Temperature Changes in the Pulp Chamber During Orthodontic Bonding Using a High-Power Light-Emitting Diode Device With Two Different Exposure Times and Intensities: An In-Vitro Study.

OBJECTIVE: This study used a high-power light-emitting diode (LED) device to evaluate the effects of two exposure times and intensities on pulp chamber temperature and cooling time during bracket bonding. MATERIALS AND METHODS: Sixty upper premolars were used in the sample in this study. These premolars were split into two main groups based on the exposure time and intensity: the first group employed a traditional curing mode (TCG) for 20 seconds with an intensity of 1200 mw/cm2, whereas the second group had a quick curing mode (QCG) for 3 seconds with an intensity of 2500 mw/cm2. The pulp chamber's temperature variations and cooling times were recorded using a thermal imaging camera. The Mann-Whitney U test was used to find differences between the two-group comparison of the pulp chamber's temperature and cooling time. RESULTS: The two groups had statistically significant differences regarding the temperature increase in the pulp chamber and cooling time (p > 0.001). The mean temperature increase in the traditional curing group was 3.52°C, which is greater than that in the quick curing group (i.e., a mean value of 1.28°C). The mean cooling time in the traditional curing group was 38.83 seconds, which is greater than that in the quick curing group (9.97 seconds). CONCLUSIONS: Reducing the exposure time to 3 seconds and increasing the intensity to 2500 mw/cm2 is considered safer for the pulp chamber during and after the curing process.

Dental and Periodontal Changes After Accelerated Correction of Lower Anterior Teeth Crowding With Periodontally Accelerated Osteogenic Orthodontics (PAOO) Procedure: A Randomized Controlled Trial.

Objective To evaluate the relative efficacy of periodontally accelerated osteogenic orthodontics (PAOO) compared to conventional fixed appliances in correcting lower anterior teeth crowding using a non-extraction treatment approach. Material and methods A single-center, two-arm, parallel-group randomized controlled trial was conducted on 38 patients (9 males, 29 females) with moderate crowding. These patients did not require premolar extraction and were randomly allocated into two treatment groups: the PAOO group and the conventional orthodontic treatment group. The Little Irregularity Index (LII) measured crowding intensity on pre-treatment study models. Changes in this index were recorded monthly in both treatment groups. The inter-canine width, inter-second-premolar width, plaque index (PI), gingival index (GI), and papillary bleeding index (PBI) were also measured before and after the leveling and alignment stage. Statistical analysis between the two groups was performed using Mann-Whitney U tests. Results For the LII, the average time for irregularity resolution was three months in the PAOO group, compared to five months in the conventional orthodontic treatment group. Regarding changes in inter-second-premolar width, the PAOO procedure led to a significant decrease in the increase of inter-second-premolar width, with an average increase of +1.52 mm compared to +2.71 mm in the control group. For the GI and PBI, it was found that their values significantly increased with PAOO application, averaging 0.18 and 0.17, respectively, compared to 0.05 and 0.07 in the control group. Conclusions The use of PAOO in orthodontic treatment accelerated the leveling and alignment process by 40%. Changes in the inter-canine width, the inter-second-premolar width, and the status of periodontal tissues were minimal and clinically negligible.

Patient-Reported Outcome Measures of Flapless Corticotomy with Low-Level Laser Therapy in En Masse Retraction of Upper Anterior Teeth: A Three-Arm Randomized Controlled Trial.

(1) Background: This study aimed to compare patient-reported outcome measures when accelerating en masse retraction between the piezocision procedure and the subsequent application of low-level laser therapy (FC+LLLT), with the piezocision alone (FC), and in a control group. (2) Methods: A three-arm randomized controlled trial (RCT) was conducted involving 60 patients (41 females and 19 males) with Class II division I malocclusion. The en masse retraction was performed using NiTi closed coil springs attached to miniscrews. The LLLT was performed using an 808 nm Ga-Al-As diode laser. Patient responses regarding pain, discomfort, swelling, and chewing difficulties were reported at ten assessment points. (3) Results: The greatest pain levels were observed 24 h after the application of force during the first and third months of retraction. The mean pain, discomfort, swelling, and chewing difficulties were significantly smaller in the control group than in the FC and FC+LLLT groups. High satisfaction levels were reported in all three groups (p < 0.05). (4) Conclusions: The accelerated en masse retraction via piezocision, followed by a small course of LLLT, was accompanied by significantly fewer pain, discomfort, and chewing difficulties than the control group. LLLT is a valuable addition to piezocision, with an improved patient experience.

