporting. Additionally, there is a wide spectrum of harms that could be associated with SAAO that the practitioner should pay attention to and alert the patient to the possibility of their occurrence.

Evaluation of the Chemical, Morphological, Physical, Mechanical, and Biological Properties of Chitosan/Polyvinyl Alcohol Nanofibrous Scaffolds for Potential Use in Oral Tissue Engineering.

Background Chitosan is a biocompatible, biodegradable, and non-toxic natural polymer that can be fabricated by different methods for use in dental and biomedical fields. Electrospinning can produce polymeric nanofibrous scaffolds and membranes with desirable properties for use in tissue engineering. The objectives of this study were to investigate several morphological, physical, and biological characteristics of these nanofibrous scaffolds and evaluate their potential use in tissue engineering. Methodology Chitosan/polyvinyl alcohol nanofibrous scaffolds (CS/PVA NFS) in a ratio of 70/30 were fabricated by conventional electrospinning. The scaffolds were evaluated chemically by Fourier transformed infrared spectroscopy (FTIR) and morphologically by the atomic force microscope (AFM) and the field emission-scanning electron microscope (FE-SEM). These scaffolds were also evaluated mechanically by a tensile strength test and several investigations, including water contact angle, swelling ratio, and degradation ratio. Biological evaluations included protein adsorption, cell culture, and cell viability assay. Results The morphological evaluation revealed a homogenous, bead-free mat with an average fiber diameter of 172.7 ± 56.8 nm, an average pore size of 0.54 ± 0.17 µm, and porosity of 74.8% ± 3.3%; the scaffolds showed a tensile strength of 6.67 ± 0.7 Mpa. Scaffolds showed a desired hydrophilic property, as shown by the water contact angle test with a mean angle of 29.5°, while the swelling ratio was 229%, and degradability in phosphate buffer solution after 30 days was 26.9 ± 2.9%. In-vitro cell culture study with adipose tissue mesenchymal stem cells and cell viability and cytotoxicity tests by MTT assay demonstrated well-attached cells with increasing proliferation rate with no signs of cytotoxicity. Conclusions Assessment of the CS/PVA NFS revealed randomly oriented bead-free and porous mats. The scaffolds were stable at aqueous solutions following thermal treatment. They were hydrophilic, biodegradable, and biocompatible, as shown by the cell culture and MTT assay, which suggest that the fabricated scaffolds have the potential to be used in tissue engineering applications either as scaffolds, bio-grafts, or barrier membranes.

Assessment of Patient-Centered Outcomes When Treating Palatally Impacted Canines Using Conventional Versus Accelerated Minimally Invasive Corticotomy-Assisted Orthodontic Treatment: A Randomized Controlled Trial.

Objective This study aimed to investigate whether there were any differences in pain levels, discomfort, and functional impairments when treating palatally impacted canines (PICs) using the conventional treatment method compared to the accelerated minimally invasive corticotomy-assisted method. Materials and methods Fifty-two patients (11 males and 41 females) with unilateral PICs were included. The patients were randomly assigned to the conventional traction group (26 patients, mean age of 20.37 ± 2.15 years) or the minimally-invasive corticotomy-assisted group (26 patients, mean age of 20.18 ± 2.18 years). The levels of pain, discomfort, and functional difficulties were assessed using a visual analog scale (VAS) after 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) following the surgical exposure procedure. Results There were no statistically significant differences between the two treatment groups for any patient-centered outcome at all assessment times (P>0.01). The levels of pain and discomfort were slightly greater in the conventional group than in the corticotomy-assisted group on the first day after surgical exposure, with no significant difference between the two groups (mean pain: 4.11, P=0.481; mean discomfort: 9.00, P=0.223). Pain and discomfort required seven days to reach low levels and four weeks to reach the lowest levels in both study groups. The levels of swelling, mastication difficulties, swallowing difficulties, limitation in jaw movements and speech changes were mild to moderate on the first postoperative day and the recovery time was four days postoperatively for swallowing difficulties and speech changes. In comparison, the recovery time was seven days for the other three outcomes in both study groups. Conclusions After one day of the surgical intervention, either by conventional or corticotomy-assisted methods, the patients reported mild to moderate pain, discomfort, and functional impairments. These disabilities gradually reached low levels during the first and second weeks to reach their lowest levels four weeks postoperatively in both study groups. The similarity between the conventional and the acceleration methods in pain levels and other oral disabilities may make corticotomy-assisted treatment a comfortable and effective method when treating adult patients with PICs. In addition, patient satisfaction with the corticotomy-assisted procedure was high.

