The Use of 3D Printers in Orthodontics - A Narrative Review.

Developments in computer-aided design and three-dimensional (3D) printing have revolutionized the workflow for orthodontic applications. The purpose of this review article is to provide information about 3D printer history and types, appliances manufactured using 3D printers, and new designs that can be used in different cases. Articles published between January 2010 and November 2020 were reviewed on PubMed, MEDLINE, ScienceDirect, Elsevier, and Google academic resources, and 69 were identified as appropriate for the study. It was seen that bracket and archwires, nasoalveolar molding devices, orthognathic surgical splints, removable appliances, expansion appliances, clear aligner, retainers, auxiliary attachments, and working models can all be made with 3D printers. The 3D printer is now a technology that is easily accessible to orthodontists, increasing the production of different customizable appliances and promising a transition to a digital clinical workflow in the future.

Sella turcica bridging and ponticulus posticus calcification in subjects with different dental anomalies.

INTRODUCTION: This study aimed to evaluate and compare the bridging and dimensions of the sella turcica and calcification of the ponticulus posticus in subjects with different dental anomalies. METHODS: Pretreatment records of orthodontic patients with palatally impacted canines (n = 95), mandibular second premolar agenesis (n = 45), maxillary lateral incisor agenesis (n = 75), tooth transpositions (TT, n = 25), peg-shaped maxillary lateral incisors (n = 30), and third molar agenesis (TMA, n = 145) were analyzed and compared with the control group (CG) consisting of 145 subjects with skeletal Class I malocclusion and no dental anomalies. The length, diameter, and depth of the sella turcica were calculated for each patient. The degree of sella turcica bridging was scored as type I, II, and III, whereas the extent of ponticulus posticus was classified as Class I, II, and III. RESULTS: Only decreases in the length and diameter of the sella turcica in subjects with TT were found to be statistically significant. Although type II bridging frequency was found to be significantly lower in subjects with mandibular second premolar agenesis, maxillary lateral incisor agenesis, TT, and TMA, type III bridging frequency was found to be significantly higher only in subjects with TMA. The decrease in Class I calcification frequencies and the increase in Class II calcification frequencies were found to be significant in subjects with palatally impacted canines, TT, and TMA compared with the CG. In addition, the presence of Class III calcification was found to be significantly more frequent in subjects with TMA than in the CG. CONCLUSIONS: Although type II and type III bridging frequencies were found to be higher than in previous studies because of the higher type II bridging frequency in the CG, type II bridging frequency was found to be insignificant. Furthermore, an increased frequency of ponticulus posticus calcification was observed in subjects with palatally impacted canines, TT, and TMA.

Efficacy of botulinum toxin for treating a gummy smile.

INTRODUCTION: This study was conducted to investigate the efficacy of botulinum toxin applied to the different muscles of patients who have excessive gingival display and to evaluate the return to baseline gingival exposure value. METHODS: Twenty-eight patients who had a gummy smile of more than 2 mm were randomly divided into 2 groups. Botulinum toxin was administered equally to the left and right of the levator labii superioris alaeque nasi muscle of group 1 and the orbicularis oris site of group 2. Photographs were taken, and measurements were taken before injection and at 3 days, 15 days, 1 month, 4 months, 5 months, and 6 months after injection. The visual analogue scale was used to assess the level of satisfaction. RESULTS: The average amount of visible gingiva in group 1 was 4.92 mm at the beginning of the treatment and 1.92 mm on the 15th day. In group 2, the average amount of visible gingiva was 4.58 mm at the beginning of treatment and 2.16 mm on the 15th day. In both treatment groups, it was determined that the measurements on the sixth month did not return to their initial values. The decrease in gingival appearances in group 1 was greater than in group 2. There was no significant difference between the groups in terms of return to baseline gingival exposure value. In both groups, it was seen that the increase in satisfaction in patients was high. CONCLUSIONS: For gummy smile correction, botulinum toxin injection is thought to be an alternative method because it is effective and conservative and has high patient satisfaction.

Effect of photobiomodulation therapies on the root resorption associated with orthodontic forces: a pilot study using micro computed tomography.

