Preadjusted Edgewise Appliance Research Articles

Effortless canine up-righting with super elastic round wire

Addressing dental irregularities and discrepancies in tooth size and arch length often involves intricate decision-making in planning orthodontic treatment for permanent teeth. Ensuring precise alignment of the dental crown's longitudinal axis is crucial for stability and achieving a balanced bite. In the past, orthodontists had to incorporate specific bends in the arch wire to achieve accurate tooth movements. However, with the introduction of the pre-adjusted edgewise appliance (PEA) it was thought to reduce the need for these complex wire manipulations, saving valuable time for clinicians. Rectangular NiTi and stainless-steel wires, along with specific auxiliaries, are commonly employed by orthodontists to correct tilted canines during the levelling and alignment phase, particularly when dealing with issues related to tip and torque using the built-in features of the PEA. Nonetheless, there are instances where these inherent features may prove insufficient due to mechanical inefficiency, prompting the utilization of auxiliary methods to rectify such issues. This article proposes a novel approach - the insertion of super elastic NiTi wire in the ribbon arch mode - to effectively rectify a tilted canine.

Anterior En Masse Retraction in Orthodontics.

This article reviews and critically analyzes the literature on mini-implants (temporary anchorage devices) for anterior en masse retraction in orthodontics. The search methods used were an E-database search, a secondary computerized search of orthodontics journals, and a reference list of selected studies. Eligibility criteria included individuals who underwent orthodontic treatment for correction of malocclusion with premolar extraction. Data were taken from PubMed and Scopus as well as the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Keywords used for searching thearticle were temporary anchorage devices, premolar extraction, orthodontics, and anterior en masse retraction,Anterior en masse retraction with sliding mechanics in pre-adjusted edgewise appliances was considered for the study.Data collection and analysis involved three different researchers performing three steps of selection. All titles were initially filtered for irrelevant review articles. In the first step, all summaries from the selected studies were reviewed, and in the second, the entire content of the papers was read. The study was then discarded based on qualifying standards. A chart was created using the data from the final chosen research as well as the findings. The following information was evaluated for the final table: author, publication year, research structure, study group, sample size, methods/measures, study findings, and conclusion about frictionless mechanics. Results showed that a meta-analysis was not feasible due to clinical and statistical variability, as well as variations in study design, sample selection, and sample size. Thus, it was concluded thatsliding mechanisms are widely employed in orthodontic treatment, but temporary anchorage devices and sliding mechanisms deliver great results. There is a need to raise awareness about these devices and use them with care.

Keep it simple: correction of anterior cross bite – an ortho-perio interdisciplinary approach

This case report explores the treatment of a 13-year-old male patient with severe dental crowding and periodontal issues using non-extraction orthodontic treatment combined with a root coverage procedure. The patient presented with a skeletal class 1 base malocclusion, and multiple anterior crossbites, along with a compromised lower central incisor and gingival recession. Despite the option of extraction, the patient declined this approach, and the final goal was to achieve stable class 1 occlusion and an improved smile.The treatment plan utilized pre-adjusted edgewise appliance (MBT 0.022 inch slot), distalization of the canine, inversion of the maxillary right lateral bracket, and the cautious use of open coil spring in the upper and lower anterior segments. After alignment was completed, a root coverage procedure was performed on the lower right central incisor. The treatment lasted for 20 months, and the results showed successful alignment of both arches, canine protected occlusion, and improved periodontal health.Overall, this case report highlights the complex relationship between orthodontic treatment and periodontal health and the importance of careful treatment planning and patient communication to achieve successful and stable results. The non-extraction approach combined with root coverage procedure proved to be an effective treatment option for this patient, leading to an improved occlusion, smile, and periodontal health.

Cephalometric evaluation of deep overbite correction using anterior bite turbos.

