Volume 38 (2022): Issue 1 (January 2022)

A surgery-first approach has many advantages related to a shortened treatment time and an immediate facial aesthetic improvement compared to a three-stage conventional orthognathic surgery protocol.

The aim of this case report was to describe the treatment of a 21-year-old, female, patient who presented with a skeletal Class III malocclusion, maxillary retrusion, a negative overjet, an anterior and bilateral posterior cross-bite, and a vertical facial pattern highlighted by a high mandibular plane angle.

Orthodontic treatment was performed using self-ligating lingual appliances and a surgery-first approach. The active treatment time was 16 months.

Successful treatment results were achieved using a combination of an orthognathic surgery-first approach and lingual appliances in a patient with high aesthetic expectations.

The sale of orthodontic materials, considered as medical devices, is regulated in order to protect patients. The availability of orthodontic products on e-commerce platforms, however, may go unregulated and compromise patient safety.

The present study aimed to investigate the sale of fixed orthodontic appliances on a local and global e-commerce platform.

A cross-sectional analysis of orthodontic materials sold on Shopee and Amazon was conducted using a specific keyword search for brackets, arch wires and ligatures. After deleting duplicates and irrelevant search results, the top 50 products for each keyword search were analysed. Product name, the type of product, seller, cost, star rating, the number of reviews, the number of sales, shipping location and brand identification were recorded. Brand registration with a medical device regulatory authority was checked. Collected data were tabulated in Google (spread)sheet to derive descriptive statistics and frequency tables.

A total of 800 search results were screened. Three hundred and forty-eight relevant results were identified, approximately two-thirds of which originated from Shopee. Ligatures generated the highest search outcome in both Shopee (39%) and Amazon (80%). Fixed orthodontic materials sold on Shopee resulted in a larger number of reviews, higher star ratings and a lower cost per item compared to those supplied by Amazon. Products on Amazon were more likely to have brand identification (97%) compared to Shopee (5%). None of the identifiable brands on Shopee were registered with regulatory bodies, whereas eight products listed on Amazon were registered. A large portion of shipping locations originated from China for both e-commerce platforms.

Orthodontic brackets, arch wires and ligatures are more readily available on Shopee compared to Amazon. The quality and safety of these products cannot be assured as the majority of the products were either not clearly labelled or their registration was not identified under the regulation of medical devices.

Maxillary canine impaction has been extensively reported, but studies of mandibular canine impaction are relatively few. Clinical studies and reports of experience treating mandibular canine impaction are of clinical benefit to both orthodontists and dentists.

This report introduces a Class II division 2 crowded case with severely impacted, fully transposed, mandibular canines treated by a non-extraction approach and mandibular arch expansion.

The completely transposed, impacted, mandibular canines were successfully aligned. The crowding was relieved by arch expansion and incisor proclination without obvious radiographic alveolar bone loss. The two severely labially displaced mandibular canines assisted in the expansion of the narrow mandibular arch.

The maxillary and mandibular arches were expanded and well aligned, and Class II molar and canine relationships and a normal overjet and overbite were established. The mandibular canines were aligned in advantageous positions. There was no regional alveolar bone resorption around the mandibular canines.

The treatment approach provided an example of significant bone remodelling. Using the impacted mandibular canines for anchorage, the age of the patient provided an opportunity to adopt a relatively conservative and unique treatment approach which may be applied to relieve crowding.

The objective of the present study was to compare the dentoskeletal effects of mini-screw-assisted rapid maxillary expansion (RME) in children with different body mass index (BMI) percentiles.

The study was performed on 20 patients who were divided into two groups based on their BMI percentiles as normal-weight (n = 10) and overweight-obese (n = 10). The linear, angular and area analyses were performed on lateral and postero-anterior cephalometric radiographs and three-dimensional dental models before and after RME therapy.

A statistically significant increase was observed in maxillary intermolar and intercanine distances and palatal area measurements in both groups (P < 0.05). There was no significant difference between the two groups when dental RME changes were measured on 3D models. A significant difference was observed in latero-nasal and maxillo-mandibular width as well as postero-anterior cephalometric parameters between the groups (P < 0.05). While a significant change was observed in the SN-GoMe, FMA, Z angle, Wits appraisal, total anterior facial height and lower anterior facial height parameters in the normal-weight group (P < 0.05), a statistically significant change was observed in the gonial and nasolabial angles in the overweight-obese group.

Mini-screw-assisted RME treatment significantly increased maxillary intermolar and intercanine width, and the palatal area in both groups; however, there was no significant difference between the BMI groups.

To investigate patient experience of aligner treatment and associated influencing factors.

