Orthodontic Appliances Research Articles

Assessment of changes in enamel colour following fixed orthodontic therapy using an advanced spectrophotometer: An in vivo study.

Any manipulation of the surface of natural teeth may result in a variation of their colour. The fixed orthodontic treatment (FOT) is one such procedure which alters the enamel surface during the procedure. To clinically evaluate the colour changes in teeth associated with comprehensive FOT (to compare the changes in test and control groups) and to determine the relationship of age and gender on enamel colour due to FOT by using an advanced spectrophotometer. The selection of sixty patients for the study was done randomly and among these thirty patients who underwent the FOT as the case group, the other thirty patients who did not need FOT, were the control group. The recordings of spectrophotometric data were done in a standardized manner for all patients in the labial circular region of every anterior tooth, following debonding and cleaning operations, and before bracket bonding. The Commission Internationale de l'Eclairage's L*, a*, and b* (lightness, red/green, and blue/yellow) tooth-type characteristics were used to measure color, and the associated color differences (DE) between the groups were computed. One-way ANOVA (a < 0.05) and the paired t-test were used to evaluate any changes in these color characteristics. Fixed orthodontic treatment is associated with changes in colour parameters. L* values decreased (P< 0.001), while a* and b* values increased (P< 0.001) at the end of treatment. All measured tooth types showed significant colour change (DE); their mean differences ranged from 1.64 to 2.96 DE units. Fixed orthodontics can change the natural colour of teeth. The CIE colour parameters L*, a*, and b* of natural teeth showed statistically significant differences after debonding the orthodontic appliances. The L* values decreased making the teeth look darker. The adolescent and male patients had more tooth colour changes than the adult and female groups.

Awareness and Periodontal Health Practices of Fixed Orthodontic Appliance Patients: A Questionnaire-Based Survey.

A well-aligned dentition is more conducive to periodontal health, which is necessary for successful orthodontic therapy. Maintaining good dental hygiene is crucial for effective treatment, and patient cooperation, education, motivation, and attitude are all important components. Orthodontists must routinely check in with their patients to see whether they are maintaining their oral hygiene and if they are using any additional assistance. Negligence on the part of the patient may be the cause of poor treatment outcomes. This study aims to show how patient education can affect treatment outcomes and the development of a functional, aesthetically pleasing, and healthy dentition. Aim This study aims to investigate awareness, attitude,andperiodontal health knowledgeamong orthodontic patients. Objectives The study explores the level of awareness and knowledge regarding periodontal health among orthodontic patients, examining its correlation with factors such as age, attitude, and duration of orthodontic treatment. Additionally, it aims to gauge the extent of education received by orthodontic patients regarding proper oral hygiene practices and the potential repercussions of neglecting them. Methods A questionnaire-based study with a cross-sectional design was performed in Jeddah, Saudi Arabia. A total of 428 participants were randomly selected from several private orthodontic clinics and hospitals. The participants in the study were individuals currently undergoing treatment with fixed orthodontic appliances. Information was gathered using a self-administered questionnaire. Results The patients undergoing orthodontic treatment have a moderate understanding of periodontal disease about dental plaque. The level of awareness of periodontal health was 41%, and the level of knowledge about periodontal health was 51%. When it came to periodontal health, adult orthodontic patients had a positive attitude toward fixed orthodontic treatment (mean score = 0.75). Subjects' attitudes regarding fixed orthodontic treatment were significantly impacted by the patient's consistency with his/her dental checkups (p value = 0.02). Conclusion The patients'periodontal health awareness was moderate, while their periodontal health knowledge was fair. Orthodontic patient's awareness levels, as well as knowledge levels, showed significant differences in age and duration but not sex. Results showed no significant difference among the attitude levels of orthodontic patients and age, sex, and duration.

