The mechanical testing and performance analysis of three-dimensionally produced lingual retainers.

BACKGROUND: Introducing three-dimensional (3D) printing has opened new visions in the orthodontic field. This research evaluates three-dimensionally produced orthodontic retainers and their future possible uses. For this purpose, in vitro tests were performed for these groups, including bond strength, failure analysis, discoloration, and biodegradation. METHODS: A total of 30 specimens (n = 30), lower incisor human teeth, were randomly divided into three groups for a bond strength failure analysis (for each group n = 10). In the experimental groups, lingual retainers were fabricated using 3D systems (group 1 with 3D dental pen and group 2 with 3D-printed). In the control group (group 3), the retainer system was a combination of a wire and composite, which is being used worldwide. A total of 30 specimens (n = 30) from the 3D dental pen and 3D-printed for discoloration and biodegradation tests were divided into three groups (water, tea, and coffee). Data were analyzed using the Mann-Whitney U test, ANOVA, and chi-square test. RESULTS: For all parameters tested, significant differences were determined among groups. The 3D pen group had the highest score for bond strength, whereas discoloration differed significantly. CONCLUSIONS: According to the limitations of this research, 3D-printed retainers have the potential for clinical use in the near future.

Single-component orthodontic adhesives: comparison of the clinical and in vitro performance.

OBJECTIVES: To investigate the clinical and in vitro performance of single-component orthodontic adhesives under metal brackets. MATERIALS AND METHODS: Bimaxillary orthodontic treatment was required for sixty patients and 60 premolar teeth were divided into three groups (n: 20). The single-component orthodontic adhesives Biofix and GC Ortho Connect (GC) that did not require primers were compared to the control group using Transbond XT, which was applied with a primer. For each patient, total bonding time was measured. The Adhesive Remnant Index (ARI(Bracket)) score was noted over 12 months. In vitro tests were used to evaluate specimens, shear bond strength (SBS), ARI(Bracket), and Enamel Surface Index (ESI). After in vitro debonding, the enamel surface and bracket base were analyzed using scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDX). RESULTS: Clinical failure rate with primer was 9.0%, while it was 8.0 and 10.0 for GC and Biofix, respectively. The mean in vitro SBS values of the Biofix, GC, and Transbond XT groups were 8.21, 8.07, and 7.37 MPa, respectively. There were no statistically differences in clinical failure (p = 0.160) and SBS values (p = 0.158). Mean differences in bond-up time per jaw were 9.65, 10.51, and 11.97 min, which were statistically significant (p = 0.0001). CONCLUSION: Single-component adhesives had acceptable SBS values and enamel effects according to SEM-EDX analysis. Clinically, bonding failure was not shown statistically inferior to bonding with primer. There was also a significant difference in bond-up times. CLINICAL RELEVANCE: Considering an intensely working clinic with bonding processes for at least two jaws per day, this means a saving of the chair time of 1 patient per week. However, better saliva contamination and moisture control with lack of the primer stage and, thereby, an acceptable bracket failure rate will bring clinically significant results with less chair time for clinicians.

Effect of Energy Drink on Bone Formation in the Expanded Inter-Premaxillary Suture.

Maxillary expansion of the median palatal suture is a common procedure in orthodontics. Even after retention, there is a strong tendency to relapse in the expanded suture. The authors' objectives are to accelerate the bone formation process in the expanded suture and to reduce the required retention time by using an energy drink (ED). Twenty rats were divided into 2 groups (n = 20). The expansion-only group was defined as the control group (Group C). The other group was defined as the expansion-plus-energy drink group (Group ED). In Group ED, ED was administered systemically through oro-gastric tubes after the expansion period. After 5 days of expansion, the springs were removed and replaced with short lengths of rectangular retaining wire. Tooth separation was maintained for 12 days. Histomorphometric analysis showed significant differences between the 2 groups in terms of newly formed bone (P = 0.018) and the bone area (P = 0.007). For the parameters that were investigated, Group ED had better results than Group C. These results show that systemic administration of an ED during the early stages of the orthopedic expansion of the inter-maxillary suture areas can stimulate bone formation and decrease the time required for retention.

