Fixed Appliance Treatment Research Articles

Comparison of Bracket Failure with Resin Modified Glass Ionomer Cement and Resin-Based Adhesive

A high strength of bonding materials is needed for orthodontic attachments to sustain therapeutic forces and patients’ masticatory habits. Objectives: To compare the bond strength of the resin modified glass ionomer cement (RMGIC) and resign based adhesive system which leads to bracket failure in orthodontic treatment (failure to bracket attachment) for the duration of 6 months at the a tertiary care hospital at Hyderabad, Sindh Pakistan. Methods: This comparative cross-sectional study involved 30 patients, each with 20 brackets, using non-probability sampling. Participants were between the ages of 13 and 30 with fully erupted permanent teeth and mild skeletal discrepancies. Quadrants were randomized, and 120 attachments were placed in total, split evenly between the two types of materials. The study involved bonding orthodontic brackets using either composite resin or RMGIC. The teeth were prepared and cleansed, and the brackets were bonded following standard procedures. Patients were monitored each month for six months (six visits) to check for any debonded or missing brackets. Chi-Square test was run to compare bracket failure between two groups. Results: There were significant differences in bracket failure rates between the composite and RMGIC sides. Composite had a lower failure rate, with 90% of brackets remaining intact compared to 63.3% with RMGIC (p=0.04). Gender comparisons showed both male and female participants experienced more failures with RMGIC than with composite, with p-values of 0.039 and 0.038, respectively. Conclusion: RMGIC could not withstand the forces experienced during fixed appliance treatment as effectively as composite resin, resulting in a higher debonding rate.

Panoramic evaluation of external root resorption in mandibular molars during orthodontic treatment: a comparison between root-filled and vital teeth treated with fixed appliances or clear aligners

BackgroundThis investigation compared the extent of external apical root resorption (EARR) in root-filled teeth (RFT) and their contralateral vital pulp teeth (VPT) counterparts during orthodontic treatment (OT) with clear aligner (CA) treatment or fixed appliance (FA) treatment.MethodsSixty-six patients with similar baseline American Board of Orthodontics (ABO) discrepancy index scores were divided into two groups: 37 patients (21 females, 16 males; mean age 17.45 ± 2.67 years) in the FA group, and 29 patients (18 females, 11 males; mean age 18.33 ± 1.96 years) in the CA group. Digital panoramic radiographs captured pre- and post-OT were used to measure tooth lengths and root surface measurements in mandibular molars. EARR in both RFT and contralateral VPT was evaluated pre- and post-OT. Statistical analysis employed paired t-tests, independent t-tests, and analysis of covariance (ANCOVA) (p < .05).ResultsAll teeth exhibited varying degrees of EARR following OT. FA treatment resulted in significantly longer treatment duration (p < .05) and greater EARR compared to CA treatment (p < .05). Moreover, statistically significant differences in EARR were observed within both groups between RFT and VPT (p < .05).ConclusionsComparison of pre- and post-OT radiographs revealed different degrees of EARR in all teeth. CA treatment resulted in less frequent and less severe EARR compared to FA treatment. RFT demonstrated greater resistance to EARR than VPT in both treatment groups.

Orthodontic YouTube™ videos made by patients for patients: What are they about and are they accurate?

To evaluate the characteristics and content of YouTube™ videos created by patients undergoing orthodontic fixed appliance treatment and to assess the content accuracy of these videos. A mixed-methods quantitative and qualitative study. YouTube™ webpage. The term 'braces' was used to search for relevant videos on the YouTube™ webpage between 18 August and 30 August 2020, with no limits imposed regarding how long the video had been available on YouTube™. Videos were included if they were made by patients and were predominantly about patients' experiences during treatment with labial fixed appliances. The main themes/subthemes of the included videos were identified. A checklist was then developed to assess accuracy of the video content for two of the main themes and the videos were assessed against the checklist. The video search identified 350 videos, of which 64 were selected as potentially eligible; 41 were subsequently excluded as they related primarily to the bond up/debond experience or had minimal information about orthodontics. This meant that 23 videos were ultimately included for analysis. Six main themes were identified in the videos: problems with fixed appliances, effects of fixed appliances, oral hygiene maintenance, dietary advice, treatment duration/appointment frequency and auxiliaries used with fixed appliances. From the 23 videos, 20 were assessed against the checklist for content accuracy related to two selected themes: oral hygiene maintenance and dietary advice. The majority of videos had low content accuracy scores, indicating that important and relevant content was generally missing. Several included videos focused on oral hygiene maintenance and dietary advice associated with fixed appliances; however, the content was incomplete and not always accurate. This is concerning to the profession, and it is therefore recommended that clinicians consider collaborating with patients to produce videos that are patient-centred and that also contain accurate information.

