Orthodontic Treatment Of Adult Patient Research Articles

Three-dimensional evaluation of condylar morphology after orthodontic treatment in adult patients with Class II malocclusion by cone-beam computed tomography

BackgroundThe aim of this study was to evaluate the condylar morphological changes after orthodontic treatment in adult patients with Class II malocclusion using a Cone-beam computed tomography (CBCT).MethodsImages of twenty-eight adult patients with Class II malocclusion who have no temporomandibular symptoms were involved in this study. To analyze the post-treatment changes in condylar morphology, mimics 17.0 software was used to measure several values and reconstruct the three-dimensional condyle, including height of the condyle, area and bone mineral density of the maximum axial and sagittal section, volume and bone mineral density of the three-dimensional condyle and condylar head before and after orthodontic treatment. Using SPSS 19.0 software package Paired t-test was applied for comparison of condylar morphology analysis between pre-treatment and post-treatment.ResultsHeight of condylar head increase significant (P < .05). Bone mineral density showed a decrease in the maximum axial and sagittal section, three-dimensional condyle and condylar head (P < .01). Evaluation of volume revealed that volume of both condyle and condylar head decrease considerably (P < .05). No significant difference was detected in other values ((P > .05).ConclusionCondylar volume decreased and height of condylar head have changed, so we speculated that adaptive bone remodeling of the condyle occurs.

Psychological impact and perceptions of orthodontic treatment of adult patients with different motivations

Motivations, perceptions, and psychosocial states of adult patients with orthodontic disorders in China have not been widely studied. The study assessed the psychosocial states and perceptions of adult patients undergoing orthodontic treatments with different motivations. Two hundred forty-three adult patients (mean age, 30.2 ± 7.4 years; women, 79.0%) undergoing orthodontic treatment were recruited from a tertiary stomatology hospital. The patients answered a patient-centered questionnaire regarding motivations and perceptions of orthodontic treatment and the Psychosocial Impact of Dental Aesthetics Questionnaire. Data were analyzed using the chi-square test on the basis of multiple responses. Multiple linear regression analyses were performed to determine the association between motivation factors and the Psychosocial Impact of Dental Aesthetics Questionnaire subscale scores (P<0.05). Patients with various motivations were as follows: occlusal function reason (70.4%), dental esthetic reason (54.7%), facial esthetic reason (24.3%), and following others' suggestions (18.5%). Patients with esthetic or occlusal motivations exhibited significantly greater need and interest for orthodontic treatment (P<0.001). Multiple linear regression analyses revealed that the scores of social impact, psychological impact, and esthetic concern subscales were significantly associated with both dental and facial esthetic motivations (P<0.001). The primary motivations of Chinese patients were observed to be improved esthetics and occlusal function. Patients with esthetic or occlusal motivations exhibited significantly greater need and interest in treatment. Patients with facial or dental esthetic motivations experienced greater impacts of psychosocial states. Therefore, the patient motivations and impacts of esthetic-related psychosocial states on them should be considered during treatment.

Evaluation of the Patient-Reported Outcome Measures (PROMs) With Temporary Skeletal Anchorage Devices in Fixed Orthodontic Treatment: A Systematic Review.

Analysis of patient-reported outcome measures(PROMs) is essential to ensure that the skeletal and traditional anchoring methods are appropriately and effectively utilized in the context of patient acceptance and satisfaction. This review's objective was to assess the available data on the levels of discomfort, soft-tissue irritation, functional impairment, and other patient-reported outcomes related to the usage of mini-implants in the context of fixed orthodontic treatment for adult patients. A total of seven electronic bibliographic databases were searched between January 1995 and February 2022. Moreover, a manual search was done in the selected orthodontic journals. This systematic review (SR) covered cohort studies, retrospective studies, randomized clinical trials (RCTs), and controlled clinical trials (CCTs) that studied the use of mini-implants, mini-plates, or onplants as anchorage devices on patients receiving orthodontic treatment. The risk of bias was assessed using Cochrane's risk of bias tool (RoB2 tool). Three RCTs and two cohorts were included in this SR with a total of 468 patients. Three of the four included studies were at high risk of bias. The pain level was in the "mild-to-moderate" category on the first day following the insertion of mini-implants, then decreased to a mild level from the fifth day to the seventh day of insertion (mean values are 36.61, 16.36, and 11.33, respectively). The levels of functional impairments were found to be located between the "mild-to-moderate" and "moderate" categories after the placement of mini-plates and intermaxillary fixation screws, while they experienced a mild level with mini-implants. The greatest pain levels were found after the insertion of the temporary anchorage devices (TADs) and then decreased until they became mild or disappeared completely after one month. Speaking, chewing, and cleaning difficulties were more problematic when using TADs compared to conventional anchorage. To obtain good evidence in this area, more high-quality RCTs are needed.