To evaluate the outcome of treating deep overbite (OB) using anterior bite elevators concurrently with a pre-adjusted edgewise appliance. The Case Western Reserve University (CWRU) cephalometric analysis was used to isolate tipping movement of upper (TUI) and lower incisors (TLI), bodily tooth movement of upper (BUI), and lower incisors (BLI), as well as vertical skeletal changes in the anterior region of the maxilla (MXSK) and mandible (MNSK). Thirty treated subjects were examined at pretreatment (T1) and posttreatment (T2) and compared to an untreated control group matched on age, sex, and Angle malocclusion from the Bolton Brush Growth Study Collection (CWRU, Cleveland, Ohio). Overbite (OB) in the treated group was decreased significantly (P < .001) (-5.6 mm) compared to controls. Statistically significant (P < .001) changes were found for BUI (-0.7 mm), TUI (0.9 mm), TLI (-1.4 mm), BLI (-1.1 mm), and MNSK (-1.6 mm). Most of the overbite correction was in the lower arch and included tipping and intrusion of the lower incisors along with an increase in lower vertical facial height. Deep OB correction was achieved efficiently using anterior bite elevators with pre-adjusted edgewise appliance. Correction using bite turbos would be a treatment option for individuals presenting with decreased lower facial height and deep bite.

Spring Back the Lost Space: Fixed Space Regainer for E Space Loss- A Case Report

Maintenance of the E space is crucial to the normal development of dentition and early loss of second deciduous molars due to caries can compromise the same if not managed with a space maintainer. Fixed space regainers are being increasingly used to upright and distalisation of molars regaining the lost space and offering rapid results over their removable counterparts. Sectional orthodontics has been the focus of interceptive orthodontics in the recent past and the use of pre-adjusted edgewise appliances bonded to the erupted teeth and introduction of NiTi coil springs can help in rapid space regaining.

Orthodontic urgencies and their management during COVID-19 pandemic-A web-based survey.

This investigation aimed to evaluate the most common orthodontic urgencies, their management, and changes in routine biosafety measures and the total income of the dental office in South India during the COVID-19 pandemic. A questionnaire was drafted using Google Forms with questions in four domains pertaining to orthodontic urgencies, biosafety measures, treatment duration, and income. After validation, this questionnairewas sent to 750 orthodontists via WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif) over a period of 14 days.Descriptive statistics and comparisons were performed using independent t- and Chi-square tests. Majority of the orthodontists (62.3%) had closed their clinics only during the first lockdown. Many (63%) had scheduled urgent appointments along with routine limited patients per day. The most frequent urgencies were related to the breakage of brackets, archwires, molar tubes, bands, and temporary anchorage devices. Aligners were the least problematic. The treatment time was also prolonged. Telephonic advice and virtual assistance via WhatsApp messages/videos were found to be successful in the management of urgencies.Most orthodontists had strengthened their routine biosafety measures.The financial impact of this pandemic was considerable, with nearly 50% reduction in total income. Urgencies linked to preadjusted edgewise appliances, such as breakage of brackets and tubes, and archwire-related injuries were the most common. Prolongation of treatment time and negative financial impact were the other problems encountered during this pandemic. Drastic changes had occurred in routine biosafety measures, which prevented the spread of infection among orthodontists and patients.

Comparison of torque control between two commonly used 0.018-inch pre-adjusted edgewise bracket systems in North Indian population: a retrospective study

ABSTRACT Objective To compare the torque control between 0.018-inch MBT and Roth Pre-adjusted edgewise appliance in Angle’s Class I malocclusion patients treated with all first premolar extraction. Materials and Methods 40 patients with Angle’s Class I malocclusion treated with fixed orthodontic appliances using MBT (Group I) and Roth (Group II) prescriptions and extraction of all first premolars were included in the study. All the patients had tooth material-arch length discrepancy of >10 mm. Pre- (T1) and post-treatment (T2) study models were evaluated for the expression of torque (labio-lingual inclination). Torque was measured on study models using a Torque angulation device. Paired t-test and unpaired t-test were used for intra-group and inter-group comparison, respectively. P < 0.05 was considered to be statistically significant. Results In Groups I and II, the pre- to post-treatment differences in labio-lingual inclination decreased significantly (P < 0.05) for following teeth: 11, 21, 12, 22, 13, 23, 31, 41, 32 and 42. Intergroup comparison of Group I and Group II showed statistically significant difference (P < 0.05) in the mean change of labio-lingual inclination of following teeth: 11, 21, 12, 22, 16, 26, 31, 41, 32, 42, 33, 43, 36 and 46 teeth. Group I shows higher torque expression when compared to Group II. Conclusion The final position of maxillary and mandibular anterior teeth showed better torque expression by MBT compared to the Roth pre-adjusted edgewise appliances. Inadequate torque control was observed in mandibular posterior teeth treated by Roth prescription appliances.

