A comparison of maxillary posterior changes following facemask therapy: Skeletal anchorage versus tooth-borne anchorage.

OBJECTIVE: To compare changes in the maxillary posterior structure as seen in cone-beam computed tomography (CBCT) images resulting from facemask therapy using skeletal (miniplate/FM) anchorage versus tooth-borne anchorage (RME/FM). MATERIALS AND METHODS: A retrospective study was conducted on 20 patients divided into the miniplate/FM group (nine patients aged 9.5 ± 1.4 years) and the RME/FM group (11 patients aged 9.2 ± 1.4 years). CBCT images before and after facemask therapy were evaluated to assess changes in the maxillary posterior structure. RESULTS: The miniplate/FM group had greater advancement of the maxilla and midface compared to the RME/FM group (p < .05). Specifically, there was about three times more advancement of the pterygomaxillary suture in the miniplate/FM group than in the RME/FM group (p < .05). Moreover, the advancement of the pterygomaxillary suture was about half the advancement of A point in the miniplate/FM group, while only about 25% in the RME/FM group. Finally, the miniplate/FM group showed an increase in the transverse dimension of the posterior and superior parts of the maxilla (p < .05). CONCLUSION: There was greater forward movement of the pterygomaxillary suture with facemask therapy using the skeletal anchorage compared to tooth-borne anchorage, leading to a more significant advancement of the maxilla and midface.

Interdisciplinary treatment of mutilated dentition and transverse maxillary deficiency with microimplant-assisted rapid palatal expansion, microimplants, and dental implants.

OBJECTIVE: This case report demonstrates an interdisciplinary approach to treat a 26-year-old male patient with hyperdivergent Class II skeletal pattern, maxillary transverse deficiency, slight anterior open bite, and multiple hopeless teeth with root rests. CLINICAL CONSIDERATIONS: An interdisciplinary treatment was required for oral hygiene improvement, caries treatment, extraction of residual roots and hopeless teeth, maxillary expansion using microimplant-assisted rapid palatal expansion, improvement of skeletal and dental relationship using orthodontic microimplants, and prosthetic restorations with the aid of dental implants. CONCLUSION: Consequently, esthetic and functional occlusal rehabilitation was achieved. CLINICAL SIGNIFICANCE: Hyperdivergent Class II facial and skeletal patterns with multiple missing teeth can be effectively treated using orthodontic skeletal anchorage. In young adults, the transverse discrepancy can be resolved using MARPE, which is also useful for improving the sagittal and vertical relationships. In the case of multiple missing teeth, orthodontic treatment can provide the proper space to facilitate dental implants to achieve optimal esthetics and function.

Interdisciplinary treatment of a mutilated dentition with multiple missing teeth and horizontal impaction of a mandibular third molar using an orthodontic skeletal anchorage and dental implants-Case report.

OBJECTIVE: This case report presents a female adult patient who exhibits poor oral hygiene, a mutilated dentition with multiple missing teeth, and skeletal asymmetry. CLINICAL CONSIDERATIONS: Interdisciplinary treatment was necessary to maintain oral hygiene, treat caries, extract residual roots, and upright a horizontally impacted third molar using a miniplate. Additionally, orthodontic mini-implants were utilized as anchorage to improve sagittal relationship and space closing. Space management was completed with orthodontic treatment, followed by restoration of the multiple missing teeth with dental implants. CONCLUSION: Consequently, an esthetic smile and functional occlusion were achieved by interdisciplinary treatment using orthodontic skeletal anchorage devices and dental implants. CLINICAL SIGNIFICANCE: Missing mandibular first molar spaces were closed with retraction of the anterior teeth and protraction of the mandibular second molars using orthodontic mini-implants. The mandibular right third molar, which should have erupted, was protracted with the second molar, while the horizontally impacted mandibular left third molar was uprighted using a miniplate and was protracted with an orthodontic mini-implant. The missing maxillary lateral incisors were replaced with the maxillary canines, and the maxillary canines were replaced with the maxillary first premolars. The missing maxillary right second premolar and first molar and left first and second molars were successfully restored with dental implants.

Dentoskeletal effects of mini-screw assisted, non-surgical palatal expansion in adults using a modified force-controlled polycyclic protocol: a single-centre retrospective study.

