Journal & Issues

Volume 39 (2023): Issue 1 (January 2023)

Volume 38 (2022): Issue 2 (July 2022)

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

Volume 37 (2021): Issue 2 (January 2021)

Volume 37 (2021): Issue 1 (January 2021)

Volume 36 (2020): Issue 2 (January 2020)

Volume 36 (2020): Issue 1 (January 2020)

Volume 35 (2019): Issue 2 (January 2019)

Volume 35 (2019): Issue 1 (January 2019)

Volume 34 (2018): Issue 2 (January 2018)

Volume 34 (2018): Issue 1 (January 2018)

Volume 33 (2017): Issue 2 (January 2017)

Volume 33 (2017): Issue 1 (January 2017)

Volume 32 (2016): Issue 2 (January 2016)

Volume 32 (2016): Issue 1 (January 2016)

Volume 31 (2015): Issue 2 (January 2015)

Volume 31 (2015): Issue 1 (January 2015)

Journal Details
Format
Journal
eISSN
2207-7480
First Published
01 May 1967
Publication timeframe
1 time per year
Languages
English

Search

Volume 38 (2022): Issue 2 (July 2022)

Journal Details
Format
Journal
eISSN
2207-7480
First Published
01 May 1967
Publication timeframe
1 time per year
Languages
English

Search

16 Articles
Open Access

Determination of treatment options for Class III malocclusions in adult patients based on cephalometric values: a systematic review

Published Online: 14 Jul 2022
Page range: 183 - 193

Abstract

Abstract Objective

The present systematic review aimed to determine cephalometric values that may be used as a guide in deciding between orthodontic camouflage and orthognathic surgery to treat a Class III malocclusion in adults. In addition, a secondary aim was to identify treatment complications and aesthetic perceptions by laypersons/orthodontists.

Methods

Without a language restriction, an electronic search of six databases and a hand search of three orthodontic journals were performed until September 2021. All studies comparing orthodontic camouflage and orthognathic surgery in Class III malocclusion patients, were included. Data extraction was carried out independently by two authors with disagreement resolved by a third author. The risk of bias related to individual studies was appraised using a modified version of the STROBE checklist. The results were summarised qualitatively, and no meta-analysis was undertaken due to the high heterogeneity between the studies.

Results

With the quality of evidence ranging from moderate to high, six retrospective studies were included. A cephalometric analysis comprising the Holdaway angle, overjet, the Wits appraisal, lower incisor inclination, the maxillary-mandibular ratio, overbite, gonial angle and an additional combination were used as a guide. No treatment complications were reported. One study examined the perception of facial profile attractiveness in borderline surgical Class III malocclusions and found no difference in outcome and significant improvements in both camouflage and surgical groups.

Conclusion

The existing evidence is insufficient to identify a cephalometric parameter threshold in deciding between orthodontic camouflage and orthognathic surgery. PROSPERO database protocol no. CRD42020165164.

Open Access

Case report: early class III correction using titanium dental implants and facemask therapy: a 24-year follow-up

Published Online: 14 Jul 2022
Page range: 213 - 226

Abstract

Abstract

The management of a Class III malocclusion in the mixed dentition presents with many challenges, in particular, the post-treatment growth-related changes which can continue into adulthood. This case report describes the multidisciplinary management of a 9-year-old female using titanium dental implants, rapid maxillary expansion and a Delaire facemask. Pre-treatment, post-treatment and long-term follow-up records of the patient are presented.

Open Access

Clear aligners brands and marketing claims: An overview of available information on the web

Published Online: 14 Jul 2022
Page range: 252 - 262

Abstract

Abstract Objectives

To investigate the current commercially available clear aligners related to brands, companies, Google trends, and marketing claims presented on their official websites.

Materials and methods

A search was conducted in October 2020 to identify the relevant web-based information, using three languages (English, Chinese, and Korean) and search terms “clear aligner”, , , and in four search engines (Google, Bing, Baidu, and Naver) to identify current clear aligner companies. Each company website was reviewed and assessed for its marketing claims.

Results

A total of 75 clear aligner brands were identified and included in the study, and 280 claims from their official websites were analysed. Most (70.7%) of the companies made claims regarding “aesthetics”, 66.7% made claims regarding “increased comfort”, 58.7% made claims regarding “shorter treatment time”, and 56.0% of the companies made claims regarding “superior material”. Other claims were made regarding their “novel technology”, “superior hygiene”, “tracking Apps”, “remote monitoring”, and “reduced in-office visits”. Of these marketing claims, only 4.5% cited references supporting the company’s website claims; however, the references were mainly derived from internal company research.

Conclusions

Using three languages (English, Chinese, and Korean), 75 different brands of clear aligners were currently found online. Most of the marketing claims from the clear aligner companies’ official websites were not referenced to quality scientific studies. Clinicians and patients should critically appraise the content of company claims and advertisements.

Open Access

Molar uprighting using a newly designed segmental wire: a case report

Published Online: 14 Jul 2022
Page range: 263 - 267

Abstract

Abstract

The ectopic eruption path of a permanent molar can cause incomplete emergence through interference by an adjacent tooth, early loss of a primary molar, or an arch length discrepancy. It is clinically important to determine the appropriate appliance that may easily be placed for the considered application of a molar corrective force. A newly designed appliance is introduced for the distal uprighting of an ectopically erupting molar and supported by two case presentations. The current technique of using a segmental wire incorporating double-sided hooks may easily and effectively resolve this problem.

