American Board Of Orthodontics Research Articles

Evaluation of Three-Dimensional Digital Models Formulated From Direct Intra-oral Scanning of Dental Arches in Comparison With Extra-oral Scanning of Poured Dental Models in Terms of Dimensional Accuracy and Reliability.

The study's objective was to assess the dimensional accuracy and reliability of dental digital models prepared by direct intraoral scanning and indirect scanning of the plaster models compared to the plaster models as the gold standard. This study included 20 patients. Nine had a class I malocclusion, seven had a class II malocclusion, and four had a class III malocclusion. Intraoral scanning was done for the upper and lower arches of all the patients enrolled in this study using an intraoral scanner (i700; Medit, Seoul, Korea). The next step was preparing the plaster model for the control group. Addition-silicone impressions were taken for each patient's arches. The impressions were poured according to American Board of Orthodontics (ABO) standards. Finally, the digital models of the indirect scanning group were prepared using a 3D desktop scanner (T710; Medit). In total, 26 measurements were made on the plaster and digital models. Paired t-tests were used to test for significant differences between the studied groups. The reliability of the studied techniques was tested using intraclass correlation coefficients (ICCs). Because of the multiple comparisons, the ɑ level was adjusted and set at 0.002. No significant differences were found between the intraoral scanning group (20 patients) and the plaster models group (20 patients; P>0.002). The ICCs ranged from 0.814 to 0.993, indicating excellent agreement between the direct digital and traditional plaster models. There were no significant differences between the digital and original plaster models (P>0.002). ICCs ranged from 0.834 to 0.995, indicating excellent agreement between the indirect digital and original plaster models. No significant differences were detected between the direct and indirect digital models (P>0.002). ICCs ranged between 0.813 and 0.999, indicating excellent agreement between direct and indirect digital models. Both direct and indirect scanning techniques are accurate and reliable for digital model preparation and can be considered an alternative to traditional plaster models used in clinical orthodontics diagnostic applications. The intraoral scanning technique can be considered a valid alternative for indirect scanning of the plaster models to prepare digital working models during the digital design and fabrication of orthodontic appliances such as clear aligners.

2023-2024 American Board of Orthodontics practice analysis study: Part 1

As a specialty board, the American Board of Orthodontics (ABO) serves to protect the public and the orthodontic specialty by certifying orthodontists. The demonstration of commitment to lifelong learning and self-improvement is critical to achieving the highest level of patient care. The ABO completed a practice analysis study in 2023 to ensure all examinations represent current assessments of proficiency in orthodontics at a level of quality that satisfies professional expectations. The practice analysis is essential to providing a demonstrable relationship between the examination content and orthodontic practice and provides a critical foundation for ABO's examination programs.

Transfer Accuracy of 3D-Printed Customized Devices in Digital Indirect Bonding: A Systematic Review and Meta-Analysis

Aim. To evaluate in vitro and in vivo the accuracy of 3D-printed customized transfer devices during indirect bonding technique (IBT). Methods. A search for articles published in the English language until April 2022 was carried out using PubMed, Web of Science, Scopus, and Google Scholar databases and by applying a specific search strategy for each database to identify all potentially relevant in vivo or in vitro studies. After the removal of duplicate articles and data extraction according to the participants-intervention-comparison-outcome-study design schema scheme, the methodological quality of the included studies was assessed using the Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies. Results. The initial search identified 126 articles, 43 of which were selected by title and abstract. After full-text reading, 15 papers were selected for the qualitative analysis and seven studies for the quantitative analysis. The evidence quality for the selected studies was moderate. Conclusions. Except for the bucco-lingual direction, the 3D-printed customized devices have a transfer accuracy within the clinically acceptable limits established by the American Board of Orthodontics. Therefore, 3D-printed transfer devices may be considered an accurate method for bonding position during IBT, both in vitro and in vivo. Additional randomized clinical studies in vivo should be suggested.

Proficiency of Clear Aligner Therapy: A Systematic Review and Meta-Analysis.