Interproximal reduction in orthodontics: Reported practices and perceptions of orthodontists in the Republic of Ireland

Objectives To ascertain reported practices and perceptions of orthodontists regarding interproximal reduction (IPR) in the Republic of Ireland (RoI). Method Questionnaires were administered to orthodontists in the RoI, seeking their demographics, reported IPR practices and related perceptions. Results Questionnaire responses were received from 105 (75%) of those invited to participate. Nearly all (98%) performed IPR, with 44% reporting increased recent use. Lower labial segment teeth were most frequently reduced in adults or adolescents to reshape teeth, resolve mild crowding or address tooth size discrepancies. This was in conjunction with aligner (59%) or fixed appliance (33%) treatments. Removal of 2-4mm of enamel per arch was most common (60%). The majority (82%) performed IPR over several visits with handheld strips, (87%) or strips in holders (58%), or with diamond burs in an air rotor (51%). Orthodontists perceived their patients to be unfamiliar with IPR, to find it uncomfortable (48%) rather than painful (9%) and preferable to extraction (71%). Conclusions Conservative IPR of less than 4mm per arch was mostly undertaken for teeth in the lower labial segment in adults or adolescents in conjunction with aligner or fixed appliance treatments. Handheld strips were most commonly used. Orthodontists perceived their patients to be unfamiliar with IPR, to find it uncomfortable rather than painful and preferable to extraction.

Patterns of orthodontic treatment of children in Australia: a national population-based study

Abstract Objective This study aimed to describe orthodontic treatment patterns of children in Australia. Methods Using data from the 2012-2014 National Child Oral Health Study (NCOHS), a cross-sectional survey representative of children in Australia aged 5 to 14 years involving parental-completed questionnaires, standardised oral examinations and malocclusion severity assessment, the present study examined: sociodemographic characteristics, types and providers of orthodontic treatment, extraction rates, treatment need levels and orthodontic service access. Results Adolescents (31.7%), children from higher-income households (22.0%), and those with handicapping malocclusions (46.6%) accessed services more than their counterparts. Of those who had ever accessed services, pre-adolescents mostly had a consultation only (46.5%) and were predominantly treated using removable appliances (25.1%). Adolescents mostly had fixed appliances (38.0%). Extractions were involved in 31.0% of fixed appliance treatments. Private orthodontists provided the majority of treatment services (80.6%). There were greater numbers of higher-severity malocclusions affecting males, indigenous children, and children from lower-income households compared with their counterparts. In those with higher-severity malocclusions, males, children with high-school-only-educated parents, and children from lower-income households accessed services less than their counterparts. Conclusions The present study provides baseline information for Australian orthodontic services. Disparities in malocclusion severity and service access were noted. Increased malocclusion severity did not necessarily increase the likelihood of accessing services.

Root resorption in orthodontic treatment with clear aligners: A systematic review

