Occlusal stability after extraction orthodontic therapy in adult and adolescent patients

Remote digital monitoring during the retention phase of orthodontic treatment: A prospective feasibility study

Objective

To evaluate if a remote digital monitoring system added at the end of orthodontic treatment could positively influence the retention phase by reducing the occurrence of misfit of removable appliances, number of emergency appointments (EA), and orthodontic relapse.

Methods

Twenty-seven patients who completed active orthodontic treatment were divided into the study and control groups. In addition to the standard chairside follow-up appointments at month 1 (T1), month 3 (T2), month 6 (T3), the study group patients were monitored using Dental Monitoring^® with monthly intra-oral scans. Occurrence of misfit of removable retainers, number of EAs, and intercanine width change were recorded for both groups. Differences in EAs and retainer fit were assessed using the chi-square test. Intra-group and inter-group differences in the intercanine width were assessed with Friedman test and Mann–Whitney U test, respectively (α = 0.05).

Results

The study group showed a significantly lower occurrence of misfit of removable retainers (p = 0.027) compared to the control group. No significant inter- and intra-group difference was found in the EAs and intercanine width change at each time-point.

Conclusions

Integrating remote monitoring systems, such as Dental Monitoring^®, to the retention phase of the orthodontic treatment may lower the occurrence of misfit of removable retainers. However, a small sample size and a short observation period limit the strength of this evidence. These preliminary results tentatively suggest that remote monitoring technologies may be beneficial, especially during the COVID-19 pandemic, when the regularity of in-office visits might be disrupted.

Stability of the Maxillary and Mandibular Total Arch Distalization Using Temporary Anchorage Devices (TADs) in Adults

Distalization with temporary anchorage devices (TADs) is commonly used to resolve crowding and to correct molar relationships in non-extraction cases. The purpose of this study was to quantify the treatment effects and post-treatment stability of total arch distalization with TADs in adults and thereby elucidate the clinical effect of this treatment modality. The subjects of the study were 39 adult orthodontic patients treated with total arch distalization with TADs. Lateral cephalograms and dental casts were taken at pretreatment (T0), post-treatment (T1), and the retention period (T2, 29.3 ± 12.8 months) to evaluate the vertical and horizontal movement of teeth, changes of arch width and molar rotation. It was concluded that even though there was a little relapse in the anteroposterior position of the maxillary and mandibular teeth during retention, there was no obvious relapse in the facial profile. Therefore, the total arch distalization can be used in patients with a moderate amount of arch length discrepancy effectively with stable retention.

Stability and relapse of maxillary anterior crowding treatment in class I and class II Division 1 malocclusions

INTRODUCTION

The maxillary anterior teeth are the most important to facial esthetics because they are the first to show on a smile. Therefore, stability of the maxillary anterior teeth alignment is an important issue. The objective of this study was to compare the stability of maxillary anterior tooth alignment in Class I and Class II Division 1 malocclusions.

METHODS

The sample comprised dental casts of 70 patients with Class I and Class II Division 1 malocclusions and a minimum of 3 mm of maxillary anterior crowding measured by an irregularity index. The patients were treated with extractions and evaluated at pretreatment and posttreatment and at least 5 years after treatment. The sample was divided into 3 groups: group 1, Class I malocclusion treated with 4 first premolar extractions comprising 30 subjects, with an initial age of 13.16 years and 8.59 mm of initial maxillary irregularity; group 2, Class II malocclusion treated with 4 first premolar extractions comprising 20 subjects, with an initial age of 12.95 years and 11.10 mm of maxillary irregularity; and group 3, Class II malocclusion treated with 2 first maxillary premolar extractions comprising 20 subjects, with an initial age of 13.09 years and 9.68 mm of maxillary irregularity.

RESULTS

The decrease in the maxillary irregularity index was significantly greater in group 2 than in group 1 during treatment. The stability of maxillary anterior alignment was 88.12% over the long term; 77% of the linear displacement of the anatomic contact points tended to return to their original positions.

CONCLUSIONS

Stability of maxillary anterior alignment between the 3 groups was similar. The stability of maxillary anterior alignment was high over the long term, but a high percentage of teeth tended to return to their original positions.

Occlusal Contact Changes with Removable and Bonded Retainers in a 1-Year Retention Period

Objective: To test the hypothesis that there is no difference in the number of occlusal contacts in centric occlusion in patients treated with bonded and removable retention procedures and a control group during a 1-year retention period.

Materials and Methods: Twenty-five patients received a removable Hawley retainer, and 25 patients received maxillary and mandibular bonded retainers. The retainer patients were compared with 20 control subjects with normal occlusions. Silicone-based impression bites were used to record occlusal contacts. Paired-sample t-test, analysis of variance (ANOVA), and Tukey tests were used to evaluate intragroup and intergroup differences.

