Maxillary molar derotation and distalization by using a nickel-titanium wire fabricated on a setup model / 대한치과교정학회지

The purpose of this article is to introduce a simple appliance that uses a setup model and a nickel-titanium (Ni-Ti) wire for correcting the mesial rotation and drift of the permanent maxillary first molar. The technique involves bonding a Ni-Ti wire to the proper position of the target tooth on a setup model, followed by the fabrication of the transfer cap for indirect bonding and its transfer to the patient's teeth. This appliance causes less discomfort and provides better oral hygiene for the patients than do conventional appliances such as the bracket, pendulum, and distal jet. The treatment time is also shorter with the new appliance than with full-fixed appliances. Moreover, the applicability of the new appliance can be expanded to many cases by using screws or splinting with adjacent teeth to improve anchorage.

Teeth discoloration during orthodontic treatment / 대한치과교정학회지

OBJECTIVE: Teeth discoloration is a rare orthodontic complication. The aim of this study was to report the clinical progression of discoloration during orthodontic treatment. METHODS: Discolored teeth, detected during orthodontic treatment between January 2003 and December 2012 by a single dentist using similar techniques and appliances, were analyzed. RESULTS: The total number of teeth that showed discoloration was 28. Progression of discoloration was evaluated in only 24 teeth that were observed without any treatment. During the observation period, the discoloration “improved” in 8 of the 24 teeth (33.3%) and was “maintained” in 16 (66.6%). The electric pulp test performed at the time of initial detection of discoloration showed 14.3% positivity, which improved to 21.4% at the final follow-up. None of the initial and final follow-up radiographic findings showed any abnormalities. CONCLUSIONS: When teeth discoloration is detected during orthodontic treatment, observation as an initial management is recommended over immediate treatments.

Finite-element analysis of the center of resistance of the mandibular dentition / 대한치과교정학회지

OBJECTIVE: The aim of this study was to investigate the three-dimensional (3D) position of the center of resistance of 4 mandibular anterior teeth, 6 mandibular anterior teeth, and the complete mandibular dentition by using 3D finite-element analysis. METHODS: Finite-element models included the complete mandibular dentition, periodontal ligament, and alveolar bone. The crowns of teeth in each group were fixed with buccal and lingual arch wires and lingual splint wires to minimize individual tooth movement and to evenly disperse the forces onto the teeth. Each group of teeth was subdivided into 0.5-mm intervals horizontally and vertically, and a force of 200 g was applied on each group. The center of resistance was defined as the point where the applied force induced parallel movement. RESULTS: The center of resistance of the 4 mandibular anterior teeth group was 13.0 mm apical and 6.0 mm posterior, that of the 6 mandibular anterior teeth group was 13.5 mm apical and 8.5 mm posterior, and that of the complete mandibular dentition group was 13.5 mm apical and 25.0 mm posterior to the incisal edge of the mandibular central incisors. CONCLUSIONS: Finite-element analysis was useful in determining the 3D position of the center of resistance of the 4 mandibular anterior teeth group, 6 mandibular anterior teeth group, and complete mandibular dentition group.

Changes in occlusal force depending on the movement of the adjacent and opposing teeth after loss of lower first molar: comparative study by using a strain gauge

PURPOSE: The aim of this study was to investigate the changes in occlusal force after loss of the lower first molar depending on the inclination and extrusion of the adjacent and opposing teeth by using a strain gauge. MATERIALS AND METHODS: Anatomic teeth were used to reconstruct the normal dental arch with loss of the lower right first molar. A uniformly thick layer of silicone was applied to the root to mimic the periodontal ligament. Four stages of dies with varying degrees of inclination and extrusion of the adjacent and opposing teeth were constructed and attached to master model interchangeably by using a CAD/CAM fabricated customized die system. The strain gauges were attached to teeth and a universal testing machine was used to determine the changes in occlusal force. An independent t-test and one-way ANOVA were performed (α = .05). RESULTS: While simulating chewing food, the upper first, second premolar and lower second molar showed greater occlusal force than before extraction. When the change of adjacent teeth's occlusal force with their progressive movement after molar loss was evaluated, the difference among four die models was significant and was in the decreasing aspect (P < 0.05). CONCLUSION: When the lower first molar was lost and the adjacent teeth did not move yet, the occlusal force in adjacent teeth was higher than that when the lower first molar still existed. In addition, the occlusal force in the upper premolars and lower second molar decreased significantly with the progressive movement of adjacent teeth.