Effect of Periodontal Scaling in Patients Undergoing Orthodontic Treatment on General Oral and Periodontal Health

Background: Orthodontic treatments, while improving dental alignment and facial aesthetics, significantly complicate oral hygiene management due to the fixed nature of orthodontic appliances. This study investigates the potential benefits of periodontal scaling in mitigating the adverse effects on oral and periodontal health among orthodontic patients. Objective: To evaluate the impact of periodontal scaling on the general oral and periodontal health of patients undergoing orthodontic treatment. Methods: This descriptive cross-sectional study included 50 patients from the College of Dentistry, Sharif Medical and Dental College, Lahore. Conducted from April 2023 to April 2024, the study utilized a questionnaire to collect demographic data and information about the patients’ last dental scaling. The Community Periodontal Index for Treatment Needs (CPITN) and the Decayed, Missing, Filled Teeth Index (DMFT) assessed the periodontal and general oral health. Results: The correlations between the time since the last scaling and general oral health (DMFT score: p=0.950) and periodontal health (CPITN: p=0.635) were not statistically significant. Higher DMFT scores were noted in patients who last had scaling over a year ago (30%), followed by those never scaled (26%). Pocket depths of 6mm were solely observed in unscaled patients. Conclusion: The incidence of decayed, missing, and filled teeth, as well as deeper pocket depths, were notably higher in orthodontic patients who had not received scaling in over a year or never at all, emphasizing the necessity of regular periodontal care.

Transforming Adolescent Smiles: Correcting Skeletal Mandibular Retrusion and Bimaxillary Protrusion with Clear Aligners.

Maxillary protrusion combined with mandibular retraction is a highly prevalent but extremely complex maxillofacial deformity that can have a serious negative impact on patients' facial aesthetics and mental health. The traditional orthodontic treatment strategy often involves extracting 4 first premolars and conventional fixed techniques, combined with mini-implant screws, to retract the anterior teeth and improve facial protrusion. In recent years, an invisible orthodontic technique, without brackets, has become increasingly popular. However, while an invisible aligner has been used in some cases with reasonable results, there remain significant challenges in achieving a perfect outcome. This case report presents an adolescent patient with bimaxillary protrusion and mandibular retrognathia. Based on the characteristics of the invisible aligners and the growth characteristics of the adolescent's teeth and jawbone, we designed precise three-dimensional tooth movement and corresponding resistance/over-correction for each tooth, while utilizing the patient's jawbone growth potential to promote rapid development of the mandible, accurately and efficiently correcting bimaxillary protrusion and skeletal mandibular retrognathia. The patient's facial aesthetics, especially the lateral morphology, have been greatly improved, and various aesthetic indicators have also shown significant changes, and to the patient's great benefit, invasive mini-implant screws were not used during the treatment. This case highlights the advantages of using invisible aligners in adolescent maxillary protrusion combined with mandibular retraction patients. Furthermore, comprehensive and accurate design combined with good application of growth potential can also enable invisible orthodontic technology to achieve perfect treatment effects in tooth extractions, providing clinical guidance for orthodontists.

Clinical effect of chlorhexidine and sodium fluoride on corrosion behavior and surface topography of nitinol orthodontic archwires

BackgroundAlterations in the mechanical properties of the materials utilized in orthodontic appliances could affect the working properties of the appliances, thereby affecting clinical progress and outcome. Numerous studies have confirmed the correlation between alloy corrosion and raised surface roughness, which has a direct impact on the working characteristics of orthodontic archwires.MethodsThirty nickel-titanium (NiTi) orthodontic archwires were utilized in this study. Patients were randomly selected and allocated into three groups according to the randomization plan; (The control group): subjects practiced regular oral hygiene; (The fluoride group): subjects used fluoride for intensive prophylaxis; (The chlorhexidine group): subjects used chlorhexidine. Representative samples were evaluated by SEM, and then SEM images with high resolution were examined using Image J software to determine the surface roughness and obtain the results for further statistical analysis.ResultsOur findings indicated a significant difference was found between the three groups regarding the anterior and posterior parts between the control and the two other groups and a non-significant difference between NaF and CHX groups. Overall, the p-value for group comparisons was 0.000 for both parts, indicating a highly significant difference especially between the control and NaF groups.ConclusionMouthwashes containing sodium fluoride demonstrated more significant surface alterations than the control and CHX groups and should be prescribed in accordance with orthodontic materials to reduce side effects.

Comparative characterization of supragingival plaque microbiomes in malocclusion adult female patients undergoing orthodontic treatment with removable aligners or fixed appliances: a descriptive cross-sectional study.