OBJECTIVES: The aim of this study is to investigate the effect of photobiomodulation therapies on root resorption compared with the placebo group. MATERIALS AND METHODS: Thirty patients who were admitted to the Gaziantep University Faculty of Dentistry Orthodontics Department for treatment, with an indication of upper right first premolar tooth extraction were included. Before the individuals' orthodontic treatment, 0.022 slot MBT brackets and tubes were placed on the maxillary first premolar and molar. A 150-g buccal tipping force was applied to the first premolar. Cantilever spring with 0.017 × 0.025 Beta Titanium wire was used for force application. Individuals were then randomly divided into three groups. For the first group, laser application was performed with an 810-nm GaAlAs laser device at 0, 3, 7, 14, 21, and 28 days to 8 J/cm2. For the second group, an LED application according to the manufacturer's instructions with an 850-nm wavelength and 20 mW/cm2 output power for 10 min per day during the experiment. For the third group, a placebo therapy was completed whereby a laser device that did not make active pulses was used. At the end of 4 weeks, the amount of root surface resorption was compared using micro-CT imaging after the extraction of the teeth. RESULTS: No significant difference was found between the groups in terms of regional and total crater volumes. It was observed that photobiomodulation therapies were not different from the control group in terms of forming root resorption. CONCLUSIONS: It is seen that laser and LED photobiomodulation therapies used for accelerate orthodontic tooth movement do not differ from the control group in terms of forming root resorption. CLINICAL RELEVANCE: According to the results of this pilot study on this subject, which needs to be clarified with new findings in the future, LED and laser applications may not increase the risk for root resorption.

Assessment of the resin infiltration and CPP-ACP applications before orthodontic brackets bonding.

The aim of this study is to investigate the efficiency of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) gel and resin infiltrant on decalcified enamel, and to explain the correlation, if any, between ion release capacities and shear bond strength (SBS). A total of 80 premolar teeth were used (n=20). Group I was the control, while a demineralization protocol was performed for other groups. CPP-ACP gel and resin infiltrant, respectively, was applied to Groups III and IV. Pre and post-demineralization energy dispersive X-Ray analysis of all groups and post-application of Groups III and IV were undertaken. SBS tests were performed. Ca/P ratio significantly increased after the applications. Both agent groups showed a significant decrease in SBS values compared to others. There was no correlation between SBS and Ca/P ratio changes. It can be said that CPP-ACP and resin infiltrant therapies enhance the tooth mineral content, but show lesser SBS values than the control and demineralization only groups.

Evaluation of Airway Measurements in Class II Patients Following Functional Treatment.

OBJECTIVE: This study aimed to evaluate the effect of fixed and removable functional treatment on pharyngeal airway measurements in class II patients. METHODS: In this study, patients treated with fixed (Forsus Fatigue Resistant Device-FRD) and removable (twin-block-TWB) appliances were included (n=15, eight females, seven males in each group). These groups were compared with untreated individuals as the control group (n=10). The mean age of individuals was 13.22±2.39 years. Initial and post-treatment cephalometric radiographs were digitized, and the sagittal pharyngeal airway changes were evaluated. The pharyngeal airway was divided into the nasopharynx, oropharynx, and hypopharynx. The one-way ANOVA, Kruskal-Wallis test, and paired samples t-test were used for statistical analyses. RESULTS: At the initial values, no statistically significant difference was observed between the groups. Only the ANB values differed between the groups (p<0.05). Although the skeletal effects of removable and fixed treatment were not exactly the same, the changes of the airway dimensions were similar. CONCLUSION: The TWB and FRD appliances lead to an increase in nasopharynx, oropharynx, and hypopharynx sagittal dimensions. However, in terms of the effect on airway sagittal dimensions, there was no significant difference between treatment groups and the control group.

Comparison of the different retention appliances produced using CAD/CAM and conventional methods and different surface roughening methods.

The purposes of this study are to conduct an in vitro comparison of the shear bond strength, breakage mode, and wire deformation of three different types of retainers and to compare the subsequent enamel surface changes. Two hundred seventy intact lower incisor teeth were embedded in acrylic blocks in pairs. Dead wire and CAD/CAM-fabricated and fiber-reinforced wires were applied to the teeth roughened with acid and Er:YAG or Er,Cr:YSGG laser. The surface roughness was observed by scanning electron and atomic force microscopy. The samples were analyzed for shear bonds. The dead wire and acid group were found to have the highest bonding strength and the strengths for all groups in which acid was used as an agent were found to be higher than others. Deformation of retainers was most noted in the dead wire-acid group. Among all the groups, the CAD/CAM-fabricated wire group showed the least deformation, with no deformation observed. In this study, it was determined that there is a significant correlation between ARI scores and agents. Consequently, acid etching was found to create more enamel surface roughness than laser groups. It was also seen that the combined use of the acid method and dead soft wire had the highest bond strength, even though it was not statistically significant. It was concluded that CAD/CAM-fabricated wire provides the opportunity for reuse in clinical applications due to its lack of deformation, being more conservative for the patient, and being more advantageous for the clinician in terms of session time, considering the residual adhesive amount left on the enamel surface.

Investigation of bacteremia after debonding procedures.

