Does age influence deep overbite correction with Invisalign? A prospective study evaluating mandibular incisor intrusion in adolescents vs adults.

OBJECTIVE: To compare the accuracy of mandibular incisor intrusion with Invisalign (Align Technology, Santa Clara, Calif) in adolescents to that in adults. MATERIALS AND METHODS: This prospective clinical study included 58 patients treated with either Invisalign Teen or Invisalign Full. Mandibular central and lateral incisors were measured on digital models created from intraoral scans. Predicted values were determined by superimposing the initial and final ClinCheck models, and achieved values were determined by superimposing the initial ClinCheck models and the digital models from the final scans. Individual teeth were superimposed with a best-fit analysis and measured using Compare software (version 8.1; GeoDigm, Falcon Heights, Minn). RESULTS: The mean accuracies of mandibular incisor intrusion were 63.5% in adolescents and 45.3% in adults, and this difference was statistically significant. The amounts of achieved intrusion were 1.7 mm in adolescents and 0.9 mm in adults, and this difference was also statistically significant. Overall, there was a weak negative correlation between age and accuracy; as age advanced, the accuracy of mandibular incisor intrusion diminished slightly. CONCLUSIONS: Mandibular incisor intrusion with Invisalign is significantly more accurate in adolescents than in adults. Orthodontists could contemplate reducing the degree of overcorrection for mandibular incisor intrusion in adolescents with deep overbites undergoing Invisalign Teen but still implementing the reverse curve of Spee mechanics.

The effect of alpha binaural beat music on orthodontic pain after initial archwire placement: A randomized controlled trial.

OBJECTIVE: The objective of this article was to evaluate the effect of alpha binaural beat music on pain level after initial placement of a maxillary fixed appliance, compared to music without binaural beats (placebo) and no music (control). METHODS: 60 patients undergoing maxillary fixed orthodontic appliance and initial archwire placement were randomly allocated into the three aforementioned groups. The pain level experienced was monitored for the following seven days, using the short-form McGill pain questionnaire (SF-MPQ). RESULTS / DESCRIPTORS: Intensity of both sensory and psychological aspects of pain reduced significantly in the binaural beat music (BBM) group, compared to the control, after the 5th day. Statistically significant lower affective and total pain scores were also found on day 6 for the placebo group, compared to the control. Present Pain Intensity (PPI): Statistically significant lower scores were found between the BBM group and the control group from days 3 to 7. Statistically significant lower scores were also found between the placebo and the control groups on days 4, 5 and 6. Visual Analog Scale (VAS): Compared to the control group, the placebo group had a lower VAS score on day 4, and the BBM group had lower scores on days 6 and 7. CONCLUSIONS: There was a significant reduction of pain demonstrated in the BBM group, compared to the control, toward the end of the first week of treatment. There was no difference in reported pain between the BBM and placebo groups for any of the scores.

Invisalign treatment with mandibular advancement: A retrospective cohort cephalometric appraisal.

Objective: To examine the skeletal, dental, and soft-tissue cephalometric effects of class II correction using Invisalign's mandibular advancement feature in growing patients. Materials and Methods: A retrospective cohort clinical study was performed on cases that were started between 2017 and 2019. A total of 32 patients (13 females, 19 males), with an average age of 13 years old (9.9-14.8 years) had undergone Invisalign treatment (Align Technology, Inc., San Jose, CA) wherein the mandibular advancement phase was completed were included. Photos, digital study models, and cephalograms were taken once during the patients' initial visit and again upon completing the mandibular advancement phase of treatment. The number of aligners worn and the time of treatment in months was recorded for each subject. Cephalometric analysis was performed and overjet and overbite were measured. Statistical analysis was performed using SPSS statistical software (version 25; SPSS, Chicago, Ill) and the level of significance was set at P <0.05. Descriptive statistics were performed to generate means and differences for each cephalometric measurement as well as patient data including age, treatment time, and aligner number. Differences between measurements from patients before treatment (T1) and after treatment (T2) with the mandibular advancement feature were evaluated using a paired t -test. Results: All 32 patients had multiple jumps staged for the precision wings, i.e., incremental advancement. The average length of treatment for the MA phase was 9.2 months (7.5-13.8 months) and the average number of aligners used during this time was 37 (30-55). Statistically significant differences between T1 and T2, in favor of class II correction, were observed in the ANB angle, WITS appraisal, facial convexity, and mandibular length. The nasolabial angle, overjet, and overbite also showed statistically significant changes between T1 and T2. Conclusion: Invisalign aligners with the mandibular advancement feature took approximately 9 months for 1.5 mm of overjet correction. The lower incisor angulation was maintained during class II correction. The minimal skeletal changes are in favor of class II correction.

