Appliance Placement Research Articles

Changes in Diet During Orthodontic Treatment in Adolescents. A Literature Review

Fixed orthodontic treatment, typically initiated during adolescence (a crucial period of growth) raises interest in evaluating dietary modifications resulting from their implementation, providing essential information for formulating appropriate dietary advice. This systematic literature review aims to assess dietary changes in adolescents following orthodontic treatment. An electronic search was conducted in the PubMed database with no time restrictions, following PRISMA guidelines. A combination of MeSH and non-MeSH terms, with no deadline, was applied, followed by a rigorous assessment of selected articles. The latest search was conducted on September the 20 th, 2023. Among the initially identified 224articles, only nine studies met the inclusion criteria. All, except one study, reported significant dietary modifications after treatment initiation. The installation of fixed orthodontic treatment in adolescents alters dietary habits, favoring soft foods. Anticipating the consequences on growth and diet habits is crucial, recommending tailored dietary advice before appliance placement. The registration number for this review on PROSPERO is CRD42023454959.

BN SO27 - Articulative Minimally Invasive Surgery and Placement of Anti-reflux Magnetic Surgical Appliance (LINX)

Abstract Background Gastro-oesophageal reflux disease (GORD) is a condition of prolonged retrograde flow of gastric contents into the oesophagus or structures beyond, causing symptoms such as heartburn and regurgitation.1 Laparoscopic Nissen Fundoplication (LNF) has been the surgical gold standard, however its side effects and technical challenges has limited its use to 1% of the GERD population.2 The use of a magnetic surgical appliance (LINX) has recently emerged as a promising treatment in overcoming the limitations of conventional LNF.3 Literature has shown patients aged less than 45 with satisfactory mean contraction amplitude (MAP) of 30mmHg and typical symptoms have favourable outcomes with LINX.3 Method This is a case of a 35-year-old patient presenting with typical reflux symptoms, with satisfactory MAP and high DeMeester score, patulous gastro-oesophageal junction and no hiatus hernia endoscopically. Steps for LINX placement are described in the video and we demonstrate the use of ArtiSential, an articulating laparoscopic instrument that provides better range of motion and angulation comparable to that of a robotic instrument. Results Using a magnetic surgical appliance (LINX) is superior to LNF through preservation of physiological belching and vomiting, reducing surgical time and duration of hospital stay while also scoring highly on quality of life and patient satisfaction.4 Conclusion We would recommend considering the placement of a LINX device in suitable patients as it provides good outcomes on par with LNF and to consider the use of an articulating instrument (ArtiSential) as it provides the surgeon better control and ease in placing a small device laparoscopically.

Changes in heavy metal levels in the oral fluid of young patients with and without plaque-induced gingivitis undergoing treatment with braces

Relevance. Research into the effects of nickel-titanium alloys and heavy metal ions on the development of inflammatory oral diseases is becoming increasingly significant in orthodontics. The relationship between toxic elements and inflammatory responses remains under-researched and controversial. Data on the connection between heavy metals and inflammatory reactions could influence the choice of orthodontic appliance materials and guide the subsequent management and monitoring of patients with braces. The question of the safe use of nickel-titanium alloy braces continues to be a relevant concern.Purpose. To assess the levels of heavy metals in the oral fluid of young patients with braces, both in those who developed plaque-induced gingivitis and those who did not.Materials and Methods. The study involved 50 clinically healthy patients (Groups I and II health categories) with intact teeth, including patients with compensated dental caries (isolated carious lesions – Grade I) and no periodontal diseases (PMA index <20), presenting with dental crowding and malocclusion (K07.2, K07.3). The average age of the patients was 22.1 ± 2.7 years, all of whom were undergoing treatment with metal braces. Oral fluid samples were analyzed for 12 heavy metal elements using inductively coupled plasma mass spectrometry (ICP-MS) in a laboratory setting. Additionally, lysozyme activity and oral fluid pH were measured before appliance placement and six months into orthodontic treatment.Results. Adaptation to braces in young patients is frequently complicated by the development of gingivitis and periodontitis due to impaired oral hygiene and the mechanical pressure exerted on teeth and gums, leading to elemental imbalances. Patients with gingivitis during orthodontic treatment are particularly at risk of developing such imbalances and therefore require timely correction of their mineral metabolism.

