Comparison of Patient Satisfaction between Invisible Appliance and Fixed Orthodontic Appliances - A Systematic Review.

To compare the patient acceptance between fixed orthodontic appliances and clear aligners. An electronic search was completed in PubMed, Cochrane Database, Web of Science, Scopus, Lilacs, Google Scholar, and Open Grey databases without any restrictions until August 23. All comparative study types contrasting patient perception between clear aligners and fixed appliances were included. After removal of duplicates, exclusion by title and abstract, and reading the full text, only eight articles were included. The studies used an observational questionnaire study design. Of the observational studies, one was retrospective and three prospective, one online survey, and the other three cross sectional. Though the response varied in terms of patient preference and acceptance, it was found that clear aligners have a positive impact with respect to quality of life, tolerance, and improved confidence. However, there is not enough evidence to make a final conclusion about treatment outcomes.

Assessment of salivary tumor necrosis factor-alpha level in the initial stages of treatment with fixed appliances and clear aligners.

OBJECTIVES: To assess and compare the tumor necrosis factor-alpha (TNF-α) levels in saliva samples during the initial stages of orthodontic treatment with fixed orthodontic appliances (FAs) and clear aligners (CAs). MATERIALS AND METHODS: This longitudinal study comprised 40 patients (22 males, 18 females, mean age 22 ± 7 years) who were categorized into two equal-sized groups. Group A comprised 20 patients treated with FA, and Group B comprised 20 patients treated with CA. Unstimulated saliva was collected before the intiation of treatment and then collected again after the placement of the FA/CA at 24 hrs, 7th day, and on the 21st day in both groups. TNF-α levels were determined through ELISA. STATISTICAL ANALYSIS: The data were subjected to statistical analysis. For intragroup comparison of TNF-α at different time points, the Wilcoxon matched-pairs signed-rank test was used, and for intergroup comparison of FAs and CAs at different time points, the Mann-Whitney U test was used. RESULTS: TNF-α levels in the saliva increased significantly at 24 hours, followed by a decline on the 7th day and 21st day in both groups. Changes in TNF-α levels were significantly higher in the FA group than those in the CA group at different time points. CONCLUSION: This study showed that the salivary TNF-α levels increased significantly during the initial stages of FA and CA treatment at different time points. The mean salivary TNF-α level in both FA and CA groups increased significantly at 24 hours, followed by a decline on the 7th day and then on the 21st day. There was a significant difference between the FA and CA treatment, where the CAs showed a significantly low level of TNF-α in saliva at different intervals of time when compared to the FAs.

Assessment of changes in enamel colour following fixed orthodontic therapy using an advanced spectrophotometer: An in vivo study.

BACKGROUND: Any manipulation of the surface of natural teeth may result in a variation of their colour. The fixed orthodontic treatment (FOT) is one such procedure which alters the enamel surface during the procedure. OBJECTIVE: To clinically evaluate the colour changes in teeth associated with comprehensive FOT (to compare the changes in test and control groups) and to determine the relationship of age and gender on enamel colour due to FOT by using an advanced spectrophotometer. METHODS: The selection of sixty patients for the study was done randomly and among these thirty patients who underwent the FOT as the case group, the other thirty patients who did not need FOT, were the control group. The recordings of spectrophotometric data were done in a standardized manner for all patients in the labial circular region of every anterior tooth, following debonding and cleaning operations, and before bracket bonding. The Commission Internationale de l'Eclairage's L*, a*, and b* (lightness, red/green, and blue/yellow) tooth-type characteristics were used to measure color, and the associated color differences (DE) between the groups were computed. One-way ANOVA (a < 0.05) and the paired t-test were used to evaluate any changes in these color characteristics. RESULTS: Fixed orthodontic treatment is associated with changes in colour parameters. L* values decreased (P< 0.001), while a* and b* values increased (P< 0.001) at the end of treatment. All measured tooth types showed significant colour change (DE); their mean differences ranged from 1.64 to 2.96 DE units. CONCLUSIONS: Fixed orthodontics can change the natural colour of teeth. The CIE colour parameters L*, a*, and b* of natural teeth showed statistically significant differences after debonding the orthodontic appliances. The L* values decreased making the teeth look darker. The adolescent and male patients had more tooth colour changes than the adult and female groups.