This study aimed to explore the effects of removable aligners and fixed appliances on the supragingival bacterial communities in adult female patients undergoing orthodontic treatment. Supragingival plaque samples from 48 female individuals underwent microbiome analysis (16S rRNA gene sequencing) using PacBio Sequel sequencing. The study included 13 adults without orthodontic treatment needs as the control group (Group C), and 35 patients with comparable initial orthodontic conditions who received treatment at a university clinic in Beijing, China. The treatment involved either traditional fixed brackets (Group B, n = 17) or Invisalign® aligners (Group AT, n = 18). Bioinformatics methods were used for data analysis. From the 48 plaque samples, a total of 334,961 valid reads were obtained, averaging 6,978 sequences per sample. The 16S rDNA sequences were classified into 25,727 amplicon sequence variants (ASVs). Significant variances in alpha and beta diversity among the groups were noted. Group B microbiome exhibited an increased presence of Gram-negative bacteria. At the phylum level, Actinobacteriota was significantly more prevalent in Group C samples, while Bacteroidota was enriched in Group B samples. Family-level relative abundance analysis showed a notable increase in Saccharibacteria (formerly TM7) and Prevotellaceae in Group B. Genus-level analysis revealed a significant rise in Lautropia in Group AT. Fixed orthodontic appliances were linked to oral microbiome changes, notably an enhanced relative abundance of anaerobes, including periodontal pathogens. The observation points to the impact of orthodontic appliance on the oral microbial community, highlighting the difference between traditional braces (Group B) and clear aligners (Group AT)in terms of the predominance of anaerobic and gram negative bacteria. This emphasizes the importance of considering the microbiological effects when choosing orthodontic appliance and underscores the need for tailored oral hygiene practices for individuals undergoing these treatments. This research might provide insights that could assist in the development of innovative cleaning techniques and antibacterial materials.

Structural and Color Alterations of Teeth following Orthodontic Debonding: A Systematic Review.

The objective of this study was to explore the effects of fixed orthodontic appliances on enamel structure by assessing microfractures, surface roughness, and alterations in color. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search of online databases was conducted using the keywords 'enamel' AND 'orthodontic debonding'. Eligibility criteria included both in vivo and ex vivo clinical trials conducted on human teeth. A total of 14 relevant papers were analyzed. Various instruments and techniques were utilized across different studies to assess surface roughness, color change, and surface fractures. The findings of this study suggest that ceramic brackets may lead to an increase in enamel fractures, particularly during bracket removal. The surface roughness of enamel exhibits variability depending on the adhesive substance and polishing methods used post-removal. Fixed orthodontic appliances could induce changes in enamel color, which may be alleviated by the use of nano-hydroxyapatite or specific polishing techniques. Further research is necessary to identify effective strategies for managing these color changes and improving the overall outcomes of fixed orthodontic treatment.

Assessment of the Alignment Acceleration of the Lower Incisors Using a Single Aligner Appliance Modified with Nickel-Titanium Coils: A Randomized Controlled Clinical Trial in Adults.

OBJECTIVE: The aim of this study was to investigate the effects of a single aligner appliance modified with nickel-titanium coils in accelerating the alignment of crowded lower incisors. MATERIALS AND METHODS: 36 patients with mild crowding of their lower incisors were randomly divided into two groups: one group received a modified aligner appliance with nickel-titanium coils (Experimental group), while the other group received traditional orthodontic brackets (Control group). The degree of irregularity in the alignment of the incisors was measured every 2 weeks using Little's irregularity index, and this was done at different time points throughout the study: before treatment (T0), after 2 weeks (T1), after 4 weeks (T2), after 6 weeks (T3), after 8 weeks (T4). RESULTS: A total of 87 patients with anterior mild crowding in the lower dental arch were initially assessed for eligibility. Out of these, 64 patients met the inclusion criteria. Eventually, 36 participants were assigned to receive the treatment. Accordingly, the data from 36 patients were analyzed statistically. There was no significant difference when comparing the two groups at T0, T1, T3, and T4. However, the difference was significant at T2 (p = 0.037). The differences were statistically significant at all time periods within each group (P &lt; 0.001). CONCLUSION: The use of a modified aligner appliance with nickel-titanium coils effectively treats lower incisors crowding, but it does not accelerate the alignment process compared to the traditional fixed orthodontic appliance.

Esthetic outcomes in orthodontics through digital customization with a lingual appliance system.