Antimicrobial Effects of Orthodontic Molar Tube Coated with ZnO Nanoparticles Using Electrophoretic Deposition Method: A Randomized Clinical Trial.

This study aimed to evaluate the antimicrobial effect of coated orthodontic molar tubes (COMT) with zinc oxide nanoparticles (ZnO NPs) using an electrophoretic deposition method (EPD) and to evaluate the orthodontic molar tubes (OMT) bond failure rate. Seventy-two orthodontic molar tubes (OMTs) for second molars were divided into two groups 36 each; one group coated with ZnO NPs and the other control negative uncoated. The OMT was coated using the EPD method with ZnO NPs in a concentration of 10g/l. The OMTs were randomly allocated using a split-mouth, cross-quadrant design. After 2weeks of appliance placement, swabs were taken from the surface of the OMTs for microbial assessment against Streptococcus mutans, Lactobacillus acidophilus, and total bacterial counts; additionally, plaque and gingival indices were assessed. The patient was followed for 3months to evaluate the bond failure rate. The COMT showed a statistically significant reduction in total bacterial accounts, S. mutans, and L. acidophilus compared to UOMT (P < 0.001). Furthermore, the plaque and gingival indices near COMT were significantly less than that of UOMT. The bond failure rate was not significant between the COMT and UOMT. The COMT with ZnO NPs has potent antibacterial activity against the tested pathogens with a reduction in the amount of plaque accumulation. The use of the EPD method was feasible without adverse effects on theorthodontic molar tubes bond failure rate.

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.

Analysis of the Effects of Different Orthodontic Appliances on Salivary pH Levels: An In vitro Approach.

Orthodontic appliances can influence the oral environment, including salivary pH levels, which play a crucial role in maintaining oral health. Understanding how different orthodontic appliances affect salivary pH levels can help in improving treatment outcomes and minimizing potential side effects. In this in vitro study, we evaluated the effects of various orthodontic appliances on salivary pH levels using a simulated oral environment. Four different types of orthodontic appliances were tested: traditional metal braces, ceramic braces, lingual braces, and clear aligners. Saliva samples were collected and subjected to pH measurements using a standardized method. The pH measurements were recorded at three different time intervals: immediately after appliance placement, after 24 hours, and after 48 hours. The initial pH values varied among the different orthodontic appliances: metal braces (pH 7.2), ceramic braces (pH 7.4), lingual braces (pH 7.1), and clear aligners (pH 7.5). After 24 hours, there was a decrease in pH levels for all groups: metal braces (pH 6.8), ceramic braces (pH 7.0), lingual braces (pH 6.7), and clear aligners (pH 7.2). After 48 hours, the pH levels continued to decrease: metal braces (pH 6.5), ceramic braces (pH 6.8), lingual braces (pH 6.4), and clear aligners (pH 6.9). Our findings suggest that different orthodontic appliances have varying effects on salivary pH levels. Metal braces and lingual braces tend to cause a more pronounced decrease in salivary pH compared to ceramic braces and clear aligners. Monitoring salivary pH levels during orthodontic treatment may be beneficial in identifying potential risks to oral health and implementing appropriate interventions.

