In vitro biomechanics of divot use, and their placement, in orthodontic aligner therapy.

INTRODUCTION: To evaluate biomechanics of an aligner utilizing divots and the effect of their vertical placement on the right maxillary central incisor. METHODS: An in vitro Orthodontic SIMulator (OSIM) was used to test forces and moments generated by aligners incorporating divots. The OSIM arch was scanned to generate a. STL version that was modified to create four models by placing divots on different positions of the right central maxillary incisor: GI - divots on gingival-third of lingual surface and incisal-third of labial surface; GM - divots on gingival-third of lingual surface and middle-third of labial surface; MI - divots on middle-third of lingual surface and incisal-third of labial surface; MM - divots on middle-third of lingual surface and middle-third of labial surface. Aligners (n = 30/model) were fabricated using a 0.75 mm thick polyethylene terephthalate material and Biostar® machine following the manufacturer's recommendations. A one-way MANOVA followed by one-way ANOVA (α = 0.05) was utilized to test effect of models on buccolingual force (Fy) and mesiodistal moment (Mx) at 0.20 mm of lingual displacement of the right maxillary central incisor. RESULTS: Mean Mx for GI (-5.68 ± 7.38 Nmm), GM (3.75 ± 5.54 Nmm), MI (-4.27 ± 1.48 Nmm) and MM (1.96 ± 0.99 Nmm) models showed statistical differences between GI and GM, GI and MM, GM and MI and MI and MM. GI exerted the largest Fy (1.87 ± 0.75 N) followed by GM (1.10 ± 0.47 N), MI (0.70 ± 0.23 N) and MM (0.28 ± 0.08 N) with significant differences between GI and GM, GI and MI, GI and MM and GM and MM models. CONCLUSIONS: Vertical divot placement on a right central incisor had a significant effect on aligner biomechanics. Buccolingual forces exerted by models GI, GM and MI were within the range suggested by literature for bodily tooth movement without major root tipping for GM and MI models.

Parental experiences in navigating health services for paediatric residual obstructive sleep apnoea: An exploratory qualitative descriptive study.

OBJECTIVES: To explore parents' experiences and perceptions regarding engagement in health services for managing residual paediatric obstructive sleep apnoea (OSA) across levels of care. METHODS: Qualitative description guided study design. Data were collected through semi-structured interviews with parents of children diagnosed with residual OSA at a university-based sleep clinic. The relevant literature informed the interview guide and was piloted before data collection. Inductive, manifest content analysis was used to describe parents' perceptions and experiences using data-driven categories and sub-categories. Several strategies were employed to ensure rigour in this study. RESULTS: Eight interviews were conducted. Parents' views were organized into five categories: awareness of the sleep issue, interaction with non-sleep specialists, interaction with sleep specialists, interaction with dental professionals, and further actions and support. Parents reported several engagement issues due to their interactions with different care providers. These issues included having to personally identify and raise the sleep problem, feeling that care providers did not take this problem seriously, waiting for an extended period to be referred for sleep services, and receiving conflicting or insufficient treatment recommendations. Overall, parents perceived that their actions and the services received across levels of care were not effective enough to address paediatric OSA. CONCLUSION: Based on this exploratory qualitative descriptive research, along with developing evidence-based clinical guidelines for paediatric OSA screening and management tailored to different levels of care, strategies intended to improve the engagement of patients and care providers in addressing paediatric OSA should be developed and empirically tested.

Tooth and root size as determined from 0.25- and 0.30-mm voxel size cone-beam CT imaging when contrasted to micro-CT scans (0.06 mm): An ex vivo study.

