Orthodontic Setup Research Articles

Modified single rigid vacuum-formed indirect bonding trays for lingual bracket application: a case report

Abstract Lingual orthodontic treatment offers an aesthetic alternative but presents unique challenges in bracket positioning. The present article introduces a modified design and fabrication process for rigid vacuum-formed indirect bonding trays for lingual bracket application. The technique is presented through a clinical case report of an adult patient who presented with bimaxillary dentoalveolar protrusion and managed using lingual appliances, premolar extractions, and mini-screws. The modified rigid vacuum-formed trays enabled the accurate simultaneous bonding of multiple teeth as well as individual teeth. The technique offers several advantages over existing indirect bonding methods, including time-saving, simplicity, easy removal of excessive adhesive, and potential cost-effectiveness. The superimposition of post-bonding scans and the digital orthodontic setup showed high agreement between the planned and actual bracket positions. Additionally, the close alignment between the planned orthodontic setup and the achieved treatment outcome highlights the reliability of the technique for predictable lingual orthodontic treatment. Further clinical studies with larger sample sizes are needed to confirm the effectiveness of this technique.

Integration of autonomous maximal smile 3D image with digital 3D dental model and investigation of its accuracy.

This study aims to establish an approach to integrate autonomous maximal smile (AMS) 3D facial image with digital 3D dental models to demonstrate the digital orthodontic set-up in the 3D facial context. Using Geomagic Studio software, the AMS 3D facial image and pre-treatment dental model were manually and globally registered. Subsequently, the pre-treatment dental model was substituted with the predicted post-treatment dental model. The intraoral region of the AMS 3D facial image was removed, achieving a conjunctive display of the AMS 3D facial image and the post-treatment dental set-up. The distances between four groups of corresponding landmark pairs on the AMS 3D facial image and the pre-treatment dental set-up were calculated, and the accuracy of the registration operation was evaluated by paired t-test. The novel approach effectively facilitated the integration of AMS 3D facial images with the pre-treatment and predicted post-treatment 3D dental models. The average distances between the pairs of points were (1.19±0.55) mm and (1.55±0.59) mm for the two registrations, respectively. Notably, no statistically significant difference was observed between the two measurements (P>0.05), indicating a high agreement (intraclass correlation coefficient=0.914). This study established an approach to integrate AMS 3D facial images with digital 3D dental models. Through this approach, the digital orthodontic set-up design can be displayed in the context of a 3D facial image, which may help to improve the quality of outcome set-up in digital orthodontics, such as clear aligner therapy.

Digital orthodontic setup and clear aligners system for treating adult patients with periodontitis: a descriptive case report

This case report describes the treatment of an adult female patient with a history of periodontitis (Stage 3 -Grade B) and presenting significant crowding in both maxillary and mandibular arches. After periodontal stabilization, the patient underwent orthodontic treatment with clear aligners (CAT) for less than one year. CAT provided an effective quantitative and qualitative control of the forces applied to resolve the malocclusion. This case report provides a detailed description of the clinical strategy and features associated with the clear aligners system which were considered ideal tools for treating periodontal patients during the decisional workflow. The orthodontic treatment goals have been successfully achieved considering functional, periodontal, and aesthetics expectations. Several characteristics of clear aligners could support the recurrence of this orthodontic system for treating patients with a history of periodontitis or at risk of periodontal damage.

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.

Is a non-radiological-assisted method valid for establishing crown-root relationships in an orthodontic set-up incorporating the roots? A retrospective study

This study aimed to obtain information on the relationship between crown and root in terms of morphology - dimensions and crown-root angles -to be used for orthodontic set-ups without the use of radiological examinations. All the good quality CBCTs of patients obeying the eligibility criteria, from 2000 to 2015, were analysed. All teeth were analysed except for third molars. Six variables were evaluated: crown (CL) and root length (RL), crown width (CW), root width (RW), crown-root angles in both the frontal (CR-frontal) and sagittal plane (CR-sagittal). All teeth were divided into 3 groups according to number of root (single, two, three-rooted). The measurements were assessed with the Invivo professional software and then, subjected to correlation matrices and linear regression statistical analysis in order to find any significant correlations between crown and root measurements (α≤0.05). Seventy-three out of 247 good quality CBCTs were assessed. Correlation matrices statistical analysis showed linear correlations for some variables investigated, especially for CW/RW pairing in all subgroups (r=0.81, r=0.70 and r=0.58 respectively for single-, two- and three-rooted) and CL/RL in the single-rooted subgroup (r=0.29). Subsequent linear regression analysis allowed to obtain information about roots starting from crown measurements by means of equations [RW=0.76+(0.73×CW) and RL=10.94+(0.25×CL) for single-rooted teeth; RL=1.11+(0.73×CW) and RW=0.99+(0.76×CW), respectively for single- and two-rooted teeth]. No linear correlation was found between crown measurements and C-R angular values. It is possible to obtain root information starting from some crown measurements but these do not fulfil the need of minimal information to guarantee a perfect root position starting from that of crown.