Bond strengths of brackets bonded to enamel surfaces conditioned with femtosecond and Er:YAG laser systems.

The aim of this study was to compare femtosecond and Er:YAG laser systems with regard to enamel demineralization and bracket bond strength. Human-extracted premolars were randomized to three groups (n = 17) depending on the conditioning treatment used for the buccal surfaces: 37 % orthophosphoric acid, Er:YAG laser etching (MSP mode 120 mJ, 10 Hz, 1.2 W), and femtosecond laser etching (0.4 W, 800 nm, 90 fs/pulse, 1 kHz). Metal brackets were bonded with Transbond XT to the conditioned surfaces and light cured for 20 s. The samples were thermocycled (5000 cycles, 5-55 °C) and subjected to shear bond strength (SBS) testing using a universal testing machine. Failure types were analyzed under an optical stereomicroscope and SEM. The adhesive remnant index (ARI) was evaluated to assess residual adhesive on the enamel surface. The results revealed no significant differences in SBS between the Er:YAG laser (7.2 ± 3.3 MPa) and acid etching groups (7.3 ± 2.7 MPa; p < 0.05), whereas a significant difference was observed between the femtosecond laser etching group (3.3 ± 1.2 MPa) and the other two groups (p < 0.01). ARI scores were significantly different among the three groups. The results of our study suggest that laser conditioning with an Er:YAG system results in successful etching, similar to that obtained with acid. The sole use of a femtosecond laser system may not provide an adequate bond strength at the bracket-enamel interface.

Different pulse modes of Er:YAG laser irradiation: effects on bond strength achieved with self-etching primers.

OBJECTIVE: The aim of this study was to compare the effects of different pulse modes of Er:YAG laser on shear bond strength (SBS) of orthodontic brackets bonded with self-etching primers (SEP) and phosphoric acid etching. MATERIALS AND METHODS: A total of 120 human mandibular third molars were randomly assigned to 3 groups of 40 specimens depending on the bonding procedure to be used. The groups were divided into two subgroups according to the pulse mode of the erbium-doped yttrium aluminum garnet (Er:YAG) laser irradiation as medium-short pulse (MSP) mode and quantum-square pulse (QSP) mode at 120 mJ, 10 Hz, 1.2 W. In each subgroup, the mesio- or distobuccal tooth surfaces were randomly assigned as experimental or control sides. After surface preparation with different modes of Er:YAG laser on experimental side, whole buccal tooth surfaces were treated with phosphoric acid etching or two different SEPs. Then metallic brackets were bonded with Transbond XT (3 M Unitek, Monrovia, CA, USA) or Kurasper F (Kuraray, Okayama, Japan). SBS values and the amount of adhesive remaining on the tooth after debonding were assessed. One-way analysis of variance (ANOVA) was used to evaluate the changes in mean SBS between groups resulting from laser etching, followed by post hoc test of Tukey. RESULTS: There were statistically significant differences between the experimental and control sides of all groups (p < 0.05). CONCLUSION: Laser etching with QSP and MSP modes increases the SBS of metallic brackets and Er:YAG laser irradiation with QSP mode increases the SBS of SEPs.

Accelerated tooth movement with piezocision and its periodontal-transversal effects in patients with Class II malocclusion.

OBJECTIVE: To compare the extent of canine distalization and the transversal changes, postdistalization gingival indices, and mobility scores between patients who were undergoing orthodontic treatment involving upper premolar extraction with (experimental group) or without piezocision. MATERIALS AND METHODS: Twenty maxillary canines of 10 patients were evaluated with split mouth design. Pre- and postdistalization dental casts were prepared and scanned with an orthodontic scanner to compare the extent of distalization and transversal changes between the two groups. The pre- and postdistalization gingival indices and mobility scores were also calculated. RESULTS: Three-dimensional analysis of the models revealed significant differences in tooth movement (lesser anchorage loss and greater canine distalization) between the experimental and control groups. Furthermore, the distalization time was shortened in the experimental group. There were no differences in the transversal changes, pre- and postdistalization gingival indices, or mobility scores between groups. CONCLUSION: Piezocision-assisted distalization accelerates tooth movement, decreases the anchorage loss for posterior teeth, and does not induce any maxillary transversal change. Moreover, piezocision does not have any adverse effects on periodontal health.

