Comparison of GUMMETAL® and stainless steel alloy during canine retraction: A pilot split-mouth randomized controlled trial

OBJECTIVES

A TiNb alloy wire (GUMMETAL® [GM], Toyota Central R&D Labs, Inc., Nagakute, Japan) was recently developed with unique properties for orthodontic applications. This pilot split-mouth randomized controlled trial compared maxillary canine retraction during space closure using sliding mechanics on GM vs. stainless steel (SS) archwires.

METHODS

Subjects who met the inclusion criteria were treated with fixed appliances and maxillary first-premolar extractions between September 2020 and March 2022. After leveling and aligning, maxillary archwires, fabricated by crimping together segments of 0.016×0.022" GM and SS archwires, were placed and canine retraction initiated using nickel-titanium coil springs. Digital models of the maxillary arch were superimposed at 0, 4, 8 and 12 weeks and the amount of canine movement (mm), rate of movement (mm/month), and 3-dimensional changes (rotational, vertical extrusion, tip) were measured and compared statistically.

RESULTS

Of the 12 subjects recruited, only six completed the study with a median age of 15.8 years (12.0-17.4 years). At 12 weeks, the median canine retraction was 3.41mm (IQR: 2.10, 4.76) with GM versus 3.71mm (IQR: 1.62, 6.45) with SS. The retraction rate was 1.14mm/month (IQR: 0.69, 1.59) with GM, versus 1.24mm/month (IQR: 0.54, 2.15) with SS. The median rotational, vertical and tip changes of the canine were 7.90̊, 0.59mm and 6.15̊ with GM, and 7.25̊, 0.29mm and 2.05̊ with SS. Intergroup differences with all measurements were not statistically significant.

CONCLUSION

No significant differences were found between GM and SS during maxillary canine retraction. GM demonstrated clinical potential for space closure mechanics, however, future larger studies are needed.

Effects of various coating methods on the mechanical, physical, and aesthetic properties of GUMMETAL® archwires: In vitro study

PURPOSE

The objective of this study was to evaluate the mechanical, physical, and aesthetic properties of GUMMETAL® (GM) orthodontic archwires after the application of various aesthetic coating materials.

METHODS

This in vitro study included 180 orthodontic wires: five experimental groups used 0.016×0.022-inch GM as the core-based wire followed by the application of epoxy, polytetrafluoroethylene (PTFE), clear ceramic, white ceramic, or silicone; and four control groups: 0.016×0.022-inch GM, 0.019×0.025-inch GM, 0.016×0.022-inch stainless steel (SS), and 0.019×0.025-inch SS. Frictional forces, force deflection rate, yield strength, aesthetic colour value, corrosive and wear resistance were compared between the experimental and control groups.

RESULTS

Among the coated wires, white ceramic exhibited the highest frictional force (2.06±0.20 N) and silicone showed the lowest values (0.88±0.12 N). There were significant differences in static friction between experimental and control groups (P<0.001). PTFE coating had the highest force deflection rate (9.03±0.12 N/mm) and yield strength (10.0±0.14 N/mm) among coated wires and white ceramic exhibited the lowest values (6.86±0.14 N/mm and 7.74±0.17 N/mm for force deflection rate and yield strength, respectively). Differences in force deflection rate and yield strength between experimental and control groups were statistically significant (P<0.001). All coated wire groups had a clinical difference in colour when compared to A1 shade. Coated and uncoated wires showed good corrosion resistance after one week in corrosive saliva with no detectable loss of mass.

CONCLUSIONS

This study has shown that coating wires can improve some aspects of the wire properties but not all when compared to uncoated GM and SS. Future investigation of the materials used in this study is required to further characterize their properties.

Friction forces generated by aesthetic Gummetal® (Ti-Nb) orthodontic archwires: A comparative in vitro study

OBJECTIVE

The aim of this in vitro study was to compare friction forces generated by the following archwires: rhodium-plated aesthetic Gummetal® (E-GM), Gummetal® (GM), stainless steel (SS) and titanium-molybdenum alloy (TMA), according to bracket-wire angulation and archwire cleanliness.

METHODS

One hundred and ninety-two samples of four orthodontic alloys (E-GM, GM, SS, and TMA) were prepared. The samples were divided into two groups: uncleaned and cleaned using 99% isopropanol in an ultrasonic bath, then subdivided into three subgroups according to bracket-wire angulation: 0°, 5° and 10°. Using a universal testing machine, the wires were pulled through SS maxillary right canine brackets to test static friction forces according to bracket-wire angulation and wire cleanliness. Representative specimens were evaluated to assess surface morphology and roughness.

