Journal of Clinical Medicine

Editorial

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5 pages, 193 KiB

Open AccessEditorial

New Approaches and Technologies in Orthodontics

by Letizia Perillo, Fabrizia d’Apuzzo and Vincenzo Grassia

J. Clin. Med. 2024, 13(9), 2470; https://doi.org/10.3390/jcm13092470 - 24 Apr 2024

Viewed by 2862

Abstract

In recent years, new diagnostic and treatment approaches in orthodontics have arisen, and there is thus a need for researchers and practitioners to stay up to date with these innovations [...] Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

Research

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16 pages, 3016 KiB

Open AccessArticle

Treatment Efficiency of Maxillary and Mandibular Orovestibular Tooth Expansion and Compression Movements with the Invisalign^® System in Adolescents and Adults

by Ludger Keilig, Lena Brieskorn, Jörg Schwarze, Werner Schupp, Christoph Bourauel and Anna Konermann

J. Clin. Med. 2024, 13(5), 1267; https://doi.org/10.3390/jcm13051267 - 23 Feb 2024

Cited by 1 | Viewed by 1333

Abstract

Objectives: Aligners are an effective and esthetic orthodontic treatment option for permanent and mixed dentition. There are only a few studies dealing with the effectiveness of orovestibular tooth movement using aligners and applying adequate examination methods. In the present retrospective study, the aligner [...] Read more.

Objectives: Aligners are an effective and esthetic orthodontic treatment option for permanent and mixed dentition. There are only a few studies dealing with the effectiveness of orovestibular tooth movement using aligners and applying adequate examination methods. In the present retrospective study, the aligner efficiency of orovestibular movements for the entire dentition was systematically evaluated using 3D superimposition, taking into account the influence of jaw, tooth type and Invisalign^® system. Methods: Group 1 (n = 18 adults, Invisalign^®) and Group 2 (n = 17 adolescents, Invisalign^® Teen) were treated with Invisalign^® Ex30 aligner material and Invisalign^® specific auxiliary means. In this non-interventional retrospective study, pre- and post-treatment maxillary and mandibular plaster cast models were scanned and superimposed with ClinChecks^® via Surface–Surface Matching Algorithm on unmoved teeth providing stable references. Effectivity of planned versus clinically realized movements was evaluated for each tooth. Statistics were performed with a t-test and Bonferroni–Holm correction (α = 0.05). Results: Orovestibular movement efficiency was excellent without statistical significance regarding jaw, tooth type or Invisalign^® system. Mandibular translational tooth movements were highly effective, and outstanding for premolars (91–98%). Maxillary translational tooth movements were successful for incisors and premolars, but less effective for canines and molars. Almost all teeth were moderately or very effectively corrected by crown tipping, performing better for mandibular (70–92%) than maxillary (22–31%) canines as much as for adolescent upper front teeth (81–85%) and lower canines (92%). Conclusions: Aligners are able to effectively implement translational orovestibular movements, supported by tilting the crowns for even more efficient implementation of the movements. This phenomenon was observed in our studies for all teeth in both jaws, regardless of the Invisalign^® system used. Treatment planning should nevertheless take into account the individual patient parameters with regard to the movements to be performed in order to make the aligner therapy as successful as possible in terms of realizing the desired therapeutic goal. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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16 pages, 6069 KiB

Open AccessArticle

Differential Recovery Patterns of the Maxilla and Mandible after Eliminating Nasal Obstruction in Growing Rats

by Mirei Keitoku, Ikuo Yonemitsu, Yuhei Ikeda, Huan Tang and Takashi Ono

J. Clin. Med. 2022, 11(24), 7359; https://doi.org/10.3390/jcm11247359 - 11 Dec 2022

Cited by 5 | Viewed by 1763

Abstract

Although nasal obstruction (NO) during growth causes maxillofacial growth suppression, it remains unclear whether eliminating the NO affects maxillary and mandibular growth differentially. We aimed to clarify whether eliminating NO can help regain normal maxillofacial growth and to determine the optimal intervention timing. [...] Read more.

Although nasal obstruction (NO) during growth causes maxillofacial growth suppression, it remains unclear whether eliminating the NO affects maxillary and mandibular growth differentially. We aimed to clarify whether eliminating NO can help regain normal maxillofacial growth and to determine the optimal intervention timing. Forty-two 4-week-old male Wistar rats were randomly divided into six groups. Their left nostril was sutured to simulate NO over different durations in the experimental groups; the sutures were later removed to resume nasal breathing. Maxillofacial morphology was assessed using microcomputed tomography. Immunohistochemical changes in hypoxia-inducible factor (HIF)-1α, osteoprotegerin (OPG), and receptor activator of nuclear factor kappa-B ligand (RANKL) of the condylar cartilage were evaluated to reveal the underlying mechanisms of these changes. Maxillary length was significantly lower in rats with NO for ≥5 weeks. In groups with NO for ≥7 weeks, the posterior mandibular length, ramus height, thickness of the hypertrophic cell layer in the condylar cartilage, HIF-1α levels, and RANKL levels were significantly lower and OPG levels and RANKL/OPG were significantly higher than those in the control group. Our findings suggest that eliminating NO is effective in regaining maxillofacial growth. Moreover, the optimal timing of intervention differed between the maxilla and mandible. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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10 pages, 3033 KiB