The use of clear aligners in orthodontic treatment has grown in popularity because of its visual appeal and patient-friendly nature. In contrast to fixed appliance treatments (FAT), the relationship between external apical root resorption (ERR) and clear aligners is still unknown. The objective of this systematic review was to evaluate the frequency and severity of root resorption in clear aligner orthodontic treatment, compare it to fixed multi-bracket appliances, and determine the factors that contribute to this phenomenon. The review was conducted without regard to linguistic constraints, using PRISMA criteria and examining studies from 2000 to 2023. MEDLINE/PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were among the databases that were searched. MeSH words about root resorption, aligners, and orthodontics were utilized. Cohort studies, case-control studies, randomized clinical trials, and comparative clinical studies assessing root resorption during clear aligner orthodontic therapy. Out of the 116 studies that were first found, 11 studies were included in the final analysis. While several trials revealed equal results or no significant differences, six reported decreased incidence and severity of ERR in clear aligner therapies (CAT) compared to FAT. A meta-analysis revealed that CAT had less severe ERRs than FAT. In both treatments, ERR frequently affected the maxillary lateral incisors. Potential significant factors included the mechanical distinctions between CAT and FAT, length of therapy, tooth movement velocity, degree of malocclusion, and extraction instances.The review indicates that there may be differences in the frequency and intensity of ERR between CAT and FAT. In multiple investigations, CAT demonstrated reduced ERR severity, although it did not completely eradicate its recurrence. Mechanical characteristics, length of therapy, degree of malocclusion, and number of extraction instances were factors affecting ERR. The included studies' quality assessment indicated a moderate to substantial risk of bias, highlighting the need for more thorough research using reliable measuring techniques, especially when utilizing CBCT imaging.

Comparison of relapse of orthodontic treatment following aligner versus conventional fixed appliance treatment. A systematic review.

Aligners are an alternative that are currently being widely used in orthodontic treatment, however, post-treatment relapse following aligner versus conventional treatment has not been compared. The objective of this study was to compare post-treatment relapse of orthodontic treatment with dental aligners versus conventional fixed orthodontics through a systematic review. An exhaustive search was carried out in the MEDLINE (via PubMed), EBSCO, SCOPUS and EMBASE databases up to September 30, 2023. A total of 522 articles were found and after applying the selection criteria, the full texts of 24 articles were chosen for evaluation. At the end of the evaluation, only 3 studies were considered, two observational studies and one randomized clinical trial. The Newcastle Ottawa and Risk of bias (ROB-2) tools were used to assess the risk of bias. Of the three studies, only one (evaluated three years post-orthodontic treatment) identified significant differences in the frequency of relapse following total, maxillary and mandibular anterior alignment using conventional orthodontics. The other two studies (one evaluated at six months and the other two years post-orthodontic treatment) did not show statistically significant differences (p>0.05). In addition, the two latter studies reported slight relapse related to detachment of the fixed retainer. The current evidence available indicates a lack of well-designed studies comparing post-treatment orthodontic relapse following the use of dental aligners versus conventional fixed orthodontic treatment, and the studies published to date have a high or moderate risk of bias. However, there are apparently no significant differences in frequency of relapse between the two types of treatment, suggesting similar stability results. Nonetheless, more well-designed studies are required to confirm this observation. Key words:Aligners, brackets, relapse, orthodontic.

Digital setup accuracy for moderate crowding correction with fixed orthodontic appliances: a prospective study

ObjectivesTo evaluate the accuracy of a semi-automatic 3D digital setup process in predicting the orthodontic treatment outcome achieved by labial fixed appliances.Subjects and MethodsTwenty-five adult patients (18 to 24 years old) with class I malocclusion and moderate crowding were prospectively enrolled and received treatment on both jaws through the straight-wire technique. Prior to treatment commencement, a semi-automatic digital setup simulating the predicted treatment outcome was performed for each patient through Orthoanalyzer software (3Shape®, Copenhagen, Denmark) to obtain the prediction model. This was compared to the final outcome model through 3D superimposition methods. Metric variables and inspection of color-coded distance maps were used to detect how accurately the digital setup predicts the actual treatment outcome.ResultsThe mean absolute distances (MAD) between the superimposed dental arches of the predicted and the final models were: 0.77 ± 0.13 mm following superimposition on the palate, 0.52 ± 0.06 mm following superimposition on the maxillary dental arch, and 0.55 ± 0.15 mm following superimposition on the mandibular dental arch. The MAD at the palatal reference area was 0.09 ± 0.04 mm. Visualization of color-coded distance maps indicated that the digital setup accurately predicted the final teeth position in a few cases. Almost half of the cases had posteriorly wider upper and lower dental arches and palatally/lingually positioned or inclined anterior teeth, whereas the rest still showed errors within 2–3 mm, distributed over the entire dental arches with no distinct pattern.ConclusionsThe accuracy of semi-automatic prediction of the labial fixed appliance treatment outcome in Class I cases with moderate crowding is not yet sufficient. While average measures showed deviations less than 1 mm, examination of individual color-coded distance maps revealed significant disparities between the simulated and the actual results.