Photobiomodulation to Reduce Orthodontic Treatment Time in Adults: A Historical Prospective Study

Background: Orthodontic treatment in adult patients is hindered by several problems, such as little time for regular dental visits and financial costs. In recent years, photobiomodulation (PBM) has been shown to significantly reduce the duration of orthodontic treatment and significantly increase patient compliance. Objective: This study aimed to investigate the efficacy of PBM in shortening the orthodontic treatment duration in adult patients while ensuring optimal patient compliance. Methods: A total of 170 orthodontic patients with a Little’s irregularity index (LII) ≥ 3 mm treated with Invisalign clear aligners (Align Technology, Santa Clara, CA, USA) were included. The treatment group (PBM) (n = 90 patients) was trained in the use of the OrthopulseTM device (Biolux Research, Vancouver, Canada) according to an application protocol of 5 min per day. The control group (n = 80 patients) was treated with transparent Invisalign® without PBM applications. The LII was measured at a baseline and each aligner change until the end of the treatment when the LII was less than 1 mm. The crowding resolution rate (CRR), expressed in mm/week, and the total treatment time were measured. Results: The alignment rate of the PBM group was significantly higher than that of the control group (0.33 mm/week vs. 0.21 mm/week) with a reduction in the treatment time of 57.5 weeks in the PBM group compared with the control group. Conclusion: The PBM performed with the Orthopulse™ is shown to be an effective and noninvasive technique for accelerating teeth movements and can contribute in a relevant way to increase access to orthodontic treatment by the adult population as well as increase its compliance.

Alveolar Bone After Intrusion and Retraction of Anterior Teeth: Fractional Dimensional Analysis

Objective: To evaluate changes in the trabecular structure of alveolar bone in maxillary incisors segment after maxillary incisor intrusion and retraction with fixed orthodontic treatment in adult patients using fractal dimensional analysis (FD). Methods: This study was conducted using a digital panoramic radiograph of 30 patients (Age Group 18 - 25 years) with class II malocclusion with maxillary incisor protrusion treated with intrusion and retraction of anterior teeth. Panoramic radiographs were taken with standard protocols at the three different periods, before orthodontic treatment (T0), immediately after alignment but before intrusion and retraction (T1), and after intrusion & retraction of anterior teeth (T2). Regions of interest were located between the apices of maxillary incisors. Findings: Fractal dimension (FD) was calculated using ImageJ software. Repeated Measure ANOVA test; indicates significant difference at p0.05. FD values of the alveolar bone of maxillary incisors at T0 were 1.312  0.09, which reduced to 1.273  0.10 at T1 and again increased to 1.325  0.07 at T2. This overall change in FD values was significant (p=0.050. Novelty: The study revealed that, during orthodontic tooth movement, the alveolar bone around the teeth was reduced. However, after a period of bone recovery, the reduced bone density recovered to its previous state from before the orthodontic treatment. Keywords: Alveolar bone; Bone trabeculae; Fractal analysis; Orthodontic tooth movement; Panaromic radiograph

Orthodontic Treatment for Adult Patients with Scissors Bite Using Tiggle Brackets

Due to the difficulty of correcting scissors bite, so many treatment modalities have been suggested. One of them are crisscross elastics, orthodontic miniscrews, trans-palatal arch with precision lingual arch wire, and so on. Tiggle brackets are one of minitubes which was recently introduced for the treatment of anterior teeth. It is designed to be positioned on the lingual surfaces of the anterior teeth. They exert very light force, so the counteraction is very small with minimum side effect. With their small size, it is good to bond on the teeth with scissors bite, reducing the possibility of falling off during masticatory movement. Tiggle brackets can be a very useful orthodontic treatment modality when correcting scissors bite.