Open AccessArticle

Lip Bumper Therapy Does Not Influence the Sagittal Mandibular Incisor Position in a Retrospective CBCT Study

by Olivia Griswold, Chenshuang Li, Justin C. Orr, Normand S. Boucher, Shalin R. Shah and Chun-Hsi Chung

J. Clin. Med. 2022, 11(20), 6032; https://doi.org/10.3390/jcm11206032 - 13 Oct 2022

Cited by 2 | Viewed by 1908

Abstract

Lip bumper (LB) therapy is used as a treatment approach for mild to moderate crowding without extraction of teeth. Previous studies demonstrated that LB increases arch length through molar uprighting and lateral expansion. However, the effects of LB on mandibular incisors are inconclusive. [...] Read more.

Lip bumper (LB) therapy is used as a treatment approach for mild to moderate crowding without extraction of teeth. Previous studies demonstrated that LB increases arch length through molar uprighting and lateral expansion. However, the effects of LB on mandibular incisors are inconclusive. The controversial results from different studies may be due to limitations including absence of a control group and/or use of 2D radiography. To address this issue, the current retrospective longitudinal CBCT study compared a rapid maxillary expansion (RME) group with no lower treatment [16 patients (9 females, 7 males); median age 8.86 years at T1 and 11.82 years at T2] and an RME + LB group [18 patients (13 females, 5 males); median age 9.46 years at T1 and 12.10 years at T2]. The CBCTs taken before and after phase 1 treatment were 3D superimposed based on the mandibular structure and were measured to determine the angular and linear changes of the mandibular incisors over the course of LB treatment. For comparisons between different timepoints within a group, a Wilcoxon matched-pairs signed rank test was used. For intergroup comparisons, a Mann–Whitney U test was used. Both groups showed eruption and protrusion of the mandibular incisors during the observation period, while there was no significant change in proclination of the lower incisors. When comparing the discrepancy of change between groups, there was no statistically significant difference detected. In summary, by utilizing a longitudinal 3D database, the current study demonstrated that the effect of LB on the position of the mandibular incisors is limited. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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11 pages, 967 KiB

Open AccessArticle

Mini-Implant Rejection Rate in Teenage Patients Depending on Insertion Site: A Retrospective Study

by Teodora Consuela Bungău, Luminița Ligia Vaida, Abel Emanuel Moca, Gabriela Ciavoi, Raluca Iurcov, Ioana Mihaela Romanul and Camelia Liana Buhaș

J. Clin. Med. 2022, 11(18), 5331; https://doi.org/10.3390/jcm11185331 - 10 Sep 2022

Cited by 3 | Viewed by 2180

Abstract

Mini-implants have undeniable advantages in Orthodontics. However, the use of mini-implants shows some limitations and disadvantages related to patient age, the quality of the bone tissue, the characteristics of the oral mucosa, implant site, the state of health of the organism and the [...] Read more.

Mini-implants have undeniable advantages in Orthodontics. However, the use of mini-implants shows some limitations and disadvantages related to patient age, the quality of the bone tissue, the characteristics of the oral mucosa, implant site, the state of health of the organism and the quality of oral hygiene. The aim of this paper was to analyze the rejection rate of mini-implants in teenage patients, depending on their insertion site, and examine their stability up to three months after insertion. This retrospective study was conducted on dental charts belonging to patients aged between 12 and 17 years, from Oradea, Romania. The mini-implants were placed for various therapeutic reasons and were inserted in the following sites: buccal maxillary area, the infrazygomatic region, palatal area, buccal mandibular area and lingual area; they had a diameter of 1.6 mm (inter-radicular spaces) and of 2 mm (nonbearing tooth areas), and a length of 6–8 mm (mandible) or 8–10 mm (maxilla). The rejection rate was checked in the first month, second month, third month and after the third month from insertion. A total of 432 patients were included in the study, and they had a total of 573 mini-implants. Most implants were placed in the buccal region of the maxilla (27.7%), and most patients had one mini-implant placed (65.7%). The highest rejection rate was obtained in the first month (15.2%). The rejection rate between genders was similar. The mini-implants from the buccal mandibular region had a significantly higher rate of rejection in the first month (M1) in comparison to the mini-implants from the palatal region (24.4% vs. 8.3%). The mini-implants from the lingual region of the mandible had a significantly higher rate of rejection in the second month (M2) in comparison to the mini-implants from the infrazygomatic or the palatal region (10.5% vs. 0%/0%). Mini-implants are very useful for carrying out various orthodontic treatments, but their stability should be enhanced. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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20 pages, 20367 KiB

Open AccessArticle

Skeletal, Dentoalveolar and Dental Changes after “Mini-Screw Assisted Rapid Palatal Expansion” Evaluated with Cone Beam Computed Tomography

by Patricia Solano Mendoza, Paula Aceytuno Poch, Enrique Solano Reina and Beatriz Solano Mendoza

J. Clin. Med. 2022, 11(16), 4652; https://doi.org/10.3390/jcm11164652 - 9 Aug 2022

Cited by 11 | Viewed by 3430

Abstract

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This [...] Read more.

