Mechanical analysis of the improved superelastic Ni-Ti alloy wire using the orthodontic simulator with high-precision sensors

PURPOSE

The authors have been using improved superelastic Nickel-Titanium alloy wire (ISW) to close and align extraction spaces simultaneously, instead of separately using rigid wires for closing extraction spaces and Ni-Ti alloy wires for leveling and aligning. ISW has a low stiffness, which makes it challenging to generate sufficient moments. This study aimed to demonstrate the forces and moments exerted on adjacent brackets using an orthodontic simulator (OSIM) attached to a high-precision 6-axis sensor.

MATERIALS AND METHODS

In experiment 1, a 0.016 × 0.022-inch ISW, stainless steel (SS) wire, and β-titanium wires were ligatured into the two brackets. The 0.018 × 0.025-inch slot self-ligating brackets were bonded to two simulated teeth at the same height, and the experiment was conducted using the high-precision OSIM. The distance between the brackets was 10 mm, the V-bend angles of the installed wires were 10°, 20°, 30°, and 40°, and the apex position was set at the center of the bracket. In experiment 2, 6.0- and 9.0-mm long elastomeric chains were placed on the same brackets as in Experiment 1 to measure forces and moments. The distance between the brackets was increased by 1.0 mm from 6.0 to 15.0 mm. Both experiments were conducted in a 37 °C thermostatic chamber similar to the oral environment.

RESULTS AND DISCUSSION

In experiment 1, we measured moments on both sides for all the wires. As the V-bend angle increased, the absolute values of the moments also increased. With a V-bend angle of 10°, there was a significant (p < 0.05) difference in the moment generated in the left and right brackets among the three wire types. In the ISW, -1.67 ± 0.38 N・mm was generated in the left bracket, while 0.38 ± 0.26 N・mm was generated in the right bracket at 10°. At 20°, -1.77 ± 0.69 N・mm was generated in the left bracket, while 2.37 ± 0.94 N・mm was generated in the right bracket. At 30°, -2.98 ± 0.49 N・mm was generated in the left bracket, while 3.25 ± 0.32 N・mm was generated in the right bracket. Moreover, at 40°, -3.96 ± 0.58 N・mm was generated in the left bracket, while 3.55 ± 0.53 N・mm was generated in the right bracket. Furthermore, in experiment 2, the moments increased in proportion to the increase in distance between the centers of the two brackets. Absolute values of the moments were approximately equal for the left and right brackets. The 6.0-mm elastomeric chain generated a minimum force of -0.09 ± 0.05 N in the left direction when the distance between brackets was 6.0 mm, while a maximum of 1.24 ± 0.3 N when the distance between brackets was 12 mm in the right bracket. In the left bracket, minimum and maximum forces of -0.09 ± 0.07 and 1.3 ± 0.4 N were generated in the right direction, respectively. The 9.0-mm elastomeric chain generated a minimum force of 0.03 ± 0.07 N in the left direction when the distance between brackets was 9.0 mm, while a maximum of 1.3 ± 0.1 N when the distance between brackets was 15 mm in the right bracket. In the left bracket, minimum and maximum forces of 0.05 ± 0.06 and 0.98 ± 0.2 N were generated in the right direction, respectively.

CONCLUSION

Mechanical data of the ISW have been collected in the study, which was previously difficult to perform owing to the low stiffness of the wire. It is suggested that the ISW can provide sufficient moments with the addition of V-bends to close the space by bodily movement.

Gastric emptying rate of a solid meal in patients with anterior open bite malocclusion: A preliminary study

Objectives:

The objective of the study was to investigate the relationship between anterior open bite (AOB) malocclusion and digestion by evaluating mastication and gastric emptying (GE) of a solid meal.

Material and Methods:

We recruited 26 female participants and divided them into two groups according to their occlusion status: The control group with normal occlusion (n = 11; age: 25.2 ± 2.8 years; and body mass index [BMI]: 21.1 ± 1.9 kg/m2) and the AOB group with AOB malocclusion (n = 15; age: 23.2 ± 5.5 years; BMI: 21.0 ± 1.6 kg/m2). GE, chewing, and occlusion were assessed simultaneously. A food questionnaire survey was also administered on the same day.

