Attachment Placement Research Articles

Understanding the effectiveness of attachments in clear aligner therapy: navigating design, placement, material selection and biomechanics

Abstract Background Clear aligner treatments have gained popularity due to their aesthetic advantages over traditional metal brackets. Attachments play a crucial role in enhancing the efficacy of treatment by addressing challenges posed by the flexibility of aligner materials. This comprehensive review aims to clarify the significance of attachments used during clear aligner therapy and explore the nuances of their design, placement, and material selection. Methods A systematic search of literature databases including Web of Science, PubMed, Scopus, Google Scholar, and Cochrane was conducted. Twelve sets of keywords related to clear aligner therapy and attachments were applied for the search. Results A total of 24 studies that met the inclusion criteria and focused on the biomechanics of attachments, attachment shape, attachment placement and materials used in attachment production were included in the analysis. Conclusions Within the limits of the review, the use of attachments in clear aligner therapy can enhance the efficacy of treatment by facilitating complex tooth movements. The selection of materials, as well as the design and positioning strategies of attachments, should be customised for each patient to optimise treatment success. By the use of clinical studies, future research should focus on the long-term performance of attachments to confirm their effectiveness in achieving planned tooth movements, particularly regarding design, positioning, and the materials used.

Mixed reality-based technology to visualize and facilitate treatment planning of impacted teeth: Proof of concept.

We propose a method utilizing mixed reality (MR) goggles (HoloLens 2, Microsoft) to facilitate impacted canine alignment, as planning the traction direction and force delivery could benefit from 3D data visualization using mixed reality (MR). Cone-beam CT scans featuring isometric resolution and low noise-to-signal ratio were semi-automatically segmented in Inobitec software. The exported 3D mesh (OBJ file) was then optimized for the HoloLens 2. Using the Unreal Engine environment, we developed an application for the HoloLens 2, implementing HoloLens SDK and UX Tools. Adjustable pointers were added for planning attachment placement, traction direction, and point of force application. The visualization was presented to participants of a course on impacted teeth treatment, followed by a 10-question survey addressing potential advantages (5-point scale: 1 = totally agree, 5 = totally disagree). Out of 38 respondents, 44.7% were orthodontists, 34.2% dentists, 15.8% dental students, and 5.3% dental technicians. Most respondents (44.7%) were between 35 and 44 years old, and only 1 (2.6%) respondent was 55-64 years old. Median answers for six questions were 'totally agree' (25th percentile 1, 75th percentile 2) and for four questions 'agree' (25th percentile 1, 75th percentile 2). No correlation was found between age, profession, and responses. Our method generated substantial interest among clinicians. The initial responses affirm the potential benefits, supporting the continued exploration of MR-based techniques for the treatment of impacted teeth. However, the recommendation for widespread use awaits validation through clinical trials.

Automated placement of dental attachments based on orthodontic pathways

The aesthetic appeal and removability of clear aligners have led to their widespread popularity in orthodontic treatments. Dental attachments significantly contribute to shortening treatment duration and enhancing orthodontic outcomes. The automation of tailor-made dental attachments for individual teeth plays a crucial role in the field of orthodontics. This is because they enable more precise control over the forces applied, thereby effectively facilitating tooth movement. This study introduces an automated algorithm that generates dental attachments based on the orthodontic path. The algorithm automatically selects and places the appropriate type of attachment according to the magnitude of rotation and translation of teeth during orthodontic procedures. It adjusts the position and posture of the attachments to fit the teeth accurately. To validate the effectiveness of automatically placed attachments in guiding teeth along the predetermined path, this study employs finite element analysis to simulate the impact of attachments on teeth. Comparative analyses between the automated method and traditional manual techniques show that the proposed algorithm significantly enhances the precision and efficiency of attachment placement. Additionally, finite element simulations confirm the feasibility and effectiveness of this approach in clinical orthodontic applications, providing a novel technical pathway for automating attachment placement in orthodontic treatments and offering significant practical value for personalized and efficient orthodontic care.

