Orthodontic Treatment Outcome Research Articles

Assessment of Various Archwire Materials and Their Impact on Orthodontic Treatment Outcomes

Assessment of Various Archwire Materials and Their Impact on Orthodontic Treatment Outcomes

Tele-Orthodontics: A Lifesaver during COVID-19 Second Wave

Aim: The study aims to evaluate the outcome of orthodontic treatment during the COVID-19 Pandemic using Tele-Orthodontics.  Objective: To explain how Tele-orthodontics represents an excellent way to perform orthodontic follow-ups during a period of restriction and to assess the effectiveness of follow-up using Tele-Orthodontics during the COVID-19 Pandemic.  Materials and Methods: Study design: Our study involves 30 patients in total, where 15 patients did not receive any further therapy and 15 patients had Tele-orthodontics treatment, with 10 patients receiving bonding treatment, 10 receiving mid- treatment treatment, and 10 receiving retention appliances. The communication tools used in our study and proposed in our model of tele-orthodontics include an online questionnaire using Google form once every 15 days, Tele-calling with Google Meet once a month, and frontal, side profile, and occlusal view (if possible) photos via WhatsApp messenger.  Results: Tele-orthodontics proved to be the only option to complete some orthodontic tasks during COVID-19 because it provided a means of communication between the dentist and the patient. Most of the patients who underwent bonding (66.7%), on retainer (96.7%), and during mid-treatment (93.3) maintained good oral hygiene during treatment. 93.3% of the patients’ appliances on retainer were holding tight in place with no discomfort and during the treatment, 70% of the patients were comfortable while speaking and 63.3% noticed changes in their appearance. Overall, Tele orthodontics was more time-saving and more desirable economically to both practitioners and patients.  Conclusion: Tele-Orthodontics is experiencing rapid growth and fierce competition. Most of the patients maintained good oral hygiene, and also had a positive perception of the use of Tele-Orthodontics.

A Comparative Analysis of Sector Classification and the Impacted Canine Grading System by Kumar and Daigavane in Patients With Unilateral Cleft Lip and Palate Utilizing Orthopantomogram (OPG) as a Diagnostic Tool.

Introduction Non-syndromic oral clefts, affecting one in 700 newborns in India, are the most prevalent craniofacial anomalies, with genetic or environmental causes impacting various life aspects. Studies indicate higher dental disturbances, particularly impacted canines, in cleft lip and palate (CLP) patients compared to non-cleft individuals. Impacted canines, trapped by hard tissues, require early diagnosis to prevent orthodontic issues. The widely used Ericson and Kurol method employs orthopantomograms (OPGs) to classify canine impaction in typical children. However, diagnosing canines in CLP patients is challenging due to palate defects and post-grafting complications. This study aims to compare the utility of the Kumar and Daigavane (KD) grading system and the sector classification to determine the best method for diagnosing impacted canine eruption paths. Method This cross-sectional comparative observational study was conducted at Sharad Pawar Dental College's Department of Orthodontics and Dentofacial Orthopaedics. The sample size, calculated using a significance level of 5% and a prevalence of 1%, required a minimum of 16 participants aged 9-11 years with non-syndromic clefts and impacted canines. Patients with systemic diseases or over 12 years of age were excluded. The sectoral and KD classification systems collected and evaluated OPGs from qualifying cleft patients. Sector classification considered the angle between the occlusal plane or canine tip and the adjacent tooth's long axis, while KD's classification considered the Frankfort horizontal plane, occlusal plane, vertical height from the occlusal plane, canine apex root position, and canine exposure to the cleft defect. Results The study found an 81.25% agreement between the KD grading system and the sector classification, with a Cohen's kappa value of 0.586, indicating a moderate agreement. The KD system showed 81.82% sensitivity and 80.00% specificity, with positive and negative predictive values of 90.00% and 66.67%, respectively. The receiver operating characteristic (ROC) curve analysis revealed the KD system's superior performance in identifying impacted and non-impacted canines compared to the sector classification. Conclusion The KD grading system demonstrated higher efficacy than the sector classification for evaluating the impacted canines in children with unilateral cleft lip and palate (UCLP). The KD system's high sensitivity and specificity make it a valuable tool for predicting canine eruption paths and addressing anatomical challenges in cleft conditions. This study highlights the need for accurate diagnostic tools tailored to cleft patients and contributes to advancing orthodontic treatment outcomes through improved classification systems.

