Mandibular molar protraction: A comparison between fixed functional appliances and temporary anchorage devices

INTRODUCTION

This study aimed to compare the efficiency of temporary anchorage devices (TADs) and fixed functional appliances (FFAs) for mandibular molar protraction.

METHODS

Orthodontic records of 1050 consecutively treated patients with molar protraction were screened. Thirty-six records (22 females and 14 males; mean age, 17.4 years) were divided into two groups: TAD (21 subjects with 25 edentulous spaces) and FFA (15 subjects with 24 edentulous spaces). The primary outcome measure was the efficiency of protraction [magnitude and time required for protraction (rate) and anchor loss (AL)]. The secondary outcomes involved measuring the type of tooth movement (TOTM), external apical root resorption (EARR), alveolar bone height change (ABHC), alveolar bone width change (ABWC) and appliance failure.

RESULTS

The rate of tooth movement was significantly higher for FFAs (0.83 ± 0.35 mm/month) versus TADs (0.49 ± 0.2 mm/month) (P = .005). Total treatment duration was less for FFAs (34.78 ± 8.1 months) versus TADs (47.72 ± 13.94 months) (P = .002). TOTM was similar for both (P = .909). EARR was 1.42 ± 1.38 mm for TAD and 1.25 ± 0.88 mm for FFA (P = .81). ABHC increased in the FFA group (1.01 ± 3.62 mm) and decreased for the TAD group (0.68 ± 1.66 mm). ABWC increased for both TAD (1.81 ± 1.73 mm) and FFA (1.75 ± 1.35 mm). The failure rate was 50% for FFAs and 33% for TADs.

CONCLUSIONS

Both systems provided translation of lower molars with comparable anchorage control. However, FFAs were more efficient than TADs for lower molar protraction.

Surgical Removal of an Orthodontic Mini-Screw Displaced Into the Lateral Pharyngeal Space: A Case Report and Review of Pertinent Literature

Oral and maxillofacial surgeons are often faced with the clinical challenge of foreign body displacement into the perioral tissues and soft tissues of the head and neck. This mainly occurs either because of trauma or inadvertently during dental treatment. In addition to the maxillary sinus, iatrogenic foreign body displacement during dental treatment could happen into one of the 16 distinct fascial spaces of the head and neck region. Commonly displaced foreign bodies related to dental treatment include tooth roots or fragments, local anesthetic needles, implants and restorations. The clinical sequelae of a displaced foreign body depend on its size, shape, anatomic location and proximity to vital structures. Although patients may remain asymptomatic for a considerable amount of time, retained foreign bodies result in persistent pain, recurrent infection and scarring of soft tissue due to inflammation, all of which may complicate delayed retrieval. In addition to the history, imaging modalities such as plain radiographs and computed tomography (CT) help in locating the displaced foreign body and its subsequent retrieval. Surgical retrieval may be attempted through intraoral, transcervical and endoscopic approaches. Additionally, surgery may be aided by real-time imaging such as fluoroscopy. The present report aims to detail a case of inadvertent displacement of an orthodontic mini-screw, commonly used as a temporary anchorage device (TAD), into the lateral pharyngeal space, while attempting placement in the mandibular retromolar area. The case report also describes the surgical retrieval procedure of the TAD screw using an intraoral approach and with fluoroscopy guidance using C-Arm radiographic imaging. This case is reported along with the pertinent review of literature, as it not only explains a rare complication of orthodontic mini-screw placement but also details a modality to remove displaced foreign bodies from fascial spaces of the head and neck, which are otherwise directly inaccessible.

Orthodontic Treatment of Palatally Impacted Canines in Severe Non-Syndromic Oligodontia with the Use of Mini-Implants: A Case Report

Background: The risk of palatally displaced canines (PDCs) rises in patients with tooth agenesis. The orthodontic extrusion and alignment of PDCs require adequate anchorage to enable tooth movement and control the side effects. There is no paper presenting treatment in the case of severe oligodontia with simultaneous PDCs and the use of mini-implants (MIs) for their orthodontic extrusion. Case presentation: A 15-year-old patient presented with non-syndromic oligodontia and bilateral PDCs. Cone beam computed tomography revealed that both PDCs were in proximity to the upper incisors' roots. There was no evident external root resorption of the incisors. The "canines first" approach was chosen. MIs were used both as direct and indirect anchorage. First, the extrusive forces of cantilevers were directed both occlusally and distally. Next, the buccal directions of forces were implemented. Finally, fixed appliances were used. PDCs were extruded, aligned, and torqued. Proper alignment and occlusion were achieved to enable further prosthodontic restorations. Conclusions: The use of MIs made it possible to avoid collateral effects, reduce the risk of complications, and treat the patient effectively. MIs provide adequate anchorage in demanding cases. The use of MIs for the extrusion of PDCs made it possible to offer this treatment option to patients with severe oligodontia. The presented protocol was effective and served to circumvent treatment limitations associated with an inadequate amount of dental anchorage and a high risk of root resorption.