For Indirect Orthodontic Attachment Placement, Adding a Custom Composite Resin Base Is Not Beneficial: A Split-Mouth Randomized Clinical Trial

Aim The aim of this study was to compare the chairside time, bond failure rate, and accuracy of bonding between two orthodontic attachment indirect bonding techniques. Methods and Materials Two indirect bonding techniques were studied: unaltered base attachment (UA) and custom base attachment (CBA) methods. Eighty-four orthodontic attachments were bonded on six patient stone models. Preoperative models were digitally scanned, and subsequently, attachments were transferred with the aid of a single but sectioned vacuum-formed tray to their corresponding patients. Finally, participants were scanned after attachment bonding to make the postoperative digital replicas. Chairside time and immediate bond failure rates were measured and compared between both techniques. Postoperative and preoperative digital models were then superimposed in order to measure the accuracy of bonding in the three dimensions of space. Results No differences existed between the two techniques regarding chairside time (P=0.87) and bond failure rates (P=0.37). There were also no differences found for the total attachment movement (P=0.73), mesiodistal (P=0.10), occlusogingival (P=0.31), torquing (P=0.21), and rotational measurements (P=0.18). The UA technique, however, proved to be more accurate for buccopalatal linear directions (P=0.04), whilst the CBA technique showed more accuracy for tipping angular deviations (P < 0.01). There was a statistically significant directional bias for the UA towards the occlusal (P < 0.01) and palatal (P=0.02) directions with mesial-out angular deviation (P=0.02). Conclusion The two indirect bonding techniques were comparable for chairside time, bond failure rates, and most linear and angular measurements. The UA technique was, however, superior in buccopalatal directions, while the CBA method showed more tipping accuracy. Both techniques were efficient and reliable for indirect bonding.

Shortening of Overall Orthodontic Treatment Duration with Low-Intensity Pulsed Ultrasound (LIPUS).

The aim of this retrospective clinical study was to determine if there is a reduction in the overall treatment duration in orthodontic patients using low-intensity pulsed ultrasound (LIPUS) and Invisalign SmartTrack® clear aligners. Data were collected from the first thirty-four patients (9 males, 25 females; average age 41.37 ± 15.02) who finished their orthodontic treatment using an intraoral LIPUS device and Invisalign clear aligners in a private clinic. The LIPUS parameters used by patients at home for 20 min/day were: ultrasonic frequency 1.5 MHz, pulse duration 200µs, pulse repetition rate 1 kHz, and spatial average-temporal average intensity 30mW/cm2. A control group (11 males, 23 females; average age 31.36 ± 14.41) matching for the same malocclusions was randomly selected from finished treatment cases of the same clinician. The date of first Invisalign attachment placement and first use of LIPUS application was recorded as T0, and the date of retainer delivery was recorded as T1. The treatment duration (T1–T0) and treatment reduction percentage with LIPUS device were collected and analyzed using two-sample t-test in Microsoft Excel. Treatment duration was significantly reduced in the LIPUS group (541.44 ± 192.23 days) compared to control group (1061.05 ± 455.64 days) (p < 0.05). The LIPUS group showed on average 49% reduction in the overall treatment time as compared to the control group. The average compliance of the patients using LIPUS was 66.02%. Patients who used LIPUS showed a clinically significant reduction in the overall orthodontic treatment duration compared to the control group who used Invisalign clear aligners only.

Learning for Employment: Challenges Encountered by Students

This paper discusses the challenges that are faced by students at the University of Botswana in learning for employment. There has been a complaint from employers that the University of Botswana does not produce students who are ready for employment. Based on this problem, this study investigated learners’ views on learning for employment so as to unearth challenges that students encounter in learning for employment. This study adopted a qualitative research approach and it used the open ended questionnaires, interviews and focus groups to tease out information from the University of Botswana students. Students who participated in this study were selected from different levels (year groups). The findings indicated that learners encountered challenges at various stages of their learning. Such challenges include but are not limited to: more concentration on theory than practice, large classes, lack of job opportunities, limited time for practice in the world of work and lack of supervision in attachment placement. The study concludes that a reflection is necessary for lecturers, the university and employees in various organizations to assist learners to gain skills for employment.

