Active Orthodontic Therapy Research Articles

Potential Use of Hyperbaric Oxygen Therapy in Orthodontic Treatment: A Systematic Review of Animal Studies.

Understanding the fundamental principles of tooth movement could reduce the duration of treatment and achieve a stable outcome, resulting in patient satisfaction. Hyperbaric oxygen therapy was a modality in which a patient inhaled 100% O2 while subjected to high atmospheric pressure. Hyperbaric oxygen therapy facilitated the supply of oxygen to the human body's organs and tissues and served a variety of applications, including patient care and wound treatment. This review article aimed to describe animal studies of the potential effects of hyperbaric oxygen therapy in orthodontic therapy. It was conducted using a systematic literature review method, including searching PubMed and Google Scholar for publications relevant to the research topics. The search was filtered to include only research on orthodontic treatment and hyperbaric oxygen therapy and was published in any year. Articles that did not specify biological components of orthodontic tooth movement (OTM) were excluded. The Preferred Reporting Items identified the papers for the Systematic Reviews and Meta-Analyses (PRISMA) strategy, which resulted in the selection of 11 publications. Hyperbaric oxygen therapy affected parameters of biomarkers representing the clinical, molecular, and cellular biology of bone formation and resorption in periodontal tissues in responding to orthodontic physical forces, including alkaline phosphatase, collagen synthesis, osteoblast, osteoclast, osteocyte, type I collagen, vascular endothelial growth factor, osteocalcin, fibroblast, matrix metalloproteinase-8, transforming growth factor-β, partial pressure of oxygen, partial pressure of carbon dioxide, trabecular bone density, and tooth mobility. Hyperbaric oxygen therapy induced an inflammatory response to follow OTM events during active orthodontic therapy. Hyperbaric oxygen therapy might play a role in the tissue healing process during passive treatment. Nonetheless, additional research should be conducted to establish the efficacy of hyperbaric oxygen therapy in orthodontics.

Rapid correction of constricted maxillary arch in a class III patient using a corticotomy assisted expansion technique

This case report introduces a noval approach of corticotomy-assisted rapid maxillary expansion for treating a severe maxillary transverse discrepancy in an adult patient. This approach uses piezo-bone perforation in conjunction with a fixed appliance and expanded jockey arch wire. This report describes the treatment of an 18-year-old male with a severe maxillary transverse discrepancy. He had a straight profile, mild maxillary crowding, severe maxillary transverse deficiency and a Class III skeletal relationship. The treatment protocol commenced with active orthodontic therapy, after leveling and aligning surgical intervention with Piezocision assisted bone perforation was performed. Immediately after the piezo assisted bone perforation on bilateral buccal side of the maxilla, active expansion force was given with expanded jockey arch wire. The expanded jockey wire was left in place for 3 months. Proper overbite and overjet, facial balance, and occlusion were achieved. The case is in final stage of finishing. This treatment approach considerably reduced the treatment time and gained bony volume. This approach is a good alternative to surgical rapid palatal expansion for treating a severe maxillary transverse deficiency in an adult patient. Key words: Corticotomy, osteotomy, accelerated orthodontics, Piezocision

Orthodontic anterior teeth space closure in an adult with posterior long standing fixed partial denture

This is a case report of a 40-year-old female patient with chief complaint of spacing in front teeth. Patient exhibited convex profile, incompetent lips, spacing in anterior maxillary and mandibular teeth. She had maxillary posterior long span fixed partial denture and generalised periodontitis. She was diagnosed as Class I malocclusion with proclined and spaced anterior teeth. Treatment objective include space closure, maintaining class I molar and canine relation, achieving ideal overjet and overbite and functional occlusion. Thorough oral prophylaxis was done prior to start of fixed mechanotherapy. The case was bonded (upper canine to canine and full lower arch) with 022 MBT bracket system. Aligning and levelling was done sequentially with 012,016,17x25 Niti wires. One bracket each side was bonded on the maxillary FPD abutment teeth for anchorage. Space closure was achieved using low forces with elastomeric chain on 19x25 SS wire. Total treatment time was 12 months. Ideal overjet and overbite achieved with functional occlusion. Periodontal condition improved and stable results were achieved. Patient is given fixed retention and removable hawleys retainer with tongue crib in upper arch. In the recent years, there has been an increase in number of adults seeking orthodontic treatment and orthodontists quiite often face patients with periodontal disease. Adult patients should follow regular oral hygiene measure in order to maintain periodontal health during and after active orthodontic therapy.