Research progress on labial protuberances of anterior teeth in orthodontic treatment.

Orthodontic treatment is a commonly utilized method for improving both facial aesthetics and occlusal function. During orthodontic treatment irregular, nodular labial protuberances on the labial side of the anterior teeth may occasionally occur, varying in number and size, which is closely connected to the differential bone remodeling patterns on the internal and external surfaces of the labial alveolar bone. Labial protuberances can not only affect the aesthetic results of orthodontic treatment, but also pose potential risks to periodontal health. Currently, it is believed that the influencing factors of the formation of the labial protuberances may be related to the patient's gender and age, tooth movement speed, and extent of anterior teeth retraction. Labial protuberances typically resolve spontaneously, however, if it is persistent, alveoloplasty may be necessary for treatment. This review provides a summary on the occurrence hypothesis, influencing factors of formation, potential biological mechanisms, and corresponding treatment methods of labial protuberances during orthodontic treatment.

Evaluating the Impact of Myofunctional Therapy on Orthodontic Treatment Outcomes

ABSTRACT Background: Myofunctional therapy has gained attention as a potential adjunct to orthodontic treatment, focusing on improving orofacial muscle function and balance. Despite its increasing popularity, the precise impact of myofunctional therapy on orthodontic treatment outcomes remains to be fully elucidated. Materials and Methods: A retrospective cohort study was conducted, involving 80 orthodontic patients aged 8–18 years, divided into two groups: Group A received orthodontic treatment alone, while Group B received orthodontic treatment combined with myofunctional therapy. Orthodontic treatment outcomes were assessed based on occlusal stability, facial aesthetics (evaluated through standardized photographs), and patient-reported satisfaction scores. Posttreatment stability of occlusion was assessed using the peer assessment rating (PAR) index, with lower scores indicating better occlusal outcomes. Results: The results indicated a significant improvement in orthodontic treatment outcomes among patients who received myofunctional therapy in addition to orthodontic treatment. Group B demonstrated a mean decrease of 25% in PAR index scores compared to Group A, indicating superior occlusal stability posttreatment. Facial aesthetics were also notably enhanced in Group B, with a higher percentage of patients achieving harmonious facial profiles than Group A. Additionally, patient satisfaction scores were significantly higher in Group B, with 85% of patients reporting high satisfaction levels, compared to 60% in Group A. Conclusion: Myofunctional therapy as an adjunct to orthodontic treatment has a positive impact on treatment outcomes, including improved occlusal stability, enhanced facial aesthetics, and increased patient satisfaction.

Comparative Analysis of Braces and Aligners: Long-Term Orthodontic Outcomes

ABSTRACT Objectives: The purpose of this retrospective study was to evaluate the long-term results of orthodontic treatment with traditional braces and Invisalign, with a particular emphasis on treatment length, patient satisfaction, correction of malocclusion, and long-term stability. Methods: Between 2020 and 2022, individuals who had orthodontic treatment at a tertiary care center had their data analysed. Patients with mild to severe malocclusions treated with conventional braces or Invisalign between the ages of 12 and 18 met the inclusion criteria. Assessments were done on results, length of treatment, degree of malocclusion, and long-term stability. With significance set at P < 0.05, statistical analyses comprised t-tests for treatment duration and Chi-square testing for malocclusion correction. Findings: The mean treatment time for Invisalign was much shorter (18 months) than for conventional braces (24 months) (P < 0.001). With 88–90% success rates, both techniques demonstrated remarkable success rates in malocclusion treatment. Even though Invisalign was associated with a somewhat greater percentage of relapse instances, the difference was not statistically significant (P > 0.05). Conclusion: In conclusion, Invisalign showed a much shorter treatment period than conventional braces, yet both showed excellent malocclusion correction. The choice of modality should be based on patient satisfaction, treatment objectives, and case complexity, taking into account the trade-offs between treatment length and potential variations in long-term stability.

Oral and Extra-Oral Manifestations of Hypersensitivity Reactions in Orthodontics: A Comprehensive Review.