A comparison of the precision of three-dimensional images acquired by 2 digital intraoral scanners: effects of tooth irregularity and scanning direction / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to compare the precision of three-dimensional (3D) images acquired using iTero(R) (Align Technology Inc., San Jose, CA, USA) and Trios(R) (3Shape Dental Systems, Copenhagen, Denmark) digital intraoral scanners, and to evaluate the effects of the severity of tooth irregularities and scanning sequence on precision. METHODS: Dental arch models were fabricated with differing degrees of tooth irregularity and divided into 2 groups based on scanning sequence. To assess their precision, images were superimposed and an optimized superimposition algorithm was employed to measure any 3D deviation. The t-test, paired t-test, and one-way ANOVA were performed (p < 0.05) for statistical analysis. RESULTS: The iTero(R) and Trios(R) systems showed no statistically significant difference in precision among models with differing degrees of tooth irregularity. However, there were statistically significant differences in the precision of the 2 scanners when the starting points of scanning were different. The iTero(R) scanner (mean deviation, 29.84 +/- 12.08 microm) proved to be less precise than the Trios(R) scanner (22.17 +/- 4.47 microm). CONCLUSIONS: The precision of 3D images differed according to the degree of tooth irregularity, scanning sequence, and scanner type. However, from a clinical standpoint, both scanners were highly accurate regardless of the degree of tooth irregularity.

Stress distributions in peri-miniscrew areas from cylindrical and tapered miniscrews inserted at different angles / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to analyze stress distributions in the roots, periodontal ligaments (PDLs), and bones around cylindrical and tapered miniscrews inserted at different angles using a finite element analysis. METHODS: We created a three-dimensional (3D) maxilla model of a dentition with extracted first premolars and used 2 types of miniscrews (tapered and cylindrical) with 1.45-mm diameters and 8-mm lengths. The miniscrews were inserted at 30°, 60°, and 90° angles with respect to the bone surface. A simulated horizontal orthodontic force of 2 N was applied to the miniscrew heads. Then, the stress distributions, magnitudes during miniscrew placement, and force applications were analyzed with a 3D finite element analysis. RESULTS: Stresses were primarily absorbed by cortical bone. Moreover, very little stress was transmitted to the roots, PDLs, and cancellous bone. During cylindrical miniscrew insertion, the maximum von Mises stress increased as insertion angle decreased. Tapered miniscrews exhibited greater maximum von Mises stress than cylindrical miniscrews. During force application, maximum von Mises stresses increased in both groups as insertion angles decreased. CONCLUSIONS: For both cylindrical and tapered miniscrew designs, placement as perpendicular to the bone surface as possible is recommended to reduce stress in the surrounding bone.

Finite element analysis of maxillary incisor displacement during en-masse retraction according to orthodontic mini-implant position / 대한치과교정학회지

OBJECTIVE: Orthodontic mini-implants (OMI) generate various horizontal and vertical force vectors and moments according to their insertion positions. This study aimed to help select ideal biomechanics during maxillary incisor retraction by varying the length in the anterior retraction hook (ARH) and OMI position. METHODS: Two extraction models were constructed to analyze the three-dimentional finite element: a first premolar extraction model (Model 1, M1) and a residual 1-mm space post-extraction model (Model 2, M2). The OMI position was set at a height of 8 mm from the arch wire between the second maxillary premolar and the first molar (low OMI traction) or at a 12-mm height in the mesial second maxillary premolar (high OMI traction). Retraction force vectors of 200 g from the ARH (-1, +1, +3, and +6 mm) at low or high OMI traction were resolved into X-, Y-, and Z-axis components. RESULTS: In M1 (low and high OMI traction) and M2 (low OMI traction), the maxillary incisor tip was extruded, but the apex was intruded, and the occlusal plane was rotated clockwise. Significant intrusion and counter-clockwise rotation in the occlusal plane were observed under high OMI traction and -1 mm ARH in M2. CONCLUSIONS: This study observed orthodontic tooth movement according to the OMI position and ARH height, and M2 under high OMI traction with short ARH showed retraction with maxillary incisor intrusion.