Cone-beam CT analysis of the correlation between incisor root resorption rate and tooth movement index in adult patients with fixed orthodontics appliance

Objective: To analyze the correlation between the root resorption rate and tooth movement of the maxillary and mandibular incisors before and after orthodontic treatment in adult patients using cone-beam CT (CBCT), and to explore the related factors that affect the apical root resorption. Methods: In this retrospective study, 23 adult patients with classⅠor class Ⅱ division 1 malocclusion [2 males and 21 females, mean age (23.4±6.3) years, treatment time (2.1±0.7) years] who received orthodontic treatment with fixed appliance in Department of Oral & Cranio-Maxillofacial Surgery, Shanghai Ninth People's Hospital from January 2017 to June 2021 were enrolled. Full-column CBCT examination was performed before and after treatment. A three-dimensional model was established to observe and record the volume of the maxillary and mandibular central and lateral incisors before and after treatment. The change of the incisal edge, the angle of rotation of the incisal edge, and the direction of the long axis of the tooth were also measured. The root resorption in each tooth before and after treatment was compared, and the root resorption rate was calculated. Pearson correlation analysis was performed on the root absorption rate before and after treatment with age, treatment time and tooth movement. Results: After treatment, the tooth volume of the maxillary and mandibular central and lateral incisors decreased significantly (P<0.01). The root absorption volumes were (20.2±6.0) mm3 and (11.2±4.7) mm3 in maxillary central and lateral incisors, and (14.7±4.6) mm3 and (14.8±5.0) mm3 in mandibular central and lateral incisors, respectively. The root absorption rates were (9.49±1.75)% and (9.13±3.24)% in maxillary central and lateral incisors, and (8.56±3.43)% and (9.13±3.24)%, in mandibular central and lateral incisors, respectively (F=0.56, P=0.640). The root resorption rate of maxillary central incisors had a weak positive correlation with the change of sagittal distance of incisal edge (r=0.36, P=0.015). The root resorption rate of mandibular central incisors had a moderate positive correlation with the vertical movement distance (r=0.48, P=0.001). The root resorption rate of mandibular lateral incisors was weakly positively correlated with the vertical movement of incisal edge and the treatment time (r=0.35, P=0.016; r=0.34, P=0.021), and was moderately positively correlated wit the change of sagittal movement of incisal edge (r=0.44, P=0.002). Conclusions: During orthodontic treatment, both maxillary and mandibular incisors had a certain degree of root resorption, which was related to sagittal and vertical movement of the incisors and the time of orthodontic treatment.

Application of mini-implants in invisible orthodontics

The control of anchorage is essential in orthodontic treatment of adult patients. Complex tooth movements in lingual appliances and aligners require anchorage planning. Mini-screws enable the orthodontists to have good control over tooth movement in all three dimensions, while preserving the patient’s aesthetics. This article describes various clinical cases performed through aligners and lingual appliances by using mini-implants.

Orthodontic-periodontic interdisciplinary approach

In the last few years, there has been a major advancement in the orthodontic treatment of adult patients. Adult orthodontics differs from children's orthodontics in that there is virtually no more growth in adults and that the tooth-supporting structures, the periodontium, have changed.Because orthodontic treatment is done through the periodontium, having a healthy tooth supporting system is a must. At the same time, when the tooth moves under the influence of orthodontic treatment, the periodontium undergoes a variety of modifications. This review article discusses relationship between periodontal tissue and orthodontic treatment.