Assessing the reliability of ChatGPT: a content analysis of self-generated and self-answered questions on clear aligners, TADs and digital imaging

INTRODUCTION

Artificial Intelligence (AI) is a tool that is already part of our reality, and this is an opportunity to understand how it can be useful in interacting with patients and providing valuable information about orthodontics.

OBJECTIVE

This study evaluated the accuracy of ChatGPT in providing accurate and quality information to answer questions on Clear aligners, Temporary anchorage devices and Digital imaging in orthodontics.

METHODS

forty-five questions and answers were generated by the ChatGPT 4.0, and analyzed separately by five orthodontists. The evaluators independently rated the quality of information provided on a Likert scale, in which higher scores indicated greater quality of information (1 = very poor; 2 = poor; 3 = acceptable; 4 = good; 5 = very good). The Kruskal-Wallis H test (p< 0.05) and post-hoc pairwise comparisons with the Bonferroni correction were performed.

RESULTS

From the 225 evaluations of the five different evaluators, 11 (4.9%) were considered as very poor, 4 (1.8%) as poor, and 15 (6.7%) as acceptable. The majority were considered as good [34 (15,1%)] and very good [161 (71.6%)]. Regarding evaluators' scores, a slight agreement was perceived, with Fleiss's Kappa equal to 0.004.

CONCLUSIONS

ChatGPT has proven effective in providing quality answers related to clear aligners, temporary anchorage devices, and digital imaging within the context of interest of orthodontics.

Accuracy of Palatal Orthodontic Mini-Implants Placed Using Fully Digital Planned Insertion Guides: A Cadaver Study

Digital workflows have become integral in orthodontic diagnosis and therapy, reducing risk factors and chair time with one-visit protocols. This study assessed the transfer accuracy of fully digital planned insertion guides for orthodontic mini-implants (OMIs) compared with freehanded insertion. Cone-beam computed tomography (CBCT) datasets and intraoral surface scans of 32 cadaver maxillae were used to place 64 miniscrews in the anterior palate. Three groups were formed, two using printed insertion guides (A and B) and one with freehand insertion (C). Group A used commercially available customized surgical templates and Group B in-house planned and fabricated insertion guides. Postoperative CBCT datasets were superimposed with the planning model, and accuracy measurements were performed using orthodontic software. Statistical differences were found for transverse angular deviations (4.81° in A vs. 12.66° in B and 5.02° in C, p = 0.003) and sagittal angular deviations (2.26° in A vs. 2.20° in B and 5.34° in C, p = 0.007). However, accurate insertion depth was not achieved in either guide group; Group A insertion was too shallow (-0.17 mm), whereas Group B insertion was deeper (+0.65 mm) than planned. Outsourcing the planning and fabrication of computer-aided design and computer-aided manufacturing insertion guides may be beneficial for certain indications; particularly, in this study, commercial templates demonstrated superior accuracy than our in-house-fabricated insertion guides.

Multidisciplinary Approach to Patient-Specific Implants (PSIs): A Case Report and Review of Literature

Orthodontic treatment often faces challenges in achieving proper anchorage. While orthodontic mini-implants have gained popularity, no universally accepted design and insertion protocol exists for these implants. However, their relatively modest failure rate indicates their clinical reliability. To address complex geometries in the maxilla and mandible, patient-specific implants (PSIs) have emerged as a solution. PSI is currently employed in various domains of oral and maxillofacial surgery like temporomandibular joint (TMJ), total joint replacement, reconstruction of the facial skeleton, and orthognathic surgery. PSI allows for the creation of customized implant fits, leading to shorter rehabilitation times. This case report presents a multidisciplinary approach involving oral surgery and orthodontics, specifically focusing on the design of PSI, surgical placement of PSI, and use of PSI in maxillary protraction in orthodontics. The report highlights the design process of designing PSI and emphasizes its role in orthodontic treatment. By incorporating PSI as a temporary anchorage device (TAD), enhanced stability, precise control over tooth movement, and accurate repositioning of jaws can be achieved. The collaborative effort between orthodontists and oral surgeons is crucial in integrating PSI into the overall treatment plan. Despite the higher costs associated with PSI, their numerous advantages outweigh these drawbacks. PSI plays a vital role in providing enhanced stability, appropriate treatment plan, and achieving desired treatment in orthodontic and oral surgery procedures.

