Cleidocranial dysplasia (CCD) is a rare congenital condition characterized by patients presenting with craniofacial anomalies, multiple supernumerary and impacted teeth, retained primary teeth, and delayed eruption, necessitating multi-stage and innovative treatment mechanics to facilitate tooth eruption. This case report highlights the orthodontic management of a 21-year-old female with CCD using a sequential, interdisciplinary approach including the extraction of retained primary and supernumerary teeth, and exposure, bonding, and forced eruption of impacted teeth. The latter was achieved with a custom-fabricated lower appliance and a modified transpalatal arch designed to reinforce anchorage and facilitate simultaneous traction of multiple impacted teeth via a closed surgical technique, achieving their successful retrieval and good orthodontic outcomes.

Modified lingual arch for simultaneous uprighting of bilaterally impacted mandibular second molars.

Oligodontia is a common manifestation of Ectodermal Dysplasia with severe implications for oral aesthetics and function. The adaptation of space maintainers becomes a challenge due to the complexity missing teeth and facial growth in children. Objective: report and describe the manufacturing and adaptation of fixed dentomuco-supported space maintainers in the maxilla and mandible of a child with Ectodermal Dysplasia. Case Report: A 4-year-old patient with Ectodermal Dysplasia and oligodontia of seven primary incisors was subjected to adaptation of fixed space maintainers. For the maxilla, a modified Nance space maintainer was fabricated with an acrylic resin extension to the vestibular to simulate gingival tissue, and artificial primary teeth were fabricated using prefabricated acetate crowns. For the mandible, a lingual arch was fabricated with an acrylic resin extension to the vestibular in the region where the four lower primary incisors were missing to simulate gingival tissue, and artificial lower primary incisors were also fabricated. Results: The patient showed excellent adaptation to space maintainers, with improvements in masticatory function, posture, and tongue function. The family reported psychological improvement in the child, who had stopped attending school due to embarrassment and returned to regular school activities. Conclusion: Space maintainers are effective in restoring function and aesthetics in complex cases of oligodontia associated with Ectodermal Dysplasia.

Anterior Open Bite (AOB) is a complex malocclusion with esthetic, functional, and psychosocial implications, highlighting the need for early diagnosis and interceptive treatment. To compare the effectiveness of bonded Tongue Spurs combined with a Low Trans Palatal Arch (TS/LTPA) versus bonded Tongue Spurs (TS) alone in managing AOB associated with tongue habit during the mixed dentition stage. Fifty children were assessed for eligibility; 32 were randomized, and 30 completed the 6-month follow-up and were included in the final analysis. They aged 7 to 11 years (10 boys, 20 girls) in the mixed dentition phase, having a dentoskeletal AOB of at least 1 mm, an Angle Class I molar relationship, and CMI stages 2 and 3. TS/LTPA group comprised 16 patients (7 males and 9 females) exhibiting bonded lingual tongue spurs and a low transpalatal arch. TS group included 14 patients (3 males and 11 females) who had bondable lingual tongue spurs only. The mean age was 8.73 ± 1.00 years in the TS/LTPA group and 9.03 ± 0.68 years in the TS group. Digital lateral cephalograms and models were obtained prior to and six months post-treatment. Both groups (TS/LTPA and TS) showed improvement in overbite closure, with a median change of + 2.97 mm (IQR 1.16 to 5.00; p < .001) in the TS/LTPA group and + 3.67 mm (IQR 2.00 to 5.00; p = .001) in the TS group, respectively. However, the difference between groups was not statistically significant. A statistically significant vertical molar control was observed in the TS/LTPA group (+ 0.40 mm, IQR 0.30 to 0.65; p = .001) compared to the TS group (+ 0.90 mm, IQR 0.70 to 1.00; p = .001), with significant differences between both groups. Both TS/LTPA and TS groups showed a reduction in overbite, along with incisor extrusion and retroclination. The TS/LTPA group provided significantly better vertical molar control than the TS group; however, the difference in AOB closure between the groups was not statistically significant. This single-center randomized controlled trial received ethical approval from Alexandria University’s Research Ethics Committee, Alexandria, Egypt (IORG0008839, No. 0313 − 10/2021). This trial was retrospectively registered in the Pan African Clinical Trial Registry (PACTR202403582913859) on 14 March 2024.