Metallic vs Ceramic Bracket Failures After 12 Months of Treatment: A Prospective Clinical Trial.

INTRODUCTION: Orthodontic treatment with fixed vestibular appliances is still widely used worldwide. When choosing the aesthetic alternative of ceramic brackets, the possibility of failure and cracking of braces should be considered. Therefore, the aim of the present study was to compare the failure rates of ceramic and metal brackets in a 12-month clinical study. METHODS: Eighty patients undergoing fixed orthodontic treatment with vestibular appliances were enrolled and divided into 2 equal groups: MET for metal brackets and CER for ceramic brackets. After bonding, bracket failures were recorded for 12 months, along with the archwire placed at the time of failure. Angle's dental class, skeletal class, Wits appraisal, Little's irregularity index, overjet, overbite, age, and gender of the patients were recorded from pretreatment cephalometric tracings and study casts. The data were statistically analysed (P < .05). RESULTS: Significantly higher failure rates were found for ceramic brackets in the overall analysis, in the mandibular arch, and in the posterior region. Regression analysis revealed a significant influence of round nickel-titanium archwires on higher failure rates, whilst a significant influence of rectangular archwires was found on lower failure rates. CONCLUSIONS: Ceramic brackets showed higher failure rates. Patients should be aware that orthodontic treatment with ceramic brackets may involve delays and inconvenience due to the higher failure rate compared to metal brackets.

A 10-year-old boy with class II oligodontia treated with buccal fixed appliances and agenesis space closure of the four second premolars: Case report No. 230075 - Titularisation Collège Européen Orthodontie (CEO), European College of Orthodontics.

The patient presented in this case report is a 10-year-old boy with hyperdivergent skeletal Class II associated with familial genetic agenesis of the second premolars. The treatment plan chosen was to close the spaces of agenesis using a bimaxillary appliance fixed buccally. The advantages and disadvantages of this treatment option were discussed. The result was stable and made it possible to avoid an implant-prosthetic solution, which would undoubtedly have been more restrictive over time.

Orthodontic treatment demand for fixed treatment and aligners among young adults in middle Europe and South America - a questionnaire study.

BACKGROUND: Patients experiencing any malocclusion, may desire for treatment. However, there is no scientific information orthodontic treatment demand and the knowledge of young adults about orthodontic treatment. The aim of the study was to assess orthodontic treatment demand in young adults from Poland and Chile, their previous orthodontic experience and their knowledge on fixed and aligner orthodontic treatment. METHODS: The target group comprised people aged 18-30. The sample size was estimated as above 400 for each country. The survey was carried out in Polish and Spanish within 3 months and consisted of 25 questions delivered via social media. Comparisons were made between countries, age subgroups and gender. RESULTS: The response rate was 1,99%, what stands for 1092 responses, 670 from Chile and 422 from Poland, respectively. The percentage of young adults who were already treated was 42,9% in Poland and 25,0% in Chile. The ones planning to have orthodontic treatment within a year counted for 11,8% in Poland and 5,3% in Chile. Most young adults who want to be treated (20,6%) rely on doctor's recommendation on type of appliance while 14,7% of all respondents are interested solely in aligners. Most respondents have heard about aligners (58%). Direct provider-to-customer service without a doctor is not acceptable, neither in Poland (85,1%) nor in Chile (64,8%). Most young adults provided incorrect answers referring various aspects of aligner treatment. CONCLUSIONS: In both countries, patients demand to be treated and monitored by the orthodontist. A high percentage of patients want to be treated exclusively with aligners. Direct-to-consumer orthodontics does not seem attractive to patients. Young adults do not have adequate knowledge referring to aligner treatment. Many people want to be treated despite a previous orthodontic treatment.

Pre-fabricated chain retainers as an alternative to traditional retainers.

