Developing a three-dimensional statistical shape model of normal dentition using an automated algorithm and normal samples.

OBJECTIVES: The statistical shape model (SSM) is a model of geometric properties of a set of shapes based on statistical shape analysis. The SSM develops an average model of several objects using an automated algorithm that excludes the operator's subjectivity. The aim of this study was to develop a three-dimensional (3D) SSM of normal dentition to provide virtual templates for efficient treatment. MATERIALS AND METHODS: Dental casts were obtained from participants with normal dentition. After acquiring the 3D models, the SSMs of the individual teeth and whole dental arch were generated by an iterative closest point (ICP)-based rigid registration and point correspondences, respectively. Then, the individual tooth SSM was aligned to the whole dental arch SSM using ICP-based registration to generate an average model of normal dentition. RESULTS: The generated 3D SSM showed specific morphological features of normal dentition similar to those previously reported. Moreover, on measuring the arch dimensions, all values in this study were similar to those previously reported using normal dentition. CONCLUSIONS: The 3D SSM of normal dentition may increase the diagnostic efficiency of orthodontic treatments by providing a visual objective. It can be also used as a 3D template in various fields of dentistry. CLINICAL RELEVANCE: Our SSM of normal dentition provides both quantitative and qualitative information on the 3D morphology of teeth and dental arches, which may provide valuable information on 3D virtual-setup, bracket fabrication, and aligner treatment.

In vitro and in vivo mechanical stability of orthodontic mini-implants.

OBJECTIVE: To compare in vivo and in vitro mechanical stability of orthodontic mini-implants (OMIs) treated with a sandblasted, large-grit, and anodic-oxidation (SLAO) method vs those treated with a sandblasted, large-grit, and acid-etching (SLA) method. MATERIALS AND METHODS: Fifty-four titanium OMIs (cylindrical shape, drill-free type; diameter  =  1.45 mm, length  =  8 mm, Biomaterials Korea Inc, Seoul, Korea) were allocated into control, SLA, and SLAO groups (N  =  12 for in vivo and N  =  6 for in vitro studies per group). In vitro study was carried out on a polyurethane foam bone block (Sawbones, Pacific Research Laboratories Inc, Vashon, Wash). In vivo study was performed in the tibias of Beagles (6 males, age  =  1 year, weight  =  10 to 13 kg; OMIs were removed at 8 weeks after installation). For insertion and removal of OMIs, the speed and maximum torque of the surgical engine were set to 30 rpm and 40 Ncm, respectively. Maximum torque (MT), total energy (TE), and near peak energy (NPE) during the insertion and removal procedures were statistically analyzed. RESULTS: In the in vitro study, although the control group had a higher insertion MT value than the SLA and SLAO groups (P < .01), no differences in insertion TE and NPE or in any of the removal variables were noted among the three groups. In the in vivo study, the control group exhibited higher values for all insertion variables compared with the SLA and SLAO groups (MT, P < .001; TE, P < .01; NPE, P < .001). Although no difference in removal TE and removal NPE was noted among the three groups, the SLAO group presented with a higher removal MT than the SLA and control groups (P < .001). CONCLUSIONS: SLAO treatment may be an effective tool in reducing insertion damage to surrounding tissue and improving the mechanical stability of OMIs.

Effects of cleft type, facemask anchorage method, and alveolar bone graft on maxillary protraction: a three-dimensional finite element analysis.

OBJECTIVE: To investigate biomechanical effects of cleft type (unilateral/bilateral cleft lip and palate), facemask anchorage method (tooth-borne and miniplate anchorage), and alveolar bone graft on maxillary protraction. DESIGN: Three-dimensional finite element analysis with application of orthopedic force (30° downward and forward to the occlusal plane, 500 g per side). MODEL: Computed tomography data from a 13.5-year-old girl with maxillary hypoplasia. INTERVENTION: Eight three-dimensional finite element models were fabricated according to cleft type, facemask anchorage method, and alveolar bone graft. MAIN OUTCOME MEASURE(S): Initial stress distribution and displacement after force application were analyzed. RESULTS: Unilateral cleft lip and palate showed an asymmetric pattern in stress distribution and displacement before alveolar bone graft and demonstrated a symmetric pattern after alveolar bone graft. However, bilateral cleft lip and palate showed symmetric patterns in stress distribution and displacement before and after alveolar bone graft. In both cleft types, the graft extended the stress distribution area laterally beyond the infraorbital foramen. For both unilateral and bilateral cleft lip and palate, a facemask with a tooth-borne anchorage showed a dentoalveolar effect with prominent stress distribution and displacement on the upper canine point. In contrast, a facemask with miniplate anchorage exhibited an orthopedic effect with more favorable stress distribution and displacement on the middle maxilla point. In addition, the facemask with a miniplate anchorage showed a larger stress distribution area and sutural stress values than did the facemask with a tooth-borne anchorage. The pterygopalatine and zygomatico-maxillary sutures showed the largest sutural stress values with a facemask with a miniplate anchorage and after alveolar bone grafting, respectively. CONCLUSION: In this three-dimensional finite element analysis, it would be more advantageous to perform maxillary protraction using a facemask with a miniplate anchorage than a facemask with a tooth-borne anchorage and after alveolar bone graft rather than before alveolar bone graft, regardless of cleft type.

