Insight into clear aligner therapy protocols and preferences among members of the American Association of Orthodontists in the United States and Canada.

OBJECTIVES: To investigate aligner treatment protocols among orthodontists in the United States and Canada and assess the factors influencing clinician choices in aligner systems, treatment protocols, and targeted malocclusions for aligners. MATERIALS AND METHODS: A validated online questionnaire was developed specifically for this research and consisted of three sections. Section 1 evaluated demographics and experience with aligners. Section 2 assessed patient selection and demands and clinician confidence in treating various malocclusions with aligners. Section 3 evaluated treatment protocols used by clinicians. The American Association of Orthodontists Partners in Research Program distributed the survey via e-mail to active members in the United States and Canada. RESULTS: A total of 160 providers completed the survey. Aligners were used by 65.00% of respondents, with the Invisalign system the most popular (81.25%). Aligners were mostly used for adults (97.50%). Tipping was ranked as the easiest movement (1.79 ± 1.35). Extrusion (4.34 ± 1.53) and root movement (4.31 ± 1.27) were ranked as the most difficult. Most were confident treating mild (98.8%) and moderate (82.5%) crowded cases, spacing (96.9%), and anterior crossbite (85%). Of the providers, 58.12% recommended aligners to be changed weekly. Respondents who were confident addressing some of the severe malocclusions were more likely to use Invisalign. CONCLUSIONS: Invisalign is the most popular aligner system, and clinicians seem to be confident using it. Providers are aware of the pitfalls of aligners; they find it challenging to perform root movement and extrusion, and they seem confident treating mild to moderate malocclusions. They avoid complex cases with impactions and severe skeletal problems.

Short-term and long-term effects of miniscrew-assisted and conventional rapid palatal expansion on the cranial and circummaxillary sutures.

INTRODUCTION: The objective of this study was to analyze the short-term and long-term effects of miniscrew-assisted rapid palatal expansion (MARPE) and conventional rapid palatal expansion (RPE) appliances on cranial and circummaxillary sutures as compared with a matched control group. METHODS: One hundred and eighty cone-beam computed tomography scans for 60 subjects were evaluated for the 3 groups: (1) MARPE (n = 20; aged 13.7 ± 1.74 years), (2) RPE (n = 21; age 13.9 ± 1.14 years), and (3) control (n = 19; age 13.3 ± 1.49 years) at pretreatment (T1), postexpansion (T2), and posttreatment (T3) (T1 to T3: MARPE, 2 years 8 months; RPE, 2 years 9 months; control, 2 years 7 months). Frontonasal suture, frontomaxillary suture, zygomaticomaxillary suture, zygomaticofrontal suture, intermaxillary suture, pterygomaxillary suture, nasomaxillary suture, and zygomaticotemporal suture were measured on the right and left sides for all 3 time labels. In addition, midpalatal suture was measured at the incisor, canine, and molar levels. RESULTS: Within-group analysis showed that MARPE and RPE led to a significant increase in the widths of frontonasal, frontomaxillary, intermaxillary, nasomaxillary, and midpalatal suture at incisor, canine, and molar levels at T2 compared with T1. Between-group analysis showed that MARPE and RPE significantly increased the width of the intermaxillary and midpalatal suture at the incisor, canine, and molar compared with controls at T2. In the long term, between-group comparisons showed no significant difference among the 3 groups except that MARPE led to a significant increase in the width of midpalatal suture at incisor, canine, and molar levels compared with RPE and controls at T3. CONCLUSIONS: MARPE led to a significant increase in the width of the midpalatal suture at incisor, canine, and molar levels compared with RPE and controls in the long term. There was no difference in the width of other cranial and circummaxillary sutures among the 3 groups in the long term.

How does alendronate affect orthodontic tooth movement in osteogenesis imperfecta: an in vivo study on a mice model.