Although rare, oral manifestations of hypersensitivity reactions in orthodontic patients pose a significant clinical challenge due to their heterogeneous presentations, and can cause discomfort and pain, possibly impacting patients' quality of life and orthodontic treatment duration and outcomes. This comprehensive review aimed to elucidate the oral, perioral, and systemic manifestations of hypersensitivity reactions in orthodontic subjects, focusing on patients with fixed appliances, removable appliances, and clear aligners, and detailing their epidemiology, macroscopic and microscopic features, allergy testing, clinical implications, and specific management strategies. Oral and extra-oral manifestations of (immediate and delayed) hypersensitivity reactions occur rarely and are due to the release of metal and non-metal ions from orthodontic appliances. They typically present as erythema, erosive-ulcerative lesions, and gingival hyperplasia, with histopathological findings showing inflammatory infiltrates. Nickel is a significant allergen, and diagnostic tests like patch tests are essential for managing these reactions. Likely due to prolonged contact with oral tissues, fixed orthodontic appliances pose a higher risk compared to removable appliances and clear aligners. Early identification and removal of allergenic materials, combined with effective treatments, can resolve symptoms and prevent recurrence. Keeping dental and medical records updated and knowing family and personal medical histories helps clinicians choose appropriate materials and counsel patients about potential risks. Proper patient education, regular monitoring, and using hypoallergenic materials are key strategies for managing these reactions.

Genetic polymorphisms linked to extreme postorthodontic external apical root resorption in Koreans

BackgroundExternal apical root resorption (EARR) is a common undesirable outcome of orthodontic treatment, this study aimed to identify genetic polymorphisms associated with the susceptibility to extreme orthodontic-induced EARR in a Korean population using extreme phenotype analysis sampling.MethodsGenomic DNA was isolated from the saliva of 77 patients who underwent orthodontic treatment involving two maxillary premolar extractions. The patients were divided into two groups based on EARR values measured on periapical radiographs: The significant resorption group (SG, EARR ≥ 4 mm) and the normal group (NG, EARR < 2 mm). In the NG group, patients with EARR < 1 mm were named the non-resorption group (NonG). Targeted next-generation sequencing was performed using the screened single nucleotide polymorphisms (SNPs), and firth logistic regression analysis was used to determine genetic associations with EARR. Haplotype-based association analysis was performed for specific SNPs.ResultsSNPs related to genes TNFSF11, TNFRSF11B, WNT3A, SFRP2, LRP6, P2RX7, and LRP1 were found to be significantly associated with severe EARR (p < 0.05, pre-Bonferroni correction p-values). Additionally, the haplotype CCA of rs17525809, rs208294, and rs1718119 P2RX7 had a higher frequency in the SG group.ConclusionExtreme phenotype analysis has identified eleven SNPs related to genes TNFSF11, TNFRSF11B, WNT3A, SFRP2, LRP6, P2RX7, and LRP1 that are associated with severe root resorption in the Korean population. These findings will contribute to the development of predictive diagnostic tools for identifying severe root resorption that may occur during orthodontic treatment.

Orthodontic treatment outcome predictive performance differences between artificial intelligence and conventional methods.

To evaluate an artificial intelligence (AI) model in predicting soft tissue and alveolar bone changes following orthodontic treatment and compare the predictive performance of the AI model with conventional prediction models. A total of 1774 lateral cephalograms of 887 adult patients who had undergone orthodontic treatment were collected. Patients who had orthognathic surgery were excluded. On each cephalogram, 78 landmarks were detected using PIPNet-based AI. Prediction models consisted of 132 predictor variables and 88 outcome variables. Predictor variables were demographics (age, sex), clinical (treatment time, premolar extraction), and Cartesian coordinates of the 64 anatomic landmarks. Outcome variables were Cartesian coordinates of the 22 soft tissue and 22 hard tissue landmarks after orthodontic treatment. The AI prediction model was based on the TabNet deep neural network. Two conventional statistical methods, multivariate multiple linear regression (MMLR) and partial least squares regression (PLSR), were each implemented for comparison. Prediction accuracy among the methods was compared. Overall, MMLR demonstrated the most accurate results, while AI was least accurate. AI showed superior predictions in only 5 of the 44 anatomic landmarks, all of which were soft tissue landmarks inferior to menton to the terminal point of the neck. When predicting changes following orthodontic treatment, AI was not as effective as conventional statistical methods. However, AI had an outstanding advantage in predicting soft tissue landmarks with substantial variability. Overall, results may indicate the need for a hybrid prediction model that combines conventional and AI methods.