Effects of clodronate on early alveolar bone remodeling and root resorption related to orthodontic forces: a histomorphometric analysis.

INTRODUCTION: The objective of this study was to evaluate the short-term effects of clodronate, a first-generation bisphosphonate, on early alveolar bone remodeling and root resorption related to orthodontic tooth movement. METHODS: The samples consisted of 54 sex-matched Wistar rats (weight, 180-230 g) allocated to the 2.5 mmol/L clodronate, 10 mmol/L clodronate, and control groups (n = 18 for each group). After application of a nickel-titanium closed-coil spring (force, 60 g) between the maxillary central incisor and first molar, 2.5 mmol/L of clodronate, 10 mmol/L of clodronate, or saline solution was injected into the subperiosteum adjacent to the maxillary first molar every third day. All animals received tetracycline, calcein, and alizarin red by intraperitoneal injection at 1, 6, and 14 days, respectively. The amounts of tooth movement were measured at 3, 6, 9, 12, and 15 days. The animals were killed at 4, 7, and 17 days. Histomorphometric analyses of bone mineral appositional rate, labeled surface, percentage of root resorption area, and number of root resorption lacunae of the mesiobuccal root of the maxillary first molar at 4, 7, and 17 days were done. One-way analysis of variance (ANOVA) with the post-hoc test were done for statistical analyses. RESULTS: Rats in the 10 mmol/L clodronate group had significant decreases of tooth movement (12 and 15 days, P <0.05) and percentages of root resorption area and numbers of root resorption lacunae (7 day, P <0.05), and increases of labeled surface and mineral appositional rates (17 day, P <0.05) over those of the 2.5 mmol/L clodronate and control groups. CONCLUSIONS: Although clodronate might decrease root resorption related to orthodontic tooth movement, patients should be informed about a possible decrease in the amount of tooth movement and a prolonged period of orthodontic treatment.

Volumetric, planar, and linear analyses of pharyngeal airway change on computed tomography and cephalometry after mandibular setback surgery.

INTRODUCTION: The purpose of this study was to use lateral cephalometry and computed tomography (CT) to examine the volumetric, planar, and linear changes in the pharyngeal airway after mandibular setback surgery. METHODS: The pharyngeal airways of 12 subjects who underwent mandibular setback surgery at Seoul National University Dental Hospital were assessed linearly and volumetrically on lateral cephalometric radiographs and CT before surgery and 6 months after surgery. The pharynx, nasopharynx, and oropharynx were evaluated by volumetric analysis. Pharyngeal depth, airway space, pharyngeal soft-tissue thickness, and hyoid bone position were measured by linear analysis. The axial section area of the airway was measured by area analysis. RESULTS: From the linear analysis, a significant decrease in pharyngeal depth and a significant posterior movement of the hyoid bone (P <0.05) were noted. Volumetric analysis by CT showed that the oropharynx decreased after mandibular setback surgery. However, the volume and the axial section area of the airway in the CT images did not change significantly after mandibular setback surgery (P >0.05). CONCLUSIONS: Although the structures around the mandible inevitably moved backward after mandibular setback surgery on linear analysis, physiologic deformation could occur to preserve the airway capacity after sagittal compression.

Root and bone response to the proximity of a mini-implant under orthodontic loading.

OBJECTIVE: To determine the histological reaction of the root and bone as a mini-implant approaches the root. MATERIALS AND METHODS: Two kinds of mini-implants were inserted into the buccal alveolar bone of 4 beagles (2 males and 2 females). The specimens were classified as the near-root group, the PDL contact group, the root contact group, and the root perforation group. Cementum resorption, dentin resorption, cementum repair, cementum growth, ankylosis, root cracking, and root fracture were assessed as the implant neared the root. RESULTS: The incidence of root resorption increased when the mini-implant was less than 0.6 mm from the root in the near-root group and PDL contact group. Root cracking and root fracture occurred in the root contact group and root perforation group. Bone resorption and ankylosis were observed in some specimens. However, some specimens of the PDL contact group and root contact group had cementum growth or little root resorption despite proximity to the root. In the root perforation group, root resorption and ankylosis occurred on the side opposite the insertion. CONCLUSIONS: There is a risk of root contact and severe tissue damage from a thick mini-implant and the drilling procedure, either of which can induce root resorption or ankylosis. Use of smaller mini-implants may reduce root contact and tissue damage. However, the small mini-implant may need enhancement of its stability.

