Comparing virtual setup software programs for clear aligner treatment.

BACKGROUND: The aim of this study was to compare the outcomes of the same amount of tooth movement among four different virtual setup software programs. METHODS: This retrospective study included 32 patients who underwent Invisalign treatment. Patients' initial stereolithography (STL) files were imported to three different software programs (SureSmile Aligner [Dentsply Sirona, Charlotte, NC], Ortho Insight 3D [Motion View software, Chattanooga, TN], and Ortho Analyzer [3Shape, Copenhagen, Denmark]). After virtually moving teeth based on the numbers from ClinCheck Pro (Align Technology, Inc., Santa Clara, CA) tooth movement tables, final STL files were exported from all four software programs. ClinCheck Pro final STL files were used as references, while final STL files from the other software programs were used as targets. Superimpositions were performed between references and target STL files using Geomagic Control X software (3D Systems, Rock Hill, SC), and color-coded maps were obtained to illustrate potential differences. RESULTS: Intraclass correlation coefficient showed a high degree of reliability for repeated methodology (0.995-0.997). The differences among absolute averages (Abs Avg.), averages of positive values (+Avg.), and negative values (-Avg.) for both upper and lower models were significant among all software programs (ClinCheck Pro, SureSmile Aligner, Ortho Insight 3D, and Ortho Analyzer), for both upper and lower STL files, the smallest difference was found between ClinCheck Pro and SureSmile Aligner with a median of (0.03, 0.31, -0.19) mm for upper and (0.02, 0.29, -0.17) mm for lower STL files (Abs Avg., +Avg. and -Avg.), respectively. The biggest difference was found to be between ClinCheck Pro and Ortho Analyzer with a median of (0.05, 0.46, -0.45) mm for upper and (0.06, 0.48, -0.40) mm for lower STL files. There were no significant differences in the number of aligners per patient. CONCLUSIONS: Final outcomes of the same amount of tooth movement in four different software programs differed significantly. The number of aligners per patient remained unchanged.

WNT10A and RUNX2 mutations associated with non-syndromic tooth agenesis.

The goal of this study was to examine the prevalence of WNT10A and RUNX2 mutations and assess their potential impact on the phenotype of non-syndromic tooth agenesis. The study included 30 participants with non-syndromic tooth agenesis, divided into hypodontia (n = 24) and oligodontia forms (n = 6), and 42 unaffected family members. Genomic DNA from buccal epithelial cells was used for polymerase chain reaction amplification of functionally important exons of the WNT10A and RUNX2 genes. Direct sequencing reactions were performed to confirm the presence of mutations. The trend of increasing prevalence of WNT10A mutations and a slight increase in the prevalence of RUNX2 mutations were revealed in tooth agenesis cases compared to unaffected family members. There was a higher prevalence of hypodontia than oligodontia, increased frequency of females over males with missing teeth, and a wide phenotypic variability was observed in individuals and families analyzed. The common missense mutations (p.Phe228Ile, p.Arg113Cys, p.Asp217Asn, and p.Gly165Arg) and c.114-56T>C in the WNT10A gene and in-frame-deletion/insertions (11A, 24Q, 30Q), synonymous variant c.240G>A, and 424-33dupC in the RUNX2 gene were identified. These findings highlight an important role of WNT10A and RUNX2 mutations in the genetic etiology of non-syndromic tooth agenesis.

Impacts of childhood malocclusion on the family.

PURPOSE: To analyze the effects of children's malocclusions and associated quality of life on family relationships by evaluating psychometric characteristics of the Family Impact Scale (FIS) in adolescents seeking orthodontic treatment. MATERIALS AND METHODS: Included were 334 participants (children aged 11-14 years; 53% female and 47% male) and their parents (84% mothers, 16% fathers) who were recruited at two dental clinics in Croatia. The Child Perception Questionnaire, Parental-Caregiver Perception Questionnaire, and FIS were administered. Malocclusion severity was estimated using the Index of Orthodontic Treatment Need Dental Health Component. The presence of caries was also recorded. Factor analysis, t­test, Pearson correlation, and multiple linear regression analysis were used for statistical analysis. RESULTS: Unidimensional FIS measuring global family impacts had higher internal consistency (α = 0.73-0.81) compared to the specific dimensions of family impacts (α = 0.60-0.69). Global family impacts were higher in children with more severe malocclusions and existing dental caries, primarily influencing parental activity, and parental emotions dimensions (p < 0.05). In multiple regression, parental perception of child's emotional well-being, oral symptoms, and social well-being (p < 0.001) were significant predictors of global family impacts, whereas child's quality of life perception, malocclusion severity, or child sex were not. Reduction of an increased overjet by orthodontic treatment affected changes in the global family impacts, mainly by reducing the emotional issues of parents (p < 0.05). CONCLUSIONS: The child's malocclusion influenced the family, primarily parental emotions. Family influences were mostly determined by parental perception of the child's altered psychosocial well-being. The FIS had adequate psychometric properties.

