Do customized orthodontic appliances and vibration devices provide more efficient treatment than conventional methods?

Robotic Archwire Bending in Orthodontics: A Review of the Literature

Malocclusion is a widespread oral health issue that adversely affects individuals' health and well-being. Currently, fixed orthodontics is considered the most efficient treatment for correcting malocclusion, with archwire bending playing a key role in orthodontic treatment. Traditionally, orthodontists manually performed archwire bending using various handheld pliers and other mechanical tools, requiring a significant amount of time, precision, and specialized training yet being unable to guarantee appliance accuracy. The process of shaping orthodontic wire is challenging due to its high stiffness and superelasticity, resulting in a time-consuming, laborious process that is prone to human errors. With advancements in orthodontics, traditional methods have taken a backseat, making way for innovative technologies that provide more accurate and personalized treatment options. The continuous efforts to enhance treatment efficiency, accuracy, efficacy, and patient experience have led to the integration of robotics into various orthodontic procedures. The use of robotics in archwire bending represents a breakthrough in orthodontics, offering unparalleled precision, consistency, and efficiency. This technology reduces treatment time and patient discomfort, overcoming the limitations of manual bending and enhancing orthodontic treatment overall. Hence, the present study aims to review the literature on robotic archwire bending in orthodontics, including their drawbacks and their impact on orthodontic treatment.

Orthodontics social media, perceptions of science- and non-science-based posts among orthodontists, dentists, students and laypeople

Worldwide, social media is gaining popularity year after year. In Brazil, by 2027, there will be more than 188 million users of social media sites, against 165 million in 2022, therefore, the usage of general population and health care professionals, including orthodontists, is increasing. Differently from scientific journals that undergo a rigorous peer review process prior to publication, the same level of demand is not found on social media. Hence, this study aimed to assess whether orthodontists can recognize scientifically based and non-science-based posts and if their perceptions are different from general opinion (laypeople), dentistry students, and dentists (non-orthodontists). The posts were created using the search tool on Instagram with the hashtags #clearaligners #acceledent #selfligatingbraces and #propelorthodontics, four scientific based posts and four without or with low scientific evidence were selected and evaluated through a virtual questionnaire in the QUALTRICS platform by 385 people, (175 laypeople, 102 dentists, 58 dentistry students, and 50 orthodontists) using a visual analogue scale (VAS). In addition, four questions were asked. ANOVA (Adjusted Bonferroni correction) and Pearson's chi-squared, and Student T tests were applied to identify statistical differences. Significant difference was found only for posts with no scientific evidence between orthodontist's group when comparing with laypeople (p < 0.001) for the #selfligatingbraces, and the #propelorthodontics for the group orthodontists when compared with laypeople (p = 0.031) and dentists (p = 0.033). Instagram was the favorite social media where most of the participants spend more than 3 h. Of the participants, 97% used social media to keep informed and read the news. Almost half of the respondents search for orthodontics services on social media. Orthodontists were able to perceive differences in only two posts from the general perception (laypeople) regarding non- or low-scientific-evidence posts.

Robotic Applications in Orthodontics: Changing the Face of Contemporary Clinical Care

The last decade (2010-2021) has witnessed the evolution of robotic applications in orthodontics. This review scopes and analyzes published orthodontic literature in eight different domains: (1) robotic dental assistants; (2) robotics in diagnosis and simulation of orthodontic problems; (3) robotics in orthodontic patient education, teaching, and training; (4) wire bending and customized appliance robotics; (5) nanorobots/microrobots for acceleration of tooth movement and for remote monitoring; (6) robotics in maxillofacial surgeries and implant placement; (7) automated aligner production robotics; and (8) TMD rehabilitative robotics. A total of 1,150 records were searched, of which 124 potentially relevant articles were retrieved in full. 87 studies met the selection criteria following screening and were included in the scoping review. The review found that studies pertaining to arch wire bending and customized appliance robots, simulative robots for diagnosis, and surgical robots have been important areas of research in the last decade (32%, 22%, and 16%). Rehabilitative robots and nanorobots are quite promising and have been considerably reported in the orthodontic literature (13%, 9%). On the other hand, assistive robots, automated aligner production robots, and patient robots need more scientific data to be gathered in the future (1%, 1%, and 6%). Technological readiness of different robotic applications in orthodontics was further assessed. The presented eight domains of robotic technologies were assigned to an estimated technological readiness level according to the information given in the publications. Wire bending robots, TMD robots, nanorobots, and aligner production robots have reached the highest levels of technological readiness: 9; diagnostic robots and patient robots reached level 7, whereas surgical robots and assistive robots reached lower levels of readiness: 4 and 3, respectively.

Does low-frequency vibration have an effect on aligner treatment? A single-centre, randomized controlled trial

BACKGROUND

Low-frequency vibrations have been proposed as a means of accelerating tooth movement and reducing orthodontic treatment times.