Nickel Accumulation in Saliva and Urine Post Orthodontic Fixed Appliance Treatment in Malay Population

Objective: Prolonged nickel exposure, even in low amounts, is cytotoxic, genotoxic and carcinogenic. The study aims to evaluate the salivary and urinary nickel levels post-orthodontic fixed appliance treatment. Materials and Methods: Saliva and urine samples of fourteen orthodontic patients were taken at debonding (T0), after one month (T1), and three months post-debonding (T2), and compared with the control group. Samples were analysed using Inductively Coupled Plasma Optical Mass Spectrometry (ICP-MS) and IBM SPSS Version 27 was used for statistical analyses. Results: The mean (SD) of orthodontic treatment duration was 33.6 (9.6) months. In comparison to the control group, the mean (SD) nickel levels in saliva and urine were highest at debonding (T0) with 12.71 ppb (9.64) and 9.71 ppb (8.27), respectively. In the test group, there was a significant difference in nickel level in saliva between T0 and T1 (MD = 9.75, 95% CI: 3.71, 15.71; p &lt; 0.05) and in urine between T0 and T1 (MD = 6.46, 95% CI: 1.38, 11.55; p = 0.012). Conclusion: Our results clearly demonstrated that the nickel level in saliva and urine remained higher at the end of orthodontic treatment compared to the control group. Further studies with a longer duration of observation and larger samples are suggested. Furthermore, our study indicates it is essential to confirm the effects of long-duration of orthodontic treatment and its post-treatment nickel level. This study raised attention about the biocompatibility of mechanical orthodontic treatment vs sustainable general health.

Efficacy of Immunoglobulin Y Chewable Tablets on Streptococcus mutans Count in Patients Undergoing Orthodontic Treatment.

The aim of the study was to determine the efficacy of commercially available immunoglobulin Y (IgY) chewable tablets on Streptococcus mutans (S. mutans) count in patients undergoing orthodontic treatment. Participants aged between 12 and 19 years who had fixed, nonextraction orthodontic treatment with no carious lesion were included in the study and advised to take IgY chewable tablet for 15 days (one course) and saliva samples were collected from the patients on day 61, 91, and 121 days from the placement of fixed appliance, to assess its ability in reduction of S. mutans count. The collected samples were processed, and S. mutans levels were estimated. The results were tabulated and subjected to statistical analysis using Statistical Package for the Social Sciences (SPSS) version 20, and the repeated measures test was used to compare different groups. Immunoglobulin Y (IgY) chewable tablet was found to be significantly effective in decreasing S. mutans counts in patients undergoing orthodontic treatment during the study period. Oral passive immunotherapy via egg yolk antibody IgY effectively decreased the S. mutans level, which was found to increase during orthodontic fixed appliance treatment. The IgY chewable tablets can be used as an adjuvant to reduce S. mutans counts and provide basic oral hygiene measures. Muthukumaran M, Jayaprakash J, Arangannal P, et al. Efficacy of Immunoglobulin Y Chewable Tablets on Streptococcus mutans Count in Patients Undergoing Orthodontic Treatment. Int J Clin Pediatr Dent 2024;17(3):265-269.

The Use of Clear Aligners in Multi-Segmental Maxillary Surgery: A Case-Control Study in Cleft Lip and Palate and Skeletal Class III Patients.

Background: Maxillary hypoplasia and mandibular asymmetry may be corrected with orthognathic surgery after growth completion. For most stable results, some cases may require segmental Le Fort I osteotomies. Unfortunately, Invisalign's software (6.0 version) still has some inherent limitations in predicting outcomes for complex surgeries. This study explores the potential of aligners, particularly in multiple-piece maxillary osteotomies in both cleft and non-cleft patients. Method: Thirteen patients who underwent pre-surgical treatment with Invisalign were retrospectively matched in terms of diagnosis, surgical procedure, and orthodontic complexity with thirteen patients treated using fixed appliances. Virtual curves following the lower arch were employed to guide the correct pre-surgical positions of the upper teeth with a simple superimposition technique. The amount of impressions required in both groups to achieve satisfactory pre-surgical alignment of the segmented arches was compared. Results: one or no refinement phases were needed in the Invisalign group to reach an acceptable pre-surgical occlusion, while the amount of pre-surgical impressions needed to reach adequate coordination with fixed appliance treatment was slightly higher (p > 0.05). Conclusions: it appears that clear aligner could serve as an effective treatment for individuals necessitating segmental Le Fort I osteotomies when aided by the suggested simple superimposition approach.