OBJECTIVES: This study assessed the dental and skeletal effects of pure bone-borne, non-surgical maxillary expansion, using a modified force-controlled polycyclic protocol. METHODS: Records of 17 adult patients, mean age 24.1 years; range 18-39 years, who had undergone maxillary expansion using a bone-borne Quad-expander (with 4 mini-screws), were analysed. In all patients, 0.17 mm/day of expansion was completed for 1 week, followed by a cyclic protocol of expansion of forward and backward turns until the force needed to turn the expander was below 400 cN, assessed weekly. After this, expansion continued at a rate of 0.17 mm/day until the desired amount of expansion was achieved. Cone beam computer tomography scans were taken pre- and post-expansion. RESULTS: The mid-palatal suture was successfully opened in 100% of patients included in this study. Axially, the amount of skeletal opening at the posterior nasal spine was 61% of the anterior nasal spine. Expansion was pyramidal in the coronal plane. Significant increases at the dental and skeletal levels were achieved, with changes at the skeletal level reaching 73%. The alveolar bone angle increased more than the angular changes at the molars and premolars. LIMITATIONS: This is a retrospective study with short-term results. CONCLUSION: The Quad-expander, with a force-controlled polycyclic expansion protocol, effectively produced a significant increase in maxillary width in skeletally mature subjects in the short term.

Cephalometric and digital model analysis of dentoskeletal effects of infrazygomatic miniscrew vs. Essix- anchored Carriere Motion appliance for distalization of maxillary buccal segment: a randomized clinical trial.

TRIAL DESIGN: Parallel. OBJECTIVE: To compare skeletally anchored Carriere Motion appliance (CMA) for distalization of the maxillary buccal segment vs. Essix anchored CMA. METHODS: Thirty-two class II malocclusion patients were randomly allocated into two equal groups. One group was treated with infrazygomatic (IZC) miniscrew- anchored CMA (IZCG) and the other group treated with Essix retainer- anchored CMA (EXG). Two lateral cephalograms and two digital models for upper and lower arches were taken for each patient: immediately before intervention and after distalization had been completed. RESULTS: Distalization period was not significantly different between the two groups. In contrast to EXG, IZCG showed insignificant difference in ANB, lower incisor proclination, and mesial movement of the lower first molar. There was significant rotation with distal movement of maxillary canine and first molar in both groups. CONCLUSION: IZC anchored CMA could eliminate the side effects of class II elastics regarding lower incisor proclination, mesial movement lower molars with a more significant amount of distalization of the maxillary buccal segment but with significant molar rotation. TRIAL REGISTRATION: The ClinicalTrials.gov Protocol Registration and Results System (PRS) has this RCT registered as (NCT05499221) on 12/08/2022.

Accuracy of digital workflow for placing orthodontic miniscrews using generic and licensed open systems. A 3d imaging analysis of non-native .stl files for guided protocols.

BACKGROUND: This study aimed to assess the accuracy of digital workflow for guided insertion of miniscrews in the anterior palate using restorative implant dentistry software and licensed software for orthodontic applications. METHODS: Twenty subjects (8 males, 12 females, mean age = 16.7 ± 2.1 years) were prospectively selected to receive guided insertion of bicortical palatal miniscrews. Virtual planning was performed using restorative implant dentistry software (Blue Sky Plan*, version 4.7) (group 1 = 10 subjects) and licensed orthodontic software (Dolphin Imaging Software, version 11.0) (group 2 = 10 subjects). A specific 3D Imaging technology was applied to permit the registration of the planned and achieved position of the miniscrews based on the superimposition of maxillary models. The angular deviation (accuracy error) between the planned and the achieved positions of the miniscrews were recorded. Independent Student's test was used with statistical significance set at p value < 0.05. RESULTS: The mean accuracy error recorded in group 1 was 7.15° ± 1.09 (right side) and 6.19 ± 0.80 (left side) while the mean error in group 2 was 6.74° ± 1.23 (right side) and 5.79 ± 0.95 (left side). No significant differences were recorded between the two groups (p > 0.05); instead, miniscrews placed on the right side were almost one degree higher than the left side (p < 0.05) in both groups. CONCLUSIONS: The clinical accuracy error was similar when using generic and licensed orthodontic software for guided systems.

Computer-guided miniscrew insertion in the paramedian and parapalatal area of the palatal vault: low failure rate and no learning curve required to obtain predictable results?

