Orthodontic Techniques Research Articles

Orthotropics Technique in Orthodontics

Orthotropics Technique in Orthodontics

Surface Characteristics of Esthetic Nickel⁻Titanium and Beta-Titanium Orthodontic Archwires Produced by Plasma Electrolytic Oxidation (PEO)-Primary Results.

Background/Aim: There is continuing interest in engineering esthetic labial archwires. The aim of this study was to coat nickel–titanium (NiTi) and beta-titanium (β-Ti), also known as titanium molybdenum (TMA), archwires by plasma electrolytic oxidation (PEO) and to analyze the characteristics of the PEO-surfaces. Materials and Methods: PEO-coatings were generated on 0.014-inch NiTi and 0.19 × 0.25-inch β-Ti archwires. The surfaces were analyzed by scanning electron microscopy and stereomicroscopy. Cytocompatibility testing was performed with ceramized and untreated samples according to EN ISO 10993-5 in XTT-, BrdU- and LDH-assays. The direct cell impact was analyzed using LIVE-/DEAD-staining. In addition, the archwires were inserted in an orthodontic model and photographs were taken before and after insertion. Results: The PEO coatings were 15 to 20 µm thick with a whitish appearance. The cytocompatibility analysis revealed good cytocompatibility results for both ceramized NiTi and β-Ti archwires. In the direct cell tests, the ceramized samples showed improved compatibility as compared to those of uncoated samples. However, bending of the archwires resulted in loss of the PEO-surfaces. Nevertheless, it was possible to insert the β-Ti PEO-coated archwire in an orthodontic model without loss of the PEO-ceramic. Conclusion: PEO is a promising technique for the generation of esthetic orthodontic archwires. Since the PEO-coating does not resist bending, its clinical use seems to be limited so far to orthodontic techniques using straight or pre-bent archwires.

Enamel protection after stripping procedures: An in vivo study

Interproximal enamel reduction (IPR) is a clinical procedure that has been in use since the advent of non-extraction orthodontic techniques. However, such a procedure affects the surface condition of the enamel and may predispose patients to cavities and hypersensitivity. The use of a remineralizing agent is recommended to prevent these side effects. The objective of our study was to evaluate the evolution of stripped proximal dental surfaces after exposure to the oral environment for 4 months with and without fluoride protection. Our sample consisted of 14 premolars (PM) from 6 patients of the Dentofacial Orthopaedics Department of the Consultation and Dental Treatment Centre of Rabat (CDTC) who required orthodontic treatment with PM extraction and had given their informed consent. The teeth were divided into 5 groups: group 1: intact enamel; group 2: intact enamel+fluoride varnish+4-month oral exposure; group 3: IPR (manual and mechanized)+extraction; group 4: IPR (manual and mechanized) without varnish+4-month oral exposure; group 5: IPR (manual and mechanized)+fluoride varnish+4-month oral exposure. Proximal surfaces were subjected to qualitative analysis by scanning electron microscopy and quantitative analysis by Dispersive Energy Spectroscopy (DES) to quantify the percentage of mineral elements. Exposure of stripped dental surfaces to the oral environment for 4 months with or without fluoride protection showed the persistence of surface irregularities caused by stripping. We noted an improvement in the percentage of mineral elements for both groups with and without fluoride protection. However, the percentages of calcium (Ca) and phosphorus (P) were close to that of intact enamel in the fluoride varnish group. Protecting stripped surfaces with fluoride varnish could help preserve the integrity of the enamel surface by restoring some of the mineral elements lost during stripping.