Effects of Flapless Laser Corticotomy in Upper and Lower Canine Retraction: A Split-mouth, Randomized Controlled Trial

Aim One of the major difficulties in orthodontic treatment is the lengthy course of therapy, particularly in situations involving extractions. Hence, various methods for accelerating tooth movement rate had been devised. Flapless corticotomy is one of those methods. This study aimed to evaluate the effects of flapless laser corticotomy (FLC) compared to the conventional retraction (CR) method on the rate of canine retraction. Methods A split-mouth, randomized controlled trial included 56 canines from 14 patients (12 females and two males) with a mean age of 20.4 ± 2.5 years, who were complaining of bimaxillary protrusion requiring extraction of four premolars. All canines were randomly assigned to four groups (maxillary FLC, maxillary control CR, mandibular FLC, and mandibular control CR). Randomization was performed by creating two equal, random computer-generated lists with a 1:1 allocation ratio-one list for the right side and one for the left. The allocation concealment was achieved using opaque sealed envelopes until the time of intervention. FLC was applied on the experimental sides before canine retraction by drilling six holes penetrating 3 mm into the bone on the mesial and distal sides of the canines. Subsequently, all canines were retracted employing closed coil springs to deliver a force of 150 g using indirect anchorage from temporary anchorage devices (TADs). All canines were assessed at T0 (before retraction), T1 (one month after retraction), T2 (two months), and T3 (three months) using three-dimensional (3D) digital models. Additionally, canine rotation, molar anchorage loss assessed using 3D digital models, root resorption assessed using cone beam computed tomography (CBCT), probing depth, plaque, gingival indices, and pulp vitality were all evaluated as secondary outcomes. It was possible to blind only the outcome analysis expert (single-blinded). Results The measurements of canine retraction during the follow-up period from T0 to T3 were 2.46 ± 0.80 mm and 2.55 ± 0.79 mm in maxillary FLC and control groups, respectively, and 2.44 ± 0.96 mm and 2.31 ± 0.95 mm in mandibular FLC and control groups, respectively. The results demonstrated a statistically non-significant difference in the distance of canine retraction between the FLC and control groups at all time points. Moreover, no differences were observed between groups in canine rotation, molar anchorage loss, root resorption, probing depth, plaque, gingival indices, and pulp vitality (p > 0.05). Conclusion In the FLC procedure performed in this study, the rate of upper and lower canine retraction could not be accelerated and no significant differences were observed between FLC and control groups in canine rotation, molar anchorage loss, root resorption, periodontal condition, and pulp vitality.

Success rates and factors associated with failure of temporary anchorage devices: A prospective clinical trial

AIM

The objective of the present study was to investigate success rates and associated factors affecting temporary anchorage device (TAD) failure in different biomechanical applications.

METHODS

A total of 180 TADs were used as a part of 82 patients' treatment plan (24 males and 58 females); their mean age was 21.41 years. Three types of TADs were used: 50 (3M ESPE, Neuss, Germany), 56 (Bone screw; Jeil Medical, Seoul, Korea), and 74 (Morelli, Sorocaba, Brazil). Eight maxillary and four mandibular sites were selected for insertion. Three different lengths (6, 8, and 10 mm) and three different diameters (1.5, 1.6, and 1.8 mm) were used. The force levels were set at 50, 100, 150, 200, and 250 g. Patient-, implant-, and operator-dependent factors were evaluated throughout the 266 days of function. Qualitative variables were described by proportions and percentages and analyzed using χ² test.

RESULTS

The overall success rate was 82.2%. The higher age group showed a significantly higher success rate. Oral hygiene showed a statistically-significant (P ˂ .05) difference between both success and failure groups. All other patient-related factors showed no significant differences. Regarding force levels used, the highest success rate was in 250 g and the lowest was in 100 g. There were no significant differences between both groups regarding other implant- and operator-related factors.

CONCLUSIONS

Temporary anchorage devices have a good success rate and are beneficial to be integrated in orthodontic treatment planning. Patient age, oral hygiene, and force level are the most significant factors affecting TAD success.

Skeletal anchorage for intrusion of bimaxillary molars in a patient with skeletal open bite and temporomandibular disorders

The treatment of severe skeletal anterior open bite is extremely difficult in adults, and orthognathic surgery is generally selected for its treatment. We report the case of an 18-year-old adult patient with skeletal anterior open bite and temporomandibular disorders who was successfully treated using temporary anchorage devices. She had an open bite of −2.0 mm and an increased facial height. Miniplates were implanted in both the maxilla and mandible, and molar intrusion resulted in counterclockwise rotation of the mandible over a period of 12 months. After active treatment, her upper and lower first molars were intruded by approximately 2 mm and her overbite became +2.5 mm. Her retrognathic profile improved with counterclockwise rotation of the mandible. Orthodontic treatment aided with skeletal anchorage is beneficial for intrusion of bimaxillary molars in patients with anterior open bite.