From Reverse Engineering Software to CAD-CAM Systems: How Digital Environment Has Influenced the Clinical Applications in Modern Dentistry and Orthodontics

Background: Reverse engineering (RE) or back engineering is a process that analyzes a physical object to obtain the primary data of the same project. RE technologies have different applications in industrial settings and productive chains; however, with the advent of digital technologies in dentistry and orthodontic fields, they are involved in the new diagnostic and clinical digital workflow. For example, 3D model scanning, 3D facial scanning, models superimposition, digital orthodontic setup, anatomical volumetric assessment, soft tissue analysis, orthodontic digital guided systems, and prototyped orthodontic appliances represent a few examples of the application of RE in orthodontics. Moreover, clinicians can manipulate the data derived from original digital file to enhance diagnosis and communication with other clinicians and dental technicians; however, RE and digital technologies systems are not exempt from shortcomings, including costs and knowledge curve. In this regard, the aim of the present manuscript was to describe the use of reverse engineering technologies in modern digital orthodontics and provide helpful information for those specialists who are at the beginning of the transition from analogic to digital orthodontic workflow.

Management of moderate crowding by two-arch distalization using passive self-ligating lingual brackets, in-house digital indirect bonding, and mini-screw anchorage: A case report

This case report presents the management of an adult patient with moderate crowding in both arches and anterior crossbite with passive self-ligating lingual brackets. The orthodontic setup and bracket positioning was done digitally with an in-house approach. Virtual setup and bracket placement was performed on Autolign software (Diorco, Gyeonggi-do, Korea). The indirect bonding trays were vacuum-formed on printed malocclusion models with resin brackets. Two palatal and two buccal shelf miniscrews were used for two-arch distalization to correct proclined incisors and anterior open bite after leveling and alignment stage. After 12-month treatment, normal overbite,overjet and well-aligned dentition were achieved without premolar extraction. The incisors were uprighted slightly and the protrusive lower lip was retracted with improvement of facial harmony. One-year retention records confirmed that the outcome was stable. In-house digital setup and bracket placement could be a cost-effective approach for indirect lingual bracket bonding. Two-arch distalization with miniscrew anchorage may have the possibility of managing moderate crowding cases without premolar extraction or interproximal stripping.

Effects of Recent/Healed Post-Extraction Protocols on Incisor and Canine Alignment During Fixed Orthodontic Appliance Therapy

The purpose of this study was to determine the effects of recent/healed post-premolar extraction protocol, gender, age, and dental arch on incisor and canine alignment during fixed orthodontic appliance therapy. The study sample consisted of 50 dental arches of patients undergoing fixed orthodontic appliance therapy. The arches were randomized into an equal number of recent and healed extraction groups. The orthodontic setup was instituted within 3-7 days and 5-6 weeks following first premolar teeth extractions in the recent and healed extraction groups, respectively. Orthodontic tooth alignment was carried out using 0.016-inch NiTi wires for 16 weeks. Study casts were made at baseline, 4, 8, 12-, and 16-week follow-up treatment. Little's Irregularity Index was used to assess orthodontic tooth alignment. Mann-Whitney U test was used to compare the alignment rates between groups, and multiple linear regression was used to predict the relationship of groups and sociodemographic factors to alignment rate. The statistical significance level was set at P < .05. The mean daily incisor and canine alignment rates in the recent and healed extraction cases were 0.13 mm and 0.11 mm, respectively (P = .332), 0.12 mm in both males and females (P = .827), and 0.13 mm and 0.12 mm in the maxilla and mandible, respec- tively (P = .534). There was however a significant difference in the mean daily alignment rate between adolescents (0.15 mm) and adults (0.10 mm) (P = .019). The rate of incisor and canine alignment was not affected significantly by recent/healed post-extraction protocol, gen- der, and dental arch. However, the rate was significantly faster in adolescents.

