Influence of malocclusion and orthodontic treatment in the masticatory efficiency of patients with craniofacial disorders.

This study evaluates masticatory efficiency in orthodontic patients with craniofacial disorders compared to controls without, considering the effect of an orthodontic appliance and malocclusion. A total of 119 participants (7-21 years), divided into a craniofacial disorder and control group (n = 42 and n = 77; mean age 13.5 ± 5.2 and 14.2 ± 3.3 years) were included. Masticatory efficiency was evaluated using a standard food model test, where masticated test food bodies were analyzed, and parameters like particle number (n) and area (mm2) were recorded. This study newly introduced the masticatory efficiency index (MEI), which encompasses the above terms (number and area), with a high MEI being an indicator of high masticatory ability. Younger orthodontic patients with a craniofacial disorder had a significantly decreased MEI (0.50 ± 0.25 n/mm2) compared to patients without (1.10 ± 0.48 n/mm2; p = 0.02). The presence of a crossbite significantly decreased masticatory efficiency, particularly in craniofacial disorder patients (0.69 ± 1.44 n/mm2) versus controls (0.89 ± 1.00 n/mm2, p = 0.04). As treatment progressed with age and fixed appliances, mastication group differences became non-significant, suggesting that patients with a craniofacial disorder were catching up to healthy controls in the rehabilitation of their masticatory function. Considering an early diagnosis of malocclusion during orthodontic therapy in combination with speech therapy can avoid negative malocclusion effects with growth, caused by muscle imbalances.

Mini-Implant Insertion Using a Guide Manufactured with Computer-Aided Design and Computer-Aided Manufacturing in an Adolescent Patient Suffering from Tooth Eruption Disturbance.

Due to dental diseases, anatomical restrictions, and mixed dentition, the reduction in the number of teeth and the displacement of tooth germs pose challenges in orthodontic treatment, limiting anchorage options. The presented case demonstrates an advanced treatment solution using digital CAD/CAM-technologies and medical imaging for the creation of a mini-implant template. A 12-year-old male patient experiencing delayed tooth eruption, multiple impacted germs, and maxillary constriction underwent intraoral scanning and CBCT. Utilizing coDiagnostiXTM Version 10.2 software, the acquired data were merged to determine the mini-implant placement and to design the template. The template was then manufactured through stereolithography using surgical-guide material. Mini-implants were inserted using the produced appliance, enabling safe insertion by avoiding vital structures. Surgically exposed displaced teeth were aligned using a Hyrax screw appliance anchored on the mini-implants for rapid palatal expansion (RPE) and subsequently used as fixed orthodontics to align impacted teeth. The screw was activated daily for 10 weeks, resulting in a 7 mm posterior and 5 mm anterior maxillary transversal increase. Skeletal anchorage facilitated simultaneous RPE and tooth alignment, ensuring accuracy, patient safety, and appliance stability. The presented case shows a scenario in which computer-aided navigation for mini-implant positioning can enhance precision and versatility in challenging anatomical cases.

Masticatory Efficiency in Orthodontic Patients with Craniofacial Disorder.

This study evaluates the masticatory efficiency in patients with craniofacial disorders (CD) compared to controls (C). A total of 119 participants (7-21 years), divided into CD group (n = 42, mean age 13.45 ± 5.2 years) and C group (n = 77, mean age 14.3 ± 3.27 years) under an orthodontic treatment were included. Masticatory efficiency was assessed using a standard food model test. The masticated food was examined according to its number of particles (n) and area (mm2), wherein a higher number of particles alongside a smaller area was an indication of better masticatory efficiency. Additionally, the influence of cleft formation, chewing side, dentition stage, age and sex were evaluated. Patients with CD chewed the standardized food in fewer particles (nCD = 61.76 vs. nC = 84.58), with a significantly higher amount of area than the controls (ACD = 192.91 mm2 vs. AC = 146.84 mm2; p = 0.04). In conclusion, patients with CD showed a significantly decreased mastication efficiency compared to healthy patients. Factors such as stage of cleft formation, chewing side, dentition stage and age showed an influence on masticatory efficiency, whereas no gender effect on the masticatory efficiency of CD patients was found.

Automation of Measurements for Personalized Medical Appliances by Means of CAD Software-Application in Robin Sequence Orthodontic Appliances.

