The effectiveness of the total-maxillary-arch-distalization approach in treating class II division 1 malocclusion: A systematic review.

OBJECTIVE: The objective of this review is to assess the effect of total maxillary arch distalization (TMAD) treatment on the dental, skeletal, soft tissues, and airways during non-extraction camouflage treatment of class II division 1 patients. METHODS: We performed a systematic review of the published data in four electronic databases up to April 2023. We considered studies for inclusion if they were examining the effects of TMAD during treatment of class II division 1 malocclusion in the permanent dentition. Study selection, data extraction, risk of bias assessment, and assessment of the strength of the evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool were performed in duplicate. RESULTS: Out of the 27 articles that met the initial eligibility criteria, 19 studies were finally selected. Fair to relatively good quality evidence was identified after the risk of bias assessment of the included studies. Out of the 19 selected studies, 5 studies used inter-radicular TADs, 10 studies used modified C- palatal plate (MCPP), 3 studies used infra zygomatic crest (IZC) TADs, 1 study compared buccal TADs versus MCPP, and 1 study compared between cervical headgear and MCPP. The maximum amount of maxillary arch distalization using buccal TADs, MCPP, IZC TADs, and headgear was 4.2mm, 5.4mm, 5mm, and 2.5mm respectively. Different results regarding the amount of dental, skeletal, and soft tissue changes were observed. CONCLUSIONS: The current low to very low certainty level of evidence suggests that TMAD is effective in camouflaging class II division 1 malocclusion. Future well-conducted and clearly reported randomized controlled trials that include a control group are needed to make robust recommendations regarding the effect of TMAD with different appliances on dental, skeletal, and soft tissue structures. CLINICAL RELEVANCE: TMAD should be given priority with caution in class II patients who refuse the extraction of premolars. TMAD may be considered an adjunctive approach to solve cases associated with high anchorage need or anchorage loss.

Evaluation of the effectiveness of the platelet-rich plasma compared to the injectable platelet-rich fibrin on the rate of maxillary canine retraction: a three-arm randomized controlled trial.

BACKGROUND: Blood-derived materials have been used recently to accelerate orthodontic tooth movement, but there are conflicting reports on their effectiveness. OBJECTIVE: To evaluate the potential effect of local injection of platelet-rich plasma (PRP) and injectable platelet-rich fibrin (i-PRF) on the rate of orthodontic tooth movement. TRIAL DESIGN: A single-center, three-arm, parallel-group randomized controlled trial. MATERIALS AND METHODS: The sample consisted of 60 patients aged between 18 and 25 years (mean age: 21.1 ±â€…2.2 years) with Class II division 1 malocclusion requiring anterior retraction. Using a computer-generated list of random numbers, patients were assigned to three groups of canine retraction: (i) assisted with PRP injection (PRP group), (ii) assisted with i-PRF group, and (iii) conventional treatment with no injections (Cont. group). In the interventional groups, injections were done immediately and at 8 weeks after the onset of canine. Transpalatal arches (TPAs) were used to reinforce anchorage. The upper canines were distalized on 0.019 × 0.025-inch stainless archwires using coil springs with a force of 150 g. The primary outcome was the amount of canine retraction, whereas the secondary outcomes were canine rotation and anchoring loss. Assessment was done at five-time points: the beginning of tooth movement (T0) and at 4, 8, 12, and 16 weeks following T0 on three-dimensional superimposed digital models. RESULTS: Sixty patients were randomized and included in this study (20 patients in each group), there were no dropouts. The rate of canine retraction was faster in the experimental groups. The PRP group showed a significantly slower movement in the second and fourth months than the i-PRF group while in the first and third months, there were nonsignificant differences between the two experimental groups. LIMITATIONS: Blinding was not possible during the clinical stage of this trial. CONCLUSIONS: PRP and i-PRF were found to be effective in accelerating orthodontic tooth movement during canine retraction. However, the effect of i-PRF was longer than that of PRP. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NCT05335824).

A Novel Method to Accelerate Orthodontic Tooth Movement Using Low-Intensity Direct Electrical Current in Patients Requiring en-Masse Retraction of the Upper Anterior Teeth: A Preliminary Clinical Report.