True vertical changes in patients with skeletal class III malocclusion after nonsurgical orthodontic treatment—a retrospective study comparing different vertical facial patterns

Background/purposeRotating mandible backward downward is one of the treatment options in non-surgical skeletal class III malocclusion. The purpose of this study was to compare the true vertical changes after camouflage orthodontic treatment of adult patients with skeletal class III malocclusion categorized by vertical facial type. Materials and methodsThis retrospective study included 27 adult patients (age >18 years) with skeletal class III malocclusion (ANB<1°) who underwent nonsurgical orthodontic treatment at Taipei Veterans General Hospital. The patients were divided into the low-angle (SN-MP<28°), high-angle (SN-MP>36°), and normal-angle (28°≤ SN-MP ≤ 36°) groups according to the original vertical facial pattern. Pretreatment (T1) and post-treatment (T2) lateral cephalograms were superimposed and treatment changes were evaluated. ResultsIn all cases, proper overjet and occlusion were achieved after treatment, and the lower anterior facial height increased with the backward rotation of the mandibular plane. Increase in vertical dimension was the most obvious in the high-angle group, while it was the least obvious in the low-angle group. Extrusion of both the maxillary and mandibular incisors was observed in the high-angle group; however, intrusion of the maxillary and mandibular incisors and decreased overbite were observed in the low-angle group. ConclusionCamouflage orthodontic treatment of skeletal class III malocclusion improves the facial profile by increasing the vertical dimension and clockwise rotation of the mandible. According to our results, patients with a high mandibular plane angle showed better response to vertical dimension increment treatment mechanics than those with low and normal mandibular plane angles.

Quality of Life Before and After Orthodontic Treatment in Adult Patients with Malocclusion: A Quasi-experimental Study

Introduction: In adult patients seeking orthodontic treatment, some common reasons include unesthetic appearance and functional impairment such as difficulty in speaking or breathing. Thus, malocclusion and orthodontic care have become a Quality of Life (QoL) issue. Aim: To investigate the oral health-related quality of life in adults before and after orthodontic treatment. Materials and Methods: This quasi-experimental study was conducted in Faculty of Dental Sciences, M.S. Ramaiah University of Applied Sciences, Bangalore, India over a 2 year period from December 2014 to October 2016. Finally, 34 patients were included in the study. Longitudinal data which included OHRQoL(Oral Health-Related Quality of Life) and study casts for assessing the outcome by the Peer Assessment Rating (PAR) index was collected from two periods: (i) pretreatment data (T1), and (ii) post-treatment data (T2) collected 1 month after fixed orthodontic appliance debonding. Pretreatment and post-treatment Oral Health Impact Profile (OHIP-14) and PAR scores were compared using Paired t-test. Correlations between occlusal indices (PAR) and OHRQoL (OHIP-14) were determined by Spearman’s rank correlation coefficient. Results: Total of 42 patients were included in the study, out of which 34 patients responded to the questionnaire in which 11 were males and 23 females in the age range 18-30 years. From pre to postorthodontic treatment mean OHIP-14 summary score had significantly improved (score reduced) from 30.3 to 16.0. Similarly, mean PAR scores had reduced from 17.62 to 3.44. Significant correlation (p-value&lt;0.05) existed between improvement in OHRQoL scores and improvement in occlusion after orthodontic treatment. Conclusion: The present study concluded that there was an improvement in oral health following fixed orthodontic treatments which were associated with changes in OHRQoL, PAR scores and changes in occlusion.

Periodontally Accelerated Osteogenic Orthodontics (PAOO) vs Osteoperforations (A Review on Periodontal Reactions to Orthodontic Tooth Movement)

A high number of adult patients are undertaking orthodontic treatment now because of the newer methods, technology, and innovations available in the market. Orthodontic profession is continually looking for new ways to perform treatment effectively for such patients, as there are many differences in the biology, motivation, and treatment objectives between adults and children. Aligner therapy and mini-implants are some of the ways of managing orthodontic treatment for adult patients. Treatment time is a concern for adult patients and methods to accelerate the orthodontic tooth movement have been a focus in the orthodontic field. Periodontal accelerated osteogenic orthodontics (PAOO) is a surgical procedure that is performed with a combination of alveolar corticotomy, bone grafting, followed by orthodontic treatment. This procedure uses the principle of regional acceleratory phenomenon (RAP). Another procedure commonly used for accelerated orthodontic tooth movement is osteoperforations. This is a minimally invasive procedure, which does not include a flap surgery. The purpose of this article is to describe the differences between adult and children periodontal tissues, the use of different appliances for adult treatment, how orthodontic treatment has been modified for adult patients, and the detailed explanation of procedures for accelerating orthodontic tooth movement such as PAOO and osteoperforations and the potential complications

Masticatory Function Assessment of Adult Patients With Cleft Lip and Palate After Orthodontic Treatment.