Evaluation of Changes on Maxillo-Facial Skeleton of Class II Patients with Deep Bite Treated with Anterior Bite Plane as a Functional Appliance

Background: Class II division 1 malocclusion can be produced by protrusion of upper anterior teeth with normal maxillary basis relationship, that can be as a result of mandibular deficiency with normal dental position or posterior rotation of the mandible due to the excessive vertical growth of the maxilla. Deep bite usually associated with class II malocclusion, in which the mandibular incisor crowns are excessively overlapped vertically by the maxillary incisors where the teeth are in centric occlusion, which can be seen in children as well as in adults. So that for the successful treatment of Class II/ 1 required controlling the deep bite before starting the virtual treatment of this malocclusion to get better retention. Aim: The aim of this study was to investigate the morphological changes in maxillary and mandibular bones relationship after using the anterior bite plane appliance. Material and Methods: Evaluative analysis of cephalograms by superimposing two lateral cephalograms before and after the treatment of 27 patients (12 girls and 15 boys) class II division 1 malocclusion with mean age 11.7 years old. They treated by utilization of anterior bite plane while the period of fixed orthodontic therapy. Cephalometric data were analyzed with the following methods: Delaire, Danguy and classical and the morphological changes were evaluated. Results: The results of superposition of every patient before and after treatment showed a significant (P<0.05) reduction of deep bite and the facial convexity reduced in an average of 2.49°, anterior-posterior discrepancy reduced also very significantly (P=0.001), with a mean value of 1.81° and increasing in total mandibular length with a mean value of 2.95 mm. The decrease of the overbite can be due especially to the mandibular rotation and also supra-eruption of posterior teeth. Change in the mandibular length and the maxillary position improved facial profile but did not correct it completely as the mandible moved forward and also downward due to vertical and horizontal ramus growth and condylar remodeling. Conclusion: It can be concluded that the use of an anterior bite plane in conjunction with a straight wire and edgewise orthodontic techniques improved the overbite. Further research is recommended to support the result. How to cite this article:Senussi IB, Abdelgader I. Evaluation of Changeson Maxillo-Facial Skeleton of Class II Patients with Deep Bite Treated with Anterior Bite Plane as a Functional Appliance. J Adv Res Dent Oral Health 2019; 4(1): 1-9.

Surgical Management of Various Types of Maxillary Canine Impaction: A Narrative Review

With the exception of the third molar, maxillary canine impaction is considered to be the most common form of tooth impaction. The position of the permanent maxillary canine at the angle of the mouth is strategically important in preserving the harmony and symmetry of the dental arches. The incidence of maxillary canine impaction in the maxilla is more than twice higher compared to the mandible. Approximately one-thirds of the cases are labially located, and two-thirds are palatally located. Bilateral impaction has been reported in 8% of the patients with canine impaction. The treatment procedure is time-consuming and imposes a significant financial burden on the patient. Impacted maxillary canines could be erupted and guided to an appropriate location in the dental arch with early detection, timely interception, and proper surgical management in order to perform orthodontic treatment. Various surgical and orthodontic techniques could be used to guide impacted canines into the arch. Accurate selection of surgical and orthodontic techniques is essential to the successful alignment of impacted teeth. Management of impacted tooth often requires an interdisciplinary approach. In addition, proper cooperation of the orthodontist, oral surgeon, and periodontist seems crucial in this process. The present study aimed to review the clinical and practical aspects required for the management of maxillary canine impaction based on the location and age of the impaction.

Changes in the alveolar bone thickness of maxillary incisors after orthodontic treatment involving extractions - A systematic review and meta-analysis.

BackgroundOrthodontic treatment involving en-masse retraction of incisors following premolar extractions, may induce morphological alterations of the alveolar bone surrounding the anterior teeth.ObjectiveTo assess changes in alveolar bone thickness around the incisors of extraction patients measured with CBCT.Material and MethodsAn electronic search was conducted in PubMed, Scopus, Embase and Cochrane Library, using search terms, with no limitation on publication date, up to April 2018. The articles selected for analysis included randomized controlled trials, case-control studies and cohort studies of patients treated with fixed appliances and premolar extractions, which had measured alveolar bone thickness with CBCT before and after treatment. Changes in bone thickness were calculated and the heterogeneity of the studies was assessed using the I2 and Cochran’s Q tests.ResultsOf the 136 articles identified in the initial search, 19 were related to the review subject. After removing a further 14 that did not meet the inclusion criteria, 5 articles were selected for analysis. All five were retrospective studies of medium quality. The main changes in alveolar bone thickness were found in the labial cervical third of the central incisor, presenting increases of 0.4-0.64 mm. On the palatal side the results varied considerably.ConclusionsA significant increase in alveolar bone thickness occurs in the labial cervical third of the central incisor. These changes may be influenced by incisor position and inclination, the orthodontic technique and mechanics employed, the timing of the final CBCT scan and the bone remodeling capacity during en-masse retraction. Key words:Cone-beam computed tomography, alveolar bone, orthodontics.