Reliability Assessment of Orthodontic Apps for Cephalometrics.

OBJECTIVE: The aim of this study was to evaluate the accuracy and reliability of cephalometric measurements using iPad apps called CephNinja and SmartCeph Pro. The measurements were compared with the measurements obtained using Dolphin Imaging computer software. METHODS: Twenty digital cephalometric radiographs were randomly selected from the archives and traced using the CephNinja app, SmartCeph Pro app, and Dolphin Imaging software. Twenty-one landmarks and 16 measurements were performed in each program. The statistical analysis was conducted using the Bland-Altman analysis at a significance level of 0.05. RESULTS: For the CephNinja app, there were seven measurements that were in accordance with Dolphin Imaging software. For the SmartCeph Pro app, six measurements were in accordance with Dolphin software. Both apps gave better results for angular measurements than linear ones. CONCLUSION: These findings indicate that, although they are user-friendly, orthodontic apps for cephalometrics are not equal with Dolphin software now and need to be developed to be more reliable for most of the measurements.

Physical properties of different orthodontic cements.

INTRODUCTION: We evaluated the water absorption, solubility, and compressive strength of different cements and resin-modified glass ionomer cements (RMGICs), namely Adhesor®, Ketac(™) Cem, Ortho Band Paste LC(™), Glass Ionomer Band Cement, and Transbond(™) Plus. Our aims were to compare the mechanical and physical properties of the cements widely used in orthodontics and to define the most suitable cements in an oral environment in terms of those characteristics. MATERIALS AND METHODS: To assess compressive strength, the cements were subjected to compression tests done on a universal testing machine. To test water absorption and solubility, the weight changes in cement specimens were determined after immersion in distilled water for 1, 7, and 30 days. RESULTS: Adhesor® and Ketac(™) Cem presented significantly higher solubility values than other cements after water immersion for 1, 7, and 30 days (p < 0.001). CONCLUSION: Our results revealed that the traditional orthodontic cements have higher water solubility and water absorption values as well as lower compressive strength values than the RMGICs used in this study. Furthermore, Transbond(™) Plus revealed the highest compressive strength, whereas Adhesor® showed the lowest.

Effectiveness of two different splints to treat temporomandibular disorders.

Nearly 5% of the the world's population has temporomandibular disorder (TMD) severe enough to make them seek treatment. A third of the total population has at least one TMD symptom. There are different types of splints to treat TMD. In our study, we compared the success of two different appliances [stabilization splint (ss), nociceptive trigeminal inhibition splint (NTI)] by using Fonseca's questionnaire, the OHQoL-UK and visual analog scale (VAS). A total of 40 patients suffering from TMD were included in this study and answered questionnaires twice, at the beginning of the treatment and 3 months later. Regarding TMD alone, 39 patients (97.5%) had some degree of the disorder, 7 of of these cases being mild (17.5%), 15 moderate (37.5%), and 17 severe (42.5%). We analyzed posttreatment changes compared to baseline. Pain complaints decreased in both groups, and the OHQoL-UK revealed better quality of life after treatment. Based on the posttreatment Fonseca's questionnaires, significant changes in the patients' complaints in the group SS (p < 0.01) were observed. The group NTI also displayed changes but these were not statistically significant after treatment (p > 0.05). Patients in both groups had fewer TMD complaints after TMJ treatment. According to the Fonseca's questionnaire, the patients' major TMD complaint was clenching-grinding, followed by pain in the craniomandibular joint, or earache.

Occurrence of Pneumatic Cavities Surrounding the Temporomandibular Joint.