Functional and morphological evaluation of the dentofacial system in patients with distal occlusion using ultrasonic diagnostic methods

Relevance. The integrity of the dentofacial system, significantly influenced by the functional condition of the masseter muscles (MM) and the morphological alterations in the alveolar bone, plays a crucial role in the outcome and duration of orthodontic treatment for distal occlusion. Ultrasonic diagnostic methods, due to their physiological compatibility, high information content, and ergonomic design, offer a preferable alternative for assessing and tracking these changes throughout orthodontic treatment.Materials and methods. This study included 55 individuals of both genders, aged 9-12, with either normal occlusions (NO) or distal occlusions (DO). Ultrasound examinations of the MM at rest and during maximum voluntary teeth clenching were conducted to evaluate MM thickness and echotexture. Ultrasonic densitometry measurements were conducted through the assessment of ultrasound transit velocity (UTV). This was carried out across the interalveolar bone with probes positioned on the buccal and oral sides between two neighboring teeth roots.Results. The findings indicated that DO patients had a notably thicker MM compared to their NO counterparts. Variations in MM echotexture were observed, with differences in the anechogenic and hyper echogenic zones. Recorded UTV values illustrated that the highest alveolar bone density in DO subjects was predominantly in the frontal regions of both jaws on the left side, whereas the lowest density was observed in the right lateral regions. For NO subjects, the highest density values were identified in the frontal region of the mandibular bone, with the lowest in the maxillary bone's lateral regions on both sides.Conclusion. The application of advanced ultrasonic diagnostic methods in this study facilitated a detailed functional and morphological analysis of the MM, as well as an evaluation of alveolar bone density in individuals with both distal and normal occlusions. The development of ultrasonic alveolar bone density chart from this research provides a valuable addition to dental examination protocols for patients undergoing orthodontic treatment.

Study on decision-making for orthodontic treatment plans based on analytic hierarchy process

BackgroundOrthodontics is a common treatment for malocclusion and is essential for improving the oral health and aesthetics of patients. Currently, patients often rely on the clinical expertise and professional knowledge of doctors to select orthodontic programs. However, they lack their own objective and systematic evaluation methods to quantitatively compare different programs. Therefore, there is a need for a more comprehensive and quantitative approach to selecting orthodontic treatment plans, aiming to enhance their scientific validity and effectiveness.MethodsIn this study, a combination of the analytic hierarchy process (AHP) and semantic analysis was used to evaluate and compare different orthodontic treatment options. An AHP model and evaluation matrix were established through thorough research and semantic analysis of patient requirements. This model considered various treatment factors. Expert panels were invited to rate these factors using a 1–9 scale. The optimal solution was determined by ranking and comparing different orthodontic treatment plans using the geometric mean method to calculate the weights of each criterion.ResultsThe research indicates a higher preference for invisible correction compared to other orthodontic solutions, with a weight score that is 0.3923 higher. Factors such as comfort and difficulty of cleaning have been given significant attention.ConclusionThe Analytic Hierarchy Process (AHP) method can be utilized to effectively develop orthodontic treatment plans, making the treatment process more objective, scientific, and personalized. The design of this study offers strong decision support for orthodontic treatment, potentially improving orthodontic treatment outcomes in clinical practice and ultimately enhancing oral health and patients’ quality of life.

Innovative and simple technique of stabilizing the lingual retainer wire before bonding

Long-term stability of orthodontic treatment outcome is attained through retention. Fabrication and bonding of the lingually bonded retainer on the lingual tooth surface are a technique-sensitive and time-consuming procedure. Stabilizing the lingual retainer wire on the tooth surface throughout the bonding procedure is a challenging task for the operator. This article introduces a new simplified technique of stabilizing the lingual retainer wire before bonding.