AIM: To evaluate the failure rate of palatal computer-guided miniscrews, placed in paramedian and parapalatal regions for orthodontic purposes. In addition, to investigate the presence of a learning curve using computer guided miniscrew insertion, and to evaluate the peri-implant soft tissues response at 2-, 6- and 12- month follow-ups. MATERIALS AND METHODS: 202 palatal computer-guided miniscrews were inserted in 78 subjects for orthodontic purposes. A surgical guide was designed after planning the appropriate insertion sites on three-dimensional images created by the fusion of cone-beam computed tomography (CBCT) and digital dental model images. The devices were disassembled monthly to perform the percussion test and to evaluate the mobility of each miniscrew. To determine the presence of a learning curve, the time of miniscrew failures and the number of surgeries were evaluated. Bleeding on probing (BOP) and probing pocket depth (PPD) were recorded for each miniscrew, at 2- (T0), 6- (T1), and 12-month follow ups (T2). RESULTS: An immediate failure rate of 4.95%, due to lack of primary stability immediately following miniscrew insertion, was recorded, with statistically significant higher failure rate of parapalatal miniscrews (P= 0.00). Miniscrew failure occurred at random time, with an absence of a learning curve. The BOP (mean: 3.13%) and PPD (mean: 1.68mm) measurements remained stable over time. CONCLUSIONS: Computer-guided miniscrew insertion in the palatal vault showed a low failure rate without a determined learning curve to obtain predictable results and with long-term stability of peri-implant soft tissues indexes.

Class III malocclusion treated with a 3D-printed hybrid hyrax distalizer combined with mentoplate using Alt-RAMEC protocol: A case report.

INTRODUCTION: The aim of this report was to assess the skeletal, dental and soft tissue changes in a juvenile patient with a severe class III malocclusion. This case report describes a novel method of class III treatment using skeletal anchorage for maxillary protraction and Alt-RAMEC protocol. PATIENT CONCERNS: The patient did not have any subjective complaints before treatment and there was no family history of class III malocclusion. CLINICAL FINDINGS AND PRIMARY DIAGNOSES: Extra-orally, the patient had a concave profile with a retrusive mid-face and prominent lower lip. The intra-oral examination revealed angle class III malocclusion with a -3-mm overjet. There was no anterior displacement on closure when the patient was assessed clinically. According to the cephalometric analysis, the sagittal jaw relation and Wits appraisal were reduced due to a retrognathic maxilla and prognathic mandible. INTERVENTIONS: The treatment plan involved maxillary protraction, Alt-RAMEC protocol for 10 weeks and upper molar distalisation with a hybrid hyrax distalizer in combination with a mentoplate. The active treatment time was estimated to 18 months followed by 6 months retention with the appliance. OUTCOMES: The sagittal jaw relationship was increased by approximately 9°, mainly due to maxillary advancement of 8 mm and a positional change of the mandible anteroposteriorly. Natural decompensation of the lower incisors was also observed. In addition, both the facial profile and the smile became more harmonious after treatment. The treatment analysis revealed that the changes achieved were mainly skeletal and it was possible to avoid adverse effects on the dentition. CONCLUSION: In conclusion, treatment with a hybrid hyrax distalizer combined with mentoplate using the Alt-RAMEC protocol is effective in correcting the anteroposterior discrepancy in a juvenile class III patient and it is possible to achieve maxillary advancement of 8 mm.

The effects of a corticotomy on space closure by molar protraction using TSADs in patients with missing mandibular first molars.

INTRODUCTION: The purpose of this study was to evaluate the effects of a triangular-shaped corticotomy on the protraction of second and third molars in patients with missing mandibular first molars. SUBJECTS AND METHODS: The corticotomy and non-corticotomy groups consisted of sixteen first molars in fifteen patients (28.6 ± 9.4 years) and nineteen first molars in fifteen patients (26.6 ± 8.4 years), respectively. A triangular-shaped corticotomy was performed between the second premolar and molar. Temporary skeletal anchorage devices (TSADs) were placed between the first and second premolars in both groups. Mandibular dentition variables were measured on the pre and post-treatment panoramic radiographs and lateral cephalograms. Analysis of covariance was performed. RESULTS: The corticotomy group exhibited 2.8 mm more inter-radicular correction between the second molar to second premolar roots (P < .001) and 1.6 mm more inter-radicular distance correction between the third molar to second premolar roots compared to the non-corticotomy group (P < .01). The corticotomy group required 5.5 months less treatment time for space closure (P < .05), but the total treatment time was the same for both groups. CONCLUSIONS: The inter-radicular distance between the mandibular second premolar and molar and treatment times for space closure was significantly reduced in the corticotomy group.