Measuring the dimensions of personalized devices can provide relevant information for the production of future such devices used in various medical specialties. Difficulties with standardizing such measurement and obtaining high accuracy, alongside cost-intensive measuring methodologies, has dampened interest in this practice. This study presents a methodology for automatized measurements of personalized medical appliances of variable shape, in this case an orthodontic appliance known as Tübingen Palatal Plate (TPP). Parameters such as length, width and angle could help to standardize and improve its future use. A semi-automatic and custom-made program, based on Rhinoceros 7 and Grasshopper, was developed to measure the device (via an extraoral scanner digital file). The program has a user interface that allows the import of the desired part, where the user is able to select the necessary landmarks. From there, the program is able to process the digital file, calculate the necessary dimensions automatically and directly export all measurements into a document for further processing. In this way, a solution for reducing the time for measuring multiple dimensions and parts while reducing human error can be achieved.

Development of Personalized Non-Invasive Ventilation Interfaces for Neonatal and Pediatric Application Using Additive Manufacturing.

The objective of this study was to present a methodology and manufacturing workflow for non-invasive ventilation interfaces (NIV) for neonates and small infants. It aimed to procure a fast and feasible solution for personalized NIV produced in-house with the aim of improving fit and comfort for the patient. Three-dimensional scans were obtained by means of an intraoral (Trios 3) and a facial scanner (3dMd Flex System). Fusion 360 3D-modelling software was employed to automatize the design of the masks and their respective casting molds. These molds were additively manufactured by stereolithography (SLA) and fused filament fabrication (FFF) technologies. Silicone was poured into the molds to produce the medical device. In this way, patient individualized oronasal and nasal masks were produced. An automated design workflow and use of additive manufacturing enabled a fast and feasible procedure. Despite the cost for individualization likely being higher than for standard masks, a user-friendly workflow for in-house manufacturing of these medical appliances proved to have potential for improving NIV in neonates and infants, as well as increasing comfort.

Accuracy Evaluation of Additively and Subtractively Fabricated Palatal Plate Orthodontic Appliances for Newborns and Infants-An In Vitro Study.

Different approaches for digital workflows have already been presented for their use in palatal plates for newborns and infants. However, there is no evidence on the accuracy of CAD/CAM manufactured orthodontic appliances for this kind of application. This study evaluates trueness and precision provided by different CAM technologies and materials for these appliances. Samples of a standard palatal stimulation plate were manufactured using stereolithography (SLA), direct light processing (DLP) and subtractive manufacturing (SM). The effect of material (for SM) and layer thickness (for DLP) were also investigated. Specimens were digitized with a laboratory scanner (D2000, 3Shape) and analyzed with a 3D inspection software (Geomagic Control X, 3D systems). For quantitative analysis, differences between 3D datasets were measured using root mean square (RMS) error values for trueness and precision. For qualitative analysis, color maps were generated to detect locations of deviations within each sample. SM showed higher trueness and precision than AM technologies. Reducing layer thickness in DLP did not significantly increase accuracy, but prolonged manufacturing time. All materials and technologies met the clinically acceptable range and are appropriate for their use. DLP with 100 µm layer thickness showed the highest efficiency, obtaining high trueness and precision within the lowest manufacturing time.

Fracture Load of an Orthodontic Appliance for Robin Sequence Treatment in a Digital Workflow.

CAD/CAM technologies and materials have the potential to improve the treatment of Robin Sequence with orthodontic appliances (Tübingen palatal plate, TPP). However, studies on the provided suitability and safety are lacking. The present study evaluates CAD/CAM technologies and materials for implementation into the workflow for producing these orthodontic appliances (TPPs), manufactured by different techniques and materials: additive manufacturing (AM) and subtractive manufacturing (SM) technologies vs. conventional manufacturing. The fracture load was obtained in a universal testing machine, and the breaking behavior of each bunch, as well as the necessity of adding a safety wire, was evaluated. The minimum fracture load was used to calculate the safety factor (SF) provided by each material. Secondary factors included manufacturing time, material cost and reproducibility. Dental LT clear showed the highest fracture load and best breaking behavior among AM materials. The highest fracture load and safety factor were obtained with Smile polyether ether ketone (PEEK). For the prototyping stage, the use of a Freeprint tray (SF = 114.145) is recommended. For final manufacturing, either the cost-effective approach, Dental LT clear (SF = 232.13%), or the safest but most expensive approach, Smile PEEK (SF = 491.48%), can be recommended.