BACKGROUND: Shortening the duration of orthodontic treatment by speeding up the rate of tooth movement has become an essential goal for both orthodontists and patients. This preliminary report aimed to investigate the safety and effectiveness of a new intraoral removable electrical device in accelerating the en-masse retraction of the upper anterior teeth using low-intensity direct electrical current. METHODS: This prospective preliminary interventional clinical study was conducted at the Department of Orthodontics, Faculty of Dentistry, Damascus University, Syria, between March 2019 and February 2020. The sample consisted of six patients (four females and two males; mean age: 19.55 ± 0.89 years) whose initial diagnosis was class II division I malocclusion, and their treatment plan suggested the extraction of upper first premolars followed by en-masse retraction. The electrical stimulation was applied on the maxillary anterior region during the en-masse retraction phase using a specially fabricated removable device that was designed by two coauthors of this manuscript (RIS, MYH). Patients were asked to wear their own electrical devices inside their mouths for five hours daily. The primary outcomes were the en-masse retraction rate and duration. The secondary outcomes were safety and patient acceptance. RESULTS: The average total retraction rate during the treatment period was 0.97±0.06 mm/month. The total amount of retraction achieved during follow-up was 5.65 ± 0.85 mm, which was about 91.86% of the space resulting from the extraction of the upper first premolars. The mean treatment duration to complete the en-masse retraction was 5.66±0.81 months. No side effects of the electrical stimulation were found during the follow-up. CONCLUSIONS: Low-intensity direct electrical current could be an effective method to accelerate orthodontic movement. The electrical accelerating device used in this study effectively increased the en-masse retraction rate of the upper anterior teeth without any side effects and with high patient acceptance.

Evaluation of Soft and Hard Tissue Changes Following the Use of Rapid Molar Intruder for the Management of Skeletal Anterior Open Bite in Mixed Dentition: A Randomized Controlled Trial.

Objective The aim of the study was to evaluate skeletal, dentoalveolar, and soft tissue changes following early anterior open bite (AOB) treatment using a rapid molar intruder (RMI). Materials and methods A two-arm, parallel-group, randomized controlled trial was conducted on 40 patients aged 8-12 years with anterior open bites. They were randomly allocated to the RMI group and the untreated control group (UCG) with a 1:1 allocation ratio. At the beginning of the treatment (T1) and after nine months of treatment (T2), lateral cephalometric images were taken of each patient. The primary outcome measures were skeletal, dentoalveolar, and soft tissue changes. A two-sample t-test was used in the intergroup comparisons of the cephalometric measurement. Results The findings showed that the overbite increased significantly in the RMI group compared to the control group (x = 4.44 mm, x = 0.19 mm, respectively; p<0.001). A statistically significant intrusion of the upper and lower first molars was observed in the RMI group (x = 2.9 mm, x = 1.54 mm, respectively) compared to a slight extrusion in the control group. The differences between the two groups were significant (p<0.001). The SN: GoMe angle and the sum of Bjork decreased significantly in the RMI group compared to an increase observed in the control group. The differences between the two groups were significant (p<0.001). Conclusion The rapid molar intruder is an effective appliance for correcting anterior open bites in mixed dentition, inducing favorable skeletal, dentoalveolar, and soft tissue changes.

Treatment of Moderately Crowded Teeth Using Lingual Fixed Appliance Prepared by a Modified HIRO® Technique: A Case Report and Method Description.

There are various manual laboratory methods available for indirect positioning and bonding of lingual brackets. The manual setup has limitations because of its complicated laboratory procedures and requires time and specialized laboratory equipment. In addition, the manual method is also prone to human errors. In this case report, a description of a new method of laboratory preparation for the indirect bonding of lingual brackets is given by merging recent advances in digital dentistry with some of the ordinary manual steps in this field. Therefore, the well-known HIRO® technique has been modified by using the three-dimensional (3D) virtual setup instead of the traditional manual setup. This method does not require the use of any specialized laboratory equipment, and it is also cost-effective for patients who cannot afford fully customized lingual appliances. In this modified technique, 3Shape Ortho Analyzer™ software (3Shape, Copenhagen, Denmark) and a 3D printer (Prusa® i3 mk3; Prusa Research, Prague, Czech Republic) were used to align the teeth three-dimensionally into their desired positions and to produce the final working printed model on which lingual brackets were placed, and transfer caps were fabricated for clinical use.