Analysis of biological and structural factors implicated in the clinical success of orthodontic miniscrews at posterior maxillary interradicular sites.

OBJECTIVE: This study aims to evaluate success factors implicated in clinical orthodontic miniscrew stability after their interradicular placement in maxilla. MATERIALS AND METHODS: Six hundred seventy-six miniscrews were inserted in maxillary interradicular sites in a sample of 276 patients (109 males and 167 females; mean age 19 ± 1.7 years) and immediately loaded. Percentage failure rate was recorded, and the influence of the following factors was investigated: structural (miniscrew length, diameter and body shape), operative (side of insertion site, pilot hole drilling or not) and biological (maximal insertion torque [MIT] and type of gingiva). A chi-square test with Monte Carlo correction was performed to detect the influence of these variables on the failure rate of orthodontic miniscrews. Then both multivariate logistic regression and post hoc analysis were performed, followed by classification and regression tree (CART) analysis. RESULTS: The average success rate was 88%. The principal factors implicated in the failure rate were miniscrew length, MIT values and type of gingiva. Specifically, 8 mm miniscrew length, alveolar mucosa and 5-10 Ncm MIT values were linked to higher failure rates. According to CART, the main variable influencing failure is miniscrew length (≤ 8 mm for higher failure rates). For others, MIT values of 5-10 Ncm are linked to higher failure rates (p < 0.05). CONCLUSION: Orthodontic miniscrews inserted in the maxilla display good success rates. However, clinicians should be discouraged from using miniscrews of length ≤ 8 mm and MIT values < 10 Ncm, even with longer miniscrews. CLINICAL RELEVANCE: Information about factors related to failure rate of miniscrews placed at posterior maxillary interradicular sites is given.

An interdisciplinary approach to orthodontic treatment of a mutilated Class III malocclusion with mini-implants, dental implants, and an autotransplant.

This case report demonstrates the interdisciplinary treatment of a 24-year-old female. Her skeletal discrepancy, anterior crossbite, mutilated dentition, and midline deviation made it challenging to achieve satisfactory treatment results, especially without major orthognathic surgery. This article thoroughly discusses the decision-making process associated with various treatment alternatives, the biomechanical considerations with temporary skeletal anchorage devices, and the detailed operational process of dental implant restoration and autotransplantation. CLINICAL SIGNIFICANCE: Orthodontic treatment aims to obtain better facial and dental esthetics, achieve functional occlusion, and improve oral health. Treatment of patients with a mutilated dentition requires interdisciplinary teamwork from a group of professionals with various types of expertise. Orthodontists should be the navigator that generates the tooth movement and space redistribution, thus facilitating the subsequent functional rehabilitation under a well-organized occlusal architecture. Autotransplantation offers an economical and biologically-friendly opportunity to replace a missing tooth.

Correction of an adult Class III malocclusion through regaining of orthodontic space and an implant restoration.

This case report describes the interdisciplinary treatment of a 23-year-old female with Class III malocclusion and a missing maxillary left second premolar. Treatment alternatives were discussed, and the selected treatment plan was presented to illustrate a way to gain space for the premolar implant restoration and correct Class III relationship through maxillary molar retraction followed by maxillary total arch protraction with a palatal temporary skeletal anchorage device. Esthetic anterior alignment and functional occlusal rehabilitation was achieved, and facial balance was maintained at the end of treatment. CLINICAL SIGNIFICANCE: Implant restoration in conjunction with regaining orthodontic space by a team of multidisciplinary dental specialists presents an effective treatment solution to permanent tooth agenesis. Class III malocclusion can be treated with a combination of maxillary protraction and mandibular retraction using temporary skeletal anchorage devices. The versatility of modified palatal C-plates presents greater clinical application when related side effects are controlled with solid understanding of their biomechanics.

Skeletal and dentoalveolar effects of class II malocclusion treatment using bi-maxillary skeletal anchorage: a systematic review.