The purpose of this study was to evaluate skeletal, dentoalveolar and dental changes after Mini-screw Assisted Rapid Palatal Expansion (MARPE) using tooth bone-borne expanders in adolescent patients after analyzing different craniofacial references by Cone beam computed tomography (CBCT) and digital model analysis. This prospective, non-controlled intervention study was conducted on fifteen subjects (mean age 17 ± 4 years) with transversal maxillary deficiency. Pre (T1) and post-expansion (T2) CBCTs and casts were taken to evaluate changes at the premolars and first molar areas. To compare means between two times, paired samples t- or Wilcoxon test were used following criteria. Significant skeletal changes were found after treatment for Nasal width and Maxillary width with means of 2.1 (1.1) mm and 2.5 (1.6) mm (p < 0.00005). Midpalatal suture showed a tendency of parallel suture opening in the axial and coronal view. For dentoalveolar changes, a significant but small buccal bone thickness (BBT) reduction was observed in all teeth with a mean reduction of 0.3 mm for the right and left sides, especially for the distobuccal root of the first molar on the left side (DBBTL1M) [IC95%: (−0.6; −0.2); p = 0.001] with 0.4 (0.4) mm. However, a significant augmentation was observed for the palatal bone thickness (PBT) on the left side. The buccal alveolar crest (BACL) and dental inclination (DI) showed no significant changes after treatment in all the evaluated teeth. MARPE using tooth bone-borne appliances can achieve successful skeletal transverse maxillary expansion in adolescent patients, observing small dentoalveolar changes as buccal bone thickness (BBT) reduction, which was not clinically detectable. Most maxillary expansions derived from skeletal expansion, keeping the alveolar bone almost intact with minor buccal dental tipping. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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11 pages, 902 KiB

Open AccessArticle

Validity and Reproducibility of the Peer Assessment Rating Index Scored on Digital Models Using a Software Compared with Traditional Manual Scoring

by Arwa Gera, Shadi Gera, Michel Dalstra, Paolo M. Cattaneo and Marie A. Cornelis

J. Clin. Med. 2021, 10(8), 1646; https://doi.org/10.3390/jcm10081646 - 13 Apr 2021

Cited by 9 | Viewed by 2391

Abstract

The aim of this study was to assess the validity and reproducibility of digital scoring of the Peer Assessment Rating (PAR) index and its components using a software, compared with conventional manual scoring on printed model equivalents. The PAR index was scored on [...] Read more.

The aim of this study was to assess the validity and reproducibility of digital scoring of the Peer Assessment Rating (PAR) index and its components using a software, compared with conventional manual scoring on printed model equivalents. The PAR index was scored on 15 cases at pre- and post-treatment stages by two operators using two methods: first, digitally, on direct digital models using Ortho Analyzer software; and second, manually, on printed model equivalents using a digital caliper. All measurements were repeated at a one-week interval. Paired sample t-tests were used to compare PAR scores and its components between both methods and raters. Intra-class correlation coefficients (ICC) were used to compute intra- and inter-rater reproducibility. The error of the method was calculated. The agreement between both methods was analyzed using Bland-Altman plots. There were no significant differences in the mean PAR scores between both methods and both raters. ICC for intra- and inter-rater reproducibility was excellent (≥0.95). All error-of-the-method values were smaller than the associated minimum standard deviation. Bland-Altman plots confirmed the validity of the measurements. PAR scoring on digital models showed excellent validity and reproducibility compared with manual scoring on printed model equivalents by means of a digital caliper. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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10 pages, 1030 KiB

Open AccessArticle

Incisor Occlusion Affects Profile Shape Variation in Middle-Aged Adults

by Georgios Kanavakis, Anna-Sofia Silvola, Demetrios Halazonetis, Raija Lähdesmäki and Pertti Pirttiniemi

J. Clin. Med. 2021, 10(4), 800; https://doi.org/10.3390/jcm10040800 - 17 Feb 2021

Cited by 6 | Viewed by 3947

Abstract

Background: The aim of this study was to assess the effect of overjet and overbite on profile shape in middle–aged individuals. Methods: The study population comprised 1754 46-year-old individuals, members of the 1966 Northern Finland Birth Cohort. Their profile images were digitized using [...] Read more.