The efficacy of low-level laser therapy versus paracetamol-caffeine in controlling orthodontic separation pain and changes in the oral-health-related quality of life in Class I malocclusions: A 3-arm, randomized, placebo-controlled clinical trial.

BACKGROUND: This study evaluated the analgesic effects of low-level laser therapy (LLLT) and paracetamol-caffeine in controlling orthodontic pain induced by elastomeric separators, as well as changes in oral health-related quality of life (OHRQoL). METHODS: A total of 54 patients (22 male, 32 female; mean age [standard deviation]: 21.68 [±2.77]) participated in the study. Elastomeric separators were placed mesially and distally to the first molars in the upper and lower dental arches. The first group (n = 18) received a single dose of aluminum gallium arsenide (GaAlAs) laser irradiation (808 nm; 350 milliwatts; 3.5 joule/point) with a placebo medication. The laser beam was applied buccally and lingually at the center of the first molar roots and the adjacent teeth (2nd molar and 2nd premolar) in both the upper and lower dental arches bilaterally. The second group (n = 18) received paracetamol-caffeine tablets (3 times daily for the first couple of days after separator insertion, and as needed for the rest of the week), with a placebo light-emitting diode (LED) light; patients in the third group (n = 18) were exposed to the 2 placebo procedures. An 11-point numeric rating scale was used to assess spontaneous and chewing pain perception immediately and at 1 hour, 24 hour, 48 hours, and 1 week after separator placement. The short version of the oral health impact profile (OHIP-14) was used to evaluate OHRQoL at 48 hours and at 1 week after separator placement. RESULTS: Pain perception reached its peak at 24 hours after separator placement (median values: 3, 3, 6.5 for spontaneous pain, and 6, 6, 8 for chewing pain in the LLLT, drug, and control groups, respectively). LLLT relieved the induced pain more than did the placebo procedures (P = 0.002 for spontaneous pain, P = 0.012 for chewing pain). Orthodontic separators worsened patients' OHRQoL scores during the entire week, especially at 48 hours after placement (median OHIP-14 score: 21, 25, 24 in the LLLT, drug, and control groups, respectively). In comparison with the control group, LLLT slightly increased the "physical pain" domain score (P = 0.015) and the "psychological disability" domain score of the scale (P = 0.010) after 48 hours, as well as the "psychological disability" domain score 1 week after separator placement. CONCLUSIONS: The pain levels were similar in the laser and drug groups. The LLLT group had decreased pain, compared with the placebo group. Paracetamol-caffeine and LLLT were unable to enhance the overall OHRQoL.

Evaluation of the efficacy of laser-assisted flapless corticotomy in accelerating canine retraction: a split-mouth randomized controlled clinical trial.

OBJECTIVE: To evaluate the efficacy of laser-assisted flapless corticotomy in the acceleration of canine retraction compared with the conventional technique and to evaluate patients' pain and discomfort levels after corticotomy. MATERIALS AND METHODS: A single-center randomized controlled trial was conducted on 18 class II division 1 patients (7 males, 11 females; age range: 16 to 24 years) who required the first-upper-premolar extraction followed by canine retraction. A split-mouth design was used in which the Er:YAG laser-assisted flapless corticotomy was randomly allocated to one side, whereas the other side served as the control side. The primary outcome measure was the canine retraction rate which was assessed immediately after laser application, 1, 2, 4, 8, and 12 weeks after laser application. Also, the levels of pain and discomfort during the first week following laser application were assessed. Paired t-tests or Wilcoxon matched-pairs signed-rank tests were used to detect significant differences. RESULTS: All of the selected eighteen patients entered the statistical analysis stage. Significant differences were observed (P < 0.001) in canine retraction rates between the experimental and control sides at the baseline to 1st-week, 1st- to 2nd-week, 2nd- to 4th-week, and 4th- to 8th-week intervals. No significant difference was found between the two sides at the 8th- to 12th-week interval. A significant reduction was seen in the mean score of pain during eating at all assessment times when compared to the baseline data (P = 0.002 at day 2, P < 0.001 at days 5 and 7). CONCLUSION: Er:YAG laser-assisted flapless corticotomy appears to be an effective treatment method for accelerating canine retraction and was accompanied by a mild degree of pain and discomfort. TRIAL REGISTRATION: ClinicalTrials.gov (No.: NCT04316403), retrospectively registered on the 20th of March 2020. URL: https://clinicaltrials.gov/ct2/show/NCT04316403.

