Load Deflection Characteristics of Orthodontic Gummetal® Wires in Comparison with Nickel-Titanium Wires: An In Vitro Study.

The aim of this study was to investigate the load deflection characteristics of Gummetal® wires in comparison to nickel-titanium (NiTi) wires. Four different NiTi wires and one Gummetal® archwire were analyzed in two dimensions (0.014″ (0.36 mm) and 0.016″ × 0.022″ (0.41 mm × 0.56 mm)) and in two different orientations (edgewise and ribbonwise) using three-point bending tests at T = 37 °C. Force-displacement curves were recorded and analyzed. The Gummetal® 0.014″ wires exhibited higher forces compared to the NiTi wires at 2.0 mm deflection. At 1.0 mm deflection, the opposite pattern was observed. For the 0.016″ × 0.022″ Gummetal® wires, the forces were within the force interval of the NiTi wires at 2.0 mm deflection. At a deflection of 1.0 mm, no residual force was measurable for the Gummetal® wires. All the NiTi wires investigated showed hysteresis and a superelastic plateau. However, the Gummetal® did not form a plateau, but hysteresis was present. An easier plastic deformability compared to the NiTi wires was observed for all the tested geometries.

Investigation of Forces and Moments during Orthodontic Tooth Intrusion Using Robot Orthodontic Measurement and Simulation System (ROSS).

The Robot Orthodontic Measurement and Simulation System (ROSS) is a novel biomechanical, dynamic, self-regulating setup for the simulation of tooth movement. The intrusion of the front teeth with forces greater than 0.5 N poses a risk for orthodontic-induced inflammatory root resorption (OIIRR). The aim was to investigate forces and moments during simulated tooth intrusion using ROSS. Five specimens of sixteen unmodified NiTi archwires and seven NiTi archwires with intrusion steps from different manufacturers (Forestadent, Ormco, Dentsply Sirona) with a 0.012″/0.014″/0.016″ wire dimension were tested. Overall, a higher wire dimension correlated with greater intrusive forces Fz (0.012″: 0.561-0.690 N; 0.014″: 0.996-1.321 N; 0.016″: 1.44-2.254 N) and protruding moments Mx (0.012″: -2.65 to -3.922 Nmm; 0.014″: -4.753 to -7.384 Nmm; 0.016″: -5.556 to -11.466 Nmm) during the simulated intrusion of a 1.6 mm-extruded upper incisor. However, the 'intrusion efficiency' parameter was greater for smaller wire dimensions. Modification with intrusion steps led to an overcompensation of the intrusion distance; however, it led to a severe increase in Fz and Mx, e.g., the Sentalloy 0.016″ medium (Dentsply Sirona) exerted 2.891 N and -19.437 Nmm. To reduce the risk for OIIRR, 0.014″ NiTi archwires can be applied for initial aligning (without vertical challenges), and intrusion steps for the vertical levelling of extruded teeth should be bent in the initial archwire, i.e., 0.012″ NiTi.

Fluid flow shear stress and tissue remodeling-an orthodontic perspective: evidence synthesis and differential gene expression network analysis.

Introduction: This study aimed to identify and analyze in vitro studies investigating the biological effect of fluid-flow shear stress (FSS) on cells found in the periodontal ligament and bone tissue. Method: We followed the PRISMA guideline for systematic reviews. A PubMed search strategy was developed, studies were selected according to predefined eligibility criteria, and the risk of bias was assessed. Relevant data related to cell source, applied FSS, and locus-specific expression were extracted. Based on this evidence synthesis and, as an original part of this work, analysis of differential gene expression using over-representation and network-analysis was performed. Five relevant publicly available gene expression datasets were analyzed using gene set enrichment analysis (GSEA). Result: A total of 6,974 articles were identified. Titles and abstracts were screened, and 218 articles were selected for full-text assessment. Finally, 120 articles were included in this study. Sample size determination and statistical analysis related to methodological quality and the ethical statement item in reporting quality were most frequently identified as high risk of bias. The analyzed studies mostly used custom-made fluid-flow apparatuses (61.7%). FSS was most frequently applied for 0.5 h, 1 h, or 2 h, whereas FSS magnitudes ranged from 6 to 20 dyn/cm2 depending on cell type and flow profile. Fluid-flow frequencies of 1 Hz in human cells and 1 and 5 Hz in mouse cells were mostly applied. FSS upregulated genes/metabolites responsible for tissue formation (AKT1, alkaline phosphatase, BGLAP, BMP2, Ca2+, COL1A1, CTNNB1, GJA1, MAPK1/MAPK3, PDPN, RUNX2, SPP1, TNFRSF11B, VEGFA, WNT3A) and inflammation (nitric oxide, PGE-2, PGI-2, PTGS1, PTGS2). Protein-protein interaction networks were constructed and analyzed using over-representation analysis and GSEA to identify shared signaling pathways. Conclusion: To our knowledge, this is the first review giving a comprehensive overview and discussion of methodological technical details regarding fluid flow application in 2D cell culture in vitro experimental conditions. Therefore, it is not only providing valuable information about cellular molecular events and their quantitative and qualitative analysis, but also confirming the reproducibility of previously published results.