OBJECTIVE: To quantify tooth volume differences from extracted teeth when using three different three-dimensional (3D) computed tomography (CT)-based imaging modalities. DESIGN: Ex vivo study. SETTING: Laboratory and clinics of the University of Alberta. METHODS: Cone-beam CT (CBCT) of 12 extracted teeth were scanned using 0.25- and 0.30-mm voxel size from CBCT and a 0.06-mm voxel size from micro-CT (reference standard). 3D reconstructions for each tooth from each imaging modality were made through the software ITK-SNAP®. The mean volume differences between each pair of scanning modalities were calculated and then compared and analysed through a repeated measures ANOVA. RESULTS: The average overestimations of the teeth volume were 15.2% for the high-resolution CBCT and 28.1% for the low-resolution CBCT compared to micro-CT measurements. The differences in absolute volume were 81.6 mm3 and 152.8 mm3, respectively. All differences were statistically significant (P < 0.05). CONCLUSIONS: Orthodontists and researchers who assess root resorption through CBCT imaging should be aware that the depicted volumes may likely be overestimating tooth volume and camouflaging real root volumetric treatment changes.

An in vitro evaluation of orthodontic aligner biomechanics around the maxillary arch.

INTRODUCTION: The objective of this study was to evaluate the forces and moments exerted by orthodontic aligners on 3 different displaced maxillary teeth and their adjacent supporting teeth. METHODS: An in vitro orthodontic simulator was used to measure the forces and moments of a 0.75-mm thick glycol-modified polyethylene terephthalate material for 3 maxillary teeth: central incisor, canine, and second premolar. Forces and moments were recorded for tested teeth displaced lingually one by one for 0.20 mm. Repeated measures of multivariate analysis of variance was used to assess the outcome. RESULTS: The mean buccolingual force applied on a displaced canine (2.25 ± 0.38 N) was significantly (P <0.001) more than the central incisor (1.49 ± 0.18 N) and second premolar (1.50 ± 0.16 N). The mean moment (that tends to tip the teeth buccally) exerted on a canine (-20.11 ± 5.27 Nmm) was significantly more (P <0.001) than the central incisor (-8.42 ± 1.67 Nmm) and second premolar (-11.45 ± 1.29 Nmm). The forces and moments acting on teeth adjacent to the displaced tooth were clinically significant and acted in opposing directions to those on the displaced tooth. CONCLUSIONS: The results of this study highlighted that for the same amount of displacement on a given tooth, the forces and moments imposed by the orthodontic aligner depend on location around the arch. These findings highlight the need to further study aligner mechanics around the dental arch and optimize aligner design to impose desired mechanical loads to avoid detrimental effects during orthodontic tooth movement.

Comparison of the contact angle of water on set elastomeric impression materials.

PURPOSE: The hydrophilicity of some elastomeric impression materials has not been fully established. The purpose of this study was to measure and compare the advancing contact angle of water on the surface of several set elastomeric impression materials. MATERIALS AND METHODS: We tested various consistencies of vinyl polysiloxane (VPS; Imprint 4) and vinyl polyether silicone (VPES; EXA'lence) with a polyether (PE; Impregum Soft) control. Impression discs (25.07 mm) were made using a metal die and ring. Deionized ultra-filtered water was placed on each disc and contact-angle measurements were made at 0, 15, 30, 45 and 60 s using a video contact angle drop shape analysis machine. The data were analyzed using repeated ANOVA and a post-hoc test with Bonferroni correction. RESULTS: VPS contact angles reached a mean of 10.1° ± 0.2° at 60 s vs. 40.7° ± 0.1° for VPES. Overall, VPS contact angles were smaller than those for VPES at all measured times. However, heavy and super quick heavy VPS had much higher contact angles at 0 s compared with other VPS consistencies. There was a significant difference in contact angles between VPS and VPES (mean difference 33.9°, p < 0.05) and between VPS and PE (mean difference 32.8°, p < 0.05) but not between VPES and PE (P = 0.196). VPS heavy and super quick heavy were significantly different from other VPS materials (p < 0.05), but not from each other (p = 1.00). CONCLUSIONS: Set VPS is more hydrophilic than VPES. Contact-angle values of VPS indicated super hydrophilicity. VPES was hydrophilic, with measurements similar to the PE control. Thus, VPS impression materials may be excellent in terms of spreading and copying wet surfaces.