Contemporary fixed orthodontic appliances are shifting from non-customized pre-adjusted appliances to custom-designed and printed appliances with novel digital setup systems. We are one step closer to precision dentistry and orthodontics using personalized mechanics and custom appliances. However, despite the evidential enhancement and other improvements to fixed appliances, tooth movement is still limited to five degrees of freedom. Opening or closing spaces still requires manually placing elastomeric chains or coil springs. In this article, we aimed to demonstrate how advancements in CAD/CAM technology, reverse engineering, and digital customization are helping orthodontics constantly evolve, enabling treatment with enhanced esthetics and minimal compliance. The clinical system (InBrace®, Irvine, CA) described in this article uses a patient-specific, digitally designed multiloop NITI wire that delivers friction-free, light, and continuous forces and activates automatically whenever the malocclusion deviates from the digital setup. Through digital customization, InBrace allows for automated tooth movement in all six degrees of freedom, including space opening or closure, via programmed non-sliding mechanics. Precision orthodontics and personalized treatment have been significant developments in orthodontics recently. This article focuses on how a technologically advanced lingual appliance system could achieve targeted cosmetic results methodically via automation and personalization.

What Are The Optimum Plaque Control Methods For Patients With Fixed Orthodontic Appliances?

Fixed appliance therapy is an integral facet of contemporary orthodontics. Despite the benefits of orthodontic care to the patient , fixed appliances, in the absence of effective and sustained oral hygiene, can result in deleterious effects to the dentition and supporting structures. The current evidence regarding the effectiveness of available methods for plaque control during fixed appliance therapy is considerable but with significant variation between studies. No review to date has summarised the available evidence for different oral hygiene interventions. The purpose of this article is to summarize the evidence for plaque control methods based on the best available evidence. In this way, our research may serve to assist clinicians in educating patients regarding optimum plaque control during fixed appliance therapy.

Establishing correlation between teeth exposure to mechanical loads during orthodontic treatment and occurrence of denticles in teeth

INTRODUCTION. Treatment with braces can correct pathologies of the bite, temporomandibular joint, and improve the facial and smile aesthetics. However, along with the positive effects of braces, there are a number of negative effects, one of which is the formation of denticles caused by mechanical stress during orthodontic treatment. Understanding not only the advantages, but also the disadvantages of braces systems can minimize the negative effects of treatment with non-removable orthodontic appliances by means of modern technologies.AIM. Establishing the effects of mechanical forces applied to the tooth during orthodontic treatment with braces on the formation and growth of denticles.MATERIALS AND METHODS. 41 cone-beam computed tomograms (CBCTs) of patients aged 11 to 59 years, randomly selected, treated with non-removable orthodontic appliances for two years were studied. A total of 90 teeth were found in which pulp denticles formed primarily or grew in size. CBCT was analyzed in Planmeca Romexis Review software before and 2 years after orthodontic treatment. Findings were recognized as statistically significant at p &lt; 0.05.RESULTS. The formation and development of denticles after wearing orthodontic appliances was observed in 87.2 % (n = 30) of cases). Primary denticle formation occurred in 46.2 % (n = 18) of cases, and an increase in denticle size was observed in 25.6 % (n = 10) of cases.CONCLUSIONS. The obtained statistical data supports the relationship between the effects of mechanical stress on teeth during orthodontic treatment and denticle formation.

A Comparative Analysis of Mechanical Properties of Polyetheretherketone (PEEK) vs. Standard Materials Used in Orthodontic Fixed Appliances: A Systematic Review.

Polyetheretherketone (PEEK), an organic thermoplastic polymer, has gained interest in dentistry due to its excellent mechanical strength, flexibility, and biocompatibility. Furthermore, the ability to utilize CAD/CAM in the fabrication of PEEK enhances accuracy, reliability, and efficiency while also saving time. Hence, several orthodontic studies have explored the utilization of PEEK in various applications, such as archwires, brackets, fixed lingual retainers, palatal expansion devices, transpalatal arches, Tübingen palatal plates, different types of space maintainers, mini-implant insertion guides, and more. However, a complete systematic review of the available data comparing the performance of PEEK with traditional orthodontic materials has not yet been conducted. Therefore, this systematic review seeks to assess if PEEK material meets the required mechanical criteria to serve as an alternative to conventional orthodontic appliances. To ensure clarity and precision, this review will specifically concentrate on fixed appliances. This systemic review followed the PRISMA guidelines and utilized databases including PubMed/MEDLINE, Embase, Springer, Web of Science, and Wiley. Searches were restricted to English language articles from January 2013 to February 2024. Keywords such as "Polyetheretherketone" or "PEEK" and "Orthodontic" or "Orthodontic device" or "Orthodontic materials" were employed across all databases. Nine studies were incorporated, covering orthodontic archwires, brackets, and fixed lingual retainers. Based on the reviewed literature, PEEK demonstrates promising potential in orthodontic fixed appliances, offering advantages in force delivery, friction reduction, and aesthetic appeal. Further research is needed to fully explore its capabilities and optimize its application in clinical practice.