Assessment of Skeletal Age Using Hand-Wrist Radiographs following Bjork System.

The knowledge of the skeletal maturation and the stage of the growth of the patients seeking orthodontic treatment are of great value in planning efficient orthodontic therapy. However, different craniofacial structures of patient show variation in growth potential. The routine use of hand-wrist radiograph for growth prediction exposes the patient to extra radiation. Cervical vertebrae in the lateral cephalograph have been recommended as an alternative method. The pubertal growth spurt is a vital period in the orthodontic treatment and should be kept in mind when planning orthodontic treatment in growing children. One of the main objectives of taking hand and wrist radiograph is to determine the amount of growth and get used of it in patients with skeletal discrepancy during adolescence. Further, this will help in the selection of the appliances required, the course of the treatment and the retention after active orthodontic therapy.

Mandibular Incisor Position Changes do not Explain Increase in Keratinized Gingiva Height after Periodontally Accelerated Osteogenic Orthodontics

Purpose This study aimed to reexamine the relationship between mandibular incisor inclination, prominence and vertical changes in position, and keratinized gingival tissue (KT) height changes labial to the mandibular incisors after orthodontic treatment with and without augmented corticotomy (Cort). Materials and Methods Two orthodontically treated groups of 35 individuals each, with (Cort) and without (conventional [Conv]) alveolar decortication and augmentation bone grafting (periodontally accelerated osteogenic orthodontics [PAOO]), were matched for sample size, gender, mandibular premolar extractions, pretreatment age, posttreatment observation period, and pretreatment KT height in this case–controlled retrospective study. Pre- and post-treatment lateral cephalometric radiographs were evaluated for mandibular incisor vertical, inclination, and prominence changes. Results As reported previously (Wilcko 2015), KT height had significantly increased by 0.78 mm (P = 0.001) in the Cort group and decreased by 0.38 mm (P = 0.002) in Conv on an average of 1.5 years after completion of active orthodontic therapy. In this study, Cort mandibular incisors proclined and protruded significantly during therapy while Conv incisors did not. Changes in mandibular incisor inclination and prominence explained neither the decrease in keratinized gingiva height in Conv nor the KT height gain in Cort. Conclusions In spite of mandibular incisor proclination and protrusion, orthodontic therapy combined with alveolar decortication and augmentation bone grafting resulted in a clinically significant increase in keratinized gingiva height 1.5 years’ posttreatment.

Instability of the mandibular dental arch? Look again!

Changes in mandibular dental arch parameters have been thoroughly investigated as a function of time after removal of orthodontic appliances and instability tenets have emerged. To date, only permanent fixed retention as a posttreatment strategy has been demonstrated effective against changes in mandibular anterior alignment. No active orthodontic therapy has been shown to improve mandibular arch outcome stability except augmented corticotomy significantly reduced 5- and 10-year rate of change in mandibular irregularity index. The purposes of this study were as follows: (1) to evaluate efficacy of augmented corticotomy in stabilizing posttreatment mandibular arch widths and length and (2) to review mandibular dental arch instability data from the scholarly literature. Results demonstrated augmented corticotomy effective in the 5-year short term for stabilizing intercanine width and arch length but not 10-year long term. Data extracted from 76 separate publications representing 4250 subjects reaffirmed the consensus view that irregularity index will increase and there will be decreases in arch width and length as a function of time. It was concluded that alveolar decortication + augmentation bone grafting (PAOO) is the only active orthodontic treatment strategy that will stabilize mandibular irregularity index for at least a decade, and permanent fixed canine-to-canine retention is the only posttreatment orthodontic strategy that will preclude recrowding and intercanine width decrease in the mandibular anterior segment.