Results: An increased number of occlusal contacts were recorded in total-arch and posterior combined (actual/near) teeth during the retention period as compared with the control group. In the Hawley group, actual and total contacts on the first and second molar and actual contacts on the premolar and canine showed statistically significant increases. In the bonded retainer group, near and total contacts on the first and second molars and premolars showed statistically significant increases. Slight occlusal changes were seen in the control sample during the observation period, presumably from growth and development. ANOVA comparisons of total contacts of anterior and posterior teeth indicated statistically significant differences in the three groups on posterior segments.

Conclusions: The hypothesis is rejected. Both retention procedures allowed relative vertical movement of the posterior teeth, but the number of contacts on the posterior segment was increased more in the bonded retainer group than in the Hawley and control groups at the end of retention.

Treatment stability with the eruption guidance appliance

INTRODUCTION

Although the eruption guidance appliance has been used to correct Class II malocclusions for many years and its effects have been demonstrated, there is no study on the stability of the changes it produces. Therefore, the objective of this study was to investigate the long-term stability of cephalometric dentoskeletal and occlusal changes after eruption guidance appliance therapy.

METHODS

Thirty-nine patients were evaluated. Occlusal evaluations were made with the peer asseessment rating index, and anterior tooth irregularity was evaluated with the Little irregularity index. Cephalometric and occlusal data were obtained at pretreatment, posttreatment, and postretention. The data were analyzed by dependent 1-way analysis of variance (ANOVA) for comparison between the 3 stages of the experimental group, with the Newman-Keuls test as a second step. To compare the cephalometric experimental group changes with mean population changes, the t test was used.

RESULTS

Cephalometrically, in the postretention stage, overjet remained stable, overbite showed significant relapse, and molar relationship improved toward a Class I relationship. The peer asseessment rating index showed stability of the occlusion. The Little irregularity index demonstrated a statistically significant relapse of crowding in the postretention stage.

CONCLUSIONS

Cephalometrically, overjet and molar relationship were stable in the long term after treatment with the eruption guidance appliance; however, there was relapse of the overbite. Occlusally, correction of the malocclusion elevated by the peer assessment rating was stable. There was relapse of the anterior teeth crowding.

Alignment stability in Class II malocclusion treated with 2- and 4-premolar extraction protocols

INTRODUCTION

The purpose of this study was to compare the postretention stability of the correction of mandibular anterior-tooth irregularity in patients with Class II malocclusions whose orthodontic treatments included extraction of 2 or 4 premolars.

METHODS

A total of 66 patients were selected who initially had at least one-half-cusp Class II malocclusions. Nineteen patients (9 male, 10 female) with an initial mean age of 14.04 years were treated with extraction of 2 premolars (group 1); 47 patients (20 male, 27 female) with an initial mean age of 13.03 years were treated with extraction of 4 premolars (group 2). A subgroup of group 2, with a similar amount of initial anterior-tooth irregularity as group 1, was also compared with group 1. Little's irregularity index was used to evaluate anterior tooth irregularity in dental casts obtained from each patient before treatment, after treatment, and 5 years after active treatment. Initial cephalometric variables, initial treatment priority index, pretreatment age, treatment time, and posttreatment time of the groups were compared with t tests. Similarly, Little's irregularity index values at prettreament, posttreatment, and postretention were also compared with the t test. Cephalometric treatment changes within groups were evaluated with dependent t tests.

RESULTS

There were no statistically significant differences in posttretention anterior-tooth irregularity between groups 1 and 2 or the subgroup.

CONCLUSIONS

Treatment of Class II malocclusion with extraction of either 2 maxillary premolars or 4 premolars provides the same mandibular anterior-tooth alignment stability.

Postretention relapse of mandibular anterior crowding in patients treated without mandibular premolar extraction

Treatment stability is one of the most important objectives in orthodontics, but, despite decades of research, it is still agreed that the stability of aligned teeth is variable and largely unpredictable. This study aimed to evaluate the relapse of mandibular anterior crowding in patients treated without mandibular premolar extraction. The sample comprised 40 patients of both sexes with Class I or II malocclusions who received nonextraction treatment in the mandibular arch with edgewise mechanics. Lateral cephalograms and dental casts of each patient were obtained at pretreament, posttreatment, and 5 years postretention. Relapse of mandibular anterior crowding was assessed, and associations between this relapse and other clinical factors were also investigated. Mandibular anterior crowding was measured by the Little irregularity index, and the data were evaluated by the Mann-Whitney test. The mean relapse of mandibular anterior crowding was 1.95 mm (26.54%) over the long term. No clinical factor studied was predictive of crowding relapse in the long term.