A total of 102 patients wearing Invisalign clear aligners (Align Technology, California, USA) were recruited in an initial treatment group (N = 62) and a refinement group (N = 40). Clinical diagnoses and treatment designs were collected. Data from a Visual Analogue Scale (VAS), a Self-Rating Anxiety Scale (SAS), and an Oral Health Impact Profile-14 (OHIP-14) were recorded at the commencement (Day 0, before wearing the first set of aligners) and during the first 7 days (Days 1–7) after wearing the first set of aligners.

The patient experience of aligner treatment (i.e., pain, anxiety and quality of life) was poorest during the first two days (P < 0.05), and returned to a normal level within a week. The level of patient experience during the initial phase was greater than that during the later refinement phase (P < 0.01). During the initial treatment, the studied factors did not significantly influence the level of pain (VAS) (P > 0.05 for all) nor anxiety (SAS) (P > 0.10 for all); the number of teeth with optimised attachments significantly (R = 0.28, P = 0.03) influenced the quality of life (OHIP-14). During the refinement phase, the studied factors did not significantly influence the level of pain (VAS) (P > 0.09 for all); the number of aligner sets significantly influenced the level of anxiety (SAS) (R = 0.41, P < 0.01); the Index of Treatment Complexity Outcome and Need (ICON) (R = 0.44, P < 0.01) and whether elastics were required significantly influenced the quality of life (OHIP-14) (R = 0.349, P = 0.03).

Patient experience of aligner treatment was poorest during the first two days and improved over a week. Patient experience during the initial phase was generally worse than that during refinement. Four clinical factors were found to have an influence, including the number of teeth with optimised attachments, the number of aligner sets, the ICON, and the need for elastics.

In recent years, clear aligners (CA) have become a popular treatment option whose efficacy depends upon the close adaptive fit of the appliance. The aim of this study was to evaluate micron-level surface imperfections found in virtual aligners (VA) caused by the conditions at the time of acquisition of the digital models required for appliance fabrication.

Fifty patients were recruited for the study. Four digital models were acquired from each patient under four different conditions using a 3Shape TRIOS intra-oral scanner (Copenhagen, Denmark). The conditions for digital model acquisition were, Group 1: No saliva isolation and scanning in daylight (S + DL), Group 2: Saliva isolation and scanning in daylight (NS + DL), Group 3: No saliva isolation but scanning under reflected light (S + RL), Group 4: No saliva isolation but scanning in relatively dark conditions (S + RDC). For each of the 200 digital models, 1 mm thick VAs were created using the Appliance Designer (Copenhagen, Denmark) software. Using the Geomagic Control X (Geomagic; Morrisville, USA) program, the four VAs of each patient were overlaid and common boundaries were obtained by three planes of section. In all comparisons, the VAs in Group 2 were used as a reference and the three other groups were evaluated. Surface deviations between VAs were assessed using the quantitative data of maximum, minimum, negative mean, positive mean, root mean square (RMS), out of the total area (OTA).

Total surface deviation (OTA) was found to be the highest in Group 4 (9.57%). OTA values in Group 1 (7.19%) and Group 3 (7.02%) were similar. Of the other parameters, the greatest data was obtained from Group 4. The distribution of RMS values between groups was: 56 microns in group 1 (S + DL), 53 microns in group 3 (S + RL), 61 microns in group 4 (S + RDC). However, the data comparison indicated that there was no statistically significant difference between the groups.

The conditions for obtaining digital models caused imperfections on the surface of the VAs. The total deviation (OTA) of 7–9% was considered excessive and so it was concluded that the conditions for obtaining digital models could affect the adaptation and success of CAs.

A controlled clinical trial was undertaken to compare the effectiveness of Vivera^® and Duran^® retainers with regard to the survival, stability and occlusal settling over the first 6 months of retention following the completion of clear aligner treatment.

Consenting participants who met the inclusion criteria were recruited from a single, metropolitan Melbourne orthodontic practice. The participants were divided according to their retainer type, Vivera^® (n = 10) or Duran^® (n = 14). Each retainer type was fabricated to a standardised design. Intra-oral scans were taken at the time of debond (T₀), at 3 months (T₂) and at 6 months (T₃). The participants wore their retainers full-time for the first 3 months and part-time for the remaining 3 months. The retainers were inspected at each review for damage that required replacement and failures were recorded in ‘days from insert’. Patient reported failures were also recorded. Intra-oral scans were assessed for changes in incisor irregularity and the number of occlusal contacts and comparisons between the two retainer groups were investigated. The impact of full-time and part-time wear on occlusal settling was also assessed for each retainer type.