Evaluation of Different Attachment Systems on Single Implant Retained Mandibular Overdenture

This study was conducted to evaluate bone height around ball and socketand equator attachment in mandibular overdenture retained by single implant. Materialand methods: Ten completely edentulous patients were selected with ages rangingfrom 50-60 years. Single implant was inserted for each patient and they all receivedheat cured acrylic dentures. The ten patients were divided into two groups, group(I) have received ball &socket attachment, group (II) received equator attachment.In the fitting surface of the lower denture two holes where made between 6 and 7acrylic teeth and were filled with radioopaque material (amalgam) . These representedposterior marker areas of evaluation the bone height. Evaluation of bone height aroundthe implant and the posterior edentulous area which were marked for measurementwas done by CAD_CAM CT at the time of attachment placement then after 3 monthsthen 6 months. Results: In our study the comparison of equator and ball and socketattachments regarding the bone height changes around the implant revealed a significantdifference. On the other hand there was an insignificant difference when comparingthe distal extension area between them throughout the six months studies period.Conclusion: According to this study the equator attachment group indicates lessermarginal bone loss, as compared with the ball and socket attachment group, and thereis no difference in bone resorption on the posterior area of the ridge between the twoattachments

The Implant stability and bone height changes for immediately loaded single implant-retained mandibular overdentures with locator attachments

Aim: The aim was to evaluate the efficacy of attachment placement on initial stability and bone height changes for immediately loaded single-implants retaining mandibular overdentures.&#x0D; Methodology: Twenty edentulous patients were recruited for this study; 9 females (45.0%) and, 11 males (55.0%) (age ranged from 59.0 to 70.0 year). Single endoosseos implant was inserted in the mandibular midline region. Immediately after surgery; Locator abutment was secured on the implant and the male housing was connected intraorally using direct pick-up procedure. Marginal bone height measurements and implant stability values were assessed at the time of implant placement (baseline), 2,4,6,8, 12, 24 weeks then every 6-month interval up to 18 months post-implant placement. &#x0D; Results: The implant stability values decreased markedly from the baseline, during 4 weeks and, then increased gradually until reaching the initial values after 12 weeks followed by continuous increase to study’s end (p&lt;0.05). The peri-implant marginal bone level revealed an acceptable range of bone loss with a statistically significant differences between different follow-up times and it continued to the end of the study (p&lt;0.05).&#x0D; Conclusion: Retaining an overdenture by immediately loaded single implant could be a successful treatment option for mandibular edentulous arches, especially in people with limited financial resources. The use of Locator attachment seemed to have a favorable effect on implant stability and marginal bone around immediately loaded single implant mandibular overdenture after 18-months of function.

Low Level Laser Therapy in Orthodontics

Lasers are widely used in most of the fields in dentistry for many years and they have recently gained popularity in orthodontic practice. Most common procedures with laser applications in orthodontics could be summarized as acceleration of tooth movement, pain reduction after force application, bone regeneration in the median palatal suture area during maxillary expansion or consolidation phase after distraction osteogenesis, enamel etching during bonding procedure, reduction of enamel decalcification, debonding of ceramic brackets, soft tissue applications such as gingival recontouring and attachment placement for impacted teeth. In this review, biostimulation effect or low level laser therapy in orthodontics will be exclusively evaluated.