The effectiveness of minimally-invasive corticotomy-assisted orthodontic treatment of palatally impacted canines compared to the traditional traction method in terms of treatment duration, velocity of traction movement and the associated dentoalveolar changes: A randomized controlled trial.

Objective: To evaluate the effectiveness of a minimally-invasive corticotomy-assisted treatment of palatally impacted canines (PICs) compared with the traditional method by evaluating treatment time, the velocity of movement, and the associated dentoalveolar changes. Materials and methods: Forty-six patients with palatally or mid-alveolar upper impacted canines were recruited and distributed into two groups: the corticotomy-assisted traction group (CAT group, mean age: 20.39±2.27 years) and the traditional treatment group (TT group, mean age: 20.26±2.17 years). The closed surgical approach was used in both study groups. The velocity of traction movement, traction duration and overall treatment duration were evaluated clinically. In addition, the bone support ratios and the amount of root resorption were assessed on cone-beam computed tomography (CBCT) images. Results: At the end of treatment, significant differences were found between the two groups regarding the velocity of traction movement, traction time, and overall treatment time (P<0.05). The mean velocity of traction movement in the CAT group was greater than the TT group ( x velocity=1.15±0.35 mm/month; 0.70±0.33 mm/month, P=0.027, respectively). The duration of the active traction and the overall orthodontic treatment in the CAT group were significantly shorter than the TT group by 36% and 29%, respectively. The mean bone support ratios of the aligned canines did not differ significantly between the two groups (88% vs. 89% in the CAT and TT groups, respectively). No significant differences were found between the two groups regarding the mean amount of root resorption on the adjacent laterals ( x resorption = 1.30±1.18 mm; 1.22±1.02 mm, P=0.612, in CAT and TT groups, respectively). Conclusions: The traction movement velocity of the palatally impacted canines can be increased using minimally-invasive corticotomy-assisted orthodontic treatment. The side effects of the acceleration procedure were minimal and almost similar to those of the traditional technique.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review.

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

Treatment effectiveness of young adults using clear aligners versus buccal fixed appliances in class I malocclusion with first premolar extraction using the ABO-Objective Grading System: A randomized controlled clinical trial.

OBJECTIVE: To compare the effectiveness of the clear aligners with the traditional fixed appliances in the treatment of premolars extraction complex cases using the American Board of Orthodontics Objective Grading System (ABO-OGS). MATERIAL AND METHODS: A single-centre, 2-parallel groups RCT with two arms. Forty severe crowding patients (14 males, 26 females; mean age: 21.40±2.42) who required four first premolars extraction were included and randomly allocated into two treatment groups: clear aligners therapy group (CAT), and fixed appliances therapy group (FAT). Cases complexities were measured on pre-treatment records using the Discrepancy index (DI). Post-treatment records were evaluated using the American Board of Orthodontics Objective Grading System (ABO-OGS). Two sample t-tests and Fisher's Exact tests were used to test for significant differences between the two groups. The statistical significance was set at P < 0.006 using Bonferroni's correction. RESULTS: For the DI, the mean scores were 32.25 (± 4.33) in the CAT group and 33 (± 7.92) in the FAT group. In the CAT group, the total OGS score ranged between 6-33 points with an average of 17.50(± 7.41), whereas the total score in the FAT group went between 4-30 points with an average of 12.89 (± 6.31) with no significant differences between the two groups (P=0.05). When comparison of the successful cases between the two groups was made, 11 cases received passing scores, and 9 cases received failing scores in the CAT group. Whereas in the FAT group, 17 cases received passing scores, and 3 received a failing score. No statistically significant differences were found in the passing rates between of the CAT and FAT groups (P = 0.421). CONCLUSIONS: According to the ABO-OGS total scores, there was no significant difference between the clear aligners and fixed appliances in the treatment of class I severe crowding cases with first premolars extraction in young adults. There were no differences between the two techniques in the OGS components scores except for the occlusal contacts, which were significantly better with the fixed appliances. When comparing the number of successful and failed cases between the two groups, no significant differences were noted, with the fixed appliances having a 30% higher success rate than the clear aligners, which must be considered clinically when choosing between these two techniques in the complex orthodontic cases treatment.

