End Of Orthodontic Treatment Research Articles

Prognostic risk factors for apical root resorption in orthodontic patients – Are the Kjær’s morphologic characteristics of clinical relevance?

BackgroundPatients undergoing orthodontic treatment (OT) face an increased risk of developing external apical root resorption (EARR). A prognostic risk assessment prior to OT can potentially be conducted through anatomical features in panoramic radiography. This retrospective study aimed to assess the significance of Kjær's morphological characteristics in analyzing the risk of EARR. MethodsPanoramic radiographs of 1,156 patients (624 females, 532 males) were retrospectively analyzed. Anamnestic and treatment-related data were extracted from patient records. The mean age at the start of OT was 12.8 ± 2.2 years (min. 6.4 years, max. 22.3 years) and at the end of OT 15.9 years (min. 8.5 years, max. 24.1 years). The mean treatment duration was 3.1 ± 1.6 years. Panoramic radiographs with a minimum of two per patient were examined for the presence of Kjær’s characteristics. The degree of EARR was registered defining resorption in four degrees of severity. Bivariate analysis and multivariate Poisson regression were performed to assess the association between Kjær’s characteristics and EARR patient- and tooth- related (α = 0.05). ResultsIn total, 72.8% of the patients showed EARR at the end of OT with lateral maxillary incisors most frequently affected. Short roots (p < 0.001) were significantly associated with EARR in patients. Tooth-related microdontia (#12, #22, lower second premolars), narrow crowns (#11, #21, lower incisors), short roots (upper incisors, lower first molars) and ectopia (#11, #21, #13), such as shorter distal roots of the mandibular first molar showed a significant association with EARR depending on severity degree. The type of orthodontic appliance (fixed: p < 0.001, fixed and removeable: p = 0.008), as well as treatment duration (p < 0.001) were also identified as risk factors for EARR. ConclusionsAlthough the risk assessment for EARR development through panoramic radiography analysis is limited, predisposition appears to be present in specific dental characteristics and treatment-related factors.

Autotransplanted premolars for substituting traumatic maxillary central incisors in a Class II growing patient

A 10-year-old young Hispanic male patient was referred to the Endodontics Department with the chief complaint of color change of maxillary central incisors. The parents reported trauma one year before and as a result root canal treatment; maxillary central incisors extractions were necessary due to poor prognosis, so he was referred to the Orthodontics Department to evaluate if the patient could be the candidate for orthodontic treatment, as he showed severe crowding. The patient had no medical conditions, and the pretreatment records showed a Class II skeletal relation and vertical pattern. Dental findings were mixed dentition, an Angle Class II molar relationship, moderate upper and lower anterior crowding, 4 mm of overbite, and 7 mm of overjet. The patient underwent autotransplantation of maxillary second premolars into the place of maxillary central incisors that needed to be extracted as stated by the endodontist (premolar extractions were needed to solve the orthodontic problems). The suggested position for the autotransplant teeth was not accomplished by the surgeon, so orthodontic forces were applied to the autotransplant teeth to the ideal position. At the end of orthodontic treatment, the autotransplanted teeth were restored by the prosthodontist. Therefore, the facial balance improved, and the final occlusal relationships were good. COVID-19 global lockdown was a challenging obstacle to overcome during treatment. This case report intends to highlight the potential benefits of tooth autotransplantation and to increase awareness of this treatment protocol.

Impact of fixed orthodontic retainers on oral health-related quality of life: a longitudinal prospective study.

The aim of the present study was to assess the impact of orthodontic retainers on oral health-related quality of life (OHRQoL) in the short and long terms after orthodontic treatment. Data from 45 patients up to three years after orthodontic treatment (T0) were analyzed. Patients were reassessed four years (T1) after T0. OHRQoL was measured using the OHIP-14 (Oral Health Impact Profile-14) questionnaire. The presence of a fixed retainer in the upper and/or lower arches, sex, and age were the predictive variables evaluated at T0 and T1. The occurrence of retainer fracture at T0 was clinically evaluated. Due to the COVID-19 pandemic, clinical examination on T1 was not possible, so the OHIP-14 and the self-perception of changes in teeth position and fracture of retainers were examined using an on-line questionnaire. At the initial examination, the presence of upper retainers had a negative impact on quality of life (p=0.018). The OHIP-14 value increased significantly from T0 to T1 (p=0.014), regardless of the presence of retainers. The fracture or debonding of the retainer reported by the patient was the only variable that had a negative impact on OHRQoL (p=0.05). The use of fixed upper retainers suggests a negative impact on the quality of life of the orthodontic patient after the end of orthodontic treatment. This impact, however, is negligible in the long term, except when associated with fracture or debonding. This study emphasizes the need for continuous follow-up of orthodontic patients during the retention period.