OBJECTIVES: The purpose of this study was to evaluate the effects of alendronate on orthodontic tooth movement (OTM) and bone modelling/remodelling in an osteogenesis imperfecta (OI) mice model. MATERIALS AND METHODS: Ten-week-old male and female OI mice (Col1a2oim, n = 32) were divided into four groups: 1. Alendronate male (AM, n = 8), 2. Alendronate female (AF, n = 8), 3. saline male (SM, n = 8), and 4. saline female (SF, n = 8). The mice in all four groups received either Alendronate (0.05 mg/kg) or vehicle (saline 0.05 mg/kg) subcutaneously for 2 weeks prior to the placement of orthodontic spring. A nickel-titanium spring applying 3-5 cN of force was used to perform the OTM for 1 week. After 7 days of OTM, the OI mice were euthanized with CO2 inhalation and microfocus computed tomography and histological analyses were performed. RESULTS: AM and AF mice showed a significant decrease (P < 0.05) in the rate of OTM compared with SM and SF mice, respectively. In addition, AM and AF mice showed a significant increase (P < 0.05) in the bone volume fraction (BVF) and tissue density (TD) compared with SM and SF mice. Histological analysis of haematoxylin-eosin staining revealed a hyalinization zone in AM and AF mice compared with SM and SF mice. Furthermore, tartrate-resistant acid phosphatase staining indicated decreased number of osteoclasts in AM and AF mice compared with SM and SF mice. Picrosirius red staining showed, Alendronate treatment led to thick uniform and smooth morphology of collagen fibres as compared with saline group. Similarly, second harmony generation images also revealed thicker collagen fibres at the periodontal ligament (PDL)-cementum entheses and PDL-alveolar bone entheses in AM and AF mice compared with SM and SF mice. CONCLUSIONS: Alendronate led to a decrease in the rate of OTM, increase in BVF and TD, decrease in the number of osteoclasts, and smooth and thick collagen fibres compared with saline in both male and female OI mice.

Acceleration of orthodontic tooth movement and root resorption with near and distant surgical insults: An in-vivo study on a rat model.

OBJECTIVE: The purpose of this study was to determine the effects of alveolar decortications (AD) closer and farther from the tooth on Orthodontic tooth movement (OTM) and root resorption. MATERIALS AND METHODS: Twenty-four Wistar rats (age 17 weeks) were used in the study. Three groups were formed by randomly dividing the rats into: 1) Control Group (N=8): OTM (14 days) without any surgical insult; 2) Near Group (N=8) OTM (14 days)+Alveolar Decortications (AD) adjacent to roots of the maxillary first molar; 3) Far Group (N=8) OTM (14 days)+AD 5mm away from the roots of the maxillary first molar. OTM was performed using a closed coil Nickel-Titanium (NiTi) spring to apply a mesial force on maxillary first molars of 8-10 grams. AD was performed with high-speed quarter round bur on the palatal aspect of alveolar bone. The rats were euthanized after 2 weeks of OTM and microfocus computed tomography and histological analysis were performed. RESULTS: Near-AD and Far-AD groups exhibited significantly increased OTM and reduction of Bone volume fraction compared to control. The root volume was significantly decreased (increased root resorption) in the Near-AD group. Histological analysis showed no statistically significant difference between the groups. CONCLUSIONS: Alveolar decortications lead to a significant increase in the rate of OTM. Increased root resorption was observed when the alveolar decortications were performed close to the maxillary molar.

Patients' perceptions of orthodontic treatment experiences during COVID-19: a cross-sectional study.

BACKGROUND: COVID-19 has impacted the care of patients undergoing orthodontic treatment. We aimed to provide an overall view of patients' perspectives, concerns, and expectations towards their treatment throughout the clinic lockdown during the pandemic; and to assess patients' levels of mental distress and its association with their confidence in resuming care. METHODS: An anonymous, validated, in-person paper questionnaire was distributed to adult orthodontic patients' post-lockdown at an academic institution. The survey focused on the clinical aspects and patients' perspectives regarding orthodontic treatment during the pandemic. The Kessler Mental Distress Scale (K10) was used to evaluate their psychological status. Survey responses were descriptively summarized and confidence in resuming care was compared between normal patients and patients with mental distress using Mann-Whitney tests. RESULTS: One hundred fifty-four patients were surveyed from July to October 2020. Mean age of the participants was 29.30 (SD = 12.01) years and 62% were females. Emergencies during the closure (21%, 32/154) involved primarily irritation with protruding wires. Patients were neutral regarding tele-dentistry and preferred their current fixed appliances over clear aligners. Upon resuming care, 80.51% were extremely pleased with the restrictive protocols and with high level of confidence in resuming treatment. The average level of anxiety was low, and a modest association was found between mental distress and reduced confidence in resuming treatment. CONCLUSIONS: Few numbers of minor emergencies occurred during the clinic closure. Despite the rising interest in tele-dentistry, patients were neutral on considering this option to monitor treatment and were content with fixed appliances. Patients had high confidence levels to resume their care based on the protocols established upon reopening. The association of mental distress and confidence in resuming care is suggestive and needs further investigation.