Results:

A significant positive correlation was noted between open bite and the occlusal analysis findings. Negative correlations were found between the food questionnaire score and both the open bite and occlusal analysis findings, which confirmed that AOB affects mastication. However, no significant difference in the GE rate parameters was observed between the two groups.

Conclusion:

Adaptive mechanisms may have a compensatory effect on the GE rate. However, the lack of tooth contact in the anterior occlusal region resulted in reduced masticatory ability. Orthodontic treatment should thus be considered, regardless of the presence of digestive problems, to improve mastication.

Post-orthodontic recontouring of anterior teeth using composite injection technique with a digital workflow

OBJECTIVE

Restorative treatment of anterior teeth is often required as the final step of orthodontic therapy to optimize the esthetics and function. This case report presents a direct minimally invasive approach for post-orthodontic recontouring of anterior teeth using the composite injection technique with a digital workflow.

CLINICAL CONSIDERATIONS

The extraction of central incisors with short roots was indicated to resolve maxillary anterior crowding. The gained space was closed with lateral incisors, and it was necessary to recontour them and canines to resemble central and lateral incisors, respectively. The restorations were digitally designed, and a transparent silicone index was fabricated from a 3D-printed cast of the digital wax-up. After lateral incisors and canines were bonded with a universal adhesive in the etch-and-rinse mode, a highly filled injectable composite resin was applied into the index. The restorative treatment was preceded by gingivectomy using an Er:YAG laser and home bleaching.

CONCLUSIONS

In cases where more complex recontouring of anterior teeth is necessary, the composite injection technique could be a suitable alternative to indirect restorations, because it is straightforward, cost-effective, and does not require any preparation. The digital workflow simplified and expedited the treatment while contributing to its precision.

CLINICAL SIGNIFICANCE

Post-orthodontic recontouring using direct composite restorations is well accepted by patients due to low cost and non-invasiveness. However, in complicated cases, the free-hand technique is time-consuming and technique-sensitive. The presented composite injection technique with a digital workflow significantly simplifies and expedites the composite placement while predictably enhancing the treatment outcome.

Three-dimensional quantification of magnetic resonance imaging artifacts associated with shape factors

Differences in the volumes of artifacts caused by variously shaped titanium objects on magnetic resonance imaging (MRI) were evaluated. Spherical-, square cubic-, and regular tetrahedron-shaped isotropic, and elongated spherical-, elongated cubic-, and elongated tetrahedron-shaped anisotropic objects, with identical volumes, were prepared. Samples were placed on a nickel-doped agarose gel phantom and covered with nickel-nitrate hexahydrate solution. Three-Tesla MR images were obtained using turbo spin echo and gradient echo sequences. Areas with ±30% of the signal intensity of the standard background value were considered artifacts. Sample volumes were deducted from these volumes to calculate the total artifact volumes. Isotropic samples had similar artifact volumes. For anisotropic samples, the artifact volume increased in proportion with the normalized projection area. MRI artifact size can be reduced by high anisotropic designs, and by positioning the long axis of the metal device as parallel as possible to the magnetic field axis.

Alternative approach using miniscrew-anchored sliding jig to correct maxillary midline deviation in a patient with unilateral missing premolar

This case report describes the use of a miniscrew-anchored sliding jig (SJ) to distalize molars in a patient with maxillary midline deviation. A 41-year-old female presented with a chief complaint of maxillary midline deviation toward the left caused by prior orthodontic treatment involving unilateral extraction of a maxillary left premolar. Clinical examination revealed facial symmetry and a straight profile. The maxillary midline was deviated 2.5 mm to the left. The patient was treated with molar distalization using miniscrew-anchored SJs. Midline correction and alignment were obtained with maxillary unilateral distalization and mandibular full-arch distalization. The total active treatment period was 32 months. Appropriate occlusion and centered midlines were maintained after 29 months of retention. Our results suggest that the treatment method described herein is effective to distalize the unilateral posterior segment in either arch.