Impact of orthodontic treatment on OHRQoL of adolescents: a longitudinal study.

The aim of this study was to evaluate the extent to which orthodontic treatment need is perceived by the patients and by the orthodontist, as well as the possible impacts on the OHRQoL (Oral Health-Related Quality of Life) over the course of conventional orthodontic treatment in adolescent patients. The sample consisted of 55 adolescents. The perception of patients and orthodontists relative to the malocclusion was evaluated by the IOTN (Index of Orthodontic Treatment Need). The OHRQoL was evaluated by the Child-OIDP (Child-Oral Impacts on Daily Performances) questionnaire before the conventional orthodontic appliance was bonded (T0); and at the following time intervals: after one week (T1), one month (T2), three months (T3), six months (T4), and after the end of orthodontic treatment (T5). Adolescents who had large orthodontic treatment needs had a poor OHRQoL, according to their self-perception (p=0.003) and according to the orthodontist's perception (p<0.001), when compared with patients with small and moderate needs. There was statistically significant difference in the OHRQoL between the time intervals T0 and T1 (p=0.021), T2 and T3 (p<0.001), T3 and T4 (p=0.033), and T0 and T5 (p<0.002). At the end of treatment, all evaluated participants reported an improvement in OHRQoL. It was concluded that adolescents and orthodontists agreed with regard to the perception of orthodontic treatment need. In the first week and in the first month of orthodontic treatment, there was a negative impact on the OHRQoL. After three months, an improvement of OHRQoL was detected, which has progressed over time.

Effects of Third Molars on Anterior Crowding and Relapse After Orthodontic Treatment

Purpose: This study aimed to evaluate the effect of the absence or presence of third molars on the relapse of mandibular incisor crowding after orthodontic treatment and to determine the indication for prophylactic third molar extraction in orthodontic patients based on Ganss ratios. Material and Method: The study was conducted with the dental models, panoramic and lateral cephalometric radiographs, and intraoral and extraoral photographs of 42 patients (26 females, mean age 16.56±4.96 years; 16 males, mean age 17.52±4.39 years). Data were collected at three time points: before (T1), at the end of (T2), and at least 2 years after the end of orthodontic treatment (T3). The patients were divided into two groups: those with impacted or erupted third molars (Group 1, n=22) and those with agenesis or extracted third molars (Group 2, n=20). Panoramic radiographs were used to determine the presence or absence of third molars at the three time points and to calculate Ganss ratio (GR) (1). Dental models were scanned with the 3 Shape TRIOS oral scanner (3 Shape Co. Copenhagen, Denmark) and mandibular anterior crowding was assessed using Little’s Irregularity Index (LII) (2). Mann-Whitney U test was used to compare mandibular LII values between the groups. GR values of mandibular impacted third molars at T1-T3 were evaluated with repeated-measures ANOVA. Pearson correlation analysis was used to determine the correlation between LII and GR in Group 1. Statistical significance was set at P&lt;0.05. Results: There was no statistically significant difference between the groups in terms of the relapse of mandibular anterior crowding and the presence or absence of mandibular third molars (P=0.940). In Group 1, GR increased significantly at T3 due to an increase in retromolar distance (P&lt;0.05). There was no correlation between LII and GR in Group 1. Conclusion: The presence or absence of mandibular third molars did not affect the relapse of mandibular anterior crowding in orthodontic patients. Prophylactic third molar extraction after orthodontic treatment does not seem necessary.

Orthodontic treatment in stage IV periodontitis patients: Timing, management and long-term prognosis

Patients affected by severe periodontitis can develop a secondary malocclusion due to pathologic tooth migration that, if untreated, can hinder the maintenance of the entire dentition. In these cases, the combination of the appropriate stepwise periodontal therapy together with orthodontic treatment may become essential to re-establish health, aesthetics and function, leading to patient satisfaction and long-term stability. However, to successfully perform orthodontic tooth movement in stage IV periodontitis patients is paramount to carefully plan the treatment with a interdisciplinary approach, respecting the correct timing of the different phases of treatment, adapting biomechanics and appliance design individually, considering loss of periodontal support suffered from each patient. At the end of orthodontic treatment, after eventual prosthetic procedures, life-long retention and supportive periodontal care are needed to ensure good long-term prognosis. The present review describes the diagnostic, prognostic and therapeutic challenges associated with the combined ortho-perio treatment of stage IV periodontitis patients, providing both a literature and expert-based support for a biologically-orientated approach.