Background/purpose: Preserving the outcome of orthodontic treatment is both important and challenging. However, there is insufficient evidence regarding the best way to ensure long-term treatment outcome. The aim of this study was to evaluate a pre-fabricated chain retainer (PFCR) in terms of: ability to maintain satisfactory treatment outcomes; periodontal and dental health; complications; and patient satisfaction. Materials and methods: Overall, 130 patients who had completed orthodontic treatment with a fixed appliance during the period 2016-2019 (follow-up time range, 24-55 months) at a specialist orthodontic clinic in Varberg, Sweden and who had a PFCR in the lower jaw were invited to take part in the study. Little's irregularity index (LII) was recorded on dental casts. Caries, gingivitis, calculus, probing pocket depth, and gingival retractions were registered during clinical examinations. Patient satisfaction and retainer complications were evaluated using a questionnaire. Results: In total, 76 patients (58.5%) agreed to participate. All patients, except for one, had their retainer still in place, and the complication rate was 40%. The LII scores were in the range of 0-4 mm (mean, 1.42 mm). At the retainer site, 82% had calculus, 74% had gingivitis, 1% had pocket depth >4 mm, 10.5% had gingival retractions >2 mm, and 0% had caries. All the patients expressed satisfaction with their retainer. Conclusion: PFCRs exhibit characteristics similar to those of traditional bonded retainers in terms of complications, stability, side-effects and patient experience. Therefore, they can be considered a viable alternative to traditional retainers installed in the lower anterior teeth.

Comparative assessment of orthodontic clear aligner versus fixed appliance for anterior retraction: a finite element study.

BACKGROUND: The aim of this study is to conduct a comparative evaluation of different designs of clear aligners and examine the disparities between clear aligners and fixed appliances. METHODS: 3D digital models were created, consisting of a maxillary dentition without first premolars, maxilla, periodontal ligaments, attachments, micro-implant, 3D printed lingual retractor, brackets, archwire and clear aligner. The study involved the creation of five design models for clear aligner maxillary anterior internal retraction and one design model for fixed appliance maxillary anterior internal retraction, which were subsequently subjected to finite element analysis. These design models included: (1) Model C0 Control, (2) Model C1 Posterior Micro-implant, (3) Model C2 Anterior Micro-implant, (4) Model C3 Palatal Plate, (5) Model C4 Lingual Retractor, and (6) Model F0 Fixed Appliance. RESULTS: In the clear aligner models, a consistent pattern of tooth movement was observed. Notably, among all tested models, the modified clear aligner Model C3 exhibited the smallest differences in sagittal displacement of the crown-root of the central incisor, vertical displacement of the central incisor, sagittal displacement of the second premolar and second molar, as well as vertical displacement of posterior teeth. However, distinct variations in tooth movement trends were observed between the clear aligner models and the fixed appliance model. Furthermore, compared to the fixed appliance model, significant increases in tooth displacement were achieved with the use of clear aligner models. CONCLUSIONS: In the clear aligner models, the movement trend of the teeth remained consistent, but there were variations in the amount of tooth displacement. Overall, the Model C3 exhibited better torque control and provided greater protection for posterior anchorage teeth compared to the other four clear aligner models. On the other hand, the fixed appliance model provides superior anterior torque control and better protection of the posterior anchorage teeth compared to clear aligner models. The clear aligner approach and the fixed appliance approach still exhibit a disparity; nevertheless, this study offers a developmental direction and establishes a theoretical foundation for future non-invasive, aesthetically pleasing, comfortable, and efficient modalities of clear aligner treatment.

Salivary levels of Osteoprotegerin and receptor activator of nuclear factor-kappa ligand during orthodontic tooth movement-A prospective pilot study.