BACKGROUND: The goal of this systematic review was to assess the available evidence regarding the skeletal and dentoalveolar effects of bi-maxillary skeletal anchorage devices (BMSADs) used in treating growing class II malocclusion patients. METHODS: A comprehensive search was conducted on PubMed, Scopus, Science Direct, Web of Science, Cochrane, and LILACS up to November 2021, which was augmented by a manual search. The studies included were clinical trials (RCTs) and/or follow-up observational studies (retrospective and prospective). The outcomes of interest were the skeletal, dentoalveolar, and occlusal treatment-induced changes obtained from pre- and post-cephalometric measurements. The risks of bias of the included studies were assessed using an assessment tool from previous publications. RESULTS: Out of 742 screened articles, only 4 were eligible and thus included in the qualitative synthesis. They showed a moderate overall risk of bias. The results are presented as mean changes in both the study and control groups. All studies reported retrusion of the maxillary base and advancement of the mandible (meaning reduced ANB angle). Three of the included studies reported an increase in the vertical jaw relation, which was contrary to what the fourth study reported. Three studies reported an increase in the maxillary incisors' inclination or position, while one study reported their retroclination. Proclination of the mandibular incisors happened in two studies, whereas the other two studies reported retroclination. The overjet was reduced in all included studies. CONCLUSION: Apart from the protrusive effects on the mandible, retrusive effects on the maxilla, and the consequent reduction of the overjet, BMSADs results in inconsistent skeletal and dentoalveolar effects. However, the current evidence is limited due to the variability in the biomechanics of the intermaxillary components, type of anchorage, and comparable groups in the included studies. Further RCTs with more standardized methodologies are highly encouraged. CLINICAL RELEVANCE: BMSADs (using miniscrews or miniplates on both jaws) induces more skeletal than dentoalveolar effects. However, this must be practiced with caution, based on the benefit to risk (surgical insertion) ratio, and the limited evidence available in hand so far. Registration The protocol for this systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO, No.: CRD42020199601).

Distalization of maxillary molars using temporary skeletal anchorage devices: A systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review is to assess the treatment effects (amount of distalization, distal tipping and vertical movement) of buccally versus palatally placed temporary skeletal anchorage devices (TSADs) on maxillary first molars during distalization. MATERIALS AND METHODS: Medline and Scopus databases were searched up to September 2020 for randomized controlled trials (RCTs) and non-randomized prospective cohort studies on maxillary molar distalization using TSADs in patients with Class II malocclusion. After study selection, data extraction and risk of bias assessment, meta-analyses were performed for the amount of distalization, distal tipping and intrusion of first molars. RESULTS: Nine studies (2 RCTs and 7 prospective studies) were included. The risk of bias of the RCTs was low to unclear. The non-randomized studies were of moderate quality. In five studies, the TSADs were placed in the infrazygomatic process while in two studies, they were placed in the buccal inter-radicular spaces, and in two studies, they were placed in the midpalatal region. The first molar distalization was 2.75 mm when buccal inter-radicular TSADs were used, but 4.07 and 4.17 mm with palatal and infrazgomatic TSADs. The palatal appliances were associated with 11.17° of distal tipping of the first molar while infrazygomatic and buccal inter-radicular TSADs resulted in 3.99° and 1.70° of tipping, respectively. CONCLUSIONS: Inter-radicular TSADs resulted in less distal tipping but also in less distalization. Palatal TSAD-supported appliances showed the greatest amount of distal tipping. Further RCTs or prospective studies on the effect of various designs of TSAD-supported distalization are warranted.

Skeletally anchored forsus fatigue resistant device for correction of Class II malocclusions-A systematic review and meta-analysis.