Postural balance in the comprehensive rehabilitation of adolescents with cleft lip and palate and maxillofacial anomalies: A literature review

BACKGROUND: Patients with cleft lip and palate experience significant jaw relationship disorders and pathological bite formation, leading to changes in the motor activity of chewing muscles and postural balance disturbances. Most studies on postural control are conducted on patients with skeletal dentofacial anomalies and deformities without cleft lip and palate. The state of postural balance in children with cleft lip and palate requiring long-term complex medical rehabilitation, including bone-reconstructive operations on the jaw bones, remains poorly understood.&#x0D; AIM: To analyze publications dedicated to the evaluation of postural balance in adolescents with cleft lip and palate combined with jaw relationship disorders and pathological bite formation.&#x0D; MATERIALS AND METHODS: The article includes an analysis and review of several studies that investigated the state of postural balance in adolescents with cleft lip and palate, particularly at the final stages of growth and formation of the musculoskeletal system. Scientific articles published in various medical journals, monographs, dissertations, and materials from scientific symposiums related to this topic were used in the literature review. PubMed, Medline, Scopus, Web of Science, and RSCI were searched without language restrictions. The search depth was 23 years, and 64 studies were selected.&#x0D; RESULTS: The article analyzes literature data related to theories of the mechanism of mutual influence between postural balance and the dentofacial apparatus (disorders and pathological bite formation). The state of postural balance is influenced by various factors, including the craniosacral system and anomalies of the cervical spine. Patients with cleft lip and palate, hemifacial microsomia, and other craniofacial dysostoses with growth disorders of jaw bones experience an imbalance in the entire “descending” chain, causing postural disturbances, increased plantar pressure, increased foot rigidity, and changes in photogrammetry indicators, which should be considered when developing an individual rehabilitation program for these patients. The treatment of these patients without considering postural balance disorders can lead to temporomandibular joint pathologies, unstable results of the conservative orthodontic treatment of bite pathologies, and bone-reconstructive operations on jaws.&#x0D; CONCLUSIONS: The study highlights the ways of adaptation of the musculoskeletal system in the presence of occlusal relationship disorders and emphasizes the need to evaluate this influence comprehensively for the treatment of these patients. The limitations of the presented studies should be emphasized: insufficient sample size, lack of control groups and prospective studies, limited types of examination, and lack of studies dedicated to more severe anomalies of craniofacial development.

Applying artificial intelligence to predict the outcome of orthodontic treatment

Objectives: The study aimed to train an algorithm to predict facial and dental outcomes following orthodontic treatment using artificial intelligence (AI). In addition, the accuracy of the algorithm was evaluated by four distinct groups of evaluators. Material and Methods: The algorithm was trained using pre-treatment and post-treatment frontal smiling and intraoral photographs of 50 bimaxillary patients who underwent all first bicuspid extraction and orthodontic treatment with fixed appliances. A questionnaire was created through Google form and it included 10 actual post-treatment and AI-predicted post-treatment images. The accuracy and acceptability of the AI-predicted outcomes were analyzed by four groups of 140 evaluators (35 orthodontists, 35 oral maxillofacial surgeons, 35 other specialty dentists, and 35 laypersons). Results: The Style-based Generative Adversarial Network-2 algorithm used in this study proved effective in predicting post-treatment outcomes using pre-treatment frontal facial photographs of bimaxillary patients who underwent extraction of all first bicuspids as part of their treatment regimen. The responses from the four different groups of evaluators varied. Laypersons exhibited greater acceptance of the AI-predicted images, whereas oral maxillofacial surgeons showed the least agreement. The base of the nose and the chin demonstrated the most accurate predictions, while gingival visibility and the upper lip-to-teeth relationship exhibited the least prediction accuracy. Conclusion: The outcomes underscore the potential of the method, with a majority of evaluators finding predictions made by the AI algorithm to be generally reliable. Nonetheless, further research is warranted to address constraints such as image tonicity and the proportional accuracy of the predicted images.