Maxillary Expansion: A Comparison of Damon Self-Ligating Bracket Therapy with MARPE and PAOO.

Purpose: The aim of this study was to investigate arch parameters and dentoalveolar changes from pretreatment to posttreatment by comparing the Miniscrew Assisted Rapid Palatal Expansion (MARPE), Periodontally Accelerated Osteogenic Orthodontics (PAOO), and Damon self-ligating bracket therapies. Materials and Methods: Seventy-nine patients underwent maxillary expansion followed by or in conjunction with Damon (n = 23), PAOO (n = 28), and MARPE (n = 28) therapies. Nine maxillary dental arch parameters were compared at pretreatment, posttreatment as well as, increments of treatment change. Measurements were made on STL study casts using 3Shape Ortho Analyzer 3D scanner software. Results: All groups showed significant posterior width increase in the molar area. The mean increase in inter-molar distance was more than 8X greater in MARPE group compared to Damon and more than 4X greater compared to PAOO. MARPE showed significantly greater increments of change in inter-molar width and palatal vault area. Conclusions: All groups showed a significant width increase in the canine and molar area. MARPE showed the greatest increase in inter-molar width, followed by PAOO and Damon. MARPE was the only group to show a significant increase in palatal vault area.

The effect of alpha binaural beat music on orthodontic pain after initial archwire placement: A randomized controlled trial

ABSTRACT Objective: The objective of this article was to evaluate the effect of alpha binaural beat music on pain level after initial placement of a maxillary fixed appliance, compared to music without binaural beats (placebo) and no music (control). Methods: 60 patients undergoing maxillary fixed orthodontic appliance and initial archwire placement were randomly allocated into the three aforementioned groups. The pain level experienced was monitored for the following seven days, using the short-form McGill pain questionnaire (SF-MPQ). Results / Descriptors: Intensity of both sensory and psychological aspects of pain reduced significantly in the binaural beat music (BBM) group, compared to the control, after the 5th day. Statistically significant lower affective and total pain scores were also found on day 6 for the placebo group, compared to the control. Present Pain Intensity (PPI): Statistically significant lower scores were found between the BBM group and the control group from days 3 to 7. Statistically significant lower scores were also found between the placebo and the control groups on days 4, 5 and 6. Visual Analog Scale (VAS): Compared to the control group, the placebo group had a lower VAS score on day 4, and the BBM group had lower scores on days 6 and 7. Conclusions: There was a significant reduction of pain demonstrated in the BBM group, compared to the control, toward the end of the first week of treatment. There was no difference in reported pain between the BBM and placebo groups for any of the scores.

RESUMO Objetivo: O objetivo deste artigo foi avaliar o efeito da música alfa com ritmo binaural sobre o nível de dor após a instalação de um aparelho fixo superior com arco inicial, em comparação com a música sem ritmos binaurais (placebo) e sem música (controle). Métodos: 60 pacientes submetidos a instalação de aparelho ortodôntico fixo superior e do arco inicial foram alocados aleatoriamente nos três grupos acima mencionados. O nível de dor experimentado foi monitorado durante os sete dias seguintes, usando a forma curta do questionário de dor McGill (SF-MPQ). Resultados: Após o quinto dia, a intensidade dos aspectos sensoriais e psicológicos da dor foi significativamente reduzida no grupo de música com ritmo binaural (BBM), em comparação com o grupo controle. Escores significativamente menores de dor afetiva e total também foram encontrados no dia 6 para o grupo placebo, comparado ao controle. Intensidade da Dor Presente (PPI): escores significativamente menores foram encontrados para o grupo BBM, em comparação ao grupo controle, nos dias 3 a 7. Escores significativamente menores também foram encontrados para o grupo placebo, em comparação ao grupo controle, nos dias 4, 5 e 6. Escala Visual Analógica (VAS): comparado ao grupo controle, o grupo placebo teve um escore VAS menor no dia 4, e o grupo BBM teve escores menores nos dias 6 e 7. Conclusões: No final da primeira semana de tratamento, houve redução significativa da dor no grupo BBM, em comparação ao grupo controle. Não houve diferença entre a dor relatada nos grupos BBM e placebo para qualquer um dos escores.

Applications of artificial intelligence and machine learning in orthodontics: a scoping review.