Development of 6-Axis Orthodontic Force and Moment Sensing Device for Decreasing Accident of Orthodontic Treatment. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018;2018:1797-1800. [PMID: 30440743 DOI: 10.1109/embc.2018.8512648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

The purpose of this study is to develop the sensing device which measures three-axis force and three-axis moment for reducing the number of accident in orthodontic treatment. The device is necessary for adequate quantitative evaluation of orthodontic forces during orthodontics. The developed sensing device is composed of six-axis force sensors, tooth models, and arms for connecting sensors and tooth models. The developed device simulates rows of teeth in orthodontic operation and measures $14 \times 6$ axes force and moment from tooth models simultaneously. The averages of the difference of force and moment to theoretical values in each direction are 1.78 % (0.043 N) and 2.72 % (0.60 Nmm) respectively. The average moment applying couple forces is 17.1 % (0.81 Nmm). Then the device is able to measure more accurately as the value of the moment was larger. Therefore using our proposed device, we can conduct the orthodontic treatment which dentition moves large for attaching the rail of wire to the teeth.

Six-axis orthodontic force and moment sensing system for dentist technique training

The purpose of this study is to develop a sensing system device that measures three-axis orthodontic forces and three-axis orthodontic moments for dentist training. The developed sensing system is composed of six-axis force sensors, action sticks, sliders, and tooth models. The developed system also simulates various types of tooth row shape patterns in orthodontic operations, and measures a 14 × 6 axis orthodontic force and moment from tooth models simultaneously. The average force and moment error per loaded axis were 2.06 % and 2.00 %, respectively.

Mechanical properties of orthodontic wires made of super engineering plastic

Most orthodontic equipment is fabricated from alloys such as stainless steel, Co-Cr and Ni-Ti because of their excellent elastic properties. In recent years, increasing esthetic demands, metal allergy and interference of metals with magnetic resonance imaging have driven the development of non-metallic orthodontic materials. In this study, we assessed the feasibility of using three super engineering plastics (PEEK, PES and PVDF) as orthodontic wires. PES and PVDF demonstrated excellent esthetics, although PEEK showed the highest bending strength and creep resistance. PEEK and PVDF showed quite low water absorption. Because of recent developments in coloration of PEEK, we conclude that PEEK has many advantageous properties that make it a suitable candidate for use as an esthetic metal-free orthodontic wire.

Development of a surgical procedure for biointegration of a newly designed orthodontic onplant

AIM

An onplant is an orthodontic anchorage device fixed to the bone surface with osseointegration. Compared with implants, the onplant has fewer limitations regarding placement and is less invasive. The purpose of this study was to clarify the effect of bone-surface treatment and the fixing method of a newly designed smaller-sized onplant and establish a prospective surgical procedure for placement of the onplant.

METHODS

Thirty-eight onplants were placed in six beagle dogs. The bone surface was planed where the cortical bone was thick and reducible (bone-planed). Where the cortical bone was thin and uneven, a filling was inserted in the space between the onplant and bone (filled). The onplant was fixed to the bone in one of two ways: using a membrane that covered the onplant and fixing the membrane with titanium pins (membrane-fixed) or fixing the onplant directly to the bone using the same titanium pins (pin-fixed).

RESULTS

Twelve weeks later, all the onplants were osseointegrated. The bone-planed group showed significantly (P < .05) larger shear stress than the filled groups. In the bone-planed group, the pin-fixed group showed significantly (P < .05) larger shear stress than the membrane-fixed group. The shear stresses were considered strong enough to function in orthodontic treatment.

CONCLUSION

The effect of the bone-surface treatment and the onplant-fixing method on the shear stress was clarified, and the findings in the present study may be useful for the improvement of surgical procedures for orthodontic onplants.

Clinical study of frontal chewing patterns in various crossbite malocclusions

INTRODUCTION

The purpose of this study was to clarify the frontal chewing patterns of various crossbite malocclusions.

METHODS

A mandibular kinesiograph was used to record the masticatory movements of 106 subjects (ages, 12-35 years) with crossbite malocclusion and 22 subjects (ages, 16-30 years) with normal occlusion. The chewing patterns were classified into 8 chewing types according to the cycle shape of the frontal incisor point movement. The crossbite subjects were divided into 5 groups by the anteroposterior position of the crossbite, and then the subjects with posterior crossbite were divided into 3 groups by the transverse position of the crossbite. The Mann-Whitney U test was used to compare the frequency of each chewing type between any crossbite group and the control group; and between the various crossbite groups.

