Orthodontic Appliances Research Articles

Autism spectrum disorder and compliance with a removable orthodontic functional appliance: A case report

Autism spectrum disorder and compliance with a removable orthodontic functional appliance: A case report

Microbial Changes in the Periodontal Environment Due to Orthodontic Appliances: A Review.

Orthodontic appliances significantly influence the microbiological dynamics within the oral cavity, transforming symbiotic relationships into dysbiotic states that can lead to periodontal diseases. This review synthesizes current findings on how orthodontic treatments, particularly fixed and removable appliances, foster niches for bacterial accumulation and complicate oral hygiene maintenance. Advanced culture-independent methods were employed to identify shifts toward anaerobic and pathogenic bacteria, with fixed appliances showing a more pronounced impact compared to clear aligners. The study underscores the importance of meticulous oral hygiene practices and routine dental monitoring to manage these microbial shifts effectively. By highlighting the relationship between appliance type, surface characteristics, treatment duration, and microbial changes, this review aims to enhance dental professionals' understanding of periodontal risks associated with orthodontic appliances and strategies to mitigate these risks. The findings are intended to guide clinicians in optimizing orthodontic care to prevent plaque-associated diseases, ensuring better periodontal health outcomes for patients undergoing orthodontic treatment.

The Role of Tele-Orthodontics in Enhancing Patient Compliance and Treatment Monitoring

ABSTRACT Background: Tele-orthodontics, the application of telecommunications technology in orthodontic care, has emerged as a promising tool to enhance patient compliance and facilitate treatment monitoring. In traditional orthodontic practice, patient compliance and monitoring are pivotal but often challenging aspects. Tele-orthodontics offers a solution by providing remote communication and monitoring capabilities, potentially improving patient engagement and treatment outcomes. Materials and Methods: This study conducted a retrospective analysis of orthodontic patients who utilized tele-orthodontics as part of their treatment plan. A total of 100 patients were included in the study, with ages ranging from 12 to 40 years old. Patients were provided with mobile applications or web-based platforms enabling them to communicate with their orthodontists, submit progress images, and receive feedback remotely. Treatment compliance was assessed based on adherence to scheduled appointments, wearing of orthodontic appliances, and completion of prescribed exercises. Results: The analysis revealed a significant improvement in patient compliance with the implementation of tele-orthodontics. Adherence to scheduled appointments increased by 30%, with patients attending 95% of their appointments compared to 65% before the introduction of tele-orthodontics. Moreover, compliance with wearing orthodontic appliances showed a remarkable rise, with patients consistently wearing their appliances for an average of 22 h per day, up from 14 h per day previously. Additionally, the completion rate of prescribed exercises saw a notable enhancement, with 80% of patients completing their exercises as instructed, compared to 50% previously. Conclusion: Tele-orthodontics plays a significant role in enhancing patient compliance and treatment monitoring in orthodontic care. The remote communication and monitoring capabilities provided by tele-orthodontic platforms empower patients to actively participate in their treatment process, leading to improved adherence to appointments, better compliance with wearing orthodontic appliances, and increased completion of prescribed exercises. These findings underscore the importance of integrating tele-orthodontics into orthodontic practice to optimize patient outcomes and satisfaction.

A digital CAD/CAM configurator for the production of orthodontic appliances – Going new ways

Functional therapy in growing patients is a highly relevant area in orthodontics. With the increasing integration of computer-aided design and manufacturing technology (CAD/CAM) in orthodontics, we are witnessing significant advancements in the design of orthodontic appliances. Modern 3D printing technologies allow for the creation of complex, customized equipment in a cost-effective and time-efficient manner, using robust and durable resins. Additionally, the creative input of dental CAD design programs has led to the development of new designs.The aim of this report is to present a novel digital orthodontic prescription that aligns with the concept of a “full digital workflow”. This prescription utilizes a digital virtual configurator, enabling effective communication between the clinician, the technician and the patient.Using this prescription system, clinicians can easily configurate an orthodontic appliance before sending it to a dental technician for individualisation. 3D printing of the final design can then be performed directly within the dental office or by the technician. This approach allows the clinician to explore different orthodontic equipment options and modules, without the requirement for a demanding and sophisticated design process and without any knowledge of CAD. The availability of the present configurator might represent a fundamental advancement in the field of the CAD/CAM production of removable appliance linked to economic and ecological benefits.