Open Access

Evaluation of exaggerated claims in the abstracts of systematic reviews reporting accelerated orthodontic tooth movement: a meta research analysis

Published Online: 14 Jul 2022
Page range: 268 - 277

Abstract

Abstract Background

The latest trend in scientific literature review is to scrutinise the practices of false or biased reporting of findings, which is rightly termed as ‘spin’. In recent years, accelerated tooth movement has gained attention from the orthodontic community, but the findings still remain unclear and controversial.

Objectives

To estimate the frequency of distorted claims and over-interpretation of abstracts of systematic reviews related to accelerated orthodontic tooth movement. The objective was to differentiate the type of claim and to determine its prevalence.

Methods

A literature search was performed using the Cochrane library and the top five most prominent orthodontic journals for systematic reviews on accelerated orthodontics were identified by applying appropriate key words. According to pre-set selection criteria, only systematic reviews published between January 2010 and September 2021 were included. The selected articles were scrutinised for the assigned exclusion criteria. The articles were finally scanned for false claims by two independent reviewers. The identified claims fell into either the categories of misleading interpretation, misleading reporting or misleading extrapolation. The obtained data were tabulated and analysed using the one-way ANOVA statistical test to indicate the difference between the different types of reported claims.

Results

There were 98 systematic reviews identified in total, of which 59 articles met the selection criteria and 39 articles were excluded. Of the 59 included articles, 38 systematic reviews had exaggerated claims. Twenty-two of the reported claims came under the misleading reporting category, 10 fell under the misleading interpretation category and 6 came under the misleading extrapolation category. The difference noted between the reporting prevalence of different types of claim was statistically significant (P < 0.001). In misleading reporting, it was noted that most of the systematic reviews refrained from reporting the adverse effects of treatment.

Conclusion

The prevalence of exaggerated claims is high in the abstracts of systematic reviews related to accelerated orthodontic tooth movement. It is recommended that a clinician critically assess the claims presented in systematic reviews which are considered to be the hallmark articles of evidence-based practice. Orthodontists should be careful when applying the findings in clinical practice.

Open Access

Guest Editorial

Published Online: 16 Aug 2022
Page range: 278 - 280

Abstract

Open Access

A comparison of SureSmileTM, InsigniaTM, and InvisalignTM, in treating non-extraction cases of mild to moderate crowding: a prospective clinical trial

Published Online: 29 Sep 2022
Page range: 290 - 306

Abstract

Abstract

Objectives: To compare the ability of SureSmileTM, InsigniaTM and InvisalignTM to achieve predicted intra-arch tooth positions and further compare their objective grading scores for alignment/rotations, marginal ridge relationships and buccolingual inclination.

Materials and methods: The study was a prospective clinical trial of 145 arches from 44 females and 29 males (54 SureSmileTM arches, 35 InsigniaTM arches, and 56 InvisalignTM arches). All arches were treated by a non-extraction approach and had ≤7 mm of crowding and 45° of tooth rotation. The manufacturer’s recommendations were followed for each group and the final scans were acquired before refinements, rebonding, or wire bending. The virtual set-ups were superimposed on the final scans and the coordinates of 34 landmarks per arch were compared. One hundred and twenty-six end-of-participation arches were suitable for 3D printing and were compared using the American Board of Orthodontics Objective Grading Scores (OGS) for alignment/ rotations, marginal ridge relationships, and buccolingual inclination.

Results: No statistically significant differences were identified in the mean deviation between the target and achieved the position of the anterior landmarks within the treatment groups. The exception was the Suresmile group which had greater vertical discrepancies in the position of the labial CEJ. Although the mean differences between the target and achieved anterior landmark positions for all groups were under 0.5 mm, the range of maximum discrepancy was between 0.7 mm and 4.1 mm. The InsigniaTM system showed significantly greater deviation in upper posterior landmark positions in the transverse and sagittal dimensions, and lower posterior landmarks in the transverse dimension. However, this was due to the InsigniaTM initial set-ups being wider. There was no statistically significant difference between the three systems in combined intra-arch OGS. However, the InvisalignTM system had a significantly poorer alignment/rotation score than the SureSmileTM group. The InsigniaTM system performed better in achieving buccolingual tooth inclination compared to SuresmileTM, and the InvisalignTM system performed better than the SuresmileTM system in the marginal ridge score.

Conclusions: The three systems were comparable in achieving the predicted tooth positions of the anterior teeth in non-extraction, mild-to-moderate, crowded cases. Large discrepancies requiring operator intervention were common within the three systems. Although the three systems had no statistically significant difference in overall intra-arch OGS scores, there were significant differences in the score components.

Open Access

Airway morphology and its influence on OSA severity and surgical intervention: a retrospective study

Published Online: 29 Sep 2022
Page range: 307 - 318

Abstract

Abstract

Introduction: The aim was to assess the relationship between airway morphology and surgical intervention in a cohort of patients presenting with increased body mass index (BMI) and a confirmed diagnosis of obstructive sleep apnoea (OSA). A secondary aim was to revisit the relationship between morphology and OSA severity.

Methods: A retrospective analysis was conducted of pre-operative maxillofacial 3D-CT scans of thirty-two patients with a confirmed diagnosis of OSA who received treatment from an ear nose and throat specialist (ENT). Lateral cephalograms were imported into Quick Ceph Studio (Quick Ceph Systems Inc, San Diego, CA, USA) after which linear and angular measurements of selected hard and soft tissues were obtained. 3D-CT images were loaded into the software program 3dMDVultus (3dMD) which permitted 3D visualisation of the airway. Measurements were repeated 3 times on the images of six patients after an interval of two weeks to establish the intraclass correlation coefficient (ICC) for intra-examiner accuracy and reliability. Logistic regression was applied to determine the relationships between morphology, OSA and surgical treatments.