Static tensional forces increase osteogenic gene expression in three-dimensional periodontal ligament cell culture.

Orthodontic tooth movement results from the combinational process of both bone resorption and formation in the compressive and tension sides, respectively. However, the genes responsible for new bone formation in tension sides have not been determined. In this study, we used DNA microarray and real-time RT-PCR to identify genes in human periodontal ligament (PDL) cells that undergo significant changes in expression in response to static tensional forces (2 or 12 hours). The genes found were alkaline phospatase (ALP), matrix metalloproteinases (MMPs), vascular endothelial growth factor (VEGF), and several collagen genes. Furthermore, an ELISA evaluating the expression of VEGF, type IV collagen and MMP-2 found levels significantly increased after 24 and 72 hours (P 0.05). ALP activity was also increased after 24 hours (P 0.05). Collectively, we found the genes up-regulated in our study by the static tensional force are related to osteogenic processes such as matrix synthesis and angiogenesis.

Effects of microgrooves on the success rate and soft tissue adaptation of orthodontic miniscrews.

OBJECTIVE: To evaluate the effect of microgrooves on orthodontic miniscrews in terms of success rate and soft tissue adaptation in animal experiments. MATERIALS AND METHODS: The sample consisted of a non-microgroove (NMG) group and a microgroove group (MG; 50 microm pitch and 10 microm depth microgroove on the upper surface of the miniscrew). Miniscrews of 1.6 mm diameter and 6.0 mm length were placed into beagle dogs. Histomorphometric analysis in each group focused on bone-to-implant contact (BIC) and the bone area (BA) of pressure and tension sides. Independent and paired t-tests were completed for statistical analysis. RESULTS: The success rate was found to be higher in the MG group than in the NMG group. The MG group showed significantly higher BIC on the pressure side when compared with the NMG group (P < .01). Although the NMG group showed significantly lower BIC on the pressure side than on the tension side at the upper side of the miniscrew (P < .01), the MG group revealed no significant differences between BIC on pressure and tension sides. The MG group generally exhibited perpendicular or circular alignment of the gingival connective tissue fiber with the miniscrew; the NMG group showed parallel alignment. CONCLUSIONS: The orthodontic load may affect bone remodeling on the pressure side of the miniscrew and may affect stability. The microgroove could exert some positive effects on soft tissue adaptation and bone healing.

Comparison of stability between cylindrical and conical type mini-implants. Mechanical and histological properties.

OBJECTIVE: To investigate the mechanical and histologic properties of conical compared with cylindrical shaped mini-implants in terms of the success rate. MATERIALS AND METHODS: The samples consisted of cylindrical and conical groups, and commonly had 1.6 mm diameter and 6.0 mm length (Jeil Medical Corporation, Seoul, Korea) placed in beagle dogs. The mechanical study for analyzing maximum insertion torque (MIT), maximum removal torque (MRT), and torque ratio (TR; MRT/MIT) in Sawbones (Pacific Research Laboratories Inc, Vashon, Wash), and the animal study for resonance frequency analysis (RFA) and histomorphometric analysis (bone-to-implant contact and bone area) in two beagle dogs were done. All measurements were statistically evaluated using independent t-tests to determine any difference in MIT, MRT, TR, RFA, bone-to-implant contact (BIC), and bone area (BA) between the cylindrical group and conical group. A P value less than 0.05 was considered significant. RESULTS: The conical group showed significantly higher MIT and MRT than the cylindrical group in the mechanical study. However, there was no significant difference in RFA, BIC, and BA between the two groups in the animal and histomorphometric studies. CONCLUSIONS: Although the conical shaped mini-implant could induce tight contact to the adjacent bone tissue and might produce good primary stability, the conical shape may need modification of the thread structure and insertion technique to reduce the excessive insertion torque while maintaining the high resistance to removal.

Initial effect of multiloop edgewise archwire on the mandibular dentition in Class III malocclusion subjects. A three-dimensional finite element study.