Distalization pattern of whole maxillary dentition according to force application points / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to observe stress distribution and displacement patterns of the entire maxillary arch with regard to distalizing force vectors applied from interdental miniscrews. METHODS: A standard three-dimensional finite element model was constructed to simulate the maxillary teeth, periodontal ligament, and alveolar process. The displacement of each tooth was calculated on x, y, and z axes, and the von Mises stress distribution was visualized using color-coded scales. RESULTS: A single distalizing force at the archwire level induced lingual inclination of the anterior segment, and slight intrusive distal tipping of the posterior segment. In contrast, force at the high level of the retraction hook resulted in lingual root movement of the anterior segment, and extrusive distal translation of the posterior segment. As the force application point was located posteriorly along the archwire, the likelihood of extrusive lingual inclination of the anterior segment increased, and the vertical component of the force led to intrusion and buccal tipping of the posterior segment. Rotation of the occlusal plane was dependent on the relationship between the line of force and the possible center of resistance of the entire arch. CONCLUSIONS: Displacement of the entire arch may be dictated by a direct relationship between the center of resistance of the whole arch and the line of action generated between the miniscrews and force application points at the archwire, which makes the total arch movement highly predictable.

Comparison of occlusal contact areas of class I and class II molar relationships at finishing using three-dimensional digital models / 대한치과교정학회지

OBJECTIVE: This study compared occlusal contact areas of ideally planned set-up and accomplished final models against the initial in class I and II molar relationships at finishing. METHODS: Evaluations were performed for 41 post-orthodontic treatment cases, of which 22 were clinically diagnosed as class I and the remainder were diagnosed as full cusp class II. Class I cases had four first premolars extracted, while class II cases had maxillary first premolars extracted. Occlusal contact areas were measured using a three-dimensional scanner and RapidForm 2004. Independent t-tests were used to validate comparison values between class I and II finishings. Repeated measures analysis of variance was used to compare initial, set up, and final models. RESULTS: Molars from cases in the class I finishing for the set-up model showed significantly greater contact areas than those from class II finishing (p < 0.05). The final model class I finishing showed significantly larger contact areas for the second molars (p < 0.05). The first molars of the class I finishing for the final model showed a tendency to have larger contact areas than those of class II finishing, although the difference was not statistically significant (p = 0.078). CONCLUSIONS: In set-up models, posterior occlusal contact was better in class I than in class II finishing. In final models, class I finishing tended to have larger occlusal contact areas than class II finishing.

Comparison of landmark positions between Cone-Beam Computed Tomogram (CBCT) and Adjusted 2D lateral cephalogram / 대한치과보철학회지

PURPOSE: This study aims to investigate if 2D analysis method is applicable to analysis of CBCT by comparing measuring points of CBCT with those of Adjusted 2D Lateral Cephalogram (Adj-Ceph) with magnification adjusted to 100% and finding out at which landmarks the difference in position appear. MATERIALS AND METHODS: CBCT data and Adj-Ceph (100% magnification) data from 50 adult patients have been extracted as research objects, and the horizontal (Y axis) and vertical (Z axis) coordinates of landmarks were compared. Landmarks have been categorized into 4 groups by the position and whether they are bilaterally overlapped. Paired t-test was used to compare differences between Adj-Ceph and CBCT. RESULTS: Significant difference was found at 11 landmarks including Group B (S, Ar, Ba, PNS), Group C (Po, Or, Hinge axis, Go) and Group D (U1RP, U6CP, L6CP) in the horizontal (Y) axis while all the landmarks in vertical (Z) axis showed significant difference (P<.05). As a result of landmark difference analysis, a meaningful difference with more than 1 mm at 13 landmarks were indentifed in the horizontal axis. In the vertical axis, significant difference over 1 mm was detected from every landmark except Sella. CONCLUSION: Using the conventional lateral cephalometric measurements on CBCT is insufficient. A new 3D analysis or a modified 2D analysis adjusted on 19 landmarks of the vertical axis and 13 of the horizontal axis are needed when implementing CBCT diagnosis.

