Extraoral Appliances Research Articles

Patient's Perspective on Miniscrews During Orthodontic Treatment-A Systematic Review With Meta-Analysis.

During orthodontic treatment, undesirable reciprocal forces are generated during tooth movement, which explains the use of anchorage strategies to minimise their harmful effects through intra and/or extraoral appliances. Miniscrews are intraoral devices used for temporary skeletal anchorage. Miniscrews are small-sized intraoral devices used for temporary skeletal anchorage and are easy to place and remove. However, some studies refer to adverse effects such as inflammation, pain, and discomfort. This systematic review aims to synthesise the available evidence on the use of miniscrews during orthodontic treatment from the patient's perspective. The literature search was conducted using various databases MedLine through PubMed, Cochrane Library, Web of Science Core Collection, and EMBASE. A search was also carried out in the grey literature. The search terms used were "Orthodontic Anchorage Procedures," "mini-implant," "Mini Dental Implant," "Miniscrew," and "microimplant." Cochrane risk of bias tools was used to assess the quality of included studies. Patients tend to overestimate the pain inherent in this procedure. The insertion of micro implants is more accepted than the tooth extraction procedure, with less postoperative pain reported. The location, surgical technique, and type of anaesthesia used in the placement of miniscrews influence levels of discomfort. Additionally, the execution of a good surgical technique and the clinician's communication skills are factors that influence patient satisfaction and positive perception. The most frequent outcome reported is pain and discomfort, which varies depending on its location (less with mini interradicular screws than with extra-alveolar screws). Most patients are satisfied or very satisfied with this application.

Evaluation of Maxillary Protraction Using a Mini Screw-Retained Palatal C-Shaped Plate and Face Mask.

To evaluate a newly designed minimally invasive palatal-plate face mask combination for the management of developing Class III malocclusion due to maxillary deficiency. A sample of 16 Class III patients due to maxillary deficiency in the early mixed dentition (8 boys and 8 girls) aged between 7 and 9 years participated in this study and were treated with a combination of palatal plate face masks. Extra-oral elastics were attached between the intra-oral and extra-oral appliances; the elastics were set at 30° to the occlusal plane. The force magnitude was 250-300 g per quadrant. Cephalometric radiographs were taken before and immediately after maxillary protraction. In addition, skeletal measurements were measured, tabulated, and statistically analyzed. The pre- and post-protraction measurements were compared using the Student's t-test, and the significance level was set at a p-value <0.05. A statistically significant increase in SNA angle and maxillary length was observed by 3.13±1.52 degrees and 2.60±0.75 mm (p<0.05), respectively, indicating forward maxillary growth. The skeletal and soft tissue patterns were also improved, as evidenced by the statistically significant increase in the ANB angle, Wits appraisal, and H angle by 4.50±1.28 degrees, 5.30±1.86 mm, and 5.02±3.24 degrees (p<0.05), respectively. A favorable clockwise mandibular rotation was observed as evidenced by the increase in the SN/MP angle and the decrease in the SNB angle by 1.46±1.96 degrees and -1.38±1.86 degrees (p<0.05), respectively. The palatal-plate facemask combination is an effective treatment alternative for Class III malocclusion due to maxillary deficiency with minimal pain and discomfort.