OBJECTIVES: The aim of this study was to monitor changes in Osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa ligand (RANKL) levels in the saliva during orthodontic tooth movement (OTM). MATERIALS AND METHODS: Nine healthy females (15-20 y of age) with four pre-molar extractions and fixed appliance were included. In total, 134 stimulated and 134 unstimulated saliva samples were collected: at baseline and then every 6-8 weeks at follow-up appointments during the whole orthodontic treatment. Twelve age-matched females with no active orthodontic treatment served as a control group. Saliva samples were analysed by enzyme-linked immunosorbent assay (Elisa). The mean levels of OPG and RANKL were calculated according to the different orthodontic treatment stages: alignment, space closure and finishing. A mixed model analysis was used to compare the means of treatment stages. Baseline OPG levels were compared with the control group using an independent t-test. OPG levels were measured in stimulated saliva due to low levels in unstimulated saliva. RESULTS: No significant difference was observed between baseline OPG values and the control group. OPG increased significantly at all treatment stages: alignment, space closure and finishing compared with baseline (P = 0.002, P = 0.039, P ≤ 0.001, respectively). The salivary levels of OPG increased gradually, except during space closure, reaching peak levels at finishing. RANKL was undetectable in stimulated and unstimulated saliva by sandwich Elisa during OTM. CONCLUSIONS: This novel approach shows the changes in the levels of OPG in OTM and indicates how and when to sample saliva during orthodontic treatment to analyse bone remodelling.

Validity and reliability of the orthodontic experience questionnaire in Malayalam, an Indian language.

AIM: To translate the orthodontic experience questionnaire into Malayalam, an Indian language, and assess its validity and reliability in the Kerala population. MATERIALS AND METHODS: The original questionnaire, which was developed in English, was translated into Malayalam. Face validity was assessed, and minor changes were made, followed by a content validity assessment by an expert panel. The final version was given to 324 patients who marked their responses on a Likert scale. Internal consistency reliability was tested using Cronbach's alpha, and test-retest reliability was tested using the intraclass correlation coefficient. Principal component factor analysis was performed to regroup the valid items. RESULTS: The principal component factor analysis revealed three domains. Reliability assessed by Cronbach's alpha of the whole questionnaire was 0.799, and that of the three domains was 0.73, 0.71, and 0.71, respectively. The test-retest reliability was found to be good (0.798). CONCLUSION: The Malayalam version of the orthodontic experience questionnaire was found to be content valid with good reliability. To obtain a successful treatment result, an orthodontist must be aware of these and this questionnaire, with adequate validity and reliability, has been designed to achieve this in the Malayalam-speaking population.

The Effects of Fixed Versus Removable Orthodontic Retainers on Stability and Periodontal Health: 4-Year Follow-Up of a Randomized Controlled Trial.

Introduction: Long-term or even indefinite retention is routinely prescribed after orthodontic treatment as a preventive safeguard against post-treatment changes induced by tooth movement, physiological healing, and the aging process. Though both fixed and removable versions of retainers may be equally effective in terms of results, sufficient research to support this assumption is missing at the moment. Objectives: Long-term effects of fixed and removable retention on the periodontium, and the compliance level when used for an extended period of time. Methods: For 4 years participants were given a supply of canine-to-canine retainers and vacuum-formed canine-to-canine retainers. The inter-canine, as well as inter-molar widths, the length, and the extraction space opening of the mandibular anterior portion, were measured. Gingival inflammation, calculus, and plaque were observed, as well as the attachment of clinical and the case of bleeding during probing. 42 members had returned in the follow-up period, with 21 from each of the two groups. Measurements of the modified gingival index and plaque scoring were performed on the 10 intra-oral photographs that were taken at 4-week intervals in this study to investigate the intra-examiner reliability. Results: After controlling for confounding variables, there was a 1.64 mm (95% confidence interval [CI], 0.30, 2.98 mm) median between-groups difference among patients who utilized vacuum-formed retainers (VFRs). The treatment groups did not vary in inter-canine and intermolar widths (P = 0.52; 95% CI, -1.07, 1.05), arch length (P = 0.99; 95% CI, -1.15, 1.14), or opening of extraction spaces (P = 0.84). Conclusion: A long-term study demonstrates that fixed retention can preserve the alignment of the mandibular anterior over time for the first time. Gingival discomfort and higher plaque scores were reported in both types of retainers.

Prevention of bacterial biofilm formation on orthodontic brackets by non-crosslinked chitosan coating.