Impact of clear aligner therapy on masticatory musculature and stomatognathic system: a systematic review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions

BackgroundClear aligner therapy has gained popularity as a minimally invasive orthodontic treatment option. However, its impact on the masticatory musculature and the stomatognathic system is an area of growing interest, as it involves the adjustment of occlusion and tooth movement. This systematic review aims to comprehensively assess and synthesise existing evidence regarding the influence of clear aligner therapy on the masticatory musculature and the stomatognathic system.MethodsAn exhaustive search was performed on electronic databases that adhered to PRISMA guidelines. Clinical studies that evaluated the impact of patients receiving aligner orthodontic treatment on the muscles of the mastication and stomatognathic systems were included. A standardised data extraction form was devised for relevant variables. Two reviewers extracted the data variables. ROB-2 was used for bias evaluation in the selected studies.ResultsA total of six studies met the inclusion criteria. The wearing of clear aligners significantly impacted the muscles of mastication. Muscle activity and discomfort showed a significant alteration in the initial days of appliance placement. but this observation was temporary, with no significant changes thereafter in subsequent follow-up. Bite force reduction was also noted. All the studies evaluated showed good methodological quality.ConclusionThe review found that aligned orthodontic treatment may have a variable impact on muscles of mastication, with a potential for initial exacerbation of symptoms followed by possible improvement. However, due to the limited number of studies and their heterogeneous nature, further robust research is recommended to fully understand the relationship between aligned orthodontic treatment and masticatory muscles.

Recognition of House Structures from Complicated Electrical Plan Images

Advances in image analysis and deep learning technologies have expanded the use of floor plans, traditionally used for sales and rentals, to include 3D reconstruction and automated design. However, a typical floor plan does not provide detailed information, such as the type and number of outlets and locations affecting the placement of furniture and appliances. Electrical plans, providing details on electrical installations, are intricate due to overlapping symbols and lines and remain unutilized as house manufacturers independently manage them. This paper proposes an analysis method that extracts the house structure, room semantics, connectivities, and specifics of wall and ceiling sockets from electrical plans, achieving robustness to noise and overlaps by leveraging the unique features of symbols and lines. The experiments using 544 electrical plans show that our method achieved better accuracy (+3.6 pt) for recognizing room structures than the state-of-the-art method, 87.2% in identifying room semantics and 97.7% in detecting sockets.

En-masse Distalization of Maxillary Arch with Modified Hybrid Hyrax Appliance: A Case Report

Class II malocclusion is one of the most commonly seen malocclusions in the orthodontic practice, with a variety of treatment modalities found in the literature. Maxillary molar distalization is a one of treatment options of dental Class II patients with excessive overjet, anterior crowding, or both. However, a commonly seen side effect in the conventional distalization devices is anchor loss. Here, in this case report, we have shown the successful treatment of a Class II malocclusion patient with a new concept of modified placement of the hybrid hyrax appliance, which was used effectively for en-masse, bodily distalization of maxillary teeth, with no anchorage loss. Also, the same appliance could be used for retention after the active distalization period till the treatment completion.

PAOO Technique for The Bimaxillary Protrusion: A Case Report

Background: Bimaxillary protrusion is a common malocclusion that can lead to functional and aesthetic issues. Conventional orthodontic treatment may not always be effective, and surgical approaches can be invasive. The Periodontally Accelerated Osteogenic Orthodontics (PAOO) technique is a minimally invasive alternative that involves corticotomy and orthodontic treatment. Objective: This case report aimed to evaluate the effectiveness of the PAOO technique for the correction of bimaxillary protrusion in a 16-year-old female patient. Methods: The PAOO technique involved corticotomy and piezocision on a 16-year-old female patient undergoing orthodontic treatment with a fixed appliance. The patient was being followed up for 18 months after orthodontic appliance placement with premolars extractions but did not get any favorable result and was referred by the Department of Orthodontics to undergo corticotomy procedure. The effectiveness of the treatment was evaluated using cephalometric and occlusal analyses. Results: The PAOO technique significantly improved the patient’s skeletal and dental parameters. The maxillary and mandibular incisors were retracted, resulting in a significant improvement in the patient’s profile. The occlusal analysis showed good intercuspation and a stable occlusion. Conclusion: The PAOO technique is a viable option for the correction of bimaxillary protrusion, as it can achieve significant improvements in skeletal and dental parameters with minimal invasiveness. Further studies are needed to validate these findings and compare the PAOO technique with conventional surgical and orthodontic approaches.