The purpose of this study was to compare the effect of a multiloop edgewise archwire (MEAW) with a plain ideal archwire (IA) on distal en masse movement of the mandibular dentition. A three-dimensional finite element model (3D FEM) of the mandibular dentition, without third permanent molars, was constructed to include the periodontal membrane (PDM), alveolar bone, standard edgewise bracket (0.018 x 0.025 inch), stainless steel IA (0.016 x 0.022 inch), and MEAW (0.016 x 0.022 inch). Stress distribution and displacement of the mandibular dentition were analyzed when Class III intermaxillary elastics (300 g/side) and 5 degree tip-back bends from the first premolar to the second molar were applied to the IA and the MEAW for distal en masse movement of the mandibular dentition. Compared with the IA, the discrepancy in the amount of tooth displacement was less and individual tooth movement with the MEAW was more uniform and balanced. There was minimal vertical displacement or rotation of the teeth with the MEAW when compared with the IA. The MEAW seems to have advantages for distal en masse movement of the mandibular dentition.

Skeletodental factors affecting chin point deviation in female patients with class III malocclusion and facial asymmetry: a three-dimensional analysis using computed tomography.

OBJECTIVE: Three-dimensional computed tomography (CT) was used to investigate which skeletodental factors are related to chin point deviation of facial asymmetry in skeletal class III malocclusion (SCIII) patients. STUDY DESIGN: Forty Korean adult female patients with SCIII, who had a three-dimensional CT taken 1 month before orthognathic surgical surgery, were assigned to group 1 (symmetry) or group 2 (asymmetry) according to the amount of chin point deviation from facial midline. Midfacial, mandibular, and cranial base variables were measured with software and statistically analyzed. RESULTS: Group 2 showed higher positions of the upper canine and first molar, shorter ramus height, more superior-posterior positioning of gonion (Go) on the deviated side, and more mesial inclination of the ramus and medial positioning of Go on the opposite side. CONCLUSION: Facial asymmetry in SCIII patients occurs due to greater growth and mesial inclination of the ramus and greater maxillary vertical excess in the opposite side.

A three-dimensional analysis of soft and hard tissue changes after a mandibular setback surgery.

This paper is concerned with a three-dimensional (3D) analysis on soft and hard tissue changes after mandibular setback surgery. For comparing with previous two-dimensional (2D) cephalometric data, we proposed a three-dimensional registration and analysis method based on the cephalometric knowledge. The 3D changes of bone, soft tissue and the ratio of soft tissue to bony movement were investigated in eight skeletal class III mandibular prognathism patients. CT scans of each patient were taken at pre- and post-operative states. Each scan was registered to a universal 3D coordinate system defined by cephalometric landmarks. A grid, parallel to the coronal plane, was also designed for the comparison of the changes. The bone and soft tissue was intersected by the projected line from each point on the grid. The coordinate values of intersected point were measured and compared between the pre- and post-operative models. In addition, the reproducibility of the universal coordinate system and the grid was evaluated. The facial surface changes after setback surgery occurred not only in the mandible but also in the mouth corner region. The soft tissue changes of the mandible were measured relatively by the proportional ratios to the bone changes. The ratios at the mid-sagittal plane were 77-102% (p<0.05). The ratios at all other sagittal planes had similar patterns to the mid-sagittal plane with decreased values. All the results conformed to the previous 2D based clinical knowledge and instinct of orthodontists. It is expected that the proposed approach would be applicable to other oral and maxillofacial surgeries as well as plastic surgeries.

Cephalometric predictors of long-term stability in the early treatment of Class III malocclusion.

The aim of this study was to examine the differences in the early craniofacial morphology of Class Ill malocclusions. Lateral cephalograms of 45 subjects with a Class III malocclusion and an anterior crossbite in the deciduous or mixed dentition were examined before treatment, after treatment, and during the long-term retention stage. The anterior crossbites of all patients were corrected after a series of orthodontic treatments. After a mean follow-up period of 5.7 years, all the subjects were reevaluated and divided into three groups according to the final occlusal status: good, fair, and poor occlusal stability. Twenty cephalometric variables on the pretreatment lateral cephalograms were analyzed by one-way analysis of variance and discriminant analysis to identify the key determinants for discriminating among the three groups. Among the 20 variables, 11 showed statistical significance. Generally, the subjects with a smaller gonial angle and a more hypodivergent skeletal pattern had good prognosis after the early treatment of Class III malocclusion. When the AB to mandibular plane angle and N-perpendicular to point A were selected in discriminant analysis, the AB to mandibular plane angle was the most significant variable. Discriminant analysis showed a relatively high degree of correct classifications of the patients with early Class III malocclusion. In particular, discriminant analysis showed the highest accuracy (93.3%) when predicting a poor prognosis.

Histomorphometric and mechanical analyses of the drill-free screw as orthodontic anchorage.