Evaluation of stress generation on the cortical bone and the palatal micro-implant complex during the implant-supported en masse retraction in lingual orthodontic technique using the FEM: Original research.

Background. This study aimed to evaluate and analyze the distribution of stresses on the palatal micro-implants and the cortical bone at the micro-implant site with optimal orthodontic retraction force in lingual orthodontics. Methods. ANSYS 12.1 software was used to construct the finite element model of the maxillary bone, teeth and the periodontal ligament along with the lingual bracket set-up with wire and the micro-implant. Six- and 8-mm micro-implants were constructed. The final model consisted of 99190 nodes and 324364 elements. A 200-gram of retraction force was applied from the micro-implant to the anterior retraction hook. The micro-implant was embedded between the second premolar and the first molar. Hyper-view software was used to get the results in X-Y-Z dimensions. Results. The maximum von Mises stresses detected were 52.543 MPa for 6-mm micro-implant and 54.489 MPa for 8-mm micro-implant. Maximum stress was at the neck of the micro-implant. The 8-mm implant model showed 6×10-3 mm of lingual displacement. The least displacement of 1×10-3 mm was noticed for both the implant models in the apico-occlusal direction. The maximum von Mises stresses in the cortical bone at the micro-implant site was 18.875 MPa for 6-mm micro-implant and 21.551 MPa for 8-mm micro-implant. Conclusion. Six-mm micro-implant can be the choice for the implant-supported lingual orthodontic retraction as it produced minimal stresses on the cortical bone, and the initial stress displacements produced on the micro-implant were also minimal.

Periodontally accelerated osteogenic orthodontics: A boon in a severe periodontally compromised Class II division 1 malocclusion patient

Periodontally accelerated osteogenic orthodontics (PAOO) is a combination of a selective decortication facilitated orthodontic technique and alveolar augmentation. With this technique, one is no longer at the mercy of the preexisting alveolar volume, and teeth can be moved two to three times further than required for traditional orthodontic therapy. It is used to treat moderate-to-severe malocclusions in both adolescents and adults. PAOO technique increases alveolar volume which can provide a more intact periodontium, inturn decreases need for extractions, increases a degree of facial reshaping. This technique also increases the bony support for both the teeth and the overlying soft tissues. Here is a case report which highlights the above-mentioned uses with PAOO technique in a severe periodontally compromised Class II division1 malocclusion patient treated with nonextraction line of orthodontic treatment.

Treatment modality of impacted central incisor associated with dentigerous cyst and compound odontome

Impacted tooth is frequently encountered in dental practice. But the impacted tooth associated with supernu­merary tooth and dentigerous cyst in anterior region is very rare case. The present case reports the successful management of impacted right central incisor with multiple odontome and dentigerous cyst by surgical inter­vention and orthodontic extrusion. Close eruption technique was applied after enucleation of cyst and extrac­tion of odontome. Thirty grams traction force was applied after bonding in the labial surface of impacted tooth. Subsequently fixed orthodontic technique was applied to get impacted central incisor into occlusion.