Measurement of forces and moments around the maxillary arch for treatment of a simulated lingual incisor and high canine malocclusion using straight and mushroom archwires in fixed lingual appliances.

INTRODUCTION: An Orthodontic SIMulator (OSIM) was used to investigate the propagation of forces and moments around a simulated archform for a gingival displaced canine and lingual displaced lateral incisor using fixed lingual orthodontic appliances. METHODS: In-Ovation L self-ligating lingual brackets were bonded to anatomically shaped teeth on the OSIM, and the teeth were positioned such that a G4 NiTi 0.016" large maxillary mushroom archwire could be ligated in passive position. Each trial consisted of two movements: a 3mm lingual displacement of the 1-2 lateral incisor at 0.2 mm increments, and a 1.5 mm gingival displacement of the 2-3 canine at 0.15 mm increments (n = 50). Anterior brackets were repositioned to accommodate G4 NiTi 0.016" universal straight archwires (n = 50). Tests were completed at 37°C, and force and moment data in all directions was collected for each tooth around the arch at all increments. RESULTS: In general, the straight archwire produced significantly larger forces and moments at the centre of resistance for teeth of interest than did mushroom archwires. Specifically, the straight archwire produced 2.62 N and 3.81 N more force in the direction of tooth movement on the tooth being moved for a gingival displaced canine and lingual displaced lateral incisor, respectively, as compared to mushroom archwires. CONCLUSIONS: Results from this study suggest that mushroom archwires may provide better mechanics for movement of teeth in the anterior segment when using a round archwire; however, only biomechanical data was considered in this study and there are many factors that need to be considered in treatment planning.

The effect of buccal-lingual slot dimension size on third-order torque response.

Introduction: The focus of the presented study was to investigate the effect of buccal-lingual (B-L) orthodontic bracket slot dimension on third-order torque mechanics. Materials and methods: Three types of orthodontic brackets and two archwire sizes were considered. Ortho Classic H4 (0.026″ B-L slot, passive), Ormco Damon Q (0.028″ B-L slot, passive), and In-Ovation R (0.028″ slot, active) brackets were tested using 0.017″ × 0.025″ and 0.019″ × 0.025″ beta-titanium archwires. An in vitro orthodontic torque simulator (OTS) was used to rotate archwires relative to a single bracket while recording forces and moments in three directions. For each bracket-archwire combination, a total of n = 47 samples were tested. Repeated measures analysis of variance between brackets was conducted for third-order torque values at 3° increments between 9° and 30° during loading and unloading for each archwire size. Results: Statistically significant differences between H4 and Q brackets were only found for 0.017″ × 0.025″ archwires during loading, and 0.019″ × 0.025″ archwires during unloading. Conversely, differences between H4 and R brackets were found for both archwires during loading and unloading phases. Finally, when using a 0.017″ × 0.025″ archwire the H4 brackets reached the 5 Nmm threshold before R and Q brackets; however, there was little difference found when using a 0.019″ × 0.025″ archwire. Conclusions: The concept of using a smaller B-L bracket slot dimension in orthodontic treatment showed it may theoretically allow for more options, primarily using smaller archwires to correct third-order rotational misalignments. However, it is suspected that bracket material limitations and added loading on the door currently prevent this from being clinically applicable.

WORK PATTERN DIFFERENCES BETWEEN MALE AND FEMALE ORTHODONTISTS IN CANADA.