Comparison of pain perception caused by aligner and conventional fixed orthodontic treatments

The aim of this study was to compare the pain perceived in fixed orthodontic and aligner treatments during the first seven days of treatment. Forty patients who had 3–6 mm maxillary dental crowding and a non-extraction treatment plan were included in this study. The subjects were randomly divided into two groups: the fixed orthodontic group and the aligner group, with ten females and ten males in each. In the fixed orthodontic group, treatment was started with 0.014-inch round nickel-titanium archwire, and a 0.018×0.025-inch preadjusted edgewise appliance was used. In the aligner group, treatment was started with a polyurethane aligner. Throughout the study, teeth in the upper jaw were treated in both groups. The pain scores of the subjects were measured with the visual analog scale at the second and sixth hours and on the first, second, third, and seventh days of treatment. The pain scores of the fixed orthodontic group were significantly higher than those of the aligner group at the sixth hour, on the first, second, and third day. The differences at the second hour and on the seventh day were not statistically significant. According to the study outcomes, less pain was felt during the aligner treatment compared to the fixed orthodontic treatment. However, it should be considered that the force activation interval is shorter in the aligner treatment, and the cumulative pain score may be higher.

Evaluation of effects of Forsus Fatigue Resistance device in correction of class II division 1 malocclusion in adolescent patient: A case report

Introduction: Class II malocclusion is one of the most prevalent malocclusions. The Class II malocclusions are caused due to forwardly placed maxilla, the backward position of the mandible, or a combination of both these factors. This disparity in skeletal base growth and position can be corrected during growth spurts using functional and fixed functional appliances. Description: An adolescent boy with Class II division 1 malocclusion, retrusive mandible, and increased overjet was treated with a pre-adjusted edgewise appliance (0.022-slot Gemini 3M -MBT prescription) along with a fixed functional appliance, Forsus TM Fatigue Resistant Device. The Skeletal age of the patient assessment using Hand wrist radiograph and CVM showed a major part of the adolescent growth spurt to be completed. Pre-treatment and post-functional cephalograms were traced and superimposed to compare changes in the skeletal base and dental structures. Result: The Class II molar and canine relationships were corrected to class I and the mandible showed forward positioning leading to correction for the skeletal base to class I. The facial profile showed marked improvement to an orthognathic pleasing profile. Conclusion: The purpose of this case report is to emphasize on use of fixed functional appliances in the treatment of adolescents with skeletal base discrepancies like Class II division 1 malocclusion. Intervention with fixed functional appliances at the appropriate skeletal age can prevent the need for extractions or other surgical procedures that may be needed to correct the malocclusion.

3D biomechanical intrusion effects of infra zygomatic bone screws and temporary anchorage device on total maxillary dentition in treatment of vertical maxillary excess: A FEM study