Cone Beam Computed Tomography (CBCT) Aid in the Management of Apical Root Resorption of Impacted Maxillary Canines and Physiologically Erupted Maxillary Canines after Orthodontic Treatment

The aim of this study is to evaluate the effects of orthodontic traction, by means of light and controlled forces, on root length in impacted maxillary canines and physiologically erupted maxillary canines. Disinclusion of impacted maxillary canines is a frequent procedure in orthodontics due to their higher incidence of impaction. The effects of orthodontic traction, by means of light and controlled forces, can lead to a resorption of the root length in impacted and physiologically erupted teeth. Therefore, apical root resorption is a common phenomenon that must be taken into consideration. Apical root resorption measurements were taken using pre-treatment CBCTs and pre-treatment and post-treatment digital panoramic radiographs of 52 patients who underwent fixed-appliance treatment by using light and controlled orthodontic forces. The experimental group consisted of 26 patients with one impacted maxillary canine. The control group consisted of 26 patients without any impaction. Apical root resorption was calculated from root lengths before and after orthodontic treatment. In the experimental group, impacted canines with incomplete apical formation underwent root elongation, while impacted canines with completed root formation went through apical root resorption. The latter showed a slightly greater apical root resorption (0.2 mm) compared to the control group (95% confidence interval; p = 0.04). The extent of root resorption of impacted canines was significantly higher than that of physiologically erupted ones. However, this differential resorption did not compromise the structural and functional integrity of the involved teeth. The orthodontic treatment performed with light and controlled forces is, therefore, a procedure to be considered acceptable and safe.

Fixed appliances orthodontic therapy as a risk factor for caries development: Systematic review.

Orthodontic treatment is often mandatory to improve the patient's health condition. However, the fixed appliance can create additional plaque retention areas, which can increase the risk of caries development. Clinically, one can observe various effects of fixed appliance treatment on caries prevalence. This study aims to analyze to what extent orthodontic therapy with fixed appliances is a risk factor for developing caries in pediatric and adult patients. The keywords used in the search strategy were as follows: ("caries" AND "caries risk" AND "caries experience" AND" "orthodontic treatment" OR "fixed appliance" ") and ("caries experience" AND "orthodontic treatment").From 808 potential articles, 15 were included in the review. In individuals undergoing fixed orthodontic therapy, several factors can increase the risk of car-ies during fixed orthodontic treatment, such as salivary composition, oral dysbiosis and plaque accumulation. On the other hand, factors that reduce caries risk are, i.e., oral hygiene self-awareness and previous orthodontic treatment. In most studies which used the Decayed, Missing, and Filled Teeth (DMFT) index, there were no significant differences between the values obtained before orthodontic treatment and after the treatment. Moreover, it is easier for a patient with aligned teeth to remove plaque.In the young population, fixed orthodontic treatment appears to reduce the incidence of caries. In the adult population, fixed orthodontic treatment increases the risk of dental caries. However, education on proper oral hygiene during orthodontic treatment can reduce the risk of dental caries. The study protocol was registered in the PROSPERO database [PROSPERO CRD42022356628].

The use of orthodontics in the management of a bilateral condylar fracture in a child

Mandibular fractures in children are different to those in adults. Greenstick fractures are more commonplace, and displacement less frequently encountered. They are mostly treated conservatively; however, if the occlusion is altered, then reduction will be required. Closed reduction is normally favoured in children because open surgical reduction and internal fixation may impair future growth. Closed reduction is often carried out with arch bars or splints. These may be traumatic and painful for the child. This case report describes the case of a 12-year-old boy who presented with bilateral condylar fractures with displacement and deranged occlusion. Minimal fixed appliance treatment was used to reduce the fractures and restore him to his pre-injury occlusion. CPD/Clinical Relevance: Minimal orthodontic treatment can be used to reduce a bilateral condylar fracture with displacement in paediatric mandibular fractures.