Stability of anterior open bite cases treated with upper and lower extrusion arches in adults: a follow-up study.

To investigate the post-treatment stability of anterior open bite (AOB) cases treated with upper and lower extrusion arches in adults. 23 patients with AOB were treated with extrusion arches and evaluated for dentoskeletal changes using lateral cephalometric radiographs before treatment (T0), after treatment (T1), and 12 months post-treatment (T2). Patients received bondable tongue spurs and vacuum-formed retainers as post-treatment retention/stability measures for 12 months. Post-treatment stability was further assessed qualitatively by the Photographic Openbite Severity Index. All the cases showed positive overlap between the anterior teeth at the end of orthodontic treatment, and 20 of 23 treated patients attended the recall visit after 12 months. A total of 85% of the cases maintained positive overlap at least 1 year post-treatment, 10% showed edge-to-edge bite, and only 5% showed no overbite. Treatment of AOB in adults with extrusion arches proved to be stable 1 year post-treatment. Changes in the overbite after 1 year of follow-up were not significant.

Occlusal Contact Changes With Traumatic Occlusion After Orthodontic Treatment: A Prospective Study

Aim: The aim of this study was to evaluate trauma from occlusion in patients undergoing orthodontic treatment through assessment of fremitus, pocket depth, gingival biotype, and occlusal contacts pre-orthodontic treatment (T0) and post-orthodontic treatment (T1). Materials and Methods: This prospective randomized trial included 40 participants selected based on a simple random sampling method, of which 27 were women and 13 were men with ages ranging from 25 to 40 years. All the participants were clinically checked for gingival recession, fremitus, pocket depth, gingival biotype, and occlusal contacts obtained via digital intraoral scans and fed to 3Shape software to perform the occlusal mapping analysis for pre-orthodontic treatment (T0) and post-orthodontic treatment (T1). T-Scan occlusal analysis was performed to check the force levels pertaining to each tooth. A paired t-test was done to find out the changes in fremitus, pocket depth, gingival biotype, and number of occlusal contacts between T0 and T1. Results: Results of paired t-tests showed a statistically significant difference for fremitus between T0 and T1 ( p &lt; .05). Gingival biotype and pocket depth did not show any improvement post-orthodontic treatment (T1) ( p &gt; .05). Number of traumatic occlusal contacts reduced at T1 for incisors and canines showing a statistically significant difference between T0 and T1 ( p &lt; .05). Conclusion: Orthodontic treatment helps in relieving the traumatic occlusal contacts, especially in the incisors and canine regions. As the teeth are relieved from traumatic occlusal contacts, fremitus also has shown to have drastically improved at the end of orthodontic treatment. Gingival biotype and pocket depth might take a longer time to regenerate and improve, which requires long-term observation.

Comparative Analysis of the Treatment Results with DENT@LIGN Digital Aligners and the Virtual Treatment Plan

The aim of the present study is to evaluate the results of the treatment with DENT@LIGN digital aligners by comparative analysis between printed virtual 3D motivational models, obtained from the virtual treatment plan, and conventional plaster casts, from the end of orthodontic treatment.&#x0D; We measured and evaluated 136 (69 from the upper and 67 from the lower dental arch) conventional plaster casts of 72 patients and 3D printed virtual motivational models of the same patients. The obtained data was evaluated statistically.&#x0D; The results from the comparative analysis showed high coincidence of the treatment results with DENT@LIGN digital aligners and the virtual treatment plan. The data showed insignificant differences between conventional plaster casts and 3D digital models in the measured parameters.&#x0D; This gave us the reason to believe that the virtual treatment planning and motivational models correspond to the achieved clinical results and are an overall reliable method for treatment planning.