Marsupialization of a Large Dentigerous Cyst in the Mandible: A Case Report.

Dentigerous cysts (DCs) are one of the most common cysts in the oral and maxillofacial region, and they are often discovered by chance in young people. The methods of treatment differ according to the size they reach, but the prognosis and results of the treatment are generally good. DCs are often associated with impacted teeth, especially mandibular third molars and maxillary canines, and they are usually discovered when they reach large sizes or get infected after they have caused great absorption and destruction of the surrounding cortical bone and displacement in adjacent teeth. This case report expresses the importance of conservative treatment of large oral cysts (by marsupialization) in the preservation of jaw bones, in a young female child of 12 years, with a DC associated with an impacted second permanent lower molar. This cyst occupied nearly half of the mandible with the danger of causing more harm to the jaw. In brief, marsupialization is a very effective method of treatment for DCs, especially those that reach very large volumes.

Evaluation of the Effectiveness of Surgical Interventions Versus Non-surgical Ones When Used in Conjunction With Fixed Appliances to Accelerate Orthodontic Tooth Movement: A Systematic Review.

The objectives of this review were to evaluate the currently available evidence regarding the effectiveness of surgical versus non-surgical acceleration methods and the side effects associated with these methods. Nine databases were searched: the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE®, Scopus®, PubMed®, Web of Science™, Google™ Scholar, Trip, OpenGrey, and PQDT OPEN from pro-Quest®. ClinicalTrials.gov and the International Clinical Trials Registry Platform Search Portal (ICTRP) were screened to explore ongoing studies and unpublished literature. Randomized controlled trials (RCTs), as well as controlled clinical trials (CCTs) of patients who received surgical interventions (invasive or minimally invasive techniques) in conjunction with traditional fixed appliances and who were compared to the non-surgical interventions, were included. The Cochrane tool for risk of bias (RoB.2) was used for evaluating RCTs, whereas the ROBINS-I tool was used for the CCTs. This systematic review included four RCTs and two CCTs (154 patients). The surgical and non-surgical interventions were found to have the same effect on orthodontic tooth movement (OTM) accelerating in four trials. In contrast, the surgical interventions were superior in the other two studies. High heterogeneity among the included studies prevented conducting the quantitative synthesis of the findings. The reported side effects related to the surgical and non-surgical interventions were similar. A "very low" to "low" evidence indicates that the effectiveness of surgical and non-surgical interventions in the acceleration of orthodontic tooth movement is similar, with no differences in the associated side effects. More high-quality clinical trials to compare the acceleration effectiveness between both modalities in different types of malocclusion is required.

The Effectiveness of Periodontally Accelerated Osteogenic Orthodontics (PAOO) in Accelerating Tooth Movement and Supporting Alveolar Bone Thickness During Orthodontic Treatment: A Systematic Review.

The current review aimed to critically and systematically evaluate the available evidence regarding the effectiveness of periodontally accelerated osteogenic orthodontics (PAOO) in accelerating orthodontic tooth movement and supporting the alveolar bone. Additionally, this review aimed to analyze the untoward effects of this procedure and the patient-reported outcome measures. A comprehensive electronic search was performed on 10 databases in addition to a manual search to retrieve all relevant studies. Randomized controlled trials (RCTs) were only included in this review. The interventional group was the PAOO procedure, whereas the control group was either a non-accelerated traditional fixed orthodontic treatment or an accelerated treatment using any other intervention. The Cochrane risk of bias tool for randomized controlled trials (RoB 2) was employed to estimate the risk of bias in the included studies. The current review included eight RCTs evaluating 175 participants (63 males and 112 females) with a mean age ranging from 18.8 to 29.6 years. Five of them assessed the effectiveness of PAOO versus traditional orthodontic treatment, i.e. without any adjuvant surgical intervention. At the same time, the remaining three studies evaluated the effectiveness of PAOO versus corticotomy-only as an adjunctive procedure. The PAOO accelerated the leveling and alignment stage from 39% to 47% and accelerated the retraction of the upper anterior teeth from 41% to 61% compared to conventional orthodontic treatment. One study only indicated that PAOO reduced treatment time by 30.3% versus a corticotomy-only as an adjunctive procedure. No significant side effects have been reported with the PAOO procedure. The PAOO procedure was effective in accelerating orthodontic movement and tended to increase the thickness of the alveolar bone. But most periodontal outcome measures regarding PAOO application were not comprehensively covered in the included trials.

