Radiographic and diagnostic approaches for mandibular asymmetries in orthodontic practice: a narrative review.

Mandibular asymmetry refers to dimensional differences between the left and right sides of the mandible in terms of size, form and volume. This condition may result in problems with functionality as well as appearance. Early intervention is often deemed optimal for addressing mandibular asymmetry; however, there is a lack of consensus regarding the diagnostic approach and strategy for identifying asymmetries in developing individuals. The purpose of this narrative review (NR) is to provide a clinician-focused update on the radiographic techniques for identifying mandibular asymmetries in orthodontic patients. Selective database searches were conducted until November 2023 to assess the available literature on mandibular asymmetry diagnosis. A health-sciences librarian developed a search strategy utilizing appropriate terms associated with mandibular asymmetry diagnosis. The databases used were Web of Science, Embase, Scopus, Liliacs and PubMed. Fifty-two studies were included in this review and data regarding the evaluation of mandibular asymmetries were presented with a narrative approach delineating clinical indications based on retrieved findings. There is no unanimous consensus on the method for diagnosing mandibular asymmetries. Cone beam computed tomography emerges as the preferred examination method for diagnosing mandibular asymmetry, thanks to the assessment of a 3D structure with a 3D image. However, the use of only orthopantomography could be advisable as a first-line diagnostic tool in children due to less radiation exposure.

Three-Dimensional Printed Lingual Arch Space Maintainer: A Game Changer in Pediatric Dentistry.

Early loss of deciduous teeth is a challenging situation to handle. In recent years, the loss of deciduous teeth has become very frequent because of the increased risk of caries. Space maintainers play a vital role in preventing space loss. Lingual arch space maintainers are effectively used to maintain space in the lower arch. In order to retain the length of the lower arch and to prevent mesial migration of the mandibular first permanent molar, lingual arch space maintainers are often indicated. Conventional lingual arch fabrication is technique-sensitive and cumbersome. Additionally, it has many documented drawbacks like solder breakage, cement loss, soft tissue lesions, etc. With the advent of newer technology like three-dimensional (3D) printing, the fabrication of appliances and prostheses has become more predictable, accurate, and relatively easier. The present case report highlights the technique and advantages of 3D printing to fabricate lingual arch space maintainers, which has the potential to revolutionize preventive orthodontics in pediatric dentistry.

A difference in application time between two direct orthodontic bonding methods: A prospective randomized clinical trial.

OBJECTIVE: This clinical study aimed to evaluate the difference in the time of application phase, employing the conventional and modified direct orthodontic bonding method. MATERIALS AND METHODS: Thirty patients who needed orthodontic therapy with fixed appliances were randomly divided into two equal groups (n = 15): the control and experimental group, according to the bonding method applied. A total of 600 metal brackets inch slot 0.022 (Mini Sprint®, Forestadent, Germany) were bonded to incisors, canines, and premolars using the light-cured adhesive Transbond XT (3M Unitek, Monrovia, CA, USA). The failure rates of the brackets were evaluated within 12 months. The independent samples t-test was applied. The Chi-square test and Fisher exact test were used for statistical analysis. RESULTS: The initial bonding time using the modified method was significantly shorter (3.27 min or 17.1% per patient) compared with the conventional bonding method (p < 0.001). Number of failed brackets between the two methods did not differ significantly (p = 0.226). CONCLUSION: The time of the application phase in initial bonding using the modified method (experimental group) was shorter than in control group. There was no statistically significant difference in the number of bond failures between the two methods. CLINICAL SIGNIFICANCE: The modified application phase of direct orthodontic bracket placement shortens the total bonding time and facilitates the manual work of orthodontists.

Evaluation of palate morphology in patients treated with leaf expander and hyrax expander: A geometric morphometric analysis.