The effect of alveolar decortication on orthodontically induced root resorption.

OBJECTIVE: To determine the effect of alveolar decortication on orthodontically induced root resorption. MATERIALS AND METHODS: A total of 24 male Wistar rats (14 week old) were used. The rats were randomly divided into one of the following three groups: group 1 (control group), orthodontic tooth movement (OTM) for 2 weeks; group 2, OTM for 2 weeks + two alveolar decortications (2AD); group 3, OTM for 2 weeks + four alveolar decortications (4AD). The first molar was moved mesially for 2 weeks. Micro computed tomography was used to analyze root volume. In addition, histological sections were stained with Tartrate Resistant Acid Phosphatase (TRAP) to quantify the osteoclast number. RESULTS: The buccal root volume in OTM + 4AD group was decreased by 8.92% and 6.11% when compared with the OTM-only group and OTM + 2AD group, respectively. Similarly, the other four root volumes in the OTM + 4AD group was decreased by 8.99% and 5.24% when compared with the OTM-only group and OTM + 2AD group, respectively. There was a decrease in buccal root density in the OTM + 4AD group by 4.66% and 3.56% when compared with the OTM-only group and the OTM + 2AD group, respectively. In addition, there was an increase in the number of osteoclasts by 195.73% and 98.74% in OTM + 4AD group in comparison with the OTM and OTM + 2AD group. CONCLUSIONS: The amount of orthodontically induced root resorption was positively correlated with the extent of surgical injury used to accelerate orthodontic tooth movement.

Miniplate-Aided Mandibular Dentition Distalization as a Camouflage Treatment of a Class III Malocclusion in an Adult.

This case report describes orthodontic camouflage treatment for a 32-year-old African American male patient with Class III malocclusion. The treatment included nonextraction, nonsurgical orthodontic camouflage by en masse distalization of the mandibular teeth using skeletal anchorage devices. The total treatment time was 23 months. Normal overjet and overbite with Class I occlusion were obtained despite the compensated dentition to the skeletal malocclusion. His smile esthetics was significantly improved at the completion of his treatment.

The effects of alveolar decortications on orthodontic tooth movement and bone remodelling in rats.

Objectives: Alveolar decortication (AD) is a minimally invasive procedure that can be performed in the orthodontic office as an intervention to accelerate tooth movement. There is a gap in the literature evaluating the earlier and delayed responses after AD using lighter orthodontic forces in a rat model. Therefore, the aim of this study was to determine the effects of AD in the amount of orthodontic tooth movement and on alveolar bone remodelling in a rodent model, after 7 or 14 days. Materials and methods: A total of 32 15-week-old male Wistar rats were used in four treatment groups: (1) orthodontic spring only (7 days), (2) orthodontic spring only + AD (7 days), (3) orthodontic spring only (14 days), and (4) orthodontic spring only + AD (14 days). A closed coil nickel-titanium spring delivering 8-10 g of force was used to move the molar mesially. Alveolar decortication was done using a high speed, quarter round bur adjacent to the left first maxillary molar, on the palatal alveolar bone. At each endpoint, rats were sacrificed and microfocus computed tomography and histological analysis were performed. Results: The spring + AD group presented with a significant increase in the rate of tooth movement when compared with spring only group, 7 and 14 days after the beginning of the experiments. In addition, the spring + AD group had a significant decrease in bone volume and tissue density and a significant increase in the trabecular spacing and the number of osteoclasts at 7 and 14 days. Furthermore, a fibrous tissue was found to replace the alveolar bone in the spring + AD group at day 14. Conclusion: Alveolar decortications enhanced bone remodelling around the tooth movement region and could be used as an adjunct surgical procedure to accelerate the rate of tooth movement.