Results: A positive correlation was found between age and the apnoea-hypopnea index (AHI). Morphological measurements of the airway did not exhibit a positive relationship with OSA severity. Posterior airway space at the level of the uvula and tongue, the length of the soft palate and position of the hyoid bone were significantly associated with BMI. No variables were found to be correlated with uvulopalatopharyngoplasty (UPPP) surgery. Notwithstanding, airway length and posterior airway space at the level of the uvula tip were significantly associated with tongue channelling.

Conclusions: Radiographic airway assessment is an invaluable and opportunistic tool for screening OSA but requires judicial use in its prescription and interpretation. There is little correlation between OSA severity and airway morphology and between surgical intervention and morphology. Additional factors need to be considered before a treatment modality is considered and is best managed in a multidisciplinary setting.

Open Access

The effect of third molars on maxillary molar distalisation using a miniscrew-supported 3D® maxillary bimetric distalising arch

Published Online: 29 Sep 2022
Page range: 319 - 328

Abstract

Abstract

Objectives: The aim of the present study was to investigate the effect of third molars on the efficiency and biomechanics of a novel miniscrew-supported 3D® Maxillary Bimetric Distalising Arch (3D-MBDA).

Methods: Twenty-three patients, whose third molars were either extracted at the beginning of treatment (Group 1, n =11) or retained (Group 2, n =12), were included in the study. Lateral cephalometric films and dental casts, taken at the beginning (T0) and at the end of upper molar distalisation (T1), were analysed to study the differences between groups.

Results: Crown distalisation of the first molars was similar between the groups; however, root distalisation, both at the trifurcation and apex levels, intrusion at the mesiobuccal cusp tip, and the distalisation rate were significantly higher in Group 1. The resultant tipping of the first molars in both groups was mesially-directed, unlike the usual distal tipping. The second molars distalised more, displaced less vestibularly and rotated mesiobuccally in Group 1, whereas they demonstrated a significantly higher vestibular displacement and distobuccal rotation in Group 2. The mean distalisation time was significantly shorter in Group 1 when compared to Group 2. The miniscrew success rate was 95.5% for Group 1 and 91.7% for Group 2.

Conclusion: The miniscrew-supported 3D-MBDA was found to have greater effects on root distalisation and the final inclination of the molars. The third molars were associated with limited root movement, unfavourable displacement of the second molars, as well as a slower distalisation rate. Therefore, the extraction of third molars prior to distalisation is recommended, especially when the miniscrew-supported 3D-MBDA is the appliance choice.

Open Access

Class III malocclusion with traumatic unilateral maxillary central incisor loss treated using orthodontic miniscrews: a case report

Published Online: 27 Oct 2022
Page range: 329 - 347

Abstract

Abstract

The present article reports the successful non-extraction orthodontic treatment using miniscrew anchorage in a patient who presented with maxillary left central incisor loss and unstable jaw movements. The chief complaints of the 23-year-old female patient were her protruding teeth and crowding of the mandibular anterior segment. The patient lost her maxillary left central incisor as a result of a traumatic injury during childhood. However, the crown was saved and attached to the adjacent teeth. The patient was diagnosed with a skeletal Class III and Angle Class III dental malocclusion. The jaw movements determined by a 6 degrees of freedom jaw movement recording system were unstable and irregular. Miniscrew anchorage was applied for distalisation of the maxillary right dentition and the mandibular dentition during non-extraction treatment. The maxillary left dentition was mesialised using miniscrew anchorage to close the space as a result of the lost maxillary left central incisor. After an active treatment duration of 36 months, the patient achieved a Class II molar relationship on the left side, a Class I on the right side, an optimal overjet and overbite, and a pleasing facial profile. Despite the asymmetric molar relationships, functionally stable and smooth jaw movements were established. The skeletal, occlusal and functional stability remained satisfactory after a 2-year retention period. In conclusion, miniscrew anchorage was valuable in supporting asymmetric tooth movement during non-extraction appliance treatment in a patient who presented with traumatic unilateral tooth loss.

Open Access

Cytotoxicity evaluation of different clear aligner materials using MTT analysis

Published Online: 21 Nov 2022
Page range: 348 - 354

Abstract

Abstract

Backround: The in vitro cytotoxic effects of six different clear aligner materials were evaluated using the MTT analysis.

Methods: The clear aligner material samples [Duran (ScheuDental GmbH, Iserlohn, Germany), Zendura-Flx (Bay Materials LLC, Fremont, CA, USA), Taglus (Laxmi Dental Export Pvt. Ltd, Mumbai, India), Smart Track (Align Technology, San Jose, CA, USA), Zendura (Bay Materials LLC, Fremont, CA, USA), Essix C + (Essix® (Raintree Essix, Inc., 4001 Division St, Metairie, LA-USA)] were initially kept in a saline solution in airtight test tubes for 8 weeks at 37°C. According to the recommended ISO standards, the weights of the samples were divided by the volumes of the dilutions in the ratio of 0.1 g/ml. To evaluate the cytotoxicity of the samples, an MTT analysis was performed using a human gingival fibroblast cell line (HGF). To analyse the data, the Kruskal– Wallis test was applied (a=0.05).

Results: Zendura was the most cytotoxic material resulting in 67.3 ± 16.20% cell viability, followed by Smart Track with 87.6 ± 5.53% cell viability. While Duran, Essix C + had 92.6 ± 26.34% and 94.9 ± 8.54% cell viability, Zendura-Flx, Taglus had 106.9 ± 12.76% and 113.183 ± 7.45% cell viability, respectively.