Vivera^® retainers showed a greater survival time in comparison to Duran^® retainers, as no Vivera^® failures were observed over the initial 6 months of retention. Both retainer groups showed similar results related to incisor stability and occlusal settling. Part-time wear resulted in increased posterior settling for both retainer types.

Vivera^® retainers were as clinically effective as the Duran^® retainer but exhibit a significantly higher survival rate. Part-time wear of full-coverage thermoplastic retainers appears to increase posterior settling.

To evaluate the influence of Fixed (FOA) and Removable Orthodontic Appliances (ROA) on oral Candida colonisation.

A search for articles published in the English language until September 2021, was carried out using Pubmed, Scopus and Web of Knowledge databases and by applying the search terms “orthodontic” OR “orthodontics” OR “fixed appliance” OR “removable appliance” OR “bracket” OR “removable aligner” AND “Candida” OR “Candidiasis” OR “Candidosis” to identify all potentially relevant human studies. After the removal of duplicate articles and data extraction according to the PICOS scheme, the methodological quality of the included papers was assessed by applying the Swedish Council on Technology Assessment in Health Care Criteria for Grading Assessed Studies (SBU).

The initial search identified 533 articles, 157 of which were selected by title and abstract. After full-text reading, sixteen articles were selected. The evidence quality for all the studies was moderate.

ROA induced a temporary increase of Candida counts from the early stage of treatment but which returned to the pre-treatment level after ROA removal. Contrasting results were reported for FOA treatment which promoted the oral colonisation of non-albicans species, although the most prevalent species was Candida albicans in both groups.

This review should be interpreted with caution because of the number, quality, and heterogeneity of the included studies.

To survey Australian-based orthodontists regarding their opinions on their extraction practices.

A pilot-tested electronic-questionnaire was distributed to 465 members of the Australian Society of Orthodontists. Questions pertained to their demographic details, current extraction rates, changes in prescribed orthodontic extraction patterns over the past 5 to 10 years and the factors that may have influenced decisions.

A response rate of 35.05% was recorded. Orthodontists estimated that they extracted permanent teeth in 21.03% and 22.06% of recently treated adults and children/adolescents presenting with a Class I malocclusion. Respondents were less comfortable carrying out non-extraction treatment in child/adolescent patients (15.4%) than in adult patients (34.7%) when crowding was greater than 6 mm. Most orthodontists (55.89%) who had practiced for more than 5 years believed that the number of patients that were treated by extractions was unchanged over the past 5 to 10 years while 34.55% believed that the proportion had decreased. More experienced orthodontists tended to report increased rather than decreased extraction rates (p = 0.0102). Most of those (88.1–93.17%) who reported decreased extraction rates considered facial aesthetics had a moderate/major influence on their extraction decisions. The increased use of ‘combined’ interproximal reduction (IPR) and arch lengthening in children/adolescents (55.8%) and IPR in adults (85%) was reported by those whose extraction rates had decreased.

Orthodontists extracted permanent teeth in just over 20% of their patients who presented with a Class I malocclusion. Most orthodontists considered that their extraction rates had not changed over the past 5 to 10 years. The increased use of IPR with or without arch lengthening procedures, was reported by those whose extraction rates had decreased over the same time period.

To compare the measurement of cephalometric parameters using 3D images obtained from CBCT to 2D images obtained from a conventional cephalogram.

An electronic literature search was conducted using PubMed, Embase, Web of Science, CNKI, CENTRAL, and the grey literature database of SIGLE (up to May 2021). The selection of the eligible studies, data extraction, and an evaluation for possible risk of bias (Quality Assessment of Measurement Accuracy Studies tool) were performed independently by two authors. Inconsistencies were judged by a third author. Statistical pooling, subgroup analysis, a sensitivity analysis and an evaluation of publication bias were performed using Comprehensive Meta-Analysis (version 2.2.064, Biostat, Englewood, NJ).

A total of eight articles were eligible for final meta-analysis. The differences in two of the skeletal measurement parameters [Ar(Co)-Gn, Me-Go] and one of the dental measurement parameters (U1-L1) were found to be statistically significant when using CBCT and conventional cephalograms (P = 0.000, P = 0.004, P = 0.000, respectively).

CBCT can be used as a supplementary option to support conventional cephalometric measurements. In clinical situations in which three-dimensional information is required, patients can benefit from CBCT analysis to improve diagnosis and treatment planning.

The Tanaka and Johnston mixed dentition analysis is a widely used method to predict the size of unerupted permanent canines and premolars. The aim of the present study was to determine the applicability of the Tanaka and Johnston analysis to Western Australian adolescents and develop a new regression equation.