OBJECTIVE: The aim of this study was to evaluate changes in shape of the palatal vault after maxillary expansion with hyrax expander (HE) and leaf expander (LE), using 3D Geometric Morphometric Analysis. SETTING AND SAMPLE POPULATION: Overall, 250 patients (110 M, 140 F) with maxillary transverse deficiency were selected for this study. In this study, 127 subjects were treated with HE, 123 with LE. MATERIALS AND METHODS: Digital dental models were obtained pre-treatment (T0) and after 12 months from the cementation of the device (T1) and processed by means of a digital scanner. Linear and morphometric analyses were conducted to determine the effects of each appliance on dental measurements and palatal shape, and a multiple linear regression was performed to analyse the influence of anchorage and appliance type on final shape. RESULTS: Morphometric analysis showed that there was a lowering of the palatal vault in the HE group, while in the LE group it remained unchanged: the difference in palatal shape at time T0 and T1 was statistically significant in both treatments (HE vs. LE). In the HE group, the change in shape also included the upper part of the palatal vault in the vertical dimension, while in the LE group the change in shape interested mainly palatal shelves and the lower portion of the palate. CONCLUSIONS: Both LE and HE produce clinically significant changes in the morphology of the palatal vault.

Enamel Deproteinization or Sandblasting for Enamel Reconditioning Before Acid Etching to Enhance the Shear Bond Strength of Metallic Brackets in a Third Bonding: An In Vitro Study.

BACKGROUND: Enamel conditioning with 37% phosphoric acid is the most common technique during orthodontic bracket bonding procedures. However, due to the repeated de-bonding of the orthodontic brackets during treatment, other methods were needed to condition the enamel surface and increase the bond strength. This study aimed to compare the effect of conditioning the enamel surface by sandblasting with aluminum oxide particles or 5.25% sodium hypochlorite gel in combination with acid etching compared to acid etching alone on shear bond strength (SBS). MATERIAL AND METHODS: One hundred eight extracted upper premolars were randomly divided into three groups according to the conditioning enamel surface method. After the first and second bonding of metal brackets, new metal brackets were bonded with a total-etching adhesive after enamel conditioning using different methods: acid etching only (37% phosphoric acid for 30 seconds) (AE group), sodium hypochlorite associated with acid etching (5.25% NaOCl gel for 60 seconds and then acid etching for 30 seconds) (NaOCl-AE group), and sandblasting associated with acid etching (sandblasting for five seconds and then acid etching for 30 seconds) (SB-AE group). The shear bond strengths of the brackets were tested with a universal testing machine. One-way analysis of variance (ANOVA) and Tukey's honestly significant difference (HSD) tests were used to detect significant differences in shear bond strength among groups at the third bonding. Repeated-measure ANOVA and Bonferroni's tests were used to detect significant differences in shear bond strength among the bonding attempts within each group. RESULTS: 5.25% sodium hypochlorite associated with the acid etching method produced significantly greater shear bond strength than sandblasting associated with acid etching and acid etching only methods at the third bonding (16.40 ± 5.80 MPa, 13.60.47 ± 6.40 MPa, and 9.90 ± 4.40 MPa, respectively; P < 0.001). However, there was no significant difference between the AE and SB-AE groups (P = 0.247). In addition, we found a significant decrease in the shear bond strength within each group after each bonding attempt. CONCLUSION: Conditioning the enamel surface with 5.25% sodium hypochlorite associated with acid etching produced greater bond strength than conditioning by sandblasting associated with acid etching and acid etching only at the third bonding. The bond strength of the metal bracket decreased with increasing bonding attempts, even with the application of enamel surface conditioning methods.

Early orthodontic treatment after periodontal surgery: a randomized controlled trial / Le traitement orthodontique précoce après la chirurgie parodontale : essai clinique randomisé et contrôlé.