The aim of this study was to evaluate the efficacy and efficiency of orthodontic treatment using clear aligner therapy (CAT). This efficiency was measured using the Peer Assessment Rating (PAR) index, the American Board of Orthodontics (ABO) index, or the similarity between the final ClinCheck and the final scanned models. A search was done electronically between 1998 and 2021 using the Cochrane Library, PubMed, and Google Scholar databases. Three reviewers individually rated the articles. The ROBINS tool and the Cochrane risk of bias tool were used to evaluate the quality of observational research and randomized controlled trials, respectively. The degree of certainty for each selected outcome was evaluated using the grading of recommendations assessment, development, and evaluation (GRADE) approach.Six studies with a total of 166 participants were considered after the full texts of 61 potential reports were reviewed. This research included in the review covered the period from 1998 to 2021 in retrospect.According to the current systematic review and meta-analysis, transparent aligners had a successful outcome. In mild to moderate cases, aligner treatment appears to have a significant advantage in terms of efficiency (treatment time); nonetheless, insufficient evidence of efficacy was observed based on multiple cross-sectional investigations. When compared to traditional brackets, clear aligners provided a more stable course of treatment.

Conventional and self-ligating lingual orthodontic treatment outcomes in Class I nonextraction patients: A comparative study with the American Board of Orthodontics Objective Grading System

This study aimed to assess and compare the duration and outcomes of orthodontic treatment with conventional and self-ligating lingual fixed appliances with the American Board of Orthodontics (ABO) Objective Grading System. Thirty consecutive patients with a complete dentition and Angle Class I malocclusion treated with a conventional lingual bracket system (STb; Ormco, Glendora, Calif) or self-ligating lingual bracket system (GC Experience-L; GC Orthodontics, Breckerfeld, Germany) were included. The occlusal outcome was assessed with the ABO instrument. The treatment duration and ABO scores of the 2 groups were recorded. Statistical analyses were evaluated using independent-sample t tests. The conventional group had a mean treatment time of 2.10 ± 0.69 years, and the self-ligating group had a treatment duration of 1.68 ± 0.48 years (P>0.05). The mean posttreatment ABO scores in the conventional group were 20.23 ± 5.13, and the mean posttreatment ABO scores in the self-ligating group were 21.00 ± 5.66. No difference was found between the groups regarding the criteria of ABO (P>0.05). The highest scores were given in the assessment of buccolingual inclinations in both conventional and self-ligating lingual bracket groups. The design of the lingual appliances used in this study did not influence the treatment duration and the total ABO scores in treating patients with a Class I relationship in this sample. Both types of lingual brackets were especially deficient in correcting buccolingual inclinations. The strengths were their ability to close spaces and correct anterior rotations and overjet regardless of the bracket types.

Direct-to-consumer orthodontics: Exploring laypeople’s perception of orthodontic treatment complexity

BackgroundThe authors aimed to explore the treatment preferences of laypeople regarding direct-to-consumer (DTC) orthodontics and to identify whether case complexity, as perceived by laypeople, is one of the factors influencing interest in DTC orthodontics. MethodsAn online cross-sectional survey was conducted. Data analysis was performed using logistic regression models. ResultsA total of 1,362 surveys were completed. A significant inverse association was identified between the complexity of an orthodontic case, as measured using the American Board of Orthodontics’ discrepancy index (DI) score, and the likelihood of choosing DTC treatment over an orthodontist. Participants were 3.53 times as likely to choose DTC treatment for a mild case (DI score, 0-10) compared with a complex case (DI score, > 20), although the likelihood of choosing DTC treatment for a moderate case (DI score, 11-20) was only 1.79 times higher than for a complex case. ConclusionsWhen laypeople were asked to consider each case as if it were their own dentition, there was a significant inverse association between the complexity of an orthodontic case, as measured using the DI score, and the likelihood of choosing DTC treatment over an orthodontist. Laypeople were seemingly more likely to choose DTC orthodontics for dentitions that did not appear crowded and were well aligned within the arches. Laypeople seemed to have an understanding that there are some limitations to DTC orthodontics. Practical ImplicationsOrthodontists should better understand the factors influencing consumers’ decisions to select DTC orthodontics and dental organizations should focus their educational campaigns on these factors.

