Characterizing orthodontic tooth movement in real time using dental monitoring scans: A pilot study.

OBJECTIVES: This pilot study aimed to quantify the magnitude and type of tooth movement occurring in short time intervals within the regular monthly orthodontic visits for patients with fixed appliances and undergoing maxillary canine retraction. Additionally, this pilot study aimed to provide a descriptive evaluation for the accuracy and reliability of the Dental Monitoring (DM)-captured scans to those of an iTero digital scans in an extraction space closure model. SETTINGS AND SAMPLE POPULATION: 3D intraoral photographic scans (DM) for 12 patients with maxillary first premolar extractions in a single-centre academic institution. MATERIALS AND METHODS: Twelve patients treated with fixed appliances and undergoing space closure for maxillary premolar extraction(s) were included. Nickel-titanium (200 g) closing coil springs were used for canine retraction. At initiation of space closure (T1), iTero scans were acquired, and patients were instructed to take DM scans every 4-5 days until their next visit in 4-5 weeks (T2). At T2, a final iTero scan in addition to a DM scan was taken. The number of patients who did the scans regularly as instructed declined as time elapsed. Stereolithography (STL) files generated from the DM scans were superimposed with the STL files from the iTero scans using GOM Inspect software to determine the accuracy of the DM 3D models. To assess rate, type and direction of tooth movement, each of the 3D image STL files generated from the DM scans, taken every 4-5 days by each patient, was superimposed on the previously captured scan. The rate of tooth movement for the maxillary molars and canines was calculated in the 3 planes of space (X, Y, Z) at each time point, until the end of the experiment. RESULTS: Preliminary results indicated that the maxillary canines appeared to be displaced the greatest amount in the first 4-5 days with initial distolateral movement. As time elapsed, the rate of tooth movement decreased, and the tooth started moving distolingually. CONCLUSIONS: Dental monitoring software provides a high-tech platform to monitor tooth movement in a 'real-time' approach. Accuracy of the photographic scans in relationship to the intraoral scans appears promising. There seems to be some evidence that the greatest amount of movement occurs initially in the first few days after activation, dropping thereafter to become a slower constant rate of tooth movement.

Assessment of the occlusal outcomes in patients treated with orthognathic surgery and clear aligners.

OBJECTIVE: This retrospective two-centre study aimed to evaluate the occlusal outcomes in patients undergoing orthognathic surgery with clear aligners. METHODS: A retrospective chart review and occlusal outcomes for 15 patients (10 females and five males) with different types of dentofacial deformities in the anteroposterior, vertical and transverse dimensions, who underwent orthognathic surgery in conjunction with clear aligners were evaluated. Weighed Peer Assessment Rating (PAR) index scores of the pre-treatment and post-treatment digital models were used to assess initial complexity, final occlusal outcomes and degree of improvement with surgery and clear aligners. RESULTS: The mean post-treatment PAR score was 3.5 ± 2.54, which was a statistically significant improvement from the pre-treatment PAR score of 27.63 ± 12.09, an 87% improvement was achieved. All subcategories of the PAR index showed statistically significant improvement except for midline assessment component. CONCLUSIONS: Occlusal outcomes with aligners showed great improvement as indicated with the PAR index scores. Orthognathic surgical cases can be treated efficiently with aligners and future studies should compare occlusal outcomes between orthognathic surgical patients treated with clear aligners and those treated with fixed appliances.

The dark side of fixed retainers: Case series.

This article focuses on on the presentation and management 9 adult patients who experienced complications because of their maxillary or mandibular fixed retainers 5-33 years after orthodontic treatment. Such complications include the development of an anterior crossbite, open bite, incisal cant, and twist- and x-effects. The detrimental effects on periodontal health were highlighted, especially in the mandibular canines. A range of fixed retainer types was identified, including flexible spiral wire bonded to 4 maxillary or 6 mandibular anterior teeth, rigid wire bonded to mandibular canines only and fiber-reinforced composite fixed retainer. Orthodontic retreatment was necessary in all patients using fixed appliances or clear aligners. Radiographic findings from cone-beam computed tomography or orthopantomogram before and after retreatment are presented when available. Despite the improvement of teeth position clinically, the cone-beam computed tomography scans taken directly after the completion of orthodontic retreatment did not show notable improvement with regards to root proximity to the cortical plates. The prevention of further complications was highlighted, including the use of dual retention, remote monitoring, frequent follow-up appointments and the importance of developing clear guidelines for monitoring patients in retention for treating clinicians and general dentists to promote early detection of adverse changes.

Insight on the influence of technology-enhanced learning in orthodontics' education: A systematic review.