Effect of orthodontic premolar extraction on maxillary teeth angulation and arch dimensions in adolescent patients: A 3-D digital model analysis.

Therapeutic orthodontic premolar extraction is a common orthodontic treatment, yet the extent of its impact on the upper dental arch dimensions and teeth angulations is still under exploration. Hypothesis: We postulated that the therapeutic extraction of orthodontic premolars significantly alters the orientation of teeth and the dimensions of the dental arch. Objective: This study assessed the impact of therapeutic orthodontic premolar extraction on dental arch dimensions and tooth angulations. We conducted a retrospective cohort study involving 30 patients who underwent bilateral upper premolar extraction and fixed appliance treatment. Pre and post-treatment dental casts were scanned, and changes in tooth angulations and arch dimensions were evaluated using 3D digital maxillary models. Statistical analyses encompassed the application of paired samples t-test. Significant post-treatment changes were observed, including distal tipping in anterior teeth, minor mesial tipping in first molars, and a reduction in torque for central incisors and canines. Dental arch dimensions were also influenced, with increased width and depth between the canines and decreased width between the second premolars while inter-molar width and overall arch depth significantly reduced post-treatment. Therapeutic orthodontic premolar extraction significantly affects dental arch dimensions and tooth angulations. These findings have implications for treatment planning and predicting changes associated with orthodontic treatments involving premolar extraction. Key words:3D digital models - orthodontic premolar extraction - teeth angulation - dental arch dimensions.

Shared decision making for patients needing dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance therapy: a comparison between Pakistani patients' and clinicians' perspective.

Shared decision making (SDM) involves presenting patients with relevant information about a health issue and reaching a clinical decision based on their preferences. However, its application in orthodontics lacks documentation. This study aimed to assess and compare the perspectives of patients and clinicians on SDM in different cases. A cross-sectional study was conducted at a tertiary care hospital in Pakistan, involving 90 patients categorized into three groups (dentofacial orthopedics, orthognathic surgery, and conventional non-surgical fixed appliance treatment). Following clinical assessment and treatment plan discussions, patients and clinicians completed a 12-item dyadic observing patient involvement in decision making (OPTION) questionnaire, to gauge their perspectives on SDM. Mean OPTION scale scores were compared using paired sample t-tests between clinicians and patients, and intergroup comparisons utilized paired sample t-tests and Pearson correlation coefficients. OPTION scores were similar between patients/parents and clinicians. However, statistically significant differences were found regarding the questions about "different sources of information", "different options (including the possibility of doing nothing)" and "concerns regarding management", with the patients giving overall lower OPTION scores. Patients gave lower SDM OPTION scores for conventional orthodontic treatment, but higher scores for orthopedic and orthognathic surgery, as compared to the clinicians. The current study revealed an overall consensus in the mean total scores of OPTION scales between patients and clinicians. However, when stratified, patients showed higher SDM scores for orthopedic and orthognathic cases, and lower scores for conventional orthodontic treatment.

Changes in Andrews' fifth key of occlusion (interproximal contacts) before and after orthodontic treatment.

This study aimed to assess the changes in interproximal contacts before and after orthodontic treatment using the OXIS classification. OXIS refers to the types of contacts that is open (O), point contact (X), straight contact (I), and curved contact (S), and thus the acronym "OXIS". Interproximal contact data of 30 orthodontic patients were obtained at three time points: T0, at the beginning of treatment; T1, at the end of fixed appliance treatment; and T2, one-year post-treatment. For the maxillary second molar-first molar contact, the most common contact at T0, was the "S" pattern (41.6%) which increased to 61.6% at T1 and reduced to 48.3% at T2. For the maxillary first molar-second premolar contact, maxillary second premolar-first premolar contact, and maxillary first premolar-canine contact, the most common contact at T0 was the "I" pattern (58.3%, 46.5% and 43.3%, respectively), which increased to 88.3%, 93.3% and 73.3%, respectively at T1 and decreased to 80%, 88.3% and 71.6%, respectively at T2. For the maxillary canine-lateral incisor contact and lateral-central incisor contact, the most common contact at T0 was the "O" pattern (45% and 33.3%) while it was the "X" pattern at T1 (63.3% and 80%) and T2 (58.3% and 80%). A similar observation was made for the posterior mandibular and anterior teeth. There was statistical significance for most of the changes in the mandibular contacts (p ˂ 0.05). Interproximal contacts change significantly from T0 to T1. Broader contacts were normal at T1 and T2 in the posterior segments. At T2, changes in the interproximal contacts were observed in the posterior segments, and substantial evidence was available, particularly for the mandibular arch.