Many studies have reported on the application and clinical efficiency of full arch maxillary dentition intrusion mechanics; however, studies about biomechanical effects such as stress, strain, and displacements on the teeth and the surrounding tissues are limited. The objectives of study was to evaluate and compare the stress distribution and displacement of total maxillary dentition under intrusion mechanics using a three-dimensional finite element analysisA three-dimensional finite element model was constructed based on computed tomography scan data, and it served basic model. The geometric model was converted to finite element model using Altair HyperMesh software. Model A with pre-adjusted edgewise appliance (PEA) setup and Model B with occlusal Splint setup was evaluated and compared for von mises stress distribution and displacement of total (full arch) maxillary dentition by using three dimensional finite element analysis; with force delivered from infrazygomatic screws and miniscrew. Force levels for Model A and Model B includes a total of 300grams of intrusive force (each side) on maxillary posterior segment from IZC bone screw and 100grams of intrusive force on anterior segment from miniscrew.In the model A; with PEA setup reinforced with two trans-palatal arches, highest von Mises stress of 0.970 Mpa was produced on second molar roots followed by molar roots and premolars and central and lateral incisors roots. In the Model A, maximum intrusive values was seen on crown tip of central and lateral incisors (8.671µm), and lowest displacement values on second molars (2.230µm). Similar pattern of von Mises stress distribution and displacement was observed in the Model B. Model A and Model B provided an effective en masse vertical control of the full arch maxillary dentition. Higher intrusion displacement values were seen in anterior segment than the posterior segments

Management of a Skeletal Class II Malocclusion: An Indian Board of Orthodontics Case Report

This case report submitted as a Category II case report in the Indian Board of Orthodontics Phase III exam describes the orthodontic treatment of an 11-year-old female patient with a skeletal Class II malocclusion due to mandibular retrognathia. She presented in the late mixed dentition and was treated with a two-phase treatment protocol. The first phase involved growth modulation with a Twin Block Appliance for mandibular advancement followed by the second phase of treatment with upper and lower fixed appliances and a non-extraction treatment plan. The fixed appliance used was 0.022’’ slot, metal pre-adjusted edgewise appliance with MBT prescription. The summary of the treatment, the case report, and the various records are reprinted here with minimal editing and reformatting so that the presentation resembles the actual documents submitted to the board.

Cephalometric Evaluation of Changes in Tongue Position, Posture and Pharyngeal Airway Dimensions Following Treatment of Angle’s Class 1 Bimaxillary Proclination

Objectives:The aim of the study is to determine and correlate the effects of anterior teeth retraction on tongue position, posture and pharyngeal airway dimensions, in Angle’s Class 1 bimaxillary dentoalveolar proclination cases treated with all first premolar extraction. Materials and Methods:Pre and post treatment lateral cephalogram of fifteen Class I bimaxillary dentoalveolar proclination patients in the age group of 15-25years treated orthodontically as maximum anchorage cases with Preadjusted Edgewise Appliances (MBT prescription) and extraction of all first premolars were compared. Results:Tongue position analysis showed significant decrease in tg1: 2.2 +/- 1.52 mm (p = 0.001) and TGL: 4.2 +/- 3.877 mm (p = 0.001). Tongue posture analysis showed a significant decrease in Point 1: 1.48 +/- 1.92 mm (p=0.028), Point 2: 1.44 +/- 1.46 mm (p=0.008) and Point 5: 1.92 +/- 2.45 mm (p=0.026).Pharyngeal airway analysis showed significant increase in PNS-Ad1: 1.2 +/- 1.69 mm (p=0.016) while V-LPW: 2.0 +/- 3.047 mm (p=0.023) was decreased. No significant correlation was found between changes in total tongue length and velopharyngeal and glossopharyngeal airway. Conclusions:A significant reduction in the total tongue length particularly in the posterior region was observed after retraction. Also there was a reduction in the distance between root of the tongue and uvula, dorsum of the tongue and the roof of mouth in the posterior and anterior part of palate respectively. There was an increase in the lower nasopharyngeal airway and a decrease in the hypopharyngeal airway.

Management of Severe Proclination and Crowding Using Mini-Screw Anchorage: An IBO Case Report

This case report was presented at the Indian Board of Orthodontics examination under category I in September 2021. It demonstrates fixed orthodontic treatment of a 13-year-old female presenting with Angle’s Class I malocclusion on Class I skeletal base with an average growth pattern. This was complicated by a 7 mm overjet with proclination and crowding of the upper and lower labial segments. She also presented a reduced overbite and a centerline discrepancy of 1.5 mm. Lips were protruded and incompetent at rest with decreased nasolabial angle. Treatment involved extraction of all first premolars followed by fixed orthodontic mechanotherapy with preadjusted edgewise appliance (0.022 × 0.028” slot with MBT–McLaughlin Bennett and Trevisi prescription). Anchorage reinforcement in the upper arch was provided with mini-screw implants.