The identification of possible reference planes on a CBCT scan taken with a small FOV—an observational analytical study

Abstract Objectives Unlike a CBCT scan which has a large field of view (FOV), a scan with a small FOV may not involve the base of the skull. Therefore, routinely used reference planes may not be available to evaluate treatment outcome. The present study was undertaken to determine if the palatal plane and a molar occlusal plane may be used as reference planes to measure the change in the axial inclination of the maxillary central incisor and the maxillary first permanent molar towards the end of orthodontic treatment on a CBCT scan captured with a small FOV. Materials and methods A lateral cephalogram and a CBCT scan with a small FOV were taken for fifteen young adults prior to, and six months after, mini-implant supported, distal movement of the maxillary arch. CBCT multi-planar slices were sequentially viewed to obtain an image that contained the entire length of the maxillary central incisor and the maxillary first permanent molar in the tangential view. The axial inclination of the maxillary central incisor and the maxillary first permanent molar was measured from the palatal plane and the molar occlusal plane on both sides. The same parameters were evaluated on the lateral cephalogram using the palatal plane as a reference. An independent t test (p = 0.05) was conducted to compare the results. A Bland–Altman plot with linear regression was constructed to measure accuracy, method agreement and reliability. Results There was no statistically significant difference when a change in the axial inclination of the maxillary central incisor and the maxillary first permanent molar was measured using the two reference planes. The change in axial inclination of the maxillary central incisor and maxillary first permanent molar had a 95% confidence interval of -1.82 to 4.19 and -4.48 to 3.05 and a p-value of 0.425 and 0.701 on the right side, respectively, and a 95% confidence interval of -1.76 to 4.79 and -4.41 to 2.79 and p-value of 0.350 and 0.650 on the left side. Conclusions The molar occlusal plane and the palatal plane may be used as reference planes for measuring change in the axial inclination of the maxillary central incisor and the first permanent molar in a CBCT scan taken with a small FOV.

Effect of socioeconomic and malocclusion-related factors on duration of orthodontic treatment by fixed appliance: A retrospective study.

The aims of this study were to evaluate the effect of related factors that influence orthodontic treatment time and to identify the predictors of orthodontic treatment duration in a Chinese population. Information for 29 sociodemographic, malocclusion and orthodontic treatment characteristics was collected. Patients were divided into two groups: the duration ≤24 months group and duration >24 months group. The treatment dates of the initial visit and end of orthodontic treatment were obtained to calculate duration. The data were subjected to univariate and multivariate logistic regression modelling to quantify the association between characteristics and the treatment duration; odds ratios (ORs) and 95% confidence intervals (95% CIs) are reported. Of 2120 patients, 704 patients (mean age, 15.9 ± 6.0 years) were included. Age, extraction, Bolton ratio (overall), rotated teeth, overjet and crowding (lower arch) were predictors for duration. The nomogram based on predictive factors exhibited strong discrimination ability, with concordance indices of 0.755 (95% CI = 0.712-0.798) in the training cohort model and 0.717 (95% CI = 0.647-0.787) in the validation cohort model. The calibration curves for the training and validation cohorts showed that the probabilities of the nomogram agreed well with actual probabilities. Young age, non-extraction and severe crowding (lower arch) can increase the chance of durations of ≤24 months. Rotated teeth, excessive overjet and Bolton ratio (overall) can increase the chance of durations of >24 months.

Biometric parameters of the upper dental arch in patients with a stable result of orthodontic treatment of abnormal position of the crowns of the maxillary canines

Aim to evaluate the metric parameters of the upper dentition in patients with a stable result of orthodontic treatment of anomalies in the position of the crowns of the upper canines in the long-term follow-up period.&#x0D; Material and methods. We conducted an open study on a sample of patients after orthodontic treatment using clinical and instrumental methods. We analyzed 126 clinical cases of patients aged from 18 to 44 years with completed orthodontic treatment of abnormal position of the crowns of the maxillary canines with satisfactory aesthetic and functional results. The duration of the retention period ranged from 5 to 10 years. 75 patients met the inclusion criteria for the study.&#x0D; Results. The study showed that the biometric parameters of the dental arches after the end of orthodontic treatment did not always correspond to the individual norm of a patient. An increase in the transversal size of the upper dentition in the region of the premolars was determined in 44 patients (58.6%), a slight narrowing in the region of the first molars in 34 patients (45.4%), lengthening or shortening of the anterior part of the dental arch in 32 (42.7%) and 23 (30.6%) patients, respectively. With the proportionality of the mesio-distal dimensions of the incisors of the upper and lower jaws (Tonn's Index 1.340.03) and the relative macrodontia of the canines of the lower jaw (anterior Bolton's ratio 81.03.2%), the symmetrical position of the crowns of canines of the upper jaw and the value of the rotational angle of 28.02.1corresponded to the functionally optimal results of orthodontic treatment.&#x0D; Conclusion. Aesthetically satisfactory and functionally stable results of orthodontic treatment of patients with anomalies in the position of the crowns of the maxillary canines during the retention period correspond to the following biometric parameters of the upper dental arch and / or their combination: lengthening of the anterior region, an increase in the transversal size in the region of the first premolars and a decrease in the region of the first molars in maintaining the individual norm of intercanine width. The stability of the results of orthodontic treatment in patients with anomalies in the position of the canines and the shape and / or size of the dental arches is ensured by the maximum possible leveling of violations of the anatomical and topographic norms of the teeth position.