Biomechanical simulation of forces and moments of initial orthodontic tooth movement in dependence on the used archwire system by ROSS (Robot Orthodontic Measurement & Simulation System).

OBJECTIVES: Aim of this study was to determine the forces and moments during simulated initial orthodontic tooth movements using a novel biomechanical test setup. METHODS: The test setup consisted of an industrial precision robot with a force-torque sensor, a maxillary model and a control computer and software. Forces and moments acting on the corresponding experimental tooth during the motion simulations were dynamically measured for two 0.016" NiTi round archwires (Sentalloy Light/Sentalloy Medium). Intrusive (#1), rotational (#2) and angular (#3) tooth movements were simulated by a control program based on the principle of force control and executed by the robot. The results were statistically analysed using K-S-test and Mann-Whitney U test with a significance level of α = 5%. RESULTS: Sentalloy Medium archwires generated higher forces and moments than the Sentalloy Light archwires in all simulations. In simulation #1 the mean initial forces/moments reached 1.442 N/6.781 Nmm for the Light archwires and 1.637 N/9.609 Nmm for the Medium archwires. In movement #2 Light archwires generated mean initial forces/moments of 0.302 N/-8.271 Nmm whereas Medium archwires generated 0.432 N/-9.653 Nmm. Simulation #3 showed mean initial forces/moments of -0.122 N/8.477 Nmm from the Light archwires compared to -0.300 N/11.486 Nmm for the Medium archwires. SIGNIFICANCE: The measured forces and moments were suitable for initial orthodontic tooth movement in simulations #2 and #3, however inadequate in simulation #1. Reduced archwire dimensions (<0.016″) should be selected for initial leveling of vertical malocclusions.

Bracket Transfer Accuracy with the Indirect Bonding Technique-A Systematic Review and Meta-Analysis.

PURPOSE: To investigate the bracket transfer accuracy of the indirect bonding technique (IDB). METHODS: Systematic search of the literature was conducted in PubMed MEDLINE, Web of Science, Embase, and Scopus through November 2021. SELECTION CRITERIA: In vivo and ex vivo studies investigating bracket transfer accuracy by comparing the planned and achieved bracket positions using the IDB technique were considered. Information concerning patients, samples, and applied methodology was collected. Measured mean transfer errors (MTE) for angular and linear directions were extracted. Risk of bias (RoB) in the studies was assessed using a tailored RoB tool. Meta-analysis of ex vivo studies was performed for overall linear and angular bracket transfer accuracy and for subgroup analyses by type of tray, tooth groups, jaw-related, side-related, and by assessment method. RESULTS: A total of 16 studies met the eligibility criteria for this systematic review. The overall linear mean transfer errors (MTE) in mesiodistal, vertical and buccolingual direction were 0.08 mm (95% CI 0.05; 0.10), 0.09 mm (0.06; 0.11), 0.14 mm (0.10; 0.17), respectively. The overall angular mean transfer errors (MTE) regarding angulation, rotation, torque were 1.13° (0.75; 1.52), 0.93° (0.49; 1.37), and 1.11° (0.68; 1.53), respectively. Silicone trays showed the highest accuracy, followed by vacuum-formed trays and 3D printed trays. Subgroup analyses between tooth groups, right and left sides, and upper and lower jaw showed minor differences. CONCLUSIONS AND IMPLICATIONS: The overall accuracy of the indirect bonding technique can be considered clinically acceptable. Future studies should address the validation of the accuracy assessment methods used.

Effect of Different Parameters of In Vitro Static Tensile Strain on Human Periodontal Ligament Cells Simulating the Tension Side of Orthodontic Tooth Movement.