Prevalence of Gingival Recession and its Relationship to Past Orthodontic Treatment in Nepalese Young Adults

Introduction: Gingival recession is characterized by apical migration of gingival margin from the cementoenamel junction. Prevalence varies from 3-100%, and appears to be lower in younger age groups.Objective: To determine the prevalence and severity of gingival recession in young adult Nepalese population and to assess the relationship between brushing technique, smoking habit and past orthodontic treatment with gingival recession.Materials & Method: A cross-sectional study was carried out among 160 healthy patients (age 18-25 years) with routine dental examinations and information regarding age, smoking habit, oral hygiene habits, brushing technique and past orthodontic treatment. Clinical examination included visible gingival inflammation, visible dental plaque, and gingival recession. SPSS version 20 was used to analyze the data. Chi-Square test was used to evaluate relationships between the variables.Result: Out of total participants; gingival recession was found in 21.3%, gingivitis in 40% and plaque in 20%. The prevalence, extent, and severity of recession were correlated with past orthodontic treatment. There was association between gingivitis, past orthodontic treatment and smoking with gingival recession.Conclusion: Orthodontic patients must undergo regular oral hygiene performance and periodontal maintenance in order to maintain healthy gingival tissue during active orthodontic therapy. The combined orthodontic-periodontic interdisciplinary approach could be effective in these situations.Orthodontic Journal of Nepal, Vol. 6 No. 1, June 2016, pp.7-11

Corticotomy-assisted rapid maxillary expansion: A novel approach with a 3-year follow-up

This case report introduces a new approach of corticotomy-assisted rapid maxillary expansion for treating a severe maxillary transverse discrepancy in a skeletally mature patient. This approach uses piezo-bone perforation in conjunction with a fixed appliance and an expander. This report describes the treatment of a 14-year-old girl with a severe maxillary transverse discrepancy. She had a straight profile, severe maxillary crowding, a maxillomandibular transverse differential index of 9 mm, and a Class I skeletal relationship. The treatment protocol consisted of surgical intervention with piezo-bone perforation and active orthodontic therapy. Immediately after the piezo-bone perforation on the lateral buccal side of the maxilla, active orthodontic therapy was started with activation of an expander. The expander was reactivated weekly. Treatment duration was 5 months 2 weeks. Proper overbite and overjet, facial balance, and occlusion were achieved. The treatment outcome was stable at the 3-year follow up. This treatment approach considerably reduced the treatment time and gained bony volume. Additionally, it transformed the periodontal biotype in contrast to conventional therapy. This approach is a good alternative for treating a severe maxillary transverse discrepancy in a skeletally mature patient, especially for a patient who does not want surgical rapid palatal expansion.

Does the maxillary midline diastema close after frenectomy

To analyze the closure, persistence or reopening of the maxillary midline diastema after frenectomy in patients with and without subsequent orthodontic treatment. All patients undergoing frenectomy with a CO2 laser were included in this retrospective study during the period of September 2002 to June 2011. Age and sex, the dimension of the diastema, eruption status of the maxillary canines, and the presence of an orthodontic treatment were recorded at the day of frenectomy and during follow-up. Of the 59 patients fulfilling the inclusion criteria, 31 (52.5%) had an active orthodontic therapy, while 27 (45.8%) had a frenectomy without orthodontic treatment. For one patient, information concerning orthodontic treatment was not available. In the first follow-up (2 to 12 weeks), only four diastemas closed after frenectomy and orthodontic treatment, and none after frenectomy alone. In the second follow-up (4 to 19 months), statistically significantly (P = .002) more diastemas (n = 20) closed with frenectomy and orthodontic treatment than with frenectomy alone (n = 3). At the long-term (21 to 121 months) follow-up, only four patients had a persisting diastema, and in three patients orthodontic treatment was ongoing. Closure of the maxillary midline diastema with a prominent frenum is more predictable with frenectomy and concomitant orthodontic treatment than with frenectomy alone. This study demonstrates the importance of an interdisciplinary approach to treat maxillary midline diastemas, ideally including general practitioners, oral surgeons, periodontists, and orthodontists.