Introduction: The pathological teeth migrations require correct multidisciplinary treatment which consists of periodontal surgery associated with early or late orthodontic treatment. The aim of this study was to know which of the two orthodontic treatments would have a better periodontal response. Material and Method: Two parameters, radiological (the height of the alveolar bone) and clinical (the depth of the periodontal pocket), were used to meet the objective of this work. Eighteen patients received early orthodontic treatment (straight wire appliance) after periodontal flap debridement surgery and eighteen others late orthodontic treatment (straight wire appliance). Results: The results showed the absence of significant difference between the two early and late orthodontic treatments after periodontal flap debridement surgery. Conclusion: Orthodontic treatment can be started early seven to ten days after periodontal surgery.

Introduction: Les migrations dentaires pathologiques exigent un traitement pluridisciplinaire correct qui consiste en une chirurgie parodontale associée à un traitement orthodontique précoce ou tardif. Le but de cette étude était de connaître lequel des deux traitements orthodontiques aurait une meilleure réponse parodontale. Matériel et méthode: Deux paramètres, radiologique (la hauteur du défaut osseux) et clinique (la profondeur de la poche parodontale), ont été utilisés afin de répondre à l'objectif de ce travail. Dix-huit patients ont reçu, après la chirurgie parodontale par un lambeau d'assainissement, un traitement orthodontique précoce (technique d'arc droit) et dix-huit autres un traitement orthodontique tardif (technique d'arc droit). Résultats: Les résultats ont montré l'absence de différence significative entre les deux traitements orthodontiques, précoce et tardif, après la chirurgie parodontale par un lambeau d'assainissement. Conclusion: Le traitement orthodontique peut débuter précocement dès sept à dix jours après la chirurgie parodontale.

Aligners: review of their chemical components, recycling, mechanical properties and therapeutic needs - Part 1 / Aligneurs : mise en perspective de la composition chimique, du recyclage, des propriétés mécaniques et des besoins thérapeutiques ­ Partie 1.

Introduction: The aligner is a thermoformed plastic device composed of various chemical components: polyurethane, polyethylene terephthalate glycol, polypropylene… All these plastics must be sufficiently resistant to abrasion and translucent for aesthetic purposes, but their solubility to salivary enzymes, insertion-disinsertion fatigue and recyclability vary according to material. From an orthodontic point of view, they must facilitate tooth movement. However, their behavior differs from that of orthodontic archwires: their Young's modulus, resilience and unloading curve are distinct, resulting in mechanical properties that fall significantly below the orthodontic requirements of multi-bracket systems. Objective: The aim of this article was to review the chemical composition, recycling and mechanical properties of aligners, and to put them into perspective with therapeutic indications. Materials and Methods: Literature data were approximated to orthodontic needs. Results: Neither plastic nor direct printing can match the mechanical properties of our archwires or the procedures of a reliable vestibular multi-attachment appliance. Discussion: Aligners remain an interesting tool in targeted indications.

Introduction: L'aligneur est un dispositif en plastique thermoformé dont la composition chimique est diverse : polyuréthane, polyéthylène téréphtalate glycol, polypropylène… Tous ces plastiques doivent être suffisamment résistants à l'abrasion et translucides pour être esthétiques mais ils présentent une solubilité aux enzymes salivaires, une fatigue liée à l'insertion-désinsertion et une recyclabilité qui sont variables selon le matériau. D'un point de vue orthodontique, ils doivent permettre de déplacer les dents. Mais leur comportement ne ressemble pas à celui des arcs orthodontiques : leur module de Young, leur résilience et leur courbe de décharge en sont éloignés et confèrent des propriétés mécaniques très inférieures aux exigences orthodontiques des appareils multi-attaches. Objectif: L'objectif de l'article était de faire le point sur la composition chimique, le recyclage, les propriétés mécaniques des aligneurs et de les mettre en perspective avec les indications thérapeutiques. Matériel et méthode: Les données de la littérature sont approchées des besoins orthodontiques. Résultats: Ni le plastique, ni l'impression directe ne sont en capacité de rivaliser avec les propriétés mécaniques de nos arcs ou avec les procédures d'un appareil multi-attache vestibulaire fiables. Discussion: Les aligneurs restent un outil intéressant dans des indications ciblées.