Plagiocephaly and malocclusion

The term plagiocephaly means oblique head. Most skull deformities are a result of intrapartum or utero molding but can be caused by congenital torticollis and after birth due to persistent head position of newborns staying in one head position for a long time and abusive use of strollers, car seats, car seats, swings. Its prevalence is growing fast, in 30 years it passes from 1 in each 300 babies in early nineties to 16 to 48 % in 2020. The aim of this paper is bringing the light to some serious conditions of treatment protocols in individuals with plagiocephaly. The skull deformity causes facial asymmetry that are not treatable by orthopedic or orthodontic intra or extra oral appliances, nor orthognathic surgery. Well, despite the fact that the patient or the tutors have to be notified of the facial asymmetry that persists, functional limitations will be presented. In more than 30 years of clinical experience treating these patients it was never sought the 4 first permanent molars and the 4 canines in the same Angle’s Class. In one side can be seen Class 1, but on the other it will be finding class 2 or class 3, the case reported exemplifies it, and the worst, mastication guidance will have to be very carefully done since, in most cases if it is tried to adjust the inferior and superior dental midline the vertical asymmetry of the occlusal plane (minimum vertical dimension) will worsen. Really there is no unique treatment protocol and it has to be considered case by case. It is time to deepen the knowledge in this area since the prevalence is growing. Based on the case reported, non-treated plagiocephaly can bring serious limitations to malocclusion treatment results. Further studies are necessary to a better understanding of the situation plagiocephaly versus malocclusion.

Customized Facial Orthopedics: Proof of Concept for Generating 3D-Printed Extra-Oral Appliance for Early Intervention in Class III Malocclusion

Background: The present case report serves as a proof of concept for the fabrication and effective clinical administration of a 3D-printed chin cup tailored to the patient’s anatomical characteristics. Methods: An 11-year-old male with a Class III malocclusion was treated using a chin cup appliance to intercept and control a Class III mandibular skeletal growing pattern early. Two tailored chin cup devices were designed using 3D face scanning and CBCT scanning and were produced with additive manufacturing techniques. The chin pads were digitally designed based on a 3D scan of the patient’s face. The 3D modeling of chin cup components was performed using 3Shape Appliance Designer and 3D printed with biocompatible resin. An analogic chin pad was also produced for the same patient. The treatment plan involved the patient wearing the chin cup for 13 h per day. The patient was instructed to use all three chin pads produced at intervals of 4 months. The patient’s experience was assessed by reporting the comfort experience via a VAS scale. The treatment strategy was effective in improving the skeletal Class III malocclusion. Additionally, the integration of 3D face scanning (or CBCT scanning), modeling, and printing enables the production of customized chin cups with superior fit and comfort, contributing to enhanced patient compliance and treatment efficacy.

A 3D-Printed Extra-Oral Appliance for Orthodontic Traction of a Palatally Impacted Canine

A 3D-Printed Extra-Oral Appliance for Orthodontic Traction of a Palatally Impacted Canine

An Innovative and Conservative Approach to Molar Distalization

ABSTRACT Nonextraction approach in correcting Class II malocclusion has gained a lot of attention over the past few years. Clinicians prefer intraoral appliances as compared to extraoral appliances to achieve distal molar movement; the reason being intraoral appliances depends minimally on patient cooperation. In this article, a case report was presented in which a patient was treated with modified rapid maxillary expander, a concept designed from Veltri distalizer considering its advantages. Molar distalization of 4 mm was achieved with minimal anchorage loss on premolars and anteriors. Class I molar, canine relation was achieved with 2 mm of overjet and overbite. Modified appliance when used at appropriate timing was found to be an effective and conservative approach in distalization of maxillary first molars.

Headgear in orthodontics and dentofacial orthopedics

Extra oral appliances have been used since ages to bring about dental changes, skeletal changes and for anchorage reinforcement. Growth modifications can be done with help of these appliances. This can be done by inhibiting the growth or redirection of the growth. The biomechanics of the extraoral appliances needs to be understood well for using these appliances. The topic of headgear is vast and the following article tries to cover the details regarding the same in brief. The location of centre of resistance for application of force is important and plays a significant role in biomechanics and outcome of treatment results. Various types of headgears and their use depending on different criterias are discussed in detail.

Tele-orthodontics and sensor-based technologies: a systematic review of interventions that monitor and improve compliance of orthodontic patients.