Adult patient expectations and satisfaction: Can they be influenced by viewing the three-dimensional predicted outcome before fixed orthodontic treatment of dental crowding?

BACKGROUND: Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment. METHODS: A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup-created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)-of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2). RESULTS: Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x¯ = 5.54 and x¯= 6.71), speech (x‾ =5.93 and x¯= 6.93), and oral hygiene improvement (x‾= 7.93 and x¯=8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x¯= 9.12 and x¯= 9.60 at T1 and T2, respectively), and teeth engagement (x¯= 8.92 and x¯= 9.40 at T1 and T2, respectively) CONCLUSIONS: Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant.

Effects of the conventional, soft start, and pulse delay modes produced by light-emitting diode device on metal brackets bond strength and enamel damage: An in vitro comparative study.

OBJECTIVES: This study aimed to compare the bond strength and enamel damage following debonding of metal brackets cured by different light-curing modes: conventional, soft start, and pulse delay modes. MATERIAL AND METHODS: Sixty extracted upper premolars were randomly divided into three groups according to the used light-curing mode. Metal brackets were bonded with a light-emitting diode device employing different modes. Group 1: conventional mode (10s mesial+10 s distal); group 2: soft start mode (15s mesial+15s distal); group 3: pulse delay mode (3s mesial+3s distal, followed by 3min of no photoactivation, then 9s mesial+9s distal). Radiant exposure was the same in all study groups. Shear bond strengths of the brackets were tested with a universal testing machine. A stereomicroscope was used to determine the number and length of enamel microcracks. One-Way ANOVA and Kruskal-Wallis tests were used to detect significant differences in shear bond strength and microcracks number and length among groups. RESULTS: The soft start and pulse delay modes produced significantly greater shear bond strength than the conventional mode (19.46±4.90MPa; 20.47±4.97MPa; 12.14±3.79MPa, respectively, P<0.001). However, there was no significant difference between the soft start and pulse delay groups (P=0.768). The number and length of microcracks increased significantly after debonding in all study groups. The change in microcracks length was not different among study groups. CONCLUSION: The soft start and pulse delay modes produced greater bond strength than the conventional mode without predisposing enamel to higher risk of damage. Conservative methods for debonding are still required.

Adult periodontal comparison after treatment of palatally impacted canines aligned by conventional or accelerated minimally-invasive corticotomy-assisted orthodontic traction: A randomized controlled trial.

OBJECTIVE: To compare the post-treatment periodontal status of the palatally impacted canines and their adjacent teeth treated by an accelerated minimally-invasive corticotomy-assisted method versus the conventional traction method. MATERIAL AND METHODS: A parallel-group two-arm randomized controlled trial was conducted on patients with palatally or mid-alveolar unilateral impacted canines. Participants were randomly selected and allocated to receive the conventional treatment (CT) with a closed surgical approach, or accelerated treatment (CAT). The evaluated periodontal variables were periodontal pocket depth (PPD), keratinized tissue width (KTW), gingival recession level (GRL), papillary bleeding index (PBI) and Gingival Index (GI). All post-treatment periodontal measurements were performed two weeks after removing the fixed orthodontic appliance. RESULTS: In total, 46 patients were included (CT group: n=23; mean age: 20.26±2.17 years), or accelerated treatment (CAT group: n=23; mean age: 20.39±2.27 years). The differences between the two study groups were non-significant for all periodontal outcomes at all measurement points (P>.05). The mean total values of PPD around the aligned canine did not exceed 2mm (XPPD=1.99±0.25mm; 1.91±0.26mm, in the CT and CAT group, respectively, P=0.677). The results of total values of PPD on the adjacent teeth were nearly similar in the two study groups (mean difference: 0.12mm; 0.02mm, for the lateral incisor and the first premolar, respectively). Very low GRL values were detected in the two study groups. CONCLUSIONS: The use of corticotomy-assisted method did not impair the periodontal health in the short follow-up term. Both treatment modalities are considered acceptable in terms of post-treatment periodontal outcomes, as the gingival indices levels were at low values.

Evaluation of the dimensional changes in the mandible, condyles, and the temporomandibular joint following skeletal class III treatment with chin cup and bonded maxillary bite block using low-dose computed tomography: A single-center, randomized controlled trial.