INTRODUCTION: Drill-free screws were developed to provide convenient orthodontic anchorage. The purpose of this study was to evaluate the effects of the drilling procedure on the stability of the screws under early orthodontic loading. METHODS: Thirty-two screws were inserted into the jaws of 2 beagles. The screws were divided into 2 groups of 16: the drilling group and the drill-free group. Screws in the drilling group were inserted into the site that had been drilled with a pilot drilling bur, and those in the drill-free group were inserted without drilling. A force of 200 to 300 g was applied using nickel-titanium coil springs 1 week after insertion. Twelve weeks after insertion, mobility was tested with Periotest (Siemens AG, Bensheim, Germany), and the screws with the surrounding bone were prepared for histomorphometric evaluation. RESULTS: Screws in the drill-free group showed less mobility and more bone-to-metal contact; they had more bone area compared with the drilling group, although bone osseointegration was generally found in both groups. CONCLUSIONS: With careful technique, drill-free screws can provide stable orthodontic anchorage.

Quantitative analysis of the adhesion of cariogenic streptococci to orthodontic metal brackets.

The aim of this study was to analyze the adhesion of cariogenic streptococci to orthodontic metal brackets in terms of the type of bacterial strains, the incubation time, and saliva coating. Two strains of Streptococcus mutans (S. mutans LM7 and S. mutans OMZ65) and two strains of S. sobrinus (S. sobrinus B13 and S. sobrinus 6715) were used. Twenty metal brackets were incubated with either unstimulated whole saliva or phosphate-buffered saline for two hours. The bacterial adhesion assays were then performed by incubating the tritium-labeled streptococci with saliva-coated or noncoated orthodontic brackets for three, six, or nine hours. The results showed a characteristic binding pattern according to the type of bacterial strains used. S. mutans OMZ65 showed the highest amount of adhesion, whereas S. sobrinus B13 showed the lowest amount of adhesion. Generally, an extended incubation time increased the adhesion of cariogenic streptococci, and the amount of adhesion was the highest after nine hours of incubation. The saliva coating did not significantly influence the adhesion of bacteria. However, this saliva-mediated adhesion differed according to incubation time. The saliva coating tended to gradually decrease the adhesion by the extended incubation time, compared with the noncoated controls. This study indicates that each strain of cariogenic streptococci has a characteristic adhesion pattern and the type of bacterial strain, the incubation time, and saliva influenced the adhesion.

Fluoride coatings on orthodontic wire for controlled release of fluorine ion.

The purpose of this study was to develop a new method of releasing fluorine in a controlled manner for applications in the field of orthodontic Ti-based wire, namely the coating of fluorides on Ti. Thin films of two fluoride compounds, CaF(2) and MgF(2), were coated on Ti via the electron-beam evaporation method. The fluorine was released rapidly from the as-deposited MgF(2) coating within a short period(,) and then the release rate slowed down. When the MgF(2) coating was heat treated, this initial burst effect was decreased, but a significant amount of cracks were generated. On the other hand, in the case of the as-deposited CaF(2) coating, fluorine was released linearly for the entire period, without an initial burst. In the heat-treated CaF(2) coatings the trend was similarly observed. The linear fluorine release from the CaF(2) coatings, even in the as-deposited state, was attributed to the high degree of crystallinity of the coatings. A preliminary cell test showed favorable cell viability on both the fluoride coatings. Given their sustained and controlled fluorine release, these fluoride coatings, particularly CaF(2), are suggested to be potentially useful in the field of orthodontic Ti-based wire.

Three-dimensional finite element analysis in distal en masse movement of the maxillary dentition with the multiloop edgewise archwire.

The purpose of this study was to compare the effects of a multiloop edgewise archwire (MEAW) on distal en masse movement with a continuous plain ideal archwire (IA). Three-dimensional finite element models (FEM) of the maxillary dentition in which the second permanent molars had been extracted were constructed to include the periodontal membrane, alveolar bone, standard edgewise bracket (0.018 x 0.025 inch), stainless steel IA (0.016 x 0.022 inch), and MEAW (0.016 x 0.022 inch). The stress distribution and displacement of the maxillary dentition were analysed when Class II intermaxillary elastics (300 g/side) and 5 degree tip-back bends were applied to the IA and MEAW for distal en masse movement of the maxillary dentition. Compared with the IA, the MEAW showed that the discrepancy in the amount of tooth displacement was lower and individual tooth movement was more uniform and balanced. There was minimal vertical displacement or rotation of the teeth using the MEAW when compared with the IA. The MEAW seems to have advantages for distal en masse movement of the maxillary dentition.