This Finite Element Analysis (FEA) study examined the stability of Polyetheretherketone (PEEK) miniscrews and tissue response in the posterior maxilla under varying angulations. A Cone beam computed tomography (CBCT)-derived three-dimensional model of the fully dentate maxilla was generated, featuring anatomical structures (teeth, periodontal ligament (PDL), alveolar bone) and orthodontic components (brackets, transpalatal arch, archwires). PEEK miniscrews were positioned bilaterally in the regions of the second premolar-first molar and first molar-second molar. A force of 100 g was applied perpendicular to the archwire. Four insertion angulations (45°, 70°, 90°, and 110°) were simulated. FEA revealed a consistent posterior displacement pattern: crowns tipped distally and buccally, while roots moved mesially, with intrusion. The first molar’s PDL peaked at 110°. Cortical bone stress was greatest in molars (1.41 × 105 Pa at 70–110°). Cancellous bone stress peaked under 70° loading in the second molar (1.25 × 105 Pa). PEEK miniscrews exhibited minimal deformation and low interfacial stress, confirming stable anchorage across all angles. Posterior PEEK miniscrews demonstrated excellent stability across all insertion angles, with 70° providing optimal biomechanical efficiency for intrusion. The first molar’s PDL experienced the highest stress concentrations at extreme angles. These findings offer clinical guidance for miniscrew placement to achieve effective intrusion while maintaining tissue safety.

ABSTRACT Purpose This study evaluated the bonding characteristics and risk factors for detachment of cobalt-chromium-fixed orthodontic appliances fabricated using computer-aided design/computer-aided manufacturing (CAD/CAM) technology. Materials and methods We evaluated 28 patients (aged 6–36 years; mean age, 15 years; six male and 22 female) who underwent treatment at the Kanagawa Dental University Hospital between 2020 and 2024 with fixed orthodontic appliances (lingual arches, Nance-holding arches, rapid palatal expanders, and maxillary protraction appliances) fabricated using 3D printing technology. Patients were categorized into the detachment and non-detachment groups based on presence or absence of detachment. Bivariate logistic regression was performed to identify the risk factors for detachment by analysing age, treatment stage (Phase I or II), bonding area, number of bonded tooth surfaces, number of bonded teeth, appliance design, and appliance type. Results The detachment and non-detachment groups comprised nine (32%) and 19 (68%) patients, respectively. Age and treatment stage were significantly associated with the risk of detachment. Detachment risk decreased by 20% for each additional year of age (odds ratio = 0.800, p = 0.038) and Phase II treatment showed a significantly lower risk of detachment than Phase I treatment (odds ratio = 0.045, p = 0.009). Bonding area (p = 0.903), number of bonded tooth surfaces (p = 0.577), number of bonded teeth (p = 0.873), and appliance type (p > 0.05) were not significantly associated with the detachment risk. Conclusion The risk of detachment of fixed orthodontic appliances fabricated using CAD/CAM technology is significantly influenced by age and treatment stage.

To compare the effects of micro-implant (MI) and transpalatal arch (TPA) combined with T-loops of varying gable bend angles on the distalization of mesially impacted canines. A finite element model of a mesially impacted left maxillary canine was developed using patient CBCT data. Separate models combining MI or TPA with T-loops featuring α-end angulations of 0°, 15°, and 30° were created. A 1N retraction force was applied, and canine displacement, stress distribution, and rotation were analyzed. Increasing the α-end angulation from 0° to 30° changed canine movement from uncontrolled tipping (crown distal/root mesial) to controlled translation (concurrent crown-root distal displacement). The 30°angulation achieved the best root control, minimizing crown-root displacement differences along the X-axis. Among the tested conditions, the 30° angulation showed the most favorable root control pattern in this analysis. Greater angulation also produced lingual root torque and intrusion, maintaining root position within the alveolar bone. Both anchorage systems enabled distalization; however, the TPA group showed slightly greater canine displacement with minor mesial movement and extrusion of anchorage teeth. Increasing the T-loop α-end angulation converts uncontrolled tipping to controlled translation by synchronizing crown and root displacement. Angulations of 15°-30°are recommended for optimal root control. While MI offers greater anchorage stability, TPA remains a practical noninvasive alternative despite some anchorage loss.