Effects of Treatment with Nociceptive Trigeminal Inhibition Splints on Electromyography in Temporomandibular Joint Disorder Patients.

AIM: This research aimed at evaluating the effects of the nociceptive trigeminal inhibition splint (NTIS) on electromyography (EMG) for masseter and temporalis muscles in patients with temporomandibular joint disorders (TMDs), and at detecting the discomfort degree originating from this splint. MATERIALS AND METHODS: The sample consisted of 15 patients having TMDs of muscular origin to be treated by NTIS. The activity degree of masseter and temporalis muscles was measured using the EMG two times: before the treatment and after 6 months. Besides, patients' discomfort was assessed after the start of treatment four times: 1 day, 2 weeks, 1 month, and 6 months. RESULTS: After the treatment, there was a significant decrease in masseter and temporalis muscles' activity in both right and left sides (p < 0.001). No significant differences were observed in the electrical muscular activity mean change between the masseter muscles (-43.87 ± 26.82) and the temporalis muscles (-54.91 ± 21.16) (p = 0.082), or between the right muscles (-51.97 ± 26.30) and the left muscles (-46.81 ± 22.90) (p = 0.422). In addition, the discomfort degree gradually decreased after 2 weeks (p < 0.01). CONCLUSION: The use of NTIS is associated with reduction in the masseter and temporalis muscles' activity. Also, the patients' discomfort degree from NTIS progressively decreases after 2 weeks of treatment. CLINICAL SIGNIFICANCE: The NTIS is an effective therapeutic approach for patients having TMDs of muscular origin.

Effect of the leukotriene receptor antagonist montelukast on orthodontic tooth movement.

Asthma is a chronic inflammatory disease, and its prevalence is relatively high among children. Optimal management of asthma often requires long-term pharmacotherapy; however, the effects of these medications on orthodontic treatment is uncertain. We evaluated the effects of the leukotriene LTD4 receptor antagonist montelukast on orthodontic tooth movement in an animal model. Eight mongrel dogs were given montelukast for periods up to 4 weeks. An orthodontic force of 150-200 g was applied to move the second and fourth premolars toward the site of the extracted third premolar. The distance between premolars was measured at baseline and at weeks 1, 2, and 4. Histological examination with hematoxylin-eosin staining was used to evaluate osteoclast activity. A slight delay in orthodontic movement and decreased osteoclast activity were observed in the montelukast-treated group, as compared with untreated controls. However, the differences were not statistically significant (P > 0.05). Our findings suggest that montelukast use will not interfere with orthodontic treatment of asthma patients. However, these findings require confirmation in clinical studies.

An evaluation of two types of nickel-titanium wires in terms of micromorphology and nickel ions' release following oral environment exposure.

BACKGROUND: This study aimed to compare superelastic and heat-activated nickel-titanium orthodontic wires' surface morphology and potential release of nickel ions following exposure to oral environment conditions. METHODS: Twenty-four 20-mm-length distal cuts of superelastic (NiTi Force I®) and 24 20-mm-length distal cuts of heat-activated (Therma-Ti Lite®) nickel-titanium wires (American Orthodontics, Sheboygan, WI, USA) were divided into two equal groups: 12 wire segments left unused and 12 segments passively exposed to oral environment for 1 month. Scanning electron microscopy and atomic force microscopy were used to analyze surface morphology of the wires which were then immersed in artificial saliva for 1 month to determine potential nickel ions' release by means of atomic absorption spectrophotometer. RESULTS: Heat-activated nickel-titanium (NiTi) wires were rougher than superelastic wires, and both types of wires released almost the same amount of Ni ions. After clinical exposure, more surface roughness was recorded for superelastic NiTi wires and heat-activated NiTi wires. However, retrieved superelastic NiTi wires released less Ni ions in artificial saliva after clinical exposure, and the same result was recorded regarding heat-activated wires. CONCLUSIONS: Both types of NiTi wires were obviously affected by oral environment conditions; their surface roughness significantly increased while the amount of the released Ni ions significantly declined.