Periodontal status of adult patients treated with fixed buccal appliances and removable aligners over one year of active orthodontic therapy

To compare the periodontal status of adults treated with fixed buccal orthodontic appliances vs removable orthodontic aligners over 1 year of active therapy. The study population consisted of 42 subjects; 22 treated with fixed buccal orthodontic appliances and 20 treated with removable aligners. Clinical indices recorded included: plaque index (PI), gingival index (GI), bleeding on probing (BOP), and probing pocket depth (PPD). Plaque samples were assessed for hydrolysis of N-benzoyl-DL-arginine-naphthylamide (BANA test). Indices and BANA scores were recorded before treatment and at 6 weeks, 6 months, and 12 months after initiation of orthodontic therapy. After 6 weeks, only mean PPD was greater in the fixed buccal orthodontic appliance group. However, after 6 months, the fixed buccal orthodontic appliance group had significantly greater mean PI, PPD, and GI scores and was 5.739 times more likely to have a higher BANA score. After 12 months, the fixed buccal orthodontic appliance group continued to have greater mean PI, GI, and PPD, while a trend was noted for higher BANA scores and BOP. These results suggest treatment with fixed buccal orthodontic appliances is associated with decreased periodontal status and increased levels of periodontopathic bacteria when compared to treatment with removable aligners over the 12-month study duration.

The use of cone beam computed tomography in the management of dens invaginatus affecting a strategic tooth in a patient affected by hypodontia: a case report

To report on the use of cone beam computed tomography (CBCT) in the diagnosis and management of dens invaginatus. Chronic apical periodontitis of an invaginated maxillary lateral incisor was diagnosed in a patient suffering from hypodontia and awaiting active orthodontic therapy. Loss of the tooth would have complicated orthodontic treatment. Conventional periapical radiographs provided insufficient information about the nature of the invagination and its relation to the root canal to formulate an appropriate plan for treating the tooth. A small volume CBCT scan of the tooth revealed that the invagination and the root canal were completely separate, non-communicating spaces and that the wall of the invagination acted as an obstruction to the effective chemomechanical debridement of the infected root canal. An innovative method of accessing the infected root canal, based on information from the CBCT images, was adapted to permit its instrumentation, disinfection and filling. • Teeth with dens invaginatus requiring endodontic treatment present diagnostic and technical challenges. • CBCT can provide essential information in the management of dens invaginatus.

Lower incisor retraction with a modified corticotomy.

This case report demonstrates the orthodontic treatment facilitated with a new conservative corticotomy technique to shorten the treatment time during lower incisor retraction. The patient was a 22-year-old woman with protrusive profile, severe anterior crowding, an anterior crossbite, and Class III dental relationship. Orthodontic treatment consisted of the extraction of four first premolars with maximum anchorage. A modified corticotomy technique, in which the lingual vertical and subapical horizontal cuts were eliminated, was combined with orthodontic therapy for the retraction of the lower anterior teeth. Corticotomy-facilitated orthodontics dramatically reduced the treatment time without any adverse effects on the periodontium and the vitality of the teeth. The main advantages of this modified corticotomy technique were the elimination of the lingual cuts and flap, the reduction of surgery time, and minimum discomfort to the patient. At the end of active orthodontic therapy, balanced occlusion and facial esthetics were achieved.