Assessment of Changes in Behavior and Quality of Life after Monobloc Treatment in Children with Obstructive Sleep Apnea or Primary Snoring.

The aim of this study was to examine the quality of life and behavioral disorders in children with obstructive sleep apnea (OSA) or primary snoring, as well as how these problems changed after monobloc treatment. Fourteen children with primary snoring and 16 children with OSA who had skeletal class II malocclusion due to mandibular retrognathia were treated with monobloc appliances. To investigate the relationship between behavioral disorders and quality of life, parents were asked to complete four questionnaires: attention deficit and hyperactivity disorder (ADHD) scale, strength and difficulties questionnaire (SDQ), pediatric sleep questionnaire (PSQ), and Pittsburgh sleep quality scale (PSQS). Mann-Whitney U and Wilcoxon signed-rank tests were used to evaluate the data. According to the results of the PSQ and PSQS, an increase in sleep quality was observed after monobloc treatment. The decrease in the total ADHD score at the end of the treatment was found to be statistically significant in both the OSA (p<0.01) and snoring (p<0.01) groups. According to the SDQ scores, the increase in the social behavior score and the decrease in the peer bullying score in the snoring group were statistically significant (p<0.05). The use of a monobloc appliance in pediatric patients exhibiting primary snoring and OSA resulted in a notable reduction in sleep-breathing disorder symptoms and a notable enhancement in their overall quality of life. Based on the analyses of the questionnaires, it was concluded that the increase in sleep quality improved the pediatric patients' quality of life after orthodontic treatment with orthodontic monobloc appliances.

Patient Satisfaction Following Orthodontic Treatment: A Systematic Review.

Patient-reported outcome measures (PROMs) have become increasingly important in orthodontic treatment as they reflect patients' perceptions of treatment outcomes. Understanding patient satisfaction with orthodontic treatment is crucial for improving healthcare delivery and patient-centered care. This systematic review aimed to critically appraise the evidence regarding patient satisfaction after orthodontic treatment, exploring the effects of different treatment types, patient demographics, and other factors on satisfaction levels. Eight electronic bibliographic databases were searched without publication time or language restrictions, including PubMed®, Scopus®, the Cochrane Central Register of Controlled Trials, Web of Science™, Embase®, Google™ Scholar, Trip, and OpenGrey. A manual search was conducted on the references in the included papers. Eligibility criteria were established based on the Population, Intervention, Comparison, Outcomes, and Study (PICOS) framework. Studies were included if they reported patient satisfaction levels following orthodontic treatment using standardized questionnaires. Two reviewers independently collected and analyzed the data. The risk of bias was assessed usingCochrane's risk of bias tool (RoB2) for randomized clinical trials, and the methodologic quality for cohort and cross-sectional studies was assessed using the modified version of the Newcastle-Ottawa scale. Fourteen studies employed various questionnaires and timings to gauge post-orthodontic treatment satisfaction. Patient satisfaction levels were generally high, with most studies reporting satisfaction rates above 91%. Fixed orthodontic appliances were associated with higher satisfaction levels compared to removable appliances. While age and gender did not significantly influence satisfaction, the quality of care and doctor-patient relationships were crucial factors in patient satisfaction. This systematic review proves that patient satisfaction with orthodontic treatment is generally high, with fixed appliances and positive doctor-patient relationships contributing to higher satisfaction levels. However, the quality of the evidence was moderate to low, highlighting the need for further high-quality clinical studies in this area.

Effect of oil pulling on the Streptococcus mutans concentation in plaque around orthodontic brackets -A prospective clinical study.