Five hundred participants (323 females, 177 males) meeting the inclusion criteria were selected from private orthodontic clinics. The mesiodistal dimensions of all permanent teeth were retrieved from pre-orthodontic treatment digital dental records using Invisalign^® technology (Invisalign®, Align Technology, Santa Clara, CA, USA) and analysed using a predicted value derived from the Tanaka and Johnston analysis. Correlation and linear regression analyses were applied to develop new regression equations.

A significant difference was found between the actual and predicted values derived from the Tanaka and Johnston analysis. A significant correlation was observed between the sum of the permanent mandibular incisors and the sum of the maxillary and mandibular canine and premolars (0.58–0.74). New regression equations and tables were derived from the study population.

The Tanaka and Johnston analysis overestimated the mesiodistal dimensions of permanent canines and premolars. The developed regression equation and tables may be used for orthodontic diagnosis and treatment planning in Western Australian adolescents.

Many orthodontic bracket-bonding materials are available for clinical use. The current study aimed to assess the preferences and factors contributing to the clinical choice of bracket bonding material.

Eight bracket bonding materials were trialled by 15 participants. The handling properties and overall ease of use of each material were scored by the participants on a Visual Analogue Scale (VAS). The participants also responded to a questionnaire regarding the use and perceptions of resin-modified glass ionomer cements (RMGICs) for bracket bonding. A quantitative analysis was conducted on the responses to the questionnaire.

Of all materials trialled, there was a consistent preference for the handling of resin composite (RC) materials. Fuji^® II LC was the highest rated RMGIC material and was considered similar to RC materials for ease of handling.

Fuji^® II LC may be a suitable alternative to RC materials for orthodontic bracket bonding. Further research is required to assess and produce bonding materials possessing anti-cariogenic properties along with comparable handling properties to bracket bonding materials that are currently preferred.

The present systematic review assesses the literature which identifies an association between surgical adjunctive procedures for accelerating tooth movement (SAPATM) during orthodontic therapy and orthodontically induced external root resorption (OIERR). By determining the level of association, the results may provide clinical evidence for minimising the deleterious effects of orthodontic tooth movement.

Electronic databases including Medline, PubMed, Embase, Scopus, CINAHL, Worldcat, OpenGrey, and the Cochrane Library were searched and followed by further searches from citations of included articles. Searches were undertaken with no restrictions on year, publication status, nor language. The selection criteria included randomised controlled trials (RCTs) conducted using surgical procedures to accelerate orthodontic therapy in conjunction with fixed orthodontic appliances on human patients. The quality of the included studies was assessed using the Cochrane Risk of Bias (RoB) Tool and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Inter-rater agreement of the review authors was used for the inclusion of primary articles, RoB assessment and evaluation of the quality of evidence (GRADE) and was calculated using Cohen’s kappa statistic.

A total of 1118 articles were retrieved in the initial search. After the review process, 13 article trials met the inclusion criteria. Sample sizes ranged from 20 to 52 patients. Two studies showed a statistically significant reduction in OIERR, with a third showing both an increase and decrease of OIERR on different roots of the same maxillary molar tooth. A significant decrease in treatment time was shown by four studies, while six studies showed increased tooth movement. All included studies were classified as having low to minor concerns of bias and a low quality of evidence.

There is an apparent shortage of well-designed and reported RCTs on the effect of SAPATM on OIERR. However, there is some evidence to suggest OIERR is reduced following SAPATM. The use of SAPATM is also shown to increase tooth movement and reduce overall treatment time, but its benefits may be considered limited to the initial post-operative period.

To evaluate the quantitative effects of palatal Temporary Anchorage Device (TAD)-supported appliances for the distalisation of maxillary molars in Class II patients.

An electronic search was conducted in PubMed, CENTRAL, Scopus and the Web of Knowledge databases using specific key terms. The selection process was independently conducted by two researchers to identify relevant articles, published in English until January 2021. After the removal of duplicate articles and data extraction according to the PICOS scheme, the methodological quality of the included papers was ranked on a 9-point scale, from low to high quality.

The initial search identified 14,830 articles, 536 of which were selected by title and abstract. After full-text reading, eleven articles were selected. The quality of evidence was moderate for ten studies, but high for one study. A total of 230 subjects in the permanent dentition were analysed. The mean molar distalisation values ranged from 3.0 millimetres (mm) to 5.3 mm. The mean molar distal tipping varied from −1.20° to 11.24°. The mean mesial movement of premolars showed negative values.

In Class II patients, palatally placed TAD-supported devices are more effective in maxillary molar distalisation compared to conventional appliances, thereby minimising molar distal tipping and preventing premolar anchorage loss during the distalisation mechanics.