OBJECTIVE: To examine sex-specific differences in the demographics and work patterns of Canadian orthodontists. METHODS: Questionnaires were mailed and emailed to a random sample of 384 orthodontists: 289 men and 95 women. Questions regarding work patterns and personal demographics were created and results were compared by sex. RESULTS: The response rate was 53.9%. The demographics and work patterns for male and female orthodontists were similar for most variables. Women were found to be 6 years younger; have 6 fewer years of work experience; expect to retire earlier; be more often married to a professional in full-time employment; and be more likely to take a leave of absence during their career than their male colleagues. Age significantly affected the number of hours worked per week and number of phase II starts per year; both variables increased with increasing age until approximately 50 years, after which they decreased with age. Having children did not significantly affect any of the analyzed variables. CONCLUSIONS: As the practice of female orthodontists was not found to be substantially different from that of men, it is not possible to speculate whether the increasing number of women specializing in orthodontics will provoke a significant change in the profession. As this is the first survey of its kind in Canada, these results may be used as a reference for future comparisons to determine work patterns and trends in the orthodontic workforce.

Accuracy and reliability of orthodontists using cone-beam computerized tomography for assessment of adenoid hypertrophy.

INTRODUCTION: Our objectives were to evaluate the reliability of agreement between orthodontists, with various degrees of cone-beam computed tomography (CBCT) imaging manipulation comfort, in classifying adenoid hypertrophy through CBCT generated images and also to determine how accurate orthodontists are compared with the gold standard diagnosis, nasopharyngoscopy. METHODS: This was a cross-sectional study in which a randomized list of board-certified orthodontists evaluated different degrees of adenoid hypertrophy of a stratified sampling of 10 scans. The available pool of CBCT images was from a multidisciplinary airway clinic in which children and adolescents had a CBCT scan and a nasopharyngoscopy (reference standard) by an otolaryngologist (head and neck surgeon) on the same day. The participating orthodontists used the same viewer software and computer, and had access to a previously published visual guideline for evaluating adenoid size. RESULTS: Fourteen orthodontists evaluated 10 CBCT reconstructions. Interoperator reliability was excellent (intraclass correlation coefficient [ICC], 0.941; 95% confidence interval, 0.882-0.984). However, the orthodontists' evaluations against the reference standard demonstrated poor accuracy, (ICC mean, 0.39; ICC range, 0.0-0.74). Dichotomous data representing healthy and unhealthy patients were analyzed individually, and the orthodontists' evaluations and the nasopharyngoscopy results (accuracy) showed, on average, poor kappa values (mean, 0.44; range, 0.20-0.80). CONCLUSIONS: Different levels of CBCT expertise impacted the assessment accuracy. The participating orthodontists showed excellent consistency among themselves; however, poor agreement between their CBCT assessments compared with nasopharyngoscopy demonstrated that this sample of clinical orthodontists had poor diagnostic accuracy. Together, these findings suggest that orthodontists may make consistent and systematic errors in this type of evaluations.

Agreement among orthodontists experienced with cone-beam computed tomography on the need for follow-up and the clinical impact of craniofacial findings from multiplanar and 3-dimensional reconstructed views.

INTRODUCTION: In this study, we aimed to assess interrater and intrarater agreement among orthodontic clinicians in their assessments of reported incidental findings in regard to both the need for additional follow-up and the impact on future orthodontic treatment in large-field maxillofacial cone-beam computed tomography (CBCT) imaging. METHODS: The study sample consisted of 18 nonrandomly selected large-field maxillofacial CBCT volumes containing a reported total of 88 radiographic findings. All scans were associated with formal radiologic reports. However, the suggestions of further follow-up were removed from the radiologic reports so as to not bias the 3 evaluating orthodontists in their subsequent decision making. The evaluators had on average 7.6 years of CBCT usage and self-interpretation experience. Reliability was determined by quantifying the level of agreement between the evaluators' assessments for both research questions for all 88 findings using a binary response (yes/no) as the outcome measure. The Cohen kappa statistic was calculated to quantify intrarater and interrater agreement globally for both statements. RESULTS: Although interrater agreement was considerable, potential decisions with clinical impact were not consistent. This needs to be considered when interpreting maxillofacial incidental findings. Evaluators demonstrated higher levels of agreement for dentoalveolar findings compared with all other extragnathic regions when assessing clinical significance. CONCLUSIONS: Among the evaluators who were considered experienced in CBCT, "fair-to-good" interrater agreement and "excellent" intrarater agreement were demonstrated in terms of the need for further follow-up and their potential impact on future orthodontic treatment.