Correction of palatally displaced maxillary lateral incisors without brackets / 대한치과교정학회지

This article describes the orthodontic treatment of a 25-year-old Korean female patient with anterior crowding, including palatally displaced lateral incisors. Her facial profile was satisfactory, but 3.5 mm of maxillary anterior crowding was observed. To correct this crowding, we decided to minimize the use of the conventional fixed orthodontic appliances and employed a less bulky and more aesthetic appliance for applying light continuous force. We determined the final positions of the maxillary teeth via a working model for diagnostic set up and achieved space gaining and alignment with simple Ni-Ti spring and stainless steel round tubes. Tooth alignment was achieved efficiently and aesthetically without the conventional brackets.

Effect of bite force on orthodontic mini-implants in the molar region: Finite element analysis / 대한치과교정학회지

OBJECTIVE: To examine the effect of bite force on the displacement and stress distribution of orthodontic mini-implants (OMIs) in the molar region according to placement site, insertion angle, and loading direction. METHODS: Five finite element models were created using micro-computed tomography (microCT) images of the maxilla and mandible. OMIs were placed at one maxillary and two mandibular positions: between the maxillary second premolar and first molar, between the mandibular second premolar and first molar, and between the mandibular first and second molars. The OMIs were inserted at angles of 45degrees and 90degrees to the buccal surface of the cortical bone. A bite force of 25 kg was applied to the 10 occlusal contact points of the second premolar, first molar, and second molar. The loading directions were 0degrees, 5degrees, and 10degrees to the long axis of the tooth. RESULTS: With regard to placement site, the displacement and stress were greatest for the OMI placed between the mandibular first molar and second molar, and smallest for the OMI placed between the maxillary second premolar and first molar. In the mandibular molar region, the angled OMI showed slightly less displacement than the OMI placed at 90degrees. The maximum Von Mises stress increased with the inclination of the loading direction. CONCLUSIONS: These results suggest that placement of OMIs between the second premolar and first molar at 45degrees to the cortical bone reduces the effect of bite force on OMIs.

Finite element modeling technique for predicting mechanical behaviors on mandible bone during mastication

PURPOSE: The purpose of this study was to propose finite element (FE) modeling methods for predicting stress distributions on teeth and mandible under chewing action. MATERIALS AND METHODS: For FE model generation, CT images of skull were translated into 3D FE models, and static analysis was performed considering linear material behaviors and nonlinear geometrical effect. To find out proper boundary and loading conditions, parametric studies were performed with various areas and directions of restraints and loading. The loading directions are prescribed to be same as direction of masseter muscle, which was referred from anatomy chart and CT image. From the analysis, strain and stress distributions of teeth and mandible were obtained and compared with experimental data for model validation. RESULTS: As a result of FE analysis, the optimized boundary condition was chosen such that 8 teeth were fixed in all directions and condyloid process was fixed in all directions except for forward and backward directions. Also, fixing a part of mandible in a lateral direction, where medial pterygoid muscle was attached, gave the more proper analytical results. Loading was prescribed in a same direction as masseter muscle. The tendency of strain distributions between the teeth predicted from the proposed model were compared with experimental results and showed good agreements. CONCLUSION: This study proposes cost efficient FE modeling method for predicting stress distributions on teeth and mandible under chewing action. The proposed modeling method is validated with experimental data and can further be used to evaluate structural safety of dental prosthesis.