Background: The aim of this study was to assess the effect of overjet and overbite on profile shape in middle–aged individuals. Methods: The study population comprised 1754 46-year-old individuals, members of the 1966 Northern Finland Birth Cohort. Their profile images were digitized using 48 landmarks and semi-landmarks. The subsequent landmark coordinates were then transformed to shape coordinates through Procrustes Superimposition, and final data were reduced into Principal Components (PCs) of shape. Overjet and overbite values were measured manually, during a clinical examination. A multivariate regression model was developed to evaluate the effect of overjet and overbite on profile shape. Results: The first nine PCs described more than 90% of profile shape variation in the sample and were used as the shape variables in all subsequent analyses. Overjet predicted 21.3% of profile shape in the entire sample (η²overjet = 0.213; p < 0.001), while the effect of overbite was weaker (η²overbite = 0.138; p < 0.001). In males, the equivalent effects were 22.6% for overjet and 14% for overbite, and in females, 25.5% and 13.5%, respectively. Conclusion: Incisor occlusion has a noteworthy effect on profile shape in middle-aged adults. Its impact becomes more significant taking into consideration the large variety of genetic and environmental factors affecting soft tissue profile. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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12 pages, 5975 KiB

Open AccessArticle

Skeletal Changes in Growing Cleft Patients with Class III Malocclusion Treated with Bone Anchored Maxillary Protraction—A 3.5-Year Follow-Up

by Ralph M. Steegman, Annemarlien Faye Klein Meulekamp, Arjan Dieters, Johan Jansma, Wicher J. van der Meer and Yijin Ren

J. Clin. Med. 2021, 10(4), 750; https://doi.org/10.3390/jcm10040750 - 13 Feb 2021

Cited by 9 | Viewed by 3858

Abstract

This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. Subjects and Method: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography [...] Read more.

This prospective controlled trial aimed to evaluate the skeletal effect of 3.5-years bone anchored maxillary protraction (BAMP) in growing cleft subjects with a Class III malocclusion. Subjects and Method: Nineteen cleft patients (11.4 ± 0.7-years) were included from whom cone beam computed tomography (CBCT) scans were taken before the start of BAMP (T0), 1.5-years after (T1) and 3.5 y after (T2). Seventeen age- and malocclusion-matched, untreated cleft subjects with cephalograms available at T0 and T2 served as the control group. Three dimensional skeletal changes were measured qualitatively and quantitatively on CBCT scans. Two dimensional measurements were made on cephalograms. Results: Significant positive effects have been observed on the zygomaticomaxillary complex. Specifically, the A-point showed a displacement of 2.7 mm ± 0.9 mm from T0 to T2 (p < 0.05). A displacement of 3.8 mm ± 1.2 mm was observed in the zygoma regions (p < 0.05). On the cephalograms significant differences at T2 were observed between the BAMP and the control subjects in Wits, gonial angle, and overjet (p < 0.05), all in favor of the treatment of Class III malocclusion. The changes taking place in the two consecutive periods (ΔT1-T0, ΔT2-T1) did not differ, indicating that not only were the positive results from the first 1.5-years maintained, but continuous orthopedic effects were also achieved in the following 2-years. Conclusions: In conclusion, findings from the present prospective study with a 3.5-years follow-up provide the first evidence to support BAMP as an effective and reliable treatment option for growing cleft subjects with mild to moderate Class III malocclusion up to 15-years old. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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11 pages, 1087 KiB

Open AccessArticle

Reliability and Reproducibility of Landmark Identification in Unilateral Cleft Lip and Palate Patients: Digital Lateral Vis-A-Vis CBCT-Derived 3D Cephalograms

by Anuraj Singh Kochhar, Ludovica Nucci, Maninder Singh Sidhu, Mona Prabhakar, Vincenzo Grassia, Letizia Perillo, Gulsheen Kaur Kochhar, Ritasha Bhasin, Himanshu Dadlani and Fabrizia d’Apuzzo

J. Clin. Med. 2021, 10(3), 535; https://doi.org/10.3390/jcm10030535 - 2 Feb 2021

Cited by 15 | Viewed by 2918

Abstract

Background: The aim of the retrospective observational study was to compare the precision of landmark identification and its reproducibility using cone beam computed tomography-derived 3D cephalograms and digital lateral cephalograms in unilateral cleft lip and palate patients. Methods: Cephalograms of thirty-one (31) North [...] Read more.

Background: The aim of the retrospective observational study was to compare the precision of landmark identification and its reproducibility using cone beam computed tomography-derived 3D cephalograms and digital lateral cephalograms in unilateral cleft lip and palate patients. Methods: Cephalograms of thirty-one (31) North Indian children (18 boys and 13 girls) with a unilateral cleft lip and palate, who were recommended for orthodontic treatment, were selected. After a thorough analysis of peer-reviewed articles, 20 difficult-to-trace landmarks were selected, and their reliability and reproducibility were studied. These were subjected to landmark identification to evaluate interobserver variability; the coordinates for each point were traced separately by three different orthodontists (OB_A, OB_B, OB_C). Statistical analysis was performed using descriptive and inferential statistics with paired t-tests to compare the differences measured by the two methods. Real-scale data are presented in mean ± SD. A p-value less than 0.05 was considered as significant at a 95% confidence level. Results: When comparing, the plotting of points posterior nasal spine (PNS) (p < 0.05), anterior nasal spine (ANS) (p < 0.01), upper 1 root tip (p < 0.05), lower 1 root tip (p < 0.05), malare (p < 0.05), pyriforme (p < 0.05), porion (p < 0.01), and basion (p < 0.05) was statistically significant. Conclusion: In patients with a cleft lip and palate, the interobserver identification of cephalometric landmarks was significantly more precise and reproducible with cone beam computed tomography -derived cephalograms vis-a-vis digital lateral cephalograms. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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9 pages, 3889 KiB

