Assessment of Inclination and Vertical Changes After En-masse Retraction with Single Versus Double Wire Retraction Protocol: A Randomized Clinical Trial

To evaluate anchorage loss after en masse retraction in bimaxillary dentoalveolar protrusion patients using friction vs frictionless mechanics. Thirty patients with bimaxillary dentoalveolar protrusion needing extraction of upper first premolars and en masse retraction with maximum anchorage were included in this two-arm, parallel, single-center, single-blinded randomized clinical trial with a 1:1 allocation ratio using fully sealed opaque envelopes. Friction group retraction utilized elastomeric power chain between miniscrews and hooks crimped mesial to upper canines on 17 × 25 stainless steel archwire. Frictionless group used customized T-loop springs loading upper first molars indirectly anchored to miniscrews. Activation was every 4 weeks until full retraction. The primary outcome assessed was anchorage loss evaluated at cusp tip and root apex of the first molar. First molar rotation, incisor tip and torque, and root resorption of anterior teeth were evaluated on digital models and cone beam computed tomography taken before and after space closure. Anchorage loss at crown of first molar was significantly more in frictionless group by 2.1 mm (95% CI = -0.4 to 3.5), (P = .014), while there was no significant difference in anchorage loss at root apex between groups. Significant mesial in molar rotation of 6.672° (95% CI = 12.2-21.2), (P = 0.02) was greater in the frictionless group. Both groups showed comparable tip, torque, and root resorption values. No severe harms were reported. There was mild gingival overgrowth and inflammation in the frictionless group due to T-loop irritation. Extra anchorage considerations are needed during en masse retraction when frictionless mechanics is implemented as higher anchorage loss and molar rotation were detected. No difference in tip, torque, and root resorption was observed.

Residents' journal review

To compare the space closure, root resorption and canine angulation during en-masse retraction of the labial segment after extraction of first premolars with or without interseptal bone reduction distal to the maxillary canines. A single-centre, parallel randomised control trial included 16 participants with a mean age of 21.5 years. Participants were allocated into treatment groups using blocked randomisation, and blinding was employed for outcome assessors and data analysts. The control group consisted of eight participants who underwent extraction of maxillary first premolars only, while the experimental group included eight participants who underwent interseptal bone reduction immediately after premolar extraction. En-masse retraction was performed using conventional friction mechanics with anchorage reinforcement in both groups. Measurements of space closure were conducted over 3 consecutive months during retraction. The time taken for total space closure was recorded. Cone-beam computed tomography scans were taken before and 3 months after retraction to assess root resorption and canine angulation. The experimental group demonstrated a significant increase in the rate of en-masse retraction compared to the control group over 3 months (mean difference [MD] = 1.09 mm, 95% confidence interval [CI] = 0.78-1.40), with an overall space closure rate of MD 0.26 mm/month (95% CI = 0.17-0.34). However, these changes were of minimal clinical significance. The change in canine angulation (MD = 4.50°, 95% CI = -1.61-10.61) did not exhibit statistical significance. Substantial root resorption was observed in six maxillary anterior teeth, with no difference between the groups. Interseptal bone reduction is a minimally invasive surgical technique, resulting in an accelerated rate of en-masse retraction in the experimental group over 3 months. However, despite the statistical significance, the clinical impact on overall space closure was minimal, with a difference of only 0.26 mm/month observed between the groups. Interseptal bone reduction did not affect the change in canine angulation and root resorption.

Shortening the duration of orthodontic treatment by speeding up the rate of tooth movement has become an essential goal for both orthodontists and patients. This preliminary report aimed to investigate the safety and effectiveness of a new intraoral removable electrical device in accelerating the en-masse retraction of the upper anterior teeth using low-intensity direct electrical current. This prospective preliminary interventional clinical study was conducted at the Department of Orthodontics, Faculty of Dentistry, Damascus University, Syria, between March 2019 and February 2020. The sample consisted of six patients (four females and two males; mean age: 19.55 ± 0.89 years) whose initial diagnosis was class II division I malocclusion, and their treatment plansuggested the extraction of upper first premolars followed by en-masse retraction. The electrical stimulation was applied on the maxillary anterior region during the en-masse retraction phase using a specially fabricated removable device that was designed by two coauthors of this manuscript (RIS, MYH). Patients were asked to wear their own electrical devices inside their mouths for five hours daily. The primary outcomes were the en-masse retraction rate and duration. The secondary outcomes were safety and patient acceptance. The average total retraction rate during the treatment period was 0.97±0.06 mm/month. The total amount of retraction achieved during follow-up was 5.65 ± 0.85 mm, which was about 91.86% of the space resulting from the extraction of the upper first premolars. The mean treatment duration to complete the en-masse retraction was 5.66±0.81 months. No side effects of the electrical stimulation were found during the follow-up. Low-intensity direct electrical current could be an effective method to accelerate orthodontic movement. The electrical accelerating device used in this study effectively increased the en-masse retraction rate of the upper anterior teeth without any side effects and with high patient acceptance.