OBJECTIVE: The purpose of this study is to investigate the effect of debonding procedures after completion of orthodontic treatments on bacteremia. MATERIALS AND METHODS: Twenty-eight patients who were treated with fixed orthodontic treatment at the Faculty of Dentistry's Department of Orthodontics at Gaziantep University and who had an indication of debonding were selected for this study, and blood samples were taken from these patients at different times and examined for bacteremia. Blood culture samples were taken from the antecubital veins of the patients prior to debonding (T0), immediately after removing the bracket (T1), and immediately after cleaning the composite residues and plaque deposits on the enamel surface (T2). The blood samples were then inoculated in blood culture bottles and investigated for bacterial growth. RESULTS: The results showed that there was no bacterial growth in the blood samples taken at T0 and T1, whereas 10 of the blood culture samples taken at T2 showed bacterial growth including the following bacteria; Streptococcus viridans, Streptococcus mitis, Streptococcus parasanguinis, Streptococcus salivarius, Streptococcus oralis, Staphylococcus aureus, Actinomyces oris, Actinomyces naeslundii and Klebsiella pneumoniae. CONCLUSION: It was concluded that patients in the risk group could develop bacteremia during debonding procedures. The presence of these bacteria in sterile blood suggested the possibility of bacterial endocarditis.

Effects of the Vertical Malocclusion Types on the Dimension of the Mandibular Condyle.

OBJECTIVE: This study aimed to find the relationship between mandibular condyle morphology and dental malocclusion in patients with anterior open bite, deep bite, and normal overbite. METHODS: Eighty patients were included in this retrospective study. All patients had skeletal Class II pattern. The initial panoramic radiographs of patients were digitized using a software program, and groups were compared in terms of condylar height, width, area, and perimeter. In addition, changes in the condyle surface shape were detected using the same panoramic radiographs. RESULTS: The mean width was 1.55±0.06 cm in the open bite group, 1.48±0.06 cm in the deep bite group, and 1.38±0.07 cm in the normal bite group. The mean height was 2.17±0.08 cm in the open bite group, 1.95±0.06 cm in the deep bite group, and 1.97±0.08 cm in the normal bite group. The mean area was 2.33±0.13 cm2 in the open bite group, 2.09±0.11 cm2 in the deep bite group, and 2.04±0.14 cm2 in the normal bite group. There was no statistical significant difference between groups in terms of condyle measurements and condyle surface shapes. CONCLUSION: The results suggest that the vertical malocclusion type does not have a considerable effect on the mandibular condyle measurements and surface shapes.

Cephalometric comparison of cesarean and normal births.

OBJECTIVE: The aim of this study was to compare cephalometric variables of subjects with normal and cesarean births. MATERIALS AND METHODS: Ninety age- and gender-matched patients, who were treated in Gaziantep University, Faculty of Dentistry Orthodontics Department were equally divided into normal and cesarean groups according to the birth methods reported by their mothers. To eliminate the negative effects of being different in terms of age and gender among parameters, control, and patient groups were matched in the present study. Pretreatment cephalometrics radiographs were used. Six measurements representing sagittal and vertical relationships were evaluated from pretreatment cephalograms using Dolphin Imaging Orthodontics Software was used in this issue by an orthodontist. Kolmogorov-Smirnov test, Student's t-test, and Mann-Whitney U-test were used for statistical comparisons. RESULTS: A point-nasion-B point angle (ANB) and Wits values were higher in the normal group, while sella-nasion-A point angle, sella-nasion-B point angle, Frankfort horizontal-mandibular plane angle, and gonion-gnathion-SN plane angle values were higher in the cesarean group. However, the groups showed no significant differences (P > 0.05). ANB angle and Wits values showed high correlation. CONCLUSIONS: Within the study limitations, the results suggest that the birth method may not have a considerable effect on the development of the craniofacial skeletal system.

Evaluation of Patients with Cleft Lip and Palate in Southeastern Anatolian Region.

OBJECTIVE: Our study included patients with cleft lip and palate who applied to Gaziantep University Dentistry Faculty Orthodontics Department between 2010 and 2014. The aim of this study was to reveal the characteristics of these patients with demographic values. METHODS: In total, 118 patients were included in this study. The patients were pursued by phone calls, and the study was conducted with only 64 patients. The demographic map was created with a statistical expert as a questionnaire. RESULTS: It was thought that the reason for not being able to include the remaining 54 patients was a change in phone number, designation, or others. One patient who was to be interviewed died because of heart failure. The results revealed that the place of birth of 18.75% patients was a metropolitan region that of 54.68% was a province, that of 21.87% was a district, and that of 4.69% was a village. The majority of patients (93.25%) had a low family income level. The average number of children was 3.28, and readership was 1.47. The rate of working mothers was 1.56%. CONCLUSION: It was concluded that the cleft lip and palate patient group had lower economic and sociocultural levels. For this purpose, raising awareness of parents and providing financial support to families are required because of the long-term treatment process. It was thought that the long-term treatment process of these patients in a single-unit authority with the guidance of universities would be appropriate for better patient follow-up and inventory. Otherwise, as seen in this study, contact cannot be established after a while and some problems can arise with regard to follow-up. Lack of communication can lead to the formation of more difficult patients with growth and development.