RESULTS

There were significant differences in static friction forces between archwires when analysed by bracket-wire angulation and cleanliness (P<0.001) except for the 0° uncleaned group. Overall, TMA archwires produced the highest friction while SS wires showed the lowest friction at 0° and 5°. E-GM wires showed comparable friction to SS at 0^o (cleaned and uncleaned), but significantly higher friction than SS at 5^o (uncleaned) and 10° (cleaned). GM wires had comparable friction to SS at 0° (cleaned and uncleaned), but significantly less friction at the 5° (cleaned) and 10° (cleaned and uncleaned). Compared to GM, E-GM had significantly higher friction at 5^o and 10° (cleaned and uncleaned). Cleaning wires reduced surface roughness but increased overall friction.

CONCLUSION

E-GM wires generate higher frictional resistance forces compared to GM and SS, especially at higher bracket-wire angulations and when cleaned. GM friction forces are comparable to SS and thus could be used for space closure with sliding mechanics. However, E-GM wires are not ideal for the same purpose.

Association between obstructive sleep apnea syndrome and bone mineral density in adult orthodontic populations

OBJECTIVE

To determine the association between obstructive sleep apnea syndrome (OSAS) and predicted bone mineral density (BMD) in adults presenting for orthodontic treatment.

METHODS

This retrospective cross-sectional study included 38 adults divided into OSAS and non-OSAS groups. Using pre-treatment CBCT images, radiographic density (RD) of left and right lateral regions of the 1st cervical vertebrae and dens of the 2nd cervical vertebrae were measured as an indicator for BMD.

RESULTS

When controlling for age, sex, and BMI, the mean RD was significantly lower in the OSAS group compared to the non-OSAS group (left CV1: 36.69 ± 84.50 vs. 81.67 ± 93.25 Hounsfield Units [HU], respectively, p = 0.031; right CV1: 30.59 ± 81.18 vs. 74.26 ± 91.81 HU, p = 0.045; dens: 159.25 ± 115.96 vs. 223.94 ± 106.09 HU, p = 0.038).

CONCLUSION

Adults with OSAS have lower values for predicted BMD than those without OSAS.

Effect of over-the-counter whitening strips and toothpaste on shear bond strength of orthodontic brackets

Background

To investigate: 1) the effects of over-the-counter white strip enamel bleaching and 2-Step whitening toothpaste application on the shear bond strength of orthodontic brackets at 24-hours and 7-days post-bleaching latent period; and 2) the correlation between amount of bleaching and shear bond strength.

Material and Methods

Sixty human premolar teeth were randomly assigned into two bleaching groups, white strip group treated with Crest® 3D WHITE™ LUXE Professional Effects Whitestrips (Proctor & Gamble, Greensboro, NC), and whitening toothpaste group, treated with Crest® 3D WHITE™ BRILLIANCE 2-Step Toothpaste (Proctor & Gamble, Greensboro, NC). The groups were further divided into 4 subgroups A, B, C, D (n=15 per group). Subgroups A and C were bonded 7 days after bleaching while subgoups B and D were bonded 24 hours after bleaching. Differences in shear bond strength between the subgroups and an unbleached control group (n=15) were compared using the Kruskal-Wallis test. Spectrophotometric color changes were recorded pre- and post-bleaching.

Results

The mean shear bond strength for the white strip groups were 10.35±3.6 MPa and 11.69±4.33 MPa for the 7-day and 24-hour delayed bonding periods, respectively. Means for the whitening toothpaste groups were 11.01±4.31 MPa and 10.83±3.79 MPa for the 7-day and 24-hour delayed bonding periods. The mean for the control group was 9.59±3.32 MPa. There were no significant differences in shear bond strength between the groups at 7-days and 24-hour (P=0.650). There was a significant difference between teeth bleached with white strips as compared to those bleached with toothpaste and controls. The correlations between color change and shear bond strength were not significant (P=0.448).

Conclusions

There is a significant difference in the amount of whitening achieved by over-the-counter white strips compared to toothpaste; however, no significant effects on shear bond strength occurred after bleaching with white strips and toothpaste at 24-hours and 7-days.

Key words:Bleaching, shear bond strength, orthodontics, over-the-counter.