Aspects in post‐orthodontic removal of Orthosystem® implants

Problems encountered in the removal of a temporary anchorage device, such as the Orthosystems implant, specially designed for orthodontic anchorage purposes after insertion at the palatal side of the maxilla, are presented and discussed. The removal of these osseo-integrated implants was originally described to be executed by means of bone cutting around the implant with a trephine explanation burr. However, situations can be encountered in which the orthodontic tooth movement resulted in close contact between the implant and neighbouring teeth or the nasal cavity. Trephine burr bone cutting around the implant can thereby lead to damage of the adjacent tooth with subsequent endodontic problems or perforation of the nasal cavity. In these cases, simple untightening by counterclockwise torque or if unsuccessful, removal of the transmucosal part of the fixture allowing creeping mucosal covering of the implant, should be considered. Furthermore, generation of CT-scan images performed after completion of active orthodontic therapy, with retraction of the upper anterior teeth, seems to be justified and indicated for planning the appropriate removal procedure. Retrospectively, the use of the longer version of the Orthosystems implant (6 mm in length) seems to be obsolete when para-median locations are chosen. Three cases are presented to illustrate these problems.

Transverse maxillary distraction with a bone-anchored appliance: dento-periodontal effects and clinical and radiological results

In 29 adult patients presenting with maxillary deficiency, a bone-anchored palatal distractor (Surgi-Tec NV, Brugge, Belgium) was applied after osteotomy of the anterolateral walls of the maxillary sinuses, midpalatal suture, and, eventually, separation of the pterygomaxillary sutures. Expansion proceeded at a rate of 0.33–0.66 mm per day and the device was retained for 4–6 months for consolidation. Active orthodontic therapy was started after 8–10 weeks. The increment of arch width and the perimeter were evaluated using dental casts. Tooth thermal sensitivity and the periodontal side effects of treatment were monitored clinically after distraction, at device removal, and after 1 year. Bone healing was also investigated during the procedure using conventional radiological techniques. This experience confirms that transverse maxillary distraction is an effective technique in adult patients, leading to the formation of new bone. There were no noticeable intraoperative complications, but postsurgical periodontal side effects were documented. The procedure offers advantages over traditional teeth-borne appliances in terms of rapidity of treatment and the absence of mechanical forces acting on the teeth. Further evaluation is required to assess the long-term stability and periodontal consequences of this technique.

The biomechanics of canine retractionwith arch wire guidance

An often required segment of active orthodontic therapy is the distal displacementof canine teeth. The appliance used may include a continuous arch wire to influence the displacement path and orientation of the canine during tooth movement. If the distal driving force of the appliance mechanics is delivered adjacent to the facial crown surface, the mechanical moment of that force has two dental reference-frame components, representing tendencies to distal crown tip and distolingually rotate the canine. Both rotations are often unwanted, and the latter may be substantially suppressed by partitioning the driving force faciolingually. An important additional challenge is the maintenance of appropriate intraoral anchorage. The focus of this article is the orthodontic displacement of the canine as viewed from a facial perspective. A plane analysis is undertaken that must necessarily consider the mechanics of the appliance action and the biomechanics of the periodontal response. An objective is to revisit several thought-provoking clinical questions. The principal inquiry is into the form of the displacement in the sagittal plane throughout the time period of this phase of orthodontic therapy.

Repair of a Defect Following the Removal of a Maxillary Adenomatoid Odontogenic Tumor Using Guided Tissue Regeneration. A Case Report

Adenomatoid odontogenic tumors (AOT) make up 3% of odontogenic tumors. This tumor, most commonly found in the maxillary arch, mimics a follicular cyst associated with an impacted tooth. This is a case report of an AOT found in a 14-year-old female undergoing active orthodontic therapy. The surgical removal of the lesion resulted in the exposure of a large bony cavity surrounding the maxillary left canine. Placement of freeze-dried bone and coverage with an expanded polytetrafluoroethylene membrane resulted in rapid and complete healing of the lesion and restoration of osseous support.

Retention and Post-Treatment Stability in the Adult Dentition

Post-treatment changes that occur in the supporting apparatus must be considered in the design and time of use of retention devices. Of equal importance is establishing the methodology of retention prior to initiating active orthodontic therapy. The different types of retainers that are best used are reviewed.