Comparing 3D Tooth Movement When Implementing the Same Virtual Setup on Different Software Packages.

BACKGROUND/OBJECTIVES: The purpose of this study was to compare the differences in tooth movements when implementing the same virtual setup on the following four different software packages: ClinCheck® Pro, Ortho Analyzer®, SureSmile®, and Ortho Insight 3D®. MATERIALS/METHODS: Twenty-five adult patients treated with Invisalign® at the Case School of Dental Medicine (CWRU)'s department of orthodontics were retrospectively collected. Initial stereolithography (STL) files were obtained and imported into three software packages. The teeth were moved in order to replicate the virtual setup from ClinCheck® Pro. The final outcomes were exported from each software package. ClinCheck® Pro STL files were used as the reference while STL files produced by the other software packages were used as the targets. Best fit superimpositions were performed using Geomagic® Control X. Based on the results, tooth position was adjusted in the three software packages until the virtual setups from ClinCheck® Pro were replicated. Once confirmed, the tables containing the tooth movements were compared. The number of aligners and number of attachments automatically generated from each of the software packages were also evaluated. RESULTS: Extrusion/intrusion (p ≤ 0.0001) and translation buccal/lingual (p ≤ 0.0004) were significantly different among the software packages. ClinCheck® Pro and SureSmile® (p ≤ 0.000), SureSmile® and Ortho Insight 3D® (p ≤ 0.014), SureSmile® and Ortho Analyzer® (p ≤ 0.009), and Ortho Insight 3D® and Ortho Analyzer® (p ≤ 0.000) generated a significantly different number of maxillary aligners. The results varied slightly for mandibular aligners, with only ClinCheck® Pro and Ortho Insight 3D® (p ≤ 0.000), SureSmile® and Ortho Insight 3D® (p ≤ 0.000), and Ortho Insight 3D® and Ortho Analyzer® (p ≤ 0.000) exhibiting a significant difference. ClinCheck® Pro and SureSmile® (p ≤ 0.000) differed significantly in the number of attachments produced. CONCLUSIONS: There are statistically significant differences in extrusion/intrusion, translation buccal/lingual, the number of aligners, and the number of attachments when implementing the same virtual setup on different software packages. Clinicians may need to consider this when utilizing software programs for digital diagnosis and treatment planning.

Predictors of patient compliance during Class II division 1 malocclusion functional orthodontic treatment.

OBJECTIVES: To determine factors that could predict Class II/1 malocclusion patient compliance during functional treatment. MATERIALS AND METHODS: The sample consisted of 77 subjects (aged 11-13 years; 47% girls) presenting with Class II/1 malocclusion. Inclusion criteria were distal molar relationship, overjet greater than 5 mm, and confirmed pubertal growth spurt. Removable functional appliances (62% Twin Block [TB], 38% Sander Bite Jumping [BJ]) with built-in maxillary expansion screws were used. Follow-up period was 1 year. Patients and parents independently filled out the Child Perception Questionnaire, Parental/Caregiver Perception Questionnaire, and Family Impact Scale to assess emotional and social well-being, oral symptoms, functional limitations, parental emotions, family activities, conflicts, and financial burden as possible predictors of compliance during treatment. Sex, overjet, and appliance type were also analyzed. RESULTS: There were more noncompliant than compliant patients (55% vs 45%). Parental perception of altered emotional well-being of their children was the strongest predictor, increasing compliance odds 3.4 times (95% confidence interval [CI], 1.2-9.4; P = .017). Patients were 3.2 times (95% CI, 1.1-9.3; P = .033) more likely to cooperate with TB compared with BJ appliance. OJ ≥ 8 mm increased compliance odds 3.1 times (95% CI, 1.0-9.4; P = .044). CONCLUSIONS: Parental perception of child's emotional well-being alteration, severity of malocclusion, and type of appliance are major predictors of compliance. Psychosocial issues and oral function limitations reported by children and family impact are of negligible influence.

Strategies for Managing the Risk of Mucogingival Changes During Impacted Maxillary Canine Treatment.

Gingival recession is a frequent mucogingival defect in the adult population. It affects the esthetics and is related to hypersensitivity and a high risk of periodontal attachment loss. The connection between orthodontic treatment and periodontal health has been debated for a long time. A healthy periodontium can be preserved during safe orthodontic tooth movement even in patients with poor mucogingival anatomy. This article aimed to review the strategies around managing the risks of mucogingival and apical root changes owing to maxillary canine impaction, with a special focus on gingival recession and impacted maxillary canine treatment. Maxillary canines are the second most frequently impacted teeth after the third molars. They can be located in the labial or buccal aspect of the alveolar bone. If interceptive procedures fail, the next step is the challenging and time-consuming comprehensive orthodontic-surgical treatment. Determining the exact impacted canine location, its relation to the adjacent teeth and structures, the least invasive surgical approach, and the best path for traction are all a part of the standard diagnostic process. It has also been suggested that orthodontists should evaluate periodontal risks to achieve the best possible results. Clinical examination and cone beam computed tomography provide valuable information for the treatment plan that yields good results with a healthy periodontium.