Employability skills: perspectives from employers and tourism graduates in Ghana

Employers of graduates of higher education have often complained of a gap between skills and work attributes required by industry and those acquired by graduates. The main aim of this paper was to provide a comparison of views of employers and tourism graduates on employability skills required for employment by industry in Ghana. The paper was based on a tracer study conducted in June and July 2011 at the Tourism Department of Cape Coast Polytechnic, in Ghana. The study, which was cross sectional, involved a sample of 174 employed tourism graduates, selected using snowball sampling and 25 of their employers selected through multi stage sampling. The results of the study indicated that while there were no vast differences in their views regarding importance of certain skills, there were variations in the level of importance placed on such skills. For instance, the graduates considered the work attribute of time management more important than the employers, while the employers gave higher priority to team working skills than the graduates. An implication of this study is that strong collaboration is needed between higher educational institutions and industry employers not only to ensure industrial attachment placement for students but also for the students to acquire the right employability skills and work attributes, needed by industry

Patient satisfaction of tooth supported overdentures utilizing ball attachments

Statement of problemTeeth retained overdenture therapy is an alternative treatment rarely used in cases with few remaining teeth. PurposeThe aim of this study was to evaluate the patient satisfaction associated with teeth retained maxillary and mandibular overdentures utilizing ready made ball attachment. Materials and methodsThirty patients treated with teeth retained overdenture utilizing ready made ball attachment. Participants completed a series of questionnaires (OHIP-14 questionnaire) after tooth supported overdenture wearing by one month (base line), then after one month and 12 months of wearing the attachment retained overdenture. ResultsStatistically insignificant difference between gender, and for upper and lower arch overdentures, before attachment placement, one month and one year post attachments placement. Statistically significant difference in patient satisfaction was recorded with different intervals of the questioner. ConclusionTooth retained overdentures using ball attachments achieve greater satisfaction scores than those conventional tooth supported overdentures.

Assessment of Periodontopathogens in Subgingival Biofilm of Banded and Bonded Molars in Early Phase of Fixed Orthodontic Treatment.

To assess the prevalence and occurrence of eleven periodontopathogens in subgingival biofilm of banded and bonded molars during the first period of fixed orthodontic treatment. Subjects were selected from patients referred to orthodontic treatment and were divided in two groups: group A comprised fifteen patients (14.4±2.45 years of age) who received orthodontic bands on first permanent molars and group B of ten patients (15.7±1.87 years of age) with directly bonded tubes on the labial surface of the same teeth. Subgingival sample collection was performed before bands and tubes application and 4-7 weeks after attachment placement. DNA-strip tehnique was used to assess the presence of eleven putative periodontopathogens at each time point. Fusobacterium nucleatum, Eikenella corrodens and Capnocytophaga spp. were found in a large number of samples, other periodontopathogens were present in a smaller rate. The 4-7 weeks after attachment placement a slight increase of putative species was observed in both groups. The presence of orthodontic tubes and bands influence the accumulation and composition of subgingival microbiota. Higher level of oral hygiene should be achieved before and during orthodontic treatment in order to prevent any side effects on periodontal tissues.

Genetic Relationship of Productive Life, Production and Type Traits of Korean Holsteins at Early Lactations.

The present study was performed to study the genetic relationship of productive life with production and type traits of Korean Holsteins at first three lactations. The data for the analysis from 56,054, 28,997, and 11,816 animals of first, second and third parity cows which were born from 2006 to 2011 were collected by Dairy Cattle Improvement Center, National Agricultural Co-operative Federation. Milk, protein and fat yields adjusted for 305 days and average somatic cell score considered as production traits and analyzed type traits were stature, strength, body depth, dairy form, rump angle, rump width, rear leg side view, foot angle, front attachment placement, rear attachment height, rear attachment width, udder cleft, udder depth, front teat placement and front teat length. A multi trait genetic analysis was performed using Wombat program with restricted maximum likelihood animal model composed of fixed effect of birth year, farm and the random effect of animal and random residual effect according to the traits. Heritability estimates of productive life were between 0.06 and 0.13. Genetic and phenotypic correlations between production and productive life traits ranged from 0.35 to 0.04 for milk, 0.16 to 0.05 for protein and 0.18 to 0.02 f 15-0034 (2nd) 150520 or fat. Somatic cells score showed a negative genetic and phenotypic correlation with productive life and also udder type traits, indicating that the selection for higher udder traits will likely to improve resistance to mastitis and persistence in the herd. Among all dairy form type traits, udder characters such as udder cleft showed a significant relationship with productive life. However, a specific change of heritabilities or correlations were not observed with the change of parity. Moreover, further studies are needed to further confirm the significance of the above traits and the effect of parity on above relationships in order to minimize both voluntary and involuntary culling rates while improving herd health and maintaining high yielding dairy cows.