OBJECTIVES: Technology-enhanced learning (TEL) provides a pliable and current way to present orthodontic curriculum material to students. This review aimed to assess the effectiveness of TEL compared with traditional learning methods in the field of orthodontics. MATERIALS AND METHODS: The search comprised randomised controlled trials (RCTs) related to orthodontics' interactive learning from the following databases: PubMed, Scopus, CENTRAL, Psyclnfo, ERIC, Web of Science, Dissertations and Theses Global. Two authors performed the screening, data extraction and assessed risk of bias using the Cochrane tool (Rob 2) blindly and in duplicate. Kirkpatrick's 4-level evaluation model was used to evaluate educational outcomes. RESULTS: A total of 3131 records were identified of which 11 RCT were included. On level 1 (Reaction), students had a positive attitude towards TEL. On level 2 (Learning), included studies did not report any significant knowledge improvement when TEL was compared with traditional learning strategies. One study assessed level 3 (Behaviour), where students felt that flipped classroom learning created feelings of greater confidence. On level 4 (Results), most studies suggested that TEL tools are as equally effective in imparting information as traditional tools and recommended that both methods should be considered in teaching students. CONCLUSION: Technology-enhanced learning techniques might have the potential to enhance educational outcomes in orthodontic education and students seem to enjoy the implementation of technology in the learning process. These educational tools should be used as an adjunct to the traditional didactic classroom, and not as a replacement, due to the challenges encountered with their application.

Comparable Skeletal and Dental Movements Achieved Using Conventional and Surgery-First Techniques in Class III Patients.

PURPOSE: The surgery-first (SF) approach to orthognathic surgery has been proposed as a more efficient method to correct the dentofacial deformity. This study aimed to evaluate if the magnitude of skeletal and dental changes achieved in Class III patients treated with either conventional orthognathic surgery (COS) or SF techniques differ. METHODS: A retrospective cohort study of Class III orthognathic surgery patients between January 2006 and May 2020 with available pre- and post-treatment lateral cephalograms was conducted at an academic institution. The primary predictor variable was surgery technique: COS or SF. Assessed outcome variables included cephalometric skeletal parameters: SNA, SNB, ANB, Wits Appraisal, Sn-GoGn, and FMA; and dental parameters: U1-SN, U1-NA (°), U1-NA (mm), L1-NB (°), L1-NB (mm), and overjet. Within-group posttreatment parameters were analyzed with paired t tests. Pretreatment, posttreatment, and between-group parameter changes were analyzed by 2-sided 2-sample independent t tests. Potential covariates, including gender, surgical procedure, previous conventional treatment, extractions (excluding 3rd molars), crowding, and midline discrepancy, were analyzed using Fisher exact tests. RESULTS: Thirty-nine subjects were included in this study: 1) 21 COS (age: 20.9 ± 8.7 years) and 2) 18 SF (age: 19.6 ± 5.0 years). Cohorts were comparable (P > .05) for all analyzed covariates. COS showed statistically significant increases in L1-GoGn (3.31 ± 6.23°; P = .024), overjet (4.26 ± 3.99 mm; P < .001), ANB (3.5 ± 2.79°; P < .001), SNA (3.5 ± 1.85°; P < .001), and Wits Appraisal (3.78 ± 4.97 mm; P = .002). SF showed statistically significant increases in L1-GoGn (4.19 ± 4.85°; P = .002), L1-NB (3.08 ± 4.13°; P = .006), L1-NB (0.79 ± 1.35 mm; P = .023), overjet (5.82 ± 2.96 mm; P < .001), ANB (5.51 ± 3°; P < .001), SNA (4.13 ± 2.38°; P < .001), and Wits Appraisal (5.92 ± 3.42 mm; P < .001) and statistically significant decreases in U1-NA (-3.69 ± 7.35°; P = .048) and SNB (-1.38 ± 2.14°; P = .014). There were no statistically significant differences in skeletal or dental parameters between groups when adjusted for pretreatment levels of that parameter. The mean treatment duration was 38 months (standard deviation = 12.7) in COS and 17.6 months (standard deviation = 5.2) in SF. CONCLUSIONS: The results show that skeletal and dental changes between groups were not statistically different, despite an average 20-month difference in treatment duration. This suggests that either technique can be used to achieve comparable degrees of skeletal and dental movement in Class III patients.

Association between initial complexity, frequency of refinements, treatment duration, and outcome in Invisalign orthodontic treatment.