Background: Insufficient evidence regarding the effects of chincup therapy on the mandibular dimensions and temporomandibular joint (TMJ) structures requires high-quality studies using three-dimensional (3D) imaging. This trial aimed to evaluate the 3D changes in the mandible, condyles, and glenoid fossa after chin cup therapy for skeletal Class III children compared to untreated controls. Methods: A 2-arm parallel-group randomized controlled trial on 38 prognathic children (21 boys and 17 girls), with mean ages 6.63±0.84 years. Patients were recruited and randomized into two equal groups; the experimental group (CC) was treated with occipital-traction chin cups in conjunction with bonded maxillary bite blocks. No treatment was provided in the control group (CON). Low-dose CT images were acquired before (T1) and after achieving  (2-4 mm) positive overjet (T2), and after 16 months apart in both groups. The outcome measures of the condyle-mandibular 3D distances, the condyles-glenoid fossa postional changes, and the quantitative displacement parameters of superimposed 3D models were compared statistically. Paired- and two-sample t-tests were used for intra- and inter-group comparisons, respectively. Results: Overall, 35 patients (18 and 17 in the CC and the CON groups, respetively) were enrolled in the statistical analysis. The mean mandibular and condylar volumes increased significantly by 777.24 mm 3 and 1,221.62 mm 3, 94.57 mm 3, and 132.54 mm 3 in the CC and CON groups, respectively. No statistically significant differences were observed between the groups regarding the volumes, superficial areas, and linear changes of the mandible and condyles, and part analysis measurements, except the changes of the relative sagittal and vertical positions of condyles, glenoid fossa, and posterior joint space, which were significantly smaller in the CC group (p<0.05) than the CON group. Conclusions: The chin cup did not affect the mandibular dimensions. Its primary action was confined to the condyles and the TMJ internal dimensions. Clinicaltrials.gov registration: NCT05350306 (28/04/2022).

Assessment of Dentoalveolar Changes Following Leveling and Alignment of Severely Crowded Upper Anterior Teeth Using Self-Ligating Brackets Alone or With Flapless Piezocision Compared to Traditional Brackets: A Randomized Controlled Clinical Trial.

Introduction Dental crowding is one of the most common types of malocclusions. It can be treated with or without extraction, depending on the severity of the crowding. Extraction-based orthodontic treatments are the preferred treatment option in cases of severe crowding, but they take longer than non-extraction cases. Objective This study aimed to evaluate the dentoalveolar changes following the orthodontic treatment of severely crowded maxillary anterior teeth in adults using self-ligating brackets alone or combined with flapless piezocision. Materials and methods The participants in this study were 63 patients (46 females and 17 males; mean age SD: 19.71 ± 2.74 years) who attended the Department of Orthodontics at the University of Damascus from January 2020 to December 2021. The participants were divided into three groups at random: Group (1): traditional brackets group, Group (2): self-ligating brackets group; and Group (3): self-ligating brackets with flapless piezocision group. Little's Irregularity Index (LII) was measured at five assessment times: before the onset of orthodontic treatment (T0), after one month (T1), after two months (T2), after three months (T3), and at the end of the leveling and alignment phase (T4). The intercanine width (lingual), the intercanine width (cusp), and the canine rotation angle were measured at two assessment times: before the onset of orthodontic treatment (T0) and at the end of the leveling and alignment phase (T4). Results The three studied groups had statistically significant differences in terms of LII during the first three months, and the most significant improvement of LII was in the self-ligating brackets with the piezocision group (P < 0.001). In addition, the intercanine width (cusp) at the end of the leveling and aligning phase revealed greater mean values in both self-ligating brackets groups compared to the traditional brackets group, and the differences were statistically significant (P < 0.001). Otherwise, no statistically significant differences were found at the end of the leveling and aligning phase in the intercanine width (lingual) or the canine rotation angle between the three studied groups (P > 0.05). Conclusion Using self-ligating brackets with flapless piezocision revealed more significant results concerning LII as compared to other groups. Thus, combining these two acceleration methods could get more effective results in aligning severely crowded teeth. Self-ligating brackets, whether used alone or with flapless piezocision, resulted in greater intercanine width at the cusp level. The type of brackets (traditional or self-ligating) did not affect the canine rotation angle.