ПРИМЕНЕНИЕ СОВРЕМЕННЫХ ОРТОДОНТИЧЕСКИХ И ХИРУРГИЧЕСКИХ ТЕХНОЛОГИЙ В КОМПЛЕКСНОЙ РЕАБИЛИТАЦИИ ДЕТЕЙ С ВРОЖДЕННОЙ РАСЩЕЛИНОЙ ВЕРХНЕЙ ГУБЫ, АЛЬВЕОЛЯРНОГО ОТРОСТКА И НЁБА

Object. Considered a clinical case of congenital cleft of the upper lip, alveolar ridge and palate describes the stages of treatment. The aimof the study is to present a comprehensive approach to the treatment of patients with congenital cleft of the upper lip, alveolar ridge and palate on a clinical example. Methodology. The article is devoted to the clinical case of treatment of a patient with congenital cleft of the upper lip, alveolar ridge and palate from birth to completion of complex rehabilitation. The patient in different age periods underwent a complete clinical examination with the use of additional research methods, as well as a step-by-step treatment plan. Within eighteen months, a comprehensive treatment was carried out on a fixed technique with a surgical stage-alveoloplasty. The step-by-step dynamics of complex treatment is presented. Results. As a result of treatment, the patient received a complex rehabilitation specialists MCMC "Bonum" of the city of Yekaterinburg, namely the closure of the defect on the upper lip, alveolar ridge and the palate, the normalization of the position of the teeth, the dentition in the sagittal, vertical and transversal plane, the restoration of the functions of respiration and speech. Conclusion. In case of congenital cleft of the upper lip, alveolarridge, palate, it is necessary to work together orthodontist and maxillofacial surgeon using modern technology, combined with the use of fixed orthodontic technique. An integrated approach allows for the rehabilitation of children with congenital cleft lip, alveolarridge, the sky in a timely manner, with a good end result.

Study on Three-Dimensional Digital Expression and Robot Bending Method of Orthodontic Archwire.

Malocclusion is the third largest oral disease in the world. At present, the most effective treatment method for malocclusion is the fixed orthodontic technique based on orthodontic archwires. Robotic archwire bending can overcome the shortcomings of manual bending such as low efficiency and low precision. The three-dimensional digital expression and robot bending method of orthodontic archwire are studied to realize the orthodontic archwire bending using a robot. Tooth is identified by the doctors' common method. The shape, position, and constraint relationship of orthodontic archwire in three-dimensional space are expressed by the Bessel curve. The bending of the archwire curve is realized by transmitting the archwire curve into the alternative lines. The planning method of forming points and the spatial angle planning method are proposed. The archwire bending experiment is carried out with the maxillary information of a patient. The error rate of the experimental and ideal values is between 2.94% and 6.74%. It can meet the physician's basic requirements after simple modification. Therefore, it can be considered that the method of using discrete Bessel curve to carry out the control point planning and angle planning is suitable for the orthodontic archwire-bending robot system, which has certain feasibility and practicability in clinical treatment.

Perception of mini-screw anchorage devices by patients

To evaluate how mini-screw anchorage are perceived by patients as well as their degree of satisfaction regarding their orthodontic treatment. A questionnaire was handed out to the study population which comprising 137 patients all undergoing orthodontic treatment, without exclusion criteria. Out of the total number of 230 questionnaires distributed to patients, only 137 (60%) questionnaires were returned (sample 1) bearing in mind that 29 patients (21.2%) were fitted with a mini-screw (sample 2). In sample 2, 86.20% of patients showed no sign of mini-screw instability during treatment. The majority of patients (62.10%) reported no pain when the mini-screws were inserted (62.1%) and among the 37.9% who did feel pain, 60% were boys and 26.3% were girls, without significant difference, P<0.11. Post-op pain decreased steadily between day 1 and day 7 regardless of the orthodontic technique used (P>0.5). When pain was felt during the 7-day period, it was significantly greater for initial tooth alignment than for micro-implant surgery (P<0.05). Most patients declared themselves satisfied with the orthodontic treatment using anchorage devices, with a 72.4% satisfaction rate. Overall, the use of mini-screw anchorage devices during orthodontic treatment is well accepted by patients. The stability rate is high with predictable results. Post-op pain is significantly lower than orthodontic alignment pain.