During orthodontic treatment, the patients are susceptible to dental caries as a result of the bacterial adhesion and biofilm formation around the orthodontic brackets. Prevention of the caries-related biofilm formation is of significance for maintaining both aesthetics and health of the teeth. Herein, the brackets were functionalized with antibacterial activity via coating a layer of non-crosslinked chitosan (CS). We firstly demonstrated the ability of free CS scaffolds (not coated on brackets) to inhibit the formation of Streptococcus mutans biofilms (inhibition rate 94.3 % for CS-0.3 mg) and to eradicate the mature biofilms (biofilm loss rate 99.8 % for CS-1.2 mg). Further, the inhibition of S. mutans biofilm formation on brackets by CS coating was investigated for the first time. As a result, the CS-coated brackets (Br-CS) kept the great biofilm inhibition capacity of free CS scaffolds. In detail, the Br-CS, prepared by immersing brackets in CS solutions (containing 1.0, 2.5, 5.0 and 10 mg/mL CS) and freeze-drying, showed the biofilm inhibition rate of 48.5 %, 88.6 %, 96.4 % and 99.6 %, respectively. In conclusion, coating orthodontic brackets with the non-crosslinked CS is a potential approach for inhibiting biofilm formation and protecting patients from dental caries.

Outcome assessment of orthodontic clear aligner vs fixed appliance treatment in adolescents with moderate to severe malocclusions.

OBJECTIVE: To compare the efficacy and efficiency of treatment with clear aligners (CAT) vs fixed appliances (FAT) in adolescents with Class I and II moderate to severe malocclusions. MATERIALS AND METHODS: One operator's (Garfinkle) cases from 2014 to 2019, started at age 12-18 years, with pre- and posttreatment records were identified and used according to an institutional review board-approved protocol. Records were measured by two calibrated, blinded investigators, aided by software (OrthoCAD [Cadent, Fairview, N.J.], Dolphin Imaging & Management Solutions [Chatsworth, Calif]). Discrepancy index (DI) and cast radiograph evaluation (CRE) scores, treatment duration, number of scheduled and emergency visits, and reported appliance and interarch elastic wear compliance were compared between groups using Wilcoxon rank sum and Fisher's exact tests. Cephalometric superimpositions were completed to evaluate craniofacial growth and dental changes. RESULTS: Records from 72 cases met the criteria and were included. For the 47 CAT and 25 FAT cases, mean DI (21 ± 5 and 24 ± 8, respectively; P = .20) and CRE (35 ± 10 and 34 ± 9, respectively; P = .90) scores were not significantly different. Other case attributes and reported appliance and interarch elastic wear compliance were also not significantly different. CAT vs FAT cases had significantly smaller treatment durations (24 ± 6 vs 27 ± 5 months; P = .01) and visit numbers (16 ± 5 vs 24 ± 4; P < .01), but emergency visit numbers were not significantly different (2 ± 2 vs 3 ± 2; P = .08). CONCLUSIONS: In adolescents with Class I and II malocclusions and moderate to severe DI scores, on average, CAT vs FAT cases were completed 3 months faster with eight fewer visits, but treatment efficacy was not significantly different.

The incidence and severity of open gingival embrasures in adults treated with clear aligners and fixed appliances: a retrospective cohort study.

BACKGROUND: To evaluate the incidence and severity of open gingival embrasures (OGEs) in adult patients treated with clear aligners and fixed appliances. METHODS: Two hundred non-extraction adult subjects with less than 5 mm of crowding (mean age, 24.6 ± 3.8 years) were enrolled in this retrospective study. The subjects were divided into the clear aligner (n = 100) and fixed appliance group (n = 100). The intraoral photographs were utilized to determine the incidence of OGEs in the upper arch between maxillary central incisors, as well as the lower arch between mandibular central incisors. Crown overlap, crown shape, posttreatment root angulation, the distance from the interproximal contact point (ICP) to the alveolar bone crest (ABC) after treatment and interproximal enamel reduction (IPR) were determined in the two groups. RESULTS: The incidence of OGEs between maxillary and mandibular central incisors after orthodontic treatment was 35.0% and 38.0% in the clear aligner group, respectively, significantly higher than that (18.0% and 24.0%) in the fixed appliance group (P < 0.05). The average area of an OGE after clear aligner treatment was larger both in the maxilla (0.16 ± 0.12mm2) and mandible (0.21 ± 0.24mm2) compared with that (0.05 ± 0.03mm2 and 0.05 ± 0.06mm2) after fixed appliance treatment (P < 0.05). No difference was found regarding pretreatment crown overlap, crown shape, treatment duration, posttreatment root angulation, amount and distribution of IPR and the distance from ICP to ABC. CONCLUSIONS: The incidence and severity of OGEs were higher in adults treated with clear aligners. Clinicians should be aware of the risk of OGEs during treatment with clear aligners.