Differences in molar relationships and occlusal contact areas evaluated from the buccal and lingual aspects using 3-dimensional digital models / 대한치과교정학회지

OBJECTIVE: The aims of this study were to use a 3-dimensional (3D) system to compare molar relationship assessments performed from the buccal and lingual aspects, and to measure differences in occlusal contact areas between Class II and Class I molar relationships. METHODS: Study casts (232 pairs from 232 subjects, yielding a total of 380 sides) were evaluated from both the buccal and lingual aspects, so that molar relationships could be classified according to the scheme devised by Liu and Melsen. Occlusal contact areas were quantified using 3D digital models, which were generated through surface scanning of the study casts. RESULTS: A cusp-to-central fossa relationship was observed from the lingual aspect in the majority of cases classified from the buccal aspect as Class I (89.6%) or mild Class II (86.7%). However, severe Class II cases had lingual cusp-to-mesial triangular fossa or marginal ridge relationships. Mean occlusal contact areas were similar in the Class I and mild Class II groups, while the severe Class II group had significantly lower values than either of the other 2 groups (p < 0.05). CONCLUSIONS: Buccal and lingual assessments of molar relationships were not always consistent. Occlusal contact areas were lowest for the Class II-severe group, which seems to have the worst molar relationships - especially as seen from the lingual aspect.

Effects of orthodontic mini-implant position in the dragon helix appliance on tooth displacement and stress distribution: a three-dimensional finite element analysis / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to investigate the stress distribution on the orthodontic mini-implant (OMI) surface and periodontal ligament of the maxillary first and second molars as well as the tooth displacement according to the OMI position in the dragon helix appliance during scissors-bite correction. METHODS: OMIs were placed at two maxillary positions, between the first and the second premolars (group 1) and between the second premolar and the first molar (group 2). The stress distribution area (SDA) was analyzed by three-dimensional finite element analysis. RESULTS: The maximal SDA of the OMI did not differ between the groups. It was located at the cervical area and palatal root apex of the maxillary first molar in groups 1 and 2, respectively, indicating less tipping in group 2. The minimal SDA was located at the root and furcation area of the maxillary second molar in groups 1 and 2, respectively, indicating greater palatal crown displacement in group 2. CONCLUSIONS: Placement of the OMI between the maxillary second premolar and the maxillary first molar to serve as an indirect anchor in the dragon helix appliance minimizes anchorage loss while maximizing the effect on scissors-bite correction.

3-D FEA on the intrusion of mandibular anterior segment using orthodontic miniscrews / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to analyze the stress distribution and the displacement pattern of mandibular anterior teeth under various intrusive force vectors according to the position of orthodontic miniscrews and hooks, using three-dimensional finite element analysis. METHODS: A three-dimensional finite element model was constructed to simulate mandibular teeth, periodontal ligament, and alveolar bone. The displacement of individual tooth on three-dimensional planes and the von Mises stress distribution were compared when various intrusion force vectors were applied. RESULTS: Intrusive forces applied to 4 mandibular anterior teeth largely resulted in remarkable labial tipping of the segment according to the miniscrew position. All 6 mandibular anterior teeth were labially tipped and the stress concentrated on the labiogingival area by intrusive force from miniscrews placed mesial to the canine. The distointrusive force vector led to pure intrusion and the stress was evenly distributed in the whole periodontal ligament when the hook was placed between the central and lateral incisors and the miniscrew was placed distal to the canine. CONCLUSIONS: Within the limits of this study, it can be concluded that predictable pure intrusion of the 6 anterior teeth segment may be accomplished using miniscrews placed distal to the canine and hooks located between the central and lateral incisors.