OBJECTIVES: The aim of this study was to investigate the occurrence, the location, and the characteristics of the pneumatic cavities (PCAs) surrounding the temporomandibular joint (TMJ) by using cone-beam computed tomography. METHODS: A retrospective study was performed by using the three-dimensional data archives from Faculty of Dentistry, Bezmialem University, Istanbul, Turkey. The age and sex had been previously recorded for all of the patients. The location and the morphologic characteristics of the PCAs were documented. RESULTS: Pneumatic cavities were found in 18 patients (15%): 11 women (61%) and 7 men (39%). Eleven (57.9%) of the patients showed unilocular pneumatic air cells and 8 (42.1%) of them showed multilocular ones. The unilateral-to-bilateral ratio was 2.3:1. The age range was 8 to 76 years (mean 29.5 ±â€Š21.86 years), and the female-to-male ratio was 1.57:1. CONCLUSION: Cone-beam computed tomography provides images without superimposition that allows accurate and easy evaluation of the PCAs surrounding the TMJ. Our results suggest that the occurrence of PCAs is higher than has been previously reported; therefore, it is recommended for clinicians who are planning to perform TMJ surgery to think about the PCAs to understand the exact morphology for avoiding intraoperative complications.

Porcelain laminate veneer conditioning for orthodontic bonding: SEM-EDX analysis.

The purpose of this in vitro study was to evaluate and compare the effects of different surface treatments and laser irradiation on the bond strength of brackets bonded to porcelain laminate veneer. Porcelain laminate veneer specimens were embedded in the centers of acrylic resin blocks. Thirty-nine teeth were used for shear bond strength testing and the remaining three (one tooth for each group) were used for evaluation of the debonded bracket interface. Specimens were randomly divided into three groups, each containing 13 specimens. The details of the groups are as follows: Group SB, sandblasting with alumina particles (50 µm); Group HFA, 9.6 % hydrofluoric acid etching; Group ER, erbium-doped yttrium-aluminum-garnet (Er: YAG) irradiation (from 1 mm distance, 2 W, 10 Hz for 10 s). After conditioning, the upper central brackets were bonded to the porcelain surfaces. Porcelain laminate veneers were examined under stereomicroscope for adhesive remnant index and surface damage after debonding. The highest shear bond strength values were obtained with Group HFA (10.8 ± 3.8 MPa) and Group ER (9.3 ± 1.5 MPa), whereas Group SB revealed the lowest values. Scanning electron microscopy energy-dispersive X-ray (SEM-EDX) analysis revealed that the silicon level in the porcelain decreased after debonding in all groups. The sandblasting method did not demonstrate any ideal bond strength values; however, the 9.6 % hydrofluoric acid etching and Er: YAG laser did. There were no significant differences among all groups in terms of laminate surface damages. The Er: YAG laser therefore can be selected for ideal bond strength and minimal damage to porcelain laminates.

Effects of caffeic acid phenethyl ester on wound healing in calvarial defects.

OBJECTIVE: The aim of this study is to analyze histologically the effect of CAPE on bone healing of Critical Size Defect (CSD) in rat calvaria. STUDY DESIGN: Thirty-two 3-month-old male rats were used. The animals were randomly divided into four groups. Group A received isotonic saline solution, Group B received CAPE (50 mmol/kg) locally, Group C received CAPE (100 mmol/kg) locally and Group D received CAPE (10 mmol/kg/day i.p. for 28 days) systematically. A 5-mm diameter calvarial defect was created in the right side of the parietal bone without damaging the underlying dura mater. Twenty-eight days after the surgery, all the animals were sacrificed. The original defect area was removed from the animal's calvarium bone en bloc. Beginning at the center of the surgical defect, serial sections of 6 µm thick were cut longitudinally. The sections were stained with hematoxylin and eosin for analysis under a light microscope. The sections were analyzed for the presence of inflammatory infiltrate, connective tissue formation and new bone formation. Computer-assisted histomorphometic measurements were carried out with an automated image analysis system. RESULTS: The total new bone areas were significantly greater in group D than in all groups and group C was statistically insignificant from the other groups (p < 0.05). Group B had a greater, but not statistically significant (p > 0.05), amount of total regenerated bone area than the control group. CONCLUSION: The results indicate that 100 mmol/kg topical and 10 mmol/kg/day systemic application of CAPE increases bone healing, especially with systemic application.