Clinical Study on Efficiency of Using Traditional Direct Bonding or OrthGuide Computer-Aided Indirect Bonding in Orthodontic Patients

Objective This study aims to clinically investigate and compare the therapeutic effects and treatment cycle between traditional direct bonding and OrthGuide computer-aided indirect bonding in orthodontic treatment. Methods Forty patients treated at the Department of Orthodontics, Beijing Rytime Dental Hospital between July 1, 2016, and December 31, 2019, were included. The patients were divided into a control group (n = 20, traditional direct bonding) and a test group (n = 20, OrthGuide computer-aided indirect bonding). The American Board of Orthodontics (ABO) measurement was performed on patients using Uceph cephalometric analysis software to compare intragroup and intergroup differences, and the treatment cycles of all patients were recorded. Results After treatment, U1-NA (mm), ∠U1-SN (°), LL-EP (mm), and UL-EP (mm) in the control group were significantly lower than before treatment, and there was no significant difference in other ABO measurement indexes, while the test group showed no marked difference in all ABO measurements between pre- and posttreatment. Further, intergroup comparison showed no significant difference in ABO measurements in pre- and posttreatment between the two groups. The test group had a shorter treatment cycle than the control group, with an average treatment cycle of 21.20 ± 7.14 months in the control group and 17.17 ± 4.16 months in the test group. Conclusion There was no significant difference in the therapeutic effects between the direct and indirect bonding techniques. However, OrthGuide computer-assisted indirect bonding demonstrated a significantly shorter treatment cycle and might be more efficient than traditional direct bonding.

Evaluation of the Severity of Malocclusion in Children with Osteogenesis Imperfecta.

Occlusion is the way in which the dental arches are related to each other and depends on craniofacial growth and development. It is affected in patients with Osteogenesis Imperfecta (OI) who present altered craniofacial development. The malocclusion present in 49 patients diagnosed with different types of OI aged between 4 and 18 was studied. The control group of healthy people was matched for age, sex, and molar class. To study the mixed and permanent dentition, the American Board of Orthodontics (ABO) discrepancy Index was applied. The primary dentition was evaluated with a Temporary Dentition Occlusion Analysis proposed for this study. The OI group obtained higher scores in the Discrepancy Index than the control group, indicating a high difficulty of treatment. The most significant differences were found in types III and IV of the disease. Regarding the variables studied, the greatest differences were found in the presence of lateral open bite in patients with OI, and in the variable “others” (agenesis and ectopic eruption). The analysis of primary dentition did not show significant differences between the OI and control groups. Patients with OI have more severe malocclusions than their healthy peers. Malocclusion is related to the severity of the disease and may progress with age.

Distalization of maxillary molars with Invisalign aligners in nonextraction patients with Class II malocclusion

This retrospective study aimed to evaluate whether the treatment of Class II malocclusion with Invisalign aligners with sequential distalization of posterior teeth in adult patients would meet the criteria of American Board of Orthodontics (ABO) standards for the treatment and assess the predictive value of ClinCheck Pro software with the final results comparing the initial time, predictive planning using ClinCheck Pro software, and the final time without any require refinement. The sample consisted of 32 adult patients with Class II malocclusion (n= 32 [7 men and 25 women]; mean age 35.47 ± 9.61 years). All of them used a set of Invisalign aligners; no refinement set was evaluated. The 7 measurements of the ABO Model Grading System, the millimeter measurements for the anteroposterior ratios of maxillary first molars and the overbite were used in the evaluations and were compared in phases initial time, predictive planning using ClinCheck Pro software, and the final time. For the intraexaminer reliability test, the intraclass correlation coefficient was calculated to analyze the reliability of the measures. The Shapiro-Wilk normality test was used to examine whether the variables were normally distributed. The Wilcoxon nonparametric test for paired samples was applied for variables that did not show normal distribution. The parametric Student t test for paired samples was used for variables that presented normal distribution. The significance level adopted for this study was 0.05. In comparison between final ClinCheck and posttreatment results, the ABO index showed a statistically significant difference between the predictions and results for alignment and rotation, buccolingual inclination, overjet, occlusal contact, occlusal relationship, molar relationship, and overbite. The final score of the ABO scores did not meet the standards for Class II correction, contrary to what the ClinCheck Pro software predicted. The null hypothesis that distalization of the posterior teeth occurs in adult patients using Invisalign aligners was rejected. The treatment of Class II malocclusion with Invisalign aligners did not occur as estimated by the virtual planning prepared by ClinCheck according to the standards for evaluating occlusal results established by the ABO at the end of the use of a set of aligners with sequential distalization.