Effects of Invisalign (G5) with virtual bite ramps for skeletal deep overbite malocclusion correction in adults

OBJECTIVES

To investigate the skeletal and dentoalveolar effects of Invisalign's G5 protocol with virtual bite ramps in the treatment of adults with skeletal deep bites.

MATERIALS AND METHODS

This retrospective study was conducted on consecutively treated adults presenting with skeletal deep bites as defined by the Overbite Depth Indicator (ODI). Subjects were divided into 2 groups: Invisalign group (n = 24) treated with the Invisalign G5 protocol and a full fixed appliance (FFA) group (n = 24) treated with edgewise FFAs and matched to the Invisalign group by ODI, sex, type of malocclusion, and non-extraction treatment. Pretreatment (T1) and post-comprehensive treatment (T2) lateral cephalograms were obtained and analyzed.

RESULTS

Both the Invisalign and FFA groups showed significant changes from T1 to T2 in ODI and other skeletal and dentoalveolar measurements. The mean change in ODI was -1.5° (P < .001) for the Invisalign group and -2.0° (P < .001) for the FFA group. The mean decrease in overbite was 1.3 mm (P < .001) and 2.0 mm (P < .001) for the Invisalign and FFA groups, respectively. The mean increase in mandibular plane angle (Sn-GoGn) was 0.65° (P = .003) for the Invisalign group and 1.15° (P < .001) for the FFA group. When the groups were compared with each other, both ODI (P = .03) and overbite (P = .003) were significantly different in addition to other measurements.

CONCLUSIONS

Although FFA treatment had more apparent skeletal changes for deep bite adult patients when compared with Invisalign, both systems were effective in opening deep bites at dentoalveolar and skeletal levels.

Mechanical properties of the NiTi Memoria Leaf Spring Activated Expander (NiTi MLSAE) for maxillary transverse discrepancy correction: An in-vitro study

Background

To determine the mechanical properties of the NiTi Memoria® Leaf Spring Activated Expander (NiTi MLSAE) in two forms, unaltered (unbent) and altered (bent) to mimic clinical use.

Material and Methods

This in-vitro pilot study was conducted using eight NiTi MLSAE expanders (American Tooth Industries, Oxnard, California) representing four force magnitudes: 10mm 500g, 10mm 900g, 6mm 450g and 6mm 900g models. Two experiments were performed: the first tested the expanders in their unbent form and the second tested them after they were bent by one experienced technician. All expanders were adapted to a standard three dimensional printed maxillary study model. A Dillion Quantrol 500N (110lbf) load cell and a custom-made fixturing apparatus was used to determine the amount of expansive forces delivered. Prior to testing, the ligation compressing the NiTi MLSAE leaves was cut to allow the appliances to expand to their original form. Emperor™ (force) Software was used to measure the expansion forces.

Results

The average expansion forces generated by the expanders were: unaltered = 897.4g (8.8N) and bent = 877.0g (8.6N) for the 10mm 900g model, unaltered = 489.5g (4.8N) and bent = 479.3g (4.7N) for the 10mm 500g model, unaltered = 458.9g (4.5N) and bent = 438.5g (4.3N) for the 6mm 450g model, and unaltered = 805.6g (7.9N) and bent = 785.2g (7.7N) for the 6mm 900g model.

Conclusions

Regardless of whether the expander was straight or bent, the forces generated by the 10mm 900g, 10mm 500g and 6mm 450g Ni-Ti MLSAEs correlated with the benchmark study conducted by the manufacturer. However, the forces generated by the 6mm 900g Ni-Ti MLSAE were less than the data published by the manufacturer. Binding was observed when the expanders were manipulated to mimic clinical use, and this may account for the reported lower expansion force.

Key words:Maxillary expansion, NiTi, posterior crossbite, malocclusion, maxillary transverse discrepancy.

Effects of mechanical vibrations on maxillary canine retraction and perceived pain: a pilot, single-center, randomized-controlled clinical trial