Maxillary dental arch changes following the leveling and alignment stage with lingual and labial orthodontic appliances: a preliminary report of a randomized controlled trial.

BACKGROUND: No randomized controlled trial has tried to compare transverse dental arch changes between the lingual and labial orthodontic fixed appliances in the early stage of treatment. OBJECTIVE: To compare upper dental arch changes between lingual and labial fixed orthodontic appliances after leveling and alignment. DESIGN, SETTING: Parallel-groups randomized controlled trial on patients with class I moderate crowding teeth treated at the University of Al-Baath Dental School in Hamah, Syria. PARTICIPANTS: About 102 patients with crowded teeth and class I malocclusion were evaluated and 58 patients fulflled the inclusion criteria. Randomization was performed using computer generated tables; allocation was concealed using sequentially numbered opaque and sealed envelopes. About 52 participants were analyzed (mean age 21.5 ± 3.2 years). They were randomly distributed into two groups with 26 patients in each (1:1 allocation ratio). INTERVENTION: Lingual vs labial fixed orthodontic appliances were used. MAIN OUTCOME MEASURE: Intercanine width, interpremolar width, intermolar width, and arch length were measured on study models before brackets' placement (T1), at the end of leveling and alignment stage (T2). RESULTS: Statistically significant increase was detected in the intercanine width in the lingual group (1.99 mm, p < 0.001) and in the labial group (1.22 mm, p < 0.001). The interpremolar width had a significant decrease in the lingual group (-0.70 mm, p < 0.001), whereas there was a significant increase in this width in the labial group (1.73 mm, p < 0.001). A significant decrease in intermolar width was detected in the lingual group (-0.79 mm, p < 0.001) whereas a significant increase was observed in the labial group (0.81 mm, p < 0.001). The differences between the two groups were significant for all comparisons (p < 0.001). CONCLUSION: The labial appliance produced a significant increase in all horizontal transverse arch dimensions, whereas in the lingual appliance group the intercanine width increased significantly in conjunction with a significant narrowing of posterior segments. FUNDING: The University of Al-Baath Postgraduate Research Budget (UBDS-00786223-PG).

Speech performance and oral impairments with lingual and labial orthodontic appliances in the first stage of fixed treatment.

OBJECTIVES: To compare (1) speech performance based on an auditive analysis and sonagraphy and (2) levels of oral impairment between fixed lingual and labial orthodontic appliances. MATERIALS AND METHODS: Thirty-four patients with Class I division 1 malocclusion and moderate crowding of upper teeth were distributed randomly into two groups. Seventeen patients in group A (mean age: 20.6 years; standard deviation [SD]: 2.9 years) were treated with fixed lingual appliances (Stealth®, AO, Sheboygan, Wisc), whereas 17 patients in group B (mean age: 21.8 years; SD: 3.3 years) were treated with conventional fixed labial appliances. Speech performance was tested using spectrographic analysis of fricative /s/ sound before, immediately after (T1), 1 month after, and 3 months after bracket placement. The levels of oral impairment were assessed using standardized questionnaires. RESULTS: A significant deterioration in articulation was recorded at all assessment times in group A but only at T1 in group B. Significant intergroup differences were recorded at all assessment times (P < .001). Speech difficulties were significantly higher in the lingual brackets group after 1 month of bracket placement (P < .001). Soft tissue irritation and chewing difficulty were significantly higher in the lingual appliance group after 24 hours of bracket placement (P < .001). CONCLUSIONS: The lingual appliance is more problematic than the labial one in terms of speech articulation. Although patients with both appliances suffered from different degrees of oral impairment, patients with lingual appliances had more untoward effects, particularly during the first month of treatment.