Effectiveness of fluoride mouthrinse in prevention of demineralization during fixed orthodontic treatment: A systematic review and meta-analysis.

Enamel demineralization is a very common occurrence around bonded brackets in an orthodontic practice. Fluoride (FLR) applications have been used to prevent decalcification and further progression of white spot lesions. The purpose of this systematic review and meta-analysis was to systematically appraise available literature on the effectiveness of fluoride mouthrinse in the prevention of demineralization around fixed orthodontic appliances. A search was conducted for randomized controlled clinical trials among four electronic databases (MEDLINE, Google Scholar, PubMed, and Cochrane Review) through MeSH terms and keywords. Studies were excluded if random allocation was not conducted, or if they were animal or in vitro studies. About 146 articles were screened and 5 studies were selected for the present review. Only two studies were selected for MA due to variations in the measurement of outcomes among studies. This review concluded that rinsing with FLR in the course of the fixed orthodontic treatment lessens demineralization around the bracket. Using FLR mouthrinse to inhibit the formation of white spot lesions or dental caries in patients with multiple cavities or restoration can be considered in clinical practice.

Assessment of salivary tumor necrosis factor-alpha level in the initial stages of treatment with fixed appliances and clear aligners.

To assess and compare the tumor necrosis factor-alpha (TNF-α) levels in saliva samples during the initial stages of orthodontic treatment with fixed orthodontic appliances (FAs) and clear aligners (CAs). This longitudinal study comprised 40 patients (22 males, 18 females, mean age 22 ± 7 years) who were categorized into two equal-sized groups. Group A comprised 20 patients treated with FA, and Group B comprised 20 patients treated with CA. Unstimulated saliva was collected before the intiation of treatment and then collected again after the placement of the FA/CA at 24 hrs, 7th day, and on the 21st day in both groups. TNF-α levels were determined through ELISA. The data were subjected to statistical analysis. For intragroup comparison of TNF-α at different time points, the Wilcoxon matched-pairs signed-rank test was used, and for intergroup comparison of FAs and CAs at different time points, the Mann-Whitney U test was used. TNF-α levels in the saliva increased significantly at 24 hours, followed by a decline on the 7th day and 21st day in both groups. Changes in TNF-α levels were significantly higher in the FA group than those in the CA group at different time points. This study showed that the salivary TNF-α levels increased significantly during the initial stages of FA and CA treatment at different time points. The mean salivary TNF-α level in both FA and CA groups increased significantly at 24 hours, followed by a decline on the 7th day and then on the 21st day. There was a significant difference between the FA and CA treatment, where the CAs showed a significantly low level of TNF-α in saliva at different intervals of time when compared to the FAs.

Efficacy of clear aligner therapy over conventional fixed appliances in controlling orthodontic movement: A systematic review.

The purpose of the current systematic review was to answer the clinical research question "Is Clear Aligner Therapy (CAT) effective in controlling the orthodontic movement?" by bringing together the most up-to-date information about the available evidence for CAT. On January 1, 2023, a search was conducted in PubMed, ERIC, Embase, and CINHAL for any research papers published in the previous 10 years that provided an overview of the PICO questions. Both the titles and abstracts of the selected studies were evaluated independently by two different authors, and if there was any disagreement between the two review authors, a third reviewer was brought in to settle it. Among included studies, three were retrospective non-randomized and two studies were prospective randomized clinical trials. Various authors reported better outcome for fixed orthodontic appliances than for clear aligner treatment (CAT) in relation to mandibular incisor proclination. The mean objective grading system score was better for braces (17) than for CAT (12) with no clinically significant difference, while staging had a significant impact on treatment efficacy. The results of this study suggest that clear aligners may be an effective alternative to traditional braces, but more research is needed to confirm these findings and determine the optimal size of future prospective studies evaluating this treatment.