Evaluation of Local Application of Glucosamine Sulfate and Chondroitin Sulfate on Temporomandibular Joint Response and Alleviation of Pain and Tension During the Functional Treatment of Skeletal Class II Patients: A Randomized Control Clinical Trial.

OBJECTIVE:  This study was conducted to assess the effects of applying a gel of combined glucosamine sulfate and chondroitin sulfate on the temporomandibular joint (TMJ) area in patients with skeletal Class II malocclusion treated by removable functional appliances in terms of TMJ internal proportions, levels of pain, and tension. MATERIALS AND METHODS: The study included 36 patients aged 10-13 years with skeletal Class II malocclusion due to retrusion of the mandible characterized by: 4-8 degrees of the sagittal skeletal discrepancy (ANB) angle, 4-7 mm of overjet, 72-76 degrees of the sagittal mandibular positioning (SNB) angle, and a bone maturity stage located at pubertal growth spurt. Patients were distributed to the experimental group (Twin-Block appliance + Jointance® gel) or the control group (conventional treatment with the Twin-Block appliance). An allocation ratio of 1:1 was employed. Pre- and post-treatment digital lateral cephalometric radiograms were taken, and the TMJ joint spaces were measured using the Viewbox software (dHAL Software, Kifissia, Greece). The pain and discomfort levels were evaluated using a questionnaire with a four-point Likert scale at three assessment times. RESULTS:  The anterior and posterior glenoid and anterior condylar distances to the pterygoid vertical (PTV) reference plane significantly decreased after treatment (p<.001), and the anterior joint space decreased significantly (p<.001). In contrast, the superior distance of the condyle to the Frankfort horizontal reference plane increased significantly after treatment, and the same results were found for the posterior and superior joint spaces (p<.05). There were no significant differences between the two groups in the evaluated linear variables. No significant differences were found when comparing pain and tension levels between the two groups at each assessment time. A gradual decrease in pain and tension levels was observed between the three evaluation times in both groups. CONCLUSIONS:  A combination of glucosamine sulfate and chondroitin sulfate did not affect the temporomandibular joint spaces, pain, and tension levels in patients with skeletal Class II malocclusions treated by removable functional appliances.

Do the Most Attractive Faces of Patients With Class II Division 1 Malocclusion Differ From Those With the Least Attractive Faces in Terms of Angular and Proportional Measurements Assessed on Frontal and Lateral Photographs?

Background This study investigated the facial angles and proportions affecting facial aesthetics in patients with skeletal class II division 1 malocclusion between those labeled the most attractive and least attractive in each gender. Methodology The study sample included pretreatment extraoral photographs of 60 patients (30 males and 30 females) with skeletal class II division 1 malocclusion according to the ANB angle aged between 18 and 21 years. A panel of 240 laypersons (aged 20-25 years; the average age of 22.5 ± 0.37 years; 120 males and 120 females) scored the aesthetic evaluation of photographs using the visual analog scale (VAS). Two groups were created according to the mean aesthetic scores of each photograph, namely, the most attractive group with the highest aesthetic scores, and the least attractive group with the least aesthetic scores. A total of 12 patients in each group were selected. Subsequently, their angular and proportional measurements on the frontal and lateral photographs were calculated. Independent-sample t-tests were used to determine if there were significant differences in these measurements between the two groups. Results There was no significant difference in frontal variables between the most attractive and least attractive groups in each gender. The angle NPog-FH was significantly greater in the most attractive males than in the least attractive males, while there was no significant difference between the most attractive and least attractive females regarding any of the profile variables. Conclusions The most attractive females with class II division 1 were similar to the least attractive on evaluating the frontal and profile variables. In contrast, the most attractive males with class II division 1 malocclusion had more protrusion in the chin than the least attractive male patients, with no differences in other profile and frontal variables. These findings suggest considering the chin position during the diagnosis and treatment planning of class II division 1 malocclusion patients.

Effects of the conventional, soft start, and pulse delay modes produced by light-emitting diode device on microleakage beneath metal brackets: An in vitro comparative study.