Lingual Fixed Orthodontic Appliances May Be Associated With More Adverse Effects Than Buccal Appliances

Adverse effects of lingual and buccal orthodontic techniques: A systematic review and meta-analysis. Ata-Ali F, Ata-Ali J, Ferrer-Molina M, Cobo T, De Carlos F, Cobo J. Am J Orthod Dentofacial Orthop 2016; 149:820-9. Not stated. Systematic review and meta-analysis.

An original approach of maxillary transversal deficiency with lingual orthodontics

The difficulty of management of a transverse maxillary hypoplasia is to choose the right treatment and the appropriate tools. When transverse maxillary insufficient is associated to sagittal and/or vertical discrepancies in adults, the gold standard treatment is a surgical procedure combined with orthodontic treatment. The surgical procedure can be done in 1 or 2 stages. If the patient chooses a lingual orthodontic technique, the tools for expansion and the stabilization of expansion are not simple to use. The aim of this article is to report the case of a 25-year-old male patient, referred to our cabinet for skeletal Class-III malocclusion associated with laterognathism and transverse maxillary deficiency. The patient underwent one-stage surgery. He choose to be treated by a lingual orthodontic technique, we used the FKS® disjunction device.

Orthodontic treatment-related risks and complications: part II periodontal complications

Introduction: Orthodontic treatment, in addition to patient benefits, includes certain risks and complications that should not beignored. The side-effects of orthodontic therapy all therapists want to avoid or reduce to a minimum.The occurrence of these complications depends on the orthodontic technique, medical knowledge in this field, patient's generaland oral health, and oral hygiene habits. Part of the risk and complications depend on the patient's ability to understand andcooperate during the therapy. For this reason, it is a medico-legal obligation to inform our patients about side effects of any medicalintervention what will be undertaken. In the previous issue, an overview of local complications of orthodontic treatment - dentalcomplications was presented.The aim: The aim of this part is to present a detailed overview of the most common complications with local effect- periodontalcomplications in the context of the contemporary attitude of the risks and complications associated with orthodontic treatment.Material and methods: Classification was presented by Graber, 2004th, in its publication, "Risk Management in Orthodontics: AnExpert's Guide to Malpractice," used as a starting point for the development of this review. A complex search was performed (PubMed, Google Scholar, etc.), with the restriction upon of publication date (beginning with 2004) to find relevant current studies.Search keywords were combinations of words: complication, orthodontic treatment, risks, side effects.Concluding remarks: Periodontal complications are the most common side effects linked with orthodontic treatment according tocontemporary literature. Serious analysis of potential risk for periodontal complications is mandatory for orthodontic patientsbefore the treatment starts. It is the only correct way to minimize complications during and after orthodontic treatment.

Orthodontic Clockwise Rotation of Maxillomandibular Complex for Improving Facial Profile in Late Teenagers with Class III Malocclusion: A Preliminary Report

Objective Orthodontic camouflage treatments improve occlusion but might worsen facial profile in patients with Class III malocclusion. It has been reported that surgical clockwise rotation of maxillomandibular complex (MMc) improves facial profile by reducing chin prominence and chin throat length in patients with Class III malocclusion. The purpose of this report was to illustrate two orthodontic techniques for clockwise rotation of the MMc in late teenagers with Class III malocclusion and preliminarily evaluate their clinical effects. Patients and Methods Six patients in late teenage with Class III malocclusion were included in this preliminary report. Bite raisers were first placed on the upper molars to open the bite and clockwise rotate the mandible. Intermaxillary elastics were then applied vertically between the upper and lower dentitions in 3 patients for bimaxillary extrusion (Technique-1) or between the upper dentition and the lower temporary anchorage devices (TADs) in another 3 patients (Technique-2) for upper dentition extrusion and closure of the anterior open bite. The three-dimensional cone-beam computed tomography images taken before and after orthodontic treatment were superimposed to evaluate the treatment effects of MMc clockwise rotation for both techniques. Results The Technique-1 extruded the upper and lower dentitions, rotated the mandible clockwise 2.01°, moved chin down 2.98 mm, and back −1.64 mm, although the mandible grew 2.47 mm during the treatment period. The Technique-2 extruded the upper dentition, rotated the mandible clockwise 0.90°, moved chin down 1.78 mm, but slightly forward 0.47 mm due to the mandible grew 2.50 mm and lower dentition was not extruded. Conclusions The orthodontic clockwise rotation of MMc is an effective technique for orthognathic camouflage. The applications of bite raisers and bimaxillary dentition extrusion could be more effective than single dentition extrusion with TADs in the mandible for clockwise rotation of MMc and improvement of occlusion and facial profile in late teenagers with Class III malocclusion. However, the comprehensive clinical effects and long-term stability need further clinical studies.