RESULTS

In the crossbite groups, normal chewing occurred much less often than in subjects with normal occlusion. In the posterior crossbite group, reverse chewing was greater (P = 0.002), and normal chewing was less frequent (P = 0.001) compared with the anterior crossbite group. When accompanied by mandibular shift, mandibular prognathism, arch crossbite, in the crossbite or shift side, reverse type, and reverse-crossing type occurred more often than in contralateral side.

CONCLUSIONS

In the frontal plane, patients with posterior crossbite might have more abnormal chewing types than those with anterior crossbite, and posterior crossbite could contribute to the high frequency of reverse and reverse-crossing chewing types, especially when accompanied by mandibular shift, mandibular prognathism, or arch crossbite.

Occlusal Hypofunction Induces Atrophic Changes in Rat Gingiva

Objective: To clarify the influence of occlusal hypofunction on the integrity of gingival tissue and gingival extracellular matrix biosynthesis.

Materials and Methods: Thirteen-week-old male Wistar rats were divided into two groups. To eliminate occlusal forces, all the right maxillary molars were extracted in the hypofunctional group. The control group was anesthetized but not subjected to surgery. The rats were killed at 2 and 4 weeks after the procedure, and the lower right second molars were prepared for histological analysis. To investigate the effect of occlusal hypofunction on collagen biosynthesis, the expression of connective tissue growth factor (CTGF) and lysyl oxidase (LOX) was determined by immunohistochemistry as well as histological examination by hematoxylin and eosin staining.

Results: Disorientation of the collagen fibers, proliferation of the connective tissue fibroblasts, and enlargement of epithelial intercellular gaps were observed in gingival tissue of rat molars with experimental occlusal hypofunction. Immunohistochemically, the expression of CTGF and LOX was increased significantly (P &lt; .05) in the hypofunctional group.

Conclusion: These results suggest that occlusal hypofunction can affect the structural integrity and the expression of CTGF and LOX in gingival tissue.

Preapplication of Orthodontic Forces to the Donor Teeth Affects Periodontal Healing of Transplanted Teeth

Objective: To investigate how the preapplication of orthodontic forces to the donor teeth affects the periodontal healing after transplantation.

Materials and Methods: The orthodontic force (1.5 cN) was applied to the maxillary right molars of 6-week-old male Spraque-Dawley rats (n = 21) in the experimental side, and the left side of the same animals was used as the control. After 7 days, both right and left maxillary second molars were extracted or replanted. Periodontal conditions were evaluated in the histological specimens 7 days after applying orthodontic force (before and after extraction) and 14 days after replantation.

Results: The application of orthodontic force for 7 days significantly increased the periodontal ligament (PDL) space and also the width of the alveolar socket, which resulted in a rich attached PDL to the root surface of the extracted teeth. Significantly more root resorption was also detected in the control side without preapplication of orthodontic force 14 days after replantation. This root resorption might involve in the disruption of the PDL.

Conclusion: These results suggested that the preapplication of orthodontic force to the donor teeth increased the PDL width and eased the extraction, which might decrease root resorption after replantation.

The influence of occlusal stimuli on basic fibroblast growth factor expression in the periodontal healing of replanted teeth

Occlusal stimuli and the periodontal healing of replanted teeth have been reported to be related. However, the mechanism for preventing dentoalveolar ankylosis remains unclear. Basic fibroblast growth factor (bFGF/FGF-2) is considered as a key factor in wound healing. The purpose of this study was to evaluate the relationship between occlusal stimuli, bFGF, and the periodontal healing after tooth replantation. Five-week-old male rats were divided into non-occluded, occluded, and recovery groups. The right maxillary first molars were replanted in all groups, and the left maxillary first molars in the 2-week occluded group without replantation were served as nontreated. An anterior bite plate was attached to the maxillary and mandibular incisors to produce occlusal hypofunction in the non-occluded group and was then removed after 1 week in the recovery group. Histological observations were performed after 1 and 2 weeks of the experimental period. After 2 weeks, the non-occluded group had detectable ankylosis and obvious periodontal tissue stricture. Meanwhile, the occluded and recovery groups showed enlarged and thickened periodontia without ankylosis. The number of bFGF-positive cells in the occluded and recovery groups significantly increased as compared to in the non-occluded group. These results suggest that occlusal stimuli enhance the production of bFGF in the periodontal healing of replanted teeth and prevent dentoalveolar ankylosis.