A Comparative Study Between Hybrid Abutments and Standard Abutments in Implant-Supported Prosthesis: A Split-Mouth Clinical Trial.

Background Implant-supported prostheses are widely used to replace extracted teeth. Therefore, studies on abutments' designs, shapes, and benefits had increased in recent years, as the design of the standard abutment still poses many problems in periodontal and cosmetic aspects. So, could the hybrid abutment solve some of these problems? Aim We aim to conduct a clinical comparison between standard and hybrid abutments in terms of the state of peri-implant gingival tissues and patients' aesthetic and functional satisfaction after the cementation of the final prostheses. Material and methods The study sample consisted of 10 patients, with 20 dental implants. Each patient received two implants as a standard abutment was placed over one implant and a hybrid abutment was placed over the other. Clinical assessment of the peri-implant gingival tissue and patients' aesthetic and functional satisfaction was performed (immediately, three months, six months, and one year) after the cementation of the final prostheses. The Mann-Whitney U test was used to detect statistically significant differences between groups. Results The percentage of the thick gingival biotype was 80%, and the percentage of the thin gingival biotype was 20% in each group during the follow-up periods. In addition, all papilla fill the whole interdental space in all samples of the two groups after six months and one year. Finally, there were no significant differences in patients' aesthetic satisfaction between groups during one year of follow-up (P = 0.631), and there were no significant differences in patients' functional satisfaction between groups during one year of follow-up (P = 0.684). Conclusion Within the limitations of the current work, there are no differences between standard and hybrid abutments in terms of affecting the peri-implant gingival tissue and patients' aesthetic and functional satisfaction.

Radiological Comparative Study Between Conventional and Nano Hydroxyapatite With Platelet-Rich Fibrin (PRF) Membranes for Their Effects on Alveolar Bone Density.

BACKGROUND: The entry of the concept of nanotechnologies into the field of biomaterials has improved the results of their use in regenerative therapies based on the principles of tissue engineering, due to its improvement of the physical properties of materials manufactured in this way, so it has become possible to produce particles of hydroxyapatite in nano sizes. AIM OF THE STUDY: This study will evaluate the efficacy of applying nanohydroxyapatite paste and platelet-rich fibrin (PRF) as a barrier membrane in comparison with traditional hydroxyapatite (a powder consisting of macro-sized particles) and PRF as a barrier membrane in symmetrically extracted alveoli of the mandible. MATERIALS AND METHODS: The research sample consisted of 40 lower alveoli (symmetrical) of the extracted teeth. The study samples were divided randomly into two groups. Group 1: A paste of nanohydroxyapatite with PRF as a barrier membrane was applied to one side of the extraction. Group 2: Hydroxyapatite powder with PRF as a barrier membrane was applied to the alveolus from the opposite side of Group 1 (the opposite side of the extraction). Three radiographs were performed by cone beam conventional tomography (CBCT) in three consecutive periods to conduct the radiological study (T0: immediately after extraction and grafting, T1: after three months, T2: after six months). RESULTS:  The mean of the radiographic bone density of the hydroxyapatite powder group at time T0 is 824.36 HU with a standard deviation of ±277.29 HU, and at time T1 is 1119.93 HU with a standard deviation of ±306.93 HU, and at time T2 is 1074.14 HU with a standard deviation of ±223.62 HU, with statistically significant differences when comparing the amount of change in radiographic bone density at time T0 and T1 with P < 0.05, and at time T0 and T2 with P < 0.05, but there were no significant differences when comparing the amount of change in radiographic bone density in T1 and T2 times with P > 0.05. The mean radiographic bone density of the nanohydroxyapatite paste group at time T0 is 629.88 HU with a standard deviation of ±193.64 HU, and at time T1 is 960.67 HU with a standard deviation of ±256.88 HU, and at time T2 is 743.87 HU with a standard deviation of ±180.96 HU, and in the time T0 and T1 with P < 0.05, and in the time T0 and T2 with P < 0.05, and in the time T1 and T2 with P < 0.05. Statistically, significant differences have been found between bone density change T1, T2 in the nanohydroxyapatite paste group and bone density change T1, T2 in the hydroxyapatite powder group P<0.05, which expresses a greater loss of density in the nanohydroxyapatite group, and thus the resorption of the bone graft and the placement of new bone tissue. CONCLUSION: Within the limits of our study, the results demonstrated that the use of traditional hydroxyapatite powder and nanohydroxyapatite paste increases the radiographic bone density, nanohydroxyapatite paste has a greater absorbency after 3 months compared with traditional hydroxyapatite powder which helps replace it by natural bone tissue.