To determine whether orthodontically treated patients with cleft lip and palate (CLP) possess a different masticatory function than those of untreated patients with normal occlusion. Occlusal contact area, occlusal force, as well as masseter and anterior temporal muscular activity were measured during maximum voluntary clenching (MVC) tests. Mandibular left and right lateral movements during mastication were also assessed. To further elucidate the nature of masticatory function, especially to determine the rate of abnormal jaw movement patterns, a parametric error index (EI) was set. Finally, masticatory efficiency was evaluated with a glucose sensitive measuring device. Fifteen patients with CLP who had previously completed the orthodontic treatments required to achieve an acceptable and more harmonious occlusion accepted to volunteer in this study along with 21 untreated patients who already possessed a normal occlusion. Patients with CLP showed a significantly lower occlusal force, reduced occlusal contact area, and decreased masticatory efficiency as well as significantly higher EI value when compared with controls. However, there was no significant difference when analyzing muscle activity, although masticatory efficiency was significantly different between the 2 groups. Despite this result, the scores obtained by the patients with CLP in the masticatory efficiency tests were still in the normal range. Orthodontic treatment for adult patients with CLP provides a satisfactory result for the patients' masticatory ability albeit significantly less ideal compared with untreated patients with normal occlusion.

Effect of surgically facilitated accelerated orthodontics on treatment duration, root resorption and bone density

Introduction: The use of orthodontic treatment in adult patients for the treatment of malocclusion is becoming more common. But the major disadvantages of conventional orthodontic technique are the time consumed for the treatment (18 – 24 months), root resorption and formation of fenestrations and dehiscence. Periodontally Accelerated Osteogenic Orthodontics (PAOO) is a surgical technique which results in an increase in alveolar bone width, shorter treatment time, increase post-treatment stability, and decrease in the amount of apical root resorption. Objectives: The objective of the study was to evaluate the effect of Periodontally Accelerated osteogenic Orthodontics (PAOO) with surgical bur and piezicision on: Duration of orthodontic space closure, amount of root resorption, and the bone density. Materials and Methods: Forty subjects who needed orthodontic treatment were randomly selected and divided into two groups. Group I consists of 20 subjects who were selected for Periodontally Accelerated Osteogenic Orthodontics (PAOO) with surgical bur Group II: consists of 20 subjects who were selected for Periodontally Accelerated Osteogenic Orthodontics (PAOO) with peizocision. Patients were recalled at baseline, 3, 6, 9 and 12 months and were evaluated for amount of retraction, bone density, root resorption and detection of fenestration and dehiscence. Cone Beam Computerised Tomography (CBCT) was used to evaluate the bone density, root resorption and for the detection of fenestration and dehiscence. Results: In subjects where corticotomy was carried out with surgical bur the treatment time was less as compared to PAOO with peizocision. Group I had a mean retraction of 5.99 ± 0.5 mm after 3 months (p Conclusion: PAOO with surgical bur (Group I) decreases the treatment time as compared to piezocision (Group II). Amount of root resorption in Group I which was around 0.34 mm and that of Group II was around 0.51mm which is very minimal and increase in the bone density wa

The National Dental Practice-Based Research Network Adult Anterior Open Bite Study: Treatment success