Fixed orthodontic appliances create areas of plaque stagnation leading to an increase in the volume, structure, and composition of plaque. This increases the chances of decalcification and white spot lesions. Oil pulling, an ancient practice involving swishing oil in the mouth, has demonstrated a significant reduction in plaque scores after 45 days, and a reduction in salivary Streptococcus mutans concentration in few studies done in nonorthodontic subjects. The aim was to compare the concentration of S. mutans in plaque around orthodontic brackets in patients using oil pulling with sesame oil and those on routine oral hygiene. Twenty subjects requiring fixed orthodontic treatment were divided into two equal groups: Group A-Oil pulling and Group B-Control. All subjects were instructed to follow common oral hygiene methods and in addition, Group A was instructed to perform oil pulling for 30 days starting 1 month after placement of fixed appliances. Plaque specimens were collected from labial surfaces of maxillary lateral incisors and quantification of S. mutans was done using real-time polymerase chain reaction. Mean and standard deviations for descriptive statistics, paired, and unpaired sample t-tests were analyzed. Comparison of S. mutans concentration between T1 and T2 demonstrated a significant difference in both control and study groups. The experimental group showed significantly lesser S. mutans concentration compared to the control group. Oil-pulling therapy with sesame oil resulted in a statistically significant reduction in the concentration of S. mutans in the plaque around orthodontic brackets.

Application of the twin-block appliance combined with braces in the treatment of a patient with distal occlusion

Relevance. Distal occlusion is one of the most frequently encountered anomalies in orthodontic practice among patients with both temporary and permanent dentitions. When selecting a treatment method for this anomaly, it is crucial to consider several significant factors, including the craniofacial stage of skeletal maturity and the type of jaw growth. Special attention should be given to the method of treating patients with incomplete skeletal growth using a twin-block appliance, followed by continued orthodontic treatment with fixed orthodontic appliances (braces).Clinical case description. This article presents a clinical case of treating a patient with distal occlusion in the peripubertal stage of skeletal growth, which is the most optimal for the initial stage of orthodontic treatment.Conclusion. Sequential treatment of distal occlusion during the pubertal growth spurt using a twin-block appliance and braces allows achieving the most physiological jaw relationship, ensuring proper functioning of the dentoalveolar system and harmonious development of the body as a whole.

White Spot Lesions in Fixed Orthodontics: A Literature Review on Etiology, Prevention, and Treatment.

White spot lesions (WSLs) are a common complication after treatment using fixed orthodontic appliances. Decalcification of enamel surrounding fixed orthodontic appliances, known as WSLs, poses a significant aesthetic difficulty during and after treatment, as the purpose of fixed orthodontic therapy is to improve facial and dental appearance. Modern dentistry utilizes remineralization therapiesto non-invasively treat WSLsto prevent the progression of disease and enhance the strength, appearance, and functionality of the affected tooth. This review aims to identify and assess the etiology, formation, and risk factors, as well as current treatment approaches used in achieving WSLs remineralization, induced by fixed orthodontic appliances.An electronic search on the PubMed and ScienceDirect databases was performed using a selected keyword.A total of 172 studies (from 2013 to 2023) were retrieved. Their references were also checked to find other relevant studies. Duplicate copies were excluded. After the abstract and full-text screening, only 39 studies were included. Even though numerous studies address the different treatment modalities for managing post-orthodontic WSLs, such as antiseptics; fluoridessuch as dentifrices, mouthwash, and varnish, and remineralizing agents such as casein phosphopeptides amorphous calcium phosphate, biomimetic self-assembling peptides, lasers, bleaching, microabrasion, and resin infiltration. There is a lack of evidence-based studies that examine the long-term effects of WSLtreatment. Further well-performed controlled clinical trials with long-term follow-up are needed to establish best clinical practice.

Development of a Novel Removable Acrylic Orthodontic Appliance Material with Protein - Repellent and Antifungal Properties

Development of a Novel Removable Acrylic Orthodontic Appliance Material with Protein - Repellent and Antifungal Properties

Inter-examiner Reliability of Two Methods for Scoring Post-Orthodontic White Spot Lesions from Digital Photographs.