Conclusion: While Zendura and Smart Track showed mild cytotoxicity, other materials showed greater cell viabilities. According to the ISO standards, the clinical use of each brand of aligners, except Zendura, may be considered reliable. Taking into account standard deviation, Zendura and Duran should be used with caution. The suppliers of aligners should adhere to the manufacturer’s recommendations since an increase in ion release might arise from material wear.

Open Access

Skeletal, dentoalveolar, and buccal bone changes using hybrid and tooth-borne expanders for RME and SARME in different growth stages

Published Online: 04 Nov 2022
Page range: 355 - 367

Abstract

Abstract Objective

To compare the skeletal, dentoalveolar and buccal bone thickness of tooth–bone-borne (Hybrid-H) and tooth-borne (TB) maxillary expanders used for rapid maxillary expansion (RME) in early and late adolescents and for surgically-assisted RME (SARME) in young adults.

Materials and methods:

This two-centre clinical study included initial and 6 months post-retention CBCT records of 60 patients (27 males, 33 females; mean age 15.7 ± 3.75 years). The cohort was divided into two groups according to the expander type (H or TB) and subdivided into a further three groups determined by cervical vertebrae maturation stages: early adolescents (EA), late adolescents (LA), and young adults (A). EA and LA patients underwent RME and young adults received a SARME.

Results:

The hybrid-designed appliance increased the internal skeletal maxillary width and nasal width more than the TB-designed appliance anteriorly in EA and posteriorly in SARME young adults. The TB expanders tipped and expanded the first premolars more than the Hybrid SARME expanders in young adults and caused a greater reduction in buccal alveolar bone thickness at the level of the first premolars and molars at the three growth stages.

Conclusion

The hybrid expanders, with relatively greater skeletal and nasal widening potential and fewer dentoalveolar side effects, were a favourable alternative to tooth-borne expanders for RME in the early and late adolescents, and for SARME in young adults.

Open Access

Prevalence of white spot lesions during clear aligner therapy: a systematic review

Published Online: 10 Nov 2022
Page range: 368 - 379

Abstract

Abstract

Objectives: To determine if an association exists between the prevalence of white spot lesions (WSLs) and orthodontic treatment using clear aligners.

Methods: Electronic databases were searched with no restrictions on year. Article selection criteria included human clear aligner studies conducted during the permanent dentition and with a full description of the applied technique and oral hygiene status.

Results: The search strategy resulted in a total of 4177 articles. After title and abstract screening, 156 relevant articles were identified from which five remained after the application of the exclusion criteria. The articles were mostly classified as having a low risk of bias.

Conclusions: Clear aligner therapy induces a lower development rate of new WSLs than orthodontic treatment by fixed appliances. In patients who have poor oral hygiene and/or existing WSLs, clear aligner treatment could be recommended.

Open Access

Evaluation of architectural changes in mandibular trabecular and cortical bone pattern after functional treatment

Published Online: 04 Nov 2022
Page range: 380 - 387

Abstract

Abstract Purpose:

To assess the changes in mandibular trabecular and cortical bone following functional appliance treatment through fractal dimension (FD) and cortical thickness (CorT) measurements.

Material and methods

The study was performed on 45 mandibular retrognathia cases. While the treatment group (T) comprised 30 patients treated using a functional appliance for one year during puberty, the control group (C) consisted of 15 patients who did not receive any orthodontic treatment due to insufficient oral hygiene. FD and CorT analyses were bilaterally evaluated for each mandible. FD measurements were performed on the condylar process, the antegonial notch, and ramus regions on panoramic radiographs. A paired t-test was applied for group analysis, before (T1) and after treatment (T2) and, correspondingly, before (C1) and after (C2) controls. In addition, an independent t-test was used to determine differences between the treatment (∆T = T2−T1) and the control group (∆C = C2−C1).

Results

Statistically significant differences were found in the treatment group between the initial and post-treatment FD values of the right (p < 0.05) and left condyles (p < 0.05), and the CorT measurements on the right (p < 0.01) and the left sides (p < 0.05). There was no statistically significant difference in FD parameters in the control group and a significant difference was only found in the left CorT (p < 0.05). A comparison of the treatment and control groups revealed that the changes in FD and CorT measurements were not statistically significantly different between the groups (p > 0.05).

Conclusion:

Mandibular protraction appliances do not produce trabecular bone alteration in the mandibular condyles, the antegonial notch and ramus over a 12-month time period.

Open Access

To evaluate the rate of canine retraction and pain perception following micro-osteoperforation – a split-mouth clinical study

Published Online: 23 Jan 2023
Page range: 388 - 395

Abstract

Abstract

Objective: To evaluate the effectiveness and influence of micro-osteoperforation on the rate of canine retraction and patient pain perception.

Method: In this prospective split-mouth clinical trial, forty adult patients in the age range of 15-25 years (18 men and 22 women) requiring bilateral first premolar extraction and upper canine retraction involving maximum anchorage, were enrolled. Two groups of 20 patients each (Group-I and Group-II) were randomly assigned and were further subdivided into subgroups A and B according to the allocation of a maxillary quadrant. Group-I A and Group-II A were the experimental quadrants in which 3 micro-osteoperforations (MOPs) and 2 MOPs were performed, respectively, and Group-I B and Group-II B served as control quadrants. With the help of a mini-screw (1.6 mm diameter, 8 mm length), MOPs were created distal to the maxillary canine following which, canine retraction continued for three months. The collection of data was obtained from monthly plaster models. The primary outcomes were the rate of canine retraction per month and the total distance moved by the canines. The secondary outcomes were to assess patient pain following the MOP procedure.