Comparison of third-order torque simulation with and without a periodontal ligament simulant.

INTRODUCTION: This in-vitro study presents the development and validation of an artificial tooth-periodontal ligament-bone complex (ATPBC) and comparison of its behavior with that of rigid dowels during third-order torque simulation. METHODS: ATPBCs were coupled using a 1:1 mixture of room-temperature vulcanization silicone and gasket sealant to act as a periodontal ligament simulant (PDLS). PDLS thicknesses ranging from 0.2 to 0.7 mm, in increments of 0.1 mm (n = 5 for each thickness), were tested using a linear crown displacement procedure. A suitable PDLS thickness was selected for use in third-order torque simulations to compare ATPBC (n = 29) and rigid (n = 24) dowel behavior. Their results were compared for archwire rotations up to 20° for both loading and unloading curves with repeated-measures analysis of variance. RESULTS: When used in third-order torque simulations, the ATPBC dowels with a 0.5-mm PDLS thickness showed a statistically significant difference from rigid dowels (P = 0.020), with a 95% confidence interval (0.254, 2.897 N·mm) and a mean difference of 1.575 N·mm. CONCLUSIONS: Inclusion of a PDLS in an ATPBC resulted in a statistical difference when compared with rigid dowels; however, the region where behavior differed was at low angles of archwire rotation, and the resultant torque was arguably outside a clinically relevant range.

Analysis of anterior dentoalveolar and perioral aesthetic characteristics and their impact on the decision to undergo a Phase II orthodontic treatment.

OBJECTIVES: Researchers have conducted extensive studies regarding dentoalveolar factors that affect anterior dental aesthetics; however, there is no consensus regarding how these factors affect orthodontic treatment decisions. Only a few studies have included multiple factors simultaneously. Therefore, the objective was to investigate if there are identifiable dentofacial and perioral aesthetic factors that bias laypeople towards discontinuing treatment after a phase I treatment with this fixed class II corrector. METHODS: An analysis of photos and dental casts of 60 children (23 males, 37 females) having received phase I orthodontic treatment with the Xbow appliance was conducted. Variables considered were incisor height and width measurements, incisor proportions, incisor angulations, vertical lip thickness, gingival/incisal display, smile width per cent, diastema, midline deviation, smile arc, gender, and use of a 2×4. A principal component analysis and a logistic regression were used to determine which factors related to a patient's likelihood of receiving further orthodontic treatment. RESULTS: Only the angulation of the right maxillary incisors was significantly related to a patient's likelihood (odds ratio 1.886 (1.004-3.466); P = 0.049) to proceed to phase II orthodontic treatment following phase I orthodontic treatment with the Xbow appliance. The odds of proceeding to phase II treatment were 86.6% greater with a one standard deviation increase in the angulation of the right central and lateral incisors. Other factors demonstrated trends but were not statistically significant. LIMITATIONS: Sample in subgroups was small, excluded smiles that did not expose the upper incisor crowns significantly, smiles in real life are observed three-dimensionally, other factors outside the aesthetic measurements were not considered in the analysis. CONCLUSIONS: In this sample, the angulation of the maxillary right incisors was the most significant factor influencing the decision to undergo an orthodontic phase II.

Comparison of deformation and torque expression of the orthos and orthos Ti bracket systems.