Nanocurcumin Release from Self-Cured Acrylic Resins; Effects on Antimicrobial Action and Flexural Strength.

The placement of orthodontic appliances into the oral area can lead to infection, inflammatory and gingival collapse. Using an antimicrobial and anti-inflammatory material in the matrix of orthodontic appliance may help to reduce these issues. This study aimed to assess the release pattern, the antimicrobial action and the flexural strength of self-cured acrylic resins after adding different weight percentages of curcumin nanoparticles (nanocurcumin). In this in-vitro study, 60 acrylic resin samples were divided into five groups (n = 12) based on the weight percentage of curcumin nanoparticles added to the acrylic powder (0 for control, 0.5, 1, 2.5, and 5%). Then, the dissolution apparatus was used for the release assessment of nanocurcumin form the resins. For antimicrobial action assessment, the disk diffusion method was used and a three-point bending test was performed with a speed of 5 mm/min to determine the flexural strength. Data were analyzed using one-way analysis of variance (ANOVA) and Post-Hoc Tukey tests (with p < 0.05 as significant level). The microscopic images showed the homogeny distribution of nanocuricumin in self-cured acrylic resins in varied concentrations. The release pattern showed a two-step release pattern for all concentrations of nanocurcumin. The one-way ANOVA outcomes indicated that adding curcumin nanoparticles to self-cured resin increased the diameter of the inhibition zones for the groups against Streptococcus mutans (S. mutans) significantly (p < 0.0001). Additionally, as the weight percentage of curcumin nanoparticles increased, the flexural strength decreased (p < 0.0001). However, all strength values were higher than the standard value (50 MPa). No significant difference was detected between the control group and the group with 0.5 percent (p = 0.57). Considering the proper release pattern and the potent antimicrobial activity of curcumin nanoparticles, then the preparing self-cured resins containing curcumin nanoparticles can be beneficial for antimicrobial aims without damaging the flexural strength to use in orthodontic removable applications.

Effects of wearing fixed orthodontic appliance on dynamic balance, reaction time, and pain perception in adolescents and young adult elite athletes

Objective To investigate the effects of using fixed orthodontic appliance on dynamic balance, auditory/visual reaction times, as well as pain perception in adolescent and young adult elite athletes. Methods A total of 34 elite athletes (n = 19 males) aged 16–21 years from different sports (track and field sprint, long jump and discus throw) were randomly allocated to treatment (n = 17) or control (n = 17) groups. The treatment group received self-ligating brackets with 0.04 cm super-elastic nickel-titanium arch wire, placed in the brackets to correct the teeth position. Perceived pain (i.e., visual analogue scale), dynamic balance (i.e., Y balance test), and auditory reaction time and visual reaction time using Direct RT software were assessed before (day−1), and on five occasions after fixed orthodontic appliance placement (day+1, +3, +7, +14, and +30). The two groups’ quantitative data [expressed as mean (standard deviation)] for each occasion were compared using the Student’s t-test. Comparisons of the Y-balance test, auditory reaction time, visual reaction time, and pain visual analogue scale data were each made between the 6 occasions via a factorial A × B analysis of variance in order to check for the possible interaction between the two groups and the (6) consecutive days (occasions). Results Compared to the control group, the treatment group showed significantly (i) lower values of anterior reach for both the dominant ([78(4) vs. 75(3)%, respectively]) and the non-dominant [76(3) vs. 74(4)%, respectively] legs at day+3, and (ii) higher values of pain visual analogue scale at day+1, day+3, and day+7 [0.00(0.00) vs. 4.94(1.25); 0.00(0.00) vs. 4.12(1.17), and 0.00(0.00) vs. 0.41(0.51), respectively). Factorial analysis of variance revealed that only pain visual analogue scale values were different between the two groups at day+1 and day+3. Conclusion FOA induced a high pain level during the first week following its placement in elite athletes.