Orthodontic anchorage control during space closure is critical to prevent unwanted tooth movement, prolong treatment and maintain facial aesthetics. This randomised controlled trial compared mini-implant versus conventional molar anchorage (transpalatal arch) in 40 premolar extraction patients for bilateral canine retraction over 3 months. Mini-implants significantly reduced anchorage loss (0.42±0.31 mm versus 2.18±0.67 mm, p<0.001) compared to conventional anchorage. Canine retraction rates were superior with mini-implants (1.24±0.28 mm/month versus 0.89±0.22 mm/month, p<0.001). Mini-implant anchorage provides superior preservation and faster canine retraction, establishing it as the preferred choice for maximum anchorage needs.

This study aimed to evaluate the new orthodontic TiNb wires in direct comparison to the gold standard in orthodontics, NiTi wires, when treating. There is limited literature on patients with severe malocclusions being treated from start to end with TiNb, and TiNb wires were mostly used in the final stages of treatment. Our protocol consisted of three orthodontic wires: 0.016, 0.016 × 0.025, and 0.019 × 0.025 for levelling and aligning the stage and 0.019 × 0.025 stainless steel for the finishing stage, in order to treat the same case reproduced on a modified scientific simulator. The bracket system used was made by GC slot 0.22, TiNb wires made by Morita, and NiTi wires produced by GC. We ligated all brackets using SS wire ligatures 0.008, and for anchorage, we used a transpalatal arch. The temperature of the scientific simulator was set between 20 and 25 degrees Celsius. We have used upper arches and studied the repositioning of upper ectopic canines and space closure in order to obtain an equilibrated maxillary arch. After each change of orthodontic wires, we scanned the upper arch using Medit i600 (Medit, Seoul, Republic of Korea). After concluding all stages on all upper arches, we assessed the results using LITTLE's Irregularity index and stereo microscopy to explain metal stress on NiTi and TiNb. We propose an optimized process for using TiNb and NiTi wires when treating class II severe malocclusions with premolar extractions. Thus, we observed permanent deformation for all 0.016 TiNb wires used in the first stage, so TiNb underperformed in comparison with NiTi. Also, the Little's Irregularity Index was superior in the NiTi wires group on 0.016 wires, verifying the change of state in the TiNb wires group.

OBJECTIVE:To evaluate and compare the expression levels of Receptor Activator of Nuclear Factor Kappa B Ligand (RANKL) and Osteoprotegerin (OPG) in canine periodontal tissues subjected to periodontal distraction versus conventional retraction at different treatment time points.MATERIALS AND METHODS:The study involved 40 cuspids from 20 patients (9 males, 11 females) randomly allocated to either the periodontal distraction (PD) group or the conventional retraction group. Appliances were applied by a single practitioner in a split-mouth design. In Group 1 (PD), a trans-palatal arch and Hyrax expanders were used following premolar extraction with osteotomies performed to facilitate distraction. Group 2 (conventional retraction) used MBT brackets with sectional archwires and elastic chains. Gingival crevicular fluid samples were collected on the first day (D0), after 1 week (W1), and 6 weeks (W6) and OPG and RANKL levels were analyzed using ELISA test.RESULTS:There was a significant difference in canine retraction duration between methods (P < 0.001), with periodontal distraction taking 24.1 ± 2.08 days versus 110.5 ± 4.84 days for conventional retraction. RANKL levels showed no baseline difference, but were significantly higher in the periodontal distraction group at weeks 1 and 6 (P = 0.010 and P = 0.001, respectively). OPG levels were initially similar, but by weeks 1 and 6, they were significantly lower in the periodontal distraction group (P = 0.001).CONCLUSION:The periodontal distraction method significantly reduces the duration of canine retraction and enhances osteoclastic activity, as evidenced by increased RANKL and decreased OPG levels, facilitating accelerated tooth movement through efficient bone resorption and remodeling.