Early Correction of a Developing Skeletal Class III Malocclusion

This case report describes the treatment of a Japanese girl aged 11 years 10 months who had a severe Class III malocclusion with a concave facial profile. She presented hypodivergent skeletal pattern with a -4.0-mm anterior crossbite and a deep overbite. She also had facial asymmetry attributed partly to the lateral mandibular shift to avoid incisal interferences. The treatment plan included a monoblock appliance, rapid palatal expansion, and fixed edgewise appliances at the final stage. The monoblock appliance was used to redirect the growth of the mandible to a clockwise direction and simultaneously correct the incisal relationships along with fixed edgewise appliances. Good incisal relationships were achieved, and facial esthetics was greatly improved after 28 months of treatment. Stability of the treatment result was excellent in the 3-year 9-month follow-up at the age of 18.

Influence of estrogen cycle on temporomandibular joint synovial membrane in rat with deviated mandible

Temporomandibular disorders (TMD) are known to be more prevalent and severe in women than in men, especially in those who are in their reproductive age. In those patients reproductive hormones may play a vital role in the host adaptive capacity of the temporomandibular joint (TMJ). In order to clarify the relationship between TMD prevalence and estrogen cycle, a mandible deviated animal model was carried out, and the expression of inducible nitric oxide synthase (iNOS), an essential enzyme in the pathogenesis of inflammatory arthritis, was investigated in the rat's synovial tissue. An appliance was attached to the rat's incisors to produce a lateral deviation of the mandible during the metestrus phase, and the animals were sacrificed in the proestrus and estrus phase, when the estrogen was at the highest and lowest level, respectively. Immunostaining was then performed for 2 consecutive estrous cycles to demonstrate iNOS expression in the synovial membrane of the TMJ. The immunoreactivity for iNOS was more intense in the synovial membrane on the contralateral side in the proestrus phase (estrogen peak phase). These observations suggest that iNOS expression in the synovial membrane with mandibular deviation may be exacerbated in the presence of estrogen.

Occlusal stimuli regulate interleukin-1 beta and FGF-2 expression in rat periodontal ligament

While many studies reported the structural changes in the periodontal ligament (PDL) under hypofunctional conditions, the associations of cytokine growth factors are still unclear. They are known to take part in inflammation, and may affect the biological properties of hypofunctional tooth. To investigate the hypofunctional PDL and the recovery from this condition, we focused on interleukin-1 beta (IL-1beta) and basic fibroblast growth factor (FGF-2). Male Wistar rats were divided into occluded, non-occluded, and recovery groups. An anterior bite plate was used to eliminate the occlusal contact of molars in the non-occluded group, and was then removed for the recovery group. After occlusal stimuli were eliminated for 7 and 14 days, and after 3 and 7 days of recovery from 7 days in the hypofunctional condition, the PDLs of the lower first molars were investigated immunohistochemically. The lack of occlusal stimuli caused atrophic changes in the PDL with the upregulation of IL-1beta and decreased expression of FGF-2, while decreased IL-1beta and enhanced FGF-2 expression were observed in the recovery process. These results suggest that occlusal stimuli regulate IL-1beta and FGF-2 expression, and the nature of this regulation may differ from that in the healing process of an inflammatory reaction.

Occlusal forces promote periodontal healing of transplanted teeth and prevent dentoalveolar ankylosis: an experimental study in rats

The process of healing periodontal ligaments (PDL) after transplantation has been widely examined, but the mechanism for preventing dentoalveolar ankylosis is still unclear. In this study, we focused on the role of mechanical stimuli in preventing ankylosis using an animal model of tooth transplantation assessed by histologic observation and evaluation of proliferating PDL cells. Five-week-old Sprague-Dawley male rats were divided into occluded and nonoccluded groups. The right maxillary first molars were replanted in both groups, and histologic observations were carried out after one or two weeks. The proliferative activity of PDL cells was also examined by assessing the distribution of 5-bromo-2'-deoxyuridine (BrdU). After two weeks in the nonoccluded group, ankylosis was clearly detected and PDL stricture was obvious, whereas no severe bone or root resorption was observed. On the other hand, the occluded group showed an enlarged and thickened PDL with extensive root resorption, but no ankylosis. Based on these findings, the replanted teeth were given a one-week healing period and then occlusion recovery was assessed, which resulted in decreased ankylosis and root resorption. The proliferative activity of PDL cells in the occluded group was generally higher than in the nonoccluded group. The activity of PDL cells in the recovery group was also higher than that of the nonoccluded group. These results suggest that occlusal stimuli promoted the regeneration of the PDL and prevented dentoalveolar ankylosis, whereas excessive initial force might cause severe root and bone resorption.