Open AccessArticle

Using Salivary MMP-9 to Successfully Quantify Periodontal Inflammation during Orthodontic Treatment

by Ionut Luchian, Mihaela Moscalu, Ancuta Goriuc, Ludovica Nucci, Monica Tatarciuc, Ioana Martu and Mihai Covasa

J. Clin. Med. 2021, 10(3), 379; https://doi.org/10.3390/jcm10030379 - 20 Jan 2021

Cited by 36 | Viewed by 2949

Abstract

Periodontitis is one of the most common immune-mediated inflammatory conditions resulting in progressive destruction of periodontium. Metalloproteinase-9 (MMP-9), an enzyme that is involved in the degradation of gelatin and collagen and present in the gingival crevicular fluid, is markedly increased in periodontitis. The [...] Read more.

Periodontitis is one of the most common immune-mediated inflammatory conditions resulting in progressive destruction of periodontium. Metalloproteinase-9 (MMP-9), an enzyme that is involved in the degradation of gelatin and collagen and present in the gingival crevicular fluid, is markedly increased in periodontitis. The aim of the study is to evaluate the effects of periodontal treatment either alone or in combination with orthodontic treatment on MMP-9 levels. In this study, 60 individuals were subjected to periodontal treatment (PD) or periodontal treatment combined with orthodontic treatment (POD). Both periodontal and periodontal plus orthodontic treatments significantly improved clinical parameters and lowered MMP-9 levels compared to control group. However, the combination of periodontal with orthodontic treatment further improved clinical parameters and enhanced the lowering effect on MMP-9 levels compared to periodontal or control groups alone. Finally, the degree of malocclusion significantly affected the effect of the treatment on MPP-9 levels with PD treatment having the most pronounced effect. We concluded that salivary MMP-9 can serve to accurately predict the level of inflammation in affected periodontal tissues during orthodontic treatment that is also associated with the type of malocclusion, making it a viable diagnosis tool in monitoring the progression of the periodontium during orthodontic treatment. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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13 pages, 7157 KiB

Open AccessCommunication

A User-Friendly Protocol for Mandibular Segmentation of CBCT Images for Superimposition and Internal Structure Analysis

by Chenshuang Li, Leanne Lin, Zhong Zheng and Chun-Hsi Chung

J. Clin. Med. 2021, 10(1), 127; https://doi.org/10.3390/jcm10010127 - 1 Jan 2021

Cited by 12 | Viewed by 2886

Abstract

Background: Since cone-beam computed tomography (CBCT) technology has been widely adopted in orthodontics, multiple attempts have been made to devise techniques for mandibular segmentation and 3D superimposition. Unfortunately, as the software utilized in these methods are not specifically designed for orthodontics, complex procedures [...] Read more.

Background: Since cone-beam computed tomography (CBCT) technology has been widely adopted in orthodontics, multiple attempts have been made to devise techniques for mandibular segmentation and 3D superimposition. Unfortunately, as the software utilized in these methods are not specifically designed for orthodontics, complex procedures are often necessary to analyze each case. Thus, this study aimed to establish an orthodontist-friendly protocol for segmenting the mandible from CBCT images that maintains access to the internal anatomic structures. Methods: The “sculpting tool” in the Dolphin 3D Imaging software was used for segmentation. The segmented mandible images were saved as STL files for volume matching in the 3D Slicer to validate the repeatability of the current protocol and were exported as DICOM files for internal structure analysis and voxel-based superimposition. Results: The mandibles of all tested CBCT datasets were successfully segmented. The volume matching analysis showed high consistency between two independent segmentations for each mandible. The intraclass correlation coefficient (ICC) analysis on 20 additional CBCT mandibular segmentations further demonstrated the high consistency of the current protocol. Moreover, all of the anatomical structures for superimposition identified by the American Board of Orthodontics were found in the voxel-based superimposition, demonstrating the ability to conduct precise internal structure analyses with the segmented images. Conclusion: An efficient and precise protocol to segment the mandible while retaining access to the internal structures was developed on the basis of CBCT images. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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13 pages, 2962 KiB

Open AccessArticle

3D Method for Occlusal Tooth Wear Assessment in Presence of Substantial Changes on Other Tooth Surfaces

by Nikolaos Gkantidis, Konstantinos Dritsas, Christos Katsaros, Demetrios Halazonetis and Yijin Ren

J. Clin. Med. 2020, 9(12), 3937; https://doi.org/10.3390/jcm9123937 - 4 Dec 2020

Cited by 15 | Viewed by 2745

Abstract

Early diagnosis and timely management of tooth or dental material wear is imperative to avoid extensive restorations. Previous studies suggested different methods for tooth wear assessment, but no study has developed a three-dimensional (3D) superimposition technique applicable in cases where tooth surfaces, other [...] Read more.