312 - Lingual arch and molar hypomineralization: a case report on an unusual indication to maintain anchorage

359 - Orthodontic Management of an Impacted Mandibular Second Molar with a Lingual Arch with a Distal Extension

51 - Comparison between nance button and transpalatal arch for preventing anchorage loss in orthodontics. Systematic review

264 - Control of Pendex Side Effects Using Lower Lingual Arch and Class II Elastics During Molar Distalization

The effects of palatal anchorage device on molar distalization with clear aligner: Three-dimensional finite element analysis.

Efficient anterior tooth retraction with simultaneous intrusion is critical for the orthodontic treatment of deep bites. Gable bends incorporated into archwires can influence the direction and magnitude of force application. This study aimed to evaluate the effect of different gable bend angles (0°, 10°, 15°, and 20°) on stress distribution and displacement patterns in the maxillary dentition using three-dimensional (3D) finite element analysis (FEA) in the context of miniscrew-assisted en-masse retraction. A 3D geometric model of the adult maxilla was constructed using high-resolution computed tomography (CT) scan data. The maxilla was segmented using MIMICS 8.11 (Materialise NV, Leuven, Belgium), and surface refinement was performed using RapidForm (INUS Technology Inc., 3D Systems, Rock Hill, SC). The model was meshed in HyperMesh 13.0 (Altair Engineering, Inc., Troy, MI), and analysis was performed using ANSYS 12.1 (ANSYS, Inc., Canonsburg, PA). The model included teeth from the central incisor to the second molar, with a 0.25-mm-thick periodontal ligament (PDL) and alveolar bone. Orthodontic appliances included 0.022" McLaughlin, Bennett, and Trevisi (MBT) brackets (3M Unitek, Monrovia, CA) from central incisor to second premolar, bands on molars, a 0.019" x 0.025" stainless steel archwire (Ortho Organizers, Carlsbad, CA), and a transpalatal arch using 0.9 mm wire (GAC Int., Bohemia, NY). A miniscrew (1.5 mm × 10 mm; S.K. Surgicals, Pune, Maharashtra, India) was placed between the second premolar and first molar at an angle of 30°from the occlusal plane. A 200 g retraction force was applied using elastomeric chains (American Orthodontics, Sheboygan, WI) from a 6-mm crimpable hook to the miniscrew. Four models were created with gable bend angles of 0°, 10°, 15°, and 20°, placed 2 mm away from the canine bracket.Each model contained 82,566 nodes and 392,108 elements. The von Mises stress increased with greater gable bend angles, especially around the implant site and canine PDL. Cortical bone stress ranged from 51.9 MPa (0°) to 64.9 MPa (20°). The anterior teeth showed enhanced retraction and intrusion with 15° and 20°gable bends. The posterior teeth exhibited minimal displacement and maintained their anchorage. Intrusion and controlled tipping of the anterior teeth were more prominent at higher gable bend angles. Gable bend angles of 15° and 20° provided optimal biomechanical conditions for en-masse retraction with effective intrusion of the maxillary anterior teeth while preserving the posterior anchorage. These configurations may offer clinical advantages for managing deep-bite cases.

Complication of Trans-Palatal Arch (TPA) appliance placement: A case of palatal mucosa embedment - IJODR- Print ISSN No: - 2581-9356 Online ISSN No:- 2581-9364 Article DOI No:- 10.18231/j.ijodr.2025.027, IP Indian Journal of Orthodontics and Dentofacial Research-IP Indian J Orthod Dentofacial Res