To compare the reliability of two scoring systems for detecting white spot lesions (WSLs) from clinical photographs captured during debonding of fixed orthodontic appliances. Digital images of 58 healthy adolescents (34 females and 24 males) were examined, depicting 384 buccal surfaces of maxillary incisors, canines, and first premolars. Three trained examiners (E1, E2 and E3) independently evaluated the fully anonymized photos in a randomized order using the Gorelick index (GI) and the modified International Caries Detection and Assessment System (ICDAS II). A 1-2-week interval separated the scorings. Spearman's rank correlation coefficient, Fisher's z-test, and the interclass correlation coefficient (ICC) were applied to compare the scoring methods and express examiner agreement. The two scoring systems showed a moderate to strong positive relationship, but inter-examiner variations were significant (p<0.05). We found moderate to good reliability (ICC 0.60 to 0.84) with the ICDAS II system and good to excellent values with the GI (ICC 0.72 to 0.94), depending on the examiner. The agreement concerning the sound surfaces and the most severe WSLs was perfect, whereas the scoring of the milder lesion stages appeared more uncertain. A moderate to strong positive relationship was demonstrated between the two methods when scoring the presence and severity of WSLs from digital images. Significant inter-examiner variations affected reliability.

Evolution of orthodontic aligners: A narrative review

Clear aligners seem to be a new modality for patients undergoing orthodontic treatment; the initial concept of this treatment evolved in the 20th century. Remensnyder’s “Flex-O-Tite” appliance led to the introduction of the aligner, from this Kesling tooth positioner appliance made up of rubber-based 1945 proposed the concept of using it for minor tooth movements in a sequential series. The purpose of this article is to provide information about chronologically ordered evolution of aligners. Various types of generations and attachments used in different aligner systems. An online search was done using databases from PubMed and Google Scholar to find the articles. Database search was done with the following string: ((aligners [Title/Abstract]) AND (comparison [Title/Abstract])) AND (((fixed appliance [Title/Abstract]) OR (braces [Title/Abstract])) OR (fixed orthodontic appliance [Title/Abstract])). 3 articles are included in the narrative review to evaluate the better outcomes of the treatment effectiveness between fixed orthodontic treatment and aligners with short summary of chronological ordered evolution, generations and attachments of aligners. The overall effectiveness of orthodontic treatment depends upon the knowledge of clinician therefore knowledge about recent advances is important for proper treatment of the patient.

Effectiveness of TENS and Acetaminophen for Pain Control During Orthodontic Treatment: A Comparative Study.

Orthodontic treatment often induces pain, especially post appliance placement. This study compares transcutaneous electrical nerve stimulation (TENS) and acetaminophen for orthodontic pain management. A randomized trial included 120 fixed orthodontic patients divided into three groups (n = 40): Group A received TENS, group B received acetaminophen, and group C was the control. Data were expressed as mean ± SD. Repeated ANOVA analysis compared mean values, followed by post-hoc Tukey analysis. Pain levels were assessed using a visual analog scale before any intervention and at 30 minutes, 6 hours, and 24 hours post activation. TENS and acetaminophen significantly reduced pain compared to the control. Group A (TENS) showed significant pain reduction post activation. Group B (acetaminophen) exhibited comparable pain relief, with no significant difference between groups. Both TENS and acetaminophen effectively manage orthodontic appliance activation pain.

Effect of Fixed Orthodontic Appliances and Filgrastim on Body Weight A Murine Model

Aim: The aim was to assess how orthodontic treatment and Filgrastim injections affect body weight in Wistar albino rats during and after treatment. Materials and Methods: Orthodontic tooth movement (OTM) was induced using the appliances, followed by a 14-day healing period after their removal. This study adopted a "split-mouth design," with OTM occurring exclusively on the left side of the mouths of 55 male Wistar albino rats, divided into five groups: A (no Filgrastim during active OTM, n = 12), B (Filgrastim during active OTM, n = 11), C (no Filgrastim during active OTM and healing, n = 11), D (Filgrastim during active OTM and healing, n = 11), and E (no Filgrastim during active OTM and healing, n = 10). Filgrastim (10 µg/kg) was administered intraperitoneally three times weekly throughout the trial. A force of 100 grams was applied mesially to the first molar using a fixed orthodontic device. Results: Rats exhibited significant body weight reduction (p &lt; 0.05) after the first week, followed by gradual, slight weight recovery post-appliance removal. However, their final weight did not return to baseline. Conclusion: Orthodontic intervention significantly reduced rat body weight, with Filgrastim showing minimal to no effect.