The Changes in Nickel and Chromium Ion Levels in Saliva with Fixed Orthodontic Appliances: A Systematic Review

Fixed orthodontic appliances (braces systems) contain variable amounts of nickel and chromium, which can lead to immune responses and allergic reactions. The objective of the present review was to evaluate the changes in the quantity of nickel and chromium in saliva among patients wearing braces systems. The electronic databases used to perform the search were Pubmed, ReasearchGate, and Google scholar. After an initial search of these electronic databases, 12 studies were included in the systematic literature review. Overall, 554 patients wearing non-removable orthodontic appliances participated in the research that we reviewed. The age of the subjects ranged from 11 to 35 years. The quantity of chromium and nickel ions in saliva was measured before the braces systems were placed and after some period of having them. After evaluating the changes in nickel and chromium levels in saliva during orthodontic treatment with fixed brackets, it can be concluded that there is an increase in the levels of nickel and chromium ions in saliva. There is a significant increase in these ions after placement of the orthodontic appliances, peaking from three to six months, but not reaching toxic levels. The levels then gradually decrease. A full and detailed examination of the patient before starting orthodontic treatment is important, and alternative orthodontic appliances for patients who are allergic to nickel and/or chromium should be recommended.

A MULTIDISCIPLINARY APPROACH TO MANAGING BIMAXILLARY HYPERHYPODONTIA: A CASE REPORT

Bimaxillary hyperhypodontia (BHH) is a very rare numeric anomaly with a prevalence of 0.002% to 3.1% described by the presence of a supernumerary tooth in the premaxilla region and a missing mandibular incisor tooth. This case highlights the multidisciplinary management of a child presenting with BHH who complies with the recommended protocol by surgically removing the supernumerary tooth and then proceeding with orthodontic treatment for function and aesthetics. A 9-year-old healthy Malay boy presented with a fully erupted tooth 21, a labially palpable bulge of unerupted tooth 11, a missing tooth 32, and a tendency for an anterior and posterior crossbite. The radiographs showed an inverted, unerupted, conical-shaped supernumerary tooth overlapping the unerupted tooth 11 and hypodontia of tooth 32. The management was surgical removal of the supernumerary tooth and the placement of an upper removable appliance with a palatal expansion screw followed by comprehensive fixed orthodontics.

Impact of fixed orthodontic appliances on blood count and high-sensitivity C-reactive protein levels: A prospective cohort study

The aim was to elucidate the magnitude of alterations in systemic blood counts in healthy patients during the first 14 days after fixed orthodontic appliance placement. This prospective cohort study consecutively included 35 White Caucasian patients starting orthodontic treatment with fixed appliances. The mean age was 24.48 ± 6.68 years. All patients were physically and periodontally healthy. Blood samples were collected at 3 time points: (1) baseline (exactly before the placement of appliances), (2) 5 days after bonding, and (3) 14 days after baseline. Whole blood and erythrocyte sedimentation rates were analyzed in automated hematology and erythrocyte sedimentation rate analyzer. Serum high-sensitivity C-reactive protein levels were measured by the nephelometric method. Standardized sample handling and patient preparation procedures were adopted to reduce preanalytical variability. A total of 105 samples were analyzed. All clinical and orthodontic procedures were performed without complications or side effects during the study period. All laboratory procedures were performed per protocol. Significantly lower white blood cell counts were detected 5 days after bracket bonding, compared with baseline (P<0.05). Hemoglobin levels were lower at 14 days than baseline (P<0.05). No other significant shifts or alteration patterns were observed over time. Orthodontic fixed appliances led to a limited and transient change in white blood cell counts and hemoglobin levels during the first days after bracket placement. The fluctuation of high-sensitivity C-reactive protein levels was not significant, demonstrating a lack of association between systemic inflammation and orthodontic treatment.

Pain and discomfort perception during miniscrew-anchored maxillary protraction: secondary data analysis of a randomized clinical trial.