Comparative cone-beam computed tomographic evaluation of maxillary incisor intrusion and associated root resorption: Intrusion arch vs mini-implants

Transposition of a maxillary canine and a lateral incisor and use of cone-beam computed tomography for treatment planning

Aim: In orthodontics, applying forces to move teeth generates equal and opposite reactions on the anchorage units, potentially causing unwanted movement—a phenomenon known as anchorage loss. This can impede treatment outcomes by complicating anteroposterior corrections and affecting facial aesthetics. This study aims to evaluate and compare the degree of anchorage loss during en masse retraction in bimaxillary protrusion cases using two different Methods: active tiebacks and coil springs. Methods: Sixteen patients diagnosed with Angle's Class II bimaxillary protrusion were randomly assigned to two groups: one treated with active tiebacks and the other with coil springs. Lateral cephalograms were taken before en masse retraction (T0) and after space closure (T1) to measure changes in the position of the first molars and quantify anchorage loss. Results: Both groups exhibited anchorage loss during en masse retraction. However, the group using active tiebacks showed less anchorage loss compared to the coil spring group. Specifically, the mean distance from the pterygoid vertical (PTV) to the distal contact point of the upper first molar increased by 1.78 mm with active tiebacks, whereas it increased by 3.37 mm with coil springs. Conclusion: There was a statistically significant difference in anchorage loss between the two methods, with coil springs causing greater loss than active tiebacks. This suggests that active tiebacks may be more effective in minimizing anchorage loss during en masse retraction.

Background: Orthodontic forces generate comparable, opposite reactions on anchorage units, known as anchorage loss, potentially causing unwanted movements that adversely impact outcomes. Likewise, anteroposterior corrections might be complicated, and facial aesthetics can be compromised. This study attempted to compare anchorage loss when en-masse retraction was applied in patients with bimaxillary protrusion with active tiebacks and coil springs as two different methods. Methods: Sixteen Cl I bimaxillary protrusion patients were studied in two groups of active tiebacks and NiTi coil springs with random assignment. Changes in first molar positions and anchorage loss were quantified using lateral cephalograms before en-masse retraction and after space closure (T0 and T1, respectively). Paired t-test and independent t-test were used for statistical analyses. P-value<0.05 was considered as significant. Results: Molar anchorage loss was noted in both groups during en-masse retraction, with the active tieback group exhibiting less anchorage loss. An increase of 1.78 mm was noted in the mean distance between the pterygoid vertical (PTV) and the distal contact point of the upper first molar using active tiebacks; in contrast, the increase with coil springs was 3.37 mm, with no significant difference between these two groups (P=0.22). Conclusion: The two methods exhibited a statistically significant difference in anchorage loss, with coil springs causing greater anchorage loss; therefore, active tiebacks more effectively decreased anchorage loss during en-masse retraction.

Background- Class II malocclusion is a common skeletal discrepancy which may be managed through various treatment modalities, including fixed functional appliances like AdvanSyncTM and ForsusTM FRD, widely used for non-compliant patients . However, one of the significant concerns associated with these appliances wasorthodontically induced external apical root resorption (OIEARR).This study aimed to evaluate and compare the degree of orthodontically induced external apical root resorption in skeletal Class II patients treated with Forsus™ and AdvanSync™ 2 fixed functional appliances using Cone Beam Computed Tomography (CBCT). Materials and Methods-The study involved 20 patients with skeletal Class II malocclusions (true mandibular retrusion), divided into two groups of 10 each. CBCT scans were taken before and after 6–12 months of fixed functional treatment with AdvanSync™ 2 (Group I)and Forsus™ (Group II) to assess root resorption and tooth inclination changes. Statistical analysis was performed using the Wilcoxon signed-rank test and the Mann–Whitney U test. Results- Root resorption was observed in all patients, with Forsus™ demonstrating a significantly higher mean root resorption compared to AdvanSync™ 2. The highest values were recorded for mandibular canines, with statistically significant differences between the two groups. Additionally, both appliances caused an increase in mandibular incisor proclination, but Forsus™ resulted in greater inclination changes compared to AdvanSync™ 2. Conclusion-AdvanSync™ 2 and Forsus™ are both effective in treating skeletal Class II malocclusion by facilitating mandibular advancement. However, the extent of orthodontically induced external apical root resorption (OIEARR) differs significantly between the two appliances, with Forsus™ demonstrating a higher predisposition for root resorption. These findings underscore the importance of careful appliance selection based on patient-specific factors