The management of palatally displaced maxillary canines: Considerations and challenges

This article opens with a recognition that ectopic maxillary canines may lead to frank impactions requiring a coordinated and multidisciplinary approach to their surgical/orthodontic management and the potential benefit of managing canine ectopia, particularly palatally displaced canines, more conservatively in their pre-eruptive ectopic positions in an effort to avoid impaction. The prevalence of palatally displaced canines (PDC) in various populations and corroborating as well as competing or conflicting opinions of etiology are briefly reviewed. Some of the traditional as well as relatively newer strategies and associated investigations of managing pre-eruptive palatally displaced maxillary canines are discussed, and the imaging techniques utilized to identify and locate ectopic maxillary canines are also discussed. Early detection of ectopic canines must include at the very least panoramic and/or periapical radiographs as part of any mixed dentition orthodontic examination and assessment. The sometimes unpredictable continued path of the ectopic maxillary canine poses clinical and ethical issues to the clinician when developing treatment strategies as part of any overall orthodontic treatment plan for young patients presenting with maxillary canine ectopia. The need for more thoughtful and carefully designed randomized clinical trials with a greater emphasis on subject sample scrutiny is strongly recommended to add much needed clarity to the clinical management of ectopic maxillary canines.

Retention of Implant-Supported Overdenture With Bar/Clip and Stud Attachment Designs

The degree of retention for overdenture attachments depends on design, location, and alignment of supporting dental implants and the type of attachments. The aim of this study was to evaluate the retention of an implant-supported overdenture with different attachment designs. An overdenture was made on an edentulous mandibular model with 2 ITI implants (4.1 × 10 mm) in the symphyseal region. Five specimens of 8 attachment designs with corresponding abutments and superstructures were used: ITI regular Dolder bar with 1 metal clip, ITI regular Dolder bar with cantilever and 3 metal clips, Hader bar with 1 plastic clip, Hader bar with cantilever and 3 plastic clips, Sphero block abutment with Rhein plastic caps (green, white, and pink), and retentive anchor with ITI elliptical matrix. The attachments' housings were interchangeable and fixed into the overdenture through nut and screw. The overdenture attachments were subjected to 8 consecutive pulls on a universal testing machine with a crosshead speed of 50.8 mm/min in the vertical and posteroanterior directions. Analysis of variance and Duncan tests were used to determine differences between mean retention values (α = .05). The highest average value retention was recorded for the ITI Dolder bar with cantilever and 3 metal clips in both the vertical and posteroanterior directions, respectively (P < .05). The Rhein pink caps had the lowest retention in the posteroanterior direction (P < .05). Retention decreased over the course of consecutive pulls for all attachments in both directions. The type, number, and placement of attachments affect the retention of implant-supported mandibular overdentures.

A Quality-of-Life Comparison Between Self-Aligning and Ball Attachment Systems for 2-Implant–Retained Mandibular Overdentures

The aim of this study was to evaluate the self-aligning overdenture attachment system by comparing its oral health-related quality of life (OHRQL) with a traditionally used ball attachment system. In this randomized, within-subject crossover trial, 25 edentulous subjects each received 2 mandibular implants, and were then assigned to receive either self-aligning or traditional ball attachments. After 3months, all subjects were switched to the second attachment type. The OHRQL was evaluated for both of the treatments using the short form of the Oral Health Impact Profile (OHIP-14). A subanalysis among subjects with below-average space available for attachment placement was also performed. Wilcoxon signed-rank test was used to compare differences between groups. Scores on the OHIP-14 physical disability domain were significantly better for the self-aligning attachment system (P = .049). Among subjects with below-average attachment space, functional limitation, psychological discomfort, physical disability, psychological disability, and total OHIP-14, scores were significantly better for the self-aligning attachment system (P = .041, P = .047, P = .048, P = .026, and P = .005, respectively). The self-aligning attachment system for 2-implant-retained mandibular overdentures is equal or superior to traditional ball attachments in all domains of the OHIP-14.