To compare the perception of pain and discomfort of patients and guardians during treatment between miniscrew-anchored maxillary protraction (MAMP) therapy using Hybrid (HH) and Conventional Hyrax (CH) expanders. Group HH was composed of 18 subjects (8 female, 10 male; initial age: 10.80 years) with Class III malocclusion treated with a hybrid expander in the maxilla and two miniscrews in the anterior region of the mandible. Class III elastics were used from maxillary first molar to mandibular miniscrews. Group CH was composed of 14 subjects (6 female, 8 male; initial age: 11.44 years) treated with a similar protocol except for conventional Hyrax expander. Pain and discomfort of patients and guardians were assessed using a visual analog scale immediately after placement (T1), after 24 hours (T2), and 1 month after appliance installation (T3). Mean differences (MD) were obtained. Intergroup and intragroup timepoint comparisons were performed using independent t-tests, analysis of variance for repeated measures and Friedman test (P < 5%). Both groups demonstrated similar levels of pain and discomfort with a significant decrease after 1 month of appliance placement (MD: 4.21; P = .608). Compared to patient perceptions, guardians reported a higher level of pain and discomfort at all timepoints (MD, T1: 13.91, P < .001; T2: 23.15, P < .001; T3: 9.35, P = .008). MAMP therapy with HH and CH produced similar levels of pain and discomfort after appliance installation until 1 month after treatment. Pain and discomfort may not influence the choice between HH and CH expanders.

Salivary peptidome analysis and protease prediction during orthodontic treatment with fixed appliances

Orthodontic tooth movement (OTM) occurs through proteolytic remodelling within the periodontium following the application of external force to the tooth. This study describes the first characterization of the salivary peptidome and protease profile during the alignment stage of fixed appliance orthodontic treatment. Unstimulated whole mouth saliva from 16 orthodontic patients (10 males, 6 females, mean (SD) age 15.2 (1.6) years) was collected prior to fixed appliance placement (T1), 1-h (T2), 1-week (T3) following fixed appliance placement and on completion of mandibular arch alignment (T4). Salivary peptides were extracted using filtration followed by mass spectrometry to identify amino acid sequences. Protease prediction was carried out in silico using Proteasix and validated with gelatin zymography and enzyme-linked immunosorbent assay. A total of 2852 naturally-occurring peptides were detected, originating from 436 different proteins. Both collagen and statherin-derived peptide levels were increased at T2. Proteasix predicted 73 proteases potentially involved in generating these peptides, including metalloproteinases, calpains and cathepsins. Changes in predicted activity of proteases over time were also observed, with most metalloproteinases showing increased predicted activity at T2–T3. Increased gelatinolytic activity and MMP8/MMP9 levels were detected at T3. Collectively, multiple protein targets and changes in protease-predicted activity during OTM have been identified.

Use of liquid-based cytology samples reveals genomic instability and cell death in patients undergoing orthodontic treatment.

To examine the use of liquid-based exfoliative cytology to determine the presence of genomic instability and cell death in the oral mucosa of patients with orthodontic appliances. Fifty-four oral mucosa samples were collected from 18 patients and divided into three stages: T0, before fixation of orthodontic appliances; T1, 25 days after appliance fixation; T2, 90 days after appliance fixation. All samples were Papanicolaou-stained and observed by microscopy (1,000 cells/sample) to ascertain the frequency of micronucleated cells (MN) and nuclear abnormalities (nuclear buds (NB), binucleated (BN), condensed chromatin (CC), karyorrhexis (KR), and karyolysis (KL)). Differences were analyzed statistically using the Mann-Whitney, Wilcoxon, Kruskal-Wallis and chi-squared tests. After placement of orthodontic appliances, significant differences were observed for genomic instability biomarkers (MN and NB) and cell death (CC, KR and KL) (P < 0.05). Female patients and older patients exhibited a higher frequency of MN. Liquid-based cytology has revealed that orthodontic appliances induce genomic instability and cell death in epithelial tissue of the oral mucosa, facilitating sample preservation and yielding more than one preparation per sample. Future studies should investigate whether such cell damage can be reversed through cell repair or whether cell alterations evolve and lead to disease.