Agreement of the Discrepancy Index Obtained Using Digital and Manual Techniques—A Comparative Study

The discrepancy index evaluates the complexity of the initial orthodontic diagnosis. The objective is to compare whether there is a difference in the final discrepancy index score of the American Board of Orthodontics (ABO) when obtained using digital and manual techniques. Fifty-six initial orthodontic records in a digital and physical format were included (28 each) in 2022 at the Center for Research and Advanced Studies in Dentistry. For the digital measurements, iTero and TRIOS 3 intraoral scanners were used, along with Insignia software and cephalometric tracing with Dolphin Imaging software. Manual measurements were obtained in dental casts using the ruler indicated for the previously mentioned discrepancy index, in addition to conventional cephalometric tracing. Student’s t-test did not show statistically significant differences between the digital and manual techniques, with final discrepancy index scores of 24.61 (13.34) and 24.86 (14.14), respectively (p = 0.769). Cohen’s kappa index showed very good agreement between both categorical measurements (kappa value = 1.00, p = 0.001). The Bland–Altman method demonstrated a good agreement between continuous measurements obtained by both techniques with a bias of 0.2500 (superior limit of agreement =9.0092988, inferior limit of agreement = −8.5092988). Excellent agreement was observed in obtaining the discrepancy index through digital technique (Intraoral scanning and digital records) and manual technique (conventional records).

American Board of Orthodontics (ABO) Discrepancy Index and peer assessment rating (PAR) index with models versus photographs

BackgroundThe objectives of this study were to determine whether rating systems, such as the Peer Assessment Rating (PAR) and the American Board of Orthodontics Objective Grading System (ABO-OGS) can be applied to intraoral photographs. MethodsModels and photographs of 50 cases were graded by 4 raters, and a 20% repeat of randomized cases was completed 2 weeks later. Intraclass correlation coefficients (ICCs) were used to assess inter- and intra-rater agreements, as well as the level of agreement between the ratings on models and photographs. ResultsThe intra- and inter-rater agreements were considered good to excellent. The paired mean difference (model minus photo) for the PAR index and the ABO Discrepancy Index as a total was 2.405 and 1.156, respectively. Overjet was the subdomain that produced the highest differences between photos and models. The ABO- Discrepancy Index method on photographs was more reliable than the PAR index when grading pre-treatment and more-severe malocclusions. ConclusionsBoth methods can be used, but the choice depends on the purpose of the evaluation, and on consideration of the weaknesses and strengths of each relating to its use on photographs.

Effects of self-ligating brackets and other factors influencing orthodontic treatment outcomes: A prospective cohort study.

ObjectiveThe purpose of this study was to evaluate the effects of self-ligating brackets (SBs) and other factors that influence orthodontic treatment outcomes.MethodsThis two-armed cohort study included consecutively treated patients in a private practice. The patients were asked to choose between SBs and conventional brackets (CBs); if any patient did not have a preference, he or she was randomly allocated to the CB or SB group. All patients were treated using an identical archwire sequence. Evaluated parameters were as follows treatment duration, number of bracket failures, poor oral hygiene, poor elastic wear, extraction, use of orthodontic mini-implants (OMI), OMI failure, American Board of Orthodontics (ABO) Discrepancy Index (DI), arch length discrepancy, and ABO Cast-Radiograph Evaluation (CRE) score. Stepwise regression analysis was performed to generate the equation for prediction of the CRE.ResultsThe final sample comprised 134 patients with an average age of 22.73 years. The average DI, CRE, and treatment duration were 21.81, 14.25, and 28.63 months, respectively. Analysis of covariance showed a significant difference in CRE between the CB and SB groups after adjusting for the effects of confounding variables. Stepwise regression analysis using four variables, namely extraction, SB use, poor elastic wear, and additional appliance use, could explain only 25.2% of the variance in the CRE.ConclusionsAlthough the CRE was significantly better for CBs than for SBs, the clinical significance of this result seems to be limited. Extraction, SB use, poor elastic wear, and additional appliance use may have significant effects on treatment outcomes.