Long-term Management of a Patient with Apert Syndrome

To present an Apert syndrome patient with midfacial growth deficiency treated with Le Fort III distraction osteogenesis and subsequent two-jaw surgery. Apert syndrome is expressed as a severe and irregular craniosynostosis, midfacial hypoplasia, and symmetric syndactyly in the fingers and toes. For craniosynostosis syndromes, treatment planning is complex due to the disharmony between facial profile and occlusion. A 4-year-and-5-month-old boy, diagnosed with Apert syndrome, showed a concave profile accompanied with midfacial hypoplasia, moderate exorbitism, a reversed occlusion of -10.0 mm, an anterior open bite of -5.0 mm, and skeletal class III jaw-base relationship. The patient, aged 15 years and 4 months, underwent a Le Fort III osteotomy, and subsequent osteodistraction was performed via a rigid external distraction (RED) device. His midfacial bone was advanced by approximately 7.0 mm. One year after the distraction, preoperative treatment with 0.018-in preadjusted edgewise appliances was initiated. Two-jaw surgery with a Le Fort I osteotomy and bilateral sagittal split ramus osteotomy was performed after 42 months of preoperative orthodontic treatment. At the age of 20 years and 9 months, his facial profile dramatically changed to a straight profile, and an acceptable occlusion with an adequate interincisal relationship was obtained. A functional occlusion with an excellent facial profile was maintained throughout the 2-year retention period, although the upper dental arch width was slightly decreased, resulting in the recurrence of the left posterior crossbite. Our report indicates the necessity of long-term follow-up in patients with craniosynostosis because of syndrome-specific growth and methodologically induced relapse. The two-stage operation combining early distraction osteogenesis and postgrowth orthognathic surgery proves to be an effective therapy for correcting midfacial hypoplasia and skeletal mandibular protrusion caused by Apert syndrome.

Influence of tooth morphology on torque expression with preadjusted edgewise appliance in anterior teeth in a mixed indian population: An in-vitro study

The effect of racial and ethnic variations of dental morphological traits on torque expression of preadjusted edgewise appliances has rarely been documented. This in vitro experiment was carried out with the aim to study the extent to which the anterior tooth morphology of a mixed Indian population affects torque expression of a preadjusted edgewise appliance. This study was conducted on extracted maxillary and mandibular anterior teeth of a mixed Indian population. These teeth were divided into two similar groups and were bonded with 0.018” Roth and MBT prescriptions. Full slot engagement was obtained using a 0.018” x 0.025” stainless steel wire to study how the variation in the tooth morphology affects the torque expression. Each tooth with the test wire engaged in the slot was radiographed using standardised procedures. The radiographs were photographed; images were transferred to a computer and enlarged 6 times. Printouts of the images were taken and the torque expression angle for each tooth of the two groups was measured. A wide range of torque expression was obtained reflecting the influence of tooth morphology on the expression of torque, suggestive of significant variations in the tooth morphology of the same tooth type. However, the mean torque expressions obtained in this study were comparable to the average values of torque prescribed for the two prescriptions.

Non-extraction orthodontic treatment in a patient with severe anterior crowding

A 12 years 6 months old Indian male presented with a chief complaint of irregular upper and lower front teeth. Patient exhibited a mild convex profile on Class l skeletal base with slightly decreased vertical proportions. This was complicated by severe upper and lower labial segment crowding. Also the molar relationship was half unit class ll bilaterally. Since the patient did not want to go for extraction of premolars, treatment involved use of Pendulum appliance along with upper and lower pre-adjusted edgewise appliance (0.022x0.028” slot) with MBT prescription. Various elastics and overlay wires were used along with proximal stripping for the correction of severe crowding in upper and lower anterior teeth.: Clinically Angle’s Class I occlusion was achieved bilaterally with good intercuspal relationship. Vertical growth continued throughout the treatment.