Factors influencing young patient arrival date at the orthodontic office: a study of 456 cases / Facteurs influençant la date d'arrivée du jeune patient au cabinet d'orthodontie : une étude sur 456 cas.

Introduction: The arrival date young patient's first orthodontic consultation is unrestricted but may influence the choice of treatment plan as well as its modalities. The objective of this study was to determine the factors that influence the date of the first consultation at the orthodontic office: advice from a third party or a health professional, the patient's gender, the socioeconomic level, the actual need for orthodontic treatment, and the vertical and anteroposterior skeletal dysmorphia. Materials and Methods: Young patient's file younger than 16 years were systematically included. A Wilcoxon and Kruskal-Wallis test was performed in univariate and multivariate analysis. The threshold was 5%. Results: 456 young patients were included. Anteroposterior skeletal discrepancy, referral by an acquaintance, and socioeconomic level appeared to be factors influencing patient arrival date. Gender, actual need for orthodontic treatment, referral from a health professional, and vertical skeletal discrepancy did not influence the arrival date at the office. Discussion: The date of consultation is not related to the actual orthodontic treatment need. Word-of-mouth seems to play an important role. Patients seem to relate an anteroposterior discrepancy to the need to consult an orthodontist, but do not relate it to vertical discrepancy, although ventilation may be related to severe dysmorphia. Conclusion: This study encourages more communication about orthodontic treatment indications with patients and caregivers.

Introduction: La date d'arrivée du jeune patient en première consultation orthodontique est libre mais peut influencer le choix du plan de traitement, ainsi que ses modalités. L'objectif de cette étude était de déterminer les facteurs qui influencent la date de première consultation au cabinet d'orthodontie : le conseil d'un tiers ou d'un professionnel de santé, le genre du patient, le niveau socio-économique, le besoin réel de traitement orthodontique, la dysmorphie squelettique verticale et antéro-postérieure. Matériels et méthodes: Les dossiers de jeunes patients de moins de 16 ans ont été systématiquement inclus. Un test de Wilcoxon et Kruskal-Wallis a été effectué en analyse univariée et multivariée. Le seuil retenu était de 5 %. Résultats: Au total, 456 patients ont été inclus. Le décalage squelettique antéro-postérieur, le fait d'être adressé par une connaissance et le niveau socio-économique semblent être des facteurs influençant la date d'arrivée du jeune patient. Le genre, le besoin réel de traitement orthodontique, le fait d'être adressé par un professionnel de santé, le décalage squelettique vertical n'ont pas d'influence sur la date d'arrivée au cabinet. Discussion: La date de consultation n'est pas liée au besoin réel de traitement. Le bouche à oreille semble jouer un rôle important. Les patients semblent faire le lien entre un décalage antéro-postérieur et la nécessité de consulter un orthodontiste, mais ne le font pas pour le décalage vertical alors que la ventilation peut être liée à des dysmorphies sévères. Conclusion: Cette étude encourage à communiquer davantage sur les indications de traitement orthodontique avec les patients et les soignants.

Fractal analysis of mandibular trabecular pattern following protraction facemask therapy : A pilot study.