Result: A significant increase in the rate of tooth movement was seen in Group-I A, whereas, in Group II, there was no significant difference in the movement rate between the subgroups A and B. In addition, Group-I A showed a significant increase in the rate of canine retraction compared to Group-II A. The patients did not report significant pain, nor discomfort nor other complications during or after the procedure.

Conclusion: Micro-osteoperforation appears to be an effective, comfortable, and safe procedure to accelerate tooth movement and significantly reduce the duration of orthodontic treatment.

16 Articles
Open Access

Determination of treatment options for Class III malocclusions in adult patients based on cephalometric values: a systematic review

Published Online: 14 Jul 2022
Page range: 183 - 193

Abstract

Abstract Objective

The present systematic review aimed to determine cephalometric values that may be used as a guide in deciding between orthodontic camouflage and orthognathic surgery to treat a Class III malocclusion in adults. In addition, a secondary aim was to identify treatment complications and aesthetic perceptions by laypersons/orthodontists.

Methods

Without a language restriction, an electronic search of six databases and a hand search of three orthodontic journals were performed until September 2021. All studies comparing orthodontic camouflage and orthognathic surgery in Class III malocclusion patients, were included. Data extraction was carried out independently by two authors with disagreement resolved by a third author. The risk of bias related to individual studies was appraised using a modified version of the STROBE checklist. The results were summarised qualitatively, and no meta-analysis was undertaken due to the high heterogeneity between the studies.

Results

With the quality of evidence ranging from moderate to high, six retrospective studies were included. A cephalometric analysis comprising the Holdaway angle, overjet, the Wits appraisal, lower incisor inclination, the maxillary-mandibular ratio, overbite, gonial angle and an additional combination were used as a guide. No treatment complications were reported. One study examined the perception of facial profile attractiveness in borderline surgical Class III malocclusions and found no difference in outcome and significant improvements in both camouflage and surgical groups.

Conclusion

The existing evidence is insufficient to identify a cephalometric parameter threshold in deciding between orthodontic camouflage and orthognathic surgery. PROSPERO database protocol no. CRD42020165164.

Open Access

Case report: early class III correction using titanium dental implants and facemask therapy: a 24-year follow-up

Published Online: 14 Jul 2022
Page range: 213 - 226

Abstract

Abstract

The management of a Class III malocclusion in the mixed dentition presents with many challenges, in particular, the post-treatment growth-related changes which can continue into adulthood. This case report describes the multidisciplinary management of a 9-year-old female using titanium dental implants, rapid maxillary expansion and a Delaire facemask. Pre-treatment, post-treatment and long-term follow-up records of the patient are presented.

Open Access

Clear aligners brands and marketing claims: An overview of available information on the web

Published Online: 14 Jul 2022
Page range: 252 - 262

Abstract

Abstract Objectives

To investigate the current commercially available clear aligners related to brands, companies, Google trends, and marketing claims presented on their official websites.

Materials and methods

A search was conducted in October 2020 to identify the relevant web-based information, using three languages (English, Chinese, and Korean) and search terms “clear aligner”, , , and in four search engines (Google, Bing, Baidu, and Naver) to identify current clear aligner companies. Each company website was reviewed and assessed for its marketing claims.

Results

A total of 75 clear aligner brands were identified and included in the study, and 280 claims from their official websites were analysed. Most (70.7%) of the companies made claims regarding “aesthetics”, 66.7% made claims regarding “increased comfort”, 58.7% made claims regarding “shorter treatment time”, and 56.0% of the companies made claims regarding “superior material”. Other claims were made regarding their “novel technology”, “superior hygiene”, “tracking Apps”, “remote monitoring”, and “reduced in-office visits”. Of these marketing claims, only 4.5% cited references supporting the company’s website claims; however, the references were mainly derived from internal company research.

Conclusions

Using three languages (English, Chinese, and Korean), 75 different brands of clear aligners were currently found online. Most of the marketing claims from the clear aligner companies’ official websites were not referenced to quality scientific studies. Clinicians and patients should critically appraise the content of company claims and advertisements.

Open Access

Molar uprighting using a newly designed segmental wire: a case report

Published Online: 14 Jul 2022
Page range: 263 - 267

Abstract

Abstract

The ectopic eruption path of a permanent molar can cause incomplete emergence through interference by an adjacent tooth, early loss of a primary molar, or an arch length discrepancy. It is clinically important to determine the appropriate appliance that may easily be placed for the considered application of a molar corrective force. A newly designed appliance is introduced for the distal uprighting of an ectopically erupting molar and supported by two case presentations. The current technique of using a segmental wire incorporating double-sided hooks may easily and effectively resolve this problem.

Open Access

Evaluation of exaggerated claims in the abstracts of systematic reviews reporting accelerated orthodontic tooth movement: a meta research analysis

Published Online: 14 Jul 2022
Page range: 268 - 277

Abstract

Abstract Background

The latest trend in scientific literature review is to scrutinise the practices of false or biased reporting of findings, which is rightly termed as ‘spin’. In recent years, accelerated tooth movement has gained attention from the orthodontic community, but the findings still remain unclear and controversial.

Objectives

To estimate the frequency of distorted claims and over-interpretation of abstracts of systematic reviews related to accelerated orthodontic tooth movement. The objective was to differentiate the type of claim and to determine its prevalence.