Salivary pH Changes and Biofilm Formation During Active Orthodontic Treatment with Clear Aligners and Fixed Appliances

Objective: To examine salivary pH changes and the plaque formation in two different orthodontic treatments clinically. Methods: The study sample included 40 patients, who were divided into two groups according to the type of orthodontic appliance: Group CA, (n=15) clear aligners; Group FT, (n=25) fixed appliances. Group FT received both metal (FT/SS) and elastic ligatures (FT/EM) for 2 weeks respectively to test the effect of ligature type also. Salivary pH values, plaque index, and plaque percentage were measured at T0 (after scaling and polishing) and T1 (after 2 weeks). pH was measured with a digital caliper (HI 2211 pH/ORP Meter) and plaque was identified by a discoloring agent (Tri Plaque ID Gel). The Paired t-test, Independent t-test, Anova test and Pearson Correlation tests were used in the statistical analysis. Results: There was significant decrease in salivary pH values after two weeks of metal ligature in FT/SS. Plaque index and plaque percentage parameters showed significant incremental changes between groups with the least increase in CA, followed by FT/SS and FT/EM respectively. Conclusion: Different types of orthodontic treatment and ligatures significantly effected salivary pH and the amount of plaque formation during orthodontic treatment. Aligners had the least effect on salivary pH and plaque formation while fixed treatment with elastic ligature affected the most. Therefore, aligner treatment may be more beneficial for patients with compromised oral hygiene.

Oral and Extra-Oral Manifestations of Hypersensitivity Reactions in Orthodontics: A Comprehensive Review.

Although rare, oral manifestations of hypersensitivity reactions in orthodontic patients pose a significant clinical challenge due to their heterogeneous presentations, and can cause discomfort and pain, possibly impacting patients' quality of life and orthodontic treatment duration and outcomes. This comprehensive review aimed to elucidate the oral, perioral, and systemic manifestations of hypersensitivity reactions in orthodontic subjects, focusing on patients with fixed appliances, removable appliances, and clear aligners, and detailing their epidemiology, macroscopic and microscopic features, allergy testing, clinical implications, and specific management strategies. Oral and extra-oral manifestations of (immediate and delayed) hypersensitivity reactions occur rarely and are due to the release of metal and non-metal ions from orthodontic appliances. They typically present as erythema, erosive-ulcerative lesions, and gingival hyperplasia, with histopathological findings showing inflammatory infiltrates. Nickel is a significant allergen, and diagnostic tests like patch tests are essential for managing these reactions. Likely due to prolonged contact with oral tissues, fixed orthodontic appliances pose a higher risk compared to removable appliances and clear aligners. Early identification and removal of allergenic materials, combined with effective treatments, can resolve symptoms and prevent recurrence. Keeping dental and medical records updated and knowing family and personal medical histories helps clinicians choose appropriate materials and counsel patients about potential risks. Proper patient education, regular monitoring, and using hypoallergenic materials are key strategies for managing these reactions.

ORTHODONTIC TREATMENT OF VERTICAL DEFORMATIONS OF THE POSTERIOR PART OF THE DENTAL ARCH, AS A PREPARATORY STAGE FOR PROSTHETICS

The numerical distribution of anomalies and deformations of dentition in the adult population of Ukraine actualizes the development of new methods of orthodontic treatment of maxillofacial deformations. The aim. To analyze dental occlusion in young patients who underwent orthodontic treatment before prosthetics to assess the distribution of vertical deformations of the dental rows in the buccal areas and investigate methods of their elimination. Materials and methods. A retrospective investigation of the medical histories of 427 young people (228 women (53.4%) and 199 men (46.6%)) was carried out; consent for treatment was signed by 254 people (179 women and 75 men), which was 59.5% of the number of examined people. The sample identified the following pathological conditions that required orthodontic correction: abnormalities in the number of teeth in 3 persons (1.2%); retention in 1 person (0.4%); an abnormal position of teeth on the upper jaw in 158 people (62.5%) and 198 people (78%) on the lower jaw; malformation of the shape of dental rows in 208 people (82%) on the upper jaw and 220 people (86.6%) on the lower jaw, sagittal malocclusion in 32 people (12.3%), transversal malocclusion in 44 people (17, 2%), vertical malocclusion in 75 people (29.5%). 61 individuals (24%) were identified with partially edentulous dental rows, which were localized, mainly, in the lateral areas of the upper and lower jaws. In the selected sample, men predominated (40 people 65.6%), and a significantly smaller number of women (21 people 34.4%). Spaces with missing two and three teeth were present in some patients on the lower and upper jaws (12.5% of men and 9.5% of women). Distally located edentulous spaces were lesser extent compared to included defects (41% compared to 59%). Dentoalveolar deformities prevailed (95.1%): 38 men 62.3% and 20 women 32.8%. The carried-out treatment with the appliance of the own design proved the effectiveness in the treatment of the II-III levels of vertical dentoalveolar distally located occlusal malformation, where it is difficult to provide anchorage for intrusion. Further research is important for a detailed study of the use of fixed orthodontic appliances depending on the general somatic condition of patients and the condition of the jaw bone.