This study aimed to investigate the effects of different magnitudes and durations of static tensile strain on human periodontal ligament cells (hPDLCs), focusing on osteogenesis, mechanosensing and inflammation. Static tensile strain magnitudes of 0%, 3%, 6%, 10%, 15% and 20% were applied to hPDLCs for 1, 2 and 3 days. Cell viability was confirmed via live/dead cell staining. Reference genes were tested by reverse transcription quantitative real-time polymerase chain reaction (RT-qPCR) and assessed. The expressions of TNFRSF11B, ALPL, RUNX2, BGLAP, SP7, FOS, IL6, PTGS2, TNF, IL1B, IL8, IL10 and PGE2 were analyzed by RT-qPCR and/or enzyme-linked immunosorbent assay (ELISA). ALPL and RUNX2 both peaked after 1 day, reaching their maximum at 3%, whereas BGLAP peaked after 3 days with its maximum at 10%. SP7 peaked after 1 day at 6%, 10% and 15%. FOS peaked after 3 days with its maximum at 3%, 6% and 15%. The expressions of IL6 and PTGS2 both peaked after 1 day, with their minimum at 10%. PGE2 peaked after 1 day (maximum at 20%). The ELISA of IL6 peaked after 3 days, with the minimum at 10%. In summary, the lower magnitudes promoted osteogenesis and caused less inflammation, while the higher magnitudes inhibited osteogenesis and enhanced inflammation. Among all magnitudes, 10% generally caused a lower level of inflammation with a higher level of osteogenesis.

STAndard Reporting of CAries Detection and Diagnostic Studies (STARCARDDS).

AIM: The aim of this paper is to present recommendations from an international workshop which evaluated the methodology and reporting of caries diagnostic studies. As a unique feature, this type of studies is focused on caries lesion detection and assessment, and many of them are carried out in vitro, because of the possibility of histological validation of the whole caries spectrum. This feature is not well covered in the existing reporting STARD guideline within the EQUATOR Network. PARTICIPANTS AND METHODS: An international working group of 13 cariology researchers was formed. The STARD checklist was reviewed and modified for caries detection and diagnosis purposes, in a three-step process of evaluation, consensual modification, and delivery during three 2-day workshops over 18 months. Special attention was paid to reporting requirements of caries studies that solely focus on reliability. RESULTS: The STARD checklist was modified in 14/30 items, with an emphasis on issues of sample selection (tooth selection in in vitro studies), blinding, and detailed reporting of results. CONCLUSION: Following STARCARDDS (STAndard Reporting of CAries Detection and Diagnostic Studies) is expected to result in complete reporting of study design and methodology in future caries diagnosis and detection experiments both in vivo and in vitro, thus allowing for better comparability of studies and higher quality of systematic reviews. CLINICAL RELEVANCE: Standardization of caries diagnostic studies leads to a better comparability among future studies, both in vivo and in vitro.

Systematic review and meta-analysis of diagnostic studies of proximal surface caries.

AIM: This systematic review and meta-analysis aimed to assess the diagnostic accuracy and reliability of commonly used caries detection methods for proximal caries diagnostics. Visual examination (VE), bitewing radiography (BWR), laser fluorescence (LF), and fibre-optic transillumination (FOTI) were considered in detail. MATERIAL AND METHODS: PRISMA guidelines for the reporting of systematic reviews and meta-analyses were applied. The mnemonic PIRDS (problem, index test, reference test, diagnostic and study type) concept was used to guide the literature search. Next, studies that met the inclusion criteria were stepwise selected and evaluated for their quality with a risk of bias (RoB) assessment tool. Studies with low/moderate bias and sufficient reporting were considered for meta-analysis. The pooled sensitivity (SE), specificity (SP), diagnostic odds ratio (DOR), and area under the ROC curve (AUC) were calculated. RESULTS: From 129 studies meeting the selection criteria, 31 in vitro studies and five clinical studies were finally included in the meta-analysis. The AUC values for in vitro VE amounted to 0.84 (caries detection) and 0.85 (dentin caries detection). BWR ranged in vitro from 0.55 to 0.82 (caries detection) and 0.81-0.92 (dentin caries detection). LF showed higher AUC values for overall caries detection (0.91) and dentin caries detection (0.83) than did other methods. Clinical data are limited. CONCLUSION: The number of diagnostic studies with low/moderate RoB was found to be low and indicates a need for high-quality, well-designed caries diagnostic studies. CLINICAL RELEVANCE: BWR and LF showed good diagnostic performance on proximal surfaces. However, because of the low number of includable clinical studies, these data should be interpreted with caution.

Effect of Tension on Human Periodontal Ligament Cells: Systematic Review and Network Analysis.

