Am J Orthod Dentofacial Orthop. 2022 Oct 12:S0889-5406(22)00546-7. doi: 10.1016/j.ajodo.2021.08.023. Online ahead of print.

ABSTRACT

INTRODUCTION: The objective of this study was to test the precision of in-vivo indirect bracket placement via medium-soft, transparent, broad-coverage, computer-aided designed and manufactured transfer trays using an automated digital method.

METHODS: Seventeen patients requiring vestibular fixed appliances were consecutively recruited, and bonding accuracy was measured at each bracket, evaluating 3 linear (mesiodistal, buccolingual, and vertical) and 3 angular measurements (torque, tip, and rotation) with an automated method involving digital superimposition of individual teeth. Mean and standard deviation values were calculated for both arches, single arch, and tooth type, and the percentages of single deviations over the thresholds of 0.25 mm and 1° were calculated, as well as maximum and minimum values for each deviation and directional bias. Correlations between each variable (arch, tooth type, and single tooth) and deviations were investigated through classification and regression trees (CART) predictive models.

RESULTS: Neither mean nor single linear deviations ever exceeded the set cutoff value of 0.25 mm. Mean angular deviations never exceeded 1°, but some individual angular deviations did, specifically 8.31% of torque, 13.16% of tip, and 7.16% of rotation deviations. The highest percentage of deviation was recorded for rotation of the maxillary incisors (18.11%). No evident trend in directional deviation bias was found. Tooth type appears to influence mesiodistal and torque deviations, whereas the single tooth variable influenced the percentage of rotation deviations exceeding 1° (P <0.05).

CONCLUSIONS: This computer-aided designed and manufactured medium-soft, transparent transfer tray provides accurate bracket placement and could be recommended for routinely fixed orthodontics.

PMID:36243597 | DOI:10.1016/j.ajodo.2021.08.023

Angle Orthod. 2022 Oct 11. doi: 10.2319/052022-371.1. Online ahead of print.

ABSTRACT

OBJECTIVES: To provide clinical information on overcorrection to be included in the initial digital setup to make clear aligner therapy (CAT) more efficient.

MATERIALS AND METHODS: Prescription data for 150 patients (80 women and 70 men; mean age 33.7 ± 12.7 years) treated successfully with CAT (F22 Aligners, Sweden & Martina, Due Carrare, Italy) and requiring only a single, minimal finishing phase were acquired retrospectively. The inclusion criteria were Class I dental malocclusion with only minimal crowding (≤3 mm), 12-20 aligner steps per arch, no use of auxiliaries or interarch elastics, and rotations ≤25° for round-shaped teeth. The prescribed and corrective movements to be achieved in the main and finishing treatment phases, respectively, were quantified by the dedicated clear aligner setup software. The magnitudes of inclination (buccal-lingual crown tipping), angulation (mesial-distal crown tipping), rotation, intrusion, and extrusion were extracted and analyzed by tooth type, maxilla and mandible, and both arches. Descriptive statistics, that is, mean, standard deviation, and percentage, were calculated for each movement investigated. Classification and regression trees (CART) were generated using the model-based recursive partitioning approach, and the corrective movements were correlated with respect to both the amount of the movements prescribed and the tooth type. Statistical significance was set at 5%.

RESULTS: Inclination and rotation required the greatest correction, whereas angulation, intrusion, and extrusion required only minimal correction. Expressed as a percentage of prescribed movement, mean corrective movements were 20.5% for inclination, 14.5% angulation, 28.4% rotation, 11.7% extrusion, and 22% intrusion. According to CART, all corrective movements except extrusion depended on both tooth type and the magnitude of prescribed movement.

CONCLUSIONS: To achieve more efficient CAT, approximately 20% overcorrection should be added to the initial planning phase when planning challenging movements such as inclination and rotation.

PMID:36223202 | DOI:10.2319/052022-371.1

Prog Orthod. 2022 Sep 30;23(1):44. doi: 10.1186/s40510-022-00429-0.