Recent advances in orthodontics offer appealing tools to monitor compliance and designate protocols to enhance it. This systematic review of systematic reviews (SRs) aimed to assess the effectiveness of digitized communication methods and sensor-based devices that track compliance in orthodontic patients. Five electronic databases (PubMed, Web of Science, MEDLINE, PsycINFO, and EMBASE) were searched from database inception up to 4 December 2022. SRs using digitized systems and sensor-based technologies to monitor and/or improve compliance with orthodontic treatment or during an active retention phase were included. Study selection, data extraction, and risk of bias assessment using the AMSTAR 2 tool were performed independently by two review authors. A qualitative synthesis of outcomes from moderate- and high-quality SRs was provided, and evidence was graded in accordance with a scale of statements. A total of 846 unique citations were retrieved. After study selection, 18 SRs met the inclusion criteria, and 9 moderate- and high-quality reviews were further integrated into the qualitative synthesis. Digitized communication methods were found to be effective in improving compliance with oral hygiene practices and adherence to orthodontic appointments. Monitoring removable appliance wear with microsensors revealed sub-optimal levels of compliance with wear instructions of intra-oral and extra-oral appliances. One review discussed the informational value of social media platforms and their importance in guiding the decision-making process to seek orthodontic treatment and compliance-related experiences. The variability in the quality of included SRs and the limited number of primary studies on certain outcomes present as limitations within this overview. The integration of tele-orthodontics and sensor-based technologies to improve and monitor compliance within orthodontic practices is promising. There is sufficient evidence that establishing communication channels with orthodontic patients through reminders and audiovisual systems positively impact their oral hygiene practices throughout orthodontic treatment. However, understanding the informational value of social media as communication channels between clinicians and their patients, and their overall effect on modulating compliance is still insufficient. CRD42022331346.

Comparison of the effectiveness of butterfly arch versus transpalatal arch in anchorage reinforcement: A linear 3D finite element study.

Background. Although there are various intraoral and extraoral appliances for anchorage management in orthodontics, most fail to preserve the anchorage efficiently. Thus, there is a need for an appliance that can preserve anchorage in the sagittal, vertical, and transverse directions with good patience compliance and cost-effectiveness. This study compared the efficacy of butterfly arch and transpalatal arch (TPA) as an anchorage reinforcing unit during orthodontic space closure using a linear finite element model. Methods. A 3D model of the maxilla and associated structures was developed from CT images of an individual's skull at a slice thickness of 1 mm. The magnitude of movements of anchor teeth in vertical, horizontal, and transverse directions was calculated in first premolar extraction cases during anterior retraction using a linear finite element model analysis and compared in two situations-butterfly arch and TPA attached to maxillary first molar for anchorage. Results. The anterior teeth had similar movements in the case of TPA and butterfly arch. There was more mesial and lingual movement in the first molars with TPA than in the butterfly arch, which had buccal but no mesial movement. The anterior teeth showed extrusion and the second premolars showed intrusion with TPA. Also, the von Mises stress and maximum principal stress were maximum with TPA at the cervical region of anterior and posterior teeth compared to the butterfly arch, where both stresses were uniformly distributed all over the teeth. Conclusion. A butterfly arch with its unique design, configuration, and biomechanical properties can be used as a device that can maintain the posterior anchorage efficiently.

Molar distalization classification – A review

Esthetics plays a major role from orthodontic treatment to results. Gaining space in dental arch is the most important step in the treatment planning which can be achieved by different methods one of which is molar distalisation. There are a number of methods (Arch expansion, interproximal reduction, proclination of teeth, molar derotation, use of functional appliances) to gain space. Each method has its own advantages and disadvantages and specific indications. A child with class I bases and acceptable profile, with minimal space requirements for relief of crowding or mild protrusion can possibly be best treated without sacrifice of tooth material. Various intaoral and extraoral appliances have been invented using non-extraction treatment to distalise molars. Aim of distalization is to move molars distally so as to gain space. This article provides a comprehensive review of the various methods (intraoral &amp; extraoral) used for molar distalization.