Pharyngeal Airway Changes after Bimaxillary Orthognathic Surgery--Preliminary Results.

INTRODUCTION: Dentofacial deformity, a deviation from normal facial proportions and dental relationships, is corrected by jaw repositioning in all three spatial planes, which changes the position and tension of the surrounding tissues, bones and muscles. These changes may also affect the dimensions of the pharyngeal airways (PA). OBJECTIVE: The aim of this study was to evaluate and compare three-dimensional PA changes in patients treated by a combination mandibular set-back/maxillary advancement versus patients that had bimaxillary advancement with genioplasty. METHODS: The sample consisted of 7 patients treated by combined mandibular set-back/maxillary advancement and 7 patients treated with bimaxillary advancement surgery. Nasopharyngeal (NP) volume, oropharyngeal (OP) volume and the area of maximum constriction (AMC) in the OP were measured on CBCT scans (2 mA/120 kV/12" FOV) taken before (T1) and 3 months after surgery (T2). Paired samples t-test was used for analyzing statistical significance of changes (p ≤ 0.05). RESULTS: OP volume and AMC increase after bimaxillary advancement was statistically significant, while for the mandibular set-back group the increase was non-significant. NP volume was not reduced in any of the two groups. No significant differences in PA dimensions were found between groups at neither T1 nor T2 time points. CONCLUSION: Results suggest that the combination of mandibular set-back/maxillary advancement did not reduce airway dimensions, while bimaxillary advancement surgery led to a statistically significant increase in the OP dimensions.

Reliability of computerized cephalometric outcome predictions of mandibular set-back surgery.

INTRODUCTION: A successful treatment outcome in dentofacial deformity patients commonly requires combined orthodontic-surgical therapy. This enables us to overcome functional, aesthetic and psychological problems. Since most patients state aesthetics as the primary motive for seeking therapy, cephalometric predictions of treatment outcome have become the essential part of treatment planning, especially in combined orthodontic-surgical cases. OBJECTIVE: The aim of this study was to evaluate the validity and reliability of computerized orthognathic surgery outcome predictions generated using the Nemotec Dental Studio NX 2005 software. METHODS: The sample of the study consisted of 31 patients diagnosed with mandibular prognathism who were surgically treated at the Hospital for Maxillofacial Surgery in Belgrade. Investigation was done on lateral cephalograms made before and after surgical treatment. Cephalograms were digitized and analyzed using computer software. According to measurements made on superimposed pre- and postsurgical cephalograms, the patients were retreated within the software and the predictions were assessed by measuring seven angular and three linear parameters. Prediction measurements were then compared with the actual outcome. RESULTS: Results showed statistically significant changes between posttreatment and predicted values for parameters referring to lower lip and mentolabial sulcus position. CONCLUSION: Computerized cephalometric predictions for hard-tissue structures in the sagittal and vertical planes, as well as the VTO parameters, generated using the Nemotec Dental Studio NX 2005 software are reliable, while lower lip and mentolabial sulcus position predictions are not reliable enough.

Association of fibronectin with hypogalactosylated immunoglobulin G in gingival crevicular fluid in periodontitis.

BACKGROUND: Fibronectin (FN) can bind to immunoglobulins (Ig), influencing both the normal clearance and abnormal deposition of circulating immune complexes. This study focuses on the possible interaction between FN and IgG present in gingival crevicular fluid (GCF) of periodontitis patients and periodontally healthy controls, with the aim to determine whether such interaction may be connected with the glycosylation profile of IgG and, thus, consequentional in accumulation of proinflammatory IgG in periodontal pockets. METHODS: The study included 30 patients with initial or advanced periodontitis, and 13 periodontally healthy subjects. GCF IgG was purified and analyzed for the presence of FN and its fragments and for galactose expression. RESULTS: IgG isolated from GCF contained FN, which was bound to the IgG heavy chains. IgG from GCF of advanced periodontitis patients contained high levels of hypogalactosylated IgG, and bound more FN than IgG from GCF of the other two groups, which contained low levels of this glycoform. FN was in a degraded form in GCF from all studied patients, and a fragment of 48- to 53-kDa molecular mass seemed to be the sole one linked to IgG. CONCLUSIONS: IgG and the FN fragment of 48 to 53 kDa in GCF of periodontitis patients and periodontally healthy subjects are physically connected. This fragment was linked to the heavy chains of IgG and the reaction seemed to be particularly intensive with IgG from advanced periodontitis, which contained significantly less galactose in its sugar chains.