Supragingival dental biofilm profile and biofilm control during orthodontic treatment with fixed orthodontic appliance: A randomized controlled trial

ObjectiveThe effectiveness of supragingival dental biofilm control during orthodontic treatment and changes in the bacterial profile were analyzed. DesignSixty-four participants aged 12–22 years (57% female) were included in the study. Participants underwent orthodontic treatment with fixed appliances and were randomly assigned to one of the three groups, which during a period of one month: (I) used chlorhexidine digluconate (CHX), (II) used high concentration of fluoride (F) gel and (III) performed standard oral hygiene. The plaque and gingivitis index, pH of biofilm and white spot lesions (WSL) were assessed. Changes of the bacteria in the biofilm were analyzed by the quantitative polymerase chain reaction ResultsIncrease in the plaque index, pH of biofilm, and WSL was observed during orthodontic treatment with standard oral hygiene. Large interindividual variability was present, and the effects of one-month use of fluorides and CHX on clinical parameters were not significant. Despite standard hygiene the abundance of studied biofilm bacteria increased - the most Streptoccocus mutans (14.2x) and S. salivarius (3.3x), moderate Veillonella parvula (3x) and the least S. sobrinus (2.3x) and Agregatibacter actinomycetemcomitans (1.9x). The use of CHX reduced S. sobrinus (2.2x) and A. actinomycetemcomitans (1.9x). Fluoride use reduced A. actinomycetemcomitans (1.3x) and S. sobrinus (1.2x). Fluorides better controlled S. mutans than CHX. ConclusionBacterial biomass in supragingival biofilm increased during treatment with metal orthodontic appliances, with greater increase in cariogenic bacteria than periopathogens. Fluoride controlled S. mutans, while CHX S. sobrinus and A. actinomycetemcomitans.

Alignment for alveolar bone graft and improvement of transverse discrepancy in adult patients with unilateral/bilateral cleft lip and palate

Since 2019, orthodontic treatments of cleft lip and/or palate have been supported by the Korean National In­surance System. Based on the national claim data, more than 30% of fixed orthodontic treatments were provided to adult cleft palate patients. Their maxillary arches frequently were deformed and collapsed, and sometimes needed arch coordination for alveolar bone graft. Therefore, the treatment progress for two patients with uni­lateral/bilateral cleft palate was introduced, presenting improvement of inter-arch horizontal disharmony and dental alignment with fixed orthodontic appliances to enable iliac bone graft and implant prosthesis.

Influence of malocclusion on OHRQoL in adolescents in initial orthodontic treatment phase.

Besides correcting malocclusions, another main objective of orthodontic treatment is to improve patients' oral health-related quality of life (OHRQoL). This study aimed to assess changes in OHRQoL of children within the first six months of orthodontic therapy with fixed orthodontic appliances. 85 patients aged 11 to 14 years requiring fixed orthodontic appliance therapy were included. The children completed the German version of the Child Perceptions Questionnaire (CPQ-G-11-14) before (T0), 1 month (T1) and 6 months (T2) after the start of orthodontic treatment. The type of malocclusion was categorized according to the Index of Orthodontic Treatment Need (IOTN). The initial type of malocclusion affected the children's OHRQoL, whereas gender and age did not. The IOTN dental health component (DHC) had a significant impact on the CPQ score (median CPQ of 15.00 for the group DHC 4 vs. 22.50 for DHC 5, p = 0.032). The onset of orthodontic treatment initially affected the CPQ domains "Oral symptoms" and "Functional limitations, with a change versus baseline of 2.00 (p = 0.001), but improved again after 6 months. Regression analysis demonstrated that children with an IOTN DHC 5 malocclusion experienced a greater impact on their ORHQoL, as indicated by a CPQ score 7.35 points higher than that of children with an IOTN DHC 4 malocclusion (p = 0.015). At the beginning of orthodontic treatment, the OHRQoL slightly worsens, probably due to the discomfort and appearance of the appliances. However, 6 months after the start of orthodontic treatment, OHRQoL improved again in patients with severe malocclusion (IOTN 4 and 5), and approached baseline values. The results help the clinician to better understand specific aspects of oral health that may be affected by different malocclusions, thereby improving the child's satisfaction and overall quality of life.

3D Printer-Assisted Layered Fabrication of a Novel Appliance for Oral Myofunctional Therapy and Functional Evaluation of Its Effects on Orofacial Muscles During Wear.