OBJECTIVE: To assess the remodeling effects of protraction facemask therapy on the trabecular pattern of the mandible and identify quantitatively the regions of the mandible undergoing maximum changes in the trabecular pattern. MATERIALS AND METHODS: The retrospective study was conducted in 30 subjects divided into two groups. The treatment group (group 1) consisted of 15 subjects with skeletal class III malocclusion treated with a facemask (mean age: 9.1 ± 2.1 years). Digital panoramic radiographs (OPG) were obtained before treatment (T0) and at the end of active facemask therapy (T1) with a mean duration of 16.1 ± 2.5 months. In all, 15 skeletal class I subjects who did not undergo any orthodontic treatment (mean age 9.1 ± 2.2 years) comprised the control group (group 2) who had two OPGs at a mean interval of 13.6 ± 2.2 months. The fractal dimensional (FD) value was calculated in three regions: angular, condylar, and corpus region. RESULTS: Intragroup comparisons revealed a significant increase in the FD values in the right condylar (T0 = 1.2 ± 0.2; T1 = 1.4 ± 0.1) and left condylar (T0 = 1.2 ± 0.1; T1 = 1.4 ± 0.1) region (p < 0.05) and in the corpus region (FD values: right T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; left T0 = 1.2 ± 0.1, T1 = 1.4 ± 0.1; p < 0.05). The intergroup comparison demonstrated that the treatment group showed greater changes compared with the controls in the condylar process (mean difference: right = 0.19, left = 0.20; p < 0.05) and the corpus region (0.172; p < 0.05). CONCLUSION: FD analysis demonstrated that the condylar process and the corpus region underwent the most significant change in the trabecular pattern in subjects treated with protraction facemask therapy.

Assessment of the Effect of Thermoforming Process and Simulated Aging on the Mechanical Properties of Clear Aligner Material.

Background Choosing the optimal aligner material on the market is crucial to ensure constant forces for tooth displacement. Processes like manufacturing and intraoral usage can result in the degradation of certain properties, which can affect the overall efficacy of treatment. Objective The objective of the study is to compare the surface roughness and flexural modulus of two aligner materials following the processes of thermoforming and aging. Materials and methods Two groups of 12 samples each were tested: Group 1 consisted of polyethylene terephthalate glycol (PET-G) and Group 2 of zendura-polyurethane (PU). The groups were tested at three time points: T0 - pre-thermoformed; T1 - after thermoforming; T2 - after thermoforming and aging. The surface roughness and the flexural modulus were evaluated. One-way ANOVA followed by a Bonferroni post hoc test was conducted to compare the changes within each group across the three times. An independent t-test was done to compare the values between the two groups at each time point. The statistical tests were performed using SPSS software version 26 (IBM Corp., Armonk, NY, USA). P-values >0.05 were considered statistically significant. Results There was a significant change in the surface roughness post-aging in Group 2 (p=0.03) and flexural strength within Group 1 (p=0.031) and Group 2 (p=0.06) across the three time points. Comparing the changes within the three time points in Group 1, significant changes were observed between T0-T1 (p=0.045) and T0-T2 (p=0.07). In Group 2, significant changes were observed between T0-T2 (p=0.012). Comparing the flexural strength between the two groups, significant differences were observed at T0 (p=0.012) and T1 (p=0.001). Conclusion The aging process affected the surface roughness in Zendura (PU). The thermoforming and aging process resulted in reduced flexural strength in both Zendura (PU) and Duran groups (PET-G).

Longitudinal bibliometric investigation of published orthodontic research 2013-23: are we investigating patient-reported outcomes?

BACKGROUND: The published literature represents the fundamental basis of any academic specialty, including orthodontics. Orthodontic research outputs provide useful insight into clinical and research priorities, which can help inform future research efforts and resource outputs. In recent years, the need for more patient-reported outcomes in orthodontic research has been highlighted. OBJECTIVES: To identify the most common reported research subjects in orthodontics between 2013-23; (2) identify the main outcomes and types of study design associated with this research, including study design related to patient-reported outcomes; and (3) identify trends in this research activity based upon these findings. MATERIAL AND METHODS: A literature search was performed in a single electronic database (Scopus) to return all indexed publications with relevance to orthodontics published from 2013 to 2023. The 50 most-cited publications per year were then identified. Publication characteristics were extracted using a data collection sheet. Descriptive statistics including frequency distributions were calculated. RESULTS: A total of 14 397 publications were identified. Publications on orthodontic bonding made up 7.02% of all output, followed by materials (5.88%) and tooth movement (5.42%). Subsequent analysis of the most-cited publications per year revealed the most frequently published subjects were aligners (12.5%), orthodontic tooth movement (9.45%), and digital workflow (9.09%), and the most common study designs were in vitro (19.09%) and retrospective observational studies (15.45%). The most common outcome type was morphological features of malocclusion (26.9%). Conversely, patient-focused measures were only reported in 12.7% of studies. CONCLUSIONS: Orthodontic research outputs are dynamic but do show consistent research interest in certain subjects. There is a predilection for the reporting of clinician-focused outcomes; whilst these have some value, more efforts should be focused on conducting rigorous and robust studies that include patient-reported outcomes.