Early diagnosis and timely management of tooth or dental material wear is imperative to avoid extensive restorations. Previous studies suggested different methods for tooth wear assessment, but no study has developed a three-dimensional (3D) superimposition technique applicable in cases where tooth surfaces, other than the occlusal, undergo extensive morphological changes. Here, we manually grinded plaster incisors and canines to simulate occlusal tooth wear of varying severity in teeth that received a wire retainer bonded on their lingual surfaces, during the assessment period. The corresponding dental casts were scanned using a surface scanner. The modified tooth crowns were best-fit approximated to the original crowns using seven 3D superimposition techniques (two reference areas with varying settings) and the gold standard technique (GS: intact adjacent teeth and alveolar processes as superimposition reference), which provided the true value. Only a specific technique (complete crown with 20% estimated overlap of meshes), which is applicable in actual clinical data, showed perfect agreement with the GS technique in all cases (median difference: −0.002, max absolute difference: 0.178 mm³). The outcomes of the suggested and the GS technique were highly reproducible (max difference < 0.040 mm³). The presented technique offers low cost, convenient, accurate, and risk-free tooth wear assessment. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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13 pages, 807 KiB

Open AccessArticle

Novel Sub-Clustering of Class III Skeletal Malocclusion Phenotypes in a Southern European Population Based on Proportional Measurements

by Leixuri de Frutos-Valle, Conchita Martín, José Antonio Alarcón, Juan Carlos Palma-Fernández, Ricardo Ortega and Alejandro Iglesias-Linares

J. Clin. Med. 2020, 9(9), 3048; https://doi.org/10.3390/jcm9093048 - 22 Sep 2020

Cited by 5 | Viewed by 2307

Abstract

Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using [...] Read more.

Current phenotypic characterizations of Class III malocclusion are influenced more by gender or ethnic origin than by raw linear skeletal measurements. The aim of the present research is to develop a Class III skeletal malocclusion sub-phenotype characterization based on proportional cranial measurements using principal component analysis and cluster analysis. Radiometric data from 212 adult subjects (115 women and 96 men) of southern European origin affected by Class III skeletal malocclusion were analyzed. A total of 120 measurements were made, 26 were proportional skeletal measurements, which were used to perform principal component analysis and subsequent cluster analysis. The remaining 94 supplementary measurements were used for a greater description of the identified clusters. Principal component analysis established eight principal components that explained 85.1% of the total variance. The first three principal components explained 51.4% of the variance and described mandibular proportions, anterior facial height proportions, and posterior–anterior cranial proportions. Cluster analysis established four phenotypic subgroups, representing 18.4% (C1), 20.75% (C2), 38.68% (C3), and 22.17% (C4) of the sample. A new sub-clustering of skeletal Class III malocclusions that avoids gender influence is provided. Our results improve clinicians’ resources for Class III malocclusion and could improve the diagnostic and treatment approaches for this malocclusion. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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11 pages, 1848 KiB

Open AccessArticle

Evaluation of the Reliability, Reproducibility and Validity of Digital Orthodontic Measurements Based on Various Digital Models among Young Patients

by Seo-Hyun Park, Soo-Hwan Byun, So-Hee Oh, Hye-Lim Lee, Ju-Won Kim, Byoung-Eun Yang and In-Young Park

J. Clin. Med. 2020, 9(9), 2728; https://doi.org/10.3390/jcm9092728 - 24 Aug 2020

Cited by 12 | Viewed by 5088

Abstract

The advantages of intraoral model scanning have yielded recent developments. However, few studies have explored the orthodontic clinical use of this technique particularly among young patients. This study aimed to evaluate the reliability, reproducibility and validity of the orthodontic measurements: tooth width, arch [...] Read more.

The advantages of intraoral model scanning have yielded recent developments. However, few studies have explored the orthodontic clinical use of this technique particularly among young patients. This study aimed to evaluate the reliability, reproducibility and validity of the orthodontic measurements: tooth width, arch length and arch length discrepancy in each digital model obtained by model scanner and intraoral scanner, relative to a plaster model. Arch length measured using two methods: curved arch length (CAL) measured automatically by digital program and sum of sectional liner arch length (SLAL) measured sum of anterior and posterior liner arch lengths. Arch length discrepancy calculated each arch length measurement methods: curved arch length discrepancy (CALD) and sum of sectional liner arch length discrepancy (SLALD). Forty young patients were eligible for the study. A plaster model (P), model-scanned digital model (MSD) and intraoral scanned digital model (ISD) were acquired from each patient. The reliability of the measurements was evaluated using Pearson’s correlation coefficient, while the reproducibility was evaluated using the intraclass correlation coefficient. The validity was assessed by a paired t-test. All measurements measured in P, MSD and ISD exhibited good reliability and reproducibility. Most orthodontic measurements despite of CAL in MSD exhibited high validity. Only the SLAL and SLALD in ISD group differed significantly, despite the good validity of the tooth width, CAL and CALD. The measurements based on the digital program appeared high reliability, reproducibility and accurate than conventional measurement. However, SLAL and SLALD in ISD group appeared shorter because of distortion during intraoral scanning. However, this could be compensated by using digital programed curved arch. Although the validity of SLAL and SLALD in the ISD group differed statistically, the difference is not considered clinically significant. Although MSD and ISD are acceptable for a clinical space analysis, clinicians should be aware of digital model-induced errors. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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Review