Indication and uses of temporary anchorage device in orthodontic

Treating various types of malocclusion is dependant on providing a secure anchorage. In this context, it has been shown that teeth, intramaxillary, and/or extraoral appliances are required to achieve favorable outcomes regarding anchorage treatment. A Temporary anchorage device (TAD) has been introduced in the literature in this context. It has been described as a temporary device that can be used after completing treatment. The aim of the study was to review the indications and uses of TADs in orthodontic treatment. The current evidence shows that introducing TADs in the field of orthodontic treatment has been associated with favorable outcomes that encountered the previous multiple challenges reported with the conventional anchorage approaches. Contemporary orthodontic settings reported various uses for TADs, including corrections in transverse, vertical, and anteroposterior dimensions. Combined use of TADs and conventional approaches were also evaluated with favorable outcomes. These findings indicate the validity of TADs in orthodontic treatment and call for its future implications and clinical applications. However, it should be noted that post-treatment evaluation on a long-term basis was not adequately reported in the current literature, indicating the need for future investigations for further validation.

Tetrafocal intraoral bone transport for mandibular reconstruction combined with free fibula flap and mandibular zygomatic implants

Purpose This retrospective study was performed to evaluate a multiple bone transport system designed to predictably and securely perform major reconstruction of the mandible, including the mandibular symphyseal area, by using a free fibula flap. The aim of this study was to present our clinical experience in using transport DO technique (TDO) for treating mandibular bony defects after tumor ablation in patients with benign tumors, combined with a free fibula flap to correct the area of the symphysis at a single surgical session, avoiding the use of grafting in the docking site for the direct contact of the transport disk and the fibula. Methods Eight patients (5 females and 3 males; ages 27–45 years; average age 32 years) underwent tetrafocal distraction osteogenesis after major mandibular resection, including the complete symphyseal area, 2 ameloblastomas, and 2 odontogenic myxoma. All patients underwent partial mandibulectomy and reconstruction plate placement through the intraoral route. A fibular flap segment was used to reconstruct the symphyseal area. The internal distraction devices were 45 mm long and were cut, bent, and fixed over the reconstruction plate; a 7-day latency period was allowed, and 1 mm/day activation period followed. Once the transported disk or bullet reached the parasymphyseal area and met the bony segments, a docking site surgery was performed to unite the 2 segments, with adequate rigidity to the reconstruction plate. Twelve months later, transmandibular zigomatic implants were inserted, and dental rehabilitation was completed. Results All mandibles were reconstructed by using intraoral bone transport, creating 70.5 to 100.3 mm of new bone to allow dental implant placement and dental rehabilitation. No infections, fractures, or nonunions were seen. The patients were seen on a weekly basis for 3 months and then every 30 days until completion of the treatment and rehabilitation. Evaluations were made every year. Conclusions This multiple bone transport system permits mandibular reconstruction for a very difficult clinical situation and yields excellent results. The advantages and goals of this technique are excellent biologic response, feasibility for implant placement, complete functional and aesthetic rehabilitation, and no need for extraoral appliances. This retrospective study was performed to evaluate a multiple bone transport system designed to predictably and securely perform major reconstruction of the mandible, including the mandibular symphyseal area, by using a free fibula flap. The aim of this study was to present our clinical experience in using transport DO technique (TDO) for treating mandibular bony defects after tumor ablation in patients with benign tumors, combined with a free fibula flap to correct the area of the symphysis at a single surgical session, avoiding the use of grafting in the docking site for the direct contact of the transport disk and the fibula. Eight patients (5 females and 3 males; ages 27–45 years; average age 32 years) underwent tetrafocal distraction osteogenesis after major mandibular resection, including the complete symphyseal area, 2 ameloblastomas, and 2 odontogenic myxoma. All patients underwent partial mandibulectomy and reconstruction plate placement through the intraoral route. A fibular flap segment was used to reconstruct the symphyseal area. The internal distraction devices were 45 mm long and were cut, bent, and fixed over the reconstruction plate; a 7-day latency period was allowed, and 1 mm/day activation period followed. Once the transported disk or bullet reached the parasymphyseal area and met the bony segments, a docking site surgery was performed to unite the 2 segments, with adequate rigidity to the reconstruction plate. Twelve months later, transmandibular zigomatic implants were inserted, and dental rehabilitation was completed. All mandibles were reconstructed by using intraoral bone transport, creating 70.5 to 100.3 mm of new bone to allow dental implant placement and dental rehabilitation. No infections, fractures, or nonunions were seen. The patients were seen on a weekly basis for 3 months and then every 30 days until completion of the treatment and rehabilitation. Evaluations were made every year. This multiple bone transport system permits mandibular reconstruction for a very difficult clinical situation and yields excellent results. The advantages and goals of this technique are excellent biologic response, feasibility for implant placement, complete functional and aesthetic rehabilitation, and no need for extraoral appliances.