Histomorphometric evaluation of the effects of various diode lasers and force levels on orthodontic mini screw stability.

OBJECTIVE: The purpose of this study was to evaluate the effects of different laser dose and force levels on the stability of orthodontic mini screws used for anchorage, by histomorphometric analyses. BACKGROUND DATA: Low-level laser therapy speeds up blood flow, improves the mechanism of the revitalization processes, reduces the risk of infection, boosts metabolic activities, and accelerates the healing of the damaged tissue. Although there are many research studies about low-level laser therapy applications in a variety of areas, no investigations were found concerning mini screw stability using various laser dose levels with different force level applications. METHODS: Seventeen New Zealand white rabbits were used. A total of 68 cylindrical, self-drilling orthodontic mini screws were threaded at the fibula. Experimental subjects were divided into six groups; force application was not performed in the first three groups, whereas 150 g of force was applied via nickel-titanium closed-coil springs placed between two mini screws in the other three groups. Measurements of the initial torque values (10 Ncm) were manipulated by a digital portable torque gauge. Various low-level laser doses were applied to the groups during the postoperative 10 days. After 4 weeks, bone-to-implant contact and cortical bone thickness were histomorphometrically analyzed. RESULTS: In the 150 g force plus 20 J/cm(2) dosage group, the highest bone-to-implant contact values were observed. (p<0.05) There were no statistically significant correlations between cortical bone thickness and bone-to-implant contact values; on the other hand, no significant difference was found among the same groups in terms of cortical bone thickness values (p>0.05). CONCLUSIONS: Low-level laser therapy was noticed to induce the mini screw-bone contact area. Low-level laser therapy may be a supplementary treatment method to increase the stability of the orthodontic mini screw.

Effect of different temporary crown materials and surface roughening methods on the shear bond strengths of orthodontic brackets.

OBJECTIVE: The aim of this study was to evaluate the effect of different temporary crown materials (TCMs) and surface roughening methods on the shear bond strength (SBS) of orthodontic brackets. BACKGROUND DATA: TCMs are widely used during orthodontic treatment in teeth in need of prosthetic treatment, to prevent damage to the final restoration. However, there is no consensus considering the best method for roughening of the surface of TCMs. METHODS: Five different TCMs [Dentalon Plus-(D), Basworth Trim II-(B), Voco Structure Premium-(V), 3M ESPE Protempt 4-(P), and Revotek LC-(R)] were used in this study. Different surface roughening methods (37% phosphoric acid, sandblasting, and Er:YAG laser) were employed in three subgroups (n=20). The SBS test was used to assess the durability of all groups. Scanning electron microscopy (SEM) analysis was performed on a representative specimen in each group. RESULTS: The highest mean SBS value was observed in group V, followed by groups D and P, regardless of the surface treatment. The lowest SBS values were observed in group B. The laser-irradiated groups had higher SBS values than the sandblasted and acid-etched groups. Furthermore, a significant difference in SBS values was observed between the laser-irradiated group V and all other groups (p<0.005). CONCLUSIONS: The effects of the chemical nature of TCMs on the SBS values appeared to be clinically negligible, whereas the type of surface treatments had a significant influence on bond strengths. Er:YAG laser irradiation caused a significant increase in bond strength between the TCMs and orthodontic brackets.

Effects of water flow rate on shear bond strength of orthodontic bracket bonded to enamel surface after Er:YAG laser ablation.

OBJECTIVE: The aim of present study was to evaluate the effect of water flow rate on enamel surface roughness and shear bond strength (SBS) of orthodontic brackets after Er:YAG laser ablation. BACKGROUND DATA: It is well known that external water supply is a fundamental requirement for Er:YAG laser efficiency on dental hard tissues. However, there is no consensus considering the water flow rate used during Er:YAG laser ablation. METHODS: Eighty sound human upper premolar teeth were used in the present study. Seventy-six teeth were assigned into four groups according to surface treatments. The 37% phosphoric acid-etched group served as the control. Er:YAG laser irradiation was performed in three subgroups with water flow rates of 25, 36, and 48 mL/min, respectively. All specimens were subjected to a SBS test. One specimen from each different surface treatment modality was examined by scanning electron microscopy. Kruskal-Wallis test was used to compare the SBS value of each group. RESULTS: Although the control group had the highest SBS value, statistically no significant differences were found among groups. CONCLUSIONS: Er:YAG laser application with a water flow rate of 48 mL/min produced better enamel surface alterations without any thermal damage to yield higher SBS values.