The influence of fluoxetine on orthodontic tooth movement in rats.

This study aimed to evaluate the effects of chronic use of fluoxetine on the amount of orthodontic tooth movement and tissue changes in rats. A total of 192 Wistar rats were divided into 4 groups: S, 0.9% saline solution; F, 20 mg/kg of fluoxetine; SM, 0.9% saline solution with orthodontic movement; and FM, 20 mg/kg of fluoxetine with orthodontic movement. After 30 days of daily saline or fluoxetine administration, an orthodontic device (25cN) was used to mesially displace the first molar in animals of the groups SM and FM. The animals were euthanized 2, 7, 14, and 28 days after placement of the orthodontic appliances and animals of groups S and F were euthanized at the same time. The assessment of tooth movement was made in gypsum castings, the collagen neoformation was assessed by polarization microscopy, the number of osteoclasts and root resorption were evaluated using tartrate-resistant acid phosphatase, and presence of hyalinized areas was assessed by hematoxylin-eosin staining. Fluoxetine did not affect the amount of tooth displacement, percentage of collagen, number of osteoclasts, and presence of hyalinized areas (P>0.05). There was a higher frequency of root resorption areas in the FM group than in the SM group only on the second day (P<0.05). The findings of this study show that chronic use of 20 mg/kg fluoxetine does not affect the amount of tooth movement, collagen neoformation, number of osteoclasts, or hyalinized areas and does not affect root resorption until the last day of orthodontic movement.

Efficiency of a Bite Wafer on Pain Relief after Self-ligating Orthodontic Fixed Appliance Placement in Adolescents: A Single-centre Randomised Controlled Trial

Introduction: The most common treatment proposed to relieve pain and discomfort stemming from the orthodontic treatment is Non Steroidal Anti-Inflammatory Drugs (NSAID). Non pharmacological approaches, such as chewing a Bite Wafer (BW), have emerged to manage orthodontic pain to avoid sideeffects of ibuprofen or paracetamol in adolescents. Aim: To compare efficiency between a BW chewing group and a control group to relieve orthodontic pain after the placement of a self-ligating fixed appliance in adolescents. Materials and Methods: The present single-centre randomised controlled trial in the Department of Orthodontics and Dentofacial Orthopaedics, University Hospital, Liège, Belgium, between August 2019 and December 2020 included 33 teenagers who needed a self-ligating bimaxillary fixed orthodontic appliance. The patients were randomly allocated either to a test group encouraged to first chew on a BW to relieve the pain and then use paracetamol according to need, or to a control group authorised to consume paracetamol only. The BW group was hypothesised to be non inferior to the control group with a margin of 250 mg (one tablet). Data were collected for eight times over a seven-day period. For both groups, pain during four oral functions (biting with front and back teeth, chewing a piece of apple and tapping teeth together three times) were assessed at each time point through the use of a numerical analog scale. The impact of orthodontic appliance on eating habits and functional limitations was evaluated at the end of the study period. Data was calculated as means and standard deviation for quantitative variables, median and Interquartile Range (IQR) were added for skewed data. Results: The mean age of study participants was 12.3±1.1 years and 12.9±1.8 years for control group and BW group, respectively. At each time point, no statistically significant difference was observed between the two groups for the paracetamol consumption and the pain reported while the four oral functions. Functional limitations were also comparable. Total average consumption of paracetamol over seven days was lower in the test group (1000±954 mg vs 1150±844 mg) but non inferiority of BW compared to paracetamol only could not be statistically demonstrated. The test group used BW on average 5.6±8.9 times and 12.8±12.4 minutes during the seven days. Conclusion: No significant difference in consumption of paracetamol was seen between the BW and paracetamol group.