INTRODUCTION: This study explored possible associations between treatment duration, initial complexity, outcomes in Invisalign therapy, and the number of refinements. METHODS: Three-dimensional models (initial, final, and refinements) of 355 Invisalign patients (114 males and 241 females; 33.8 ± 17.1 years) were analyzed using the Peer Assessment Rating (PAR) index questionnaire tool in the Ortho Analyzer software (version 2.0; 3Shape, Copenhagen, Denmark) to calculate the weighted total and individual PAR index scores for each component of the PAR index. Data related to demographics, treatment duration, and the number of refinements were collected. RESULTS: Treatment duration increased as the number of refinements increased. Percent of improvement was higher in PAR ≥22 group than PAR <22 with an increase in the number of refinements: 83.3% vs 73.8% for 2 refinements; 94.7% vs 91.2% for 3 refinements; and 100% vs 85.7% for ≥4 refinements. Those who achieved great improvement or improvement and those who did not were significantly different in treatment duration (P <0.001 and P = 0.027), number of refinements (≥3 refinements; P <0.001), initial occlusal severity (PAR ≥22; P <0.01 and P = 0.031). Most subjects achieved improvement after the first refinement (64.5% for PAR <22 and 78.5% for PAR ≥22). Few had ≥4 refinements, and if they did, none achieved improvement with additional refinements. CONCLUSIONS: Initial complexity for an Invisalign case is associated with treatment duration, achieved outcomes, and the number of refinements. Treatment duration increased with an increased number of refinements. Great improvement or improvement for the first time dropped to 0 if additional refinements were carried out after 3. Therefore, performing additional refinements does not necessarily mean better occlusal outcomes.

The biological sex lens on early orthopaedic treatment duration and outcomes in Class III orthodontic patients: a systematic review.

BACKGROUND: Treatment outcomes for Class III orthopaedic treatment are highly unpredictable and dependent on the timing of interception, age, and biological sex. OBJECTIVE: This systematic review aimed to assess the effects of sex dimorphism on outcomes and duration of orthopaedic treatment for Class III malocclusion in young children. SEARCH METHODS: Unrestricted search in six electronic databases until May 2021 was conducted. Supplemented by search in resources for published, unpublished literature, and ongoing trials. SELECTION CRITERIA: Randomized and non-randomized controlled trials reporting the use of Class III growth modification appliances, with baseline and outcome data for both sexes, were included. DATA COLLECTION AND ANALYSIS: Study selection and data extraction were performed blindly and in duplicate by two reviewers. ROBINS-I, Cochrane Risk of Bias, and GRADE tools were used for certainty assessment. RESULTS: A total of 2429 records were screened. Four trials fulfilled the inclusion criteria, one was a randomized clinical trial (RCT) comparing facemask and facemask with mini-screw. Two clinical trials evaluated the effects of facemask appliance, one had a control group, another was prospective non-controlled. One compared the effects of the maxillary protraction bow appliance to a no treatment control. Two of the clinical trials were appraised as low and one was appraised as high risk of bias. The overall certainty of the available evidence was assessed as moderate. There was significant clinical heterogeneity in terms of methodology, type of intervention, and the measured outcomes, precluding a meta-analysis. CONCLUSIONS: Minimal variations in sagittal, vertical, and dentoalveolar post-treatment cephalometric changes were reported between sexes. The available evidence is unclear to support these variations. Long-term-powered RCTs assessing cephalometric outcomes between sexes until the end of growth spurt and without pooling are not available, therefore, much needed. REGISTRATION: PROSPERO database number CRD42020185797.

Orthodontic and surgical management of a patient with severe mandibular deficiency and asymmetry with condylar hypoplasia using 3-dimensional surgical planning in combination with a modified surgery-first approach.

Progressive improvements in digital technology and surgical techniques have synergized the speed, predictability, and favorable outcomes for patients undergoing surgical-orthodontic treatment with handicapping dentofacial deformities. This case report will demonstrate the management of a patient with severe mandibular hypoplasia, condylar hypoplasia, and mandibular asymmetry. The dentofacial deformity, and consequently, the unaesthetic facial appearance, led to psychosocial stress, symptoms of excessive daytime sleepiness, and functional limitations, especially related to mandibular movements. A modified surgery-first approach was used, which was successfully performed using computer-assisted surgical planning. Postsurgical orthodontics was accomplished with the aid of temporary skeletal anchorage mini-plates. An additional alloplastic enhancement of the chin addressed the severe microgenia, which the osseous advancement could not achieve. This resulted in a total advancement of the pogonion by 26 mm yielding a remarkable improvement in the patient's facial esthetics. Furthermore, a considerable improvement in mandibular function and reduction in daytime sleepiness occurred. The severe malocclusion with a discrepancy index value of 47 was treated to a successful final occlusion in 21 months of treatment time.