Radicular attachment assisted prosthetic rehabilitation of a patient with a unilateral maxillectomy defect secondary to adenocystic carcinoma

The rehabilitation of patients with acquired defects of the maxilla is a challenge in terms of re-establishing oronasal separation. In most patients these goals are met by means of prosthetic rehabilitation with an obturator prosthesis. Prosthetic rehabilitation can be achieved satisfactorily if all facets of treatment planning and design consideration are taken well into account prior to the rehabilitation process. In many cases effective obturation is achieved but in the relative majority, the prosthesis is usually rejected by the patient as being non-retentive and the outcome is a failure. So, making the prosthesis hollow and the placement of attachments can have a dramatic effect on the stability and retention of the obturator prosthesis in partially dentulous maxillectomy patients. This paper describes a clinical case of post maxillectomy due to adenocystic carcinoma, rehabilitated with the hollow bulb obturator stabilized with Dalla Bona type of radicular attachment.

Retention of maxillary implant overdenture bars of different designs

Statement of Problem. The specific degree of retention for overdenture attachments is unknown in relation to design, location, and alignment to supporting dental implants. Purpose. The purpose of this study was to evaluate the initial retention characteristics of 5 implant maxillary overdenture designs under in vitro dislodging forces. Material and Methods. A simulated edentulous maxilla was fabricated with 4 screw-type 3.75 × 13-mm implants anteriorly. Five overdenture designs with the following attachments were evaluated: 4 plastic Hader clips with an EDS bar; 2 plastic anterior Hader clips with an identical EDS bar; 2 Hader clips with 2 posterior ERA attachments; 3 Zaag attachments on a bar; and 4 Zaag attachments with no bar. Overdentures were fabricated with full palatal coverage. Each design was subjected to 10 consecutive retention pulls on a universal testing machine. Data were subjected to analysis of variance and t tests to determine differences. Results. The highest average value after 10 pulls was 19.8 lb for the combination ERA and Hader clip design. The lowest retentive values were recorded for the 2 and 4 Hader clip designs (5.08 ± 0.89 lb and 5.06 ± 0.67 lb, respectively). Retention decreased over the course of consecutive pulls for all designs, especially for the most retentive designs. The smallest retention decrease occurred with the least retentive designs. Conclusion. The results of this in vitro study suggest that the precise selection and placement of attachments may affect the clinical success of maxillary implant-retained overdentures. (J Prosthet Dent 2001;86:603-7.)

Scientific rationale for the surgical and prosthodontic protocol for immediately loaded root form implants in the completely edentulous patient.

This paper discusses a modified surgical and prosthodontic protocol to place implants in the completely edentulous patient. Methods for presurgical, prosthodontic workup, impression transfer technique, provisionalization, and attachment placement are also discussed.

Some aspects of extracranial causes of facial pain

30. Pruzansky S, Pesek M, Osborn LF: Quantitative analysis of the Reprint requests to: electromyogram in masticating chewing gum of varying toughDR. CHARLES H. GIBBS ness. Am J Orthod 44~149, 1958 (Abstr). UNIVERSITY OF FLORIDA 31, Ahlgren J: Mechanism of mastication. Acta Odontol &and 24~1, COLLEGE OF DENTISTRY 1966 (Supple No. 44). Box J-424 32. Sposetti VJ, Gibbs CH, Alderson TH, Jaggers JH, Richmond GAINESVILLE, FL 32610 A, Conlon M, Nickerson D: Bite force and muscle activity in overdenture wearers before and after attachment placement. J