INTRODUCTION: This scoping review aims to provide an overview of the existing evidence on the use of artificial intelligence (AI) and machine learning (ML) in orthodontics, its translation into clinical practice, and what limitations do exist that have precluded their envisioned application. METHODS: A scoping review of the literature was carried out following the PRISMA-ScR guidelines. PubMed was searched until July 2020. RESULTS: Sixty-two articles fulfilled the inclusion criteria. A total of 43 out of the 62 studies (69.35%) were published this last decade. The majority of these studies were from the USA (11), followed by South Korea (9) and China (7). The number of studies published in non-orthodontic journals (36) was more extensive than in orthodontic journals (26). Artificial Neural Networks (ANNs) were found to be the most commonly utilized AI/ML algorithm (13 studies), followed by Convolutional Neural Networks (CNNs), Support Vector Machine (SVM) (9 studies each), and regression (8 studies). The most commonly studied domains were diagnosis and treatment planning-either broad-based or specific (33), automated anatomic landmark detection and/or analyses (19), assessment of growth and development (4), and evaluation of treatment outcomes (2). The different characteristics and distribution of these studies have been displayed and elucidated upon therein. CONCLUSION: This scoping review suggests that there has been an exponential increase in the number of studies involving various orthodontic applications of AI and ML. The most commonly studied domains were diagnosis and treatment planning, automated anatomic landmark detection and/or analyses, and growth and development assessment.

Outcomes of clear aligner treatment with and without Dental Monitoring: A retrospective cohort study.

INTRODUCTION: The effects of Invisalign clear aligner treatment with and without Dental Monitoring (DM) were compared for treatment duration, number of appointments, refinements and refinement aligners, and accuracy of Invisalign in achieving predicted tooth positions (aligner tracking). The null hypothesis was that there are no differences between Invisalign with and without DM in these parameters. METHODS: A sample of 90 consecutively treated Invisalign patients (45 control, 45 DM) fitted the inclusion and exclusion criteria. Treatment duration, number of refinements, number of refinement aligners, time to first refinement, number of appointments, number of emergency visits, and accuracy of predicted tooth movement were observed for differences. RESULTS: The 2 groups were homogeneous (P >0.05) for sample size, age, gender, Angle classification, maxillary and mandibular irregularity index, and the number of initial aligners. There was a significant (P = 0.001) reduction in the number of appointments by 3.5 visits (33.1%) in the DM group. There was also a significant (P = 0.001) reduction in the time to the first refinement (1.7 months) in the DM group. Compared with Invisalign predicted tooth positions, actual tooth positions were statistically (P <0.05) more accurate for the DM group for the maxillary anterior dentition in rotational movements and mandibular anterior dentition for buccal-lingual linear movement. Invisalign therapy without DM was closer to predicted tooth positions for the maxillary posterior dentition for the tip. None of these differences surpassed the clinically significant thresholds (>0.5 mm or >2°); however, the DM group achieved this in 1.7 fewer months. CONCLUSIONS: DM with Invisalign therapy resulted in a reduced number of appointments by 3.5 visits (33.1%). The DM group also achieved a clinically similar accuracy in obtaining predicted tooth movements compared with the control group in 1.7 fewer months, indicating improved aligner tracking in the DM group.

The effect of vestibular, lingual, and aligner appliances on the quality of life of adult patients during the initial stages of orthodontic treatment.

BACKGROUND: Patient quality of life (QoL) during orthodontic treatment is an important consideration that requires greater academic investigation as greater focus is placed on enhancing patient experience. Quality of life (QoL) was assessed in three orthodontic appliance groups, i.e., vestibular, lingual, and aligners during the initial stages of treatment. The sample was comprised of 117 adult patient-subjects distributed into 3 groups: vestibular (n = 41), lingual (n = 37), and aligner (n = 39). A WHOQOL-BREF questionnaire surveyed four domains (physical health, psychological health, social relationships, and environment). RESULTS: Mean scores for domain 1, physical health, showed that the aligner group (28.1) had significantly greater scores than that of the vestibular (22.7) or lingual (22) groups. Domain 2, psychological health, demonstrated significant differences (P < 0.001) between all groups, with the aligner group scoring the highest (23.2), followed by the lingual (18.4) and vestibular (15.2) groups. Domain 3, social relationship, showed that aligner (10.9) and lingual (10.2) scores were significantly greater (P < 0.001) than those of the vestibular group (7.8). Domain 4, environment, displayed significant differences between all groups, with the aligner group scoring highest (32.1), followed by the lingual group (29.3), and lastly the vestibular group (26.4). Overall, the highest mean score was obtained by the aligner group (23.1) and the lowest mean score was by the vestibular group (18). The mean domain scores for all three groups were significantly different (P ≤ 0.005) from each other (Table 2). CONCLUSIONS: Overall, patients undergoing Aligner therapy reported the overall highest QoL scores, followed by lingual and vestibular groups.