Genetic and environmental impact on variation in the palatal dimensions in permanent dentition: a twin study.

The objective of this study was to assess the relative contributions of genetic and environmental factors to variation in palatal parameters in twins with completed maxillary growth. The subjects of this study comprised digital dental casts of 50 monozygotic and 35 dizygotic twin pairs. The subjects' average age was 17.95 ± 2.83 years. Zygosity determination was carried out using 15 specific DNA markers and an amel fragment of the amelogenin gene. The interdental distances were measured between selected dental landmarks at the occlusal and gingival planes. The palatal height, surface area and volume were measured between the gingival plane and the midpalate suture. High heritability estimates were observed for all transverse intra-arch measurements. The palate height (a2 = 0.8), dental arch width in the molar area (a2 = 0.86), palatal surface area (a2 = 0.61) and palate volume (a2 = 0.69) were under strong additive genetic control. Moderate genetic dominance was observed for dental arch widths at the gingival line in the canine (d2 = 0.5) and premolar regions (d2 = 0.78-0.81). Sexual dimorphism was shown, with males exhibiting a greater arch width, palate surface area and volume than females (p < 0.01). The majority of palate parameters variation in twins was controlled by genetic effects, and most were highly heritable.

Midline Diastema Closure Following Frenectomy Using M-spring: A Case Report.

Midline diastemas are one of the most prevalent dental malocclusions. In young adults this may create aesthetics problems, especially in individuals marked by a gap between central incisors higher than 4 mm. This case report demonstrates the treatment of a patient with Angle's Class I malocclusion and midline diastema with the M-spring appliance resulting in complete closure within four months. The case included a frenectomy for correction of the abnormal labial frenal attachment followed by an M-spring orthodontic appliance. This "M" shaped device, with specific activation points, provides control over tooth movement and consequently achieves this site closure in a short duration of time by tipping the crowns of central incisors in a mesial direction. This procedure aimed to resolve aesthetic issues while also enhancing and ensuring functional occlusion.

What could be the role of genetic tests and machine learning of AXIN2 variant dominance in non-syndromic hypodontia? A case-control study in orthodontically treated patients.

BACKGROUND: Hypodontia is the most prevalent dental anomaly in humans, and is primarily attributed to genetic factors. Although genome-wide association studies (GWAS) have identified single-nucleotide polymorphisms (SNP) associated with hypodontia, genetic risk assessment remains challenging due to population-specific SNP variants. Therefore, we aimed to conducted a genetic analysis and developed a machine-learning-based predictive model to examine the association between previously reported SNPs and hypodontia in the Saudi Arabian population. Our case-control study included 106 participants (aged 8-50 years; 64 females and 42 males), comprising 54 hypodontia cases and 52 controls. We utilized TaqManTM Real-Time Polymerase Chain Reaction and allelic genotyping to analyze three selected SNPs (AXIN2: rs2240308, PAX9: rs61754301, and MSX1: rs12532) in unstimulated whole saliva samples. The chi-square test, multinomial logistic regression, and machine-learning techniques were used to assess genetic risk by using odds ratios (ORs) for multiple target variables. RESULTS: Multivariate logistic regression indicated a significant association between homozygous AXIN2 rs2240308 and the hypodontia phenotype (ORs [95% confidence interval] 2.893 [1.28-6.53]). Machine-learning algorithms revealed that the AXIN2 homozygous (A/A) genotype is a genetic risk factor for hypodontia of teeth #12, #22, and #35, whereas the AXIN2 homozygous (G/G) genotype increases the risk for hypodontia of teeth #22, #35, and #45. The PAX9 homozygous (C/C) genotype is associated with an increased risk for hypodontia of teeth #22 and #35. CONCLUSIONS: Our study confirms a link between AXIN2 and hypodontia in Saudi orthodontic patients and suggests that combining machine-learning models with SNP analysis of saliva samples can effectively identify individuals with non-syndromic hypodontia.