Orthodontic tooth movement is based on the remodeling of tooth-surrounding tissues in response to mechanical stimuli. During this process, human periodontal ligament cells (hPDLCs) play a central role in mechanosensing and mechanotransduction. Various in vitro models have been introduced to investigate the effect of tension on hPDLCs. They provide a valuable body of knowledge on how tension influences relevant genes, proteins, and metabolites. However, no systematic review summarizing these findings has been conducted so far. Aim of this systematic review was to identify all related in vitro studies reporting tension application on hPDLCs and summarize their findings regarding force parameters, including magnitude, frequency and duration. Expression data of genes, proteins, and metabolites was extracted and summarized. Studies' risk of bias was assessed using tailored risk of bias tools. Signaling pathways were identified by protein-protein interaction (PPI) networks using STRING and GeneAnalytics. According to our results, Flexcell Strain Unit® and other silicone-plate or elastic membrane-based apparatuses were mainly adopted. Frequencies of 0.1 and 0.5 Hz were predominantly applied for dynamic equibiaxial and uniaxial tension, respectively. Magnitudes of 10 and 12% were mostly employed for dynamic tension and 2.5% for static tension. The 10 most commonly investigated genes, proteins and metabolites identified, were mainly involved in osteogenesis, osteoclastogenesis or inflammation. Gene-set enrichment analysis and PPI networks gave deeper insight into the involved signaling pathways. This review represents a brief summary of the massive body of knowledge in this field, and will also provide suggestions for future researches on this topic.

Identifying and Avoiding Risk of Bias in Caries Diagnostic Studies.

Caries diagnostic studies differ with respect to their design, included patients/tooth samples, use of diagnostic and reference methods, calibration, blinding and data reporting. Such heterogeneity makes comparisons between studies difficult and could represent a substantial risk of bias (RoB) when it is not identified. Therefore, the present report aims to describe the development and background of a RoB assessment tool for caries diagnostic studies. The expert group developed and agreed to use a RoB assessment tool during three workshops. Here, existing instruments (e.g., QUADAS 2 and the Joanna Briggs Institute Reviewers' Manual) influenced the hierarchy and phrasing of the signalling questions that were adapted to the specific dental purpose. The tailored RoB assessment tool that was created consists of 16 signalling questions that are organized in four domains. This tool considers the selection/spectrum bias (1), the bias of the index (2) and reference tests (3), and the bias of the study flow and data analysis (4) and can be downloaded from the journal website. This paper explores possible sources of heterogeneity and bias in caries diagnostic studies and summarizes the relevant methodological aspects.

A Comparative Study of Antioxidative Activity of Saliva in Children and Young Teenagers with and without Gingivitis.

Objectives: The aim of this study was to compare the values of total antioxidant capacity (TAC), catalase (CAT) and glutathione peroxidase (GPX) in the saliva of children and young teenagers with and without gingivitis. Materials and Methods: A total of 120 children and young teenagers of the mean age of 12.2 participated in the research. Gingival condition was assessed using the Löe and Silness Gingival Index. The subjects were divided into groups of those without gingivitis and those with gingivitis. Samples of unstimulated saliva were collected, and TAC, CAT and GPX were determined spectrophotometrically. Results: By comparing the values of TAC, CAT and GPX in subjects with and without gingivitis, significantly lower values of TAC (p < 0.001) and CAT (p < 0.001) were observed in the group of subjects with gingivitis. The correlation analysis of these values showed a positive correlation in groups of subjects not suffering from gingival inflammation and those with gingival inflammation. Conclusions: The study showed significantly lower values of TAC and CAT in the saliva of subjects with gingivitis. This indicates their possible role as a potential biomarker in the early diagnosis and expression of periodontal disease in children and young teenagers.

Effect of static compressive force on in vitro cultured PDL fibroblasts: monitoring of viability and gene expression over 6 days.

OBJECTIVES: The aim was to investigate the impact of static compressive force (CF) application on human PDL-derived fibroblasts (HPDF) in vitro for up to 6 days on the expression of specific genes and to monitor cell growth and cell viability. MATERIALS AND METHODS: CF of 2 g/cm2 was applied on HPDFs for 1-6 days. On each day, gene expression (cFOS, HB-GAM, COX2, IL6, TNFα, RUNX2, and P2RX2) and secretion (TNFα, PGE2) were determined by RT-qPCR and ELISA, respectively. Cell growth and cell viability were monitored daily. RESULTS: In comparison with controls, significant upregulation of cFOS in compressed HPDFs was observed. HB-GAM showed no changes in expression, except on day 5 (P < 0.001). IL6 expression was significantly upregulated from day 2-5, reaching the maximum on day 3 (P < 0.001). TNFα expression was upregulated on all but day 2. COX2 showed upregulation, reaching the plateau from day 3 (P < 0.001) until day 4 (P < 0.001), and returning to the initial state till day 6. P2RX7 was downregulated on days 2 and 4 to 6 (P < 0.001). RUNX2 was downregulated on days 2 and 5 (both P < 0.001). Cells in both groups were proliferating, and no negative effect on cell viability was observed. CONCLUSION: Results suggest high molecular activity up to 6 days, therefore introducing further need for in vitro studies with a longer duration that would explain other genes and metabolites involved in orthodontic tooth movement (OTM). CLINICAL RELEVANCE: Extension of an established in vitro force application system for prolonged force application (6 days) simulating the initial phase of OTM.