Digital setup accuracy for moderate crowding correction with fixed orthodontic appliances: a prospective study

ObjectivesTo evaluate the accuracy of a semi-automatic 3D digital setup process in predicting the orthodontic treatment outcome achieved by labial fixed appliances.Subjects and MethodsTwenty-five adult patients (18 to 24 years old) with class I malocclusion and moderate crowding were prospectively enrolled and received treatment on both jaws through the straight-wire technique. Prior to treatment commencement, a semi-automatic digital setup simulating the predicted treatment outcome was performed for each patient through Orthoanalyzer software (3Shape®, Copenhagen, Denmark) to obtain the prediction model. This was compared to the final outcome model through 3D superimposition methods. Metric variables and inspection of color-coded distance maps were used to detect how accurately the digital setup predicts the actual treatment outcome.ResultsThe mean absolute distances (MAD) between the superimposed dental arches of the predicted and the final models were: 0.77 ± 0.13 mm following superimposition on the palate, 0.52 ± 0.06 mm following superimposition on the maxillary dental arch, and 0.55 ± 0.15 mm following superimposition on the mandibular dental arch. The MAD at the palatal reference area was 0.09 ± 0.04 mm. Visualization of color-coded distance maps indicated that the digital setup accurately predicted the final teeth position in a few cases. Almost half of the cases had posteriorly wider upper and lower dental arches and palatally/lingually positioned or inclined anterior teeth, whereas the rest still showed errors within 2–3 mm, distributed over the entire dental arches with no distinct pattern.ConclusionsThe accuracy of semi-automatic prediction of the labial fixed appliance treatment outcome in Class I cases with moderate crowding is not yet sufficient. While average measures showed deviations less than 1 mm, examination of individual color-coded distance maps revealed significant disparities between the simulated and the actual results.

Can esthetically pleasing aligners change the root morphologies? – A narrative review

Background: The occurrence of root resorption (RR) is an unavoidable result of orthodontic treatment. Finding a straightforward approach to its prevention remains a challenge. It is a tragic occurrence when radiographically detected, even though it is rarely severe. The application of force starts a sequence of biological mechanisms. Although we are well aware of how and when it is provoked, we are unable to foresee what will happen in the end. In the past few years, clear aligner therapy has become very popular. Although not much data has been established describing RR after this treatment. Aim: The following review determines the effect of aligner therapy on the resorption of roots leading to the shortening of root length. Methods: Research publications were searched on search engines such as Scopus, PubMed, and Google Scholar using terms such as “RR,” “risk factors of RR” and “effects of clear aligner therapy on RR.” These publications were then collected. Results: For this review, 30 articles were collected and further used to formulate this review. Conclusion: (1) Most affected teeth were the maxillary central and lateral incisors post aligner therapy. (2) Multiple factors that influenced RR were gender, malocclusion, the severity of crowding, type of tooth movement, and close approximation of root toward the cortical plate (3) Clear aligner therapy is comparable to LightForce fixed orthodontics appliances but surpasses heavy-force orthodontic appliances in the terms of the risk associated with developing RR.

ORTHODONTIC EXTRUSION TECHNIQUE AS A METHOD FOR ALVEOLAR BONE VOLUME INCREASE BEFORE DENTAL IMPLANTATION. CLINICAL CASE

Objectives: Tooth extraction and replacement with dental implant represents a common treatment choice, when teeth are hopeless. We presented a clinical case, the treatment of which was carried out by the method of orthodontic extrusion technique. This technique can increase alveolar bone level and also soft tissue level. The increased amount of alveolar bone can improve primary implant stability and be compared with bone regeneration techniques. The purpose of presenting this clinical case is to emphasize the efficiency of orthodontic extrusion. Methods and materials: A 45-year-old female patient referred by the general dentist regarding cosmetic defect and tooth mobility in the area of the anterior upper teeth. During the examination, her upper right central incisor was found to be mobile, with diastema and slight congestion in the anterior teeth Photographs, CT and X-ray studies of the patient were used. The patient was bonded with .018 slot Roth prescription ceramic brackets (Dentaurum, Germany). After achieving the optimal results of orthodontic treatment and the necessary extrusion of the upper right central incisor, the tooth was removed and replaced with a dental implant. After six months, the patient had a crown with a screw fixation of zirconium dioxide with ceramic application Results: As a result of orthodontic extrusion, clinically significant increase in alveolar bone and gingival tissue was reported. This resulted significant qualitative and quantitative improvements in the implant site. As the clinical case was in aesthetic zone, we could also rehabilitate beautiful smile of patient and increase her self-esteem. Conclusions: Summing up the above and the results of the treatment of this patient, we can definitely say that orthodontic extrusion technique is effective for implant site development. As we have described, this can effectively move the facial gingival margin and allow for esthetic restoration of implant placed in the extruded tooth position without any bone graft.