Orthodontic torque expression is the result of axial rotation of rectangular archwires within a rectangular bracket slot. This study investigates the effect of bracket material on torque expression. Torque exerted by a rotating archwire on each bracket will be measured as well as the relative deformation of each bracket slot. A total of 60 tests were performed where archwires were rotated within a bracket slot to produce torque within a bracket. Thirty Ormco Orthos Ti and 30 Orthos SS were compared to investigate the effect of torque on bracket material. Each bracket was mounted on a six-axis load cell that measured forces and moments in all directions. The archwire was rotated from an initial angle of 0 degree in 3 degrees increments to maximum angle of 51 degrees and then returned to the initial position. An overhead camera took images at each 3 degrees increment. The bracket images were post-processed using a digital image correlation technique to measure the relative deformation of each bracket slot. The maximum torque expressed at 51 degrees was 99.8 Nmm and 93.0 Nmm for Orthos Ti and Orthos SS, respectively. Total plastic deformation measured at 0 degrees post-torquing of the Orthos SS was 0.038 mm compared to 0.013 mm for Orthos Ti. The Orthos Ti brackets plastically deformed less than the Orthos SS brackets after torquing. The Orthos SS bracket plastic deformation was 2.8 times greater than that of Orthos Ti brackets. The Orthos Ti brackets expressed more torque than the stainless steel brackets but exhibited substantial variation.

Investigation into the effects of stainless steel ligature ties on the mechanical characteristics of conventional and self-ligated brackets subjected to torque.

OBJECTIVE: Torque is applied to orthodontic brackets in order to alter the buccal-lingual angulation of a tooth. One factor that can affect torque is the ligation mode used to retain the archwire in the bracket slot. The objective of this study was to investigate the effects of stainless steel ligation on torque expression and bracket deformation. METHODS: This study utilized 60 upper right central incisor Damon Q brackets and 60 Ormco Orthos Twin brackets. The brackets used in this study were subdivided into four groups: (1) Damon Q ligated with SS ligature; (2) Damon Q with the sliding bracket door; (3) Orthos Twin bracket ligated with SS wire; and (4) Orthos Twin ligated with elastic ties. All brackets were tested using an orthodontic torque simulating device that applied archwire rotation from 0° to 45°. RESULTS: All brackets ligated with stainless steel ties exhibited greater torque expression and less deformation than brackets without stainless steel ties. As well, Damon Q brackets exhibit less bracket deformation than Orthos Twin brackets. CONCLUSIONS: Stainless steel ties can reduce the amount of plastic deformation for both types of brackets used in this study.

An evaluation of root resorption associated with the use of photobiomodulation during orthodontic treatment with clear aligners: a retrospective cohort pilot study.

OBJECTIVES: To evaluate the change in tooth root volume using cone-beam computed tomography (CBCT) in a group of patients treated concurrently with clear aligners and an adjunctive photobiomodulation (PBM) device. MATERIALS AND METHODS: This retrospective cohort pilot study included the records of 32 consecutively treated clear aligner patients (23 female, 9 male) from the private practice of one orthodontist. The PBM group (n = 16) used the device once per day for 5 minutes per arch and was compared with a matched control group (n = 16). A semiautomated segmentation technique was used to obtain tooth volume of anterior teeth from CBCT imaging prior to (T0) and during or immediately following (T1) orthodontic treatment with clear aligners. The change in root volume between time points was assessed. RESULTS: There was no statistically significant difference between the pre- and posttreatment root volumes of maxillary and mandibular anterior teeth, regardless of which intervention group the patient belonged to (P > .05). There was also no difference in the mean percentage change in root volume between clear aligner patients in this study who were treated with the PBM device compared with a matched control group (P > .05). CONCLUSIONS: Clear aligner patients in this study who changed their aligners every 3 to 5 days and used adjunctive photobiomodulation therapy did not experience clinically relevant orthodontically induced external root resorption. Due to the small sample size and measurement error in the root segmentation process, the results should be interpreted with caution.

Craniofacial morphology in pediatric patients with persistent obstructive sleep apnea with or without positive airway pressure therapy: a cross-sectional cephalometric comparison with controls.