Methods

A literature search was performed using the Cochrane library and the top five most prominent orthodontic journals for systematic reviews on accelerated orthodontics were identified by applying appropriate key words. According to pre-set selection criteria, only systematic reviews published between January 2010 and September 2021 were included. The selected articles were scrutinised for the assigned exclusion criteria. The articles were finally scanned for false claims by two independent reviewers. The identified claims fell into either the categories of misleading interpretation, misleading reporting or misleading extrapolation. The obtained data were tabulated and analysed using the one-way ANOVA statistical test to indicate the difference between the different types of reported claims.

Results

There were 98 systematic reviews identified in total, of which 59 articles met the selection criteria and 39 articles were excluded. Of the 59 included articles, 38 systematic reviews had exaggerated claims. Twenty-two of the reported claims came under the misleading reporting category, 10 fell under the misleading interpretation category and 6 came under the misleading extrapolation category. The difference noted between the reporting prevalence of different types of claim was statistically significant (P < 0.001). In misleading reporting, it was noted that most of the systematic reviews refrained from reporting the adverse effects of treatment.

Conclusion

The prevalence of exaggerated claims is high in the abstracts of systematic reviews related to accelerated orthodontic tooth movement. It is recommended that a clinician critically assess the claims presented in systematic reviews which are considered to be the hallmark articles of evidence-based practice. Orthodontists should be careful when applying the findings in clinical practice.

Open Access

Guest Editorial

Published Online: 16 Aug 2022
Page range: 278 - 280

Abstract

Open Access

A comparison of SureSmileTM, InsigniaTM, and InvisalignTM, in treating non-extraction cases of mild to moderate crowding: a prospective clinical trial

Published Online: 29 Sep 2022
Page range: 290 - 306

Abstract

Abstract

Objectives: To compare the ability of SureSmileTM, InsigniaTM and InvisalignTM to achieve predicted intra-arch tooth positions and further compare their objective grading scores for alignment/rotations, marginal ridge relationships and buccolingual inclination.

Materials and methods: The study was a prospective clinical trial of 145 arches from 44 females and 29 males (54 SureSmileTM arches, 35 InsigniaTM arches, and 56 InvisalignTM arches). All arches were treated by a non-extraction approach and had ≤7 mm of crowding and 45° of tooth rotation. The manufacturer’s recommendations were followed for each group and the final scans were acquired before refinements, rebonding, or wire bending. The virtual set-ups were superimposed on the final scans and the coordinates of 34 landmarks per arch were compared. One hundred and twenty-six end-of-participation arches were suitable for 3D printing and were compared using the American Board of Orthodontics Objective Grading Scores (OGS) for alignment/ rotations, marginal ridge relationships, and buccolingual inclination.

Results: No statistically significant differences were identified in the mean deviation between the target and achieved the position of the anterior landmarks within the treatment groups. The exception was the Suresmile group which had greater vertical discrepancies in the position of the labial CEJ. Although the mean differences between the target and achieved anterior landmark positions for all groups were under 0.5 mm, the range of maximum discrepancy was between 0.7 mm and 4.1 mm. The InsigniaTM system showed significantly greater deviation in upper posterior landmark positions in the transverse and sagittal dimensions, and lower posterior landmarks in the transverse dimension. However, this was due to the InsigniaTM initial set-ups being wider. There was no statistically significant difference between the three systems in combined intra-arch OGS. However, the InvisalignTM system had a significantly poorer alignment/rotation score than the SureSmileTM group. The InsigniaTM system performed better in achieving buccolingual tooth inclination compared to SuresmileTM, and the InvisalignTM system performed better than the SuresmileTM system in the marginal ridge score.

Conclusions: The three systems were comparable in achieving the predicted tooth positions of the anterior teeth in non-extraction, mild-to-moderate, crowded cases. Large discrepancies requiring operator intervention were common within the three systems. Although the three systems had no statistically significant difference in overall intra-arch OGS scores, there were significant differences in the score components.

Open Access

Airway morphology and its influence on OSA severity and surgical intervention: a retrospective study

Published Online: 29 Sep 2022
Page range: 307 - 318

Abstract

Abstract

Introduction: The aim was to assess the relationship between airway morphology and surgical intervention in a cohort of patients presenting with increased body mass index (BMI) and a confirmed diagnosis of obstructive sleep apnoea (OSA). A secondary aim was to revisit the relationship between morphology and OSA severity.

Methods: A retrospective analysis was conducted of pre-operative maxillofacial 3D-CT scans of thirty-two patients with a confirmed diagnosis of OSA who received treatment from an ear nose and throat specialist (ENT). Lateral cephalograms were imported into Quick Ceph Studio (Quick Ceph Systems Inc, San Diego, CA, USA) after which linear and angular measurements of selected hard and soft tissues were obtained. 3D-CT images were loaded into the software program 3dMDVultus (3dMD) which permitted 3D visualisation of the airway. Measurements were repeated 3 times on the images of six patients after an interval of two weeks to establish the intraclass correlation coefficient (ICC) for intra-examiner accuracy and reliability. Logistic regression was applied to determine the relationships between morphology, OSA and surgical treatments.

Results: A positive correlation was found between age and the apnoea-hypopnea index (AHI). Morphological measurements of the airway did not exhibit a positive relationship with OSA severity. Posterior airway space at the level of the uvula and tongue, the length of the soft palate and position of the hyoid bone were significantly associated with BMI. No variables were found to be correlated with uvulopalatopharyngoplasty (UPPP) surgery. Notwithstanding, airway length and posterior airway space at the level of the uvula tip were significantly associated with tongue channelling.