BACKGROUND: This study aimed to evaluate microleakage beneath metal brackets cured by different light curing modes. MATERIALS AND METHODS: Sixty extracted human premolars were randomly divided into three groups according to the light curing mode. Metal brackets were bonded in all groups according to the manufacturer's recommendations with a light-emitting diode device. Light curing was applied as follows: group 1: conventional mode (10 s mesial+10 s distal); group 2: soft start mode (15 s mesial+15 s distal); group 3: pulse delay mode (3 s mesial+3 s distal, followed by 3min of no photoactivation, then 9 s mesial+9 s distal). Radiant exposure was the same in all study groups. After curing, the teeth were incubated at 37 degrees for 24hours, then thermocycled 500 times. Next, they were sealed with nail varnish, immersed in methylene blue 1% for 24hours, sectioned, and examined under a stereomicroscope. Microleakage was measured at both enamel-adhesive and bracket-adhesive interfaces, and the total microleakage for each tooth was computed. Statistical analyses were performed using Kruskal-Wallis and Welch test for comparing microleakage among groups. Wilcoxon signed ranks test was used for comparing microleakage between the bracket-adhesive and enamel-adhesive interfaces. RESULTS: There was no significant difference in microleakage at the bracket-adhesive interface among study groups. At the enamel-adhesive interface and total microleakage, the pulse delay group exhibited significantly lower microleakage than the conventional group. Whereas there was no significant difference between the soft start group and other study groups. In all study groups, microleakage at the enamel-adhesive interface was greater than that at the bracket-adhesive interface. CONCLUSION: The pulse delay mode caused lesser microleakage than the conventional mode. This supports the use of this mode in orthodontic bonding.

Comparative assessment of dental and basal arch dimensions of passive and active self-ligating versus conventional appliances : A randomized clinical trial.

PURPOSE: In this parallel, three-arm, single-center randomized trial, the dental and basal arch dimensions after orthodontic treatment using conventional brackets and passive and active self-ligating (SL) brackets were compared. METHODS: Patients needing comprehensive orthodontic treatment were randomly allocated to the active SL, passive SL, or conventional brackets (control) group. All patients were treated with a standardized arch wires sequence. Eligibility criteria included class I malocclusion in the permanent dentition, crowding (4-6 mm), and adequate oral hygiene. The primary outcome was intermolar width, based on cone beam computed tomography (CBCT) scans. Secondary outcomes were maxillary and mandibular widths in the canines and premolars regions, dental arch depth, buccolingual inclination, and alignment duration. Blinding of outcome assessment was implemented. Patients were followed every 4 weeks until insertion of the stainless steel 0.019â€¯× 0.025 wire. Mean values were computed from CBCT sections, and data were analyzed using a one-way analysis of variance. RESULTS: In all, 66 patients (ages 18-25 years) were randomized into a 1:1:1 ratio; 7 patients dropped out before treatment initiation. Examining dental arch dimensions in the canine and premolar regions showed that expansion of the maxillary dental arch was greatest in the passive SL brackets group, less in the active SL brackets group, and lowest in the control group (P < 0.01). Changes in maxillary intermolar width between the three groups were not significant, and changes in basal arch dimensions, depth of dental and basal arches, buccolingual inclination, and alignment duration were similar in the three groups. CONCLUSIONS: Self-ligating brackets were not more effective than conventional brackets when examining intermolar width, basal transverse dimensions, depth of the arch, and alignment duration.

The Efficacy of Accelerating Orthodontic Tooth Movement by Combining Self-Ligating Brackets With One or More Acceleration Methods: A Systematic Review.

This review aimed to evaluate the effectiveness of using one or more acceleration methods with self-ligating brackets to accelerate orthodontic tooth movement in adults and the associated effects of these interventions. An electronic search of the following databases (PubMed, Scopus, Google Scholar, EMBASE) was performed (From January 1990 to November 2021). ClinicalTrials.gov and the International Clinical Trials Registry Platform were also electronically searched to find any unpublished studies and ongoing trials. The selected randomized controlled trials (RCTs) involved adult patients treated using self-ligating brackets combined with one or more acceleration methods compared with self-ligating brackets or conditional brackets alone. The risk of bias was assessed using Cochrane's risk of bias tool. A total of seven RCTs and one controlled clinical trial (CCT) were included in this review. Combining self-ligating brackets with flapless corticotomy, low-level laser therapy (LLLT), and infrared light accelerated orthodontic movement by 43% and 50% for surgical methods, 20-50% for LLLT, and 22% for infrared light. Regarding side effects on periodontal tissues, neither flapless corticotomy nor low-frequency vibrational forces caused any damage. Combining self-ligating brackets and flapless corticotomy, low-level laser, or infrared light effectively accelerated orthodontic movement by 20% to 50 %. In contrast, the combination of self-ligating brackets with vibrational forces did not affect speeding tooth movement. The acceleration methods did not have any side effects on the periodontal tissues, but the available evidence was insufficient. There is a need for further primary research regarding the effectiveness of combining self-ligating brackets with acceleration methods and the possible untoward side effects.