Influence of type of radiograph and levels of experience and training on reproducibility of the cervical vertebral maturation method.

INTRODUCTION: The objective of this study was to assess the reproducibility of cervical vertebral maturation (CVM) method based on the type of radiographic image and the level of experience and level of training of the evaluator. METHODS: Ten evaluators (5 orthodontic residents and 5 faculty members) were randomly divided into 2 groups: trained and untrained. All participants evaluated 80 radiographic images previously acquired in 4 different formats: (1) 2-dimensional (2D) digital (2D-digital), (2) 2D digitized hard copy from the Iowa Facial Growth Study (American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection), (3) 2D digital reconstructed from a 3-dimensional (3D) radiograph (2D-from 3D), and (4) 3D cone-beam computerized tomographic (3D-CBCT) images. Agreement among evaluators on the morphology of the cervical vertebrae (CV) and the CVM stage of each radiographic image was assessed using Randolph's kappa statistic and Kendall's W coefficient of concordance. RESULTS: Interobserver agreement on the determination of a curvature on the inferior border of the CV was substantial to perfect, whereas agreement on shape was fair to moderate. Overall, the level training in all image types, except 3D-CBCTs, but not the level of experience affected the agreement for shape and curvature of the CVs. Interobserver agreement on CVM staging for all combined images was substantial at 0.72. Faculty had a higher level of agreement than residents except for 2D-digital and 3D-CBCT images, whereas trained evaluators had an overall higher level of agreement than untrained evaluators except for 3D-CBCT images. CONCLUSIONS: Interobserver agreement in determining CVM stage was substantial for all images evaluated; experience and training resulted in higher level of agreement for some image types. The 3D-CBCT images did not provide increased interobserver agreement over current 2D-digital lateral cephalograms in determining CVM staging or shape of the CV. The highest agreement in CVM staging was obtained on 2D-digital lateral cephalograms with training.

Biomarkers of orthodontic tooth movement with fixed appliances and vibration appliance therapy: a pilot study.

INTRODUCTION: The aim of this study was to investigate the effect of supplemental vibratory force on biomarkers of bone remodelling during orthodontic tooth movement, the rate of mandibular anterior alignment (RMAA), and compliance with a vibration device. DESIGN, SETTINGS, AND PARTICIPANTS: Forty patients between the ages 15-35 undergoing fixed appliance treatment that presented to a university orthodontic clinic were randomly allocated to supplemental use of an intraoral vibrational device (n = 20, AcceleDent®) or fixed appliance only (n = 20). Salivary multiplex assay was completed to analyse the concentration of selected biomarkers of bone remodelling before treatment (T0) and at three following time points (T1, T2, T3), 4-6 weeks apart. Irregularity of the mandibular anterior teeth and compliance was assessed at the same trial time points. Data were analysed blindly on an intention-to-treat basis with descriptive statistics, Mann-Whitney U-test, Wilcoxon signed-rank test, and linear mixed effects regression modelling. RESULTS: No difference in the changes in salivary biomarkers of bone remodelling and RMAA between groups at any time point over the trial duration was observed. No correlation was found between changes in irregularity and biomarker level from baseline to another time point. Lastly, there was no association between RMAA and compliance with the AcceleDent® device. CONCLUSIONS: Supplemental vibratory force during orthodontic treatment with fixed appliances does not affect biomarkers of bone remodelling or the RMAA. LIMITATIONS: The main limitation of the study was the small sample size and the large variability in the salivary biomarkers. HARMS: No harms were observed during the duration of the trial. PROTOCOL: The protocol was not published prior to trial commencement. REGISTRATION: The study was registered in Clinical Trials.gov (NCT02119455) first posted on April 2014.

Is Short Root Anomaly (SRA) a risk factor for increased external apical root resorption in orthodontic patients? A retrospective case control study using cone beam computerized tomography.