Skeletal Class I with Open-Bite Malocclusion Treated with Anterior Vertical Elastics (AVE)

Enhancing aesthetics, occlusion and functions is a primary motivation for individuals with open-bite malocclusion seeking orthodontic treatment. Open-bite malocclusion, characterized by a lack of vertical overlap of the anterior teeth, can be effectively treated using anterior vertical elastics. It’s a common, non-surgical orthodontic approach to correct open-bite issues. In this case report, we present the treatment of a male patient with anterior open-bite malocclusion. Initially, the patient underwent a lingual frenectomy followed by an active and passive phase of swallowing rehabilitation by wearing a nocturnal lingual envelope (NLE). Subsequently, a fixed orthodontic appliance was bonded to achieve well-aligned arches, normalize the overjet and overbite with the use of anterior vertical elastics (AVE) and enhance both aesthetics and functions.

Use of Electropolishing in Orthodontic Appliances: An Option to Reduce the Risk of Metal Hypersensitivity.

Electropolishing is a common treatment in the industry; however, how it behaves in the mouth and what benefits it can bring over metal dental attachments have not yet been established. Thus, the aim of this study was to determine the levels of corrosion, the released metal ions, and the changes in structural composition in metallic orthodontic appliances following electropolishing treatment. This study included 56 orthodontic brackets and 28 archwires. The samples were subjected to a pH cycle to simulate an oral environment. Using UV-Vis spectrophotometry, the release of metallic particles was evaluated, and using scanning electron microscopy, the structural and composition changes were evaluated. Groups were compared using Student's t-tests with a value of p ≤ 0.05. The cyclical pH solutions showed variations between groups and days (1, 3, 5, 7 and 15), reaching the highest acidification in the self-ligating brackets; the absorbance between solutions did not differ significantly. As seen from the SEM results, the experimental group showed minor irregularities compared with the control groups. The experimental brackets decreased in iron and increased in chromium after electropolishing, while for the NiTi archwires, they decreased in nickel. Therefore, electropolishing treatments in metallic orthodontic attachments improve their surface structure and corrosion resistance could reduce the risk of metal hypersensitivity, mainly from nickel.

Effect of probiotics on pain and ulceration in patients undergoing fixed orthodontic treatment.

Ulcers caused by mucosal irritation of fixed orthodontic appliances remain an unsolved problem, and more research is needed to improve the pain caused by orthodontic appliances to provide more comfortable treatment for these patients. This study investigated the effect of probiotic Lactogum on pain and ulceration in patients undergoing fixed orthodontic treatment. In this study, 64 patients over 12 years of age and candidates for fixed orthotic treatment were divided into case and control groups (n=32). The control group received orthodontic waxes, and the case group received the same orthodontic waxes and "Lactogum" probiotic lozenges from the beginning of the treatment. The number of ulcers, the amount of pain, and the location of the ulcer were recorded and compared between the two groups. An independent-sample t-test was used to compare the pain level and number of ulcers between the two groups. A significance level of 0.05 was considered for all tests. SPSS 17 was used for data analysis. The mean number of ulcers in the case group was significantly lower than the control group (P<0.001). The mean pain in the case group was significantly lower than in the control group (P<0.001). The most frequent location of ulcers was the buccal mucosa, followed by the labial mucosa. Lactogum probiotic lozenges can reduce traumatic oral ulcers and pain levels in patients undergoing fixed orthodontic treatment. However, larger clinical trials are encouraged to confirm these findings.