Use of retention in orthodontics, is it necessary? Literature review

One of the main goals at the end of orthodontic treatment is occlusal stability, but changes after bracket removal may be unavoidable. Retention is one of the problems that orthodontists are most concerned about, as the protocol to be followed is not defined, and the devices used for this purpose require the patient's collaboration. For the literature review, a search was carried out in the following electronic databases: Pubmed, Lilacs, Springer, Google Scholar, Chocrane Library. The keywords used were: retention, post orthodontics, orthodontics, containment. The search was restricted to articles in English, Spanish and Portuguese published since 2012. A literature review of 113 articles was carried out of which 50 articles from Pubmed, Lilacs 21, Springer 6, Google Scholar 23, Cochrane Library 13. After applying the inclusion criteria, a total of 16 articles were obtained and reviewed. It was concluded that the use of retainers (in general) post orthodontics does not guarantee that relapse will occur in the medium or long term; likewise, the adequate use of retainers by the patient prevents the percentage of relapse from increasing. The fixed mandibular retainer has better acceptance and adaptation and the use of informed consent at the time of starting orthodontic treatment allows the professional to explain the consequences of a possible relapse.

A Digital 3D Retrospective Study Evaluating the Efficacy of Root Control during Orthodontic Treatment with Clear Aligners

This study aimed to investigate the efficacy of torque movement and the incidence of root resorption in the maxillary and mandibular teeth with clear aligner therapy using cone-beam computed tomography. The sagittal root positions, the faciolingual inclinations, and the root lengths of 672 teeth, from central incisors to first molars for each arch, were measured and compared on virtual cross sections from pre-treatment and post-treatment cone-beam computed tomography of 28 patients who received comprehensive orthodontic treatment with clear aligners. An improvement of root position was found in incisors, canines, and premolars of the upper and lower arches: over 78% of their root was centered in the alveolus at the end of orthodontic treatment. There was a statistically significant torque increase for incisors, canines, and first premolars at the end of therapy. The most considerable torque changes were achieved in incisors and canines, while the lowest was in posterior teeth. The maxillary and mandibular central incisors achieved 3.26 ± 1.95° and 2.97 ± 2.53° of mean torque increase, respectively. The root length loss was greater in the upper and lower central incisors. All teeth showed mild resorption (&lt;10%) except for two upper lateral incisors, which showed moderate resorption (10.79% and 10.23%). Comprehensive treatment with clear aligners improved sagittal root position and increased torque, especially in the anterior teeth. Most teeth showed mild resorption after clear aligner therapy, and only two showed moderate resorption.

Correlation of the inclination of the incisors to the stability of the alignment of the anterior sector, based on PAR index criteria

Introduction: the objective of this study was to evaluate the relationship between incisor inclination at the end of orthodontic treatment with the anterior teeth alignment stability using PAR index. Methods: analytical cross-sectional study, the angle formed between the plane (Silla-Nasion) (U1-NS) and the inclination of the upper incisor and the angle between axial inclination of the lower incisor and mandibular plane (Go-Gn), were measured in 47 initial and final lateral radiographs of patients who finished orthodontic treatment. The anterior sector PAR index was applied to pretreatment (T0), posttreatment (T1) and follow-up (T2) casts. Statistical analysis was performed using frequency and percentage distributions, T test, Anova I, Anova II and Manova; significance p = 0,05. Results: no association was found between upper and lower incisor inclination, alignment stability and PAR weighted score between T2-T1 (p&gt; 0,05). The PAR decreased 75,29% from T0 to T1 and 58,79% from T0 to T2, with a recurrence of 16,5%. There was no association between retainer type and PAR weighted score. From T0 to T2 there was an association between the interaction of the incisor inclination of upper (p = 0,03) and lower (p = 0,04), with the weighted total score of the PAR index. Conclusion: there was no association between the modification of the incisor inclination with the stability of the anterior sector. At the end of orthodontic treatment there was a high level of correction in the anterior-superior and inferior sector, however, there was a recurrence of 16,5%.