MODIFIED APPROACH OF FORCE APPLICATION IN IZC MINI-IMPLANT FOR ARCH DISTALIZATION BY ELASTOMERIC CHAIN

&#x0D; &#x0D; &#x0D; Distalization of whole arch required an appropriate force of application along with sound knowledge of biomechanics. After development of mini-implants it became quite easy because it doesn't need patient compliance which was a problem in olden days with conventional extraoral appliances. Introduction of extra-radicular mini-implant (IZC mini-implant) in orthodontics makes complete arch distalization single step procedure in comparison to intra-radicular mini-implants (conventional TADs) which we have to reposition due to root approximation. This article represents a modified approach of Elastomeric chain application in IZC mini-implant for whole arch distalization.&#x0D; &#x0D; &#x0D;

Rapid maxillary expansion facemask therapy in growing patients: A 2 case report and review of literature

Class III malocclusion is progressive in nature and it worsens with age. Class III malocclusion is associated with any deviation in the sagittal relationship of the maxilla and the mandible; it is characterized by a deficient maxilla, retrognathic mandible, or a combination of both. It is very difficult to diagnose and treat Class III malocclusion. Many treatment approaches can be found in the literature regarding orthopedic and orthodontic treatment of Class III malocclusion, including intra- and extra-oral appliances. The early treatment of Class III malocclusions requires orthopedic intervention at the end of primary dentition or the beginning of mixed dentition, prior to growth spurt, which provides successful results, with good facial balance, modifying the maxillofacial growth and development, and prevents future surgical treatment by increasing the stability. Approximately 30%–40% of Class III patients exhibit some degree of maxillary deficiency; therefore, devices can be used for maxillary protraction for orthodontic treatment in early mixed dentition. In cases in which dental components are primarily responsible for Class III malocclusion, early therapeutic intervention is recommended. In this article, we described the treatment options for Class III malocclusion in growing patient with an emphasis on maxillary protraction.

Extraoral vs intraoral appliance for distal movement of maxillary first molars: a randomized controlled trial.

Using randomized controlled trial methodology, the aim of this study was to evaluate and compare the treatment effects of an extraoral appliance (EOA) and an intraoral appliance (IOA) for distal movement of maxillary first molars. A total of 40 patients (mean 11.5 years, SD 1.29) at the Orthodontic Clinic, National Health Service, Skane County Council, Malmö, Sweden, were randomized to receive treatment with either extraoral traction (cervical headgear) or an IOA using superelastic coils for distal movement of maxillary first molars. The inclusion criteria were a nonextraction treatment plan, a Class II molar relationship and maxillary first molars in occlusion with no erupted maxillary second molars. The outcome measures to be assessed in the trial were treatment time, cephalometric analysis of distal molar movement, anterior movement of maxillary central incisors, ie, anchorage loss and sagittal and vertical skeletal positional changes of the maxilla and mandible. In the IOA group, the molars were distalized during an average time of 5.2 months, whereas in the EOA group the corresponding time was 6.4 months (P < .01). The mean amount of distal molar movement was significantly higher in the IOA than in the EOA group, three mm vs 1.7 mm (P < .001). Moderate anchorage loss was produced with the IOA implying increased overjet (0.9 mm) whereas the EOA created decreased overjet (0.9 mm). It can be concluded that the IOA was more effective than the EOA to create distal movement of the maxillary first molars.