Anterior open bite (AOB) continues to be a challenging malocclusion for orthodontists to treat and retain long-term. There is no consensus on which treatment modality is most successful. This study reports on the overall success rate of AOB orthodontic treatment in the adult population across the United States, as well as 4 major treatment modalities and other factors that may influence treatment success. Practitioners and their adult patients with AOB were recruited through the National Dental Practice-Based Research Network. Patient dentofacial and demographic characteristics, practitioner demographic and practice characteristics, and factors relating to orthodontic treatment were reported. Treatment success was determined from posttreatment (T2) lateral cephalometric films and intraoral frontal photographs. Treatment was categorized into 4 main groups: aligners, fixed appliances, temporary anchorage devices (TADs), and orthognathic surgery. Extractions were also evaluated. Bivariate and multivariable models were used to investigate the association between treatment success and treatment modality, pretreatment (T1) dentofacial characteristics, patient and practitioner demographics, and practice characteristics, adjusting for clustering of patients within practice. A total of 254 patients, enrolled by 84 practitioners, contributed to T2 data for this study. There were 29 patients in the aligner group, 152 in fixed appliances, 20 in TADs, and 53 in surgery. A total of 49 patients underwent extractions of teeth other than third molars. Ninety-three percent finished treatment with a positive overbite on the T2 lateral cephalogram, and 84% finished with a positive vertical overlap of all incisors. The small number of aligners and TAD patients limited the ability to compare success rates in these groups. Patients treated with orthognathic surgery had a higher rate of success compared with those treated with fixed appliances only. Treatment success was also associated with academic practice setting, T1 mandibular plane angle≤30°, no to mild T1 crowding, and treatment duration<30months. The overall success of orthodontic treatment in adult patients with AOB who participated in this study was very high. Orthognathic surgery was the only treatment modality that exhibited a statistically higher odds of successful outcomes. Some T1 dentofacial characteristics and treatment factors were associated with the successful closure of AOB.

Changes in clinical and microbiological parameters of the periodontium during initial stages of orthodontic movement in patients with treated severe periodontitis: A longitudinal site-level analysis.

Applying orthodontic braces makes oral hygiene difficult and increases plaque accumulation, frequently resulting in gingival inflammation. In patients with previous severe periodontitis, this inflammation overlaps with the pre-existing inflammatory challenge and can lead to further progression of periodontal attachment loss. The aim of this study was to assess longitudinal site-level changes as mirrored by clinical and microbiological parameters during the initial remodeling of alveolar bone and the periodontal ligament, produced as an effect of light orthodontic forces in adult patients with severe periodontal disease that underwent standard (non-surgical and conventional surgical) periodontal therapy. Thirteen patients with previously treated severe generalized periodontitis were given fixed orthodontic appliances for re-alignment of teeth misaligned or displaced during the course of periodontitis. Before insertion of orthodontic appliances and at 2, 4, and 6 months of treatment, periodontal clinical parameters were recorded in the same deepest residual pocket of at least 3 mm in each patient. The same pocket was sampled at baseline and after 6 months of orthodontic treatment for the frequency of positive detection of Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Tanerella forsythia (Tf), Treponema denticola (Td). An average reduction in Pocket Depth by 0.2 mm at the end of the assessment period was identified. The only clinical parameter with statistically significant improvement was bleeding on probing. The frequency of detection of Aa, Pg, Pi, and Tf was not significantly different between baseline and 6 months of treatment, while a marginally significant increase of Td was found. There were no significant differences in the clinical parameters or microflora in the initial phase of orthodontic treatment in patients with reduced periodontal support. By correlating clinical and microbiological data, we concluded that the presence of periopathogens do not negatively influence periodontal health during orthodontic treatment in adult patients treated for severe periodontitis.

Orthodontic treatment of periodontal patients: challenges and solutions, from planning to retention

ABSTRACTIntroduction: There is an increasing number of adult patients with sequelae of periodontal diseases seeking orthodontic treatment to improve their occlusion and quality of life. However, it is important to highlight that the patient who has vertical bone loss has unique needs, arising from the frequent related pathological migrations. Therefore, it requires an individualized orthodontic treatment in terms of anchorage, biomechanics, and multidisciplinary planning, which raises doubts in the hierarchy of priorities and organization of the treatment plan. Objectives: It was proposed a stratified hierarchy of the needs of orthodontic-periodontal treatment in six levels, which were illustrated with examples of clinical cases in which biomechanical planning and a multidisciplinary approach made it possible to obtain a balanced occlusion, aesthetic improvement and stabilization of the results. Conclusion: Orthodontic treatment of periodontal patients with a multidisciplinary approach is increasingly frequent and should be planned individually, considering bone losses suffered by each patient. Respecting some limitations, it is possible to improve the level of bone insertion, smile aesthetics and masticatory function, to facilitate oral hygiene through the orthodontic treatment of adult patients with little bone support. It is also important to highlight that there are unique aspects in the orthodontic retention in these cases.