Digital Planning Technique for Surgical Guides for Prosthetic Implants before Orthodontic Treatment

Background: The use of digitalization allows clinicians to plan the position of dental implants in orthodontic patients treated with aligners in the beginning of their orthodontic treatment, instead of waiting until the end of orthodontic treatment, integrating implant restorations with orthodontic biomechanics. Aim: The aim of this case report is to describe a digital workflow for aligner treatment supported by implants, in which implants are placed at the beginning of the treatment and support the orthodontic treatment. Materials and Methods: Digital planning for orthodontic treatment with clear aligners and the preparation of surgical guides for implant surgery before orthodontic treatment are used to solve two multidisciplinary cases. Cone-beam computed tomography (CBCT) and virtual dental impressions are used for the virtual planning. Successively, a surgical guide for implant placement and aligners are used in the treatment plan. Results: The digital orthodontic setup with the integration of the root position allows the clinician to plan the position of dental implants on the final occlusion. The placement of the implant before the start of the orthodontic treatment allows the implants to be used as skeletal anchorage, thereby helping the orthodontic biomechanics. Conclusions: This study describes how to perform a digital workflow with orthodontic virtual planning and the design of surgical guides for implant placement. This technique is potentially promising for complex orthodontic cases.

Operator Performance of the Digital Setup Fabrication for Orthodontic-Orthognathic Treatment: An Explorative Study.

The purpose of this study was to explore the operator performance of the fabrication of digital orthodontic setups integrated into cone beam computed tomography (CBCT) scans. Fifteen patients who underwent a combined orthodontic–orthognathic surgical treatment were included. The pre-treatment digital dental models and CBCT scans were fused, and four operators made virtual setups twice for all patients. Differences between the virtual setups were calculated by recording tooth crown movement from the pre-treatment model to the virtual setup. To examine performance, Pearson’s correlation coefficients, duplicate measurement errors, and inter-operator differences were calculated. For intra-operator performance, correlation values varied among tooth types, with mean correlation values from 0.66 to 0.83 for the maxilla and 0.70 to 0.83 for the mandible. For inter-operator performance, mean correlation values varied from 0.40 to 0.87 for the maxilla and from 0.44 to 0.80 for the mandible. Rotational mean differences exceeded the range of clinical acceptance (>2 degrees) at 18% for the maxilla and 20.8% for the mandible, and translational mean differences exceeded the range of clinical acceptance (0.6 mm) at 9.7% and 26% for the maxilla and mandible, respectively. The intra- and inter-operator performance of digital orthodontic setup construction for virtual three-dimensional orthognathic planning shows significant errors.

Planejamento virtual utilizando software de livre acesso

The orthodontic setup is a tool used for tridimensional simulation for visual treatment planning. Its analysis allows to plan the mechanics to be used during the orthodontic treatment. For this purpose, it is necessary to duplicate the cast model, to cut the teeth and replace them in their respective cast bases. However, this process demands laboratory time and physical space for cast models storage. The traditional setup with cast models has been substituted by the 3D virtual version once it does not demand physical space for storage. Despite the learning curve, the 3D virtual computerized process has a reduced time when compared to the setup with cast models. But the software high cost is still the main point of disadvantage for its use. Thus, the aim of this study is to describe a step-by-step of 3D virtual orthodontic setup process, by using an open-source software.

Archform x Nemocast – comparação entre dois softwares ortodônticos

For the production of the in-office aligners, after the intraoral scanning, we move on to digital planning called orthodontic setup. Orthodontic softwares allow to simulate tooth movements from the beginning to the end of orthodontic planning, visualizing patient’s final occlusion. The aim of this article is to compare two software programs widely used by orthodontists (Nemocast and Archform) by analyzing each stage of the virtual setup.

Interdisciplinary digital simulation of orthodontic setup modeling and dental implant treatment

Interdisciplinary digital simulation of orthodontic setup modeling and dental implant treatment

The digital POIP concept: Preorthodontic implant placement.

The aim of this report is to present an interdisciplinary treatment involving periodontics, orthodontics, dental implant placement, and prosthodontics with a fully digital dentistry approach. The patient presented with an edentulous ridge on the area of the lower left lateral incisor as well as gingival recession on the adjacent teeth. After performing a digital orthodontic setup and indirect bonding bracket placement, a dental implant placement was carried out before orthodontic treatment in combination with guided bone regeneration (GBR), connective tissue graft (CTG) and periodontal accelerated osteogenic orthodontics (PAOO). In a 6-month period, orthodontic treatment was fully completed and the dental implant was restored at 8 months. Following one-and-a-half years, significant gingival recession reduction was accomplished and soft tissue augmentation around the dental implant appeared stable with a good functional and esthetic result. The use of the digital POIP concept with a proper diagnosis and careful planning is crucial for reducing treatment time and enhancing precision.