Evaluation of root length following treatment with clear aligners and two different fixed orthodontic appliances. A pilot study.

OBJECTIVES:The purpose of this pilot study was to evaluate the root lengths of upper incisors as an indication of the degree of orthodontically-induced apical root resorption following treatment with Smart Track® aligners and compare it with two different fixed orthodontic appliances – regular and Damon brackets – using cone-beam computerized tomography (CBCT).MATERIALS AND METHODS:The sample comprised 33 patients with class I malocclusion and 4–6 mm crowding divided in 3 groups; Group I: 11 patients treated with Smart Track® aligners, group II: 11 patients treated with Damon brackets, and group III: 11 patients with regular brackets. Maxillary incisors teeth lengths were assessed using Dolphin imaging software before and after treatment. All data were analyzed using analysis of variance and t-test.RESULTS:All groups showed statistically significant root resorption, 0–1.4 mm for clear aligners, 0.1–2.3 mm for Damon, and 0–2.5 mm for regular brackets group. However, cases treated with fixed appliance in general showed significantly higher resorption than those treated with Smart Track® aligners (P < 0.05).CONCLUSION:Orthodontically-induced root resorption, as evaluated by root length, is an inevitable drawback with different orthodontic techniques. However, the use of Smart Track® aligners showed less root resorption relative to regular fixed appliances.

Orthodontic traction technique: Clinical case report based on literature

Orthodontic traction technique: Clinical case report based on literature

Tooth movement mechanobiology

The current concept of “pressure-tension” tooth movement is based upon reductionist explanations of parsed physiological processes that do not provide a cohesive understanding of clinically relevant tooth movement. The biology underlying accelerated orthodontic techniques have refocused attention on disruptions of tensional integrity of microenvironments, resulting in epigenetic changes in cell products, and the intentional spatio-temporal adaptations of tissues to build strength to overcome tissue strain, all for the sake of re-establishing homeostasis. Differentiating how interstitial bone fluid pressure and flow is affected by the various tissue microporosities in regulating bone modeling and remodeling processes, will lead to a better understanding of tooth movement mechanobiology.

Electromyographic evaluation in children orthodontically treated for skeletal Class II malocclusion: Comparison of two treatment techniques

ObjectiveTo compare the clinical efficacy of two techniques for fabricating a Bimler device by assessing the patient’s surface electromyography (sEMG) activity at rest before treatment and six months after treatment.MethodsTwenty-four patients undergoing orthodontic treatment were enrolled in the study; 12 formed the test group and wore a Bimler device fabricated with a Myoprint impression using neuromuscular orthodontic technique and 12 formed the control group and were treated by traditional orthodontic technique with a wax bite in protrusion. The “rest” sEMG of each patient was recorded prior to treatment and six months after treatment.ResultsThe neuromuscular-designed Bimler device was more comfortable and provided better treatment results than the traditional Bimler device.ConclusionThis study suggests that the patient group subjected to neuromuscular orthodontic treatment had a treatment outcome with more relaxed masticatory muscles and better function versus the traditional orthodontic treatment.