Orthodontic Camouflage Treatment of a High-Angle Severe Skeletal Class II Discrepancy Skeletal Cla

Proper orthodontic treatment in adult patients with severe skeletal Class II discrepancy can be challenging. Recently, miniscrew implants have been used as a strategy to treat skeletal Class II patients. Objective: This report illustrates a skeletal Class II malocclusion management combining straight wire technique and miniscrew implant anchorage. Case report: The patient was a 21-years- old Indonesian female with Class II skeletal discrepancy, a retrognathic mandible, a high mandibular plane angle, and a mouth breathing habit due to a history of allergic rhinitis. Anchorage control is important in the sagittal and vertical directions. Miniscrew implants were placed in the interradicular ar ea bet ween t he upper second pr emolar and fir st mol ar on bot h sides. Further more, en -masse retraction of the six anterior teeth was performed using miniscrew implants as the anchorage. After 16 months of treatment, esthetics and function were improved and the chief complaint of the patient was resolved. Class I canine and incisor relationship was achieved. These mechanics contributed to the correction of the gummy smile of this patient. Conclusion: Placement of miniscrew implants in the posterior regions of the maxilla effectively camouflaged a high-angle skeletal Class II discrepancy. This technique requires minimal patient compliance and is useful for the correction of high-angle cases in adult patients.

Prosthetic and Orthodontic Treatment of Adult Patients with a Unilateral Cleft Lip and Palate: Two Clinical Reports

Adult cleft lip and/or palate (CL/P) patients with a maxillomandibular skeletal discrepancy and missing teeth require an interdisciplinary approach for esthetic satisfaction. The prosthetic and orthodontic treatments for two unilateral CL/P patients with 2 different prostheses and orthodontic interventions are described. A 20-year-old woman with a skeletal Class II, anterior open bite, and the missing teeth was treated with zirconia-based fixed dental prostheses after orthodontic treatment with the intrusion of the maxillary molars using miniscrews. A 34-year-old man with a skeletal Class III, anterior crossbite, chronic generalized moderate periodontitis, and the defected area was treated with a dental implant, and zirconia-based fixed dental prostheses after periodontal treatment and bimaxillary surgery. These clinical reports demonstrate that prosthetic treatment combined with nonsurgical or surgical orthodontic treatment can be effective for adult patients with unilateral CL/P and missing teeth. The therapeutic approaches resulted in improvements in the patients’ facial appearances and satisfaction.

Remote Corticotomy Accelerates Orthodontic Tooth Movement in a Rat Model.

Introduction With an increasing demand for orthodontic treatment for adult patients, orthodontic professionals are constantly seeking novel strategies and technologies that can accelerate tooth movement in order to shorten the treatment period. For instance, in recent years, the influences of different surgical techniques on orthodontic tooth movement in the ipsilateral side of surgery were intensively investigated. Here, we attempt to examine if corticotomy could also affect the rate of tooth movement in the contralateral side of the surgery by using a rodent model. Materials and Methods 72 eight-week-old Sprague-Dawley rats were randomly divided into three groups as follows: the Control group (orthodontic treatment devices delivered only, no tooth movement), the orthodontic tooth movement (OTM) group (orthodontic treatment devices delivered and orthodontic treatment performed), and the Corticotomy + OTM group (remote corticotomy performed, orthodontic treatment devices delivered, followed by orthodontic treatment). The surgical procedure was conducted on the right side of the maxilla at the time of appliance placement and a force of 60 g was applied between the maxillary left first molar and maxillary incisors using nickel-titanium springs to stimulate OTM. The OTM distance and speed were tracked at 3, 7, 14, and 28 days post-surgery, followed by histological and immunohistochemical assessments. Results In comparison with orthodontic treatment only, the contralateral corticotomy significantly accelerated OTM. Furthermore, animals undergoing corticotomy + OTM presented with a greater number of osteoclasts on the compression side, stronger staining of the osteogenic marker on the tension side, and higher expression of an inflammatory marker than the OTM group animals. Conclusion Our current study demonstrates that remote corticotomy effectively accelerates alveolar bone remodeling and OTM. The study enriches our understanding of the regional acceleratory phenomenon (RAP) and offers an alternative strategy for accelerating OTM to shorten the orthodontic treatment period.