The aim of this study was to investigate the effect of mechanical vibratory stimulation on maxillary canine retraction and pain perception in adolescents undergoing full-fixed orthodontic treatment with extraction. A pilot randomized-controlled clinical trial was conducted in one university orthodontic clinic. Twenty-one healthy adolescents who underwent full-fixed orthodontic treatment with maxillary first-premolar extraction were recruited. Subjects were randomly assigned to the experimental group (N = 10) that used a mechanical vibration device (AcceleDent Aura, OrthoAccel Technologies, Inc.) or the control group (N = 11) that did not receive a vibration device. The evaluation timepoints were T₀ = day of initial canine retraction; T₁ = 4 weeks post-initiation; T₂ = 8 weeks post-initiation; and T₃ = 12 weeks post-initiation. Three-dimensional palatal landmark superimpositions were made to assess amount of tooth movement (mm) at each visit, monthly rate of tooth movement (mm), and perceived pain levels (VAS scores). The total amount of tooth movement was observed in the control versus experimental groups, respectively, as 1.12 ± 0.22 mm versus 1.39 ± 0.36 mm at 4 weeks (p = 0.058), 2.59 ± 0.37 mm versus 2.49 ± 0.76 mm at 8 weeks (p = 0.702), and 3.54 ± 0.23 mm versus 3.37 ± 1.37 mm at 12 weeks (p = 0.716). The rate of tooth movement was 1.21 ± 0.32 mm/month in the control and 1.12 ± 0.20 mm/month in the experimental groups, which was not statistically significant at any of the timepoints and neither was the level of pain. This study found no statistically significant differences in canine retraction and pain perception between the experimental and control groups. We propose that further optimization of accelerated tooth movement with mechanical vibration devices is necessary.

Effects of clear aligner therapy for Class II malocclusion on upper airway morphology and daytime sleepiness in adults: A case series

INTRODUCTION

To evaluate the effects of clear aligner therapy (CAT) on the upper airway dimensions and on daytime sleepiness in adults with dentoskeletal Class II malocclusion.

METHODS

This study was conducted from August 2017 to February 2019. Inclusion criteria were healthy adults≥18years old, Angle Class II division 1 malocclusion, first-molar relationship of end-to-end or greater, overjet<10mm, and presenting for multi-arch comprehensive orthodontic treatment with aligners. Treatment mechanics included mandibular dentoalveolar advancement with Class II elastics without maxillary sequential distalization programmed into aligners. Post-treatment changes in dentoskeletal and upper airway dimensions were assessed using CBCT images. The treatment effect on daytime sleepiness was evaluated using an Epworth Sleepiness Scale (ESS).

RESULTS

Eight subjects were included in this pilot study (mean age at treatment initiation=44.6years [SD=15.3]). The mean treatment duration was 12.2months (SD=3.4). No statistically significant treatment changes were observed in upper airway dimensions or dentoskeletal cephalometric analyses. Subjects with excessive daytime sleepiness at pre-treatment reported an improvement post-treatment, but no significant difference in the mean ESS score was found.

CONCLUSION

Treatment of Class II division 1 malocclusion in adults by mandibular dentoalveolar advancement using CAT has no statistically significant effects on the airway and dentoskeletal measurements, or daytime sleepiness.

An in vitro comparison of ultraviolet versus white light in the detection of adhesive remnants during orthodontic debonding

OBJECTIVES

To assess the effectiveness and efficiency of ultraviolet (UV) illumination compared to conventional white light in the detection of fluorescent-tagged adhesive remnants during orthodontic debonding.

MATERIALS AND METHODS

Orthodontic brackets were bonded to extracted human premolars using one of two bonding resins having fluorescent properties (Pad Lock, Reliance Orthodontics, Itasca, Ill; Opal Bond MV, Opal Orthodontics, South Jordan, Utah; n = 40 each). The brackets were then debonded and, in each adhesive group, half the teeth had the remaining adhesive resin removed under illumination using the operatory light and the other half using a UV (395 nm) light emitting diode (LED) flashlight (n = 20/group). Time for teeth cleanup was recorded. Follow-up images were obtained under a dissecting microscope using UV illumination, and the surface area of adhesive remnants was calculated. Effectiveness of adhesive removal was also assessed using scanning electron microscopy imaging. Analysis of variance and Kruskal-Wallis tests were used to analyze time and adhesive remnants, respectively.

RESULTS

Assessment using the dissecting microscope found groups using UV light during adhesive removal had statistically significantly lower amounts of adhesive remnants than groups using white light (P ≤ .01). Time for adhesive removal was significantly lower with Opal Bond MV adhesive using UV light when compared with the white light (P ≤ .01). Assessment by scanning electron microscopy showed that thin remnants of adhesive (<2 μm) remained undetected by UV illumination.

CONCLUSIONS

UV light is more effective and tends to be more efficient than white light in the detection of fluorescent adhesive during orthodontic debonding. Although there are limitations, the use of UV LED lighting is a practical tool that aids in adhesive detection.