Smile Attractiveness Evaluation of Patients Selected for a U.S.-Based Board Certification Examination

Objectives The aims of this study were to assess smile attractiveness of a collection of 68 smiling photographs of successfully treated cases submitted to the American Board of Orthodontics (ABO) clinical examination and identify variables that influence the assessment. Materials and Methods A panel of 81 non-Caucasian assessors from various clinical disciplines were instructed to score the smile attractiveness on a visual analog scale from 1 (least attractive) to 10 (most attractive) and to select which components contributed to a lesser attractive smile. The mean, standard deviations (SDs), and quartiles of the smile attractiveness were obtained with descriptive statistics. Multilinear regression analysis was performed to investigate the scores of the perceived quality of smile attractiveness when the clinical disciplines and gender of the assessors were the factors taken into consideration. Receiver operating characteristic (ROC) curve was generated to establish the relationship between smile attractiveness and the achievement of a perfect smile. Results The mean (SD) rating of each clinical photograph of the anterior occlusion on smiling ranged from 3.11 (1.47) as the least attractive smile to 7.59 (1.45) as the most attractive smile. The overall mean (SD) score for smile attractiveness was 5.30 (1.10). Problems associated with teeth, gingiva, and lips corresponded with a reduction of the smile attractiveness score by 1.56, 1.82, and 1.47, respectively. Gender was not associated with smile attractiveness ratings. Orthodontists, periodontists, and prosthodontists demonstrated no difference in the ratings, while plastic surgeons were more critical than orthodontists regarding smile attractiveness. Conclusions This study suggested that only 2 out of 68 AOB validated treatment finishes had a perfect and attractive smile.

Comparison of the Treatment Effectiveness between Labial and Lingual Fixed Mechanotherapy and Patients’ Response toward Lingual Fixed Mechanotherapy: A Prospective Clinical Study

Objective: The present study was conducted to evaluate the effectiveness of treatment outcome using American Board of Orthodontics (ABO) scoring and total treatment time between labial and lingual appliance and also to assess patients’ perception of the lingual appliance system. Materials and Methods: Twenty patients requiring first premolar extraction were selected; 10 patients were treated with a lingual and 10 with a labial appliance. The treatment duration and ABO scores were recorded from the posttreatment dental casts and orthopantomogram (OPG). A questionnaire was used to evaluate the perception of patients on lingual treatment using a visual analogue scale (VAS). Results: The total ABO scores of the 2 groups were not statistically significant. The lingual- and labial-appliance treatments were completed in 19.30 ± 7.50 and 22.40 ± 6.35 months, respectively. The VAS showed that lingual-appliance patients experienced a moderate amount of pain and discomfort to the tongue and soft tissues. Patients did not have considerable difficulty with speech and in maintaining oral hygiene. Conclusion: Lingual appliance cases finished with a comparable quality of orthodontic treatment precision well within the normal treatment time frame. These patients had moderate difficulties with speech, tongue irritation, and pain. They did not have difficulty in maintaining their oral hygiene and were satisfied with their smile and treatment outcome.

Correlation between adolescent orthodontic quality of life and ABO Discrepancy Index in an orthodontic treatment-seeking population: A cross-sectional study

To evaluate the association between adolescents' orthodontic quality of life before initiating orthodontic treatment and their objective case complexity as measured by the American Board of Orthodontics' Discrepancy Index (DI). A single-centre, cross-sectional survey study. The Orthodontic Quality of Life Assessment Survey (OQoLAS) was administered to 240 adolescents (aged 11-14 years) during their record-gathering appointment. After completion of the survey, a DI score was calculated for each patient based on pretreatment measurements. Pearson correlation coefficients, r, were used to assess the association of DI scores with OQoLAS total and subdomain scores. A multiple linear regression of OQoLAS total scores adjusting for age, gender and DI scores was conducted. The study did not find a strong correlation between OQoLAS and DI scores (r = 0.10; P = 0.6497). On average, the OQoLAS scores (functional, emotional and social subdomains of OQoLAS) were slightly higher among girls than among boys but there was no statistical difference for total OQoLAS score between boys and girls (42.4 vs. 45.4, P = 0.2005). However, there was a significant difference in oral health perception rating between boys and girls, with girls being more likely to rate their oral health positively (adjusted P = 0.0226). The total DI scores of boys with respect to girls were not statistically different (P = 0.4256). The components of the DI that showed highest score were for cephalometric measures, followed by overjet; and the lowest scores were for lateral open bite and buccal posterior crossbite. The measure of association analysis did not show any strong correlation between the OQoLAS (total score and subdomain scores), and DI score or any of its components. Malocclusion severity was not found to be correlated with orthodontic quality of life in adolescents aged 11-14 years seeking orthodontic treatment.