Effect of clear aligner wear protocol on the efficacy of tooth movement.

OBJECTIVES: To compare the efficacy of orthodontic tooth movement with three aligner wear protocols: 7 day, 10 day, and 14 day. MATERIALS AND METHODS: Eighty patients were randomly allocated into three groups: group A (7-day changes), group B (10-day changes), and group C (14-day changes). The posttreatment scans were compared with the final virtual treatment simulations through digital superimposition. The differences between predicted and actual achieved treatment outcomes were computed in six angular and six linear dimensions. Differences >0.5 mm for linear measurements and >2° for angular measurements were considered clinically relevant. RESULTS: Within groups, and irrespective of wear protocol, all linear discrepancies in both jaws were deemed clinically insignificant (<0.5 mm) while nearly all angular discrepancies were considered clinically significant (>2.0°). When the three groups were compared, group C (14-day changes) showed significantly greater accuracy in the posterior segment for maxillary intrusion, distal-crown tip and buccal-crown torque, and mandibular intrusion and extrusion. The mean treatment duration in the 7-day aligner change group was nearly half that of the 14-day aligner change group (5 months vs 9 months). CONCLUSIONS: Fourteen-day changes were statistically significantly more accurate in some posterior movements. However, this difference in accuracy did not exceed the threshold for clinical significance (>0.5 mm/>2.0°). Achieving a clinically similar accuracy between the 7-day protocol and 14-day protocol in half the treatment time suggests a 7-day protocol as an acceptable treatment protocol. Clinicians may consider slowing down to a 14-day protocol if challenging posterior movements are desired.

Smartphone applications used in orthodontics: A scoping review of scholarly literature.

Mobile applications (apps) play an increasingly important role in day to day life. With the number of orthodontic-related apps continuing to increase, and the rapid development of artificial intelligence, the potential to yield tremendous benefits to both clinicians and patients is apparent. However, if orthodontic apps are to become mainstream and obtain greater acceptance, scientific validation and investigation of these apps are to be undertaken. This scoping review aimed to determine the scope and extent of the published literature on mobile apps in orthodontics, as well as identify the types of studies published, and summarize the outcomes studied- thus also giving direction for future research in a rapidly evolving subject area.

Clinical outcomes and patient perspectives of Dental Monitoring® GoLive® with Invisalign®-a retrospective cohort study.

BACKGROUND: The aims of the study were to compare the effects of Invisalign® with and without Dental Monitoring® (DM) GoLive® on the following parameters: treatment duration, number of appointments, number of refinements, total number of refinement aligners, and time to initial refinement. The patients' perspectives on Dental Monitoring® were also evaluated using an online questionnaire. A sample of 155 consecutively treated Invisalign® patients (67 control, 88 DM) fit the inclusion and exclusion criteria. RESULTS: The two groups were homogeneous (P > .05) for age, gender, angle classification, Little's Irregularity Index, and number of initial aligners. The DM group had significantly fewer office visits compared to the control (7.56 vs 9.82; P < .001). There were no significant differences between the DM and control groups respectively pertaining to treatment duration (14.58 vs 13.91), number of refinements (1.00 vs 0.79), number of refinement aligners (19.91 vs 19.85), and time to first refinement (9.46 vs 9.97). Questionnaire results showed that 68.8% (44 respondents) indicate that DM scans were "easy" or "very easy" to perform while 16 responders (25%) found it "difficult" or "very difficult." 71.9% (46 responders) were "satisfied or very satisfied" with the level of communication with the orthodontist using DM and 16% (10 responders) were "dissatisfied" or "very dissatisfied." The mean duration observed by patients to take a scan was 5.16 ± 3.6 min. Eighty-eight percent (56 responders) of patients prefer few office visits as possible, while 12% (8 responders) would actually prefer additional office visits. Overall, the mean satisfaction of patients with DM was 4.25 on the 5-point Likert scale. CONCLUSION: The DM group had a significantly reduced number of appointments (7.56) compared with the control group (9.82) (a reduction of 23%) over the treatment duration. There were no significant differences between the two groups in treatment duration, number of refinements, number of refinement aligners, or time to 1st refinement. Overall, DM was well received by patients. However, there was a small percentage (usually less than 15%) that was generally unsatisfied with DM in varying aspects and preferred more frequent, traditional office visits.