A cross-sectional study to correlate oral hygiene habit among orthodontic patients with their clinical findings and periodontal treatment need.

BACKGROUND: Orthodontic treatment requires good oral hygiene for successful completion of treatment. As protocol, patients are usually given instructions for oral hygiene and diet at the start of treatment, however, they are not fully followed. Different methods are employed in order to increase patient compliance including digital means, however, these are not possible in teaching hospitals with high burden of patient care and limited resources. The present study aims to correlate the patient reported behavior with their clinical findings and treatment need. This will enable us to identify potential sources of motivation which will be incorporated in daily practice and enable us to improve methods to enhance patient's behavior. METHOD: A cross-sectional study was conducted in the orthodontic department of a semi-government teaching hospital from August to October 2023 using a modified questionnaire. The clinical examination was done using a Community Periodontal Index for Treatment Need-C (CPITN-C) probe. The diagnosis of presenting clinical conditions and treatment need was done using Community Periodontal Index for Treatment Need (CPITN) and Gingival Bleeding Index (BI). Data collected was analyzed for frequencies and correlation was done using Spearman Correlation Coefficient. P- value ≤ 0.05 was taken as statistically significant. RESULT: The sample size consisted of 110 patients of which 60% were entitled to receive treatment. The predominant age group was 15-20 years (39.1%). Approximately 70% patients were in code 1 for CPITN and GI and in need of oral hygiene instructions. Overall patients' showed good level of awareness, however, they were not compliant in behavior. CONCLUSION: Although patients showed a good level of awareness towards oral hygiene practices, there was a lack of compliance in following them. Patients were more concerned for being affected by dental caries due to poor oral hygiene than its effect on overall treatment outcome.

A multidisciplinary approach to managing severe gummy smile using 3D simulation and digital surgical guide: a case report.

A smile that reveals >4 mm of gum tissue is called a gummy smile (GS), offering negative impacts on people's self-confidence and aesthetic appearance. The treatment for GS should be planned according to underlying causes such as altered passive eruption of teeth, dentoalveolar extrusion, vertical maxillary excess, and short or hyperactive lip muscles. In this case report, a patient with severe GS received orthodontic and gingivoplasty treatment, aided by digital tools such as 3D simulation, smile design, and 3D printed guides. The treatment yielded remarkable and satisfactory results, without the need for extensive surgery. Our findings suggest that gingivoplasty is a minimally invasive, time- and cost-effective alternative to more extensive procedures for correcting severe gum recession.

Revolutionizing Smiles: Advancing Orthodontics Through Digital Innovation.

Orthodontics is undergoing a digital revolution, transforming traditional techniques with modern technology. This evolution is driven by the need for precise diagnosis and treatment planning. Digital platforms, including digital radiography and cone beam computed tomography (CBCT), are replacing conventional methods, enhancing documentation, analysis, and appliance production. Three-dimensional imaging enables customized treatment plans and appliance design using computer-aided design and computer-aided manufacture (CAD/CAM). Integration of digital models and software facilitates treatment simulation and patient communication. Digital videography enhances diagnostic capabilities. Embracing digital processes is essential for improved patient care and practice efficiency in orthodontics. This review article on digital orthodontics aims to provide a comprehensive overview and critical analysis of the current advancements, technologies, applications, benefits, and challenges in the field of orthodontics utilizing digital tools and technologies.