Finite-element investigation of the center of resistance of the maxillary dentition / 대한치과교정학회지

OBJECTIVE: The aim of this study was to investigate the 3-dimensional position of the center of resistance of the 4 maxillary anterior teeth, 6 maxillary anterior teeth, and the full maxillary dentition using 3-dimensional finite element analysis. METHODS: Finite element models included the whole upper dentition, periodontal ligament, and alveolar bone. The crowns of the teeth in each group were fixed with buccal and lingual arch wires and lingual splint wires to minimize individual tooth movement and to evenly disperse the forces to the teeth. A force of 100 g or 200 g was applied to the wire beam extended from the incisal edge of the upper central incisor, and displacement of teeth was evaluated. The center of resistance was defined as the point where the applied force induced parallel movement. RESULTS: The results of study showed that the center of resistance of the 4 maxillary anterior teeth group, the 6 maxillary anterior teeth group, and the full maxillary dentition group were at 13.5 mm apical and 12.0 mm posterior, 13.5 mm apical and 14.0 mm posterior, and 11.0 mm apical and 26.5 mm posterior to the incisal edge of the upper central incisor, respectively. CONCLUSIONS: It is thought that the results from this finite element models will improve the efficiency of orthodontic treatment.

Finite-element analysis of the shift in center of resistance of the maxillary dentition in relation to alveolar bone loss / 대한치과교정학회지

OBJECTIVE: The aim of this study was to investigate the changes in the center of resistance of the maxillary teeth in relation to alveolar bone loss. METHODS: A finite element model, which included the upper dentition and periodontal ligament, was designed according to the amount of bone loss (0 mm, 2 mm, 4 mm). The teeth in each group were fixed with buccal and lingual arch wires and splint wires. Retraction and intrusion forces of 200 g for 4 and 6 anterior teeth groups and 400 g for the full dentition group were applied. RESULTS: The centers of resistance were at 13.5 mm, 14.5 mm, 15 mm apical and 12 mm, 12 mm, 12.5 mm posterior in the 4 incisor group; 13.5 mm, 14.5 mm, 15 mm apical and 14 mm, 14 mm, 14.5 mm posterior in the 6 anterior teeth group; and 11 mm, 13 mm, 14.5 mm apical and 26.5 mm, 27 mm, 25.5 mm posterior in the full dentition group respectively according to 0 mm, 2 mm, 4 mm bone loss. CONCLUSIONS: The center of resistance shifted apically and posteriorly as alveolar bone loss increased in 4 and 6 anterior teeth groups. However, in the full dentition group, the center of resistance shifted apically and anteriorly in the 4 mm bone loss model.

Three dimensional analysis of tooth movement using different sizes of NiTi wire on NiTi scissors-bite corrector / 대한치과교정학회지

OBJECTIVE: The purpose of this study was to compare the difference in three dimensional tooth movement using three different wire sizes (0.018 x 0.025-in, 0.016 x 0.022-in, 0.016-in) on a NiTi scissors-bite corrector. METHODS: Computed tomography (CT) images of the experimental model before and after tooth movement were taken and reconstructed into three dimensional models for superimposition. The direction and the amount of tooth movement were measured and analyzed statistically. RESULTS: The lingual and intrusive movements of the crown of the maxillary second molar were increased as the size of the NiTi wire increased. The roots of the maxillary second molars moved buccally except for the 0.016-in group. The intrusive movement of the roots of the maxillary second molars was increased as the size of the NiTi wire increased. Due to the use of orthodontic mini-implants, anchorage loss was under 0.2 mm on average. CONCLUSIONS: The 0.018 x 0.025-in NiTi wire was most effective in lingual and intrusive movement of the maxillary second molar which was in scissors-bite position. Indirect skeletal anchorage with a single orthodontic mini-implant was rigid enough to prevent anchorage loss.

Class III nonsurgical treatment using indirect skeletal anchorage: A case report / 대한치과교정학회지

Treatment of adult patients with Class III malocclusion frequently requires a combined orthodontic and surgical approach. However, if for various reasons, nonsurgical orthodontic treatment is chosen, a stable outcome requires careful consideration of the patient's biologic limitation. This case presents the orthodontic treatment of an adult with a Class III malocclusion, which was treated nonsurgically using indirect skeletal anchorage.