Effect of cigarette smoking on alveolar bone thickness and density in patients undergoing leveling and alignment of crowded lower anterior teeth: a controlled clinical trial.

OBJECTIVE: To evaluate the effect of cigarette smoking on the alveolar bone thickness and density in patients undergoing leveling and alignment of crowded lower anterior teeth. METHODS: This controlled clinical trial involved 17 smokers and 17 nonsmokers with mild to moderate crowding of the anterior mandibular teeth. Two cone-beam computed tomography images of the mandible were taken before and after treatment. The length of each tooth root was calculated in each T0 image, and the root was divided into three equal regions. Three lines were drawn parallel to the line of the cementoenamel junction at these three regions of the root, and the previously drawn lines were used to measure bone thickness and bone density. RESULTS: The mean changes in cortical bone thickness and bone density were significantly smaller in smokers than nonsmokers. Cortical bone thickness and bone density were significantly lower after than before treatment in both smokers and nonsmokers. CONCLUSION: In addition to all of its known dangers, cigarette smoking may also harm the alveolar bone by decreasing the bone thickness and density during orthodontic treatment in heavy smokers.

The Effectiveness of In-house Clear Aligners and Traditional Fixed Appliances in Achieving Good Occlusion in Complex Orthodontic Cases: A Randomized Control Clinical Trial.

OBJECTIVE: To compare the effectiveness and efficiency of the in-house clear aligners with the traditional fixed appliances in treating premolar-extraction-based complex cases. MATERIALS AND METHODS: A single-centered, 2-arm parallel-group randomized controlled clinical trial was conducted on thirty-six (12 males, 24 females; mean age: 21.24 ± 2.33) patients with severe crowding who required orthodontic treatment with four first premolars extraction. The patients were equally and randomly divided into two groups: The in-house clear aligners (CA) group and the fixed appliances (FA) group. All the measurements were made on the pre-and post-treatment dental cast models. The effectiveness was evaluated using Little's irregularity index (LII) and the Peer Assessment Rating index (PAR). The efficiency was evaluated by studying the treatment duration. Two sample t-tests and chi-square tests were used to test for significant differences between the two groups. Bonferroni correction was applied, and the adjusted alpha level was set at 0.006.  Results: Before treatment, there were no significant differences between the two groups regarding LII in the upper and lower jaws (p˃0.006). After treatment, the mean LII decreased in both groups, with no significant differences between the two studied groups (p˃0.006). There were no significant differences in all studied PAR domains between the two groups (p˃0.006). The mean score reduction in the CA group was 28.39 (±8.51) points, whereas it was 26.39 (±5.76) points in the FA group, with no significant differences between the two groups. All the patients in this study were improved. However, a great improvement was achieved in 88.9% of the patients in the CA group and 91.7% in the FA group, with no significant differences between them (p=0.674). The average treatment duration in the CA group was 23.27 (±5.28) months, whereas the average was 26.20 (±5.27) in the FA group, with no significant difference between the two groups. CONCLUSION: In-house clear aligners can be effective as fixed appliances in achieving good occlusion when treating complex orthodontic cases when suitable teeth movement protocol is used.

Assessment of Patient-Centered Outcomes When Treating Palatally Impacted Canines Using Conventional Versus Accelerated Minimally Invasive Corticotomy-Assisted Orthodontic Treatment: A Randomized Controlled Trial.