Oral health-related quality of life in orthodontic patients during initial therapy with conventional brackets or self-ligating brackets

Background/purpose

The self-ligating brackets (SLB) have been introduced in modern orthodontic treatment in recent years for malocclusion patients. This study was conducted to compare two treatments, conventional brackets (CB) and SLB, in malocclusion to determine which treatment will provide better oral health-related quality of life (OHRQoL) outcomes.

Materials and methods

The research involved a prospective randomized clinical trial, composed of two sets of questionnaires, Short Form-36 (SF-36T) and oral health impact profile-14 (OHIP-14T), concerning HRQoL and OHRQoL. In total, 88 malocclusion patients who were eligible and met the inclusion and exclusion criteria from the Orthodontic Department of Mackay Memorial Hospital from June 2010 to November 2011 participated in the study, and all patients had completed a minimum follow-up of 1 week and 1 month. The quantitative analysis of the questionnaires was conducted through descriptive statistics and repeated measures of analysis of variance to indicate the differences in OHRQoL between the two sets of brackets systems.

Results

For SF-36T, the physical component score, the mental component score and all of the eight scales yielded no statistically significant differences between the CB and SLB group. For OHIP-14T, the overall score and all of the seven scales yielded no statistically significant difference between the CB and SLB group. Results of this study showed that SLB systems were not shown to be statistically superior to CB systems in improving OHRQoL for malocclusion patients during initial orthodontic treatment.

Conclusion

This study may provide the orthodontists with a better understanding how malocclusion patients experience the change of OHRQoL and discomfort for CB systems and SLB systems during the initial fixed orthodontic therapy.

Are temporary anchorage devices truly effective in the treatment of skeletal open bites?

Objective:

The aims of this study were to evaluate the effects of temporary anchorage devices (TADs) in the treatment of skeletal open bites and to compare the results with untreated controls.

Materials and Methods:

A total of forty patients with skeletal anterior open bites were assigned to two groups of twenty each. The mean chronological age for the treatment group (14 female, 6 male) was 16.68 ± 2.80 years old, compared with 16.63 ± 2.83 years old for the control group (11 female, 9 male). Titanium miniplates fixed bilaterally to the infrazygomatic crest area were used as TADs and intrusive forces were applied to the posterior teeth with Ni-Ti coil springs. The treatment and normal growth changes were evaluated using 24 measurements (2 angular, 22 linear).

Results:

Statistically significant differences were found between the groups in Bx, By, Sn/GoGn, Ax-Bx, U6x, U6y, overjet, overbite, SN/OccP, N-Me, Ans-Me, S-Go/N-Me, interpremolar width, and intermolar width (P < 0.05). In the treatment group, statistically significant upper molar intrusion (mean ± standard deviation [SD], 3.59 ± 1.34; 95% confidence interval [CI], 2.96–4.22), posterior rotation of the occlusal plane (mean ± SD, 3.42 ± 2.17; 95% CI, 2.39–4.43), anterior rotation of the mandible (mean ± SD, 2.25 ± 1.91; 95% CI, 1.36–3.14), and resultant overbite improvement (mean ± SD, 4.82 ± 1.53; 95% CI, 4.10–5.53) were found (P < 0.05).

Conclusions:

Mild to moderate skeletal anterior open bites could easily be treated with TADs without orthognathic surgery. With the rigid anchorage of miniplates, true molar intrusion of up to 4 mm was achieved. With molar intrusion, anterior rotation of the mandible and a significant reduction in anterior face height were determined.

Acceptance of orthodontic miniscrews as temporary anchorage devices

OBJECTIVE

To study the patient's acceptance, expectation, and experience of pain with orthodontic temporary miniscrews.

METHODS

Questionnaires were distributed to 165 potential temporary orthodontic miniscrew recipients or their parents. Using the numeric rating scale, patients who received miniscrews as part of their orthodontic treatment were also asked to rate the pain or discomfort experience after miniscrew placement.

RESULTS

A total of 165 subjects completed the first set of questions. There was a significant relationship between level of education and prior knowledge about orthodontic miniscrews (P=0.029). Even though only 12.7% had heard about miniscrews, 82.4% agreed to have miniscrews placed to facilitate orthodontic tooth movement. Eighty-three subjects who needed miniscrews as part of their orthodontic treatment completed two more sets of questions after 6 and 24 hours of miniscrew insertion. After 6 hours of miniscrew insertion, there was a significant difference in pain perception between men (mean =2.6±2.2) and women (mean =2.1±1.5; P=0.03). After 24 hours, there was no difference between men (0.2±0.4) and women (0.2±0.5; P>0.05). Postplacement, 32.5% did not require any pain medication, while 59.1% required a single dose and only 8.4% required two doses. A total of 76 patients (91.6%) said that they would recommend this procedure.

CONCLUSION

Patients do accept miniscrew as a treatment option in orthodontics. Postoperative pain is significantly low. The acceptance of miniscrews was not related to patient's previous knowledge of the device, and patients preferred miniscrews to extractions.