Different approaches to the treatment of skeletal Class II malocclusion during growth: Bionator versus extraoral appliance.

ABSTRACT Introduction: Class II malocclusion, which has a significant incidence in the population, may compromise facial esthetics and the smile, as well as the masticatory and respiratory functions. Often associated with skeletal abnormalities, it severely affects and compromises quality of life. An accurate diagnosis is fundamental to prepare a treatment plan to correct dental and skeletal anomalies. Objectives: This study discusses treatment alternatives to the correction of Class II division 1 and 2 malocclusion in growing patients, using a Bionator and an extraoral appliance.

Modified transpalatal auxiliary arch for enhanced anchorage and tooth movement

Intraoral appliances such as transpalatal arch and Nance appliance fail to resist forces that tend to loosen the anchorage. The infirmity arises due to the long-lever arm and the mesial force that is perpendicular to the long axis of the appliance. The butterfly arch is presented here as an intraoral appliance that withstands the mesially directed forces with a mechanism that puts strain on a stiff wire along its long axis. The unique shape of the butterfly arch is advantageous in maximum anchorage cases, cases in which arch width preservation is critical and cases with a vertical growth pattern. With the aid of the butterfly arch, clinical concerns such as patient cooperation, wearing extraoral appliances, complicated mechanics in extraction cases, and control of the arch length, arch width, and vertical dimension would be greatly diminished.

Review of maxillary molar distalising appliances with palatal anchorage on miniimplants

Maxillary molar distalisation is one of treatment methods for patients with Angle class II. Intraoral appliances supported by patient’s own teeth inevitably lead to loss of anchorage. Mini-implants are additionally used to reduce this side effect. The area of the hard palate is the best anatomical place to attach mini-implants, and it provides the lowest risk of complications. &lt;b&gt;Aim.&lt;/b&gt; To present issues associated with appliances used for maxillary molar distalisation that are based on bone anchorage in the hard palate region. &lt;b&gt;Material and methods.&lt;/b&gt; The literature review using the PubMed database and the Polish Medical Bibliography with the following key words: molar distalisation, orthodontic miniimplants, skeletal anchorage. 37 positions from the years 1996–2018 were selected and analysed. &lt;b&gt;Results.&lt;/b&gt; As a result of the literature review, 37 articles describing nine distalisation appliances modelled on three basic constructions: Pendulum, Distal Jet and Keles Slider, and the MCPP appliance were identified. &lt;b&gt;Summary.&lt;/b&gt; Distalising appliances supported by palatal mini-implants do not lead to loss of anchorage in the anterior segment. At the stage of anterior teeth retraction they can be used for stabilisation of the distalised segment. They are less visible compared to extraoral appliances or those placed on the external side of the dental arch. They can be used simultaneously with fixed braces or during preparation for subsequent therapy with fixed braces. Depending on the design, they are not free of the side effects typical of the prototypes they originate from, i.e. rotation and inclination of molars. The most parallel distal movement of teeth is made possible by appliances whose force acts at the height of the CR (centre of resistance) of teeth being moved.

Residents' journal review

Residents' journal review

Cephalometric evaluation of the effect of dynamax and monoblock appliances on vertical facial height in patients with distal malocclusion

The most common abnormality in orthodontics is distal malocclusion. The patient will benefit more if is treated during active growth phase. Various types of functional appliances are used in order to control maxillary and mandibular growth. In this article we compared vertical changes in mandibular position as a result of 3 different distal malocclusion treatment methods. To this end, groups consisting of, 17 patients treated with dynamax appliance, 17 patients treated with Monoblock appliance, 16 patients treated with a Monoblock-Headgear combination were created. Research has shown that, treatment with removable functional appliances results in parallel downward positioning of mandible; treatment with semiremovable appliances results in backward and downward rotation of mandible and that the extraoral appliances are useless to control the lower facial height.