INTRODUCTION: Compression on the midface with nasal mask-delivered positive airway pressure (PAP) therapy in growing patients might contribute to midface retrusion. The objective of this study was to investigate the association between long-term PAP use and craniofacial morphologic pattern in children with persistent obstructive sleep apnea. METHODS: Images generated with cone-beam volumetric imaging were used to complete lateral cephalometric analyses of anteroposterior projection of the midface region. The study group included 12 subjects (10 boys, 2 girls; mean age, 9.0 years) who used PAP therapy for at least 6 months and at least 6 hours per night. Measurements from this group were compared with those of a control group of 11 subjects (5 boys, 6 girls; mean age, 9.6 years) with obstructive sleep apnea who did not have PAP. Measurements were taken at 1 time point. RESULTS: No significant differences were identified between the groups for any cephalometric variable. Multivariate linear regression analysis also did not identify a significant association between the number of months of PAP therapy and the cephalometric variables. Cephalometric data for both groups were pooled for comparison with appropriate published normative values for age and sex. Anterior cranial base length, overall anteroposterior length of the maxillary base, and mandibular body length were significantly shorter than normal in the subjects compared with published normative values. CONCLUSIONS: No association was demonstrated between midface projection and PAP use in growing patients. When compared with normative data for anterior cranial base, children with obstructive sleep apnea had shorter maxillary and mandibular lengths.

An investigation into the mechanical characteristics of select self-ligated brackets at a series of clinically relevant maximum torquing angles: loading and unloading curves and bracket deformation.

Edgewise orthodontic treatment utilizes a force couple in order to achieve labial-lingual tooth angulation. Two self-ligating brackets (Damon Q and Speed) were examined across a range of clinically relevant torques in order to assess the loading and unloading curves and bracket deformation. A previously developed torquing and load measurement system was utilized to rotate a 0.199 × 0.25 in stainless steel wire in a fixed bracket slot to the following angles: 16, 20, 24, 28, 32, and 40 degrees. The torque on the bracket was measured during both wire loading and unloading cycles. The torque play for the Damon brackets was determined to increase by less than 0.4 degrees when torqued to 70 Nmm, whereas the increase for the Speed brackets was 2.1 degrees at the same torque magnitude. The deformation curves for the Damon and Speed brackets were found to be different for loading and unloading. Speed brackets were found to start to plastically deform when torqued to 24 degrees (26 Nmm of torque), while Damon brackets did not plastically deform until 28 degrees (38 Nmm of torque). Damon brackets were found not to plastically deform as easily and to have a smaller increase in torque play than Speed brackets. Both the Damon and the Speed brackets demonstrated minimal effect of plastic deformation and torque play at maximum angles of twist less than 20 degrees. Torque measured in the brackets was different for loading and unloading.

Characterization of craniofacial-based clinical phenotypes in children with suspected obstructive sleep apnea.

STUDY OBJECTIVES: We conducted this study to identify phenotypes of obstructive sleep apnea (OSA) in children based on lifestyle, sleep habits, age, obesity, sex, soft tissue facial features, and specific craniofacial abnormalities. METHODS: Seventy-three children with symptoms of pediatric OSA who underwent overnight observed polysomnography participated in this study. Soft tissue facial features were assessed using a 3-dimensional stereophotogrammetric system. Craniofacial abnormalities were evaluated based on the most common facial features associated with orthodontic treatment needs. Data regarding lifestyle, sleep habits, age, obesity, and sex were also collected. To identify phenotypes of OSA, a sequential analysis was then performed on categories of variables using fuzzy clustering with medoids. RESULTS: Craniofacial abnormalities and soft tissue facial features defined clusters. Three clusters were identified. Cluster 1 comprised a group of younger children (5.9 ± 3.8 years) without obesity, without craniofacial abnormalities, and with smaller soft tissue facial features dimensions. Cluster 2 comprised a group of older children (9.6 ± 3.9 years) without obesity and with larger mandibular dimensions and mildly arched palates (71.4%). Cluster 3 comprised a group of older children (9.2 ± 3.9 years) with obesity and a history of health issues (68.4%), excessive lower facial height (63.2%), and midface deficiency (73.7%). No differences were observed across clusters regarding sleep features. A moderate severity of obstructive and mixed respiratory events was observed in all 3 clusters. CONCLUSIONS: The study results did not identify distinct phenotypes of pediatric OSA based on soft tissue facial features or craniofacial abnormalities alone. Age and body mass index likely modify the effect of soft tissue facial features and craniofacial abnormalities as risk factors for OSA in children. CITATION: Fernandes Fagundes NC, Loliencar P, MacLean JE, Flores-Mir C, Heo G. Characterization of craniofacial-based clinical phenotypes in children with suspected obstructive sleep apnea. J Clin Sleep Med. 2023;19(11):1857-1865.