Effect of maxillary and mandibular extrusion arches on dentoskeletal changes in adults with anterior open bite: a quantitative analysis.

To quantify dentoskeletal changes accompanying the use of extrusion arches during the treatment of anterior open bite (AOB) in adults. A total of 23 adult patients with an AOB of -3.05 mm ± 1.27 mm were treated with upper and lower extrusion arches after the alignment phase. Lateral cephalograms were taken before placement of the extrusion arch, immediately after closure of the open bite (T2), and at the end of orthodontic treatment (T3). Data were statistically analyzed using repeated-measures analysis of variance and the Bonferroni post hoc test for pairwise comparisons (α = 0.05). Successful closure of AOB, with an overall change in overbite of 4.73 ± 1.93 mm, was achieved in an average of 3.8 months and remained stable at T3. Upper and lower incisors were significantly extruded by 2.05 mm ± 0.72 mm and 2.54 mm ± 1.63 mm, respectively, and significantly retroclined by 6.36° ± 1.63° and 8.45° ± 3.83°, respectively, with a resultant increase in the interincisal angle of 12.80° ± 2.09°. Statistically significant intrusion and mesial tipping (P < .001) of the maxillary and mandibular first molars were observed at T2. Dentoskeletal changes remained stable at T3, except for a significant reduction of the mesial tipping of the maxillary and mandibular first molars. The combined use of maxillary and mandibular extrusion arches resulted in significant favorable dentoskeletal changes that led to the successful closure of AOB during a short duration of treatment.

Effect of lip thickness and competency on soft-tissue changes

Improvement in facial esthetics is a major reason for seeking orthodontic treatment. Soft tissues responsible for esthetics show a variable response to the movement of underlying teeth during orthodontics. The purpose of this cross-sectional study was to analyze the response of soft tissues and compare it among groups presenting with different lip thickness and competence. It was carried out on 37 patients with Class I and Class II Division 1 malocclusion who had undergone extractions of maxillary first premolars and had completed their orthodontic treatment. Data were obtained by corresponding lateral cephalometric radiographs taken before and at the end of orthodontic treatment. Association was analyzed with a Pearson correlation test. Differences among groups exhibiting varying competency and lip thickness were tested with an independent sample t test. A P value of≤0.05 was considered statistically significant. Pearson correlation revealed significant associations among incisor tip retraction with lip base retraction (r= 0.68), lip base thinning (r= 0.41) and vermilion retraction (UV) (r= 0.73). Regression analysis showed a moderate increase in lip length (AB) and thickness at vermilion, which were 0.11 mm and 0.15 mm for each mm of incisor retraction at the tip, whereas stronger effects were observed for UV (0.38 mm) and lip base retraction (0.55 mm). There was significantly more lip base thinning (P= 0.03) and UV (P= 0.04) in the incompetent group compared with the competent group. The AB increased significantly in the sample with thicker lips (P= 0.01). Pearson correlation coefficient showed a strong association of lip retraction at the base and vermilion with the incisor movement at the cervical area, for competent and incompetent lips, and thicker and thinner lips. Lip retraction at vermilion and lip base thinning was significantly more in patients with incompetent lips, whereas the AB increased significantly more in the group with thicker lips.

P-56240663-116 - Surgery first and Invisalign: A comparative assessment of periodontal health in postsurgical orthodontic treatment with Invisalign or traditional fixed appliances