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15 pages, 1235 KiB

Open AccessReview

Mechanistic Insight into Orthodontic Tooth Movement Based on Animal Studies: A Critical Review

by Hyeran Helen Jeon, Hellen Teixeira and Andrew Tsai

J. Clin. Med. 2021, 10(8), 1733; https://doi.org/10.3390/jcm10081733 - 16 Apr 2021

Cited by 42 | Viewed by 10064

Abstract

Alveolar bone remodeling in orthodontic tooth movement (OTM) is a highly regulated process that coordinates bone resorption by osteoclasts and new bone formation by osteoblasts. Mechanisms involved in OTM include mechano-sensing, sterile inflammation-mediated osteoclastogenesis on the compression side and tensile force-induced osteogenesis on [...] Read more.

Alveolar bone remodeling in orthodontic tooth movement (OTM) is a highly regulated process that coordinates bone resorption by osteoclasts and new bone formation by osteoblasts. Mechanisms involved in OTM include mechano-sensing, sterile inflammation-mediated osteoclastogenesis on the compression side and tensile force-induced osteogenesis on the tension side. Several intracellular signaling pathways and mechanosensors including the cilia and ion channels transduce mechanical force into biochemical signals that stimulate formation of osteoclasts or osteoblasts. To date, many studies were performed in vitro or using human gingival crevicular fluid samples. Thus, the use of transgenic animals is very helpful in examining a cause and effect relationship. Key cell types that participate in mediating the response to OTM include periodontal ligament fibroblasts, mesenchymal stem cells, osteoblasts, osteocytes, and osteoclasts. Intercellular signals that stimulate cellular processes needed for orthodontic tooth movement include receptor activator of nuclear factor-κB ligand (RANKL), tumor necrosis factor-α (TNF-α), dickkopf Wnt signaling pathway inhibitor 1 (DKK1), sclerostin, transforming growth factor beta (TGF-β), and bone morphogenetic proteins (BMPs). In this review, we critically summarize the current OTM studies using transgenic animal models in order to provide mechanistic insight into the cellular events and the molecular regulation of OTM. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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20 pages, 4269 KiB

Open AccessReview

Application of Vibrational Spectroscopies in the Qualitative Analysis of Gingival Crevicular Fluid and Periodontal Ligament during Orthodontic Tooth Movement

by Fabrizia d’Apuzzo, Ludovica Nucci, Ines Delfino, Marianna Portaccio, Giuseppe Minervini, Gaetano Isola, Ismene Serino, Carlo Camerlingo and Maria Lepore

J. Clin. Med. 2021, 10(7), 1405; https://doi.org/10.3390/jcm10071405 - 1 Apr 2021

Cited by 39 | Viewed by 3248

Abstract

Optical vibrational techniques show a high potentiality in many biomedical fields for their characteristics of high sensitivity in revealing detailed information on composition, structure, and molecular interaction with reduced analysis time. In the last years, we have used these techniques for investigating gingival [...] Read more.

Optical vibrational techniques show a high potentiality in many biomedical fields for their characteristics of high sensitivity in revealing detailed information on composition, structure, and molecular interaction with reduced analysis time. In the last years, we have used these techniques for investigating gingival crevicular fluid (GCF) and periodontal ligament (PDL) during orthodontic tooth treatment. The analysis with Raman and infrared signals of GCF and PDL samples highlighted that different days of orthodontic force application causes modifications in the molecular secondary structure at specific wavenumbers related to the Amide I, Amide III, CH deformation, and CH₃/CH₂. In the present review, we report the most relevant results and a brief description of the experimental techniques and data analysis procedure in order to evidence that the vibrational spectroscopies could be a potential useful tool for an immediate monitoring of the individual patient’s response to the orthodontic tooth movement, aiming to more personalized treatment reducing any side effects. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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13 pages, 297 KiB

Open AccessReview

The Oral Microbiota Changes in Orthodontic Patients and Effects on Oral Health: An Overview

by Maria Contaldo, Alberta Lucchese, Carlo Lajolo, Cosimo Rupe, Dario Di Stasio, Antonio Romano, Massimo Petruzzi and Rosario Serpico

J. Clin. Med. 2021, 10(4), 780; https://doi.org/10.3390/jcm10040780 - 16 Feb 2021

Cited by 65 | Viewed by 7041

Abstract

Nowadays, there is a considerable interest to study the biological and microbiological changes that accompany orthodontic treatment. Growing knowledge on oral microbiota allows, day after day, to identify and characterize the microbial arrangements specifically associated with oral and extra-oral conditions. The aim of [...] Read more.