The Relationship between Posttreatment Smile Esthetics and the ABO Objective Grading System: Class I Extraction versus Non-Extraction Cases.

This study aimed to evaluate the relationship between the components of the objective grading system developed by the American Board of Orthodontics (ABO) and smile esthetics in Class I extraction vs non-extraction cases. A total of 40 extraoral smile images of orthodontically treated (20 extraction and 20 non-extraction) cases in the age group of 13-30 years and Class I skeletal malocclusion with an average mandibular plane angle were selected. Smile images were rated only by the orthodontist, and this panel included 12 members. Scoring of post-treatment dental casts and panoramic radiographs of each patient was performed by 1 investigator per the guidelines of the ABO grading system. The Pearson correlation coefficient and logistic regression analysis were used to ascertain whether the scores of the ABO grading system could foretell whether a smile would be "attractive" or "unattractive." The correlation between all the criteria of the ABO grading system and attractiveness of the smile was extremely weak. The r values ranged from -0.53 to 0.37 for extraction cases and -0.63 to 0.003 for non-extraction cases (p>0.05). Neither individual parameters nor total scores of the ABO grading system could predict whether the smile was attractive or unattractive in either group. No correlation was found between post-treatment ABO grading and smile esthetics in patients with extraction or non-extraction. Hence, this study recommends that ancillary soft tissue variables have to be incorporated into the grading system to evaluate a smile.

A User-Friendly Protocol for Mandibular Segmentation of CBCT Images for Superimposition and Internal Structure Analysis.

Background: Since cone-beam computed tomography (CBCT) technology has been widely adopted in orthodontics, multiple attempts have been made to devise techniques for mandibular segmentation and 3D superimposition. Unfortunately, as the software utilized in these methods are not specifically designed for orthodontics, complex procedures are often necessary to analyze each case. Thus, this study aimed to establish an orthodontist-friendly protocol for segmenting the mandible from CBCT images that maintains access to the internal anatomic structures. Methods: The “sculpting tool” in the Dolphin 3D Imaging software was used for segmentation. The segmented mandible images were saved as STL files for volume matching in the 3D Slicer to validate the repeatability of the current protocol and were exported as DICOM files for internal structure analysis and voxel-based superimposition. Results: The mandibles of all tested CBCT datasets were successfully segmented. The volume matching analysis showed high consistency between two independent segmentations for each mandible. The intraclass correlation coefficient (ICC) analysis on 20 additional CBCT mandibular segmentations further demonstrated the high consistency of the current protocol. Moreover, all of the anatomical structures for superimposition identified by the American Board of Orthodontics were found in the voxel-based superimposition, demonstrating the ability to conduct precise internal structure analyses with the segmented images. Conclusion: An efficient and precise protocol to segment the mandible while retaining access to the internal structures was developed on the basis of CBCT images.

Class II malocclusion correction with Invisalign: Is it possible?

This research aimed to determine whether Class II malocclusion can be treated with clear aligners after completing treatment with the initial set of aligners. A sample of 80 adult patients were divided into Group 1 with Class I molar malocclusions (n=40 [11 men and 29 women]; 38.70±15.90years) and Group 2 with Class II molar malocclusions (n=40 [11 men and 29 women]; 35.25±15.21years). All patientshad finished treatment with the initial set of Invisalign aligners (Align Technology, Santa Jose, Calif) without known centric occlusion-centric relation discrepancies, issues of compliance, or overcorrection. The 7 measurements using the American Board of Orthodontics (ABO) Model Grading System and millimetric measurements for anteroposterior (AP) and vertical dimensions were assessed and compared between the 2 groups at pretreatment, posttreatment ClinCheck (Align Technology) prediction, and posttreatment. No improvements were observed in the APcorrection. The amount of AP correction in patients with Class II malocclusion was 6.8% of the predicted amount. The amount of overbite correction achieved was 28.8% and 38.9% of the predicted amounts in patients with Class I and Class II malocclusion, respectively. Significant improvements in alignment and interproximal contact scores were observed, with only slight improvements in total ABO scores. An increase in mean occlusal contacts score was observed after treatment. No patient with Class II malocclusions would meet the ABO standards after Invisalign treatment. The Invisalign system successfully achieves certain tooth movements but fails to achieve other movements predictably. No significant Class II correction or overjet reduction was observed with elastics for an average of 7-month duration in the adult population. Additional refinements may be necessary to address problems created during treatment, as evidenced by a posterior open bite incidence.