Effect of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions during orthodontic treatment: a randomized controlled trial.

OBJECTIVE: To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment. TRIAL DESIGN: Three-armed parallel-group randomized controlled trial. METHODS: The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis. RECRUITMENT: October 2010 to December 2012. RESULTS: In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01. CONCLUSIONS: To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended. LIMITATIONS: The protocol was not registered, and the present study did not use a double-blinded design.

Dentoalveolar and Airway Changes Following En Masse Distal Movement of the Maxillary Dentition with Infrazygomatic Crest Anchorage: A Prospective Study.

Aims and Objectives: Mini screws placed buccal to the maxillary first or second molars in the infra zygomatic crest (IZC) region can be used as anchors for various types of tooth movement. En masse distal movement of the maxillary dentition with IZC anchorage is routinely practiced nowadays as more patients demand a non-extraction treatment and it should be evaluated. The goal of this study was to assess dentoalveolar and airway changes in individuals with class II malocclusion after en masse distal movement of the maxillary dentition utilizing infrazygomatic anchorage. Materials and Methods: This prospective study included patients who required en masse distal movement of the maxillary dentition. Following initial leveling and aligning, mini screws were placed in the IZC region, and the maxillary arch was distalized en-masse. Pre (T0) and post distalization (T1) lateral cephalograms were traced for dentoalveolar and airway changes. Statistical tests were done with SPSS software. Shapiro-Wilk test for normality and paired T test for comparison between before and after en masse distalization were done. Results: The changes in dental angular and linear measurements such as U1 to N-A, L1 to N-B and interincisal angle, U1 to N-A and U1 to point A distance, U1 to palatal plane, L1 to N-B, L1 to Apo line distance, U6 to PtV were statistically significant (P > 0.05). Linear parameters such as L1 to ApO line, upper airway, and lower airway were not statistically significant (<0.05). Conclusion: Class II div I malocclusions can be efficiently corrected without extractions using IZC anchorage by en masse distal movement of the maxillary dentition. Significant reduction in upper anterior inclination, intrusion of maxillary anterior teeth, and distal movement of the posterior teeth were noted. No changes in airway dimensions were noted.

Effects of fixed retainers on gingival recession - a 10-year retrospective study.

OBJECTIVE: The aetiology of gingival recessions is not fully understood, and no evidence has yet emerged of a single predisposing factor that instigates this apical shift of the gingival margin. Nonetheless, both fixed retainers and orthodontic treatment have been cited as potential risk factors. The aim of this study was to assess the effects of orthodontic treatment and orthodontic fixed retainers on gingival recessions. SUBJECTS AND METHODS: In total, 105 patients at the Department of Orthodontics at the University of Gothenburg who had undergone orthodontic treatment between 1995 - 2003 were included in this study. Intraoral photographs of the anterior segment and study casts acquired at baseline (pre-treatment), post-treatment and at the 10-year follow-up were used as recorded measurements of gingival recession and orthodontic treatment. At the 10-year follow-up, the patients were divided into two groups based on: long-term (10 years) presence of a fixed retainer [orthodontic treatment and retainer (OR) group; N = 76]; and short-term (<5 years) presence of a fixed retainer [orthodontic treatment (O) group; N = 57]. These groups were compared to a control group (C) of untreated subjects (N = 29). RESULTS: In the anterior segment, gingival recessions were not present at baseline and post-treatment between the two orthodontically treated groups. At the 10-year follow-up, there was no statistically significant difference between the two orthodontically treated groups and the controls. CONCLUSIONS: Orthodontic treatment per se does not increase the risk for gingival recessions, nor does the use of fixed retainers following orthodontic treatment.