AIM OF THE STUDY:This research paper was intended to quantify the stresses and the displacement distribution pattern released by Omega-loop transpalatal arch (TPA) activated in the Burstone geometries (II, III, and V) within two different materials.MATERIALS AND METHODS:Three-dimensional solid models of the maxilla and maxillary teeth were created using CBCT data for a 20-year-old man. A molar band and Omega-loop TPA were constructed. Force application was pretended virtually to geometry II, III, and V within stainless-steel and Armco β-titanium (TMA) (titanium–molybdenum–aluminum) material.RESULTS:The schemes for stresses and the displacements were alike for both stainless-steel and TMA alloy Omega-loop TPAs. The stresses and displacements for the stainless-steel Omega-loop TPAs were higher than those for the TMA. Mesial tipping was seen in the unit with a large moment, distally in the opposite side. The highest displacement values were seen around the x-axis, which represent the tipping molar movement.CONCLUSIONS:This study results have shown that Omega-loop TPA can effectively derotate upper first molars. Anchorage reinforcement for the opposite molar should be kept in the orthodontist mind to avoid the unwanted movement as a result of the reactive forces for the active unit, especially when it is decided to use a high force to correct unilateral molar rotation.

Background: To evaluate the anchorage loss during fixed orthodontic treatment using different reinforcement methods, including transpalatal arch, chromosome appliance, and second molar banding, in comparison with conventional first molar anchorage. The analysis was performed using the finite element method. Materials and Methods: A CBCT scan was used to create a 3D model of the maxilla and mandible. DICOM data were processed in MIMICS software, and STL files were reverse-engineered for modeling in Dassault Systèmes’ 3D EXPERIENCE platform. Four models were developed: (1) first molar banding, (2) first and second molar banding, (3) TPA, and (4) chromosome appliance. All models included 0.022×0.028-inch MBT brackets, 0.019×0.025-inch stainless steel archwires, and retraction power arms. Each model was meshed to generate nodes and elements, and material properties were applied to teeth, PDL, bone, and appliances. The superior maxillary border was restrained to simulate clinical stability. A 150-gram retraction force was applied from the power hook to the molar tube. Displacement of the first molar was measured in the sagittal plane using 3D-matic software, with the mesial CEJ as a reference point. Simulation was performed in ANSYS 2024 R2. Results: FEM analysis revealed that anchorage loss, measured as anterior displacement along the Y-axis, decreased with the addition of reinforcement. The greatest displacement occurred in the first molar-only model, while the chromosome appliance showed the least. Conclusion: The chromosome appliance provided the most effective anchorage control, followed by second molar banding and TPA. First molar-only anchorage showed the highest displacement, underscoring its limitations. These findings highlight the clinical importance of selecting appropriate anchorage strategies to minimize unwanted tooth movement and enhance treatment efficiency.

Introduction: Anterior open bite is a challenging malocclusion often associated with anterior tongue posture. Tongue Spurs (TS) and low transpalatal arch (LTPA), and TS alone are two common orthodontic modalities used to address Anterior open bite (AOB). However, patient acceptance and comfort levels with these appliances remain understudied. Objectives: To compare patient acceptance of tongue spurs and low trans palatal arch versus tongue spurs alone in the treatment of developing anterior open bite.Materials and methods: Thirty children, aged 7-11 years, in mixed dentition phase, presenting with an AOB of at least 1 mm and an Angle Class I molar relationship, randomly allocated to Group I: received treatment with bondable lingual TS combined with a LTPA, while Group II was treated with bondable lingual TS alone. Lateral cephalograms and digital models were collected both before treatment and after a 6-month follow-up period. A questionnaire evaluated patient acceptance and perception of pain and discomfort after a 6-month follow-up.Results: Lingual TS group reported significantly better experiences, with 100% "Very Good" satisfaction (p<.00001), less noticeable appliances (42.86%, p=.0034), and milder speech/eating difficulties compared to LTPA/TS group. The TS alone group had less pain (71.43% p<.00001), and no gum bleeding (100%, p<.00001).Conclusion: The Lingual Tongue Spurs offer superior patient comfort, functionality, and social acceptability, making them a preferred choice for orthodontic treatment despite similar debonding rates. Clinicians should consider these findings when selecting appliances to optimize patient satisfaction and outcomes.