Reconstruction of mandible using a computer-designed 3D-printed patient-specific titanium implant: a case report.

Reconstruction of mandibular defects after trauma or tumor resection is one of the most challenging problems facing maxillofacial surgeons. Historically, various autografts and alloplastic materials have been used in the reconstruction of these types of defects. The use of individualized designed biomaterials has opened new possibilities in reconstructive surgery, and now, it is possible to use the patient's computed tomography (CT) to construct patient-specific implants (PSIs). A case of a large mandibular tumor resection and reconstruction of the defect using a customized 3D-printed titanium implant is described. The treatment had excellent postoperative esthetic and functional results without complications. CONCLUSION: Because titanium implants are customizable, easily workable especially with help of 3D virtual planning techniques, bioinert, and nonporous, they represent an ideal alloplastic material for mandibular reconstruction.

Nonsurgical Management of Adult Skeletal Class 3 with Deep Bite utilizing Mini-implants.

INTRODUCTION: Malocclusions with anterior crossbite are a major esthetic and functional concern for patients. This case report presents a 27-year-old Syrian female who was diagnosed with a class 3 malocclusion, combined with anterior crossbite, deep bite, concave profile, and inadequate maxillary incisor exposure. There was a centric occlusion (CO)/centric relation (CR) discrepancy and the mandible could be manipulated to near edge-to-edge incisal relation. Correction was done by class 3 intermaxillary elastics on upper and lower mini-implants for the first 6 months, followed by preadjusted edgewise appliance. The objective of implant-supported elastics was to adapt the patient for the CR condylar position without dental effect. Treatment was completed in 24 months with satisfactory dental and facial relationship.

Finite element analysis of stress distribution on the mandible and condylar fracture osteosynthesis during various clenching tasks.

PURPOSE: The purpose of the study was to evaluate the effect of clenching tasks on the stress and strain of condylar osteosynthesis screws and plates, as well as on the stress, strain distribution and displacement on the whole mandible and bone surrounding screws. METHODS: Three-dimensional finite element models of the mandible, two straight four-hole plates and eight screws were established. Six static clenching tasks were simulated in this study: incisal clench (INC), intercuspal position (ICP), right unilateral molar clench (RMOL), left unilateral molar clench (LMOL), right group function (RGF) and left group function (LGF). RESULTS: Based on the simulation of the six clenching tasks, none of the inserted screws and plates were broken or bended. For the whole mandibular bone, the maximum von Mises stress and von Mises strain observed were yielded by the ICP. For the bone surrounding the inserted screws, the maximum von Mises stress and von Mises strain were yielded by the LMOL (49.2 MPa and 3795.1 µ). CONCLUSION: Clenching tasks had significant effects on the stress distribution on the condylar osteosynthesis and the bone surrounding screws. Contralateral occlusion task (LMOL) had the maximal results of von Mises stress and strain and healing problems could be occur, this result confirms the importance of soft diet after surgery.

Assessment of the Biomechanical Performance of 5 Plating Techniques in Fixation of Mandibular Subcondylar Fracture Using Finite Element Analysis.

PURPOSE: The aim of this study was to compare the performances of 5 plating techniques for fixation of unilateral mandibular subcondylar fracture. MATERIALS AND METHODS: Five titanium plating techniques for fixation of condylar fracture were analyzed using the finite element method. The modeled techniques were 1) 1 straight plate, 2) 2 parallel straight plates, 3) 2 angulated straight plates, 4) 1 trapezoidal plate, and 5) 1 square plate. Three-dimensional models were generated using patient-specific geometry for the mandible obtained from a computerized tomographic image of a healthy living man. Plates were designed and combined with the mandible and analyzed under a 500-N load. RESULTS: The single straight plate presented the most inferior performance; it presented maximum displacement and strain on cortical bone. The trapezoidal plate induced the least amount of strain on cortical bone and was best at resisting displacement. CONCLUSION: The trapezoidal plate is recommended for fixation of subcondylar fracture.