Edge level of aligners and periodontal health: a clinical perspective study in young patients

ABSTRACT Introduction: Although the superiority of clear aligners over multi-bracket appliances in keeping gingiva healthy has been suggested, the possible benefits of one aligner design over another have not yet been investigated, especially with regard to the vestibular edge. Objective: The aim of this study was to measure several periodontal indexes in adolescents undergoing orthodontic treatment with aligners, comparing two different types of rim. Methods: The study involved 43 patients aged between 14 and 18 years. The periodontal health was assessed using plaque index (PI), gingival index (GI), and gingival bleeding index (GBI), at the start of the treatment with aligners (T0), with a vestibular rim (VR) reaching up to 3 mm beyond the gingival margin. Three months later (T1), aligners were set to obtain a juxtagingival rim (JR) on the second quadrant and VR on the first quadrant. The periodontal indexes were measured again, both at T1 and then three months later (T2). Results: Intra-quadrant comparisons revealed a statistically significant worsening of the periodontal indexes only for the second quadrant (p<0.05), at T1 (GI), and especially at T2 (PI, GI, GBI), while no statistically significant changes were found for the first quadrant. Conclusions: More severe mechanical irritation, especially during insertion and removal of the aligner, can explain the worsening inflammatory indexes with the JR. In addition, the pressure exerted by the JR on the gingival sulcus seemed to facilitate plaque deposition, whereas the VR had a protective effect, reducing the risk of mechanical trauma.

RESUMO Introdução: Embora se alegue uma superioridade dos alinhadores transparentes sobre os aparelhos multibraquetes em manter a gengiva saudável, ainda não foram investigados os possíveis benefícios de um modelo de alinhador sobre outro, especialmente no que diz respeito à borda vestibular. Objetivo: O objetivo deste estudo foi medir vários índices periodontais em adolescentes submetidos a tratamento ortodôntico com alinhadores, comparando dois tipos diferentes de borda. Métodos: O estudo envolveu 43 pacientes com idade entre 14 e 18 anos. A saúde periodontal foi avaliada por meio do índice de placa (IP), índice gengival (IG) e índice de sangramento gengival (ISG), ao início do tratamento com alinhadores (T0), com borda vestibular (BV) estendendo-se até 3 mm além da margem gengival. Três meses depois (T1), os alinhadores foram ajustados para se obter uma borda justagengival (BJ) no segundo quadrante e BV no primeiro quadrante. Os índices periodontais foram medidos novamente tanto em T1 quanto três meses depois (T2). Resultados: As comparações intraquadrantes revelaram uma piora estatisticamente significativa nos índices periodontais apenas para o segundo quadrante (p<0,05), em T1 (IG) e especialmente em T2 (IP, IG, ISG), enquanto nenhuma mudança estatisticamente significativa foi encontrada para o primeiro quadrante. Conclusões: Irritações mecânicas mais intensas, principalmente durante a inserção e remoção do alinhador, podem explicar a piora dos índices inflamatórios com a BJ. Além disso, a pressão exercida pela BJ no sulco gengival pareceu facilitar a deposição de placa, enquanto a BV teve um efeito protetor, reduzindo o risco de trauma mecânico.

Clinical Performance Evaluation of a Hyaluronic Acid Dental Gel for the Treatment of Traumatic Ulcers in Patients with Fixed Orthodontic Appliances: A Randomized Controlled Trial.

BACKGROUND: A newly available gel containing hyaluronic acid (HA) and polyvinylpyrrolidone was tested for efficacy on traumatic oral ulcers (TOU) caused by fixed orthodontic appliances. METHODS: A double-blind RCT was conducted to test the new gel versus a placebo. According to the sample size calculation, a total of 60 patients were considered sufficient and randomly allocated to one of the two groups out of a pool of 100 total patients who initially agreed to participate in the study. A VAS scale test and lesion measurements at T0, T1, and T2 were performed on the patients. RESULTS: A total of 70 patients developed TOU, with 8 drop-outs; the intergroup comparison showed a statistically significant greater dimension of the lesion in the control group at T2 when compared to the test group. The pain experienced by the patients belonging to the test group was significantly lower than the pain in the patients in the control group Conclusions: Under the limitations of the study, the new formula might provide faster healing with less pain experienced by the patient when compared to a placebo.