LASER assisted soft tissue procedures for orthodontic treatment.

Light Amplified Stimulated Emission of Radiation (LASER) therapy has been the subject of numerous researches as an auxiliary method in orthodontic practice. Therefore, it is of interest to assess the clinical evaluation of laser assisted soft tissue procedures for orthodontic treatment. The soft tissue surgical procedures carried out were aestheticre-contouring, gingivectomy, maxillary frenectomy, operculectomy and surgical exposure of impacted canines. The clinical outcomes evaluated in each patient were post-operative pain, bleeding during surgical procedure. In our study, clinical evaluation of outcomes in both categories revealed reduced pain at 1 hour and 24 hour after surgical procedures in patients who underwent surgery with LASER.. Soft tissue Laser can be an alternative to conventional surgery for soft tissue surgeries in orthodontics with better pain relief and reduced bleeding.

Accuracy of full arch scans using the iTero Element 2® intra-oral scanner: A clinical study.

OBJECTIVE: To investigate the accuracy of full arch scans taken using the iTero Element 2® under clinical settings. DESIGN: Prospective clinical study. METHODS: A customised upper removable appliance (URA) with four spheres (A-D) was fabricated from a maxillary arch iTero® scan for a 24-year-old patient. Six linear values were measured on the URA using a high-accuracy coordinate measuring machine. A total of 60 intra-oral iTero® scans were taken by two operators (HA and AS) with the test URA inserted to the participant's maxillary dentition at T1 and T2. Geomagic Control X software was used to measure the six linear distances between the reference spheres (1-4) in all scans. Comparisons between distances on full arch scans to true distances on the URA were made to evaluate accuracy. RESULTS: The median distance to the prepared bench top URA mean was significantly away from zero for each operator and timepoint across all measurements except AD versus 14 and BD versus 24. Statistically significant, although clinically non-significant, differences in median linear distances in relation to the prepared benchtop URA were observed between evaluators in segments AB versus 12 (operator 1 -0.021 mm vs. operator 2 -0.06 mm) and AC vs. 13 (operator 1 -0.044 mm vs. operator 2 -0.167 mm) at T1. CONCLUSION: The accuracy of scanners is defined as the trueness and precision of the captured scans to the dental arches. The accuracy of iTero Element 2® is acceptable for diagnosis and treatment planning in orthodontics. Length and location of the scanned segment and scanning sequence 'protocol' affect accuracy.

Adolescent Patient's Perceptions During Treatment With Class II Elastics.

The article presents a case of a 13-year-old adolescent male patient who started orthodontic treatment at the age of 12. Before treatment, he was diagnosed with narrow maxilla, proclination of upper incisors, deep overbite, distal occlusion bilaterally with significant sagittal overjet in frontal area, skeletal Class II, and hypodivergent growth pattern. During treatment, the patient is in his pubertal growth spurt. About 2 months after intermaxillary Class II elastics (1/4 heavy, 6.5 Oz) were applied, he complained of pain during mastication, wide opening of the mouth, and sometimes during protrusive and lateral movements in the right TMJ. The TMJ X-ray examination did not reveal abnormal morphological changes. Occlusion was evaluated by an electromyographic device, Teethan. The result was typical for Class II malocclusion. During the bilateral palpation of the zones of TMJ and opening of the mouth and chewing, the patient reported pain on the right side. There was no clicking in the joint. The elastic wear was stopped, and soon afterwards, the pain disappeared. These complaints point to a possible relationship between orthodontic treatment and TMJ pain. However, the disappearance of complaints after the removal of the Class II elastics points that the temporomandibular joint disorder (TMD) symptoms are reversible and resolved.