Conclusions: Radiographic airway assessment is an invaluable and opportunistic tool for screening OSA but requires judicial use in its prescription and interpretation. There is little correlation between OSA severity and airway morphology and between surgical intervention and morphology. Additional factors need to be considered before a treatment modality is considered and is best managed in a multidisciplinary setting.

Open Access

The effect of third molars on maxillary molar distalisation using a miniscrew-supported 3D® maxillary bimetric distalising arch

Published Online: 29 Sep 2022
Page range: 319 - 328

Abstract

Abstract

Objectives: The aim of the present study was to investigate the effect of third molars on the efficiency and biomechanics of a novel miniscrew-supported 3D® Maxillary Bimetric Distalising Arch (3D-MBDA).

Methods: Twenty-three patients, whose third molars were either extracted at the beginning of treatment (Group 1, n =11) or retained (Group 2, n =12), were included in the study. Lateral cephalometric films and dental casts, taken at the beginning (T0) and at the end of upper molar distalisation (T1), were analysed to study the differences between groups.

Results: Crown distalisation of the first molars was similar between the groups; however, root distalisation, both at the trifurcation and apex levels, intrusion at the mesiobuccal cusp tip, and the distalisation rate were significantly higher in Group 1. The resultant tipping of the first molars in both groups was mesially-directed, unlike the usual distal tipping. The second molars distalised more, displaced less vestibularly and rotated mesiobuccally in Group 1, whereas they demonstrated a significantly higher vestibular displacement and distobuccal rotation in Group 2. The mean distalisation time was significantly shorter in Group 1 when compared to Group 2. The miniscrew success rate was 95.5% for Group 1 and 91.7% for Group 2.

Conclusion: The miniscrew-supported 3D-MBDA was found to have greater effects on root distalisation and the final inclination of the molars. The third molars were associated with limited root movement, unfavourable displacement of the second molars, as well as a slower distalisation rate. Therefore, the extraction of third molars prior to distalisation is recommended, especially when the miniscrew-supported 3D-MBDA is the appliance choice.

Open Access

Class III malocclusion with traumatic unilateral maxillary central incisor loss treated using orthodontic miniscrews: a case report

Published Online: 27 Oct 2022
Page range: 329 - 347

Abstract

Abstract

The present article reports the successful non-extraction orthodontic treatment using miniscrew anchorage in a patient who presented with maxillary left central incisor loss and unstable jaw movements. The chief complaints of the 23-year-old female patient were her protruding teeth and crowding of the mandibular anterior segment. The patient lost her maxillary left central incisor as a result of a traumatic injury during childhood. However, the crown was saved and attached to the adjacent teeth. The patient was diagnosed with a skeletal Class III and Angle Class III dental malocclusion. The jaw movements determined by a 6 degrees of freedom jaw movement recording system were unstable and irregular. Miniscrew anchorage was applied for distalisation of the maxillary right dentition and the mandibular dentition during non-extraction treatment. The maxillary left dentition was mesialised using miniscrew anchorage to close the space as a result of the lost maxillary left central incisor. After an active treatment duration of 36 months, the patient achieved a Class II molar relationship on the left side, a Class I on the right side, an optimal overjet and overbite, and a pleasing facial profile. Despite the asymmetric molar relationships, functionally stable and smooth jaw movements were established. The skeletal, occlusal and functional stability remained satisfactory after a 2-year retention period. In conclusion, miniscrew anchorage was valuable in supporting asymmetric tooth movement during non-extraction appliance treatment in a patient who presented with traumatic unilateral tooth loss.

Open Access

Cytotoxicity evaluation of different clear aligner materials using MTT analysis

Published Online: 21 Nov 2022
Page range: 348 - 354

Abstract

Abstract

Backround: The in vitro cytotoxic effects of six different clear aligner materials were evaluated using the MTT analysis.

Methods: The clear aligner material samples [Duran (ScheuDental GmbH, Iserlohn, Germany), Zendura-Flx (Bay Materials LLC, Fremont, CA, USA), Taglus (Laxmi Dental Export Pvt. Ltd, Mumbai, India), Smart Track (Align Technology, San Jose, CA, USA), Zendura (Bay Materials LLC, Fremont, CA, USA), Essix C + (Essix® (Raintree Essix, Inc., 4001 Division St, Metairie, LA-USA)] were initially kept in a saline solution in airtight test tubes for 8 weeks at 37°C. According to the recommended ISO standards, the weights of the samples were divided by the volumes of the dilutions in the ratio of 0.1 g/ml. To evaluate the cytotoxicity of the samples, an MTT analysis was performed using a human gingival fibroblast cell line (HGF). To analyse the data, the Kruskal– Wallis test was applied (a=0.05).

Results: Zendura was the most cytotoxic material resulting in 67.3 ± 16.20% cell viability, followed by Smart Track with 87.6 ± 5.53% cell viability. While Duran, Essix C + had 92.6 ± 26.34% and 94.9 ± 8.54% cell viability, Zendura-Flx, Taglus had 106.9 ± 12.76% and 113.183 ± 7.45% cell viability, respectively.

Conclusion: While Zendura and Smart Track showed mild cytotoxicity, other materials showed greater cell viabilities. According to the ISO standards, the clinical use of each brand of aligners, except Zendura, may be considered reliable. Taking into account standard deviation, Zendura and Duran should be used with caution. The suppliers of aligners should adhere to the manufacturer’s recommendations since an increase in ion release might arise from material wear.