<h3>Introduction</h3> Removable clear aligners have become very popular in the last few decades, but they are still little used in the field of orthognathic surgery. The objective of this 2-arm parallel trial was to compare periodontal health associated to postsurgical orthodontic treatment with either fixed orthodontic appliances or clear aligners. <h3>Methods</h3> Patients with dentofacial deformities undergoing orthognathic surgery (OS) at our institution were randomly allocated to receive postsurgical orthodontic treatment with either Invisalign or fixed orthodontic appliances. Eligibility criteria included: 1) skeletal malocclusion requiring combined surgical and orthodontic treatment without extractions; and 2) informed consent for this novel protocol. The main outcome was plaque index (PI). The secondary outcomes were probing depth (PD) and bleeding on probing (BP). The data were analyzed at T1 (immediately before surgery) and T2 (end of orthodontic treatment). The total duration of treatment was also recorded. <h3>Results</h3> Twenty-eight patients (mean age at the time of surgery, 30.75 years, range 18-52 years) were randomized in a 1:1 ratio to either fixed orthodontic appliances or Invisalign. Sixteen patients were women and 12 were men. Baseline characteristics were similar between groups. The means and standard deviations of PI at T1 (Invisalign, 0.86±0.77; brackets, 1.57±0.94) were similar (p=0.05). However, they were statistically significant (p=0.001) at T2 (Invisalign, 0.64±0.75; brackets, 1.79±0.58). No adverse events occurred during the study. <h3>Conclusion</h3> Within the limits of this study, it can be concluded that compared to traditional orthodontics with fixed appliances, patients managed with clear aligners after orthognathic surgery (surgery-first approach) had better periodontal outcomes.

Skeletal, Dental and Soft Tissue Cephalometric Changes after Orthodontic Treatment of Dental Class II Malocclusion with Maxillary First Molar or First Premolar Extractions.

The aim of the present retrospective study was evaluating skeletal, dental and soft tissue changes of two groups of Class II patients orthodontically treated with extractions of upper first premolars (U4 group) and upper first molars (U6 group). In total, 21 patient records (9M and 12F; mean age 12.5 ± 1.2 years) were selected for the U4 group, and 38 patient records (17M and 21F; mean age 13.2 ± 1.3 years) were recruited for the U6 group. Twenty cephalometric variables were analysed on standardised lateral cephalograms at baseline (T0) and at the end of orthodontic treatment (T1). Means and standard deviations (SDs) were calculated for both groups and increments were calculated. After revealing the normal distribution of data with the Shapiro–Wilk test, Student’s t-test was used to compare variables at T0 between groups. A paired t-test was used to analyse changes between time points within each group, and Student’s t-test to compare differences between groups at T1. Both groups showed a significant increase in the distance among upper second molars and the vertical pterygoid line (PTV-maxillary second molar centroid U6 group: 6.66 ± 5.00 mm; U4 group: 3.66 ± 2.20 mm). Moreover, the distance of upper incisors to the palatal plane significantly increased (PP-maxillary incisor tip U6 group: 1.09 ± 1.52 mm; U4 group: 0.20 ± 2.00 mm; p = 0.061). Significant changes were found for overjet (U6 group: −4.86 ± 1.62 mm; U4 group: −3.27 ± 1.90 mm; p = 0.001). The distance between upper lip and esthetic plane showed a significantly reduction in both groups (ULip-E Plane U6 group: −2.98 ± 1.65 mm; U4 group: −1.93 ± 1.57 mm). No statistically significant changes were found in sagittal or vertical skeletal values. The significantly larger reduction of upper lip protrusion and overjet in the U6 group compared to the U4 group suggests preferring molar extraction treatment for severe Class II with protrusive soft tissues’ profile and increased overjet. Since no differences on vertical values were found, an increased SN^GoGn angle should not be considered a discriminating factor for choosing molar extraction treatment.

Digital Planning Technique for Surgical Guides for Prosthetic Implants before Orthodontic Treatment

Background: The use of digitalization allows clinicians to plan the position of dental implants in orthodontic patients treated with aligners in the beginning of their orthodontic treatment, instead of waiting until the end of orthodontic treatment, integrating implant restorations with orthodontic biomechanics. Aim: The aim of this case report is to describe a digital workflow for aligner treatment supported by implants, in which implants are placed at the beginning of the treatment and support the orthodontic treatment. Materials and Methods: Digital planning for orthodontic treatment with clear aligners and the preparation of surgical guides for implant surgery before orthodontic treatment are used to solve two multidisciplinary cases. Cone-beam computed tomography (CBCT) and virtual dental impressions are used for the virtual planning. Successively, a surgical guide for implant placement and aligners are used in the treatment plan. Results: The digital orthodontic setup with the integration of the root position allows the clinician to plan the position of dental implants on the final occlusion. The placement of the implant before the start of the orthodontic treatment allows the implants to be used as skeletal anchorage, thereby helping the orthodontic biomechanics. Conclusions: This study describes how to perform a digital workflow with orthodontic virtual planning and the design of surgical guides for implant placement. This technique is potentially promising for complex orthodontic cases.