Nowadays, there is a considerable interest to study the biological and microbiological changes that accompany orthodontic treatment. Growing knowledge on oral microbiota allows, day after day, to identify and characterize the microbial arrangements specifically associated with oral and extra-oral conditions. The aim of the present work is to highlight any further correlations between orthodontic appliances and the qualitative and quantitative modifications of the oral microbiota, such as predisposing factors for the onset of caries, periodontal diseases, and other infections, which can impact the oral and systemic health of the orthodontic patients. When compared with subjects without orthodontic appliances, orthodontic patients reported significant qualitative and quantitative differences in supra- and subgingival plaque during the entire treatment period. Certain components of fixed appliances (mainly bonded molar brackets, ceramic brackets, and elastomeric ligatures) showed high risks of periodontal disease and tooth decay for patients. An unclear prevalence of Candida spp. and the paucity of studies on viruses and protozoas in the oral microbiota of orthodontic patients need to be further investigated. The evidence emerging from this study could guide clinicians in modulating the timing of controls and enhance patient motivation to prevent the formation of mature plaque, thus reducing the risks of oral-plaque-related diseases. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

18 pages, 962 KiB

Open AccessReview

Orthopedic Treatment for Class II Malocclusion with Functional Appliances and Its Effect on Upper Airways: A Systematic Review with Meta-Analysis

by Darius Bidjan, Rahel Sallmann, Theodore Eliades and Spyridon N. Papageorgiou

J. Clin. Med. 2020, 9(12), 3806; https://doi.org/10.3390/jcm9123806 - 25 Nov 2020

Cited by 15 | Viewed by 4266

Abstract

Aim of this systematic review was to assess the effects of orthopedic treatment for Class II malocclusion with Functional Appliances (FAs) on the dimensions of the upper airways. Eight databases were searched up to October 2020 for randomized or nonrandomized clinical studies on [...] Read more.

Aim of this systematic review was to assess the effects of orthopedic treatment for Class II malocclusion with Functional Appliances (FAs) on the dimensions of the upper airways. Eight databases were searched up to October 2020 for randomized or nonrandomized clinical studies on FA treatment of Class II patients with untreated control groups. After duplicate study selection, data extraction, and risk of bias assessment according to Cochrane guidelines, random effects meta-analyses of mean differences (MDs) and their 95% confidence intervals (CIs) were performed, followed by subgroup/meta-regression analyses and assessment of the quality of evidence. A total of 20 nonrandomized clinical studies (4 prospective/16 retrospective) including 969 patients (47.9% male; mean age 10.9 years) were identified. Orthopedic treatment with FAs was associated with increased oropharynx volume (MD = 2356.14 mm³; 95% CI = 1276.36 to 3435.92 mm³; p < 0.001) compared to natural growth. Additionally, significant increases in nasopharynx volume, minimal constricted axial area of pharyngeal airway, and airway were seen, while removable FAs showed considerably greater effects than fixed FAs (p = 0.04). Finally, patient age and treatment duration had a significant influence in the effect of FAs on airways, as had baseline matching and sample size adequacy. Clinical evidence on orthopedic Class II treatment with FAs is associated with increased upper airway dimensions. However, the quality of evidence is very low due to methodological issues of existing studies, while the clinical relevance of increases in airway dimensions remains unclear. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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18 pages, 743 KiB

Open AccessReview

Combined Surgical and Orthodontic Treatments in Children with OSA: A Systematic Review

by Laura Templier, Cecilia Rossi, Manuel Miguez, Javier De la Cruz Pérez, Adrián Curto, Alberto Albaladejo and Manuel Lagravère Vich

J. Clin. Med. 2020, 9(8), 2387; https://doi.org/10.3390/jcm9082387 - 26 Jul 2020

Cited by 16 | Viewed by 5318

Abstract

Obstructive sleep apnea (OSA) is a sleeping breathing disorder. In children, adenotonsillar hypertrophy remains the main anatomical risk factor of OSA. The aim of this study was to assess the current scientific data and to systematically summarize the evidence for the efficiency of [...] Read more.

Obstructive sleep apnea (OSA) is a sleeping breathing disorder. In children, adenotonsillar hypertrophy remains the main anatomical risk factor of OSA. The aim of this study was to assess the current scientific data and to systematically summarize the evidence for the efficiency of adenotonsillectomy (AT) and orthodontic treatment (i.e., rapid maxillary expansion (RME) and mandibular advancement (MA)) in the treatment of pediatric OSA. A literature search was conducted in several databases, including PubMed, Embase, Medline, Cochrane and LILACS up to 5th April 2020. The initial search yielded 509 articles, with 10 articles being identified as eligible after screening. AT and orthodontic treatment were more effective together than separately to cure OSA in pediatric patients. There was a greater decrease in apnea hypoapnea index (AHI) and respiratory disturbance index (RDI), and a major increase in the lowest oxygen saturation and the oxygen desaturation index (ODI) after undergoing both treatments. Nevertheless, the reappearance of OSA could occur several years after reporting adequate treatment. In order to avoid recurrence, myofunctional therapy (MT) could be recommended as a follow-up. However, further studies with good clinical evidence are required to confirm this finding. Full article

(This article belongs to the Special Issue New Approaches and Technologies in Orthodontics)

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