Aim Balanced function of the orofacial muscles is important for normal occlusion and dentition; however, patients with malocclusion often present with myofunctional disorder (MFD). Myofunctional therapy (MFT) has received much attention as a method for reducing MFD. Moreover, prefabricated functional appliances (PFAs) have been developed as a method to eliminate abnormal muscle pressure and guide the tongue into the correct position. However, PFAs have disadvantages, such as poor intraoral retention, limited usage time due to discomfort and poor patient compliance, and changes in the axis of the mandibular anterior teeth.Therefore, this study aimed to develop a new custom-made splint-type orthodontic appliance with CAD/CAM technology. Moreover, we evaluated the characteristics of the appliance and conducted functional tests to determine the effects of the appliance on the orofacial muscles and the discomfort associated with its use. Materials and methods Twenty-five volunteers (nine females and 16 males; mean age 28.4 ± 3.4 years) with normal swallowing function were included in the study. Lip-closing strength (LCS), electromyogramduring swallowing, oxygen saturation, and pulse rate were measured and compared when the appliance was not worn and when it was worn. In addition, tongue habits were evaluated, and the maximum tongue pressure was measured when the appliance was not worn. The subjects were asked to answer a questionnaire using a numerical rating scale (NRS) regarding discomfort when wearing the appliance. The evaluation items were swallowing difficulty, speaking difficulty, and breathlessness, which were rated on an 11-point scale ranging from 0 to 10. Statistical tests were conducted using IBM SPSS version 28.0.1 (IBM, Armonk, NY, USA) with the Shapiro-Wilk and Levene's test, followed by the Wilcoxon signed rank sum test. The significance level was set at α = 0.05. The measurement error for each measurement item was evaluated using an intraclass correlation coefficient. Results A new custom-made splint-type orthodontic appliance was fabricated for each subject. The fit and retention of the appliance in the mouth were good when fitted, and a comparison of the functional test measurements of 25 subjects with and without the appliance showed that the LCS decreased significantly (p<0.05) before and after wearing the appliance. However, no statistically significant differences were found for the other items. The Mann-Whitney U test regarding the effects of sex, previous orthodontic treatment, or MFT, and oral habits did not statistically significantly influence the effects of wearing the device. In the NRS results, "difficulty swallowing" was observed in half of the subjects, "difficulty breathing" was rarely observed, and "difficulty speaking" was observed in all subjects. Conclusions A novel custom-made splint-type orthodontic appliance was designed and fabricated using digital workflow and 3D printing technology. This appliance was designed to correct oral habits and was made from a new material classified as a class II medical appliance according to the international harmonized classification.

Impact of COVID-19 Pandemic on Treatment with Conventional Fixed Orthodontic Appliances Versus Clear Aligners in Saudi Arabia: A Multi-Center Cross-sectional Study

Background: This study aimed to compare the treatment progress and complications between patients receiving conventional orthodontic treatment and clear aligners during the coronavirus disease-2019 (COVID-19) pandemic. Methods: An electronic survey was distributed randomly among orthodontic patients in Saudi Arabia to understand how the global health crisis caused by COVID-19 affected orthodontic patients. The survey questions were structured into four sections, including demographic data, continuation of orthodontic follow-up appointments during the COVID-19, reasons for missed appointments, and problems of orthodontic patients. Data analysis consisted of simple descriptive statistics presented in frequency tables and percentages. Statistical significance was set at P≤0.05. Results: A total of 512 electronic responses were received. Sixty-two (12.11%) participants missed no orthodontic follow-up appointment during the COVID-19 lockdown. Hence, the study included 450 (87.89%) participants to evaluate the impact of COVID-19 pandemic on sustained orthodontic treatment. The proportion of patients in the fixed appliance group (35.2%, 86 patients) who responded that “they had not even once tried to communicate with their orthodontists” was significantly higher than that in the clear aligner group (9.2%, 19 patients) (P&lt;0.001). The proportion of participants who received fixed appliances (62.3%, 152 patients) and disagreed with the lockdown of orthodontic clinics during the COVID-19 was significantly higher than that in clear aligner users (19.4%, 40 patients) (P&lt;0.001). Conclusion: The results indicated that most issues were reported by patients who had fixed appliances. Thus, tele-orthodontics could provide a solution to continue dental practice during the COVID-19, and clear aligners are preferable to traditional orthodontic treatment methods.