OBJECTIVES: To evaluate the amount of external apical root resorption (EARR) secondary to orthodontic treatment in patients with Short Root Anomaly (SRA) compared to patients with average root lengths using Cone Beam Computed Tomography (CBCT). SETTINGS AND SAMPLE POPULATION: Cone beam computed tomography scans of 23 SRA and 26 control patients were selected from 232 pretreatment scans from a single private practice. MATERIALS AND METHODS: Cone beam computed tomography scans before (T1) and after orthodontic treatment (T2) were evaluated for differences in the change in tooth and root length of the maxillary incisors between both groups. Gender, treatment duration and age were examined as covariates. RESULTS: The mean values for root and tooth length of the maxillary incisors decreased by a range of 0.6 to 1.3 mm after orthodontic treatment. There was no significant difference between the groups for the majority of the measurements although there was a trend for less EARR in the SRA group. The maxillary left central incisor had significantly less proportional and non-proportional loss in tooth length in the SRA group. Age, gender and treatment duration were not associated with change in the proportional and non-proportional lengths for both groups. CONCLUSION: Patients with SRA did not exhibit a significant difference in the proportional and non-proportional change of length after orthodontic treatment when compared to the controls for most measurements. Only tooth length for the maxillary left central incisor had significantly less reduction after orthodontic treatment for both the proportional and non-proportional measurements in the SRA group compared to the control group.

Efficiency of piezotome-corticision assisted orthodontics in alleviating mandibular anterior crowding-a randomized clinical trial.

OBJECTIVES: The aim of this clinical trial was to investigate the duration of mandibular-crowding alleviation with piezotome-corticision orthodontics compared with conventional orthodontics. DESIGN: Single-centre, two-arm parallel group randomized controlled trial. SETTING: Orthodontic clinic at the University of Connecticut. ETHICAL APPROVAL: The study was approved by the Institutional Review Board (IRB # 12-0147-2). SUBJECTS AND METHODS: Forty-one adult subjects from a single centre with more than 5mm of mandibular anterior crowding were randomly allocated using block randomization into experimental and control groups. The experimental group received a corticision procedure with a piezotome on the labial aspect of the mandibular incisors in conjunction to a self-ligation fixed orthodontic appliance. The control group received the self-ligation fixed orthodontic appliance and no corticision. Same archwire sequence (0.014 inch followed by 0.014 × 0.025 inch copper-nickel-titanium) was followed for both groups. Mandibular study casts taken every 4-5 weeks were used to assess changes in the irregularity index by blinded outcome assessors. OUTCOME MEASURES: The time to alignment was calculated in days. RESULTS: Twenty-nine subjects (16 experimental and 13 control) completed the study. Overall, no significant difference in the time required to correct mandibular crowding with piezotome-corticision assisted (102.1 ± 34.7 days; 95% CI, 83.6 to 120.6) and conventional orthodontics (112 ± 46.2 days; 95% CI, 84-139.9) was observed. No complications with treatment or unintended consequences were observed on any of the subjects. LIMITATIONS: A high attrition rate. CONCLUSIONS: This randomized clinical trial found no evidence that piezotome-corticision assisted orthodontics was more efficient in alleviating mandibular anterior crowding. REGISTRATION: ClinicalTrials.gov, Identifier: NCT02026258. FUNDING: Division of Orthodontics, University of Connecticut. CONFLICT OF INTEREST: None.

Management of severely impacted mandibular canines and congenitally missing mandibular premolars with protraction of autotransplanted maxillary premolar.

Transmigrated mandibular canines increase the treatment complexity in terms of both anchorage and biomechanical planning. Additionally, a Class II malocclusion with a deep overbite and associated dental anomalies such as hypodontia can further increase the treatment complexity and the overall treatment time. This case report describes the successful interdisciplinary treatment of a patient, aged 12.5 years, with transmigrated and severely impacted mandibular canines and congenitally missing mandibular second premolars. The transmigrated mandibular right canine was extracted, and a maxillary second premolar was autotransplanted to the missing mandibular right second premolar site with the aid of a stereolithographic donor tooth replica fabricated with 3-dimensional cone-beam computed tomography and a rapid prototyping technique. Furthermore, the autotransplanted tooth was protracted by 4 to 5 mm to close the space caused by the extraction of the mandibular right canine. The impacted mandibular left canine was orthodontically guided into its normal position in the arch. Good esthetic outcome and functional occlusion were achieved.

Increasing orthodontic and orthognathic surgery treatment efficiency with a modified surgery-first approach.

This case report describes the treatment of a 33-year-old white man who had a skeletal Class III and dental Class II subdivision malocclusion caused by a retrognathic maxilla, with severe maxillary crowding, a highly placed maxillary left canine, mild mandibular crowding, and a bilateral posterior crossbite. Treatment was performed with a modified surgery-first approach, which included a short presurgical alignment phase for the correction of the significant maxillary crowding while controlling the incisal angulation, followed by LeFort I maxillary advancement surgery. The short presurgical orthodontic phase aimed at eliminating the anterior dental interferences before the maxillary advancement, and the use of the inherent increased bone turnover in the postsurgical phase helped to reduce the total orthodontic treatment time to 12 months. Pleasing esthetic results and a good functional occlusion were achieved.