The use of skeletal anchorage with fixed functional appliances (FFA) has been proposed by various authors to produce skeletal changes and reduce lower incisor proclination. To compare the skeletal and dentoalveolar effects of Forsus Fatigue Resistant Device (FFRD) with or without skeletal anchorage (miniplates and mini-implants). The electronic database PubMed, Cochrane Library, Medline, Embase and Google Scholar along with a manual search of orthodontic journals till the year 2019. Only randomized control trials (RCTs) were included in the systematic review. One controlled clinical trial (CCT) which involved FFRD was included in the review since it was a continuation of an RCT which was expanded to a CCT. Skeletal and dentoalveolar outcome data were extracted to collect study characteristics. After evaluating risk of bias, the standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated. Three RCTs and one prospective CCT were evaluated. The analysis included data from 116 Class II subjects [(58) treated with FFA along with skeletal anchorage and (58) treated with FFA]. There were no significant difference between the two groups with respect to mandibular length changes (P value = .10) and SNB angle changes (P value = .22). With respect to lower incisor inclination however, there was a significant difference between the two groups (P value = .005) signifying better results with respect to skeletal anchorage. The studies reviewed provide insufficient evidence to form a conclusion regarding the effects of the use of skeletal anchorage with FFRD. The available weak evidence suggests that the use of skeletal anchorage with FFRD has no superior skeletal effects but is able to reduce proclination of the lower incisors. Control of lower incisor proclination remains the most significant advantage of skeletal reinforcement, and miniplate-anchored FFRD showed more promising results in preventing lower incisor proclination than miniscrew-anchored FFRD.

Critical issues concerning biocreative strategy in contemporary temporary skeletal anchorage device orthodontics: A narrative review.

Biocreative Orthodontic Strategy (BOS) is designed to establish a physiologically stable occlusion in harmony with masticatory and TMJ function and healthy supporting tissues with strategic use of temporary skeletal anchorage devices (TSADs). This narrative review surveys current research that demonstrates how BOS with TSADs uses a target approach to overcome the limitations experienced with conventional orthodontic treatment. A narrative review article including research on TSADs orthodontics in the permanent dentition. This review is a brief survey of five BOS principles for contemporary TSAD orthodontics: elegant selection of TSADs, bracket prescription to enhance TSAD orthodontics, antero-posterior dimension control, transverse dimension control and airway control issues. Severe malocclusion and craniofacial dysmorphology can be treated with Biocreative Orthodontic Strategy with a minimum number of TSADs. In order to achieve successful treatment outcome using TSADs, it is critical to understand the key diagnosis and treatment principles of BOS and how to develop a target approach for the tooth and bone movement.

Determining the short-term effects of different maxillary protraction methods on pharyngeal airway dimensions.

OBJECTIVE: This study sought to evaluate the effects of different maxillary protraction methods on the pharyngeal airway in Class III patients with maxillary retrognathia. SETTING AND SAMPLE POPULATION: A total of 59 individuals (31 females and 28 males) with a mean age of 11.38 ± 1.24 years were included in this study. MATERIAL AND METHODS: Fifty-nine treated maxillary retrognathic patients who underwent different protraction methods were evaluated. Twenty patients treated with RME (Rapid Maxillary Expansion) made up the first group, and 20 patients treated with 5-week Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) protocol comprised the second group. Lastly, 19 patients on whom face masks with miniplates were applied were included in the skeletal anchorage (SA) group. Sixteen linear and four areal pharyngeal airway measurements were made on lateral cephalograms before and after treatment. Differences between the groups were assessed using analysis of variance (ANOVA) tests. RESULTS: The mean maxillary protraction levels were determined as 2.7, 3.69 and 4.01 mm in the RME, Alt-RAMEC and SA groups, respectively. In the nasopharynx, AD1-PNS, AD2-PNS, PNS-Ba and PNS-Ho measurements revealed a significant increase in the SA group compared to the other groups (P < .05). In the oropharynx, PNS-Ep measurement increased significantly in the RME group (P < .05). In the total pharyngeal airway area, an increase was detected in the SA, Alt-RAMEC, and RME groups. CONCLUSION: The most effective protraction method in terms of pharyngeal airway dimensions, especially in the nasopharynx, is the application of the face mask with skeletal anchorage. A greater increase in vertical airway length (PNS-Ep) was observed with RME.

Palatal temporary skeletal anchorage devices (TSADs): What to know and how to do?