Objective This study aimed to investigate whether there were any differences in pain levels, discomfort, and functional impairments when treating palatally impacted canines (PICs) using the conventional treatment method compared to the accelerated minimally invasive corticotomy-assisted method. Materials and methods Fifty-two patients (11 males and 41 females) with unilateral PICs were included. The patients were randomly assigned to the conventional traction group (26 patients, mean age of 20.37 ± 2.15 years) or the minimally-invasive corticotomy-assisted group (26 patients, mean age of 20.18 ± 2.18 years). The levels of pain, discomfort, and functional difficulties were assessed using a visual analog scale (VAS) after 24 hours (T1), four days (T2), seven days (T3), 14 days (T4), and 28 days (T5) following the surgical exposure procedure. Results There were no statistically significant differences between the two treatment groups for any patient-centered outcome at all assessment times (P>0.01). The levels of pain and discomfort were slightly greater in the conventional group than in the corticotomy-assisted group on the first day after surgical exposure, with no significant difference between the two groups (mean pain: 4.11, P=0.481; mean discomfort: 9.00, P=0.223). Pain and discomfort required seven days to reach low levels and four weeks to reach the lowest levels in both study groups. The levels of swelling, mastication difficulties, swallowing difficulties, limitation in jaw movements and speech changes were mild to moderate on the first postoperative day and the recovery time was four days postoperatively for swallowing difficulties and speech changes. In comparison, the recovery time was seven days for the other three outcomes in both study groups. Conclusions After one day of the surgical intervention, either by conventional or corticotomy-assisted methods, the patients reported mild to moderate pain, discomfort, and functional impairments. These disabilities gradually reached low levels during the first and second weeks to reach their lowest levels four weeks postoperatively in both study groups. The similarity between the conventional and the acceleration methods in pain levels and other oral disabilities may make corticotomy-assisted treatment a comfortable and effective method when treating adult patients with PICs. In addition, patient satisfaction with the corticotomy-assisted procedure was high.

Evaluation of Patient-Centered Outcomes Associated With the Acceleration of Upper Incisor Decrowding Using Self-Ligating Brackets With or Without Piezocision in Comparison With Traditional Brackets: A Three-Arm Randomized Controlled Trial.

Introduction The pain and discomfort associated with orthodontic treatment are considered undesirable complications which may negatively affect the patient's cooperation and reduce the efficiency of orthodontic treatment. This trial aimed to assess patient-centered outcomes in the treatment of class I malocclusion with severe crowding using self-ligating brackets (SLBs) with or without an acceleration procedure (piezocision) compared to the traditional brackets (TBs) in a three-arm trial. Materials and Methods Sixty-six patients (51 females, 15 males; mean age ± SD: 20.08 ± 2.61 years) attending the Department of Orthodontics, the University of Damascus, Damascus (Syria) from April 2019 to October 2020 participated in this study. The patients were randomly allocated to three groups: the TBs s group (n = 22; mean age ± SD: 18.72 ± 2.42), the SLBs group (n = 22; mean age ± SD: 20.48 ± 2.84), and the SLBs with the piezocision group (SLBs+P; n = 22; mean age ± SD: 19.17 ± 2.59). Patient-centered outcomes were assessed using two standardized questionnaires depending on visual analog scales (VAS) for the majority of the questions and a binary scale (Yes/No) for the last two questions in the second questionnaire. The levels of pain, discomfort, swelling, difficulties with mastication, swallowing, and jaw movement restriction were measured at five assessment times: one day (T1), 3 days (T2), 7 days (T3), 14 days (T4), and 28 days (T5) after the beginning of treatment. The satisfaction levels, acceptance to undergo the applied treatment again, and willingness to advise a friend to receive similar treatment were measured at the last assessment time (T5). One-way ANOVA test or its alternative nonparametric test (i.e., Kruskal-Wallis test) was utilized to compare the three groups. Results There were statistically significant differences between the three groups regarding pain, discomfort, swelling, difficulties with mastication, problems with swallowing, and jaw movement restriction during the first three assessment times only (T1, T2, and T3; P < 0.001). The differences were mainly between the SLBs+P group and the other two groups, where the mean values were greater in the SLBs+P group. Otherwise, there were no significant statistical differences between the SLBs and the TBs groups. Concerning patients' satisfaction with the provided treatment, a statistically significant difference between the three groups was detected after 28 days (T5; P < 0.001). The SLBs+P group showed the lowest mean values, whereas there were no significant differences between the two other groups. Conclusion The levels of pain and discomfort, swelling, difficulties in mastication and swallowing, and restriction of jaw movement were greater in SLBs with the piezocision group compared to the sole use of SLBs or TBs in the first week only. The patients showed a high level of satisfaction with the applied therapeutic procedures, which means that SLBs alone or in combination with piezocision can be an accepted treatment modality by patients in the acceleration of orthodontic tooth movement.