Open Access

Skeletal, dentoalveolar, and buccal bone changes using hybrid and tooth-borne expanders for RME and SARME in different growth stages

Published Online: 04 Nov 2022
Page range: 355 - 367

Abstract

Abstract Objective

To compare the skeletal, dentoalveolar and buccal bone thickness of tooth–bone-borne (Hybrid-H) and tooth-borne (TB) maxillary expanders used for rapid maxillary expansion (RME) in early and late adolescents and for surgically-assisted RME (SARME) in young adults.

Materials and methods:

This two-centre clinical study included initial and 6 months post-retention CBCT records of 60 patients (27 males, 33 females; mean age 15.7 ± 3.75 years). The cohort was divided into two groups according to the expander type (H or TB) and subdivided into a further three groups determined by cervical vertebrae maturation stages: early adolescents (EA), late adolescents (LA), and young adults (A). EA and LA patients underwent RME and young adults received a SARME.

Results:

The hybrid-designed appliance increased the internal skeletal maxillary width and nasal width more than the TB-designed appliance anteriorly in EA and posteriorly in SARME young adults. The TB expanders tipped and expanded the first premolars more than the Hybrid SARME expanders in young adults and caused a greater reduction in buccal alveolar bone thickness at the level of the first premolars and molars at the three growth stages.

Conclusion

The hybrid expanders, with relatively greater skeletal and nasal widening potential and fewer dentoalveolar side effects, were a favourable alternative to tooth-borne expanders for RME in the early and late adolescents, and for SARME in young adults.

Open Access

Prevalence of white spot lesions during clear aligner therapy: a systematic review

Published Online: 10 Nov 2022
Page range: 368 - 379

Abstract

Abstract

Objectives: To determine if an association exists between the prevalence of white spot lesions (WSLs) and orthodontic treatment using clear aligners.

Methods: Electronic databases were searched with no restrictions on year. Article selection criteria included human clear aligner studies conducted during the permanent dentition and with a full description of the applied technique and oral hygiene status.

Results: The search strategy resulted in a total of 4177 articles. After title and abstract screening, 156 relevant articles were identified from which five remained after the application of the exclusion criteria. The articles were mostly classified as having a low risk of bias.

Conclusions: Clear aligner therapy induces a lower development rate of new WSLs than orthodontic treatment by fixed appliances. In patients who have poor oral hygiene and/or existing WSLs, clear aligner treatment could be recommended.

Open Access

Evaluation of architectural changes in mandibular trabecular and cortical bone pattern after functional treatment

Published Online: 04 Nov 2022
Page range: 380 - 387

Abstract

Abstract Purpose:

To assess the changes in mandibular trabecular and cortical bone following functional appliance treatment through fractal dimension (FD) and cortical thickness (CorT) measurements.

Material and methods

The study was performed on 45 mandibular retrognathia cases. While the treatment group (T) comprised 30 patients treated using a functional appliance for one year during puberty, the control group (C) consisted of 15 patients who did not receive any orthodontic treatment due to insufficient oral hygiene. FD and CorT analyses were bilaterally evaluated for each mandible. FD measurements were performed on the condylar process, the antegonial notch, and ramus regions on panoramic radiographs. A paired t-test was applied for group analysis, before (T1) and after treatment (T2) and, correspondingly, before (C1) and after (C2) controls. In addition, an independent t-test was used to determine differences between the treatment (∆T = T2−T1) and the control group (∆C = C2−C1).

Results

Statistically significant differences were found in the treatment group between the initial and post-treatment FD values of the right (p < 0.05) and left condyles (p < 0.05), and the CorT measurements on the right (p < 0.01) and the left sides (p < 0.05). There was no statistically significant difference in FD parameters in the control group and a significant difference was only found in the left CorT (p < 0.05). A comparison of the treatment and control groups revealed that the changes in FD and CorT measurements were not statistically significantly different between the groups (p > 0.05).

Conclusion:

Mandibular protraction appliances do not produce trabecular bone alteration in the mandibular condyles, the antegonial notch and ramus over a 12-month time period.

Open Access

To evaluate the rate of canine retraction and pain perception following micro-osteoperforation – a split-mouth clinical study

Published Online: 23 Jan 2023
Page range: 388 - 395

Abstract

Abstract

Objective: To evaluate the effectiveness and influence of micro-osteoperforation on the rate of canine retraction and patient pain perception.

Method: In this prospective split-mouth clinical trial, forty adult patients in the age range of 15-25 years (18 men and 22 women) requiring bilateral first premolar extraction and upper canine retraction involving maximum anchorage, were enrolled. Two groups of 20 patients each (Group-I and Group-II) were randomly assigned and were further subdivided into subgroups A and B according to the allocation of a maxillary quadrant. Group-I A and Group-II A were the experimental quadrants in which 3 micro-osteoperforations (MOPs) and 2 MOPs were performed, respectively, and Group-I B and Group-II B served as control quadrants. With the help of a mini-screw (1.6 mm diameter, 8 mm length), MOPs were created distal to the maxillary canine following which, canine retraction continued for three months. The collection of data was obtained from monthly plaster models. The primary outcomes were the rate of canine retraction per month and the total distance moved by the canines. The secondary outcomes were to assess patient pain following the MOP procedure.

Result: A significant increase in the rate of tooth movement was seen in Group-I A, whereas, in Group II, there was no significant difference in the movement rate between the subgroups A and B. In addition, Group-I A showed a significant increase in the rate of canine retraction compared to Group-II A. The patients did not report significant pain, nor discomfort nor other complications during or after the procedure.

Conclusion: Micro-osteoperforation appears to be an effective, comfortable, and safe procedure to accelerate tooth movement and significantly reduce the duration of orthodontic treatment.

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