Fluxo digital na montagem simplificada de bráquetes linguais

Introduction: In lingual orthodontics technique the brackets are positioned on the teeth lingual surface, and for this reason it is known as a difficult technique due to the complexity of brackets positioning. During the evolution of this technique many forms of lingual appliance assembly were developed. The most used technique recommended to make an orthodontic set-up model and later to transfer the appliance to the patient’s mouth using trays or jigs in order to perform the bonding itself. Subsequently, another and more simplified lingual appliance form emerged, in which the bonding would be performed directly, that is, on the lingual surface of the enamel, but it required greater skill from the professional. Also, it could be done on the cast model of malocclusion, without making the set-up model. Objectives: To facilitate the technique using technological resources with as a scanner and a software replacing some analogical steps in the assembly of the lingual device. Material and Method: Intraoral digitizing is performed by a scanner where the models are obtained in STL files, that inserted in the software together with the STL files of the lingual brackets will be positioned on the virtual surface of the digital models. A virtual transfer tray will be made of resin in a 3D printer where the metal brackets will be inserted for the actual bonding. Conclusion: The assembly of the simplified lingual device can be performed with excellence by digital means in almost all steps.

Virtual setup in orthodontics: planning and evaluation

ObjectivesThe purpose of this study was to evaluate the clinical accuracy of virtual orthodontic setups by using a new CBCT-based approach.Materials and methodsTen patients who underwent pre-surgical orthodontics were included in this study. Pre-treatment and pre-surgical cone-beam CT (CBCT) scans and digital dental models were available. The pre-treatment digital dental model was used to create an orthodontic virtual setup. The digital dental models were fused with the corresponding CBCT scans, and the two CBCT scans were aligned using voxel-based matching. Moving each individual tooth from the virtual setup to the final outcome allows the calculation of the accuracy of the virtual setup by using an iterative closest point algorithm. Differences between virtual setup and final outcome were recorded as well as the ICC between two observers.ResultsThe inter-observer variability showed a high level of agreement between the observers. The largest mean difference between observers was found in the cranial/caudal direction (0.36 ± 0.30 mm) and the roll rotation (1.54 ± 0.98°). Differences between the virtual setup and final outcome were small in the translational direction (0.45 ± 0.48 mm). Rotational mean differences were larger with the pitch of the incisors (0.00 ± 7.97°) and molars (0.01 ± 10.26°) as largest difference. Excessive extrusion of all upper teeth and more anterior movement than planned were seen for both upper and lower arch. Lower molars showed less extrusion.Clinical relevanceThe data of this study can be used to obtain more insight in the accuracy and achievability of orthodontic virtual setup. Tooth movement can now be studied in more details which can lead to new insights.

Assessment of Changes in Nickel and Chromium Levels in the Gingival Crevicular Fluid during Fixed Orthodontic Treatment.

Various components of appliances used in fixed orthodontic treatment are fabricated from materials that are highly resistant in nature and have high strength and biocompatibility. Corrosion of materials occurs inside the oral cavity due to numerous environmental or oral factors that act on them. These factors include temperature, pH variation, salivary conditions, mechanical loads, microbiological and enzymatic activity, and various food components. Gingival crevicular fluid (GCF) is the material obtained from the gingival sulcus and might act as a potential source for various biomarkers in the orthodontic setup because inflammatory-induced response is directly related to orthodontic forces in GCF. In the light of above-mentioned data, we planned this study to assess and evaluate the changes occurring in nickel and chromium levels in the GCF during fixed orthodontic treatment. This study included assessment of 30 patients who underwent fixed orthodontic treatment. Three samples were taken from the GCF of the patients giving a total of 90 samples. The samples were collected at the following time intervals: At baseline (pretreatment time), 1 month after the start of orthodontic treatment, and at 6 months after the commencement of orthodontic treatment. Cellulose strips were used for isolation of the tooth region. For GCF collection, a standardized cellulose acetate absorbent strip was used. Placement of the strips was done in the sulcus for 60 seconds for the collection of the samples. Refrigeration of the specimen bottles was done for a minimum of 7 days and was then sent to a laboratory where specimens were transferred for atomic absorption spectrophotometry. All the results were analyzed by Statistical Package for the Social Sciences software. At 1 month, the mean value of nickel and chromium in GCF was found to be 4.5 and 4.9 ug/gm of GCF respectively. While comparing the mean nickel levels between 1 and 6 months and between baseline and 6 months, significant results were obtained. Significant results were also obtained while comparing the mean values of chromium in GCF between baseline and 6 months and between 1 and 6 months. Gingival health index of the patients was found to be associated with increased inflammation with the progression of time of orthodontic treatment. Levels of nickel and chromium might show considerable elevation in the GCF with time along with an increase in the severity of inflammation in the gingival health in patients undergoing fixed orthodontic treatment. Regular oral prophylaxis of the patients undergoing orthodontic treatment should be done to avoid tox-icities caused by the release of nickel and chromium and for maintenance of good oral hygiene and oral health.