Torque control of anterior teeth by clear aligners

Appropriate torque control of anterior teeth is of great significance to obtain ideal orthodontic treatment outcome. Clear aligners are less effective in torque control of anterior teeth due to their special application mode and material properties. Therefore, it is important to investigate how to improve the torque control of anterior teeth by using clear aligners, with the expectation of providing guidance for clinicians. This article discussed the methods to control the torque of anterior teeth by using traditional fixed appliances, the efficiency of clear aligner in controlling the torque of anterior teeth, the difficult points of clear aligner in controlling the torque of anterior teeth and the therapeutic methods to better control the torque of anterior teeth by using clear aligners.

The second molar dilemma in orthodontics: to bond or not to bond?

To compare orthodontic treatment (OT) outcome in adolescents undergoing nonextraction fixed OT with or without bonding of second molars using the score of the American Board of Orthodontics Cast Radiograph Evaluation (C-R-Eval). This study included healthy adolescents with skeletal Class I or mild Class II/Class III malocclusion, normal or deep overbite (OB), and mild-to-moderate dental crowding (<5 mm) who underwent nonextraction fixed OT with ("bonded" group) or without ("not-bonded" group) bonding of second molars. Patient treatment records, pre- and posttreatment digital models, lateral cephalograms, and orthopantomograms were assessed. The evaluated outcomes included leveling of the curve of Spee (COS), OB, control of incisor mandibular plane angle (IMPA), number of emergency visits (related to poking wires and/or bracket failure of the terminal molar tubes), treatment duration, and C-R-Eval. Treatment variables were compared across time points and among groups. The sample included 30 patients (mean age 16.07 ± 1.80 years) in the bonded group and 32 patients (mean age 15.69 ± 1.86 years) in the not-bonded group. The mean overall C-R-Eval score was significantly higher (P < .001) in the not-bonded group (25.25 ± 3.98) than in the bonded group (17.70 ± 2.97). There were no significant differences in mean changes of COS, OB, IMPA, or treatment duration among groups. The mean number of emergency visits was significantly higher in the bonded (3.3 ± 0.6) than the not-bonded group (1.9 ± 0.4) (P < .001). Bonding of second molars enhances the outcome of nonextraction fixed OT as demonstrated by the C-R-Eval without increasing treatment duration, irrespective of more emergency visits.

Orthodontic finishing errors detected in board-approved cases: common types and prediction.

To report and rank orthodontic finishing errors recorded in the clinical phase of the Brazilian Board of Orthodontics and Dentofacial Orthopedics (BBO) examination and correlate pretreatment case complexity with orthodontic treatment outcomes. This single-center cross-sectional survey collected retrospective data from the clinical phase of BBO examinations between 2016 and 2023. The quality of orthodontic clinical outcomes of each case was assessed by means of the Cast-Radiograph Evaluation (CRE), while case complexity was evaluated using the Discrepancy Index (DI), both tools provided by the American Board of Orthodontics. Survey items were analyzed using descriptive statistics, and a correlation analysis between total CRE and DI scores (p<0.05) was also performed. A total of 447 orthodontic records was included. Orthodontic finishing errors were often observed, and no case was completely perfect. In the total CRE score, an average of 15 points was discounted for each case. Most frequently found issues involved problems with alignment, buccolingual inclination, marginal ridge, and occlusal relationship. The median DI score for initial case complexity was 22.0 (range 10.0 - 67.0). There was no significant correlation between the DI and CRE scores (p=0.106). Orthodontic finishing errors are inevitable, even in well-finished board-approved cases. Rotation, excessive buccolingual inclination, and discrepancies in marginal ridges are the most frequently observed areas of concern, in that order. Moreover, while case complexity, determined by DI, can impact orthodontic planning and pose challenges for clinicians, the study did not consider it a determining factor in predicting treatment outcomes.