Effect of caffeic acid phenethyl ester on bone formation in the expanded inter-premaxillary suture.

BACKGROUND: Narrow maxilla is a common problem in orthodontics and dentofacial orthopedics. To solve this problem, a procedure called rapid maxillary expansion (RME) has been used. However, relapse tendency is a major problem of RME. Although relapse tendency is not clearly understood, various treatment procedures and new applications have been investigated. The present study aimed to investigate the possible effectiveness of caffeic acid phenethyl ester (CAPE) on new bone formation in rat midpalatal suture after RME. MATERIALS AND METHODS: Twenty male Sprague Dawley rats were used in this study. The animals were randomly divided into two groups as control and CAPE group. In the CAPE group, CAPE was administered systemically via intraperitoneal injection. RME procedure was performed on all animals. For this purpose, the springs were placed on the maxillary incisors of rats and activated for 5 days. After then, the springs were removed and replaced with short lengths of rectangular retaining wire for consolidation period of 15 days. At the end of the study, histomorphometric analysis was carried out to assess new bone formation. RESULTS: New bone formation was significantly greater in the CAPE group than the control group (P<0.05). CAPE enhances new bone formation in midpalatal suture after RME. CONCLUSION: These results show that CAPE may decrease the time needed for retention.

Temperature increase during orthodontic bonding with different curing units using an infrared camera.

AIM: To evaluate the effects of different curing units and light-tip tooth surface distances on the temperature increase generated during orthodontic bonding, using an infrared camera (IR) and artificial neural networks (ANN). MATERIALS AND METHODS: Fifty-two freshly extracted human premolar teeth were used. Metallic orthodontic brackets were bonded to the buccal surfaces of the teeth and thermal records were taken using an IR camera and ANN. Brackets were cured with a light-emitting diode (LED) and high intensity halogen (HQTH). Teeth were divided into four groups according to the curing units (LED and HQTH) and curing distances (from tooth surface and 10 mm away from tooth surface). The results were analyzed with analysis of variance (ANOVA) and the Tukey HSD test. RESULTS: The ANOVA and Tukey HSD tests revealed that temperature changes were influenced by the type of light source and exposure times. All groups revealed significant differences between each other (p < 0.001). The highest surface temperature increase was gained from curing with a LED unit from the tooth surface (11.35°C ± 0.91°C). The lowest surface temperature increase was gained from curing with a HQTH unit 10 mm away from the tooth surface (2.57°C ± 0.6°C). CONCLUSION: The LED unit induced significantly higher temperature changes than did the HQTH. The temperature increase during orthodontic bonding was increased with long exposure time. A shorter light-tip tooth surface distance leads to greater increases in temperature.

Antibacterial and mechanical properties of propolis added to glass ionomer cement.

OBJECTIVE: To investigate whether adding ethanolic extracts of propolis (EEP) might influence the antibacterial and mechanical (shear-peel band strength [SPBS]) properties of conventional glass ionomer cement (GIC) used in orthodontic band cementation. MATERIALS AND METHODS: The cement was divided into four groups: one using the original composition and three with 10%, 25%, and 50% EEP added to the liquid and then manipulated. An antimicrobial assay, broth-dilution method was used to determine the antibacterial capacity of the GIC containing EEP. Eighty teeth were used for the mechanical assay, and an Instron testing machine was used to evaluate the SPBS. Kolmogorov-Smirnov and Kruskal-Wallis tests were used for statistical analyses. RESULTS: GIC with the addition of 25% and 50% EEP activated inhibition of Streptococcus mutans (ATCC 25175) growth, but this effect did not occur in the group to which 10% EEP was added or in the control GIC group. There was no significant difference between the groups in terms of SPBS (P > .05). CONCLUSIONS: The addition of EEP may increase antibacterial properties without negatively modifying the mechanical properties of conventional GIC.