OBJECTIVES: Since palatal temporary skeletal anchorage devices (TSADs) have become important tools for orthodontic treatment, this narrative review was aimed to provide an updated and integrated guidelines for the clinical application of palatal TSADs. SETTING AND SAMPLE POPULATION: A narrative review article including researches on palatal TSADs in orthodontics related to anatomy, success rate and clinical application. MATERIALS AND METHODS: The anatomical characteristics, success rate and its consideration factors and clinical application of palatal TSADs based on the direction of tooth movement were evaluated. RESULTS: To improve the stability of TSADs, hard tissue factors such as bone depth, cortical bone thickness, bone density and soft tissue thickness were evaluated. Anatomically risky structures, including the nasopalatine foramen, canal and the greater palatine foramen, nerve, vessel need to be identified before placement. The success rate of palatal TSADs was greater than that of the buccal inter-radicular space. Palatal TSADs have been used for various purposes because they can control tooth movement in all directions and, three-dimensionally; their applications include the retraction of anterior teeth, protraction of posterior teeth, distalization, intrusion, expansion and constriction. They can be applied directly or indirectly to the lingual arch or transpalatal arch. Design modifications using splinted 2 miniscrews have been suggested. CONCLUSION: Palatal TSADs allow clinicians to perform minimally invasive and easy placement with good stability by understanding the anatomical characteristics of the palatal region, and they show good control over 3-dimensional tooth movements in various clinical cases.

Tooth-borne versus tooth-bone-borne rapid maxillary expanders according to a stereophotogrammetric evaluation of facial soft tissues: A randomized clinical trial.

OBJECTIVES: To evaluate the effects of tooth-borne and tooth-bone-borne rapid maxillary expansion (RME) on soft tissue with stereophotogrammetry. SETTING AND SAMPLE POPULATION: Thirty two patients (15 males and 17 females) who met inclusion criteria were divided into two groups. In the first group, tooth-borne RME appliance (hyrax) was applied to 16 patients (9 males and 7 females mean age 13.4 ± 1.3 years), and in the second group, tooth-bone-borne RME appliance (hybrid hyrax) was applied to 16 patients (6 males and 10 females, mean age 13.05 ± 1.24 years). MATERIALS AND METHODS: Changes in soft tissues before RME (T0) and post-retention (T1) period were evaluated by stereophotogrammetry. Linear and angular measurements were performed. Independent- and dependent-sample t tests were used to compare intra- and inter-group differences at P < .05 significance level. RESULTS: The data revealed statistically significant changes in nasal width, mid-face width, upper lip vermillion length/lower lip vermillion length ratio and upper lip angle in hyrax group. (P < .05) Also nasal width, lower lip length, lower lip vermillion length, anterior face height, lower face height, convexity angle and mandibular angle showed statistically significant changes in hybrid hyrax group. (P < .05) In the inter-group evaluation, no significant differences were found except upper lip and mandible angle. (P < .05). CONCLUSION: Both hyrax and hybrid hyrax expanders had effects on soft tissue profile. Anterior face height and lower face height increased in both groups. Upper lip length increased by 0.36 mm in the hybrid group and 0.10 mm in the hyrax group. TRIAL REGISTRATION: This trial was registered at Clinicaltrials.gov (Identifier: NCT04828213).

Treatment efficiency of activator and skeletal anchored Forsus Fatigue Resistant Device appliances.

OBJECTIVES: The aim of the study was to investigate the treatment efficiency of miniplate anchored Forsus Fatigue Resistant Device (MAF) as compared with the activator appliance. MATERIALS AND METHODS: Mandibular retrognathia was treated with two methods, the MAF group (8 girls, 11 boys, mean age 13.03 ± 0.69 years) and the activator group (7 girls, 12 boys, mean age 12.68 ± 0.73 years). An untreated control group (9 girls, 10 boys, mean age 12.95 ± 0.73 years) was constructed to eliminate growth-related changes through the American Association of Orthodontists Foundation Legacy Collection. Data of 114 lateral cephalograms were analyzed. RESULTS: The inhibition of the maxillary growth was greater in the MAF group, whereas forward displacement of the mandible was higher in the activator group (P < 0.05). Sagittal maxillomandibular relation was improved similarly in both treatment groups (P < 0.05). Mandibular length was increased in both treatment groups with the highest increase in the activator group (P < 0.05). Retroclination of the incisors was observed in the MAF group (P < 0.05). The upper lip was retruded in the MAF group and lower lip was protruded in the activator group (P < 0.05). CONCLUSION: The activator created greater mandibular changes, whereas the MAF provides somewhat smaller mandibular changes due to the restriction caused by retroclined maxillary incisors. CLINICAL RELEVANCE: Although both MAF and activator treatments caused favorable maxillomandibular changes, new treatment alternatives that reduce dentoalveolar side effects and eliminate patient cooperation are still required to achieve skeletal correction in class II malocclusion treatment in growing patients.