Clinical outcomes of lingual fully customized vs labial straight wire systems : Assessment based on American Board of Orthodontics criteria.

To evaluate orthodontic treatment outcome in patients treated with alingual appliance (Incognito™ Appliance System, 3MUnitek, Monrovia, CA, USA) versus patients treated with alabial appliance (Victory series™, 3MUnitek, Monrovia, CA, USA). Atotal of 72patients were retrospectively analyzed. The complexity of each case was evaluated using the American Board of Orthodontics (ABO) Discrepancy Index (DI), and orthodontic clinical outcomes were evaluated using the ABO Objective Grading System (cast-radiograph evaluation: C‑REval). The mean total ABO C‑REval score was 16 ± 9.1 in the labial appliance group and 12.7 ± 5.4 in lingual appliance group (p = 0.152). The mean total ABO-DI scores were 16.3 ± 7.3 and 15.4 ± 6.6 in the labial and lingual appliance groups, respectively (p = 0.445). A significant correlation was observed between the total DI and total C‑REval scores. In this particular study and in the hands of two experienced orthodontists, no differences in the finishing quality of orthodontic treatments using the lingual technique or the buccal appliance technique were found. However, further prospective studies with larger sample sizes are necessary in order to generalize these results.

The Herbst appliance combined with a completely customized lingual appliance: A retrospective cohort study of clinical outcomes using the American Board of Orthodontics Objective Grading System

In this retrospective study we aimed to evaluate the quality of treatment outcomes using the American Board of Orthodontics (ABO) scoring system with a completely customized lingual appliance used in combination with a Herbst appliance for Class II correction. Patient selection criteria for this study were Class II division 1, II/2 or subdivision treated with a WIN® lingual appliance combined with an L-pin Herbst device. Thirty-two consecutively debonded cases were included in this retrospective case series. Pre- and post- treatment dental casts, dental set-ups, panoramic X-rays, cephalometric analysis, photographs and clinical files were available for data collection. The primary outcome was the ABO score based on the Discrepancy Index (ABO DI) including: overjet, overbite, anterior open bite, lateral open bite, crowding, occlusion (Angle class), lingual posterior crossbite, buccal posterior crossbite, ANB, IMPA and SN-GoGN angles and the Cast-Radiograph Evaluation (ABO CR-Eval) comprising of alignment/rotations, marginal ridges, buccolingual inclination, overjet, occlusal contacts, occlusal relationship (Angle class), interproximal contacts and root angulation. In addition, overjet, overbite and Class II correction were also evaluated on pre- and post-treatment models. The secondary outcome was bracket failure and complications related to the Herbst device. The study cohort included 18 female and 12 male patients with a mean age of 15.8 (range 12, 6- 18, 5). Twenty patients were Class II division 1 and ten were Class II division 2. The mean pre-treatment value of ABO DI was 20.8 (range 10-39); more than two-thirds of the sample were rated as being either of moderate difficulty (ABO DI: 16-24) or severe (ABO DI: over 25). The average post-treatment ABO Cast-Radiograph Evaluation score was 15.0 (SD=4.4), which is considered a passing score. Twenty-six patients had a score equal or lower than 20 (undisputed passing score). The Class II discrepancy was effectively corrected from a score of 16.83 penalty points (SD: 3.65) pre-treatment to a score of 1.57 (SD: 1.70) post-treatment. No association was found between initial and final Class II occlusal relationships (P=0.42), indicating that regardless of the initial discrepancy, no difference in the success of Class II correction was observed. The mean bracket failure rate was 3.8 per patient. Herbst related complications were few: 1.6 per patient, with the majority of complications being of little consequence and with 43% of the patients having no breakages. The completely customized lingual appliance assessed in this study combined with an L-pin Herbst led to effective Class II correction regardless of the initial severity of the sagittal discrepancy. The average ABO CR-Eval score for this sample was well below the undisputed passing score indicating a high quality of treatment outcomes.