ABSTRACT

BACKGROUND: Regardless of the treatment protocol, stability in Class III patients always represents a major concern. The aim of this study was to assess the short and long-term skeletal and dentoalveolar modifications in a group of class III patients treated with hybrid rapid maxillary expander (RME) and facemask (FM). Indeed, no long-term studies have been conducted yet with the objective of evaluating the effects of this kind of approach when applied to patients who have already gone thought their peak of growth.

MATERIAL AND METHODS: 27 patients with skeletal Class III malocclusion were treated using hybrid RME according to alternating rapid maxillary expansion and constriction (ALT-RAMEC) protocol, followed by 4 months of facemask therapy. After the orthopaedic phase, each patient underwent orthodontic treatment with fixed multibracket appliances. A mean follow-up of 7 years, 10 months was performed. Pre-treatment (TO), post-treatment (T1) and follow up (T2) cephalometric tracing were analysed, comparing dental and skeletal measurements.

RESULTS: Point A advanced by a mean of 3.5 mm with respect to VerT, then relapsed by 0.7 in the post-facemask period, thereby yielding of a mean advancement of 2.7 at T2. The sagittal relationship significantly changed after RME + facemask protraction (3.8° of ANB and 5.189 mm of Wits). Although both Wits and ANB values worsened over time, the improvement from T0 is still appreciable at T2.

CONCLUSION: Despite the physiological relapse due to mandibular growth, the long-term cephalometric follow-up confirms the maintenance of all positive outcomes of the previous orthopaedic treatment with hybrid RME and facemask.

PMID:36178519 | DOI:10.1186/s40510-022-00429-0

J Orthod. 2022 Sep 12:14653125221122054. doi: 10.1177/14653125221122054. Online ahead of print.

ABSTRACT

INTRODUCTION: The aim of these two case-reports is to illustrate and compare the therapeutic effects of Class II elastics in combination with F22 aligners in an adult and an adolescent patient, respectively.

CASE PRESENTATION: Two patients with a mild skeletal Class II malocclusion, associated with mild-to-moderate crowding, presented for orthodontic treatment. The first patient was 12 years old, while the second was 40 years old. In both cases, the goal was to obtain bilateral molar and canine Class I with ideal overjet and overbite, and Class II skeletal relationship improvement in the young patient as well. Both treatments were approached without extractions and using clear aligners (CAs) in combination with Class II elastics, giving the patient the opportunity to take advantage of a therapy that is both comfortable and aesthetic.

DISCUSSION: Final records of both cases demonstrate how appropriate analysis and diagnosis enable CAs in conjunction with Class II elastics to be used with considerable efficiency and efficacy for Class II treatment. In the first case, the key to success was exploiting residual jaw growth, while in the second case it was careful orthodontic digital planning.

CONCLUSION: In the presence of good patient compliance, CAs associated with Class II elastics provide satisfactory occlusal outcomes if biomechanics and digital set-up are carefully evaluated and executed and if diagnosis is appropriate.

PMID:36112856 | DOI:10.1177/14653125221122054

Int Orthod. 2022 Sep 9:100686. doi: 10.1016/j.ortho.2022.100686. Online ahead of print.

ABSTRACT

OBJECTIVE: To resolve a complex Class II case with unilateral crossbite through an aesthetic approach, namely a hybrid orthodontic treatment combining aligners with miniscrews and auxiliaries.

MATERIALS AND METHODS: A 14-year-old hypodivergent female patient with dental Class II and posterior crossbite presented for orthodontic treatment. The patient refused conventional fixed multibracket treatment and was therefore prescribed aligners used in association with miniscrews and sectional lingual appliances. Pre- and post-treatment records and 2-year follow-up records are presented.

RESULTS: Treatment objectives, namely ideal occlusion and improved profile, were achieved in 12 months. Post-treatment panoramic radiography showed good root parallelism, and no sign of either crestal bone height reduction or apical root resorption. The patient was satisfied with the functional and aesthetic outcomes, which were stable at 2 years.

CONCLUSION: This case report illustrates that a hybrid aligner approach may be used to treat posterior crossbite and class II malocclusion with reduced treatment times, optimal oral hygiene and excellent aesthetics.

PMID:36096935 | DOI:10.1016/j.ortho.2022.100686