Occlusal forces promote periodontal healing of transplanted teeth with enhanced nitric oxide synthesis

It has been reported that occlusal forces promote periodontal healing of transplanted teeth and prevent dentoalveolar ankylosis, although its mechanism is still unclear. Nitric oxide (NO) produced by NO synthase (NOS) is considered to be an important factor which is involved in wound healing, and it increases with mechanical stimuli. The objective of this study was to examine the relationship among occlusal stimuli, inducible NOS (iNOS) and PDL healing of transplanted teeth. Five-week-old Sprague-Dawley male rats were used for this study. The right maxillary first molars of rats were replanted and animals were divided into occluded and non-occluded groups. Histologic observations were carried out after one and two weeks. After two weeks, the non-occluded group had clearly detectable ankylosis and obvious PDL stricture. On the other hand, the occluded group showed an enlarged and thickened PDL without ankylosis. The number of iNOS positive cells in the occluded group, samples significantly increased in comparison to that of the non-occluded group. These results suggest that occlusal stimuli enhanced the production of NO in the PDL healing process of transplanted teeth and a favorable result could be obtained.

Effects of mechanical strain on proliferation and differentiation of bone marrow stromal cell line ST2

Differentiation of mesenchymal stromal cells into osteoblasts is regulated by many factors including growth factors, cytokines, and hormones. Mechanical stress has been considered to be an important factor in bone modeling and remodeling. However, biological responses of stromal cells to mechanical stimuli are still unknown. To show the correlation between magnitude of mechanical strain and differentiation of stromal cells into osteoblasts, we investigated the proliferation and the expression of osteoblast-related genes in stromal cell line ST2 that is in the process of osteoblastic differentiation by treatment with ascorbic acid and beta-glycerophosphate, under 0.8%-15% elongation using the Flexercell Strain system. The expression of osteoblast-related genes was analyzed by real-time quantitative polymerase chain reaction (PCR). Cell proliferation significantly increased at 5%, 10%, and 15% elongation compared to that of unloaded controls. Alkaline phosphatase (ALPase) activity significantly increased at 0.8% and 5% elongation but decreased at 10% and 15% elongation. At 1 h and 6 h, mRNA level of Cbfa1/Runx2 increased at lower magnitudes of strain (0.8% and 5% elongation) but decreased at higher magnitude of strain (15% elongation). At 24 and 48 h, Cbfa1/Runx2 and osteocalcin mRNAs decreased at 5%, 10%, and 15% elongation, whereas cell proliferation and expression of type I collagen mRNA increased at the same elongation. These results indicate that mechanical strain stimulates osteoblastic differentiation of stromal cells at low magnitudes of strain.

Experimental tooth movement under light orthodontic forces: rates of tooth movement and changes of the periodontium

AIM

To investigate light forces for experimental tooth movement.

METHOD

Light orthodontic forces of 1.2, 3.6, 6.5, and 10 g force (gf) were applied for 14 days to move rat molars, and the effects of the forces on the rate of tooth movement and changes of the periodontium were examined.

RESULTS

In the early period, despite the different levels of force used in each group, there were no significant differences in tooth displacement. From hour 56 to day 14, the tooth displacement in the 1.2 gf group was significantly smaller than that in the other groups and the rate was nearly constant. The rates of tooth displacement in the 3.6, 6.5, and 10 gf groups fluctuated repeatedly, while the orthodontic forces gradually decreased.

CONCLUSION

Experimental tooth movement in rats, tipping without friction under light forces, were either constant or fluctuated in cycles of several days' duration. This is in contradiction to the three-phases-theory of tooth movement described in previous investigations using heavy forces.