Treatment outcome comparison of Invisalign vs fixed appliance treatment in first premolar extraction patients

In this study, we compared the dentitional changes after Invisalign and conventional orthodontic treatment with 4 first premolar extractions. This retrospective study included 57 patients whose orthodontic treatment involved the extraction of 4 first premolars because of bialveolar protrusion. A total of 27 patients were treated with Invisalign (mean age, 25.5 ± 5.2 years) and 30 patients with the fixed appliance (mean age, 24.4 ± 5.8 years). The angular and linear changes of the maxillary and mandibular central incisors, second premolars, first molars, and second molars were measured from the recordings on the basis of the lateral cephalograms taken before and after treatment. The angular changes of the canines and second premolars were measured using panoramic radiographs. The overbite and interincisal angle increased significantly in the Invisalign group compared with in the conventional fixed appliance group (P<0.05). The maxillary central incisors showed increased lingual tipping in the Invisalign group (P<0.05), whereas there was no statistically significant difference in the angular change of the mandibular incisors between groups (P>0.05). The maxillary first and second molars showed mesial tipping in the Invisalign group (P<0.05). The maxillary second premolars, first and second molars, and the mandibular second molars showed mesial movement in the Invisalign group (P<0.05). The Invisalign group showed more statistically significant lingual tipping of the maxillary central incisors, distal tipping of the maxillary canines, and mesial tipping of the maxillary first and second molars after maximum retraction of the anterior teeth compared with the fixed appliance group.

A service evaluation of patients requiring growth modification in a public service setting.

Aim To conduct a service evaluation of patients who had functional appliance treatment to correct Class II malocclusions in a public orthodontic clinic. To evaluate the effect of prioritisation and earlier treatment of these patients on treatment duration and patient compliance. Methodology The prioritised treatment group (PTG) had twin block appliances fitted when they were 11 or 12 years old. In comparison, the routine treatment group (RTG) had twin block appliances fitted when they were 13 or 14. Electronic patient records were screened to find a sample of 100 patients from each cohort. The number of compliance issues, functional appliance treatment duration, fixed appliance treatment duration and total treatment duration was recorded retrospectively from patient charts. Results While mean total treatment time was similar across the two cohorts, the PTG did have significantly shorter fixed appliance treatment durations than the RTG. The PTG was also found to have better compliance than the RTG. Conclusion Prioritising patients who require functional appliance treatment does not reduce total treatment duration. A correlation between earlier treatment, improved patient compliance, and a shorter course of fixed appliance therapy can be seen, which may prove clinically beneficial. Further research in this area would be valuable.

The accuracy of virtual setup in simulating treatment outcomes in orthodontic practice: a systematic review

ObjectivesTo evaluate the accuracy of virtual orthodontic setup in simulating treatment outcomes and to determine whether virtual setup should be used in orthodontic practice and education.Materials and MethodsA systematic search was performed in five electronic databases: PubMed, Scopus, Embase, ProQuest Dissertations & Theses Global, and Google Scholar from January 2000 to November 2022 to identify all potentially relevant evidence. The reference lists of identified articles were also screened for relevant literature. The last search was conducted on 30 November 2022.ResultsThis systematic review included twenty-one articles, where all of them were assessed as moderate risk of bias. The extracted data were categorized into three groups, which were: (1) Virtual setup and manual setup; (2) Virtual setup and actual outcomes in clear aligner treatment; (3) Virtual setup and actual outcomes in fixed appliance treatment. There appeared to be statistically significant differences between virtual setups and actual treatment outcomes, however the discrepancies were clinically acceptable.ConclusionThis systematic review supports the use of orthodontic virtual setups, and therefore they should be implemented in orthodontic practice and education with clinically acceptable accuracy. However, high-quality research should be required to confirm the accuracy of virtual setups in simulating treatment outcomes.