OBJECTIVE

To determine any differences in the accuracy of dental movement in patients treated with a low-frequency vibration aligner protocol and/or by reducing the aligner replacement interval with respect to a conventional protocol.

DESIGN

This trial was designed as a single-centre, randomized controlled clinical trial.

METHODS

Participants: Patients (aged 27.1 ± 9.0 years) who required orthodontic treatment with aligners. Randomization: Patients were randomly allocated to three arms as determined by a computer-randomization scheme. Group A were assigned a conventional protocol (aligners replaced every 14 days); group B also used a low-frequency vibration device for 20 minutes per day; group C followed the same vibration protocol but replaced their aligners every 7 days. Blinding: The operator who performed the set-up and the one who analysed the data were blinded to the group of the patients. Outcome: Pre- and post-treatment digital models were analysed using VAM software to identify the accuracy/imprecision of dental movements. One-way analysis of variance (P < 0.05) and the Bonferroni post hoc test were used to identify any statistically significant differences between the three arms in terms of the accuracy of tooth movement versus the prescription.

RESULTS

Numbers analysed: A total of 45 patients (15 for group) were analysed (i.e. 2286 dental movements). Outcome: No statistically significant differences emerged between groups A and C in the upper arch, or among groups A, B, and C in the lower. Group B displayed significantly greater accuracy with respect to group A in upper incisor rotation (P = 0.016), and to group C in vestibulolingual (P = 0.007) and mesiodistal tipping (P = 0.029) of the upper canines, and vestibulolingual tipping of the upper molars (P = 0.0001). Harms: No adverse events or side-effects were registered.

CONCLUSIONS

Considering all tooth and movement types of the 45 participants, the mean total imprecision was 2.1 ± 0.9 degrees, with respect to a mean prescription of 5.7 ± 2.2 degrees. There was no difference in accuracy between replacing the aligners accompanied by low-frequency vibration every 7 days and replacing them every 14 days without vibration. Moreover, low-frequency vibration seemed to improve the accuracy of a conventional protocol in terms of upper incisor rotation.

TRIAL REGISTRATION

The German Clinical Trials Register (DRK00015613).

Customised fixed appliance systems and treatment duration

DesignRandomised controlled trial.InterventionPatients aged 12-30 years requiring fixed orthodontic treatment were eligible and were randomly allocated to treatment with the Insignia customised orthodontic system or the Damon Q noncustomised orthodontic system.Outcome measureThe primary outcome measure was treatment duration. Secondary outcomes were quality of treatment result; the degree of improvement graded using the Peer Assessment Rating (PAR) score; number of visits from the first visit after bonding to debonding; number of loose brackets; time required for treatment planning; and number of complaints.ResultsOne hundred and eighty patients entered the trial. Four were lost to follow-up and two did not complete treatment, so 174 were analysed. Treatment duration was 1.29 ± 0.35 years in the customised group and 1.24 ± 0.37 years in the noncustomised group. The PAR did not differ significantly between groups. However, the orthodontist had a significant effect on treatment duration, quality of treatment outcome and number of visits (P < 0.05). Compared to the noncustomised group, the customised group had more loose brackets, a longer planning time and more complaints.ConclusionsThe customised orthodontic system was not associated with significantly reduced treatment duration, and treatment quality was comparable between the two systems.

Computerized Casts for Orthodontic Purpose Using Powder-Free Intraoral Scanners: Accuracy, Execution Time, and Patient Feedback

Introduction

Intraoral scanners allow direct images of oral situation, with fewer steps than conventional impressions. The purpose of this study was to compare the accuracy of digital impressions, traditional impressions, and digitalization of full-arch gypsum models, to evaluate timing of different methods and finally to study perception of patients about conventional and digital impression techniques.

Methods

Dental arches of fourteen patients were evaluated by alginate impression, titanium dioxide powder-free intraoral scanning (Trios, 3Shape), and digitalization obtained from gypsum models using the same scanner. Conventional and digital techniques were evaluated through measurements (lower and upper arch anteroposterior length, lower and upper intercanine distance, and lower and upper intermolar distance) with a caliber for analogic models and using a computer software for digital models (Ortho Analyzer, Great Lakes Orthodontics). In addition, chairside and processing times were recorded. Finally, each patient completed a VAS questionnaire to evaluate comfort. Statistical analyses were performed with ANOVA and Tukey tests for accuracy measurements and paired t-test for times and VAS scores. Significance was predetermined at P < 0.05.

Results

The measurements obtained with intraoral scanning, gypsum models after conventional impression, and digitalized gypsum models were not significantly different. Both chairside and processing times of digital scanning were shorter than the traditional method. VAS reporting patients comfort were significantly higher when evaluating digital impression.

Conclusions

Intraoral scanners used for orthodontic applications provide useful data in clinical practice, comparable to conventional impression. This technology is more time efficient than traditional impression and comfortable for patients. Further evolution with more accurate and faster scanners could in future replace traditional impression methods.