Orthodontic office design: Principles and practice

In this competitive world where each and every patient walking into your practice is precious, the first thing that the patient experiences is the orthodontic office design or setup. And this is something that has not been a part of our orthodontic training for all this while and given the least preference. It’s time we look from the patient’s perspective and make the entire orthodontic experience of the patient as memorable as possible, right from the first orthodontic consultation till the treatment ends. In this article, we have discussed key points to be considered while designing your orthodontic setup validated with a survey by the top architects in the world who are into designing orthodontic offices. In this competitive world where each and every patient walking into your practice is precious, the first thing that the patient experiences is the orthodontic office design or setup. And this is something that has not been a part of our orthodontic training for all this while and given the least preference. It’s time we look from the patient’s perspective and make the entire orthodontic experience of the patient as memorable as possible, right from the first orthodontic consultation till the treatment ends. In this article, we have discussed key points to be considered while designing your orthodontic setup validated with a survey by the top architects in the world who are into designing orthodontic offices. www. Dezeen.com/tag/dentists

Reliability of digital orthodontic setups.

To evaluate the reliability of digital orthodontic setup technology by comparing it with manual setups and models cast at the end of orthodontic treatment. Initial models, manual setups, and final models of 20 patients were used. The initial and final models, as well as the manual setups, were scanned using a 3Shape R-700 scanner, while the digital setups were fabricated based on the initial models using 3Shape OrthoAnalyzer software. Evaluation of the models based on the manual setup, digital setup, and final models of each patient was performed using the following linear measurements: intercanine widths, intermolar widths, and length of the upper and lower dental arches. The results disclosed that none of the measures assessed through the manual setup, digital setup, and final models showed statistically significant differences (P > .05). Based on these findings, it can be inferred that digital setups are as effective and accurate as manual setups and constitute a tool for diagnosing and treatment planning that can be reliably reproduced in orthodontic treatments.

Surgery First in Orthognathic Surgery: What Have We Learned? A Comprehensive Workflow Based on 45 Consecutive Cases

In some patients, "surgery first" (SF) may represent a reasonable approach for the expedited correction of a maxillofacial deformity. Based on the prospective evaluation of a large sample, this article provides a specific orthodontic and surgical protocol, discusses the benefits and limitations of this approach, and updates its indications. Forty-five patients were managed with an SF approach. Selected cases presented symmetrical skeletal malocclusions with no need for extractions or surgically assisted rapid palatal expansion. Periodontal or temporomandibular joint problems and management by an orthodontist without experience in orthognathic surgery were considered exclusion criteria. Virtual treatment planning included a 3-dimensional orthodontic setup. Standard orthognathic osteotomies were followed by buccal interdental corticotomies to amplify the regional acceleratory phenomenon. Miniscrews were placed for postoperative skeletal stabilization. Orthodontic treatment began 2 weeks after surgery. Archwires were changed every 2 to 3 weeks. At 12-month follow-up, patient satisfaction and orthodontist satisfaction were evaluated on a visual analog scale of 1 to 10. Descriptive statistics were computed for all study variables. The studied sample consisted of 27 women and 18 men (mean age, 23.5 yr). The main motivation for treatment was the wish to improve facial esthetics. Bimaxillary surgery was the most common procedure. Mean duration of orthodontic treatment was 37.8 weeks, with an average of 22 orthodontic appointments. Mean patient and orthodontist satisfaction scores were 9.4 (range, 8 to 10) and 9.7 (range, 8 to 10), respectively. The SF approach significantly shortens total treatment time and is very favorably valued by patients and orthodontists. Nevertheless, careful patient selection, precise treatment planning, and fluent bidirectional feedback between the surgeon and the orthodontist are mandatory.