The comparison of facial estethics between orthodontically treated patients and their parents.

Orthodontists emphasize the importance of facial esthetics while planning a treatment, and orthodontist state that orthodontics have more than expected effects on dentofacial esthetics. The facial esthetics of treated patients and their parents was analyzed and compared to define facial growth and to use in forensic sciences. Our study was applied to 45 orthodontic patients who were treated in our clinic and their untreated parents. The patients were divided into Classes I, II, and III groups according to their malocclusions. Pre- and posttreatment changes, pretreatment facial esthetics of the paitents and its accordance with their parents, and the calculation of heritability tests were performed. After the statistics, for pre- and posttreatment changes, all the groups except Class I revealed significant changes. There were significant correlations of patients for the heritability values and pretreatment esthetic in accordance with parents, but there were more correlations of fathers when compared to mothers. The facial esthetics in adolescences is related with so many factors, not only related with one factor. The facial esthetics in fact includes the aim of evaluation of facial properties partly or totally. Because orthodontic treatments affect facial esthetics, performing similar studies for the treatment outcomes, capabilities, and borders is important.

Effect of pine bark extract on bond strength of brackets bonded to bleached human tooth enamel.

AIM: The purpose was to investigate the effect of pine bark (proanthocyanidin, natural antioxidant) solution on the shear bond strength (SBS) of metal brackets bonded with composite resin to human enamel after bleaching with hydrogen peroxide (HP). MATERIALS AND METHODS: Sixty recently extracted premolars were divided into an experimental group (n = 45), which was bleached with 40% HP, and a control group (n = 15), which was not bleached. The experimental group was further divided into three sub-groups. Specimens in group IB (n = 15) were bonded immediately after bleaching; specimens in group SA (n = 15) were bleached, then treated with 10% sodium ascorbate and then bonded; group PB specimens (n = 15) were bleached, then treated with 5% pine bark solution and bonded. The specimens were debonded with Universal testing machine. The adhesive remnant index was calculated. RESULTS: No significant differences in shear bond strength were noted when the pine bark treated group was compared with the control group and sodium ascorbate group (p > 0.05). Treating the bleached enamel surface with 10% sodium ascorbate or 5% pine bark solution reverses the SBS reduction. CONCLUSION: So, as a natural antioxidant and less hazardous, clinicians can choose pine bark solution instead of sodium ascorbate.

The effect of tooth bleaching on the shear bond strength of orthodontic brackets using self-etching primer systems.

OBJECTIVE: The purpose of this study was to determine the effect of 10% carbamide peroxide and 38% hydrogen peroxide bleaching agents on the shear bond strength of orthodontic brackets using self-etching primer systems. METHODS: Forty five freshly extracted human premolar teeth were randomly divided into 3 groups of 15 teeth each: control (group 1), 10% carbamide peroxide at-home bleached (group 2), and 38% hydrogen peroxide in-office bleached (group 3). Three weeks later, all brackets were bonded using a self-etching primer system. The shear bond strength of these brackets was measured and recorded in MPa. Adhesive remnant index (ARI) scores were determined after the brackets failed. Data were analyzed using Kruskal- Wallis test, pairwise comparisons were made using the Mann-Whitney U test and ARI scores were analyzed using a chi-square test at a significance level of P<.05. RESULTS: The shear bond strengths of group 1 (mean: 17.7 ± 9.7 MPa) were significantly higher (P<.05) than those of group 3 (mean: 9.9 ± 5.4 MPa). No significant differences were found between group 2 (mean: 12.3 ± 4.7) and either group 1 or group 3 (P>.05). ARI scores did not differ significantly among the 3 groups. CONCLUSIONS: The use of 10% carbamide peroxide bleaching does not significantly reduce shear bond strength values. In contrast, use of 38% hydrogen peroxide bleaching significantly reduces these values.