Mallet fractures are avulsion fractures of the extensor tendon from the distal phalanx base and often occur due to sudden flexion or axial loading. In this study, we aimed to compare the clinical and radiological results of patients treated with single and double dorsal wires from the dorsal in the extension block method.Patients to whom a single wire from dorsal was applied were assigned to Group 1 (n: 22), and those to whom double wires were applied were assigned to Group 2 (n: 23). Surgical treatment was decided for patients with more than 1/3 of the fracture fragment containing the joint surface and volar subluxation. The range of motion of the distal interphalangeal (DIP) joint was measured with a goniometer. The displacement of the fragment was measured before and after surgery on lateral radiographs. The presence of bridging callus formation on anterior-posterior and lateral radiographs was evaluated for a union.There were 30 male (66.7%) and 15 (33.3%) female patients. The mean age of the patients was 32 years. Radiographic union was obtained in all patients. Pseudoarthrosis was not observed in any patient. The Crawford score was excellent in 13 (28.9%) cases, the score was good in 18 (40%) cases, the scores were moderate in 13 (28.9%) cases, and the score was poor in 1 case (2.2%). There were no complications in 35 (77.8%) cases, dorsal bump complications occurred in 9 cases (20%), and osteoarthritis and dorsal bump complications occurred in 1 (2.2%) case. We did not observe nail deformity, skin necrosis, infection, or fingertip sensitivity. We found similar functional and clinical results between the groups.We recommend using single dorsal wire, as using double dorsal wires requires extra operation time, effort, and fluoroscopy.

En-masse maxillary anterior retraction to close the extraction space with fixed orthodontic appliances: A systematic review.

Aim of the study: The aim of this study was to evaluate the effect of corticotomy-assisted orthodontics on the rate of miniscrew supported en-masse retraction of maxillary anterior teeth.Materials and methods: The sample of this study included 20 adult female patients with an age range 18-27 years that needed fixed orthodontic mechanotherapy which included extraction of upper first premolars and anterior en-masse retraction. The sample was divided equally into 2 groups: Group 1 was extraction with corticotomy and Group 2 was extraction without corticotomy. Both groups were evaluated in terms of the rate of maxillary anterior teeth retraction and the amount of maxillary first permanent molar movement. Results: Group 1 had higher maxillary en-masse retraction rate than Group 2 In the 1st, 2nd , 3rd , 4th and 5th month, Group 1 also showed statistically significantly higher mean anterior retraction rate than Group 2. In Group 1, the highest retraction rate was found in the 1st month, followed by the 2nd, 3rd, 4th month then 5th month with statistical significance in-between each. However in Control group, no statistically significant difference was reported between retraction rates at different times. Slight distal molar movement occurred in both groups but was not statistically significant Conclusion: Corticotomy accelerates orthodontic tooth movement with increased rate of en-masse retraction compared to conventional orthodontics without corticotomy. No molar anchorage loss was observed. Mild distal molar movement occurred in both study groups and was slightly higher in Corticotomy group , however it was not statistically significant.

Advanced Sternal Closure to Prevent Dehiscence in Obese Patients

Objective To evaluate changes in the anchor molar position (horizontal, vertical) after retraction in bimaxillary protrusion maximum anchorage cases. Materials and Methods Thirty patients requiring maximum anchorage after extraction of the first premolars were selected for this study. The second molars were banded in both arches along with trans-palatal arch in the maxillary arch and lingual arch in the mandibular arch. En mass retraction was done using sliding mechanics. Horizontal and vertical positions of the anchor first molars were evaluated cephalometrically before and after orthodontic retraction. Results In the horizontal plane, maxillary first molars showed net mesial movement of 1.72 mm, and there was a statistical difference between the pre- and post-values (P < 0.001). The mandibular molars showed a net horizontal movement of 2.26 mm, and there was a statistically significant difference between the pre- and post-values (P < 0.001). In the vertical plane, there was vertical movement of the maxillary anchor molars by a net value of 0.95 mm which was statistically significant (P < 0.001). The mandibular anchor molars moved vertically by a net value of 0.45 mm. This difference was statistically not significant. Conclusion There was anchorage loss seen in both the planes (horizontal, vertical) of the maxillary anchor molars. In the mandibular anchor molars, there was anchorage loss seen only in the horizontal plane. No anchorage loss was seen in the vertical plane.

To compare rate and anchorage loss during en-masse retraction of anterior maxillary teeth between friction mechanics (FM) and frictionless mechanics (FLM). Thirty-eight patients requiring en-masse retraction of protruded anterior maxillary teeth were randomly allocated into FM and FLM groups. En-masse retraction with sliding mechanics (FM) using an elastomeric chain was compared with continuous mushroom loop archwire mechanics (FLM). Study models and lateral cephalograms were taken before (T1) and immediately after retraction (T2). The primary outcome was the rate of en-masse retraction. Anchorage loss was the secondary outcome. Intergroup comparison was performed using an independent t test (P< .05). Baseline characteristics were similar between groups. Thirty-six patients completed the trial. Two patients were lost to follow-up in the FLM group. The rate of en-masse retraction did not differ significantly (P= .625) between FM (0.7 mm/mo) and FLM (0.8 mm/mo) groups. The intragroup comparison showed significant anchorage loss in FM (2.28 mm) and FLM (1.13 mm) groups; however, the intergroup comparison showed no statistically significant difference (P= .093). Maxillary first molar showed a statistically significant change in angulation between the two mechanic groups (P< .001). Vertical movement of the maxillary incisor and first molar showed no significant difference between FM and FLM groups (P= .143, P= .546, respectively). The rate of en-masse retraction and anchorage loss was comparable between the FM and FLM groups. Significant anchorage loss was seen with both mechanics. The result suggests that both the mechanic group require external reinforcement to prevent anchorage loss.