Investigating the role of aligner material and tooth position on orthodontic aligner biomechanics.

The primary objective of this work was to investigate the effect of material selection and tooth position on orthodontic aligner biomechanics. Additionally, material property changes with thermoforming were studied to elucidate its role in material performance in-vitro. An orthodontic simulator (OSIM) was used to evaluate forces and moments at 0.20 mm of lingual displacement for central incisor, canine and second premolar using Polyethylene terephthalate (PET), Polyurethane (PU) and Glycol-modified polyethylene terephthalate (PET-G) materials. The OSIM was scanned to generate a model used to fabricate aligners using manufacturer-specified thermoforming procedures. Repeated measures of MANOVA was used to analyze the effect of teeth and material on forces/moments. The role of thermoforming was evaluated by flexural modulus estimated by 3-point bend tests. Pre-thermoformed and post-thermoformed samples were prepared using as-received sheets and those thermoformed over a simplified arch using rectangular geometry, respectively. Groups were compared using Two-way ANOVA. The PET, PU, and PET-G materials exerted maximum buccal force and corresponding moments on the canine. PU exerted more buccal force than PET-G on the canine and second premolar, and more than PET on the second premolar. The impact of thermoforming varied according to the specific polymer: PET-G remained stable, there was a slight change for PET, and a significant increase was noted for PU from pre-thermoformed to post-thermoforming. The results of this study elucidate the influence of material and arch position on the exerted forces and moments. Further, the mechanical properties of thermoplastic materials should be evaluated after thermoforming to characterize their properties for clinical application.

Deformation and warping of the bracket slot in select self-ligating orthodontic brackets due to an applied third order torque.

OBJECTIVE: To measure the plastic deformation of three different self-ligated brackets as a result of third order torque by analysing slot dimensions and determine its impact on torque play. METHODS: Three different self-ligating orthodontic brackets (0·022-inch slot) were investigated: Damon Q®, In-Ovation R®, and Speed® (30 per group). A digital SLR camera coupled to a microscope was used to capture images of the slot profile of each bracket before and after torquing. Each bracket was torqued to 63° in the same manner using a 0·019×0·025-inch SS wire. RESULTS: The mean change in slot height as measured at the top of the slot was 0·013 mm (SD 0·020), 0·007 mm (SD 0·010) and 0·070 mm (SD 0·03) for Damon Q®, In-Ovation R® and Speed®, respectively. Slot taper increased 0·75° (SD 0·96), 0·41° (SD 1·05) and 9·30° (SD 4·24), respectively. Increase in torque play was calculated to be 0·9, 0·6 and 7·7° respectively, as calculated using the novel formula presented in this study. CONCLUSIONS: Damon Q® and In-Ovation R® maintain high levels of linearity in the shape of the slot walls and experience small, but significant amounts of plastic deformation that are physically insignificant. Speed® demonstrates the most plastic deformation with visually identifiable warping in the bracket slot.