A pre and post treatment comparison of class ii division 1 malocclusion cases treated with pre-adjusted edgewise appliances using the par index

PAR index provides a single summary score for all the occlusal anomalies and may be used for all types of malocclusions, treatment modalities and extraction/non extraction cases. The score provides an estimate of how far a case deviates from normal & the difference in score for pre & post – treated cases reflects the perceived degree of improvement & therefore the success of treatment. The aim of the study is to assess the success of treatment in class II Div. 1 cases by PAR index, treated in Department of Orthodontics, RUHS college of Dental Sciences Jaipur. Sample included 100 cases of Class II Div. 1 malocclusion treated with pre adjusted edgewise appliances which were divided into 2 groups, group A (extraction) and group B (non-extraction). The same were evaluated pre and post treatment.Material: Pre & Post treatment study models of selected cases, PAR index guidelines.Method-Class II Div. 1 pre treatment study models of patients were assessed by the PAR index and the deviation from the normal occlusion determined by the PAR index. A comparison of pre and post values in PAR index recorded. It serves as an indicator for correction achieved in malocclusion in post treatment cases.Results: Results showed significant pre and post treatment difference (p< 0.05) between group A and group B using PAR index, in terms of over jet and overbite.Conclusion: All the cases irrespective of extraction or non extraction mechanics showed significant overall improvement after treatment with pre adjusted edgewise appliance.

One Phase Treatment of Adolescent Class II Malocclusion Using Twin-Block Appliance and Preadjusted Edgewise Appliance—A Case Report

This case report was presented in the Indian Board of Orthodontics examination under category II in September 2020. It demonstrates the one-phase treatment of a skeletal class II malocclusion in a 11 year-4-month old female using a combination of functional and fixed appliance therapy. The treatment summary along with various supporting records are reprinted here with minimal editing and reformatting so as to reproduce the actual documents submitted to the board.

Unilateral Brodie bite correction in a growing patient using palatal and buccal miniscrews: A case report

Abstract This case report describes a 13-year-old Caucasian male who presented with a Class I dental relationship on a mild Class II skeletal base and an associated unilateral Brodie bite on the right side but an ideal anterior overjet and overbite. The posterior teeth in the first quadrant had supra-erupted due to a lack of opposing occlusion. The treatment comprised two phases, the first of which involved miniscrew-based intrusion of the maxillary right buccal teeth followed by non-extraction, full upper and lower pre-adjusted edgewise appliances during a second phase. A satisfactory occlusal result was achieved in 24 months.

Treatment of Class II malocclusion with the improved superelastic nickel-titanium alloy wire and long hooks for mandibular molar protraction

• Two patients were treated with extraction of the mandibular second premolars. • We used superelastic nickel-titanium alloy wires as working wires. • The use of nickel-titanium wires and long hooks worked to mesialize the molar bodily. The mandibular first molar must be carefully moved to prevent mesial tipping and extrusion in case extraction of the mandibular second premolar is required to achieve the desired goals. The nickel-titanium alloy has unique mechanical properties, including superelasticity and shape memory, leading to the generation of continuous light forces that may be more biologically compatible than intermittent strong forces. However, it provides poor root control because of its low stiffness. We herein have experienced the patients with Angle Class II malocclusion that uses the improved superelastic nickel-titanium wire (ISW) and long hooks to achieve bodily movement of the mandibular first molar. The 0.022 × 0.028-in slot preadjusted edgewise appliances and 0.020 × 0.025-in ISWs as the working archwire were used. We pinched the crimpable long hooks on the rectangular ISW and applied 100-150 g of contractile force between the fixed long hooks and bracket hooks of the mandibular first molars to activate the system with ligature wire lacing. The mandibular molars were uprighted and mesially moved; panoramic radiographs did not indicate severe root resorption. These experiences suggest that this method involving the combined use of the ISW and long hooks may be one of the useful methods for closing spaces by facilitating the uprighting and mesial movement of the molars in treating Class II malocclusion.